[Contribution to the medical treatment of anxiety and obsessive states].
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Neurotic disorders are commonly encountered in psychiatric outpatient clinics. Treatment of the commoner conditions like the anxiety states, depressive, obsessive-compulsive, hypochondrical and phobic neuroses will be described. This includes general supportive measures, pharmacological, cognitive, behavioural and psychodynamic approaches.
The DSM-III-R subclassifies panic disorder (PD) under the anxiety disorders (or anxiety and phobic neuroses) along with phobic, obsessive compulsive (OCD), generalized anxiety and posttraumatic stress disorder (PTSD). Although allowances are made for the specification of the current degree of impairment as severe, e.g., at least eight panic attacks monthly, avoidance behavior resulting in being completely house-bound or compulsions being the major life activity, the anxiety disorder category does not provide for the simultaneous occurrence of associated psychotic features as part of the disorder. In fact, depending on the circumstances, diagnostic hierarchial principles, in the DSM-III-R, require dual diagnoses or a diagnosis of the more pervasive disorder only, if elements of both anxiety and psychosis are present. In contradistinction to the anxiety disorder category, the DSM-III-R recognizes a myriad of psychotic features, including delusions, hallucinations, thought insertion and broadcasting, as extreme manifestations of the affective syndromes. The following case report of a patient with panic disorder, culminating in a florid psychosis, puts into question current official nosology. Conflicting outcome data from the schizophreniform disorders may be due, in part, to the mislabelling of patients with psychoses secondary to severe anxiety disorders as schizophreniform.
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Obsessive-compulsive phenomena occur in 'normal,' neurotic and psychotic individuals. Operational definition, quantitative assessment, and diagnostic evaluation are still unsatisfactory, particularly with regard to differentiation of obsessive-compulsive phenomena (phenomenology), differentiation of trait and symptom factors, and evaluation of different obsessive-compulsive factors in the various kinds of neuroses. Our investigation of phenomenology differs from previous similar ones in basically two aspects: The newly developed obsessive-compulsive checklist covers the whole range of obsessions and compulsions, and questionnaire items of the checklist are operationally difined without reference to constructs from theories of personality or from psychopathology. Results include: Two-thirds of all patients suffer from combined obsessions and compulsions; factorial analysis reveals five symptom factors which are quite different from factor analytic results of previous studies; depression and phobias constitute a factor by themselves; checklist ratings and factor analytic results show the necessity for and basis of a new self-rating questionnaire to substitute for those currently in use. Implications of these results for future research in psychopathology as well as treatment evaluation are discussed.
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