Autonomic nervous system disorder: anxiety, neurosis, panic attacks

Autonomic neurosis (vegetative neurosis) is a complex of pathologies that appear when there are disturbances in the functioning of the higher centers of the autonomic nervous system.

• Causes
• Symptoms
• Diagnostics
• How to treat vegetoneurosis?

The symptoms of these diseases are similar to somatic ailments (that is, diseases of the internal organs), but a more in-depth examination does not reveal any abnormalities, which greatly complicates the diagnosis of vegetative neurosis.

The cause of painful sensations is the fact that the autonomic nervous system acts as an “intermediary” between the general nervous system and the internal organs of a person. When its work is disrupted, the body can “make a mistake” and regard these signals as disturbances in the functioning of other organs and systems.

The autonomic nervous system plays an important role in our body. It controls the functioning of all organs and systems while a person sleeps, and also helps restore strength and energy after physical exertion. In addition, the autonomic system takes an active part in regulating metabolism. The physical and psycho-emotional state of a person also directly depends on its work, so any disruption in the functioning of the autonomic nervous system can lead to serious consequences for the body.

Autonomic neurosis manifests itself in two large categories of diseases. The first group includes disorders of various systems and organs of the human body, when problems arise with the heart, gastrointestinal tract, genitourinary and respiratory systems, etc. This category is also called neurosomatic neurosis. Patients experience headaches, decreased sensitivity and other symptoms that, at first glance, do not relate to disorders of the nervous system. The second category includes mental disorders: phobias, depression, hysterical neuroses, etc.

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.

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Symptoms

Autonomic neurosis has many symptoms - and this, on the contrary, makes it difficult to diagnose. The most pronounced signs of diseases of the genitourinary, cardiovascular and digestive systems of the body. In addition, the patient may experience severe headaches and sudden changes in blood pressure; pain in muscles and joints is even less common.

Other symptoms include chronic fatigue, which does not go away even in the absence of high physical activity and good rest. People suffering from autonomic neurosis get tired quickly, do not tolerate sharp sounds well, and often become irritated at the slightest provocation. This condition is isolated into a separate disease, which is called asthenic syndrome.

In addition, autonomic neurosis is distinguished by several signs that usually do not correspond to most diseases:

• Deterioration of the condition of the skin, hair and nails; muscle atrophy, the appearance of trophic ulcers;
• Changes in the skin: increased secretion of sweat and sebum, peeling, appearance of age spots, etc.;
• Periodic stool disorders, lack of oxygen, disturbances in the functioning of the gallbladder;
• Various allergic reactions;
• Hypochondria, which is characterized by increased suspiciousness and suspicion of illness, as well as fear at the slightest ailment;
• Fears without any reason, and patients realize their groundlessness, but cannot resist them.

Disturbances in the functioning of the heart muscle, indicating autonomic neurosis, cannot be treated with medications, since they are not caused by diseases of the internal organs. Such pains are called false. Despite the fact that they do not talk about heart disease, their occurrence is very unpleasant and painful for a person. The same applies to pathologies of other organs and systems.

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If you feel pain in one or another part of your body, do not self-medicate. It is possible that your organs are healthy, and with your medications you will harm the body. To determine the cause of the pain, consult a doctor.

Signs of autonomic neurosis in most cases do not appear individually. To accurately diagnose the disease, the doctor must conduct a comprehensive examination of the patient. Only after receiving the results of all tests and observations can appropriate treatment be selected.

