Neuroses are neuropsychic dysfunctions of a psychogenic nature, which manifest themselves in somatovegetative and emotional-affective clinical phenomena. These diseases include only those neuropsychic disorders in which their reversibility, combined with the absence of manifestations of pathomorphological disorders of the nervous system. Therapy for this group of diseases consists of two main directions, medication and psychotherapeutic treatment.

Causes of neurosis

The phenomenon of neurosis is caused by many different factors of an endogenous and exogenous nature. Each type of neurosis develops against the background of psychogenic disorders resulting from conflicts and psychoneurological stress. At the same time, the social and individual significance of the person who has succumbed to the experience is important, that is, the individual experiences a neurological reaction only if there is a stimulus that passes individually. Also, one of the key factors influencing the development of neurosis is the phenotypic personality trait, determined by heredity and upbringing.

According to the results of some studies, it is known that most often the formation of a hypersthenic neurasthenic is caused by neglect and poor upbringing, and a hyposthenic neurasthenic is formed if the personality is subject to oppression in the process of its development. With excessive attention from loved ones, there is a high risk of developing hysteria. If a person does not have any neurotic tendencies, then psycho-emotional overloads can provoke neurotic states, vegetoneurosis or reactive states; however, without a constitutional predisposition of the person, such types of neuroses as obsessional neurosis or hysteria usually do not develop.

Risk factors for the development of neuroses include:

• somatic diseases;
• physical stress;
• 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 that arose as a result of close connections between the higher vegetative centers and the psycho-emotional sphere.

Pathogenetic aspects of neuroses

Today, most scientists believe that the basic role in the pathogenesis of neurosis is assigned to dysfunction of the limbic-reticular complex, in particular, the hypothalamic part of the diencephalon. Failure in the functioning of the limbic-reticular complex in neuroses is often combined with neurotransmitter disorders. This is evidenced by the insufficiency of the noradrenergic systems of the brain, which is one of the links in the mechanism of anxiety development.

There is also an opinion that pathological anxiety is associated with the abnormal development of GABAergic and benzodiazepine receptors or a decrease in the amount of neurotransmitters that affect them. This hypothesis is confirmed by the positive dynamics in the treatment of anxiety with benzodiazepine tranquilizers. The pathogenetic connection of neurosis with a disorder of serotonin metabolism in brain structures 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 neuropsychic 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. IN medical literature There are a large number of different classifications of neuroses. Most often in clinical practice neuroses are divided according to their form and the nature of their course. Depending on the form, the following neuroses are distinguished:

• hysteria (hysterical neurosis);
• neurasthenia;
• motor and autonomic neuroses;
• obsessive-compulsive neurosis;
• neurosis syndrome (neurosis-like conditions).

Based on the nature of their course, the following 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 characteristics that depend on the 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 behavioral features of patients with hysterical neurosis is their desire to be the center of attention of others, to evoke 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. Neurosthenics may be irritated by too loud a conversation, bright light, etc.; they often complain of bursting headaches and heaviness in the head. In addition, somatic symptoms are added: loss of 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, occupational seizures. As a rule, their development is preceded by other neurasthenic disorders (headaches, hyperirritability, increased fatigue, sleep disturbances, etc.).

Autonomic neurosis

Autonomic neurosis is represented by selective dysfunction internal organs. In most cases, with this form of neurosis, the cardiovascular system suffers, hypertension develops, and the skin of patients becomes pale. The digestive and respiratory systems may also be affected.

Obsessive-compulsive disorder

Patients with obsessive-compulsive disorder have general neurological symptoms and obsessive-phobic manifestations. Often the clinical picture of this form of neurosis is expressed by cardiophobia (obsessive fear of cardiac pathologies), cancerophobia (fear of cancer pathologies), claustrophobia (fear of enclosed spaces), etc. General neurological signs of this disease include poor sleep, deterioration of mood, irritability.

Neurosis-like conditions develop against the background of general somatic pathologies, intoxication, trauma, infection, while neurasthenic disorders are less pronounced in nature compared to the symptoms of other forms of neurosis.

Stages of development of neurosis

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 the conditions of appropriate treatment tactics. In the absence of quality medical care and prolonged exposure to a traumatic stimulus, the third stage of neurosis develops. At the third stage of neurosis, changes in personality structure become persistent and even with a competent approach to treatment, these personality disorders persist.

