Neuroses
Neuroses are neuropsychiatric dysfunctions of a psychogenic nature that manifest themselves in somatovegetative and emotionally affective clinical phenomena. These diseases include only those neuropsychiatric disorders in which their reversibility is combined with the absence of manifestations of pathomorphological disorders of the nervous system. The therapy of this group of diseases consists of two main directions, drug and psychotherapeutic treatment.
The content of the article:
Causes of neurosis
Pathogenetic aspects of neuroses
Classification of neuroses
Stages of neurosis development
Common symptoms of neurosis
Diagnosis of neurosis
Treatment of neurosis
Prognosis and prevention of neurosis
Neuroses
Causes of neurosis
The phenomenon of neurosis is caused by many different factors of an endogenous and exogenous nature. Each of the types of neurosis develops against the background of psychogenic disorders that have arisen as a result of conflicts and neuropsychiatric overstrain. At the same time, the social and individual significance of a person who has succumbed to experiences is important, that is, a person has a neurological reaction only if there is an individual stimulus. Also, one of the key factors influencing the development of neurosis is the phenotypic personality trait due to heredity and upbringing.
According to the results of some studies, it is known that most often the formation of a neurotic hypersthenic is due to neglect and poor upbringing, and a neurotic hyposthenic is formed if a person is subject to harassment in the process of his development. With excessive attention from close people, there is a high risk of hysteria. If a person does not have any neurotic tendencies, then psychoemotional overloads can provoke neurotic states, vegetoneurosis or reactive states, however, without a constitutional predisposition of the personality, such types of neuroses as obsessive-compulsive neurosis or hysteria usually do not develop.
Risk factors for the development of neuroses include:
somatic diseases;
physical overstrain;
injuries;
professional dissatisfaction;
uncontrolled use of sleeping pills and tranquilizers;
alcohol abuse;
trouble in the family.
A special place in the clinic of neuroses is given to changes in the vegetative-endocrine system and homeostasis, which arose as a result of close ties of the higher vegetative centers with the psycho-emotional sphere.
Pathogenetic aspects of neuroses
To date, most scientists believe that the basic role in the pathogenesis of neurosis is assigned to the dysfunction of the limbic-reticular complex, in particular, the hypothalamic part of the intermediate brain. A malfunction of the limbic-reticular complex in neurosis is often combined with neurotransmitter disorders. This is evidenced by the insufficiency of the noradrenergic systems of the brain, which acts as one of the links in the mechanism of anxiety development.
There is also an opinion that pathological anxiety has a connection with the abnormal development of gabaergic and benzodiazepine receptors or a decrease in the number of neurotransmitters that affect them. This hypothesis is confirmed by the positive dynamics in the treatment of anxiety with benzodiazepine tranquilizers. The pathogenetic relationship of neurosis with a disorder of serotonin metabolism in the structures of the brain is evidenced by the positive effect of antidepressant therapy.
Classification of neuroses
The fact that neuroses are represented by diseases in which the absence of visible pathomorphological changes in the nervous system is combined with neuropsychiatric dysfunction does not at all exclude the material substrate of neuroses, since they develop subtle transient changes in nerve cells and metabolic processes at various levels of the nervous system. There are a large number of different classifications of neuroses in the medical literature. Most often in clinical practice, the separation of neuroses by form and by the nature of the course is used. Depending on the form , such neuroses are distinguished:
hysteria (hysterical neurosis);
neurasthenia;
motor and vegetative neuroses;
obsessive-compulsive disorder;
neurosis syndrome (neurosis-like states).
By the nature of the course , such types of neuroses are known:
acute neurosis;
reactive state (neurotic reactions);
neurotic development.
Hysteria
Hysterical neurosis (hysteria) is a rather complex disease, it is based on behavioral features that depend on increased suggestibility and emotionality of the individual. The risk group for hysteria includes women aged 20-40 years, although this disease also occurs in men. One of the features of the behavior of patients with hysterical neurosis is their desire to be the center of attention of others, to cause admiration, surprise, envy, etc. The increased emotionality of patients affects all assessments and judgments, as a result of which they become extremely unstable and changeable.
Neurasthenia
Neurasthenia is overwork, nervous exhaustion. It is expressed by a combination of fatigue and increased irritability. With this form of neurosis, patients are characterized by inadequate reactions to minimal stimuli, as well as the inability to suppress them. Neurotics can be irritated by too loud conversation, bright lights, etc., they often complain of bursting headaches and heaviness in the head. In addition, somatic symptoms are added: decreased appetite, sweating, bloating, tachycardia, polyuria, sleep disorders (difficulty falling asleep). Neurasthenia can be hyposthenic (depressive) and hypersthenic (irritable).
