Phobic Syndrome Research Articles

Systemic approach to сhild psychiatry: insights in etiopathogenesis and organization of assistance

Aim. Integration of information on systemic approach published in literature, and of the own practical experience in rendering psychotherapeutic assistance to children with different forms of phobic anxiety disorders (PAD) aimed at improvement of effectiveness of treatment, of social adaptation of patients with PAD, and at search for organization forms of medical assistance to the given category of childrens population.
 Materials and Methods. Into the study 61 children of 8-17 years old were involved living at home and admitted to G.E. Sukharevskaya Research and Practical Center of Mental Well-Being of Children and Adolescents in 2018 for different mental disorders including PAD. In the study, analysis of medical histories and protocols of classes with a family psychologist were used.
 Results. On the basis of the parameters of family functioning three groups of phobic anxiety syndromes were isolated: disorders of the structural aspect (limits, hierarchy, coalitions, triangles), disorders of communication sphere, or of family history. The working systemic hypotheses were illustrated with ten classic examples.
 Conclusion. Systemic hypotheses of formation of PAD in children permit to construct treatment and rehabilitation strategies directed at improvement of patients state through creation of conditions for a prolonged stable remission in the family. Inclusion of classes with a family psychologist/psychotherapist into the plan of treatment and rehabilitation permits to shift the accent of help to a child to the outpatient environment.

Psychocorrection and optimal pharmacotherapy in anxiety-phobic syndrome.

The article presents methods of detection and ways of correction of psychosomatic disorders among patients suffering from anxiety and phobic syndrome. These studies have shown that among patients with anxiety-phobic syndrome of psychosomatic disorders are most pronounced anxiety, phobia, fear, panic. Therefore, in addition to the basic therapy in patients with anxiety-phobic syndrome, psychotherapy was used, which leaded to early recovery, effective treatment, as well as lengthening the period of remission.

Do Symptoms of Irritable Bowel Syndrome Improve when Patients Receive Cognitive Behavioural Therapy for Co-morbid Anxiety Disorders in a Primary Care Psychological Therapy (IAPT) Service?

Irritable bowel syndrome (IBS) is a common co-morbid condition with anxiety disorders, and patients often report a fear of incontinence in public places. This type of bowel control anxiety (BCA) can be conceptualized as a phobic syndrome. Yet little evidence exists on the prevalence or outcomes of these co-morbidities in routine primary care psychological therapy (Improving Access to Psychological Therapies, IAPT) services. To examine the prevalence and outcomes of IBS and BCA patients treated with cognitive behavioural therapy (CBT) for anxiety disorders within a routine IAPT service. An observational cohort study screened 2322 referrals to an IAPT service over 12 months for the presence of IBS. Patients with co-morbid anxiety disorders and IBS were grouped into those with, and without BCA. Patients completed the IBS symptom severity scale and the IAPT minimum data set. Diagnoses and outcomes were examined for all groups up to 6 months follow-up. A greater proportion of BCA patients had a primary diagnosis of phobic disorder. After receiving CBT, patients made clinically significant improvement in both anxiety and IBS symptoms at 6 months follow-up. Patients with BCA made greater improvement in phobia scales and IBS symptoms than non-BCA patients. Anxiety disorders with co-morbid IBS improved significantly in a routine IAPT service. A significant proportion of co-morbid IBS sufferers had a fear of incontinence in public places (BCA). Directly addressing and modifying these fears with CBT appeared to enhance improvement in both phobic anxiety and IBS symptoms.

Structure of comorbid psychopathological disorders in patients with type 2nd diabetes mellitus

