Fits and faints due to psychological disease

Dr. R. A. R. Perera

Consultant Psychologist

Patients who present to doctors with fits, fainting attacks and dizziness, for which there is no physical explanation are frequently suffering from an undiagnosed psychological disorder.

Often, these fits, and fainting attacks are presented in a dramatic manner.

Commonly, the physical diagnoses are pursued with extensive investigations, while the possibility of a mental disorder is relegated to a diagnosis of exclusion.

This can lead to common psychological disorders not being formally diagnosed and therefore not being adequately treated. Apart from the disability for the individual patient whose psychological disorder remains undiagnosed, the cost of the patient of ongoing, unnecessary investigations and consultations is substantial.

The clinical presentation of a psychological disorder as a fit or a fainting attack is an example of a condition called ‘somatisation’. The term somatisation is defined as ‘the tendency to experience mental states and distress as physical symptoms’.

Somatisation is perhaps the most common of the psychological phenomena seen by doctors, with the presentation of physical symptoms in the setting of a mental disorder. This is not surprising since throughout history and across cultures, the expression of psychological distress through physical symptoms has really been the norm.

The doctor should asses the presence of both psychological as well as, physical causes for his/her condition. Often patients are told ‘there is nothing wrong’ without having their fears addressed. Patients are often not reassured by simply being informed of normal diagnostic tests. Many patients will need assistance to understand the link between their physical symptoms and their emotional state.

It is very important to keep an open mind to alternative diagnoses as a patient is followed up.

There is a strong association with stress and ‘fits’, and therefore it is important to obtain corroborative history to differentiate this form a ‘fit’ due to a physical cause.

A major depression due to an unresolved grief like a death in the family or a separation can cause dizziness and fainting attacks. A person with anxiety and panic attacks like fear for heights or crowds can cause fainting attacks.

In Eastern countries like Sri Lanka fainting attacks are a common occurrence in funeral houses and in schools, especially in girls’ schools.

Another place, which you see, these mass fainting attacks are in the factories at free trade zone where majority of workers are girls. The press, reports frequently about incidents where sometimes-large numbers of girls are being admitted to the hospital due to fainting attacks. These are called mass hysterical reactions.

Management of a person with these difficulties includes a careful history, clarifying what the person means by the ‘fit’ or the fainting attack and the assessment of his depression and/or anxiety. Reassurance of the person showing that all his tests is within the normal range.

These patients should be given psychological education about, fainting due to panic attacks and due to an unresolved-grief reactions or a separation.

Cognitive behavioral therapy techniques, relaxation and slow breathing exercises also helps these parsons.

Sometimes medications involving anti-depressant drugs or anti-anxiety drugs are useful.

Chinese ‘living longer than ever’

A UN report on China says the lives of its people have been vastly improved over the last three decades.

Poverty has fallen, adult literacy has climbed and Chinese people are now living longer than ever, it says. But despite rapid economic progress, new problems have emerged, such as the gap between rich and poor. The United Nations Development Programme (UNDP), which published the report, says these problems need urgent attention.

The report, entitled Basic Public Services for 1.3 Billion People, comes just weeks before China celebrates 30 years of economic reforms. During this period, the Chinese government has largely ditched central planning in favour of the free market.

These reforms, started by the late, former leader Deng Xiaoping, have brought spectacular results, as the report makes clear. “The speed, scope and magnitude of the improvements... rank among the moststunning achievements in the history of human development,” says the UN’s chief representative in China, Khalid Malik, in the report.

Between 1978 and 2007, rural poverty fell from 30.7% to just 1.6%, according to the UN. But new problems have emerged, with not everyone benefiting equally from rapid economic expansion.

Rural areas lag behind urban areas, the east coast is richer that the western hinterland and there is a large wealth gap between different social groups.

Schoolchildren in the wealthy coastal city of Shanghai receive 10 times more funding than some rural pupils, the report says. According to the UNDP, one problem is the Chinese system that requires all citizens to be registered in one particular place. People usually receive welfare benefits in the area they are registered, which brings difficulties if they move.

This is a particular problem for the tens of millions of rural people who move to the cities to find work.

Chinese leaders have already acknowledged the existence of some of these problems, and have launched programmes to solve them.

The report makes it clear that the country now has the money to fix some of these problems.

Story from BBC NEWS

Parent-child relationship prevents stress

Bickering parents and poor caregiver relationships each increase levels of the stress hormone cortisol in children, new studies say.

The two studies, published in the November/December issue of Child Development, show the biological effects stress has on children in these common situations.

Long-term or frequent rises in cortisol can have negative health consequences. Research with animals and people suggest that secure relationships help prevent cortisol rises in children confronted with stress.

The first study, which looked at 191 full-time day-care children, found that many preschoolers experience increasing levels of cortisol throughout the day, the opposite of how the hormone is produced in most humans.

Children in classrooms with around 10 children were more likely to experience normal cortisol decreases from morning to afternoon; however, those in classes with closer to 20 children tended to have greater increases in cortisol across the day.

The study, by Washington State University, Auburn University, Washington State Department of Early Learning, and Pennsylvania State University researchers, also found that children with more clingy relationships with their teachers also had greater cortisol increases throughout the day.

Those with poorer relationships with their caregivers also experienced a hormone boost after one-on-one interactions with the caregiver.

“This study sheds additional light on an as yet incompletely understood phenomenon among many young children attending full-day child care,” study author Jared A. Lisonbee, an assistant professor of human development at Washington State University, said in a news release from the journal’s publisher.

“Additionally, the study begins to situate child care-cortisol research in the context of a broader literature on the role of relationships in shaping how children function and how they react to stress.”

In the second study, higher cortisol levels were found in children distressed by their parents’ fighting.

Children who become very upset when their parents fight are more likely to develop psychological problems. But little is known about what happens beyond these behavioral reactions in terms of children’s biological responses. A new study has found that also have higher levels of cortisol.

The study, by researchers at the University of Rochester, the University of Minnesota, and the University of Notre Dame, looked at more than 200 6-year-olds and their mothers. The children’s levels of hostility and their involvement during the arguments didn’t always link to their levels of cortisol, but those who were very distressed and very involved had especially high levels of the stress hormone.

“Our results indicate that children who are distressed by conflict between their parents show greater biological sensitivity to conflict in the form of higher levels of the stress hormone, cortisol,” study leader Patrick T. Davies, professor of psychology at the University of Rochester, said in a news release from the journal’s publisher.

“Because higher levels of cortisol have been linked to a wide range of mental and physical health difficulties, high levels of cortisol may help explain why children who experience high levels of distress when their parents argue are more likely to experience later health problems.”

The authors suggested that the study could affect future policy and practice. They said physiological measures like cortisol levels may help determine how well intervention programs are doing as well as the common practice of looking for improvements in how children function psychologically.