Neurotic disorders: causes, symptoms, treatment

What is a neurotic disorder

What is a neurotic disorder? It is a heterogeneous group of dysfunctions that arise as a result of acute or chronic psychological trauma. Symptoms are varied, but maladaptation, phobias, asthenia, obsessions and somatovegetative disturbances are always noted. A person's physical and mental abilities are temporarily weakened. Self-awareness and criticism persist. The diagnosis is made based on complaints, medical history and the person’s life history. To eliminate the problem, they resort to psychotherapy and medication.

Neurotic disorder is characterized

Doctors mean by neuroses a group of pathologies that arise due to the influence of mental trauma. A neurotic disorder is characterized by a deterioration in well-being, mood swings are noted, and somato-vegetative symptoms appear. In severe cases, suicidal thoughts are possible.

Causes of neurotic disorders

Doctors have different opinions regarding the catalyst for neuroses. Some believe that this condition develops due to a genetic predisposition, others – childhood psychological trauma. Children's psyche is weak, their memory is tenacious, any serious stress persists for a long time. Most of the complexes that a person suffers from in adulthood arose in childhood. Women are more susceptible to the disease.

Other causes of neurotic disorders:

• unfavorable environment, poor living conditions;
• prolonged physical overload in combination with stress;
• exhaustion of the nervous system;
• too busy work schedule;
• lack of proper rest;
• alcohol and drug abuse.

Neurotic dysfunctions occur when the body is exhausted.

Types of nervous system diseases

The peripheral NS performs the communication function. Fibers reach out to every organ, tissue, and cell in the human body. Thanks to these connections, the brain receives complete information about life processes. This allows you to regulate the functioning of the body, respond in a timely manner to destructive factors, and maintain vital functions.

Since the entire human body is permeated by nerve fibers, NS diseases can be expressed in various pain symptoms. Based on the location of pain, one or another lesion can be diagnosed.

Doctors distinguish the following groups of diseases of the central nervous system and PNS:

• Vascular - they are divided into chronic and acute. The chronic group includes cerebrovascular accidents, chronic cerebral ischemia (also called encephalopathy), and vascular parkinsonism. Acute - strokes, ischemic attacks.
• Infectious are meningitis (inflammation of the meninges), encephalitis (inflammation of the brain matter), myelitis (inflammation of the spinal cord).
• Autoimmune – damage to the nervous system as a result of inadequate functioning of one’s own immunity. The most common manifestation is multiple sclerosis.
• Neurodegenerative diseases are diseases that are accompanied by the death of nerve cells. Among this group are Parkinson's and Alzheimer's diseases.
• Traumatic – damage to the brain or spinal cord as a result of trauma.

Classification of neurotic disorders

Disorders are divided into 3 groups:

• hysterical;
• obsessive states;
• asthenic.

This classification of neurotic disorders is not similar to practice. It does not contain approved certain and most common pathologies. The differences lead to different ways of systematizing disorders.

Types of neurotic disorders

When making a diagnosis, doctors take into account the following types of neurotic disorders.

1. Anxious-phobic. The main symptom is a sharp increase in anxiety and the appearance of obsessive fears. This group includes panic attacks, simple and complex phobias, and generalized anxiety disorder.
2. Obsessive-compulsive. The main symptom is the appearance of obsessive ideas and actions.
3. Asthenic disorders are characterized by asthenic syndrome.
4. Somatoform. Clinically, they are similar to somatic ones, but do not imply a physical basis.
5. Dissociative disorders imply disorders of motor function and sensations. Previously, this disease was classified as hysterical neuroses.

The sooner the patient seeks help, the more favorable the prognosis.

Forms of neurotic disorders

There are such forms of neurotic disorders.

1. The most common is neurasthenia; it is divided into 3 stages. The first phase is characterized by irritability. Mental and physical abilities are not affected. The second stage is characterized by a decrease in working capacity, a person understands this. The third phase is manifested by lethargy, reluctance to do anything, and asthenic syndrome.
2. Hysterical neurosis is the second form. The disease is caused by inappropriate behavior; the person is unpredictable and extremely irritable. There are signs such as seizures, paresis, vomiting, hypotension. The patient also complains of obsessive thoughts, a “lump” in the throat, and insomnia. During an attack, a person screams, lies on the floor, can get into a fight, or injure himself.
3. The third form is depressive neurosis. It is characterized by symptoms such as insomnia, bad mood, loss of the ability to feel joyful emotions, a feeling of burden, and tearfulness. There are also disturbances in heart rhythm, stomach function, slow reaction to events, sexual dysfunction, and hypotension. The patient complains of despondency, sadness appears, and a feeling of uselessness.
4. Obsessive states. With it, the patient is unable to control his thoughts and actions.
5. Hypochondriacal neurosis - there is a fear of a circumstance from which a person cannot find a way out, or a fear of falling ill with an incurable pathology. The condition is complemented by hysteria and obsessions.

Each form requires an individual approach to therapy.

Neurotic disorders in adults

Neurotic disorders in adults have a reversible, relatively mild course, unlike psychoses. According to statistics, the problem is detected in 20% of the population. The causes include a disorder of brain activity responsible for human adaptation. Somatic and mental disturbances appear. Patients are rarely admitted to the hospital; conservative methods are usually successful.

Neurotic disorders in children

In children, the catalyst for the development of neurosis is delays in personality development. Against the background of separation from parents, stress, loss of a loved one, psychological trauma is possible. A child who experiences these situations becomes infantile or acquires neurosis.

Neurotic disorders in children: features of occurrence and course.

1. The age of 7-11 years is considered the affective stage of personality formation. If at this time the child encounters a traumatic factor, his development as a person may be delayed. In adulthood, such people experience emotional instability; a person cannot adequately assess the situation or think about the consequences. The only and beloved children acquire hysterical traits.

2. At the age of 11-14, a teenager learns to independently assess the situation, analyze, and plan his actions. There is a subsequent development of the affective component of the personality. If at this age a stressful situation arises, neuroses are possible in the future. Such teenagers outwardly look older than their peers and are more reasonable, but subconsciously, the synchronicity of personality development is disrupted.

Attention! The most important role in the successful growth of a child is played by the relationship with parents. Those who felt overprotected in childhood and were not allowed to make their own decisions become timid and unsure of themselves. It is in this category of people that neurotic disorders arise.