At the first stage of the development of neurosis, neurotic dysfunction occurs as a result of acute psychotrauma and is short-term in nature (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 neurosis itself. At the same time, personal characteristics undergo significant changes.

General symptoms of neuroses

Common signs of neuroses can be various neurological dysfunctions, most often they are represented by tension headaches, dizziness, hyperesthesia, a feeling of instability while walking, tremors of the limbs, muscle twitching and paresthesia. Also, patients with neurosis often experience sleep disturbances in the form of hypersomnia or insomnia. Permanent or paroxysmal disorders may develop on the part of the autonomic nervous system.

In case of defeat of cardio-vascular system against the background of neurosis, patients complain of a feeling of discomfort or pain in the heart area. Objectively, such patients have a heart rhythm disturbance 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, loss of appetite, constipation, diarrhea, flatulence and abdominal pain of unknown origin. Genitourinary disorders manifest themselves in the form of enuresis, cystalgia, itching in the genital area, pollakiuria, decreased libido, as well as erectile dysfunction in men. Often one of the symptoms of neurosis may be chills, low-grade fever and hyperhidrosis. The skin of neurotic patients may become covered with a rash such as psoriasis, urticaria, or 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 bothered by various phobias and constant anxiety, and some of them are susceptible to dystomia (decline in mood, with feelings of melancholy, grief, sadness, despondency).

Neuroses are often associated with mental disorders in the form of forgetfulness, inattention, deterioration of memory and inability to concentrate.

Diagnosis of neurosis

Diagnosis of neuroses consists of several stages. The first is taking an anamnesis. In the process of interviewing the patient, information is found out about hereditary predisposition to this group of diseases, previous events in the patient’s life that could have caused the disease.

In addition, during the diagnostic process, psychological testing of the patient, pathopsychological examination, and personality structure studies are carried out.

The neurological status of a patient with neurosis implies the absence of focal symptoms. Tremor may be visualized during examination upper limbs, 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, the series is executed additional research(USDG of head vessels, MRI of the brain, EEG, REG). In case of severe sleep disorders, a consultation with a somnologist is recommended, who will decide on the advisability of polysomniography.

The complex of diagnostic measures necessarily includes differential diagnosis, the main task of which is to exclude diseases with a similar clinical picture (bipolar disorder, schizophrenia, psychopathy); similar manifestations occur not only in psychoneurological 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 symptoms and the desire to eliminate these pathological phenomena. Sometimes a psychiatrist may be brought in to clarify the diagnosis. In some cases, you need the help of specialists from other categories of medicine (gynecologists, urologists, gastroenterologists, cardiologists, etc.), as well as ultrasound of organs abdominal cavity, bladder, ECG, FGDS, etc.

Treatment of neurosis

Today, a large number of methods for treating neuroses 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 may prescribe group psychotherapy, psychotropic and restorative drug therapy. It is very important to get enough rest. For a positive effect from treatment 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 aimed at reducing its significance, this is achieved through the use of various techniques psychotherapy.

In the case of vegetative neurosis, 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 patient’s state of hypnotic sleep and during waking moments. Quite often, auto-training is used for various forms of neurosis. During autogenic training, the doctor selects the necessary phrases, which in the future the patient independently repeats for 15-20 minutes. It is recommended to perform auto-training 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 relaxed. An auto-training session most often begins with phrases like these: “I’m calm, I’m relaxed, I’m resting, I’m 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 expanded formula of calm, which instills an understanding that the patient is becoming calmer, more self-confident and this state is becoming stable. Self-hypnosis 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 may be sent to a sanatorium resort.

In the case of severe forms of hysteria and motor neuroses, hospital treatment is mandatory.

Drug treatment of neurosis is based on the neurotransmitter aspects of its origin. Medications help the patient to make it easier to work on himself during 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.

Forecast and prevention of neurosis

The prognosis of neurosis is interconnected with the form of the disease, as well as the age of the patient. The most favorable prognosis 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.

A large number of conditions contribute to minimizing the incidence of neuroses:

• competent labor education in school and family;
• positive atmosphere in the production team;
• timely treatment of somatic diseases;
• regulation of neuropsychic stress;
• fight against bad habits;
• widespread sporting and tourism events.

Taking into account the fact that neuroses are caused by factors that are traumatic to the psyche, measures to prevent them play a key role in the prevention of nervous system disorders. An important place in the prevention of neuroses is given to the fight against acute and chronic intoxications, injuries, as well as the 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 their child such qualities as endurance, hard work, perseverance, and the ability to overcome difficult situations. Children who have been allowed and pampered since childhood turn into egoists in the future, since it is difficult for them to take into account other people’s opinions; such individuals are more susceptible to nervous breakdowns in situations that require endurance. Improper upbringing can cause a child to be sensitive to certain irritating factors.

