Module FourANXIETY AND SOMATOFORM

DISORDERS Lesson 1: Anxiety and its manifestations

Lesson 2: Disorders caused by anxiety

Lesson 3: The causes and the treatment of Anxiety Disorders

Lesson 4: Somatoform Disorders

Lesson 1

ANXIETY AND ITS MANIFESTATIONS 

Step 1: Introduction Anxiety, like sadness, is a normal emotion. Usually anxiety is a reaction to a stressful

situation. Normal anxiety is the one we feel when we are

exposed to external stressful situations and remains until the solution of the problem.

We are aware of anxiety both by psychological and somatic expression.

Anxiety’s somatic symptoms derive from the hyperactivity of Autonomous Nervous System.

Step 4: Slide projectionSlide 4.1.1: Anxiety’s manifestations Emotion of stress, uneasiness, fear, nervousness Irritability Impossible to relax Difficulties in concentration Muscles aches (headaches, abdominal pain) Poor appetite Restless sleep – difficulties to fall asleep Somatic symptoms from Autonomous Nervous

System

Step 4 (continued)Somatic symptoms from the Autonomous Nervous

System Dry mouth Fast breathing irregular heart beating Dizziness – feel faint Excitement Perspiration Fear Hyperactivity of cysts and intestines

Step 5: Theory presentation Normal anxiety becomes alarming when the

symptoms are so intense or they last for so long that the person cannot accomplish its everyday tasks, because they are extremely painful and stressful. Then it is considered that the person shows an Anxiety Disorder.

The Anxiety Disorders are many times described as “neurosis”. The term “neurosis” is used to distinguish “psychosis” from disorders where the person does not lose contact with reality (there are no delusions or aberrant ideas). Neurosis’ symptoms are similar to experiences that all people have but more severe.

Step 6: Discussion

Describe briefly a personal experience that made you feel anxious.

Step 7: Questions and comments

Lesson 2

DISORDERS CAUSED DROM ANXIETY

Step 1: Slide projection Slide 4.2.1: Anxiety Disorders Panic Attack Agoraphobia Specific Phobia Social Phobia Generalized Anxiety Disorder (GAD) Posttraumatic Stress Disorder Obsessive Compulsive Disorder

Step 2: Discussion

What Anxiety Disorder do you usually encounter in your practice?

Step 3: Theory presentation

Panic attack Recurrent panic attacks, usually under great

stress. The person needs to abandon the situation it is

into. Because of the intensity of physical symptoms,

the person believes that is going to die. Between the attacks the person might show

milder anxiety symptoms.

Step 3 (continued)Agoraphobia Intense anxiety when found in specific locations

or situations or even thinking of these. Anxiety might be so intense that manifests Panic

Attack. The person feels like loosing control of the

situation. Usually avoids these locations or situations or

needs to be accompanied by another person. In Agoraphobia, fear is not related to a specific

situation but to several.

Step 3 (continued)Specific Phobia The person fears of a specific object or situation and has

the tendency to avoid it. The thing might be: a dog, a cockroach, other animal or

blood, injections, etc. The specific situations include: enclosed spaces, height,

airplanes, etc. The person fears that something bad is going to happen

when he/ she meets the object or is found in a specific situation.

May be the person fears that he/she is going lose control (of the situation), have a panic attack or faint.

Step 3 (continued)

Social Phobia Anxiety (or distress) is apparent to social or

performance situations (to all or specific). The person is worried that might be the centre of

interest. Tends to avoid the situation that is afraid of.

Step 3 (continued)

Generalized Anxiety Disorder (GAD) At this disorder the person experiences

distress and anxiety for long periods of time, usually longer than 6 months.

Along with anxiety emotion the person shows many other stress symptoms.

Step 4 (continued)Posttraumatic Stress Disorder (PTSD) Disorder developed after the person has

experienced a severe traumatic event. The person might develop various symptoms in

which there are included : Symptoms of anxiety and depression. Recurrent memory of the event in dreams or

re-experiencing it (…? ). Tendency to avoid thoughts, conversations or

activities that remind him/ her the event.

Step 4 (continued)Obsessive Compulsive Disorder Obsessions are uncontrollable intrusive thoughts

or ideas, compulsions or images that come to the person’s mind.

Distract his/her attention and prevent him/her from accomplishing their tasks.