Signs of illness

Symptoms of somatoform disorder are quite varied and manifest themselves in malfunctions of almost all body systems.

As a rule, several symptoms associated with different systems occur simultaneously.

There are the following types of this disorder:

• hypochondriacal;
• somatized;
• somatoform dysfunction of the autonomic nervous system (SDVNS);
• chronic somatoform pain disorder;
• undifferentiated somatoform disorder.

Patients with somatoform dysfunction are distinguished by several features. This includes a peculiar, emotional or overly specific narrative about one’s condition. For example, a man comes to a cardiologist with pain and discomfort in his heart. But at the same time, he speaks not only about their character, but also about the fact that they cause him a lot of inconvenience. Such attacks occur at work, at the moment when he is supposed to make a report on his achievements. As a result, he cannot concentrate, paying all attention to his heart.

The reason here is this aspect: perhaps the man is psychologically not ready to talk about his work (for example, due to his failures), and the heart is assigned to the extreme. And it is precisely this that reacts to this stressor in order to divert attention from it.

Other distinguishing features are:

• exaggeration of pathological sensations;
• denial of the role of psychological factors in their development;
• increased irritability towards others.

Astheno-neurotic syndrome

Astheno-neurotic syndrome is manifested by chronic fatigue, apathy, increased fatigue and irritability. This disease is complemented by loss of appetite and insomnia. Physical signs are associated with apparent heart disease. It may seem to a person that he has a slow heartbeat, or vice versa – tachycardia. No changes are observed on the cardiogram. However, the patient feels pain in the heart muscle. Stomach problems and migraines are also possible. Diagnostics involves interviewing and examining a person. An examination is being carried out for a viral infection. The prognosis is favorable, especially if the person additionally attends art therapy sessions. Drawing has a relaxing effect on the psyche, negative thoughts dissipate, and the patient feels harmony.

Dysthymia – depressive neurotic disorder

The disease is characterized by a depressed state in the patient, which does not go away for more than 2 years. The pathology is characterized by decreased vital energy and increased fatigue. A person feels apathy and is unable to enjoy life. Self-esteem decreases and self-confidence is lost. Such people rarely share their emotions with others. The most severe consequence is suicide. The patient is referred to a psychotherapist. With timely treatment, dysthymia, or depressive neurotic disorder, is treatable.

Symptoms of neurotic disorders

Neurotic dysfunctions are characterized by instability of mood and rash actions. Patients suffer from memory impairment, problems with concentration, and a number of other clinical manifestations:

1. causeless psychological stress;
2. increased fatigue;
3. sleep problems;
4. isolation;
5. fixation on problems in life;
6. memory impairment;
7. dizziness;
8. fainting;
9. migraine;
10. pain in the heart muscle and joints;
11. frequent urination;
12. excessive sweating;
13. decreased potency;
14. high or low self-esteem;
15. inconsistency, uncertainty;
16. tearfulness;
17. aggressiveness;
18. suspiciousness;
19. poor prioritization.

Symptoms of neurotic disorders are often complemented by increased sensitivity to light, sound, and reactions to minor temperature changes.

Signs of neurotic disorders

Signs of neurotic disorders vary by gender. In women, asthenic neurosis more often appears, characterized by aggressiveness, loss of mental and physical ability, and lack of sexual desire. During intimacy, it is impossible to relax. A woman suffering from asthenic neurosis quarrels with relatives and often loses her temper over trifles. Constant tension is fraught with the development of diseases of internal organs.

In men there are the following types:

• depressed – a person is not able to realize himself in the world of work, or adapt to sudden changes in any area of ​​life;
• male neurasthenia - usually appears after physical or moral overstrain; workaholics are susceptible to this type.

Men and women over 45 years of age are prone to these types of diseases. They may still have problems with the functioning of their internal organs.

Neurotic disorder syndrome

The syndrome of neurotic disorders is a reflection of a traumatic circumstance and is often combined with other neurotic manifestations. The patient's mood decreases, but there is no feeling of melancholy. Usually, a bad mood is combined with emotional lability, asthenia, mild anxiety, loss of appetite and insomnia. During the day, no special fluctuations are observed, or they are mild. Mental and motor retardation, self-flagellation, and suicidal thoughts are not typical.

1. Neurotic depression is distinguished from reactive depression, which is also caused by traumatic circumstances. In the second type, the symptoms reach the level of reactive psychosis - the patient is depressed, inhibited, consciousness is narrowed, and thoughts of suicide appear.
2. In the case of psychotic depression, the patient wishes to die, there is gross disorientation of the personality with separation from life, sudden anosognosia, delusional ideas of self-humiliation, manic episodes. The condition can be controlled with antidepressants and a repeated course of treatment.
3. Neurotic depression is characterized by the preservation of the basic personality qualities, the patient is aware of his condition. Obsessive phobias and pronounced hysterical manifestations appear.

Important! Psychotic depression is more dangerous for a person and requires immediate treatment.

Levels of neurotic disorders

Neurotic disorders occur at 3 levels: as a manifestation of individual symptoms, at the level of minor syndromes, and as specific disorders.

Levels of neurotic disorders.

1. Individual symptoms. They are also present in those who do not suffer from mental disorders.
2. A minor emotional disorder can be complemented by several neurotic syndromes, of which the leading one is not identified.

The patient population consists of 2 types:

• some suffer from an acute, short-term stress reaction;
• others experience long-term, chronic impairment.

Most patients recover within six months, while others recover in no less than 3 years.

How are neurosis, symptoms and signs of its main varieties classified?

