Somatoform dysfunction of the autonomic nervous system: bodily symptoms of a psychotic disorder

Somatoform dysfunction of the autonomic nervous system is a disease accompanied by signs of dysfunction of internal organs.
However, numerous examinations reject the presence of organic pathology: the condition is due to a psychogenic nature. Often the concept is replaced by the terms vegetative-vascular dystonia or neurocirculatory dystonia, which are not included in the official international medical classification. ICD-10 classifies somatoform dysfunction as a neurotic disorder, defining it with code F 45.3.

Formation mechanism

The autonomic nervous system is the main regulator of the activity of internal organs, blood vessels and glands. Therefore, this system is often called visceral. The ANS regulates the functioning of organs in accordance with changes in environmental conditions.

The autonomic system is represented by two departments: sympathetic and parasympathetic, which have mutually opposite effects:

• The sympathetic nervous system mobilizes the body's defense reactions, preparing it for vigorous activity. Intensifies metabolism, increases arousal;
• The parasympathetic nervous system restores wasted energy. Stabilizes the body's condition. Supports its work during sleep.

Both departments have opposite effects on internal organs.

The opposite influence of systems with balanced work helps to balance the condition of the internal organs. The ANS is not subject to human will. For example, we cannot make the heart stop beating. But vegetative activity is subject to the influence of stress factors. This is easy to check. Remember how your heart begins to “rumble” when you are scared. The mouth becomes dry, intestinal colic appears, and the urge to urinate increases. This activates the sympathetic department, mobilizing the body's protective resources.

The fear went away - the heart calmed down, breathing returned to normal. This is the merit of parasympathetics.

Problems begin when the activities of both departments are separated. There are several reasons for this imbalance:

• heredity;
• hormonal changes;
• chronic stress;
• powerful simultaneous stress impact;
• overwork;
• chronic intoxication;
• alcohol abuse;
• radiation;
• action of high temperatures.

Disharmony in the activity of the ANS triggers the formation of somatoform dysfunction of the autonomic nervous system. Vegetative control over organs decreases. Their work is disrupted, giving rise to painful symptoms, but there are no organic changes. The main reason is stress.

Somatic symptoms are a way of experiencing stressful situations at a physiological level. This was also discussed by Adler, who developed the concept of the symbolic language of organs. The theory said: organ systems specifically mirror mental processes.

Prevention of autonomic dystonia syndrome

Strengthening health and restorative measures is the most important stage in the prevention of SVD. It is important not only to monitor the child and his lifestyle, but also to maintain a good microclimate in the family (reduce stress, prevent conflicts, and so on). Proper nutrition should be combined with adequate physical activity that is feasible for the child’s body. For preventive purposes, walks in the forest, drinking mineral waters, swimming in the sea, and clean mountain air are useful.

General picture of the disorder

The main symptom of the disorder is the appearance of somatic symptoms affecting one or more organ systems.
The pathological manifestations are multiple, reminiscent of the clinical picture of a separate disease, but are characterized by blurriness, uncertainty, and rapid variability. A peculiarity of the presentation of complaints by patients is a special dramatism. Patients present symptoms emotionally vividly, exaggeratedly, using all kinds of epithets. They visit a huge number of doctors of various specialties and require examinations. When examinations refute the presence of physical pathology, the patient resists this news, is confident in the examination’s error and continues further vigorous diagnostic and treatment activities. Patients often spend years on “treatment” before a correct diagnosis is made.

Such people are quite sensitive to their own feelings, tend to exaggerate them, and often call an ambulance and are hospitalized. Numerous examinations and ineffective treatment fuel patients’ confidence in the presence of the disease. This situation causes distrust in individual specialists and medicine itself.

