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MDP DEPRESSION
Symptoms are subjected to diurnal variations, being aggravation in the morning hours.

FEATURES
Sad mood
Gloomy face, wrinkled forhead, drooping of eyelids, sagging angle of mouth
Speech is slow, low voice, delusion of guilt for imagined crimes & blames
Hopelessness and worthlessness's uicidal ideas
Nihilistic and hypochondriacally delusions, depressive mutism
Auditory hallucinations, retarded motor activity, tend to stoop while walking
Self centered and left undisturbed
Ignore routine work due to feeling of general weakness
Depressive stupor later, pseudo dementia ( apparent impaired memory)

SOMATIC SYMPTOMS
Headache, chest pain , generalized ache
Giddiness, amenorrhoea, impotence
Anorexia, constipation, insomnia

DIAGNOSIS
From clinical features
Depressed mood, retarded psychomotor activity
Pessimistic attitude, wirthleness, quilt
Suicidal tendencies, hypochondriasis
Masked depression – only somatic symptoms  
D/D
Schizophrenia
Secondarydepression( due to atherosclerosis,gpi,hypothyroidism,vit-b12 deficiency )

COURSE
Risk of suicide is high

TREATMENT
Drugs
ECT

PSYCHONEUROSIS  

1.ANXIETY NEUROSIS
Commonest form of psychoneurosis characterized by lack of concentration, loss of interest and unforeseen fears due to the failure of adaptation to environmental stress.
AETIOLOGY
Genetic – family history
Learning theory – thought to be a fear response which by conditioning is attached to another impulse
Psychodynamic theory - stresses like familial ,personal or sexual
Emotional instability
Constitutional,enviromental or hereditary factors
Sexual background

CLINICAL FEATURES
Anxiety symptoms always dominate
Fear of body and mind, think that he may die or commit suicide
Insomnia, sleep disturbed by night terrors
- an autonomic imbalance-
GIT : Nausea, vomiting, hiccough, diarrhea, dysphagia, dry mouth
NERVOUS : Twitching, terror. blurring of vision, giddiness, tinnitus
GENITOURINARY : Seminal emission, frequency of mictiuriation
CVS : Palpitation, low BP, precordial pain
Effort syndrome ( Dacosta syndrome) if the above seen in soldiers
RESP : Constriction chest, dyspnoea, hyperventilation syndrome, pain chest
OTHERS : Head ache, insomnia, fear of open place

PROGNOSIS : Good  

TRETMENT
Psychotherapy
Drugs
Good food & poly vitamins
Change of place may be effective
Treat the cause

HYSTERIA

A condition of unconscious want of relief from intolerable stress characterized by clear cut physical signs and mental symptoms in absence of any pathological change in the body.

AETIOLOGY
Family history
Characteristic hysteric type personality
Mental stress
Constitutional factors

CLINICAL FEATURES
Aged.
Female more
a) Conversion hysteria (where patient present with same physical symptoms with or without sign)
b) Dissociative hysteria where different types or altered states of awareness are present due to dissociation between different mental activities
Neurological : Motor weakness with flaccidity
Limping gate, mute
Stock & glove type cutaneous sensibility
Hysterical blindness( 2 different type of field defect)
GIT : Vomiting with out prior nausea
Globus hystericus
Pseudocysis
       Chronic abdominal pain
RESP : Hysterical hyperventilation
Hysterical aphonia
CVS : Palpitation & pericardial pain
OCCULAR : Blepharospasm
SKIN : Dermatitis artifact ( dermographism)artificial eruptions made by the patient
MENSTRUAL : Amenorrhoea or oligomenorrhoea
DISOCIATIVE HYSTERIA : Delirium or may talk nonsense

TREATMENT
Psychological
Drugs
Psychotherapy

OBSESSIVE COMPULSIVE NEUROSIS  

These are thoughts and feelings which cannot be get rid of by voluntary effort because of their persistent recurrence in the mind against the will and the patient has insight of this abnormality.

AETIOLOGY  
Constitutional factors
Hereditary influences
Physical factors-head injury,enchephalitis etc.
Psychological factors – conflict between moral standards & more primitive urges eg.sex
Rigid routine made by the parents

CLINICAL FEATURES
# . Anxious pre occupation with same obsessive facts  
A) Obsess ional ideas
On religious or philosophical problem Eg. Existence of god
Patient have repetitive brooding on thought (obsess ional rumination)
Having obsess ional doubt – examine scrupulously every aspect of his action  
B) Obsess ional impulse
Sexual – fear of pregnancy in females /impregnating women in males
Aggressive – connected with causing harm or injury to others
C) Obsess ional phobias
Repetitive irritable fears of closed or open spaces, sharp instruments etc.
Ultimately every sort of social binding at home
#. Morbid compulsion or compulsive acts
Checking doors and windows repeatedly before going to bed
Constantly washing hands on account of fear of contamination, washing clothes several times – Ritualistic behavior
Compulsive acts are so designed to allay anxiety
May compelled to touch or steal something

PROGNOSIS
Poor if no affective disorder and sloe onset
When obsession as a part of depression – good

TREATMENT
Psychotherapy has no use
Reassurance,modelling
Behavior therapy
Keeping the patient engaged at work
Drugs

PSYCHOSOMATIC DISORDERS

These are disorders where the emotional and physical factors might have a cause and effect relationship in the aetiopathogenesis.
Are often precipitated by emotional upset or stressful period
CVS – Essential hypertension,IHD
RESP – asthma,vasomotor rhinitis
GIT - peptic ulcer,ulcerative colitis
Endocrine – Thyrotoxicosis,DM,DI
Loco motor – rheumatoid arthritis
Skin- urticaria,eczema
Reproductive–PMt,menopausal syndrome,amernorrhoea,dysmenorrhoea

TREATMENT
Assertion the factors responsible for precipitation
Each case should be judged by its independent merits
Advice to modify their attitude- tension & anxiety avoided
Discuss the problem of child freely with parents

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