The following types of neuroses are differentiated: • Anxiety disorders and phobias in the form of increased anxiety, panic attacks and unreasonable fears (phobias). In the clinic, this type of neurosis is divided into three stages. At the 1st stage, fear arises only in a truly dangerous situation, when the patient is afraid of something, at the 2nd stage - when thinking about the possibility of being in a similar situation again, at the 3rd stage - even when verbally mentioning phenomena, somehow associated with a phobia. The symptoms are dominated by various fears. This may be a fear of contracting some disease (for example, cancer, syphilophobia or speedophobia), which can ultimately lead to hypochondria. Phobias such as claustrophobia (fear of enclosed spaces), agoraphobia (fear of open spaces and crowds), etc. are quite common. • Obsessive-compulsive disorders, manifested in obsessive actions, thoughts, memories and aspirations, perceived by a person as unpleasant and alien. Patients are not able to cope with them on their own. Persons prone to suspiciousness, anxiety and introspection (reflection) are susceptible to this type of neurosis. Obsessive thoughts can manifest themselves in the form of counting steps, passing cars of a certain color, repeated attempts to answer meaningless questions, for example, why there are so many letters in one word, and more or less in another. Particularly difficult to perceive is the obsessive desire to do something shameful and unacceptable, for example, to undress naked in a public place, swear obscenely, or kill a loved one. Obsessive actions (compulsions) can reach the point of absurdity - washing hands up to 100 times a day, returning home multiple times to check that household appliances, gas, or doors are closed. There is also the performance of ritual actions before certain events (look in the mirror a certain number of times before leaving the house, jump or pull your ear, etc.). Only after such rituals can the patient leave home with confidence that nothing unpleasant or terrible will happen to him. • Hysterical reactions, otherwise conversion disorders, accompanied by changes in sensory sensations, disturbances in motor and autonomic reactions, memory loss, etc. Women are more susceptible to hysteria. The signs of neurosis in women are so diverse and changeable that they can resemble many bodily ailments. Hysteria is often called the great malingerer. The predisposition to it is more pronounced in individuals with an overly labile or immature infantile psyche. Hysterical disorder is manifested by such signs as a constant desire to be the center of attention, to play the main role in the team and family, and to dominate others. Hysterics are also characterized by hyper-emotionality, mood swings, a tendency to exaggerate their own role, demonstrative behavior, and elements of theatricality. Those around them often get the impression that a hysterical person revels in his illness, advertises it in every possible way and uses it to attract attention. The extreme manifestation of hysteria is a hysterical seizure, reminiscent of an epileptic one. • Somatoform disorder, otherwise somatic distress disorder, associated with the manifestation of symptoms of a physical disease without the presence of the disease itself. Signs of neurosis in this case most often resemble symptoms of a particular disease. A peculiarity of this type of neurosis is the particular torment and excessive focus of the patient’s attention on somatic manifestations, aggravated by contact with medical workers, which cannot be persuaded either by the results of clinical and laboratory examinations or by medical reasoning. The patient is confident that he has a disease, is deaf to any counterarguments and constantly initiates new examinations, which are practically useless and often expensive. Moreover, the symptoms differ in duration and progressive variability. For example, vegetative-vascular dystonia may be replaced by hypertension, tachycardia may be complicated by arrhythmia, stomach pain may be accompanied by intestinal spasms, etc. Moreover, only one symptom is rarely present; multiplicity is usually characteristic, for example, migrating pain throughout the body, neurosis with dizziness, headaches, high or low blood pressure, tachy- or bradycardia. Autonomic dysfunction of the cardiovascular, respiratory and gastrointestinal systems is often observed. All this significantly reduces the quality of life of the patient himself and his immediate environment. In therapeutic practice, almost every fourth patient has complaints that are not confirmed by a clinical diagnosis. • Neurasthenia – a state of increased intellectual fatigue, headaches with mental stress, inability to completely relax and sleep disturbances. This condition deserves more detailed discussion due to its relevance and impact on mental activity and intellectual abilities.

Diagnosis and treatment of neurotic disorders

A person should contact a psychologist or psychotherapist. Diagnostics requires an integrated approach.

The color technique is widely used.

1. All shades take part in it. Neurosis-like syndrome is noted when a person selects or repeats gray, purple, brown or black.
2. With hysterical neurosis, the patient chooses 2 colors - purple and red. This also indicates low self-esteem.

To determine the symptoms, a test is carried out - it makes it possible to identify the presence of chronic fatigue, anxiety, and self-doubt. Diagnosis and treatment of neurotic disorders are closely interrelated.

Drug therapy is used in the first stages to relieve internal tension and eliminate insomnia. Antidepressants and tranquilizers are widely prescribed. Depending on the severity and duration of the clinical picture, the doctor prescribes drugs from different groups to the patient:

• non-selective – Amitriptyline, Imipramine;
• selective influence - Maprotiline, Fluoxetine;
• sedative antidepressants – Doxelin, Azafen;
• balanced – Sertalin, Tryptophan;
• stimulants - Heptral, Bupropion.

Obsessive states are well relieved by drugs from the SIDS group - Prozac, Paroxetine, Escitalopram. Frequently prescribed tranquilizers include Phenazepam, Tofisopam, Meprobamate. All medications are prescribed in a short course of 5-7 days, sometimes extended to 10.

Important! If a person self-prescribes medications, the disease may transform and the condition may worsen.

Psychotherapy for neurotic disorders

To achieve maximum effect, doctors recommend supplementing drug treatment with rational, cognitive psychotherapy. The main objective of this technique is to eliminate the consequences of a stressful situation so that the general condition of a person improves and the symptoms of neurosis are eliminated. The doctor discusses the cause of the problem and works through the traumatic circumstances. The patient learns relaxation techniques, the ability to level out negative emotions and complexes. The most difficult thing to eliminate is negative attitudes given by parents. A person must show his will, diligence, and do his homework. Typically, psychotherapy for neurotic disorders consists of 7-15 sessions, depending on the degree of complexity of the problem. In severe cases, the patient is admitted to the department of borderline mental disorders.

Functional disorders in neurological practice

G.M. DUKOVA

, Doctor of Medical Sciences, Professor,
First Moscow State Medical University named after.
THEM. Sechenov The article discusses the main clinical manifestations, approaches to diagnosis and modern methods of treating functional disorders.

More than 30% of patients visiting a neurologist complain of somatic symptoms that cannot be explained by any organic disease [19, 20]. Such patients are often recommended expensive research and treatment, consultations with various specialists, which, as a rule, do not lead to a positive result, causing dissatisfaction for both the patient and the doctor [1]. The most common disorders in this category of patients are tension headaches and other chronic pain syndromes, conversion disorders, hyperventilation syndrome, dizziness, asthenia, depression, anxiety and somatoform disorders [16, 19].

