Psychiatry is often “mystified”, as a result of which the treatment of mental illness seems to most to be something extremely extraordinary, unknown and complex. And very often this is exactly what happens: the process of treating psychiatric patients really does cause a lot of problems and difficulties.
A psychiatrist is the same doctor as a therapist, cardiologist, ENT specialist, etc.
Society has developed a very specific attitude towards psychiatry, and it is unfounded and even absurd. Treatment by a psychiatrist, unfortunately, is condemned by people, considered shameful and often hidden from family and friends.
It is important to understand that mental health therapy is a routine treatment for an unusual illness. Nowadays, there are not so many differences between the principles of treatment in psychiatry and, say, therapy (although some “unusual” procedures are still used).
A person should not be more afraid of a visit to a psychiatrist than a visit to a therapist, cardiologist or ENT specialist. This, in many ways, is the key to the mental health of the population. Let's look at what a consultation with a psychiatrist can be like using the example of obsessive-compulsive neurosis, the treatment of which is very important due to its wide distribution.
What is obsessional neurosis, and does it need to be treated?
The main goal of treatment is to maximize the patient’s quality of life. If a disease interferes with life, then it definitely needs to be treated. Does obsessional neurosis interfere with normal life? To understand this, you need to find out what is commonly understood by this term.
Obsession is the appearance in a person of thoughts or actions that are perceived by him as something alien. A person cannot get rid of them: obsessions force him to perform certain actions, thereby becoming the cause of debilitating mental discomfort.
Forecast
The patient’s personality traits directly affect the course of a panic attack, its severity and duration. Panic attacks become most severe for patients who perceived the first such incident as a real disaster. Sometimes the reaction of health care workers can also contribute to a faster progression of the disease. For example, when hospitalizing a patient in an ambulance, a thought is formed in his subconscious about serious health problems and the presence of serious illnesses.
Starting treatment as quickly as possible contributes to a positive prognosis for recovery. Each attack aggravates the situation, creates limitations in behavior, and is also clear evidence for the patient that the disease exists and is very dangerous. Recovery is possible when two factors coincide: adequate treatment by medical professionals and the efforts of the patient himself. In chronic panic attacks, these factors will contribute to a colossal increase in interpanic time.
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Manifestations of obsessional neurosis
The most common manifestation of obsessional neurosis is fear, which is very difficult and sometimes almost impossible to overcome. Phobias make social contacts, work and all other aspects of life very difficult.
Another version of neurosis is, in fact, obsessive thoughts that a person cannot “drive” out of his head. These thoughts interfere with learning, concentration and greatly tire the patient. An important criterion: a person with obsessional neurosis never realizes his thoughts. The last type is compulsive. It manifests itself through obsessive movements and excessive ritualism.
Causes
There are many reasons for the occurrence of low-grade fever. First of all, these are, of course, infectious processes occurring in the human body. Any infection, be it viral, chlamydial, bacterial or intestinal, can cause low-grade fever. When a person is infected with intracellular or protozoan parasites, low-grade fever is also observed. Constantly elevated temperature is also characteristic of cancer of various etiologies in men and women. The cause of low-grade fever can be sarcoidosis. Chronic fatigue syndrome, which occurs due to constant stress, lack of sleep, and overwork, also refers to the causes of low-grade fever. If we talk about newborns and infants, then due to imperfect heat exchange, any infection can cause a persistent fever. In pregnant women, low-grade fever occurs without any special manifestations, but it is necessary to find out the cause of the fever as quickly as possible. Since many infectious diseases are fraught with serious consequences for the fetus and unborn child.
Examples of obsessional neurosis
It is very easy to explain the essence of this phenomenon with examples. Let's say you believe that you shouldn't look in the mirror before leaving the house. However, if you accidentally look in the mirror, you will still leave the house without giving it much importance.
Or, for example, a black cat on the road will not force you to reschedule your business: you may be a little worried, but you will soon forget about it. A person with compulsive obsessions, looking in the mirror, will bolt the door and stay at home all day, and, having met a black cat, go to the pharmacy for sedatives.