Aim: to identify and explore the structure of comorbid psychopathological disorders in patients with type 2nd diabetes mellitus (DM).Materials and methods: 543 patients with type 2nd DM were included into the study. The average age of patients was (56.2 ± 0.65) years. The patients were divided into three groups according to the severity of DM. The first clinical group (CG-1) included 57 patients with type 2nd DM of mild severity, who was treated in outpatient department; the average age in the group was (51.8 ± 1.28) years. The second clinical group (CG-2) made up of 312 patients with type 2nd DM, moderate severity, they were in inpatient department; the median age of the group was (55.1 ± 1.12) years. The third clinical group (CG-3) included 174 patients with type 2nd DM, severe degrees of severity, they undergone inpatient treatment too; average age in the group was (61.8 ± 0.85) years.Research methods: clinical-anamnesis, clinical- psychopathological, statistical.Research results. The study established the incidence of non-psychotic mental disorders of varying severity in patients with type 2nd DM at the level of 94.11 %, among them, for 91.16 % – of psychogenic origin.Proportional correlation between the severity of type 2nd DM and the absence of comorbid psychopathological manifestations was detected (rs = -0.3416, p < 0.01). It is revealed that the dominant psychopathological syndromes among all patients with type 2nd DM were psychoorganic (62.43 %), dyssomnia (60.86 %), asthenic (55.58 %) and anxiety (43.05 %) syndromes. Structure of the dominant psychopathological syndromes was established depending on severity of type 2nd DM: in CG-1 dominated dyssomnia (36.84 %), anxiety (31.58 %), psychoorganic (21.05 %) syndromes; in CG-2 – psychoorganic (65.38 %), asthenic (40.38 %), dyssomnia (38.46 %), anxiety (37, and 82 %) syndromes; in CG-3 – dyssomnia (97.70 %), asthenic (89.08 %), organic mental (70.69 %), anxious 48.28 %) syndromes. Significant prevalence among all study groups was detected for hysterical (χ2 = 13.416, p < 0.01) and phobic syndromes (χ2 = 6.161, p < 0.05) in g CG-1 compared to CG-2 and CG-3; and asthenia (χ2 = 162.663, p < 0.01), anxiety (χ2 = 7.177, p < 0.05), depression (χ2 = 13.298, p < 0.01), dyssomnia (χ2 = 171.058, p < 0.01), hypochondric (χ2 = 19.331, p < 0.01), psychoorganic (χ2 = 47.830, p < 0.01) syndromes in CG-3 compared to CG-1 and CG-2. Direct correlation between the severity of type 2nd DM and the presence of the clinical picture asthenic (rs = 0.4033, p < 0.01) and psychoorganic (rs = 0.2344, p < 0.01) syndromes was identified; and inverse correlation between the severity of type 2nd DM and the presence of the clinical manifestation of patients with hysterical syndrome (rs = -0.1444, p < 0.01).Conclusion. The study established the frequency of occurrence and genesis of nonpsychotic mental disorders of varying severity in patients with type 2 DM. Correlation between the severity of type 2nd DM and comorbid psychopathological symptoms was revealed. The identified dominant psychopathological syndromes among patients with type 2nd DM, as well as the structure of psychopathological disorders depended on the severity of type 2nd DM.

Clinical-psychopathological Specificity of Resistant Dissociative Disorders

Objectives An increasing amount of chronic, prolonged forms of mental disorders stipulates an actuality of this problem and require development of diagnostic and therapeutic strategies directed on prevention and overcoming of resistance. Aim The aim of the investigation was to define clinical-psychopathological peculiarities of dissociative disorders with signs of resistance. Methods Fifty patients with dissociative disorders (including 30 with signs of resistance and 20 without signs of resistance) were examined. The clinical-psychopathological method including a clinical-phenomenological analysis of psychopathological symptoms was used with addition of the Symptom Check List-90-Revised (SCL-90-R) scale. Results It was found out that resistant dissociative disorders were characterized with a prolonged onset of the disease (J (xij) = 0.37); a somatization of clinical manifestations with formation of permanent somatic symptoms in several systems of organism (J (xij) = 0.30); a comorbidity with somatic-neurological pathology (J (xij) = 0.49); a combination of hypochondriac, depressive, and phobic psychopathological syndromes (J (xij) = 0.22) accompanied by a steady limitative behavior (J (xij) = 0.30). Conclusions The results obtained are expedient to use as criteria for diagnosis and targets for treatment of resistant dissociative disorders.

Experimental single-session imagery rescripting of distressing memories in bowel/bladder-control anxiety: a case series.

Bowel and bladder obsession [bowel/bladder-control anxiety (BBCA)] is a viscerally centered phobic syndrome involving a specific concern about losing control of bowel or bladder functioning in a public place. Like other anxiety disorders, BBCA is characterized by intrusive imagery. We have previously described the nature of intrusive mental imagery in BBCA and found imagery themes to be linked to actual experiences of loss of control or to “near misses.” A causal role for imagery in symptom maintenance can be inferred by examining the effects of imagery rescripting. Moreover, successful rescripting may point to a potentially efficacious avenue for treatment development. Three cases of imagery rescripting are described here with pre-, post-, and follow-up (1-week) data reported. After rescripting, two participants experienced pronounced reductions in imagery vividness, distress, shame, disgust, and belief conviction. Most importantly, all three participants experienced a reduction in fear-associated bladder and/or bowel sensations. The results support a causal role for mental imagery in bowel-bladder-control anxiety and suggest that rescripting of distressing intrusive memories linked to recurrent images may be a useful avenue for development of cognitive-behavioral treatments of bladder/bowel-control anxiety.

