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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.
57 neurotic patients were included in the trial because they met the following criteria: no signs of psychic disorders before emergence of psychogeny, close relation of the disease with change in social condition, only minor psychic symptoms. The patients have suffered psychic traumas caused by loss of social significance of their job, loss of financial well-being, family problems. The reactive condition was associated with psychogenic complex. The patients developed neurotic depression rather early. It consisted of 3 stages: neurasthenic disorders, anxiety, depressive condition with distress affection. Adaptative disorders need both psychotherapy and psychopharmacotherapy. Inpatients were given bensodiazepines, antidepressants, mild neuroleptics, nootropes. It is shown than the duration of the treatment course and choice of chemotherapy depend primarily on the time of seeking medical advice and start of therapeutic measures.
For the differentiation of neurotic disorders, the indices of pupilary reactions and hippus were studied. The study was performed with the aid of a pupillograph. A comparison of the pupillographic data in patients with borderline neurotic disorders of the 3 main groups (asthenic, obsessive-phobic and hysterical), demonstrated statistically significant differences in the control group and within the group with different forms of neurotic disorders. The quantitive and informative characteristics of the pupilary reactions and some regular tendencies in the characteristic of the hippus may help in the solution of one of the main problems of borderline psychiatry, an improved diagnosis.
78 patients with neurotic disorders, 46 patients with cerebral organic pathology (tumors of the brain, epilepsy) and 25 healthy individuals were examined. Their age was 10-17 years. Clinical, paraclinical, experimental-psychologic, psycholinguistic methods were used. Psycholinguistic analysis of the reports concerning the dreams of the children and juveniles was performed by means of original computer system of the analysis of the meaning of the texts and by specially elaborated scheme for categorization of the words. Neurotic patients had a significant quantitative and qualitative peruliarity of speech which reflected stable changes in patients' personality concerning the sphere of meaning.
Epidemiological studies related to the occurrence of neurotic disorders commonly use symptom check-lists. The results of such studies depend on, amongst others, the construction of the questionnaire and especially on the specification of the value of the questionnaire (GSI) which is determined as the boundary between the "psychophysiological" or organic symptoms and neurotic symptoms. A control study was carried out on the norms of two symptom checklists which have been used for many years in Poland: SCL-"S" (73 symptoms), most often diagnosed in neurotic patients, at the time of constructing the questionnaire and the SCL-"O" (the same 73 + 62 other symptoms). The criterion population was made up of 843 untreated subjects and 2026 patients of day-hospitals. The norms specified by the method of finding the "optimal cut-off point" were approx. 5% in the SCL-"S" and 3% in the SCL-"O" higher for the cohort of women than for men. According to those norms, about 30% of the untreated population gains the same result of Global Severity Index (GSI) as about 90% of patients treated for neurotic disorders and could be diagnosed as neurotic disorders. The GSI norms for the SCL-"S" more often indicated the existence of these disorders in the group of untreated women than in the men's group, while the norms of SCL-"O" indicate a similar frequency of the disease independently of the gender. The symptom frequency analysis presenting differences in the women (1165 ss.) and men (861 ss.) patient groups and lead also to the hypothesis on the dependency of such epidemiological data on the construction of the symptom check-lists--especially the number of variables concerning symptoms more frequent in the female and/or in the male populations.
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BACKGROUND: Evidence on the association between socioeconomic status and the prevalence of neurotic disorder is contradictory. We studied the association between three elements of socioeconomic status and the prevalence of neurotic psychiatric disorder in a representative sample of adults aged 16-64 living in private households in the UK. METHODS: A cross-sectional survey of 10,108 adults aged 16-65 resident in private households in the UK was selected by a multi-stage, clustered, random-sampling design. Neurotic disorders were defined using a standardised interview, the revised clinical interview schedule (CIS-R). Data for 9570 people were available for this study. FINDINGS: We used housing tenure and access to cars as measures of standard of living; both were associated with the prevalence of neurotic disorder even after adjustment for other socioeconomic and demographic variables, including Registrar General's Social Class and educational attainment. Those people with no access to a car had an odds ratio for neurotic disorder of 1.4 (95% CI 1.1-1.7), compared with those who had access to two or more cars. People who rented their homes were also at increased risk (1.3 [1.1-1.5]). We estimated that about 10% of the neurotic disorder in the UK could be attributed to the increased prevalence of those without cars who rented their homes. There was a complex interaction between Registrar General's Social Class and sex, and there was no independent association with educational attainment. INTERPRETATION: There is an independent association between low standard of living and the prevalence of neurotic psychiatric disorder. The UK has experienced one of the largest increases in income inequality within western market economies over the past 20 years, and this inequality may have had adverse consequences for the mental health of the population.