In domestic medicine, such disorders are most often referred to as “vegetative dystonia syndrome” (G-90.9) or “astheno-neurotic reactions”; in therapeutic practice the term “neurocirculatory dystonia” is used. Some authors use the term “psychovegetative syndrome”, proposed in the 60s of the last century by German internists [2].

In foreign literature there is also no uniform terminology to refer to this group of disorders. In recent decades, authors have increasingly resorted to terms such as “medically unexplained symptoms” [18] or “subjective health complaints” [22], however, these are not satisfactory, because they are based not on positive, but on negative criteria.

Recently, it has been proposed to use the term “functional” and designate disorders in the somatic sphere with the term “functional somatic symptoms”, and in the neurological sphere with the term “functional neurological symptoms”. The advantage of this term is its “positive” meaning and patient acceptability, since dysfunction is emphasized, there is no definition of “unexplained” that worries the patient, as well as the mention of a psychogenic factor, which usually causes internal resistance of the patient, even if this is not realized by the patient.

Main clinical manifestations of functional disorders:

— Autonomic (permanent and paroxysmal) — Chronic pain syndromes — Motivational — Functional-neurological — Emotional-affective — Behavioral

Autonomic disorders

The main characteristic of autonomic disorders is their polysystemic nature. Table 1

The main manifestations of autonomic disorders are presented.

Analysis of the semiotics of autonomic disorders requires determining the type of their course: permanent and/or paroxysmal. Permanent autonomic disorders mean subjective and objectively recorded disorders of autonomic functions that are permanent or occur sporadically. These disorders may manifest predominantly in one system or have a distinct multisystem nature.

Paroxysmal autonomic disorders, autonomic crises or panic attacks (PA) are the most striking and dramatic manifestation of the psychovegetative syndrome.

The following criteria are used to diagnose panic disorders:

1. Sudden, sometimes unexpected appearance of 4 or more symptoms: - vegetative (cardiovascular, respiratory, vasomotor, etc.); - vestibular (dizziness, instability, etc.) - emotional-affective (panic, fear, aggression, etc.) - dissociative (derealization, depersonalization) 2. Anticipation and repetition of these episodes 3. Constant worry about the consequences of attacks 4. Behavior changes in connection with panic attacks (agoraphobia and restrictive behavior) 5. The appearance of attacks regardless of any organic factor (for example, caffeine intoxication or hyperthyroidism).

Attacks consisting of several symptoms are called “abortive” or “minor”. If during an attack the patient experiences most of the above symptoms, then they speak of “extended”, “large” PA.

There are several types of PA depending on the dominant symptoms: respiratory, vestibular, cognitive and “non-insured”, as well as by the time of occurrence: night/day attacks [9].

Outside of attacks, agoraphobic syndrome is most often observed, which ultimately manifests itself as fear of a situation potentially threatening the development of PA and difficulty in obtaining medical care. Such situations can be being in a crowded room, in a store, transport, cinema, alone at home or in the country. Agoraphobia is the factor that determines the psychological and social consequences of PA, namely restrictive behavior and secondary depression. It is these consequences that are the target for therapeutic interventions (psychotherapy and psychopharmacotherapy).

Chronic pain syndromes

In clinical practice, chronic pain syndromes make up a significant proportion of patients. Beyond the clearly defined somatogenic and neuropathic pain, there are a variety of chronic pain syndromes labeled as “functional,” “medically unexplained,” “dysfunctional,” “somatoform,” “somatized,” “psychogenic,” etc.

Chronic pain syndromes observed in clinical practice

— Headaches — Atypical facial pain — Pain in the left side of the chest (“non-cardiac pain”) — Back pain — Abdominal pain — Pain in the lower abdomen (pelvic pain) — Anogenital pain — Pain throughout the body (fibromyalgia) Currently the above chronic pain syndromes of different localization, together with other symptoms (mental, autonomic, motivational and neuroendocrine) are regarded as functional based on common factors that are naturally observed in all these forms. These include: the frequent combination of different syndromes in the same patient, both simultaneously and sequentially, the predominance of women, emotional disorders and a history of childhood psychotrauma, the leading role in the pathogenesis of these syndromes of dysfunction of certain cerebral systems (limbic parts of the brain, prefrontal and parietal cortex ) and the therapeutic effectiveness of antidepressants.

Currently, there are 2 groups of factors that are involved in the chronicization of pain syndromes: biological and psychosocial, the structure of which is presented in Table 2

.

Diagnosis of chronic pain syndrome includes the following:

1. Exclusion of possible somatic (organic) factors causing pain. 2. Clarification of the temporal characteristics of pain. Duration of pain: most of the day, at least 15 days per month, lasting at least 6 months. 3. Qualitative characteristics of pain: monotonous pain, periodically intensifying before an attack, in the description of pain the use of non-pain terms (“cotton head”, “stuffiness” in the left half of the chest, “unpleasant tickling” in the lumbar region, etc.), senestopathic coloring of pain. 4. The localization of pain during examination and palpation is always much wider than the patient presents. 5. Painful behavior - marking a “sick” organ - immobilizing it, constantly rubbing the skin in the heart area, regularly taking analgesics, and if they have no effect, regularly calling an ambulance. 6. Psychogenesis of pain. Presence of close relatives suffering from pain. Often the patient himself experienced pain, or observed it in emotionally charged situations, for example, the death of a parent from a myocardial infarction with severe pain. 7. Beaten paths. Debut or exacerbation of chronic pain after injuries, surgical interventions, infectious diseases. 8. Syndromic environment, including psychovegetative and motivational disorders.

Functional neurological symptoms

This term refers to neurological symptoms that do not have an underlying organic cause. In the practice of a neurologist, such symptoms account for up to 19% of outpatient visits [16] and 9% of hospitalized patients [10]. In modern classifications, they belong to the headings of “dissociative (conversion)” disorders in ICD-10 or “somatoform” disorders in DSM-IV.

The clinical phenomenology of functional neurological disorders (FNS) is presented as follows:

1. Paralysis and paresis 2. Paroxysmal disorders (seizures) 3. Gait disorders 4. Sensory disorders 5. Visual and oculomotor disorders 6. Dyskinesia 7. Speech and voice disorders 8. Impairments of consciousness 9. Cognitive impairments

Functional neurological disorders can be observed both in the structure of PA and in the permanent version. A special study showed that in the structure of a typical panic attack, up to 30% of symptoms can be classified as FNS [23]. Often they are the subject of special concern for relatives and diagnostic errors of doctors.