Motor neurosis
Motor neurosis refers to local motor dysfunctions: stuttering, tics, professional seizures. As a rule, their development is preceded by other neurasthenic disorders (headaches, hyper-irritability, fatigue, sleep disorders, etc.).
Vegetative neurosis
Vegetative neurosis is represented by selective dysfunction of internal organs. In most cases, with this form of neurosis, the cardiovascular system suffers, hypertension develops, the skin of patients becomes pale. The digestive and respiratory systems may also be affected.
Obsessive-compulsive disorder
Patients with obsessive-compulsive disorder have neurological symptoms and obsessive-phobic manifestations. Often, the clinic of this form of neurosis is expressed by cardiophobia (obsessive fear of cardiac pathologies), carcinophobia (fear of oncopathologies), claustrophobia (fear of enclosed spaces), etc. The neurological signs of this disease include poor sleep, mood deterioration, irritability.
Neurosis-like conditions develop against the background of general somatic pathologies, intoxication, trauma, infection, while neurasthenic disorders are less vivid in nature compared to the symptoms of other forms of neurosis.
Stages of neurosis development
There are three main stages in the development of neurosis. The main distinguishing feature of the first two stages from the third is the high probability of complete elimination of the disease in conditions of appropriate treatment tactics. In the absence of high-quality medical care and prolonged exposure to a traumatic stimulus, the third stage of neurosis develops. At the third stage of neurosis, changes in the personality structure become persistent and even with a competent approach to treatment, these personality disorders persist.
At the first stage of neurosis development, neurotic dysfunction occurs as a result of acute psychotrauma and has a short-term character (no more than one month). Most often, the first stage of neurosis manifests itself in childhood. In some cases, neurotic disorders can also occur in mentally healthy people.
The long course of a neurotic disorder develops into a neurotic state, which is represented by the neurosis itself. At the same time, personal characteristics undergo significant changes.
Common symptoms of neurosis
Common signs of neuroses can be various neurological dysfunctions, most often they are represented by tension headache, dizziness, hyperesthesia, a feeling of instability while walking, tremor of the limbs, muscle twitching and paresthesia. Also, patients with neurosis often have sleep disorders in the form of hypersomnia or insomnia. Permanent or paroxysmal disorders may develop on the part of the autonomic nervous system.
In case of damage to the cardiovascular system against the background of neurosis, patients complain of a feeling of discomfort or pain in the heart area. Objectively, such patients have a violation of the rhythm of heart contractions in the form of tachycardia or extrasystole, arterial hypotension or hypertension, Raynaud’s syndrome, pseudocoronary insufficiency syndrome. Respiratory disorders are expressed by a feeling of suffocation or a lump in the throat, lack of air, yawning and hiccups, as well as fear of suffocation.
Disorders of the digestive system against the background of neuroses include heartburn, vomiting, nausea, decreased appetite, constipation, diarrhea, flatulence and abdominal pain of unclear genesis. Genitourinary disorders manifest themselves in the form of enuresis, cystalgia, itching in the genital area, pollakiuria, decreased libido, as well as erectal disorders in men. Often, one of the symptoms of neurosis can be chills, subfebrility and hyperhidrosis. The skin of neurotic patients may be covered with a rash of the type of psoriasis, urticaria, atopic dermatitis.
One of the typical symptoms of neurosis is asthenia, which is expressed not only by mental, but also by physical fatigue. Patients may be disturbed by various phobias and constant anxiety, and some of them are prone to dystomy (mood decline, with a feeling of longing, grief, sadness, despondency).
Neuroses are often associated with mnestic disorders in the form of forgetfulness, inattention, deterioration of memorization and inability to concentrate.
Diagnosis of neurosis
The diagnosis of neuroses consists of several stages. The first is the collection of anamnesis. In the process of interviewing the patient, information is found out about the hereditary predisposition to this group of diseases, previous events in the patient’s life that could cause the disease.
In addition, during the diagnostic process, psychological testing of the patient, a pathopsychological examination, as well as studies of the personality structure are carried out.
The neurological status of a patient with neurosis implies the absence of focal symptoms. During the examination, tremor of the upper extremities may be visualized, when they are pulled forward, hyperhidrosis of the palms and a general revival of reflex reactions. In order to exclude cerebropathologies of vascular or organic origin, a number of additional studies are performed (ultrasound of the vessels of the head, MRI of the brain, EEG, REG). In the case of severe sleep disorders, a consultation with a somnologist is recommended, who decides whether it is advisable to conduct polysomniography.