Diagnosis of autonomic dystonia syndrome

In the diagnosis of the disease, an important place is occupied by symptoms, namely their development and course. Against this background, special importance is given to the collection of complaints and anamnesis. Next, the doctor examines the patient, monitors blood pressure, takes pharmacological and physical samples, studies the heart rate, and makes a thorough assessment of vegetative indices. To make a 100% correct diagnosis, additional procedures may be needed, such as cardiointervalography or electrocardiography. After the above studies, Doppler ultrasound of the vessels of the brain, neck and heart is usually performed.

Somatic symptoms of dysfunction

The main target organs of somatoform dysfunction are the heart, lungs, and digestive tract.

Frequent complaints are heart pain that is not clearly localized. Cardialgia is attributed to a different character: stabbing, cutting, aching, squeezing, pressing, “scorching.” The intensity is variable: from unpleasant to painful, depriving sleep. The pain can persist for several minutes or hours and affects the area of ​​the shoulder blade, arm, and right side of the chest.

The cause of pain is fatigue, anxiety, and weather changes. These appear after physical activity. This circumstance is important to take into account when differentiating VNS DM from angina pectoris, characterized by the appearance of pain during physical activity.

Cardialgia is accompanied by anxiety, restlessness, weakness, and lethargy. There is a feeling of lack of air, internal trembling, tachycardia, increased sweating.

You may feel a change in rhythm. Tachycardia is usually limited to 90-140 beats per minute, but is situational. It is provoked by changes in body position, drinking strong tea, coffee, alcoholic beverages or smoking. It goes away quickly. Often there is a feeling of fading, interruptions in the heart.

Pressure during somatoform dysfunction rises to reasonable limits, changes many times during the day, at night and stabilizes in the morning.

An indicative symptom of the respiratory system is shortness of breath, caused by a state of emotional stress. There is a pressing sensation in the chest. It's hard to take a breath. The patient experiences shortness of breath. Experiencing this, a person suffering from somatoform dysfunction constantly ventilates the premises and feels discomfort when being in closed spaces.

Patients are accompanied by frequent, shallow breathing, interrupted by periodic deep sighs. Attacks of neurotic cough occur.

Changes in the digestive system are characterized by:

• epigastric pain that occurs regardless of food intake;
• difficulty swallowing;
• stool disorder. The patient suffers from constipation or diarrhea;
• poor appetite;
• belching, heartburn, vomiting;
• improper salivation.

Somatoform dysfunction of the autonomic nervous system may be accompanied by hiccups, which are intrusive and quite loud.

VNS diabetes provokes urinary disorders. The urge becomes more frequent, and there is a need to empty the bladder in the absence of a toilet. Difficulty urinating in public toilets is typical.

Other signs of the disorder include low-grade fever, joint pain, fatigue, and decreased performance. Patients often suffer from insomnia, they become irritable and excitable.

It should be noted that the symptoms of somatoform dystonia are provoked by stress, nervous strain and are not caused by circumstances that cause the manifestations of an actual disease.

Somatoform dysfunction of the ANS has the following features:

• multiplicity of symptoms;
• non-standard nature of the symptoms shown;
• strong emotional reaction;
• discrepancy with the results of objective diagnostics;
• too intense severity of symptoms or, conversely, lack of brightness of symptoms;
• lack of response to standard provoking factors;
• futility of somatotropic therapy.

Treatment of autonomic dystonia syndrome

There are several basic principles in the treatment of SVD:

• A complex approach. Doctors combine therapeutic methods of treatment: physiotherapy, drug therapy, herbal medicine, acupuncture, physical therapy, and so on.
• Individual approach. The disease is thoroughly studied, starting with the causes of its occurrence, the degree of development of symptoms and ending with the severity of the disease.
• Timely treatment. Vegetative dystonia syndrome is much easier to cure by consulting a doctor in a timely manner.
• Long-term treatment. It takes a lot of time to treat the consequences of SVD. And we are talking not so much about eliminating the symptoms that have appeared, but about complete recovery.
• Help for the whole family. Psychotherapeutic activities are carried out both with the sick child and with the parents.

