General psychopathology  © Tushnik Ghosh

 

CHAPTER 13:
Psychogenic disorders and somatoform disorders

 

INTRODUCTION: The possibility of occurrence of psychiatric disorders after psychotraumatic events are considered among psychiatrists. They are called psychogenic disorders. But some schools of psychiatry do not consider them as separate group of diseases. These diseases have a connection between the psychotrauma and on the other hand with the duration and clinical presentations of psychic disorders. Jaspers formulated a connection of triad: 1. Psychogenic diseases are developed after psychological trauma without any mediator. 2. Presentation of the disease follows the psychological trauma without any mediator, between the two there is a clear connection of psychological understanding. 3. Duration of the disease is closely related to severity and the actuality of the psychotrauma; on withdrawing the psychotrauma process of disease stops or significantly weakens.

We must pay attention on the fact that not all individual act in the same way for a same situation. It depends on the psychophysiological constitution (temperament) and also on genetic factors. Besides unlike endogenic diseases it never occurs nor progresses in a psychologically wellbeing man. There is also no trace of organic changes 5n the brain. It tells that the disease has a good prognosis. In most of the cases these patients need psychotherapy. These all make these diseases to be classified in a separate group. Russian school of psychiatry divides the disorders in two large groups: severe disorder with severe disturbances of behavior (reactive psychosis) and mild condition without loss of insight (neurosis). We should remember that clear margin between these two groups is absent. As by the term hysteria we may mean hysteric neurosis and may also be hysteric reactive psychosis, but the basic development of these diseases lie in the same group of psychological mechanism. There is another big difficulty we face when we differentiate neurosis from pathological trait of character i.e. personality disorder or psychopathy. As an explanation of neurosis, often the term marginal disorder is used. The content of the term is not fully defined as it cannot explain the disorder lying between neurosis and psychosis nor the margin between a psychiatric ill and a psychiatric healthy person. For explanation of mild shorttime psychological disturbances closely related to psychotrauma, the term neurotic reaction is often used. In ICD10, this disorder is divided according to its syndrome, and therefore is put under many groups. Severe reactive depression is classified under affective group in F3, and reactive paranoid is considered in the same group with schizophrenia and delusional disorders in class F2. Other diseases of this disorders are mostly classified in group F4 (neurotic, related to stress and somatoform disorders). Symptoms that are seen in hysteric psychosis and hysteric neurosis are put in different groups: F44- dissociative disorders, F45 somatoform disorders. Different presentations of obsessive neurosis are considered under F41, F42 and F40. in group F43 severe psychotic and mild neurotic reactions after stress are included.

 

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