On the issue of diagnosis and treatment of psychovegetative disorders in general somatic practice

More than 25% of patients in the general somatic network have psychovegetative syndrome as the most common variant of vegetative dystonia syndrome (VDS), behind which there are anxiety, depression, as well as adaptation disorders, which doctors establish at the syndromic level. However, manifestations of psychovegetative syndrome are often mistakenly diagnosed as somatic pathology. This, in turn, is facilitated by the commitment to somatic diagnosis of both doctors and patients, as well as the special clinical picture of somatization of mental disorders in the clinic of internal medicine, when behind a multitude of somatic and vegetative complaints it is difficult to identify psychopathology, which is often subclinically expressed. Subsequently, incorrect diagnosis with the establishment of a somatic diagnosis and ignoring mental disorders leads to inadequate treatment, which manifests itself not only in the prescription of ineffective groups of drugs (beta blockers, calcium channel blockers, nootropics, metabolic drugs, vascular drugs, vitamins), but also in carrying out too short courses of therapy with psychotropic drugs. The article provides specific recommendations for overcoming such difficulties.

Mental pathology is widespread among patients in primary care and is often presented in the form of depressive and anxiety disorders, including stress reactions and adaptation disorders, and somatoform disorders [1]. According to the Russian epidemiological program COMPASS, the prevalence of depressive disorders in general medical practice ranges from 24% to 64%. At the same time, in patients who visited the clinic once during the year, affective spectrum disorders are detected in 33% of cases, in 62% of patients who visited the clinic more than five times, and also more often among women than among men [2].

Similar data have been obtained on the high prevalence of anxiety and somatoform disorders in the primary network [3–5]. It is worth noting that it is difficult for general practitioners to identify psychopathology behind the many somatic and vegetative complaints of patients, which is often subclinically expressed and does not fully satisfy the diagnostic criteria for a mental disorder [6], but leads to a significant decrease in the quality of life, professional and social activity [7– 9] and is widespread in the population. According to Russian and foreign researchers, about 50% of individuals in society have either threshold or subthreshold disorders [2, 10–12]. In foreign literature, the term “Medical Unexplained Symptoms” was proposed to refer to such patients, which literally means “Medically unexplained symptoms” (MSU).

Currently, this term replaces the concept of “somatization” and is the most appropriate to describe a large group of patients whose physical complaints are not verified by traditional diagnoses [13]. MNS is widespread in all healthcare settings. Up to 29% of patients in general somatic clinics have subthreshold manifestations of anxiety and depression in the form of somatic symptoms that are difficult to explain by existing somatic diseases [14], and their identification is contested by numerous cross-sectional and syndromic diagnoses [15]. In Russia and the CIS countries, doctors in their practice actively use the term “SVD”, by which most practicing doctors understand psychogenically caused multisystem autonomic disorders [16]. It is the psychovegetative syndrome that is defined as the most common variant of SVD, behind which there are anxiety, depression, as well as adaptation disorders, which doctors establish at the syndromic level.

In such cases, we are talking about somatized forms of psychopathology, when patients consider themselves to be somatically ill and turn to doctors of therapeutic specialties [17]. Despite the fact that there is no nosological unit of SVD as such, in certain territories of Russia the volume of the diagnosis of SVD is 20–30% of the total volume of registered data on morbidity, and in the absence of the need to refer the patient for consultation to specialized psychiatric institutions, it is coded by doctors and statisticians of outpatient clinics as a somatic diagnosis [18]. According to the results of a survey of 206 neurologists and therapists in Russia, participants in conferences held by the Department of Pathology of the Autonomic Nervous System of the Scientific Research Center and the Department of Nervous Diseases of the First Moscow State Medical University named after I.M. Sechenov for the period 2009–2010, 97% of respondents use the diagnosis "SVD" in their practice, of which 64% use it constantly and often.

According to our data, in more than 70% of cases, SVD is included in the main diagnosis under the heading of somatic nosology G90.9 - disorder of the autonomic (autonomic) nervous system, unrefined or G90.8 - other disorders of the autonomic nervous system. However, in real practice, there is an underestimation of concomitant somatic disorders and psychopathology. The use of the “Questionnaire for identifying autonomic dysfunction” [16] in 1053 outpatients with signs of autonomic dysfunction made it possible to establish that in the majority of patients (53% of patients), the existing autonomic imbalance was considered within the framework of such somatic diseases as “dyscirculatory encephalopathy”, “dorsopathy” "or "traumatic brain injury and its consequences."

