A feeling of intense anxiety accompanies the central manifestation and leads the individual to take counter measures against the initial idea or impul

manifestations: are characterised by presence of obsessions and compulsions. Obsessions are recurrent or persistent ideas, thoughts, images or impulses. Compulsions are urges or impulses to action that, when put into operation lead to compulsive acts which are performed either according to certain rules or in a stereotyped manner. Obsessions and compulsions have certain features in common - (a) An idea or impulse intrudes impellingly into an individual's conscious awareness. (b) A feeling of intense anxiety accompanies the central manifestation and leads the individual to take counter measures against the initial idea or impulse. (c) The obsession or compulsion is ego-alien, i. e. is experienced as being foreign to and not a part of one's experience of oneself ; it is undesirable and unacceptable. (d) The individual recognises the obsession or compulsion as being absurd or irrational. (e) The suffering individual feels a strong need to resist those obsessions or compulsions. When the symptoms become severe, the patient may develop additional symptoms of anxiety anchor depression. PROGNOSIS - Natural remissions of symptoms are known; hence the prognosis is not always gloomy. Prognosis is bad when the personality is obsessional and symptoms are severe and of long-standing. Management: 1. Drugs - Fluoxetine (20-60 mg/day) or sertraline (50-300 mg/day) or clomipramine (75-200 mg/day) Trazodone (50^1-00 mg/day) is also effective in some cases. 2. Psychotherapy- Supportive as well as analytical gives satisfactory results in some cases. 3. Behaviour therapy - Satisfactory results are seen in some cases. IV. Hysteria Types of hysterical disorders -1. Conversion disorder - (Hysterical neurosis, conversion type). Here the special senses or voluntary nervous system are affected causing symptoms such as blindness, deafness, paralysis, akinesias, etc. for which there is no organic basis. Often the patient shows an inappropriate lack of concern ("la-belle" indifference) about those symptoms which may actually provide secondary gains by winning sympathy. 2. Dissociative disorder - (Hysterical neurosis, dissociative type). Here alterations may occur in the patient's state of consciousness or in his identity to produce such symptoms as amnesia. somnambulism, fugue and multiple personality. Etiology: There is sufficient evidence to suggest that the symptoms are psychogenic and that the environmental factors are the important etiological factors. 1. Age - The peak incidence is between the ages of 20 to 35 years. 2. Sex - Incidence is higher in females. 3. Intelligence - People with low intelligence more likely. 4. Personality - Commonest is histrionic personality (characteristics - dramatizing and exhibitionistic, attention seeking, immature, having shallow and superficial emotional relationships). 5. Marital status - More common in unmarried, widowed and divorcees. 6. Socio-cultural factors - More common in primitive, developing and less sophisticated or cultured societies. 7. Psychoanalytical theories - Hysterical symptoms are viewed as symbolic representations and distorted expressions of unresolved intrapsychic conflicts about one's sexual drive (libido). When the libidinal energy manifests itself as somatic symptoms through the ego-defence mechanism of conversion, the resulting disorder is known as conversion disorder. When the libidinal energy manifests as psychological symptoms through the defense mechanism of dissociation, the resulting disorder is labelled dissociative disorder. Clinical manifestations: 1. SYMPTOMS OF CONVERSION DISORDER - These arise because of the involvement of voluntary neuromuscular system. (a) Motor symptoms - These are of two types: (i) Akinesia e.g. paresis or paralysis involving a part of the body like monoplegia, hemiplegia, paraplegia, etc. (ii) Hyperkinesia and dyskinesia e. g. tremors, torticollis, convulsons or fits (b) Sensory symptoms: These can be in the form of anaesthesia, hypoaesthesia, hyperaesthesia and paraesthesia. This disturbance can affect all the general sensations. Special organs of sense, like those for sight, hearing, smell and taste can also be disturbed resulting in blindness, deafness, etc. (c) Visceral symptoms - Common ones are hiccoughs, vomiting, dyspnoea, dysphagia, aphonia, etc. 2. SYMPTOMS OF DISSOCIATION DISORDER - (a) Somnambulism and somniloquy. (b) Amnesia -usually circumscribed and covers up the psychologically traumatic event. (c) Trance - An altered state of consciousness lasting for a few minutes to a few hours, during which the patient appears to be oblivious of the surroundings. (d) Fugue - An altered state of consiousness wherein the patient travels long distances over a period of days and subsequently has amnesia for the entire episode. (e) Multiple personalities like those of Dr. Jekyl and Mr. Hyde. (f) Ganser's syndrome, a rare disordercharacterised by giving of "approximate answers", somatic or psychological hysterical symptoms, hallucinations and an apparent clouding of consciousness. Characteristics of hysterical symptoms - 1. Absence of organic basis for symptoms. 2. They serve both primary gain (resolution of intrapsychic conflicts) and secondary gain (obtaining sympathy and attention). 3. In conversion disorder - (a) Symptoms seldom occur when patient is alone, on the other hand, symptoms are exaggerated in presence of other persons. (b)