Q& A

Woman's Era - - Con­tents -

Y DAUGH­TER-IN-LAW IS ABOUT 25 YEARS OLD, SINCE LAST one year some­times she faints and some­times she get fits and al­tered states of aware­ness. We have con­sulted a doc­tor. Af­ter ex­am­i­na­tion and in­ves­ti­ga­tions he di­ag­nosed her as a case of dis­so­cia­tive hys­ter­i­cal neu­ro­sis. I want to know about the dis­ease in de­tail.

Dis­so­cia­tive hys­ter­i­cal psy­choneu­ro­sis is a pro­tean group of dis­or­ders, com­mon in all branches of medicine. Es­sen­tially a hys­ter­i­cal neu­ro­sis con­sists of the pro­duc­tion of the symp­toms or signs of phys­i­cal ill­ness by a pa­tient for some per­sonal pur­pose, with­out his or her be­ing fully aware of the mo­tive in do­ing so. Fa­mil­iar ex­am­ples are sud­den black-outs or loss of mem­ory by which a pa­tient evades a par­tic­u­larly painful or hu­mil­i­at­ing oc­cur­rence. It in­cludes the nu­mer­ous al­tered states of aware­ness such as faint­ness, fits, am­ne­sias, trances, twi­light states and forms of mul­ti­ple per­son­al­ity.

A fugue state is one in which the pa­tient wan­ders away from home in a con­di­tion of al­tered aware­ness. Hys­ter­i­cal stu­por, when the pa­tient lies mo­tion­less show­ing no re­ac­tion to the en­vi­ron­ment, is some­times seen in pseu­do­de­men­tia, the pa­tient be­haves as if in­sane. Treat­ment may be a dif­fi­cult prob­lem. Re­moval of a symp­tom can of­ten be achieved by a pro­longed in­ter­view in which in­tense per­su­a­tion is used but if the pre­cip­i­tat­ing sit­u­a­tion is un­al­tered, re­lapse is usual. The method may be jus­ti­fied how­ever in cer­tain cir­cum­stances as when apho­nia pre­vents dis­cus­sion or when loss of mem­ory in hys­ter­i­cal am­ne­sia pre­vents the pa­tient from com­mu­ni­cat­ing his iden­tity or re­veal­ing the events which pre­cip­i­tated the ill­ness. The prin­ci­ples de­scribed for psy­chother­apy in the treat­ment of anx­i­ety neu­ro­sis are also rel­e­vant in hys­ter­i­cal psy­choneu­ro­sis. The use of drugs to ob­tain re­duc­tion of dis­tress­ing mood dis­tur­bance is of­ten a nec­es­sary pre­lim­i­nary to ef­fec­tive psy­chother­apy, anx­i­ety re­duc­ing drugs are ef­fec­tive.

Y DAUGH­TER IS ABOUT 14 YEARS OLD AND MEN­STRU­AT­ING since last one year but her men­strual cy­cle is usu­ally ir­reg­u­lar. We have con­sulted a lady doc­tor for this prob­lem. Af­ter thor­ough ex­am­i­na­tions and in­ves­ti­ga­tions she told us that men­strual cy­cle re­mains ir­reg­u­lar dur­ing the first few years of men­stru­a­tion but be­comes reg­u­lar af­ter some time. I want your opin­ion.

The men­strual cy­cle is of­ten ir­reg­u­lar dur­ing the few years af­ter pu­berty but at about the age of 17 or 18 the nor­mal cy­cle for the in­di­vid­ual be­comes es­tab­lished. It should be borne in mind that the men­strual cy­cle is the time in­ter­ven­ing be­tween the first day of one pe­riod and the first day of the next. When a pa­tient states that she men­stru­ates ev­ery month she does not nec­es­sar­ily mean that the men­strual cy­cle is 28 days. She may mean that the in­ter­val be­tween the last day of one pe­riod and the first day of the next is 28 days. Un­less the nor­mal men­strual cy­cle, as dis­tinct from the in­ter­val be­tween pe­ri­ods, is taken as the ba­sis, con­fu­sion is cer­tain to fol­low. For ex­am­ple, with my­omata (fi­broid of the uterus) the du­ra­tion of men­strual loss is pro­longed so that the in­ter­val be­tween pe­ri­ods is re­duced and the pa­tient may com­plain that she men­stru­ates more fre­quently be­fore, when ac­tu­ally the men­strual cy­cle it­self is un­al­tered. Sim­i­larly, it will of­ten be found, if pa­tients are ques­tioned closely, that there has been a vari­a­tion of a few days from the cy­cle of 28 days, and even a dif­fer­ence of as lit­tle as one or two days may be of im­por­tance in the his­tory when such con­di­tions as etopic ges­ta­tion (preg­nancy other than in the uterus) are be­ing con­sid­ered.

Y DAUGH­TER IS ABOUT 10 YEARS OLD. ONE WEEK AGO she de­vel­oped a sore throat, shiv­er­ing, fever and her ton­sils were en­larged. We have con­sulted a pae­di­a­tri­cian. He told us that she is suf­fer­ing from scar­let fever. Some­one told me that af­ter some time kid­ney prob­lems will de­velop as a com­pli­ca­tion of this dis­ease. I want to know about this dis­ease in de­tail and your opin­ion also.

Al­though scar­let fever is at present a mild dis­ease, it may not nec­es­sar­ily re­main so as fluc­tu­a­tions in its sever­ity have been recorded. The pri­mary site of in­fec­tion in scar­let fever is usu­ally the phar­ynx or the ton­sils. It is trans­mit­ted by air­borne in­fec­tion or, more rarely, by milk or ice-cream con­tam­i­nated by strep­to­cocci bac­te­ria. The in­cu­ba­tion pe­riod is about two to four days. Scar­let fever oc­curs most com­monly in chil­dren. It has a sud­den on­set and the more se­vere cases present with a sore throat, shiv­er­ing, fever, headache and vom­it­ing. There is in­flam­ma­tion of the fauces and the ton­sils are en­larged. There is ten­der en­large­ment of the ton­sil­lar lymph nodes. The rash, which usu­ally ap­pears first be­hind the ears on the se­cond day, rapidly be­comes a gen­er­alised punc­tu­ate ery­thema. It is most in­tense in the flex­ures of the arms and legs. The tongue is ini­tially furred but shows prom­i­nent red papil­lae, an ap­pear­ance known as the white straw­berry tongue. A pro­fuse growth of haemolytic strep­to­cocci can usu­ally be ob­tained from a throat swab. The com­pli­ca­tions are less com­mon than ear­lier as a re­sult of the mild form of the dis­ease and the in­tro­duc­tion of ef­fec­tive chemo­ther­apy. Rheumatic fever and nephri­tis (kid­ney dis­ease) are rare se­que­lae which de­velop two or three weeks af­ter the on­set of any haemolytic strep­to­coc­cal in­fec­tion. The treat­ment of scar­let fever can be done with broad- spec­trum an­tibi­otic drugs. An in­sti­tu­tional epi­demic calls for chemo­pro phy­laxis with peni­cillin. Any treat­ment should be taken only with the ad­vice of a doc­tor.

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