In less than half of those examined (47% of patients), along with somatovegetative symptoms, concomitant emotional and affective disorders were identified, mainly in the form of pathological anxiety, which in 40% of these patients was diagnosed as vegetative-vascular dystonia, in 27% - as neurosis or neurotic reactions, in 15% - as neurasthenia, 12% - as panic attacks, 5% - as somatoform dysfunction of the autonomic nervous system and 2% - as an anxiety disorder.

Our results are consistent with data obtained in designed epidemiological studies assessing the prevalence and diagnosis of anxiety and depression by general practitioners, which once again highlights the wide representation of somatized forms of psychopathology [17], as well as their frequent neglect by general practitioners [2, 19]. Such underdiagnosis is associated, firstly, with the existing system of organizing care, when there are no clear diagnostic criteria for indicating manifestations of non-somatic origin, which leads to subsequent difficulties in explaining symptoms, as well as the impossibility of using psychiatric diagnoses by general practitioners.

Secondly, along with the reluctance of patients to have a psychiatric diagnosis and their refusal to be treated by psychiatrists, there is an underestimation by practicing doctors of the role of traumatic situations [19]. As a result, underdiagnosis of psychopathology, adherence to a somatic diagnosis and ignorance of concomitant mental disorders underlie inadequate treatment of patients with psychovegetative syndrome. A significant contribution to underdiagnosis is made by the features of the clinical picture, namely the somatization of mental disorders in the clinic of internal diseases, when behind a multitude of somatic and vegetative complaints it is difficult to identify psychopathology, which is often subclinically expressed and does not fully satisfy the diagnostic criteria of a mental disorder [6]. In most cases, doctors do not consider these conditions as pathological and do not treat them [20, 21], which contributes to the chronicization of psychopathology up to the achievement of full-blown psychopathological syndromes [22].

Considering that general practitioners identify somatovegetative manifestations of anxiety and depression at the syndromic level in the form of SVD, as well as the impossibility in practice of using psychiatric diagnoses, at the first stage of managing a large number of patients, syndromic diagnosis of psychovegetative syndrome becomes possible, which includes:

1. active identification of multisystem autonomic disorders (during a survey, as well as using the “Questionnaire for identifying autonomic changes” recommended as a screening diagnostic of psychovegetative syndrome (see table on page 48) [16]);
2. exclusion of somatic diseases based on the patient’s complaints;
3. identifying the connection between the dynamics of the psychogenic situation and the appearance or worsening of vegetative symptoms;
4. clarification of the nature of the course of autonomic disorders;
5. active identification of mental symptoms accompanying autonomic dysfunction, such as: reduced (sad) mood, anxiety or guilt, irritability, sensitivity and tearfulness, a feeling of hopelessness, decreased interests, impaired concentration, as well as deterioration in the perception of new information, changes in appetite, a feeling of constant fatigue, sleep disturbance.

Considering that autonomic dysfunction is an obligatory syndrome and is included in the diagnostic criteria for most anxiety disorders: pathological anxiety (panic, generalized, mixed anxiety-depressive disorder), phobias (agoraphobia, specific and social phobias), reactions to a stressful stimulus, it is important for the doctor to evaluate mental disorders: level of anxiety, depression using psychometric testing (for example, the use of a psychometric scale validated in Russia: “Hospital Anxiety and Depression Scale” (see table on page 49) [23]).

Prescribing adequate therapy requires the doctor to inform the patient about the essence of the disease, its causes, the possibility of therapy and prognosis. The patient’s ideas about his own illness determine his behavior and seeking help. So, for example, if the patient views the existing manifestations of psychovegetative syndrome not as a somatic disease, but within the framework of social problems and character traits, preference in treatment will be given to one’s own efforts, non-professional methods and self-medication. In a situation where the patient considers his existing symptoms as the result of somatic suffering and damage to the nervous system, he seeks medical help from a neurologist or therapist. There are so-called “vulnerable” groups of people with a high risk of developing psychovegetative syndrome. Among the many factors, the following main ones are distinguished:

• low assessment of the patient’s well-being;
• presence of traumatic situations over the past year;
• female;
• marital status (divorced, widowed);
• lack of employment (not working);
• low income;
• elderly age;
• chronic somatic/neurological diseases;
• frequent visits to the clinic, hospitalizations.