As you can see, obsessional neurosis makes the patient’s life very difficult. This means that we can say confidently and definitely: this disease definitely needs treatment, and the treatment must be professional and complete.
Treatment of patients carried out at the Verimed clinic
Before starting treatment, it is important to understand the cause of the attacks and the severity of the reaction itself. If the manifestation is minor and there are no pathomorphological reasons, the patient may be recommended to study with a psychologist. Treatment of outbursts of aggression characteristic of mental pathologies requires the mandatory use of medications.
For these purposes, specialists at the Verimed clinic use:
- benzodiazepine tranquilizers. This group of sedatives is recommended for neurotic disorders, the usual acute variant of aggressive behavior in sociopsychopaths;
- neuroleptics. Medicines of this class give a pronounced effect in mental pathology of an organic nature. For mental illnesses accompanied by hallucinations, illusions, personality degradation, and inadequate reactions. Most often we are talking about schizophrenia, manic-depressive psychosis, sometimes epilepsy, and severe forms of psychopathy. To treat unmotivated aggression, various forms of drugs can be used - in the form of injections, tablets for oral and sublingual use. Each method has its own advantages. Complicated options require injection treatment. In milder cases, especially when patients are aware of the problem, it is quite enough to get by with pills;
Important: Taking medications must be combined with psychotherapeutic effects, which provide indispensable help in eliminating an acute aggressive attack.
After eliminating the acute form of aggression, it is necessary to construct a plan of treatment measures that will be used for a long time. You should definitely find out what type of treatment is most appropriate in a particular case: outpatient or inpatient. To do this, it is necessary to understand the attitude and self-perception of the patient himself. Does he have an awareness of his painful condition, and does he want to get rid of it himself? If the patient has a positive attitude, the necessary medications can be prescribed to be taken at home. It is better if the use of prescribed medications is additionally monitored by someone close to you.
The most difficult options are forms of treatment for aggression in men. Especially if such attacks are unmotivated. In addition, men are the patients who most often refuse medical care. Therefore, when choosing a therapeutic plan, the doctor must place increased emphasis on psychotherapy and motivation of the patient.
Treatment of aggression in women is most often based on eliminating hormonal problems that cause mental disorders. Aggression in an elderly person in most cases is the result of senile degradation (dementia), based on the development of cerebrovascular insufficiency. “Falling into childhood” with childhood fears, subsequent flattening of emotions, irritability require the use of special drugs that improve cerebral circulation and metabolism of brain cells. Correct and timely administration of the necessary medications for senile aggressiveness allows one to achieve good clinical results.
A separate group consists of patients who combine depression with aggression. They require inpatient monitoring and proper selection of drugs and doses. Psychotherapy plays an important role in the treatment of all types of pathology. All its types are used: rational persuasion, suggestion, hypnosis, treatment in groups.
Treatment of obsessional neurosis
We found out what this disorder is and what its danger is. Let's return to the main question: how to treat obsessive-compulsive disorder? There are several options here. It is best to combine them if possible, because this is how you can achieve the best result.
Here is what a psychiatrist has in his “arsenal” for patients with obsessional neurosis:
- antidepressants of various types and generations; - means that normalize mood (normalizers); - psychotherapy.
Now let's look at each of these points in more detail.
Antidepressants
Antidepressants are a group of drugs that affect certain active substances in the brain. By changing the balance of these active substances, and acting differently on the same substance, antidepressants change the speed and orientation of many mental processes, mood and general condition.
In the treatment of obsessional neurosis, antidepressants occupy a central place, because only they can return a person to the possibility of normal communication and full socialization. Proper use of antidepressants guarantees long-term remission without relapse. Sometimes a course of treatment (combined, of course) is enough for a person to get rid of neurosis for life.
