1. She Used Silence to Explain Everything
Mirta Vranko, Dolores Novak, Tajana Dodig, Petrana Brečić
University Psychiatric Hospital Vrapče
Paper discusses the psychogenic stuttering as one of the symptoms of anxiety-depressive disorder, that is caused by traumatic experiences. Psychogenic stuttering first time occurs in adulthood. The most common causes are: stressful situations, traumas, anxiety, depression or other emotional crisis, problems of adjustment, problems in the family, post-traumatic neurosis and psychiatric psychopathology. Symptoms in this stuttering are: repetition of initial sounds/syllables, extension votes, interrupts speech, delays or blockages and shallow and rapid breathing.
The amount of symptoms depends on the intensity of the mental condition of the person. When a person is mentally well, speaking is fluent which may last several days, weeks. When the mental state of the person worsens it increases the strength of stuttering.
The patient (48) to be shown has experienced severe cases of sexual abuse and harassment during two years at work. Also, she lived in a primary family with alcohol addicted father who was aggressive. After she married, she wasn’t well accepted by her father-in-law who also was aggressive towards her, especially during periods while her husband was absent. First time she comes in psychiatric hospital in 2003 year because of depression and suicide attempt; poorly controlled anxiety, depressive-dysphoric mood, deficits of interests, will and energy, also utter lack at all levels of functioning (especially cognitive and social functioning). During her treatment, it is noticed that in the situations of overwhelming anxiety, psychical suffering and strong emotional involvement, patient starts to stutter. While in ambulant treatment, it is observed that psychogenic stuttering is symptom of underlying disease.
Within the anxiety-depressive disorder, there is a symptom of psychogenic stuttering. Better control of anxiety and depression led to significant remission of symptoms of the anxiety-depressive spectrum; in a way that the result of depression (Beck's depression inventory - II) and anxiety measurement (Social anxiety questionnaire for adults, SAQ-30) at the beginning of current hospitalization indicated a major depressive disorder - the current episode of severe and poorly controlled anxiety. By evaluating treatment upon completion of hospitalization by conducting the same questionnaires, the patient achieves better results of lower intensity of depressive symptoms as well as better control of anxiety. Stated is in accordance with the clinical impression - better control of psychogenic stuttering.
Heredity of mental illness
Anxsious, depressive, primarly vulnerable structure and personality dynamics, helplessness, self-accusations, hysterical patterns of perception and behavior
Dysfunctional primary family, alcoholic father, domestic violence, low socioeconomic status, sexual abuse at work, suicide attempt, conflict with parents-in-law
Biological risk factors
Psychological risk
factors
Psychopharmacotherapy
Maprotilin a 25 mg
Mirtazapin a 30 mg
Pregabalin a 75 mg
Klonazepam a 0,5 mg
Sulpirid a 200 mg
Midazolam a 15 mg
Psychotherapy
Individual therapy
Group therapy
Occupational therapy
Creative workshops
Handicraft workshops
Sociotherapy
Social and communication training skills
Psychoeducation
Social
risk factors
Beck’s depression inventory – II (Beck, A., 1972)
It is a 21-question multiple-choice self-report inventory, one of the most widely used psychometric tests for measuring the severity of depression. The BDI-II is designed for individuals aged 13 and over, and is composed of items relating to symptoms of depression such as hopelessness and irritability, cognitions such as guilt or feelings of being punished, as well as physical symptoms such as fatigue, weight loss, and lack of interest in sex. The BDI-II also contains 21 questions, each answer being scored on a scale value of 0 to 3. Higher total scores indicate more severe depressive symptoms. The standardized cutoffs used differ from the original: 0–13: minimal depression, 14–19: mild depression, 20–28: moderate depression, 29–63: severe depression.
Social anxiety questionnaire for adults, SAQ-30 (Caballo, V. E., Salazar, I. C., Arias, B., Irurtia, M. J., Calderero, M., & the CISO-A Research Team Spain, 2010) The questionnaire is designed to measure specific and/or generalized social phobia/anxiety in adults (18 years and more) from general and clinical populations. This is very useful for identifying not only people with generalized social phobia but particularly specific social phobia. The higher the score in every dimension the more anxiety the person has in this specific dimension. The sum of all the dimensions is the general score of the questionnaire. The five dimensions are the following: ) Speaking in public/talking with people in authority, 2) Interactions with the opposite sex, 3) Assertive expression of annoyance, disgust, or displeasure, 4) Criticism and embarrassment, and 5) Interactions with strangers.
Beck AT (1972). Depression: Causes and Treatment. Philadelphia: University of Pennsylvania Press.
Caballo, V. E., Salazar, I. C., Arias, B., Irurtia, M. J., Calderero, M., & the CISO-A Research Team Spain (2010a) Validation of the Social Anxiety Questionnaire for Adults (SAQ-A30) with Spanish university students: Similarities and differences among degree subjects and regions Behavioral Psychology/ Psicologia Conductual, 18, 5–34.