The presence of the above factors in combination with clinical manifestations allows the doctor to explain to the patient the essence of the disease and argue for the need to prescribe psychotropic therapy.

At the stage of choosing the optimal treatment tactics and making a decision on mono- or polytherapy, it is necessary to adhere to the recommendations in the treatment of patients with psychovegetative disorders. The current standards of treatment for patients with VDS and, in particular, with a diagnosis defined by ICD-10 code G90.8 or G90.9, along with ganglion blockers, angioprotectors, and vasoactive agents, recommend the use of sedatives, tranquilizers, antidepressants, and minor neuroleptics [ 24]. It should be noted that most symptomatic drugs are ineffective in the treatment of psychovegetative syndrome. These include beta blockers, calcium channel blockers, nootropics, metabolic drugs, vascular drugs, vitamins. However, according to a survey conducted among doctors, we found that most doctors still prefer to use vascular-metabolic therapy (83% of therapists and 81% of neurologists), beta-blockers (about half of the doctors). Of the anti-anxiety medications, sedative herbal preparations are still popular among 90% of therapists and 78% of neurologists. Antidepressants are used by 62% of therapists and 78% of neurologists. Minor antipsychotics are used by 26% of therapists and 41% of neurologists.

Considering that psychovegetative syndrome is a frequent manifestation of chronic anxiety, which is based on an imbalance of a number of neurotransmitters (serotonin, norepinephrine, GABA and others), patients need to be prescribed psychotropic drugs. The optimal drugs in this situation are GABAergic, serotonin-, noradrenergic, or drugs with multiple actions.

Of the GABAergic drugs, benzodiazepines are the most suitable. However, in terms of tolerability and safety profile, this group is not a first-line drug of choice. High-potency benzodiazepines, such as alprazolam, clonazepam, lorazepam, are widely used in the treatment of patients with pathological anxiety. They are characterized by a rapid onset of action, they do not cause an exacerbation of anxiety in the initial stages of therapy (unlike selective serotonin reuptake inhibitors), but at the same time they are not without the disadvantages characteristic of all benzodiazepines: the development of sedation, potentiation of the effect of alcohol (which is often taken by patients with anxiety). -depressive disorders), the formation of addiction and withdrawal syndrome, as well as insufficient influence on symptoms comorbid with anxiety. This makes it possible to use benzodiazepines only in short courses. Currently, the drugs are recommended as a “benzodiazepine bridge” - in the first 2-3 weeks of the initial period of antidepressant therapy.

Drugs that affect the activity of monoaminergic transmission are a priority in the choice of pharmacotherapy. Modern first-choice drugs for the treatment of pathological anxiety include antidepressants from the group of selective serotonin reuptake inhibitors (SSRIs), since predominantly the deficiency of this neurotransmitter realizes the psychovegetative manifestations of pathological anxiety [5]. SSRIs are characterized by a wide range of therapeutic options with fairly high safety during long-term therapy. However, despite all its positive aspects, SSRIs also have a number of disadvantages. Side effects include worsening anxiety, nausea, headaches, dizziness during the first few weeks of treatment, as well as their lack of effectiveness in some patients. In older adults, SSRIs may cause unwanted interactions. SSRIs should not be prescribed to patients taking NSAIDs, since the risk of gastrointestinal bleeding increases, as well as to patients taking warfarin, heparin, since the antithrombotic effect is enhanced with the risk of bleeding.