Bowel and Bladder-Control Anxiety: A Preliminary Description of a Viscerally-Centred Phobic Syndrome

People with anxiety disorders occasionally report fears about losing control of basic bodily functions in public. These anxieties often occur in the absence of physical disorder and have previously been recognized as "obsessive" anxieties reflecting a preoccupation with loss of bowel/bladder control. Motivated by our observations of the non-trivial occurrence of such anxieties in our clinical practice we sought to fill a gap in the current understanding of "bowel/bladder-control anxieties". Eligible participants completed an internet survey. Bowel/bladder-control anxieties (n = 140) tended to emerge in the mid to late 20s and were associated with high levels of avoidance and functional impairment. There was a high prevalence of panic attacks (78%); these were especially prevalent among those with bowel-control anxiety. Of those with panic attacks, 62% indicated that their main concern was being incontinent during a panic attack. Significantly, a proportion of respondents (~16%) reported actually being incontinent during a panic attack. Seventy percent of participants reported intrusive imagery related to loss of bowel/bladder control. Intrusion-related distress was correlated with agoraphobic avoidance and general role impairment. Some differences were noted between those with predominantly bowel-, predominantly bladder- and those with both bowel and bladder-control anxieties. This preliminary characterization indicates that even in a non-treatment seeking community sample, bowel/bladder-control anxieties are associated with high levels of distress and impairment. Further careful characterization of these anxieties will clarify their phenomenology and help us develop or modify treatment protocols in a way that takes account of any special characteristics of such viscerally-centred phobic syndromes.

P01-149 Different pathways into panic disorder, agoraphobia and specific phobia

Background:In light of the ongoing debate whether agoraphobia [AG] should be viewed as a severe phobic disorder similar to specific phobia [SPE] or as a complication of panic disorder [PD] we aim to study the vulnerability structure of PD, AG and SPE.Methods:3021 14-24 year-olds from the general population were followed-up over 10 years. DSM-IV syndromes were assessed via computerized M-CIDI interview and vulnerability factors via questionnaires. Associations were assessed with odds ratios from logistic regression. Latent class analysis (LCA) regressed on vulnerability factors was used to derive classes that underlie panic and phobic syndromes and to assess their associations with vulnerability factors.Results:1.Vulnerability patterns were largely similar between PD, AG and SPE.2.The LCA resulted in a best fitting model with 4 classes: a healthy class, a class with moderate frequency of phobias without PD, a class characterized by PD and AG and moderate frequency of SPE (PDAG class) and one class characterized by high frequency of AG and SPE situational type and lower frequency of PD (AGSIT class).3.All classes showed different associations with multiple vulnerability measures. Subjects in the PDAG class reported less SPE in parents (OR=0.2; 95% CI=0.0-0.6) and older onset-age of any psychopathology (OR=2.0; 95% CI=1.07-3.6) than the AGSIT class.Discussion:We found indications for separate latent classes underlying PD and phobias that were characterized by different vulnerability factors. We interprete the different classes as different vulnerability clusters and evidence of multiple pathways leading to panic and phobias.

Psychogenic disorders in children with perinatal injury of CNS: ethiology, pathogenesis, clinical picture, correction

Peculiarities of occurence of psychogenic disorders in children are explored, and efficiency of psychotherapy is estimated. In clinical picture of psychogenic disorders anxiety-depressive (59,0%), cerebroasthenic (61,5%) and phobic (8,6%) syndromes prevailed. In 34% of children increased level of anxiety was noted. In 87% of children low physiologic stress resistance was found. Use of psychotherapy in correction of psychogenic disorders was found to be effective. The performed analysis of psycho- traumatic effects makes it possible to recommend use of psychotherapeutic procedures adapted for the given age in combined therapy of psychogenic disorders.

Functional rearrangements in the human brain during emotional self-regulation with biological feedback.

The concept that functional psychopathology producing phobic syndromes is mediated by a specific deficiency in the integrative activity of the brain as a loss or partial limitation of the ability to recognize subjective experiences was used to develop a special method for mobilizing the selective attention of patients to the time course of subjective states. The fact of recognition of a state was demonstrated by the patient's ability to reproduce it by achieving specific parameters in a biological feedback test based on skin electrical responses. Success was positively reinforced by avoidance of an anxiously expected electrical stimulus. After successful training, patients could spontaneously adaptively correct their general daily behavior. Computer analysis of EEG traces revealed the specific structural-functional features of various states provoked during training.