In recent years, there have been quite a lot of antidepressants: fundamentally new substances have been synthesized that have fewer side effects, are safer and more effective. Old drugs are gradually leaving the practice of psychiatrists (although they remain in the practice of doctors of other specialties). It is unlikely that a psychiatrist will prescribe you amitriptyline or a similar drug: much more effective substances are now available, the use of which gives lasting, good results without the risk of repeated exacerbations or unsuccessful treatment.
The most popular are antidepressants that affect serotonin receptors. These medications do not cause drug dependence and have relatively few contraindications. One significant disadvantage of this group of drugs: in the first week of treatment, almost all patients complain of severe, debilitating nausea.
Normotimics
Mood stabilizers are drugs used to correct mood: they ensure its stability, stability and constancy. Interestingly, there is not a single drug that belongs specifically to this group and was created only to normalize mood. All such drugs (even the ancient drug made from lithium salts) initially had a different purpose, and the normothimic effect is a kind of pleasant bonus.
If a person suffers from obsessive neurosis, his treatment will necessarily include drugs that normalize mood. Like antidepressants, mood stabilizers affect the main links in the pathogenesis of obsessional neurosis, and their combination is considered the most effective treatment method.
Carbamazepine and its derivatives are most often used. This drug is also used to treat epilepsy (and its various types), but in addition to the anticonvulsant effect, carbamazepine also has a pronounced normothimic effect. By the way, carbamazepine is a substance that was synthesized from a strong antidepressant. To some extent, this explains this effect and high effectiveness in the treatment of obsessive thoughts and, in particular, obsessive movements (compulsions).
Psychotherapy
One of the most important aspects of treating obsessions is psychotherapy. Perhaps you notice fear or obsessive thoughts, or maybe you observe obsessive movements in your child, contact a psychiatrist. In this situation, individual psychotherapy is indicated.
The most common direction is behavioral psychotherapy, based on neurolinguistic programming or “body” orientation. Indeed, in a sense, obsessions are behavioral disorders, so treatment should be aimed at it. Behavioral psychotherapy can be combined with suggestive psychotherapy (it is rarely used as a single treatment method).
Suggestion is what is called “suggestion.” This technique is carried out, as a rule, after preliminary preparation: the person is immersed in a state of medicated or natural sleep, hypnosis, etc. Sometimes suggestion is practiced with a awake person, who must, of course, be calm and relaxed. This state is most easily achieved with sedatives, although experienced psychotherapists can do without them.
Panic attacks. Symptoms
Characteristic features of panic attacks are:
- repeatability;
- surprise;
- unpredictability and brightness of manifestation.
Often a panic attack occurs in the absence of a real threat.
Attacks occur with a frequency ranging from several times a day to several times a year and last from several minutes to an hour or more.
On the mental side, the predominant symptoms are:
- fear (including fear of madness and death);
- anxiety;
- despair;
- loss of control over oneself and the unreality of what is happening.
The anticipation of an attack, which is also accompanied by fear and anxiety, brings considerable discomfort and restrictions to life.
The cascade of reactions that accompany panic attacks affects both the cerebral cortex (where, according to some scientists, a stable focus of excitation occurs), and subcortical structures (the limbic system), and the autonomic nervous system. Especially its sympathetic department, responsible for the “quick response” to an emerging threat to life (it’s not for nothing that a panic attack is also called a sympathoadrenal crisis). Hence the “bodily accompaniment” of a panic attack in the form of vegetative disorders:
- heartbeat;
- chest pain;
- difficulty breathing (up to a feeling of suffocation);
- nausea, vomiting;
- trembling and muscle spasms (convulsions are possible);
- dizziness and lightheadedness;
- lump in throat, etc.
There are panic attacks in which pronounced signs of autonomic disorders are practically not accompanied by mental symptoms. Such states are called “panic without panic.”
Even if initially panic attacks were the only symptom bothering a person and were not accompanied by other mental disorders, over time the situation worsens. A “vicious circle” of mental and physical reactions is formed, disrupting the functioning of an increasing number of organs and systems. And to the panic symptom complex are added signs characteristic of phobic and anxiety disorders, depression, etc.