Dual-acting antidepressants and tricyclic antidepressants are the most effective drugs. In neurological practice, these drugs and, in particular, selective serotonin and norepinephrine reuptake inhibitors (SNRIs) have shown high effectiveness in patients suffering from chronic pain syndromes of various localizations [25–29]. However, along with a wide range of positive effects, with increasing efficiency, the tolerability and safety profile may deteriorate, which determines the wide list of contraindications and side effects of SNRIs, as well as the need for dose titration, which limits their use in the general somatic network.

Among drugs with multiple actions, small neuroleptics deserve attention, especially Teraligen® (alimemazine), characterized by a favorable efficacy and safety profile. Its wide spectrum of action is due to its modulating effect on central and peripheral receptors. Blockade of dopamine receptors of the trigger zone of the vomiting and cough center of the brain stem is realized in antiemetic and antitussive effects, which determines the use of Teraligen® in the treatment of vomiting in children in the postoperative period [30]. Its weak effect on the blockade of D2 receptors of the mesolimbic and mesocortical systems leads to the fact that it has a mild antipsychotic effect. However, it does not cause severe side effects in the form of iatrogenic hyperprolactinemia and extrapyramidal insufficiency, observed when prescribing other minor and major antipsychotics [31].

Blockade of H1-histamine receptors in the central nervous system leads to the development of a sedative effect and the use of the drug in the treatment of sleep disorders in adults and children [32], in the periphery - in antipruritic and antiallergic effects, which has found its application in the treatment of “itchy” dermatoses” [33] . Blockade of alpha-adrenergic receptors in the reticular formation of the brain stem has a sedative effect, and the locus coeruleus and its connections with the amygdala contribute to the reduction of anxiety and fear [34]. The combination of blockade of peripheral alpha-adrenergic receptors (which manifests itself in a hypotensive effect) and M-cholinergic receptors (which manifests itself in an antispasmodic effect) is widely used for the purpose of premedication in surgery and dentistry [35], in the treatment of pain. The tricyclic structure of alimemazine also determines its antidepressant effect due to its effect on presynaptic receptors and enhancing dopaminergic transmission [36].

The results of our own studies assessing the effectiveness of Teraligen® (at a dose of 15 mg/day, divided into three doses, over 8 weeks of therapy), obtained in 1053 outpatient neurological patients with autonomic dysfunction, demonstrated its significant therapeutic effect in the form of positive dynamics according to the “Questionnaire to identify autonomic changes” (see table on page 48) and reduce somatovegetative complaints. The majority of patients were no longer bothered by the sensations of palpitations, “fading” or “cardiac arrest,” a feeling of shortness of breath and rapid breathing, gastrointestinal discomfort, “bloating” and abdominal pain, as well as tension-type headaches. Against this background, there was an increase in performance. Patients began to fall asleep faster, sleep became deeper and without frequent awakenings at night, which generally indicated an improvement in the quality of night sleep and contributed to a feeling of sleep and vigor when waking up in the morning (

).

The favorable efficacy and tolerability profile of alimemazine allows Teraligen® to be widely used in patients with psychovegetative syndrome at an average therapeutic dose of 15 mg/day, divided into three doses. An important factor for good compliance is the administration of Teraligen® according to the following scheme: the first four days are prescribed 1/2 tablet at night, over the next four days - 1 tablet at night, then every four days 1 tablet is added in the morning and after four of the day during the daytime. Thus, after 10 days the patient takes a full therapeutic dose of the drug (

).

Alimemazine (Teraligen®) is also indicated as an additional therapy for:

• sleep disorders and, in particular, difficulty falling asleep (since it has a short half-life of 3.5–4 hours and does not cause post-somnia stupor, lethargy, or a feeling of heaviness in the head and body);
• excessive nervousness, excitability;
• to enhance the antidepressant effect;
• with senopathic sensations;
• for conditions such as nausea, pain, itching [37].