In addition to drug methods of treating vegetative dystonia syndrome, non-drug methods are actively used. Medicines are used mainly for long-term VDS or severe disease. At the initial stage of the disease and in mild cases, experts prefer to use non-drug treatment. It should be supplemented by an adjusted lifestyle: sleep - 8-10 hours, daily walks in the fresh air - at least 2 hours a day, a maximum of 1.5 hours should be devoted to television and the computer, and parents should in every possible way protect the child from stress, create a environment around him pleasant microclimate.

It is necessary to strictly adhere to the prescribed diet. It is recommended to eat foods rich in magnesium and sodium salts: vegetables, fruits, legumes, cereals, and so on. In this case, sunflower oil must be replaced with olive oil.

Tea and coffee should be consumed only with milk, kefir and chocolate should be added to the daily diet, and foods with a high liquid content should be consumed as often as possible. The consumption of table salt should be reduced to a minimum in cases with hypertensive syndrome of vegetative dystonia, and beans, cottage cheese, milk, salads, spinach, carrots, and barley porridge should be added to the diet. In the cardiac form of SVD, any food that has a beneficial effect on the properties of the blood is relevant: a moderate amount of spices, vegetable oil, citrus fruits, gray porridge, and so on.

Regardless of the type of disease, honey (for 2-3 months before bedtime), compote of sea buckthorn, cranberries, rowan berries, rose hips, apricots, raisins, dried apricots, lingonberries, various fruit and vegetable juices, infusions and mineral waters are mandatory for consumption. .

Under no circumstances should you be freed from physical activity. Physical education and sports help in the treatment of all forms of SVD, with the exception of diseases that have reached a crisis. In the event of a crisis, it is necessary to engage exclusively in therapeutic exercises. In other cases, running and walking, cycling, skating, swimming, hiking, and skiing help well. A massage of the spine and cervical-collar area (up to 20 sessions) will not be amiss.

The hypotensive form of SVD involves active physical activity and active sports: tennis, shaping, dancing, and so on. In the treatment of cardiac autonomic dystonia syndrome, badminton, swimming and jogging are recommended. The hypertensive type of SVD limits the patient only to swimming, walking and hiking. For any type of disease, it is not recommended to engage in team sports such as basketball, football, handball, volleyball and so on.

Experts agree that physiotherapeutic treatment methods are more than successful. These include treatment with ultrasound, sinusoidal modulated currents, inductometry, electrosleep, electrophoresis of drugs and other methods of similar action. Mixed type vegetative dystonia syndrome is preferably treated with electrophoresis of drugs using one of the methods: either endonasal electrophoresis of a solution of novocaine (2%), or a 1% solution of novocaine in combination with a 0.2% solution of potassium iodide. For sympathicotonia, electrophoresis with a 0.5% solution of aminophylline, magnesium sulfate, papaverine, and bromine is recommended. For vagotonia, the most relevant is electrophoresis with caffeine, mesatone, and calcium. These procedures are carried out every two days for 20-30 days. If necessary, the course of treatment can be repeated after 1-2 months.

Treatment with medications is usually started either in combination with the above methods or after their use has ended. It is preferable to start drug treatment of vegetative dystonia syndrome with common drugs (Zamanikha, bromine, valerian) that have a minimal number of side effects. Drugs and their dosage are prescribed taking into account the individual characteristics of the patient’s body. Age plays a big role in choosing the dosage of medications. Since the duration of treatment for vegetative dystonia syndrome is long-term, drugs are prescribed gradually and often replace each other.

Part of the therapy consists of antipsychotics and tranquilizers that have a sedative effect. The former can significantly reduce the reaction to various external stimuli. Neuroleptics for children are selected from the most “light” ones, which are well tolerated when tranquilizers have shown their ineffectiveness. Sonopax (10-30 mg per day depending on age), frenolone (about 10 mg per day), Terolene (about 10 mg per day) are prescribed. These drugs can be combined.