Diagnosis of these disorders requires special awareness of the typical neurological manifestations of hysteria, as well as the use of specific tests and samples [25, 21].

Violation of biological motivations

There are 4 basic biological motivations that are basic for preserving life, the full functioning of the body and procreation. These include the need for food intake, the need for sleep and sexual activity. Separate and important for human existence is the need for activity, action, participation in society, etc. The mechanisms of motivation at the cerebral level are primarily associated with the activity of the limbic-reticular complex systems, which regulate adaptive behavior in response to any type of stress.

With functional disorders, disturbances occur in the sphere of motivation. Their syndrology is presented below:

— Eating disorders (anorexia with weight loss or bulimia with weight gain) — Dissomnia disorders (difficulty falling asleep, early awakenings, shallow sleep, hypersomnia, parasomnia) — Sexual disorders (decreased libido, potency, anorgasmia, etc.) — Asthenia (weakness, fatigue) As a rule, patients do not focus attention on them, but with active questioning it is possible to reveal that “there is no appetite, and even the smell of food causes nausea” or, conversely, “you constantly want to eat and even have to get up at night to do this” , patients often talk about certain sleep disorders. Problems in the area of ​​intimate life often appear before the onset of the disease, and during the course of the disease, sometimes sexual life “comes to naught.”

Separately, it is necessary to dwell on the violation of motivation for activity. Clinically, this manifests itself as asthenic syndrome. Asthenic syndrome is one of the most common syndromes in the clinical practice of any doctor. The key words in asthenia are “weakness” and “fatigue,” which are characterized by the fact that they occur not only with exertion, but also without it, and do not go away after rest. Since the feeling of fatigue is a key trigger for rest, the essence and meaning of the feeling of fatigue and weariness is an urge to stop activity, activity, any effort, etc. Reducing activity is a universal psychophysiological mechanism for preserving the vital activity of the system in the event of any threatening situation, operating according to the principle : less activity means less energy requirement. With asthenia, not only the real threat of depletion of energy reserves, but also an imaginary threat (emotional overstrain, stress, conflicts) are triggers for feelings of fatigue and weakness. It has been shown that changes in the sphere of motivation are key to the formation of asthenia in humans [26, 27, 6].

Emotional, affective and behavioral disorders

Patients with functional disorders usually turn to a neurologist with specific somatic complaints, such as pain, dizziness, shortness of breath, lump in the throat, sleep disturbances, etc. and, as a rule, do not complain about emotional disorders and do not associate symptoms that worry them with them. Moreover, they regard even fear in the structure of PA as secondary to “increased pressure,” “choking,” “palpitations,” or “dizziness.” This is what causes misdiagnosis and inadequate treatment. The identification of emotional disorders is complicated by the alexithymia inherent in such patients. Alexithymia refers to the patient’s difficulty in recognizing, expressing and describing (verbalizing) his own feelings, state of mind and emotions experienced by himself or other people, as well as difficulties in distinguishing between emotions and bodily sensations. Psychometric tests are usually used to identify emotional disorders and alexithymia. However, clinically it is also possible to get an idea of ​​the patient’s disturbing thoughts, threats, perceptions and associated emotions. To do this, it is enough to purposefully ask the patient how he behaves at the moment the symptom appears, in what situation the symptom appears, how the symptom affects his physical and social functioning, what actions the patient takes to avoid the “consequences of the disease” he imagines. It is often possible to identify distinct restrictive behavior, repeated tests that bring relief for a short time, obsessive rituals (constant measurement of blood pressure, precautionary use of painkillers), etc.

Thus, in the practice of a neurologist, many patients experience a variety of autonomic, neurological, motivational and behavioral disorders, in which all available research methods do not reveal an organic cause and which today are designated as functional disorders.

Therapy for functional disorders

The vast majority of patients with functional disorders are observed and treated either by neurologists or general practitioners. The dominance of asthenia, pain and autonomic syndromes in the clinical picture, the hidden nature of emotional disorders often prompts doctors to use predominantly somatotropic drugs in therapy: antihypertensive and vegetotropic drugs, analgesics, vascular-metabolic therapy, antioxidants, adaptogens, etc. And only in the case of obvious For emotional disorders, tranquilizers may be included in therapy. Such therapy often turns out to be ineffective, undermining the patient’s faith in the possibility of a cure and contributing to the chronicity of the process.

Already at the first contact, the doctor must determine the further strategy for managing the patient. At the first stage, it is absolutely necessary to exclude an organic disease, which can manifest itself with similar symptoms. A detailed clinical and paraclinical examination of the patient also has a psychotherapeutic value, showing the seriousness of the doctor’s attitude towards the patient and objectively convincing the patient of the absence of a threatening disease.

Despite the fact that pain and autonomic disorders are the most obvious in the clinical picture, psychopharmacology is currently the basic method of treatment. Psychotherapy also plays a significant role.

The main goals of therapy for functional disorders are:

1. Relief of the leading symptom or syndrome 2. Impact on secondary syndromes (agoraphobia, depression, anxiety, asthenia). 3. Prevention of relapses and further progression of the disease. For this purpose, symptomatic, pathogenetic and preventive therapy is used. Sometimes an explanatory conversation with a doctor about the essence of the disease, possibly in combination with placebo therapy, is sufficient. Our studies have shown that in 35-42% of patients suffering from panic disorder, significant improvement was achieved only with the help of placebo therapy [4].

Symptomatic therapy

aimed at quickly relieving the leading symptom. This stage of therapy has several goals. Firstly, rapid relief of the patient’s condition, which in itself has a psychotherapeutic effect, since it removes the fear of a threatened and incurable disease. Secondly, relief of the leading symptom prevents the process from becoming chronic. Thus, rapid and early relief of acute back pain prevents the development of persistent muscle spasm, which is an important pathogenetic mechanism for the formation of chronic back pain. Early and successful relief of panic attacks prevents the development of agoraphobic syndrome and restrictive behavior, which are the main factors of social disability in patients with panic disorders.