Therapy with psychotropic drugs requires the prescription of an adequate dose, assessment of tolerability and completeness of patient compliance with the treatment regimen. It is necessary to prescribe a full therapeutic dose of psychotropic drugs to relieve anxiety, depressive and mixed anxiety-depressive disorders. Given the difficulties in managing patients during the initial period of treatment, it is recommended to use a “benzodiazepine bridge” in the first 2–3 weeks of therapy with antidepressants from the SSRI or SNRI class. Combining SSRIs with minor antipsychotics (in particular, alimemazine), which affect a wide range of emotional and somatic symptoms (especially pain), is also recommended. Such combinations have the potential for faster onset of antidepressant effects and also increase the likelihood of remission.

General practitioners often face difficulties in determining the duration of a course of treatment. This is due to the lack of information about the optimal duration of treatment and the lack of standards for the duration of treatment for patients with psychovegetative syndrome. It is important that short courses lasting 1–3 months more often lead to subsequent exacerbation than long courses (6 months or more). Considering such difficulties, the following treatment regimen can be recommended for a practicing physician:

• two weeks from the start of using a full therapeutic dose of antidepressants, it is necessary to assess the initial effectiveness and the presence of side effects from treatment. During this period, it is possible to use a “benzodiazepine bridge”;
• with good and moderate tolerability, as well as with signs of positive dynamics in the patient’s condition, it is necessary to continue therapy for up to 12 weeks;
• after 12 weeks, the question of continuing therapy or searching for alternative methods should be decided. The goal of therapy is to achieve remission, which can be defined as the absence of symptoms of anxiety and depression with a return to the state that was before the onset of the disease. For example, in most randomized controlled trials, a Hamilton scale score of ≤ 7 is taken as the absolute criterion for remission. In turn, for the patient, the most important criterion for remission is improvement in mood, the emergence of an optimistic mood, self-confidence and a return to a normal level of social and personal functioning, characteristic of a given person before the onset of the disease. Thus, if the patient still reports residual symptoms of anxiety or depression, the clinician needs to make additional efforts to achieve the goal;
• Management of patients with resistant conditions by general practitioners is not advisable. In these situations, the help of a psychiatrist or psychotherapist is necessary. In this regard, there are no clear recommendations. However, in the absence of specialized care and the existing need, it is recommended to switch to antidepressants with a different mechanism of action (tricyclic antidepressants (TCAs) or SNRIs). In case of resistance to SSRIs, it is recommended to add benzodiazepines or minor antipsychotics or switch to drugs of the latter group. In such cases, the recommended dose of alimemazine is 15 to 40 mg/day.

The choice of tactics for discontinuing the basic drug depends, first of all, on the psychological mood of the patient. Cancellation of the drug can occur abruptly, the so-called “break” of treatment. However, if the patient is afraid of stopping a long-term medication, stopping the drug itself can cause a worsening of the condition. In such situations, gradual withdrawal (graduated withdrawal) or transfer of the patient to “mild” anxiolytics, including herbal remedies, is recommended.

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E. S. Akarachkova , Candidate of Medical Sciences

First Moscow State Medical University named after. I. M. Sechenova , Moscow

Contact information for authors for correspondence

Diagnostics

Despite the large number of symptoms, recognizing autonomic neurosis and starting its treatment is quite difficult. The doctor conducting the study must very accurately determine which organs or systems suffer most from neurosis. If you suspect the presence of this disease, the doctor should additionally conduct research for other diseases to make sure that they are not the cause of the detected symptoms.

How to treat vegetoneurosis? Treatment of autonomic neurosis is carried out mainly without the use of drugs. First of all, the functioning of the autonomic nervous system itself should be normalized, and then all accompanying symptoms will disappear. To achieve this, the doctor and the patient need to jointly develop a daily routine with sufficient hours for rest. Adequate sleep, proper nutrition and avoidance of stress are required.