Tranquilizers help cope with insomnia, fear, panic, and are a good remedy for cardialgia and extrasystole.

For vagotonia, amizil is recommended (about 2 mg per day). Hypersympathicotonic reactivity and sympathicotonia become the reason for the prescription of tazepam (20-30 mg per day), seduxen (about 10 mg per day). These drugs are not recommended for use in children with a tendency to hypotension, as well as in the presence of initial vagotonic tone. For mixed vegetative dystonia syndrome, bellaspon and belloid (1-3 tablets per day), phenibut (0.25-0.5 mg per day), meprobamate (0.3-0.7 mg per day). As a rule, tranquilizers in childhood are prescribed in the lowest possible doses. Over time, the dosage of the drugs is gradually increased. Treatment with small doses of tranquilizers is necessary for at least 2 months, and it is best to take the drugs in the evening or after lunch.

The further course of treatment with medications is prescribed individually and directly depends on the type of dystonia. For arterial hypertensia, sedative herbal preparations are prescribed; antispasmodic medications are used less frequently. ACE inhibitors and calcium antagonists are often prescribed, which are highly effective and have minimal possible side effects. If the effectiveness of these drugs individually is minimal, the doctor may prescribe a combination of drugs.

Rhodiola, eleutherococcus extract, tinctures of aralia, zamanika, ginseng, lemongrass, as well as other herbal psychostimulants are prescribed for arterial hypotension, which is quite severe.

Neurometabolic drugs are most relevant in childhood in the presence of autonomic dystonia syndrome with changes in the functioning of the central nervous system. Pyridoxal phosphate is prescribed for vagotonia; vitamins B4 and E in combination with potassium preparations - for sympathicotonia, and to increase the level of microcirculation - stugeron, cavinton, trental.

Drug treatment of almost all types of SVD also includes the use of herbal dietary supplements with vitamins, microelements and coenzymes.

Associated mental disorders

Somatoform dysfunction is accompanied by other mental disorders.

The disease is often accompanied by phobic disorders . Characterized by fear of death, agoraphobia, cancerophobia, fear of blushing.

Panic attacks are an extremely common companion to the disorder. It is caused by a state of extreme fear and emotional stress. Characterized by an increase in the intensity of symptoms of the disease. It often provokes the development of depersonalization, fear of loss of consciousness, madness, and death.

Generalized anxiety disorder causes extreme tension, anxiety, and fears about the future. In addition to the characteristic manifestations of the disease, it contributes to the development of ideological and emotional phenomena. Worried about dizziness, weakness, feeling of lightheadedness. It is possible to develop derealization, when existing objects seem unreal, as well as depersonalization. The individual becomes hypersensitive, reacts sharply to extraneous stimuli, expecting danger.

Causes

The development of autonomic neurosis is not caused by any single cause; it is usually the result of several factors:

• Traumatic brain injury with brain damage;
• Chronic fatigue, stress and depression;
• Consequences of certain infectious diseases;
• Wrong lifestyle;
• Mental and physical stress;
• Psychological trauma;
• Individual predisposition to neuroses.

Like many mental illnesses, this disorder often originates from a person’s childhood. Psychological trauma and shock experienced at an early age can develop into a serious illness after a few years. Moreover, not only people from disadvantaged families are susceptible to vegetative neurosis, but also ordinary children who lack the attention of their parents.

At an early age, monitoring the child’s psychological state is very important, since it is at this time that the foundation for adult life is laid. However, many parents, unfortunately, do not attach importance to this, accepting the child’s whims and tantrums as one of the manifestations of childhood.

When a person grows up, other factors influence his psycho-emotional state. Conflicts within the family, problems at work, social injustice - all this can cause autonomic neurosis.

Sometimes in adults, neurosis is caused by hormonal changes in the body, this is especially often observed in women during pregnancy. Also, the psychological state is affected by addiction to alcohol, drugs (and any poisoning in general), poor lifestyle or poor environment.