Anxiety neurosis

Every mental symptom that reflects the imperfect, poor adaptation of a person to his social environment can be called a manifestation of such a state as neurosis, provided that organic causes such as psychosis and psychopathy were carefully excluded. There is no need to exclude depression, since the symptoms of neurosis should contribute to the rapid diagnosis of depression as the basis for the development of neurosis. When planning treatment, decide for yourself the question, what is more important in a particular case - fear or depression.

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Causes of fear

• Stress (excessive fatigue or lack of work, an unfavorable environment, for example, sharp noise, endless quarrels in the family).
• Tense moments in life (the child went to school, a person changes his place of work or first gets a job, leaves his usual surroundings, gets married, marries, retires, a child appears in the family, a close one suffers a fatal disease).
• In accordance with intrapsychic theories (for example, a sense of fear is an excess of psychic energy and a manifestation of suppressed hostility or conflicting motives). According to this theory, neurotic behavior is seen as a way of getting rid of excess psychic energy, and in accordance with psychoanalytic theory it most often arises if the given personality has not passed normally through the oral, anal and genital stages of development.

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The connection between neuroses and crime

From the clinical point of view, among those who committed crimes, the most common are neurotic states, such as anxiety and neurotic depression. The least common are phobic and compulsive states.

High levels of neurosis symptoms in criminals do not at all imply a causal relationship between symptoms and crime. Criminal behavior and neurotic symptoms are correlated with the same social and personal circumstances, so that they can arise in the same person, without necessarily interacting with each other. Studies of neurosis symptoms among prisoners show significantly increased levels of neurotic symptoms among persons with personality disorders. Significant levels of substance abuse are associated with symptoms of neurosis and personality disorder. Taking into account the interaction of these disorders, it is extremely difficult to single out the precise contribution to the crime of precisely neurotic disorders.

Neuroses and Murder

Reactive neuroses (depression and / or anxiety) can be so strong that the accompanying stress can lead to an emotional explosion that ends with murder, even in the absence of a personality disorder. Courts take chronic reactive depression and moderate-level depression as the basis for applying protection due to reduced liability.

Neurosis can have a significant effect in combination with personality disorders, for example neurotic depressive reaction in a person with an explosive or antisocial personality. It can disinhibit the subject in a tense situation with a subsequent outbreak leading to murder - either in order to destroy the source of frustration, or in order to transfer tension to an innocent person.

Neuroses and theft

Thefts can be clearly associated with neurotic depressive states (this is shown in the example of shoplifting) if they are committed, presumably, with the purpose of drawing attention to the unfavorable state of the subject or for the purpose of appeasement. This motivation is also seen in the thefts committed by unhappy and restless children. Stress associated with a neurotic state can lead to theft as a psychologically destructive act. The subject may have a picture of prolonged depression, although in some cases, the concomitant behavioral disorder can be so expressed that it distracts attention from the underlying disorder of the mental state.

Neuroses and arsons

The connection between neurosis and arson is well established. This is especially true for stress states. Fire can act as a way to get rid of stress, relieve feelings of depression and symbolically destroy the source of pain. In cases of arson, the known comorbidity of a neurotic disorder with substance abuse and personality disorder may be particularly significant.

Neurosis and alcohol-related crime

Alcohol can cause a state of melancholy. Crime can also be preceded by depression or anxiety - in sensitive individuals, as well as alcoholic drinking. This combination can lead to the commission of a crime; while alcohol acts as a disinhibitor.

Neuroses and conclusion

Imprisonment both before the trial and in connection with the serving of punishment can cause the offender to have symptoms of neurosis, such as anxiety and depression. Therefore, it is very important to separate the symptoms that have arisen after arrest, from a disorder that existed before and is relevant to the commission of a crime. Conclusion is an experience that leads to fear, which includes the loss of autonomy, separation from family and friends, and the impact of direct stress of being in such an establishment. The Office of National Statistics study identifies four of the most common prisoner-related neurotic symptoms among prisoners: anxiety, fatigue, depression and irritability. Prisoners reliably more often need a doctor's consultation than individuals in the general population.

There is one particularly isolated syndrome - Ganser's syndrome, which is described as a reaction to the conclusion and is classified in ICD-10 as a form of dissociative disorder (F44.8).

Ganser in 1897 described three prisoners with the following characteristics of a mental disorder:

• inability to correctly answer the simplest questions, even if their answers indicated a certain degree of understanding of the question (Q: "How many legs does a horse have?" - O .: "Three"; V .: "And the elephant?" - O .: " Five");
• some confusion of consciousness (disoriented in place and time, distracted, confused, slow reaction and sense of their "absence", as if they were somewhere in a dream);
• hysterical conversion syndromes (for example, loss of pain sensitivity in the whole body or in areas of increased pain sensitivity);
• hallucinations (visual and / or auditory);
• a temporary sudden cessation of the disorder with the disappearance of all symptoms and a return to a state of complete clarity of consciousness, followed by deep depression and the resumption of symptoms.