Evidence on the association between socio-economic status and the prevalence of neurotic disorder is contradictory. We studied the association between three elements of socio-economic status and the prevalence of neurotic psychiatric disorder in a representative sample of adults aged 16-64 living in private households in the UK. A cross-sectional survey of 10,108 adults aged 16-65 resident in private households in the UK was selected by a multi-stage, clustered, random-sampling design. Neurotic disorders were defined using a standardised interview, the revised clinical interview schedule (CIS-R). Data for 9570 people were available for this study. We used housing tenure and access to cars as measures of standard of living; both were associated with the prevalence of neurotic disorder even after adjustment for other socio-economic and demographic variables, including the Registrar General's Social Class and educational attainment. Those people with no access to a car had an odds ratio for neurotic disorder of 1.4 (95% CI 1.1-1.7), compared with those who had access to two or more cars. People who rented their homes were also at increased risk (1.3 [1.1-1.5]). We estimated that about 10% of the neurotic disorder in the UK could be attributed to the increased prevalence of those without cars who rented their homes. There was a complex interaction between the Registrar General's Social Class and sex, and there was no independent association with educational attainment. There is an independent association between low standard of living and the prevalence of neurotic psychiatric disorder. The UK has experienced one of the largest increases in income inequality within western market economies over the past 20 years, and this inequality may have had adverse consequences for the mental health of the population.
Constructing and estimating a model to explain the mechanism of neurotic disorders is important and significant. The model helps the rearrangement or representation of knowledge obtained from professional physicians. However, it is a very difficult problem, because the objects requiring analysis are mental activities of human beings, and they originally include a comparatively large variance between individuals. The object data were obtained from patients with neurotic disorders who were diagnosed by several doctors for 10 years in a subagricultural areas in Japan. We analyzed the data and calculated the weights attached for personal information depending upon the similarity between the information and the kinds of neurotic disorders using the theory of fuzzy sets. From the results of our analysis, we constructed and estimated a model explaining the mechanism causing neurotic disorders as several linear equations. From data processing points of view, the estimation we attempted is placed in a kind of effective data compression with respect to discrete statistical data.
The organizational phases in the operation of automated system of target screening for neurotic disorders under mass preventive examinations are described. In the process of screening persons at risk for neurotic disorders are identified and examined according to three classes system. Preventive measures are carried out by medical units. The use of this system improves the detectability of neurotic disorders.
An attempt was made to predict outcomes following group Cognitive Behavior Therapy (CBT) for patients with affective and neurotic disorders. A group of 348 patients at a private psychiatric clinic, treated in a group CBT program, completed the Depression, Anxiety, and Stress Scale (DASS) before and after treatment. Prior to treatment, data from the Locus of Control of Behavior (LCB), a Global Assessment of Function (GAF), the Health of the Nation Outcome Scales (HoNOS), and the Rosenberg Self Esteem Scale (RSE) were also collected. Results indicated that posttreatment stress scores of all patients were predicted by pretreatment stress and self-esteem. Among patients with neurotic disorders, posttreatment anxiety was predicted by initial anxiety and self-esteem whereas among patients with affective disorders, posttreatment anxiety scores were predicted by initial anxiety and GAF. For patients with neurotic disorders, self-esteem did not predict variance in posttreatment depression in addition to that explained by pretreatment depression. In contrast, for patients with affective disorders, pretreatment depression and Locus of Control predicted posttreatment depression.
In previous papers from the National Survey of Psychiatric Morbidity in Great Britain, we have demonstrated that people with neurotic disorders rarely present their symptoms to primary care physicians and when they do, are quite likely not to be given treatment. In this paper, we examined survey respondents' reports of specific instances of reluctance to seek help in relation to sociodemographic, socio-economic and clinical attributes of our subjects. All people in the National Household Survey assessed as having a neurotic disorder were asked if at any time in the previous year they had avoided seeking appropriate treatment. Clinical measures included diagnosis, symptom severity, and deficits in carrying out tasks of daily living. Of nearly 1400 respondents, a quarter said they had not been to see a doctor at some time in the past year when they or their family felt they should have. The major determinant of this reluctance was symptom severity: more severe cases were more likely to report an episode of reluctance. Reasons included those related to ignorance of neurotic disorders and the effectiveness of treatment and to stigma. The attitudes detected in our subjects with neurotic disorder help to explain why people do not always seek effective help for their mental disorders, and are indicators of a worrying public education gap that will be hard to bridge.
The examination of 78 patients at different stages of neurotic disorders and 25 healthy individuals (10-17 years old) has shown that the dynamics of dreams at compensatory stage was directed to their intensification, affective and cognitive activation and to reduction of dreams' activity during decompensation of neurotic disorders. This may indicate their role in psychologic defence. In neurotic patients peculiarity of the reaction to stress was the presence of some latent period after stress, that preceded the very reaction of dream to stress, its longer duration than in healthy individuals and its qualitative peculiarity. That may reflect complexity of adaptation to stress influence in neurotic patients.
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