Psychogenic dysphonia

Psihogene disfonije predstavljaju poremećaje glasa koji su rezultat psihološke neuravnoteženosti. Većina stručnjaka klasificira ih kao vrstu funkcionalnog poremećaja glasa, iako postoje neslaganja i neusklađenosti po tom pitanju. Psihogeni poremećaji glasa javljaju se u dva osnovna oblika, kao disfonije kod kojih je kvaliteta glasa narušena, ili kao afonije kada se radi o bezglasju, iako su nevoljne radnje poput kašljanja, smijanja ili plakanja čujne. Psihogene disfonije i afonije karakterizira skup vokalnih teškoća i onih psihosocijalnih. Laringoskopskim pregledom uglavnom se ne uočavaju promjene na glasnicama, no glas je promukao, šuman, uz izraženu napetost gornjeg prsnog dijela, ramena i vrata. Nerijetko je prisutno i nepravilno disanje. Psihosocijalna situacija također je narušena. Radi se o osobama koje su pretjerano anksiozne, zabrinute, s manjkom samopouzdanja i samopoštovanja, u nepovoljnim interpersonalnim odnosima. Uzrok ovog poremećaja primarno je psihološke naravi. Uglavnom se radi o introvertiranim osobama koje naginju depresivnom stanu, imaju nisku toleranciju na frustracije, anksiozni su, ne znaju se izboriti za sebe i efikasno riješiti svoje probleme. Oni nemaju duševni (mentalni) poremećaj, ali su podložniji utjecaju psiholoških čimbenika na svakodnevno funkcioniranje. Dijagnostiku psihogene disfonije i afonije vrši stručni multidisciplinarni tim koji se sastoji od fonijatra, logopeda i psihologa. Po potrebi uključuju se i ostali stručnjaci. Konačna dijagnoza temelji se na mišljenju i procjeni svakog člana tima. Terapija zahtijeva uključenost u logopedsku i psihološku terapiju. Logopedska terapija odnosi se na kombinaciju simptomatske terapije i indirektnih vrsta terapije. Ishod terapije ponajviše ovisi o osobi i njezinoj motivaciji za napretkom. Cilj ovog rada je dati pregled dosadašnjih saznanja o psihogenoj disfoniji. Opisat će se simptomatologija, etiologija, posebno terminologija i definiranje s ciljem razjašnjenja kontroverze oko ovog poremećaja. Pojasnit će se dijagnostika i dati pregled terapijskih postupaka čime će se naglasiti važnost uloge multidisciplinarnog tima, sve u svrhu boljeg razumijevanja i postupanja kod ovog poremećaja.Psychogenic dysphonia refers to voice disorders which are result of psychological disequilibrium. Most researchers prefer to subsume psychogenic voice disorders under functional voice disorders, although there is little agreement in the nomenclature and classification of those voice disorders. Psychogenic voice disorders can be found in two forms, as dysphonia where the voice is impaired, or as aphonia when the person has lost its voice but all the non voluntary actions as coughing, laughing or crying are saved. Psychogenic dysphonias and aphonias are defined with variable vocal and psychosocial features. At a laryngoscopic level there aren't any visible changes on the larynx, but the voice can be sound harsh or hoarse, with noticeable tension of upper body part, shoulders and neck. Irregular breathing can also be observed. Social situation is not quite good. Psychogenic dysphonia is common in population which exhibits high level of tension and anxiety, with low self-esteem and self-respect, often with lots of interpersonal conflicts. Etiology of this voice disorders is primarily psychological origin. People with psychogenic voice disorders are usually introverts, easily frustrated or even becoming depressed, anxious, don't know how to fight for themselves nor solve effectively their issues. They don't have mental disorder, but can be easily influenced by emotions which can be reflected on their daily functioning. Diagnosis is given by a multidisciplinary team which consist of phoniatrician, speech therapist and psychologist. If it's needed, other experts are called. Final diagnosis is stated when every expert does his evaluation and gives his opinion. Treatment of psychogenic voice disorders implied both speech therapy and symptom based psychotherapy. Speech therapy include a combination of symptomatic vocal therapy and use of indirect methods. The outcome of therapy depends most on the person's motivation for progress. The aim of this thesis is to give some insight into the psychogenic voice disorders. Basic terms, symptoms, etiology, especially terminology and definition issues will be discussed. Diagnostic and treatments will be presented to emphasize the importance of multidisciplinary team, all in hope of gaining the better understanding of this population