Psychiatric rehabilitation of emoti

Psychiatric rehabilitation of emotional disorders
Sang-Bin Baek
Department of Psychiatry, Ulsan University Gangneung Asan Hospital, Gangneung, Korea
Emotional disorder is psychological and behavioral problems of emotional
domain that is different from cognitive domain, such as thought
and memory. Typical emotional disorders are anxiety disorder, depression,
and bipolar disorder. In the present study, we discussed on the
symptoms, progression, and treatment for the anxiety disorder (panic
disorder, social phobia, and obsessive compulsive disorder), depression,
and bipolar disorder. The goal of treatment for the emotional disorder
is removal of symptoms. In spite of the development of brain science,
removal of symptoms, prevention of recurrence, and coming back to
normal life require patience and effort.
Keywords: Emotional disorder, Depression, Bipolar disorder
INTRODUCTION
Emotional disorder is psychological and behavioral problems of
emotional domain that is different from cognitive domain, such as
thought and memory (Kaplan and Sadock, 1998; William et al.,
2002). Typical emotional disorders are anxiety disorder, depression,
and bipolar disorder. Symptoms of emotional disorders are
completely included in domain of subjective experience of an individual.
This being so, it is nearly impossible to estimate severity
of emotional symptoms through objective methods. So it is very
difficult to others sympathizing pains of emotional disorder patients.
Even family members of patients, they could not sympathize
pains of patients enough. This is the character of emotional
disorders in a word; only experience can tell the pains.
Treatment goal of emotional disorder in psychiatry is removal
of symptoms. Due to development of brain science, biological
mechanisms of emotional disorder are now unveiling. Biological
therapy, especially pharmacotherapy, is more effective. Psychiatry’s
goal is the achieving of reality. Quality of life issue of patients is
unsolved yet. Not only removal of symptoms but also prevention
of recurrence and coming back to normal life is important. It is
the goal of psychiatric rehabilitation for emotional disorder patients.
ANXIETY DISORDERS
Panic disorder
Panic disorder consists of continuous panic attack and anticipatory
anxiety (Kaplan and Sadock, 1998; William et al., 2002).
Major symptoms of panic attack are abrupt severe dyspnea and
palpitation. Thus people in panic attack always feel fear of death.
Panic attack is rare in normal life but may happen at any time.
Panic attack is likely to happen more often to those who are tremble
with fear. First panic attack often make anticipatory anxiety of
further panic attacks. People in anticipatory anxiety always concentrate
their breath and heart rate.
It is very inconvenient in life, and when people are more afraid
of panic attack, it may happen more often. The long-term result
of panic disorder is functional disturbance in occupation, study,
and everyday social life. The common places of panic attack are
long tunnel, high-level road, elevator, subway, airplane, and sauna.
When panic disorder patients are in that places, they usually feel
be sealed, be shut up. And such feeling may induce panic attack.
Life threatening memory of panic attack can induce continuous
panic attacks in the future. After this time, panic disorder patients
begin frequent calling 119 emergency medical services and frequently
visit emergency room of general hospital.
Long-term untreated panic disorder results in depression. After
http://dx.doi.org/10.12965/jer.140143
Review Article
Journal of Exercise Rehabilitation 2014;10(4):205-208
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Baek S-B • Psychiatric rehabilitation of emotional disorders
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depression develops, treatment of panic disorder becomes more
difficult. The first thing to do in mental rehabilitation of panic
disorder is isolating of patient from the panic-inducing environment,
such as too suffocating and enclosed area. And secondly, the
process of correcting the cognitive distortion is necessary. The patients
of panic disorder usually misunderstand the ordinary physical
sign as the prodromal symptom of panic symptom. Because of
this misunderstanding panic symptom develops more frequently
and seriously. So, it is very important that correcting the cognitive
distortion of the differentiating the ordinary physical sign and the
prodromal symptom of panic symptom. And then, systematic desensitization
to the avoided panic-inducing environment step-bystep
is the following process. Finally, for the mental rehabilitation
of panic disorder, panic patients of the improvement of symptoms
make self-help group and prevent relapse the symptoms.
Social phobia
Social phobia is that the patient experiences the excessive stress
and anxiety in social situation, and it occurs in occupational and
social dysfunction (Kaplan and Sadock, 1998; William et al., 2002).