The prevalence of psychotic, depressive and anxiety syndromes in demented and non‐demented 85‐year‐olds

AbstractOne‐month prevalence of mental syndromes in demented and non‐demented subjects was studied in a representative sample of 85‐year‐olds living in Gothenburg, Sweden (N = 494). All subjects were examined by a psychiatrist. Schizophreniform syndrome was significantly more common in subjects with Alzheimer's disease than in nondemented subjects (13% vs 1%, p < 0.001), and more common in severe dementia (p > 0.01). Depressive syndromes were significantly more common in subjects with mild dementia than in non‐demented subjects (34% vs 20%, p > 0.05). Phobic syndrome was less common in demented than in non‐demented subjects. It is hypothesized that the occurrence of mental syndromes in demented subjects may be related to structural and neurochemical brain changes.

The Psychoanalytic View of Phobias

The psychoanalytic literature on infantile phobias, despite disclaimers by several of its prominent authors, seems to demonstrate a growth in knowledge of these conditions and an increasing respect for methodology. It is also noteworthy in its close adherence to the presentation of clinical material. Looking at phobia from this developmental viewpoint has caused us to modify our definition of phobia, adding independence from immediate, fear-provoking stimuli and requiring an inference on the part of the observer because of some integral mental process which is nontransparent. These additions are further specifications of the meaning of the term in general; they are not intended to be limited to infantile phobias. Phobic syndromes can certainly arise well before age four, well before there is any evidence of a child's having entered the oedipal phase of development. Nevertheless, because of the early genital phase, castration reactions, albeit with a somewhat different meaning, usually appear to be involved in the symptom formation. There is also a suggestion that all infantile phobias may begin to arise at this period of development. The symptom pictures in the cases of the children reported in the psychoanalytic literature are very similar. We seem to have described a disorder which, we can hypothesize, has its beginnings in the early genital phase, may emerge as a psychopathological condition at that time, or may reach proportions sufficient to interfere with function or development only several years later. The disorder appears to make use of inherited reflex-like patterns of response to certain stimuli as dangers. On the basis of the reported psychoanalytic experience, we cannot really generalize much about psychogenetics or psychodynamics. Psychoanalysts have applied their ideas about neurotic symptom formation in general to these cases. Just why the illnesses assume these particular forms in these particular children is unclear. The only steps toward specification have been hypotheses introduced by Anna Freud and Owen Renik. Anna Freud hypothesized that a major condensation occurs to focus infantile anxieties on a single symbol, thus causing sharply focused, rather than generalized, anxiety. Renik related self-object differentiation and cognitive development to such "symbolization" in infancy, explaining phobic object formation in terms of primary and secondary process representations and their interaction. Although we have descriptively defined a syndrome "phobia," it is not yet clear whether the disorders of infancy and childhood which fit that definition have significant similarities--descriptively or psychodynamically--with conditions which develop later in life and also appear to fit the descriptive parameters.(ABSTRACT TRUNCATED AT 400 WORDS)

The Psychoanalytic View of Phobias

This paper initiates a series of communications on psychoanalytic and current psychiatric approaches to the understanding and treatment of phobic syndromes with a review and discussion of Freud's evolving ideas on phobias and anxiety. A list of issues that any theory of phobic syndromes must address is compiled on the basis of Freud's work.

Delineating the boundaries of social phobia: Its relationship to panic disorder and agoraphobia

Abstract The present article was prompted by the differential diagnostic ambiguities surrounding the social phobic syndrome. The following questions were addressed: (a) Is social phobia a distinct clinical syndrome, differing from panic disorder and agoraphobia on a number of variables? (b) What is the relationship between social phobia, panic disorder, and agoraphobia regarding co-occurrence of syndromes? (c) What are the principal differential diagnostic features which define the boundaries of the syndrome? A literature review suggested that social phobia is a distinct entity which differs from panic/agoraphobia regarding prevalence, sex ratio, age of onset, familial psychiatric history, response to provocative tests, and pharmacotherapy. Several studies have shown substantial comorbidity between the syndromes. Critical features for formulating a differential diagnosis include distinguishing type and pattern of panic attacks and determining what the patient fears. Symptoms must be evaluated within the context of the individual's disturbance, which requires an informed, precise, and thorough assessment.