Symptomatic therapy can be represented by a variety of techniques. Thus, to relieve hyperventilation disorders, it is advisable to teach the patient breathing exercises, which he can use both to relieve panic attacks and to correct respiratory disorders outside of an attack. For most functional symptoms, pharmacological drugs are used as symptomatic therapy - the so-called “treatment on demand”: to relieve nausea - prokinetics (cerucal), to reduce tachycardia - beta-blockers, to relieve pain - non-steroidal anti-inflammatory drugs and muscle relaxants, for relief paroxysms (panic attacks) - tranquilizers. It is necessary to remember and explain to the patient that this treatment operates on the “here and now” principle and is a short-term therapy, which will be canceled as the main pathogenetic therapy takes effect. Moreover, the patient’s healing process is characterized by a decrease in the need for these “life-saving” drugs. Often the patient himself does not yet realize a noticeable improvement in his condition, and the doctor can make him understand this if in a conversation he focuses the patient’s attention on the number of symptomatic medications taken in the last week. Thus, the effectiveness of pathogenetic therapy is substantively proven to the patient.

Pathogenetic therapy

is focused on preventing the reappearance of paroxysmal manifestations (panic attacks, psychogenic seizures, pain attacks, etc.), regression of the abusive factor, relief of anticipation anxiety, agoraphobic syndrome and restrictive behavior, secondary depression, asthenia and other motivational disorders.
Therapy aimed at the formation of new patterns and stereotypes
of motor behavior, cognitive aspects of thinking, motivation, emotional-affective and behavioral reactions is important.

Numerous multicenter placebo-controlled studies have shown that antidepressants (ADs) are the basic drugs in the treatment of functional disorders. It has been found that AD can be effective in chronic pain syndromes of various localizations [3], panic disorders [8, 7, 17], asthenia [15] and appetite disorders [11]. Moreover, ADs are effective regardless of whether these syndromes are combined with depression or not, and the doses used for the treatment of functional disorders are lower than for the treatment of depression.

It should be noted that the pronounced side effects of a number of ADs, in particular tricyclic ADs, significantly reduce the possibility of their use, especially in outpatient practice. Therefore, the drugs of first choice are currently drugs from the group of selective serotonin reuptake inhibitors - SSRIs (fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram and escitalopram).

Escitalopram belongs to the second generation of SSRIs, since it has a slightly different mechanism of action than other serotonergic antidepressants: it interacts not only with the primary binding locus of the serotonin transporter protein, but also with the secondary (allosteric) one, which leads to faster, more powerful and persistent blockade of serotonin reuptake due to the modulating effect of allosteric binding. At the same time, escitalopram is the most selective of the SSRI antidepressants, since it practically does not bind to serotonin (5-HT), dopamine (D-1 and D-2), α-adrenergic, histamine, m-cholinergic receptors, as well as benzodiazepine and opiate receptors. receptors [14].

M. Mazza et al. [12] revealed the effectiveness of escitalopram at a daily dose of 20 mg in the treatment of chronic lumbar pain. Therapy with escitalapram has been shown to be effective in patients with panic disorders [24]. Muller et al. studied the effectiveness of escitolapram in patients with “multisomatoform disorders,” which refers to “medically unexplained symptoms,” in a double-blind, placebo-controlled manner. At the 12th week of treatment, escitalopram was effective in 84.0% of patients, in contrast to 26.9% on placebo [13].

The most common side effects when taking escitalopram were nausea and headache, which were mild, transient and disappeared within 2-3 weeks. Escitalopram does not cause significant inhibition of the activity of the main isoenzymes of the cytochrome P 450 family in vitro, and therefore it is unlikely to be involved in clinically important pharmacokinetic drug interactions in patients.

Thus, high efficiency at a minimum dose, minor and quickly passing side effects, as well as the absence of drug interactions make escitalopram an indispensable drug in the treatment of elderly and somatically burdened patients. Treatment adherence in patients taking escitalopram is significantly higher than in similar studies with other antidepressants.

In 2014, a domestic generic version of escitalopram appeared on our market - the drug Asipi (JSC Veropharm). Based on comparative pharmacokinetics, it is shown that the drug Asipi is bioequivalent to the original drug Cipralex.

When determining the tactics of blood pressure therapy, it is necessary to resolve two main issues: choosing a drug and determining the dose.

The choice of drug is determined mainly by the clinical picture of the disease and the characteristics of the drug. When determining the dose of the drug, the following rules may be useful:

1. Taking into account the individual sensitivity and anxious suspiciousness of this category of patients, it is advisable to begin therapy with small doses (1/2-1/4 of the planned dose) with a gradual increase over 3-5 days. 2. The criterion for limiting the dose may be the severity of side effects that do not disappear within 3-5 days. 3. A daily distribution of the drug is recommended depending on the hypnogenic effect.

Before prescribing a course of drug therapy, the doctor must explain to the patient the basic principles of treatment and warn about possible difficulties in the treatment process. In this conversation, it is necessary to emphasize the following points:

1. The essence of the treatment is that it is aimed at preventing the recurrence of attacks and the social adaptation of the patient. 2. The effect of therapy may be delayed, since in most ADs the effect appears with a latent period of 14-21 days from the start of their use. 3. The course of treatment should be long, sometimes it can last up to a year. 4. Abrupt withdrawal of drugs at any stage of treatment can lead to exacerbation of the disease, therefore, at the end of treatment, drug withdrawal is carried out very gradually. Psychotherapeutic approaches to the treatment of functional disorders

can be conditionally divided into 3 types: 1) psychotherapy aimed at relieving individual symptoms and improving the general condition of the patient 2) aimed at pathogenetic mechanisms; 3) person-oriented (reconstructive) psychotherapy.

Symptomatic psychotherapy includes techniques aimed at influencing individual neurotic symptoms and the general condition of the patient. This is auto-training (in individual and group modes), hypnosis, suggestion and self-hypnosis. With the help of such techniques, anxiety is relieved, optimism and self-confidence are imparted, and the patient’s motivation for recovery is enhanced.

The second group includes cognitive behavioral psychotherapy, conditioned reflex techniques, body-oriented methods, and neurolinguistic programming. The main goal of cognitive behavioral therapy is to help the patient change the pathological perception and interpretation of painful sensations, since these factors play a significant role in the maintenance of symptoms. Cognitive behavioral therapy may also be useful in teaching the patient more effective coping strategies, which in turn may lead to increased adaptive capacity.