The causes of social phobia are divided into innate factor and situational
factor. Innate factor is mainly derived from biological and
genetic factor, so, a patient of social phobia is shy from an early
age. In severe case, a patient of social phobia has a selective mutism
who consistently fails to speak in specific situation, such as
school, despite speaking actively with family members at home.
A situational factor is usually derived from a subjective psychiatric
trauma that is linked to the experience to feel deep shame in front
of many people. Most of cases, social phobia develops after the episode
of being laughed by any mistakes during announcing at
school time. A patient of social phobia consistently avoids the similar
situations by intent, because of a shame of humiliating in front
of many people. This is even worse over time. Types of social phobia
vary depending on specific situation develops a fear for example
stage, authority, opposite sex, one’s eye, and meeting, etc.
The mechanism of social phobia is summarized as follows. At
first, a person feels extremely humiliated at the first symptom developing
situation, and fixes the symptom through the process of
cognitive distortion. And then, various symptoms, such as tremor,
stiffen, a blush, perspiration, palpitation, etc., develop, and finally,
social withdrawal avoiding social situation consistently develops.
Educating for the understanding the cultural factors of social tensions
is necessary for the mental rehabilitation of social phobia.
Understanding on the difference of oriental and western culture is
important for this education. Clear claims of their own opinions
achieve recognition in western culture, but in oriental culture, it
is considered as a virtue not to expose oneself too much. So, in oriental
culture, shyness is not a fault.
The next step is exposure of their tension rather than hide in
social situation. Through this paradoxical behavior, the patient
can experience the reduction of their tension repeatedly. Homework
of this paradoxical behavior is very useful in this step. If a
patient’s symptom is relieved, it is important to participate into
the self-help group to prevent the relapse of symptoms.
Obsessive compulsive disorder
Obsessive compulsive disorder reveals the obsessive rumination
and compulsive behavior with regard to reduce the anxiety (Kaplan
and Sadock, 1998; William et al., 2002). And obsessive compulsive
disorder is ego-dystonic and it is distinct from ego-syntonic
obsessive compulsive personality disorder. Obsessions are recurrent
and persistent thoughts, urges, images, or memories, connected
with a specific situation, or specific music or song that is
still heard. It is characterized that the more the patient try to get
rid of obsessions, the more it becomes serious. Compulsions are
defined by repetitive behaviors, such as hand washing, checking
the door, ordering, or various behaviors or mental acts. Compulsions
are daily life rituals to specify to individual. The symptoms
of obsessive compulsive disorder develop often under the stressful
circumstances, and associated with the genetic factor. Usually patient
of obsessive compulsive disorder attempts to ignore or suppress
symptoms, however symptoms become worse. In other words,
paradoxically, the efforts to resolve the problem tend to worsen
the problem, and then the disease gradually gets worse.
If obsessive compulsive disorder persists for a long time, eventually,
it can lead to neurasthenia or depressive disorder. Mental
rehabilitation of obsessive compulsive disorder starts to stop the
self-control at first, because the effort of self-control to suppress
the symptoms aggravates the symptoms. And it is helpful to try
to think the symptoms irrelevant to oneself instead of reactivating
to the symptoms. Finally, because the symptoms of obsessive compulsive
disorder could not be removed completely, it is important
to have mental attitude of living with remaining symptoms.
DEPRESSION
Depressive symptoms persist at least 2 weeks and usually if depressive
disorder occurs, it can last from 9 months to 2 years. Vulnerable
factors for depressive disorder are for example early separation
from caretaker in early developmental period, early loss of at-
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Baek S-B • Psychiatric rehabilitation of emotional disorders
tachment figure, chronic stress, recent severe stress, absence of
supportive system, etc (Kaplan and Sadock, 1998; William et al.,
2002). In the early stage of depression, patient becomes persistent
lethargic condition in body and mind and falls into vegetative
state and finally needs other’s help. Recovery period after extremely
severe period begins. In recovery period, patient’s energy becomes
to increase, but, patient’s cognitive status is still negative.
Therefore risk of suicide maximize in recovery period. The most
critical problem is that helplessness is learned and become stuck.
The negative cognitive distortion of being unable to get rid of dep