The complex of diagnostic measures necessarily includes differential diagnosis, the main task of which is to exclude diseases with a similar clinic (bipolar disorder, schizophrenia, psychopathy), similar manifestations occur not only in neuropsychiatric disorders, but also in somatic diseases (cardiomyopathy, angina pectoris, chronic gastritis, glomerulonephritis, etc.), which also need to be excluded in the process of differential diagnosis. The main difference between patients with neurosis and psychiatric patients is their awareness of the disease, an accurate description of the signs and a desire to eliminate these pathological phenomena. Sometimes a psychiatrist may be involved to clarify the diagnosis. In some cases, you need the help of specialists of other categories of medicine (gynecologists, urologists, gastroenterologists, cardiologists, etc.), as well as ultrasound of the abdominal cavity, bladder, ECG, FGDS, etc.
Treatment of neurosis
To date, a large number of neurosis therapy methods are used in clinical practice. They apply an individual approach to treatment, depending on the characteristics of the patient’s personality and the form of neurosis, they can prescribe group psychotherapy, psychotropic and general restorative drug therapy. It is very important to have enough rest at the same time. For a positive effect from therapeutic measures, it is necessary to exclude the cause of the disease, which requires changing the environment that provoked it. If it is not possible to completely eliminate the cause of neurosis, all efforts are directed at reducing its significance, this is achieved through the use of various psychotherapy techniques.
In the case of vegetoneurosis, obsessive-compulsive neurosis, neurosis-like reactions and neurasthenia, the optimal treatment method will be persuasion psychotherapy (rational psychotherapy). To eliminate motor neuroses and hysteria, it is advisable to use the method of suggestion, both in the state of hypnotic sleep of the patient, and in the moments of wakefulness. Auto-trainings are often used for various forms of neurosis. During autogenic training, the doctor selects the right phrases, which in the future the patient repeats independently for 15-20 minutes. Auto-training is recommended to be performed twice a day, in the morning and evening, at this time it is better to be in a separate room. The patient should be in a lying or sitting position and completely relax. An auto-training session, most often, begins with similar phrases: “I am calm, I am relaxed, I am resting, I am completely calm. I feel warmth and heaviness in my limbs. My nervous system is resting,” etc. This is followed by verbal formulas aimed at various disorders — irritability, poor sleep, headache, shortness of breath, etc. The session ends with an extended formula of calmness, which inspires an understanding of the feeling that the patient is becoming calmer, more confident in himself and this state becomes stable. Autosuggestion can be used at home and it is not necessary to place the patient in a hospital. After such treatment, a good rest is recommended, for this the patient can be sent to a sanatorium resort.
In the case of severe forms of hysteria and motor neuroses, treatment in a hospital is mandatory.
Drug treatment of neurosis is based on neurotransmitter aspects of its origin. Medications help the patient to facilitate self-improvement in the process of psychotherapy and record the results achieved. In addition to medications, the mechanism of action of which is aimed at eliminating disorders of the nervous system, general restorative therapy is also provided, which includes multivitamins, glycine, adaptogens, as well as reflexology and physiotherapy.
Prognosis and prevention of neurosis
The prognosis of neurosis is interrelated with the form of this disease, as well as the age of the patient. The most favorable prognosis is for vegetative neurosis, neurasthenia, neurosis-like conditions (if they are not provoked by severe somatic pathologies). It is more difficult to cure psychasthenia, hysteria and motor neuroses.
Minimizing the incidence of neurosis contributes to a large number of conditions:
competent labor education in school and family;
positive atmosphere in the production team;
timely treatment of somatic diseases;
regulation of neuropsychiatric load;
fighting bad habits;
wide distribution of sports and tourist events.
Taking into account the fact that the cause of neuroses are factors that traumatize the psyche, measures to prevent them play a key role in the prevention of disorders of the nervous system. An important place in the prevention of neuroses is given to the fight against acute and chronic intoxication, trauma, as well as normalization of the rhythm of life and healthy sleep.
The process of personality formation largely depends on the upbringing of the child. Parents need to develop in the child such qualities as endurance, diligence, perseverance, the ability to overcome difficult situations. Children who have been allowed and pampered since childhood turn into egoists in the future, because it is difficult for them to take into account the opinions of others, such personalities are more prone to nervous breakdowns in situations that require endurance. Improper upbringing can cause a child to be sensitive to certain irritating factors.
The main tendency of the correct upbringing of a child is the exclusion of any direct or indirect benefits from short temper, nervousness and any other painful manifestations.
Prevention of relapses of neuroses is aimed at changing the patient’s attitude to events that can traumatize the psyche. This is achieved through a conversation with a patient or during auto-training.
