Prognosis

Some patients have a single brief episode that resolves completely (with or without treatment), some have recurrent episodes, and others are chronically incapacitated. Patients who develop an acute neurotic illness following a temporary stress, but who had a sound premorbid personality, usually do better than those with long-standing symptoms, chronic stress, or neurotic personality traits.

Chronic neurosis can give rise to severe handicap, and is associated with raised mortality from suicide and accidents, and from neurological, respiratory, and cardiovascular disease. However, some patients improve when they reach later life.

Features of individual types of neurosis will now be described.

Case example

A young man in his late 20s described increasing fear and panic surrounding his high-pressure sales job. He was very successful at this, depending in large extent, on his gregarious and popular personality. However, after the development of financial problems from his excessive spending, and relationship difficulties, he went off work, and developed gradually increasing anxiety about going outside the house.

His GP gave him an SSRI, which made him worse, causing agitation and vomiting. He was then referred to community mental health services, and responded to trimipramine, and to the development of a supportive relationship with his community psychiatric nurse, who employed CBT in helping him rebuild his confidence. He also helped him come to an arrangement with his creditors.

Through liaison with his line manager and his human resources department, he was successfully rehabilitated via a graduated return-to-work programme.

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