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.