High results are achieved with sanatorium-resort treatment, when a person is protected from life’s problems and concentrates only on recovery and relaxation. Moderate physical activity also has a beneficial effect on health. A set of physical therapy exercises and regular walks in the fresh air have a beneficial effect on the autonomic nervous system.

In addition to rest and peace, a course of psychotherapy is recommended for treatment for patients with autonomic neurosis. Several sessions of communication with a doctor help a person get rid of internal tension and feel light and free. It is very important that the psychotherapist fights not only the consequences of neurosis, but also finds out and eliminates the causes of its occurrence. However, no matter how good a doctor is, his efforts must be supported by the desire of the patient himself. If a person is not internally inclined to treat autonomic neurosis, all measures may be useless.

If we talk about the treatment of autonomic neurosis with medications, then the doctor can prescribe painkillers and sedatives that are not addictive. Also, sometimes the patient is prescribed to use sleeping pills for proper rest and medications that directly affect the autonomic nervous system. Medicines are not always used to treat autonomic neurosis; the need for their use and dosage is determined by the doctor.

What is autonomic neurosis from a medical point of view?

Vegetoneurosis (or autonomic neurosis) is understood by doctors as a whole group of diseases caused by dysfunction of the autonomic nervous system.

The autonomic nervous system is responsible for processes occurring in the body that the person himself cannot control. This includes breathing, heartbeat, contraction of the muscles of the stomach and intestines, the production of gastric juice, and the reaction of the pupils to changes in lighting.

In other words, the area of ​​responsibility of the autonomic nervous system includes the functioning of individual organs and their systems, glands, circulatory system, as well as metabolic processes, control of the body’s activity during sleep, recovery after strenuous work, etc.

Difference between depressive neurosis and other neurotic disorders

First, let's find out what the differences between depression and neurosis are. Neurosis is a general concept for a whole group of psychogenic disorders, the appearance of which is caused by regular exposure to external stress factors. In the early stages of the disease, it is enough to eliminate these factors or change your attitude towards them for recovery to occur.

Depression is an affective disorder, that is, a mood disorder, which is characterized by a lack of ability to enjoy the positive phenomena of life, an unreasonable depressed state for a long time, a significant loss of strength and extreme fatigue. With depression, external factors are basically just a catalyst that triggers a serious illness formed by endogenous causes, including hereditary ones. The combination of a depressive and neurotic clinical picture is characteristic of depressive neurosis, but in a significantly softened version.

Despite apathy and a decrease in mental activity, the patient remains able to work, and in some circumstances is even absorbed in work; general lethargy has virtually no effect on the results of work. Apathy extends more to relationships in society - there is no desire to communicate or attend crowded meetings. The skills of habitual socialization themselves do not disappear, interest in them simply dries up.

There is no total depression; patients diagnosed with depressive neurosis do not lose self-control and are capable of adequate communication and assessment of what is happening. They do not have the painful feeling of a lack of feelings and a complete disappearance of emotions and interest in life. The sleep disturbances characteristic of ordinary depression in the form of early awakenings with the inability to resume sleep again are absent or only rarely appear. During the day, the condition may worsen slightly in the evening, while with a purely affective depressive disorder, on the contrary, it becomes a little easier in the evening. The presence of somato-vegetative disorders in this disease forces one to turn to general practitioners (most often therapists, neurologists) who treat common diseases, who can prescribe symptomatic treatment that does not correct the situation and prolongs the course of the disease.

As a differentiation from similar disorders, morning fatigue, characteristic of asthenic neurosis, is not accompanied by feelings of melancholy, restlessness and anxiety, as with depression, just as there is no extreme fixation on symptoms and the search for imaginary diseases, as is the case with hypochondria.

In general, the symptoms are much milder than the clinical picture of classical depression, in which the future is hopeless. Neurotic depression allows you to plan, see prospects and strive to achieve them, while bracketing the negativity of the existing unfavorable state of affairs. All these features and subtle differences can only be noticed by an experienced psychotherapist in order to differentiate depressive neurosis from other types of neurotic and affective disorders.