Compulsions are repeated actions that the person feels obligated to do even though these are opposite to his sense.

In most of the cases the person feels obligated to execute them in order to eliminate the anxiety (distress) caused by a compulsive idea and prevent a horrible event.

Step 5: Questions and comments

Lesson 3

THE CAUSES AND THE TREATMENT OF ANXIETY DISORDERS

Step 1: Slide projectionSlide 4.3.1: rate of incidence of Anxiety DisordersDisorder % of General PopulationAnxiety Disorders in total 20Panic Attacks 2 Agoraphobia 3Specific Phobia 9Social Phobia 8Generalized Anxiety Disorder 3Posttraumatic Stress Disorder (PTSD) ?

Obsessive Compulsive Disorder 2

Step 2: Brainstorming

What factors you think contribute to anxiety disorders?

Step 3: Slide projectionSlide 4.3.2: the causes of Anxiety Disorders

Genetic Factors Hereditary predispositionExperiences in early age Parting High emphasis to achievements Pressure for compromisesRecent experiences Stressful situations Incertitude ConflictBiological factors Dysfunction of Autonomous Nervous System

Step 4: Group discussion

What are in your opinion the appropriate therapeutical interventions for treating the needs of the persons that suffer from each one of the Anxiety Disorders?

Step 5: Slide projectionSlide 4.3.3: therapeutical interventions in Anxiety

Disorders Psychotherapies Expression and discussion of the problem Psychoanalytic psychotherapy Person – behavior therapy? Cognitive –diagnostic Therapy  Therapy with medication Antidepressants’ medication Tranquilizers

Step 6: Questions and comments

Lesson 4

SOMATOFORM DISORDERS

Step 1: Introduction The experience of manifestation of physical

symptoms with absence of somatic disease is known to everybody. Many times these appear when the person is stressed or tired.

People differ to the tendency to express the symptoms and to how much attention they give to them

In any place of the world, it is proved that 10 % to 30% of the persons that ask for help from the first aid services suffer from psychiatric problems and most of them arrive for somatic disturbances.

Step 2: Slide projectionSlide 4.4.1: relationship between physical and

mental disorders

Psychological factors as causing factors of the physical disease

Psychiatric disorders can appear as physical illness

Psychiatric consequences of physical illness Coexistence of physical and mental disorders Physical disturbances due to psychiatric disorder

Step 3: Slide projectionSlide 4.4.2: The most common Somatoform and

related to them DisordersSomatoform Disorders Somatization Disorder Hypochondriasis Conversion DisorderDisorders related to Somatoform Incomprehensible Pretentious Disorder Pretention

Step 4: Theory presentation

Somatoform Disorder

It is the disorder during which the person shows various physical disturbances during many years. These symptoms cannot be justified/ explained from a physical illness.

Step 4 (continued)

Hypochondriasis

Is the obsessive occupation of the person with the fear or the idea that suffers from a serious disease. This is based on his personal explanation of physical symptoms or emotions which consider as proof to the physical disease.

Step 4 (continued)Conversion Disorder It was called Hysteria in the past. This term is replaced by

Conversion Disorder. A conversion (traversing) symptom can indicate physical

disease, but it is manifested with out the presence of a disease coming from unconscientiously With the person being unaware of it or without doing it on purpose.

These disorders can be manifested in various forms: As movement dysfunction, for ex. Paralysis, fear, inability to

speak.As senses dysfunction for example , pain, blindness, deafness.As psychiatric symptoms, for example, memory loss, running

away (wandering with loss of memory and lack of recognition of its personality).

Step 4 (continued)Incomprehensible Pretentious Disorder      In incomprehensible pretentious disorder the

person tries with the production of the symptoms to gain the medical attention and care with no external motives. They might pretend that they have depression, delusions, traverse symptoms or pains, nausea, skin rashes, bleedings etc

There is a special case in incomprehensible pretentious disorder known as Munchausen's syndrome. People who have this syndrome usually are admitted to hospital for a disease they pretend to have and undertake tests and treatments, even surgical procedures.

Step 4 (continued)

Pretention

similar symptoms appear again in Pretension, but there is always an external Motive, as for example avoiding the military service, early retirement, etc.

Pretention is no mental disorder.

Step 6: Brainstorming

Describe what intervention(s) you consider necessary for the treatment of Somatoform and Related to these Disorders?

Step 7: Questions and comments