The third group consists of methods aimed directly at the etiological factor. The essence of these techniques is person-oriented psychotherapy with the reconstruction of the basic motivations of the individual. These techniques are aimed at revealing early childhood conflicts or current personality problems; their main goal is the reconstruction of personality. This group of methods includes psychodynamic therapy, Gestalt therapy, and family psychotherapy.

When functional disorders are combined with obvious hysterical, senesto-hypochondriacal, obsessive and/or phobic manifestations, small doses of antipsychotics are used as an addition to basic pharmacotherapy with antidepressants - Melleril (Sonapax), Theralen, Eglonil, Tiapridal, Chlorprothixene, Seroquel, Etaparazine, Neuleptil.

Non-drug therapy

Methods of non-drug therapy include information and educational programs, physical training, massage, therapeutic exercises, hydrotherapy (water gymnastics, swimming, contrast showers, Charcot shower), breathing exercises, acupuncture, complex treatment with thermo-, odorous, music and light effects carried out in a specially designed capsule, biofeedback methods, exposure to transcranial magnetic stimulation, etc. Thus, most modern researchers believe that physical activity is a priority in the treatment of asthenia. Empirical evidence and analysis of randomized controlled trials suggest that 12 weeks of graded exercise therapy, especially when accompanied by patient education programs, can significantly reduce feelings of fatigue and tiredness.

Thus, at present, a large group of patient complaints and physical symptoms are united on the basis of the absence of organic pathology and the presence of common pathophysiological mechanisms in their origin. Comprehensive treatment, in which the treatment of blood pressure is a priority, makes it possible to successfully cope with these socially disabling sufferings.

Literature

1. Barsky AJ, Orav EJ, Bates DW: Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Archives of General Psychiatry, 2005, 62: 903-910. 2. Delius L. Fahrenberg J. Psychovegetative Syndrome Thieme, 1966: 290. 3. Dharmshaktu P, Tayal V, Kalra BS. Efficacy of antidepressants as analgesics: a review. J Clin Pharmacol, 2012, 52(1): 6-17. Epub 2011 Mar 17. 4. Dyukova GM, Shepeleva IP, Vorob'eva OV. Treatment of vegetative crises (panic attacks). Neurosci Behav Physiol, 1992, 22(4): 343-5. 5. Fishbain D. Evidence-based data on pain relief with antidepressants. Ann Med, 2000, 32(5): 305-16. 6. Floris P de Lange, Joke S Kalkman, Gijs Bleijenberg, Peter Hagoort, Sieberen P vd Werf, Jos WM van der Meer and Ivan Toni Neural correlates of the chronic fatigue syndrome—an fMRI study. Brain, 2004, 127(9): 1948-1957. 7. Freire RC, Hallak JE, Crippa JA, Nardi AE. New treatment options for panic disorder: clinical trials from 2000 to 2010. Expert Opin Pharmacother, 2011, 12(9): 1419-28. 8. Gorman JM. The use of newer antidepressants for panic disorder. J Clin Psychiatry 1997, 58 Suppl 14:54-8; discussion 59. 9. Kircanski K. Craske MG, Epstein A. Wittchen HU. Subtypes of Panic Attacks: A critical review of the empirical literature. Depression and Anxiety, 2009, 26: 878–887. 10. Lempert T, Dieterich M, Huppert D, Brandt T. Psychogenic disorders in neurology. Frequency and clinical spectrum. Acta Neurol Scand 1990, 82: 335–340. 11. Leombruni P, Piero A, Lavagnino L, Brustolin A, Campisi S, Fassino S. A randomized, double-blind trial comparing sertraline and fluoxetine 6-month treatment in obese patients with binge eating disorder. Prog Neuropsychopharmacol Biol Psychiatry, 2008, 32(6): 1599–1605. 12. Mazza M, Mazza O, Pazzaglia C, Padua L, Mazza S. Escitalopram 20 mg versus duloxetine 60 mg for the treatment of chronic low back pain. Expert Opin Pharmacother, 2010, 11(7): 1049-52. 13. Muller JE, Wentzel I, Koen L, Niehausb DJH. Seedat S and Stein DJ. Escitalopram in the treatment of multisomatoform disorder: a double-blind, placebo-controlled trial. Int Clin Psychopharmacol 2008, 23: 43–48. 14. Owens MJ, Knight DL, Nemeroff CB. Second-generation SSRIs: human monoamine transporter binding profile of escitalopram and R-fluoxetine. Biol.Ps., 2001, 50: 345–50. 15. Pae CU, Marks DM, Patkar AA, Masand PS, Luyten P, Serretti A.Pharmacological treatment of chronic fatigue syndrome: focusing on the role of antidepressants. Expert Opin Pharmacother, 2009, 10(10): 1561-70. 16. Perkin GD. An analysis of 7836 successful new outpatient referrals. J Neurol Neurosurg Psychiatr 1989, 52:447-448. 17. Pollack MH, Allgulander C, Bandelow B, Cassano GB, Greist JH, Hollander E, Nutt DJ, Okasha A, Swinson RP; World Council of Anxiety. WCA recommendations for the long-term treatment of panic disorder. CNS Spectr, 2003, 8(8): 17-30. 18. Sharpe M, Mayou R, Bass C. Concepts, theories and terminology. In: Mayou R, Bass C, Sharpe M, eds. Treatment of functional somatic symptoms. Oxford: Oxford University Press, 1995: 3–16. 19. Stone J, Carson A, Duncan R, Coleman R, Roberts R, Warlow C, Hibberd C, Murray G, Cull R, Pelosi A, Cavanagh J, Matthews K, Goldbeck R, Smyth R, Walker J, MacMahon AD. Sharpe M. Symptoms 'unexplained by organic disease' in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? Brain, 2009, 132: 2878–2888. 20. Stone J et al. “Who is referred to neurology clinics?—the diagnoses made in 3781 new patients.” Clin Neurol Neurosurg, 2010, 112(9): 747-51. 21. Stone J, Carson A, Sharpe M. Functional symptoms and signs in neurology: assessment and diagnosis. J Neurol Neurosurg Psychiatry 2005, 76: 2-12. 22. Ursin H, Eriksen HR. Sensitization, subjective health complaints, and sustained arousal. Ann NY Acad Sci 2001, 933: 119-29. 23. Vein AM, Dyukova GM, Vorobieva OV. Is panic attack a mask of psychogenic seizures? A comparative analysis of phenomenology of psychogenic seizures and panic attacks. Functional neurology, 1994, IX(3): 153-161. 24. Waugh J, Goa KL. Escitalopram: a review of its use in the management of major depressive and anxiety disorders. CNS Drugs, 2003, 17(5): 343-62. 25. Dyukova G. M. Basic principles for diagnosing hysteria in neurology. Selected lectures. Eidos-Media, 2006: 316-337. 26. Kulikovsky V.V. Clinical and pathogenetic aspects of asthenic syndrome of psychogenic and somatogenic genesis. Moscow, 1994. Diss. doc. med. sc. P. 482. 27. Rodshtat I.V. Questions of the clinic and pathogenesis of asthenic conditions (neurological and psychological analysis). M. Diss. Ph.D. med. sc. 1967. P. 265.