Ganzer was sure that this state is not a simulation, but a real hysterical illness. He notes that in the cases described by him there was a previous illness (typhus and in two cases - head trauma). Since then, there has been a debate about the true nature of this condition. This syndrome rarely appears in its unfolded form and is noted not only among prisoners, but individual symptoms can manifest themselves in a variety of mental disorders. There were different views on this syndrome: that this is a genuine transient psychosis or even a simulation, but perhaps the most common belief is that this is a hysterical reaction as a result of depression. It should be distinguished from simulation, pseudodegment, schizophrenia and drug-induced conditions.

Symptoms of an anxiety neurosis (fear)

Trembling, sensation of a pre-fainting condition, chills with the appearance of goosebumps, the feeling that butterflies fly in the stomach, hyperventilation syndrome (for example, accompanied by noise and ringing in the ears, a tendency to intermittent convulsions, pain in the chest), headaches , increased sweating, palpitations, poor appetite, nausea, a sensation of a coma in the throat even without swallowing attempts (globus hystericus), difficulties in falling asleep, anxiety, excessive attention to the functions of one's own body and the physical health of others, Alikhan'yan et al thoughts, compulsive (uncontrolled) motor activity. In children, it manifests itself by thumb sucking, nail biting, urinary incontinence at night, perverted appetite and stuttering.

The prevalence of crimes in neuroses

The numbers of prevalence are unknown. In a study of people who committed shoplifting, 10% of the group were classified as neurotic, but there was no control study. The National Statistics Office reports the presence of a neurosis in 59% of people in pre-trial detention, 40% of male prisoners serving sentences, 76% of women in pre-trial detention and 40% of female prisoners serving a sentence. These figures are much higher than in the general population. People with neurosis also often experience comorbidity with personality disorder and substance abuse. Post-traumatic stress was established in 5% of men in pre-trial detention, 3% of men serving a sentence, 9% of women in pre-trial detention and 5% of women serving a sentence in custody.

Treatment of a neurosis of anxiety and fear

An effective way to reduce the feeling of anxiety is simply to listen carefully to the patient. One of the goals of psychotherapeutic treatment of such patients is to teach them to manage the symptoms of neurosis or be more tolerant to them if they can not manage them. In addition, it is necessary to improve the relationship of the patient with other people and help in resolving the most painful problems for the patient. You should ask for help from social workers. In some cases, anxiolytics can be shown that will make the work of the therapist with the patient more effective.

Approximate doses: diazepam - 5 mg every 8 hours inside for no more than 6 weeks. Problems associated with the treatment of benzodiazepines. As follows from the text, their benefits are very limited.

Progressive Learning of Relaxation

The patient is trained to stretch and relax the muscle groups in a certain order - for example, starting with the toes with the gradual involvement of all the muscles of the body in the process according to the ascending principle. At the same time, the attention of the patient concentrates on carrying out the above exercises, and the sense of anxiety (as well as the muscle tone) is reduced. Deep respiratory movements have a similar effect. The patient should perform these exercises quite often, in order for an improvement to occur. Patients can purchase commercially available cassettes with a recording of the learning process for the above exercises and reuse them.

Hypnosis

This is another powerful method of treating patients with a neurosis of anxiety and fear. Initially, the therapist doctor causes a progressive state of trance, using such techniques as his imagination tells him, and concentrating the patient's attention on various sensations of the body, for example, on breathing. Then the patients themselves learn how to induce these trance states (the state of ambulatory automatism under hypnosis).

Medico-legal aspects of neurosis

If the basis of the crime clearly lies neurosis, not complicated by any antisocial personality disorder, the courts can consider the issue of the recommendation of psychiatric treatment. This also applies to the most serious crimes, for example, when the young man is accused of depression in the murder of his wife. If the neurotic state of the subject is complicated by a psychopathic disorder, then the court's concern about public safety or lack of sympathy for the subject can lead to serious prison sentences in serious cases. In cases where a society is not in danger (for example, shoplifts committed by a person in depression) and inpatient treatment is not required, probation is usually used with the condition of outpatient treatment.

Dissociative phenomena (including dissociative phenomena associated with post-traumatic stress disorder) may be the basis for applying protection due to automatism. The legal criteria for applying protection to the basis of automatism are very strict, and with dissociative states, there is usually partial awareness and partial memory, which makes it difficult to use protection on the basis of automatism. Post-traumatic stress disorder can, under conditions of recurrent trauma, among which the "battered women syndrome" is best known, is so sensitive to the victim that a relatively weak provocation can lead to violence when the injured person reacts to weak signals from the environment , which earlier pointed to the threat of violence. In particular, in the US, the use of such syndromic evidence culminated in the use of protection on the grounds of provocation, including in cases of homicide, as "self-defense."