Genital phobia and depilation

It has recently been alleged that there was, among Greek men of the classical period, a deep-seated fear of the female genitals, and that pubic hair was a focus of that fear. On account of this phobia, it has been suggested, in order to achieve a satisfactory sexual relationship, Greek men required their women fully to depilate their genitals. The thesis has logical problems: if the cause is the sight of the mother's genitals during childhood, the syndrome can affect only one generation. Besides this, it is clear that any depilation would tend to make the vulva more visible, while a heavier growth of hair would tend to hide it. To put the alleged phobic syndrome further to the test, three questions must be answered: Did Greek women practise total pubic depilation? Did they practise pubic depilation at all? If they did depilate, why did they? As for most questions of daily life, there are two major sources of information: Comedy and vase painting. The evidence presented will show that Athenian women did practise partial genital depilation, and that female genital display—including display of pubic hair—is an important element in Attic erotic painting. These two facts are not compatible with a theory of genital phobia.

Anxiety and/or the depressive syndromes

The relationship of anxiety to depression in a number of the depressive and neurotic syndromes (agitated depressive syndrome, affective hypochondriacal syndrome, depressed obsessive-compulsive syndrome, phobic and obsessive-compulsive syndrome, anxiety state, depressive neurotic syndrome) is far from clear. Are anxiety and depression entirely separate disorders which may co-exist in the same patient? Does anxiety give rise to the depression? Does depression give rise to the anxiety? Are anxiety and depression manifestations of a single underlying disorders, dysphoria? Therapeutic responsivity to specific drugs suggest: relief of anxiety may reveal an underlying depression; anxiety syndromes which fail to respond to anxiolytics may respond to antidepressants; short-term relief of depression may occur at times with anxiolytics. Proposed mechanisms of action of depression and anxiety also involve overlap of the elements and systems involved. The basic sensations of pain, anticipation, depression and euphoria alone or in combination are sufficient to account for the dysphoric feelings and emotions when these sensations are associated with specific mental content. These may be related in turn to biogenic amines, beta-endorphins, diazepam receptors and possibly cocaine receptors.

Psychopharmacology of neuroses.

Abstract The author reviews a number of neurotic disorders, including generalized anxiety disorders, panic disorders, obsessive-compulsive disorders, the phobic anxiety-depersonalization syndrome, depressive neurosis, and psychophysiologic disorders, with regard to the effectiveness of various classes of psychopharmacologic agents and the current understanding of the pharmacologic basis for their therapeutic effects.

Adequacy of the Brief Psychiatric Rating Scale for distinguishing lesser forms of psychopathology.

The adequacy of the Brief Psychiatric Rating Scale for distinguishing among lesser forms of psychopathology, as well as among the more serious forms, was investigated. 31 psychiatrists provided symptom descriptions for 13 clinical syndromes which were selected to span the full range of inpatient and outpatient psychopathology. The symptom descriptions included, in addition to the standard 18 scales of the rating scale, 24 additional symptom- and behavior-rating constructs. It was found that the syndrome patterns could be distinguished with high accuracy in terms of the 18 variables of the rating scale alone. The only distinction that was enhanced by consideration of additional scales was the obsessive-compulsive versus phobic syndrome distinction. On the basis of these results, it is concluded that the Brief Psychiatric Rating Scale should be considered useful for description of psychopathology in outpatient settings even though most of the developmental work on the instrument was done in inpatient research.

Psychoneurotic profiles in middle age. A study of persons aged 40 to 65 registered with a general practitioner.

The Middlesex Hospital Questionnaire (M.H.Q.) is a brief self-rating inventory that is intended to cover the full clinical range of neurotic illness (Crown and Crisp, 1966). It usually takes about 7–10 minutes to complete, and a few minutes to score. Although many questionnaires attempt to measure general neurotic ill-health, the only other short test that purports to rate patients comprehensively in terms of clinical categories (e.g. anxiety state, neurotic depression, obsessional neurosis, hysteria) is Fould's Symptom-Sign Inventory, which requires verbal administration by the examiner and does not cover psychosomatic and phobic syndromes.

Fear of vocational success. A phobic extension of the paranoid reaction.

The fear of success in various areas of behavior, both sexual and nonsexual, was attributed by Freud¹to the guilt associated with the Oedipus complex. More recently, Schuster²reviewed the Freudian thesis and reached the same conclusion. Success in the patients he described, all of whom were men, unconsciously implied retaliation and punishment by the father. Hence, it was the ever-present threat of castration that forced these patients to abandon their aspirations. In this paper, I have singled out for discussion the fear of vocational success, an especially common phobic syndrome in our society. This particular form of the "success neurosis," where the patient is unable to tolerate vocational achievement, is often referred to by psychiatrists as the "success phobia." It occurs in patients of both sexes, but is seen with far greater frequency in men because they are more subject to the competitive pressures