Source

: Medical Council, No. 5, 2015

Prevention

It is possible to prevent the development of neurotic disorders by leading a healthy lifestyle. It is important to sleep 7-8 hours a day, go to bed before 1.00, resolve internal conflicts in a timely manner, and avoid stress. If a person’s work involves difficult situations or psychological overload, it is worth thinking about changing the sphere of work.

Prevention of neuroses: effective tips.

1. Do not abuse alcohol or smoking. Intoxication provokes a deterioration in adaptive capabilities, and various diseases appear. When drinking alcohol regularly, the psyche suffers and a severe hangover occurs.
2. The food menu should always include a lot of vegetables, fruits, lean meats and fish. It is advisable to rely on dairy products and take a course of vitamins in the off-season. Overeating is also dangerous; you need to consume food in moderation.
3. Music. This is an effective prevention method that involves listening to calm melodies. This could be the sound of rain or sea, falling snow and other natural phenomena. You should listen to soothing music before bed, or after a stressful situation. It can be found on YouTube, social networks, it is advisable to record it on a smartphone so that you can always relax.
4. It is important to exercise in moderation. Physical activity is the key to mental health. It is advisable to do exercises every morning or evening, you can join a gym, go to the pool 2-3 times a week.
5. Plan your actions, act according to the plan. Then there will be fewer stressful situations if a person does not let everything take its course.
6. Treat all diseases in a timely manner. Regular pain causes emotional stress.
7. It should be remembered that family conflicts, especially constant ones, cause serious stress. Family is the rear, not the battlefield. If there are problems in your personal life and they are not resolved, it is better to change your partner.

If it was not possible to prevent neurosis, you need to seek help in a timely manner. Then the chances of leveling out the negative psychological state are maximum.

Which specialists will help?

Dysfunctions of the nervous system can be caused by a variety of reasons and have completely different manifestations. Specialists dealing with such diseases are divided into 3 main categories: neurologist, psychotherapist and psychiatrist. All of them must have a diploma of higher medical education, after which they must complete an internship within 2 or 3 years and begin independent practice.

Neurologist

A neurologist is a specialist whose field of activity covers all areas of neurology: prevention, examination and influence on the central and peripheral parts of the nervous system. Neurology studies in detail the anatomy, functioning and treatment of the nervous system.

The term “neuropathologist,” which was actively used in Soviet medicine, also belongs to this category. Now it is considered outdated and incorrect, but sometimes out of habit it is used by individual doctors.

Psychotherapist

Psychotherapist - a doctor who deals with patients with mild or moderate mental disorders is called a psychotherapist. A prerequisite for his practice is a detailed study of psychotherapy.

The psychotherapist's field of activity is mental disorders caused by childhood traumas, severe stress, or due to genetic predisposition. As a rule, patients treated by this doctor do not have organic or anatomical brain injuries, but exhibit only psychological disorders.

The question often arises as to whether there are differences between a psychologist and a psychotherapist. There is a difference, and it lies in the fact that a psychologist does not have a higher medical education, and therefore can only advise patients, while a psychotherapist has the right to make a diagnosis and prescribe a course of treatment.

Psychiatrist

The scope of his activity is almost the same as that of a psychotherapist, but the psychiatrist also works with cases of the highest severity. A doctor who has studied for 6 years at a medical university and spent 2 years in an internship or is engaged in the activities of a graduate student has the right to work as a psychiatrist.

If a psychotherapist’s treatment methods are predominantly based on speech, and medications are used only as an aid, then the psychiatrist primarily carries out drug treatment and active non-drug therapy. Such methods cause stimulation of brain activity.

What happens if a neurotic disorder is not treated?

Neuroses can cause complications if left untreated. Many people ignore therapy and do not go to doctors. Post-Soviet stereotypes that going to a psychotherapist is shameful still live in people’s heads. Such negligence entails irreversible changes in the psyche.

What happens if a neurotic disorder is not treated:

• increased symptoms;
• the patient becomes hysterical and hypersusceptible;
• self-esteem suffers;
• other chronic diseases appear;
• the risk of catching a cold increases;
• the formation of an explosive personality that does not tolerate returns, is aggressive, and concentrates only on the negative.

A person becomes a hypochondriac, his personality is destroyed. The last stage is caused by complete apathy, the person does not get out of bed, and may refuse food. The patient is no longer able to do without medications or control his emotions. High risk of suicide. It is extremely difficult to treat this condition; it can lead to more serious mental pathologies. You cannot do without long-term psychotherapy, taking medications and staying in a neurosis clinic.

How to get an appointment

If the patient understands which doctor to contact, then this must be done as soon as possible. If the patient has doubts, then it is advisable to go to a therapist, who will identify a specialist.

In order to choose a qualified doctor, you need to pay attention to the following features:

• sufficient practical experience in the treatment of nervous disorders;
• an integrated approach to determining the patient’s condition;
• It is desirable to have scientific articles or works in the area that the patient is faced with;
• sufficient initial consultation time (at least 30 minutes).

At the appointment, the doctor will determine the further direction of the examination, if necessary. Having all the necessary data, he will be able to make a diagnosis and prescribe drug or non-drug treatment. If necessary, the patient will be recommended a course of treatment in a hospital.

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