Main trend proper education child, this is the exclusion of any direct or indirect benefits from temper, nervousness and any other painful manifestations.

Prevention of relapse of neuroses is aimed at changing the patient’s attitude towards events that can traumatize the psyche. This is achieved through a conversation with the patient or during auto-training.

Depressive neurosis (neurotic depression) is a term applied to a group of diseases of the neurotic spectrum, characteristic feature which is depressive affect.

With neurosis, unlike psychosis, such deep damage to the psyche does not occur. A person retains an adequate perception of reality and criticism of what is happening. Another important difference is that this disease is caused by external factors, and not by underlying neuroendocrine disorders.

The cause of depressive neurosis is a long-existing psychotraumatic situation. The state of the nervous system, which has been functioning under stressful conditions for a long time, undergoes gradual changes and depressive neurosis develops over time.

Symptoms of depressive neurosis include the so-called “depressive triad”:

reduced, depressed mood;

slowing down of thought processes;

weakening of volitional motivation and motor retardation.

In addition, sleep disturbance and various symptoms of the autonomic nervous system are very often present:

headache;

accelerated heartbeat;

arterial hypertension;

periodic heart pain;

shortness of breath and other breathing disorders;

gastrointestinal disorders, etc.

As already mentioned, depressive neurosis is a collective concept that includes a number of mixed disorders:

astheno-neurotic;

anxious-phobic;

anxiety-depressive;

hypochondriacal.

To choose effective treatment, you need to conduct a full diagnosis. In addition, it is necessary to differentiate autonomic symptoms from serious somatic pathology (heart disease, bronchial asthma, diseases of the gastrointestinal tract, etc.). Only a specialist can do this.

Depressive neurosis and depression: what are the differences?

Although depressive neurosis and true (endogenous) depression have many common symptoms, there are fundamental differences between these diseases.

Intensity of manifestations

With endogenous depression, the decrease in mood reaches the level of the deepest, painful melancholy that is constantly present in the patient’s life. There are ideas of self-blame, even sinfulness, complete failure and lack of hope for change for the better. These experiences are so painful that a person is visited by thoughts of leaving life.

In the case of depressive neurosis, the decrease in mood is not so strong. Such patients do not have suicidal thoughts and, in general, have an optimistic outlook on the future.

Cause of occurrence

With endogenous depression, the cause lies within the patient himself. A persistent imbalance is formed in his neuroendocrine system, which does not depend on external factors. As a result, the patient’s emotional state is completely beyond volitional control or situational influence.

Depressive neurosis, on the contrary, is formed as a result of prolonged exposure to an external psychotraumatic factor. By switching his attention to a psychologically more comfortable situation, a person with depressive neurosis is able to temporarily escape its influence, while the symptoms of neurosis weaken for some time. A classic example is “running to work” when there are family problems.

Quality of life and social adaptation

With endogenous depression, a person loses his ability to work and becomes socially maladjusted. Moreover, due to severe motor retardation and apathy, the ability to self-care is sharply reduced.

With depressive neurosis, a person maintains high performance for a long time (if the traumatic situation is not related to work) and social activity. This is not due high level energy, but by psychological escape to conditions that are more comfortable for the patient’s psyche. However, persistent stressful situations and the return of symptoms cause a low level of quality of life.

This is the main difference between depressive neurosis, the symptoms and treatment of which largely depend on the cause of its occurrence. At the same time, this disease responds very well to treatment with psychotherapy and auxiliary general health methods (massage, physiotherapy, reflexology, etc.).

The Alliance mental health center employs qualified psychotherapists. Thanks to advanced diagnostic methods, they will be able to clarify the diagnosis and select the most effective treatment, which may include not only proven psychotherapeutic techniques (group, family, body-oriented therapy, etc.), but also rehabilitation measures: massage, physiotherapy, reflexology, etc.

Prognosis and possible complications

Provided that treatment is started in a timely manner, the prognosis for depressive neurosis is favorable. Manages to achieve full recovery, prevent relapses and significantly improve quality of life.

If neurotic depression exists long enough, it transforms into a deeper disease - neurotic personality disorder.

Another very important point is that if a chronic traumatic situation persists and there is no treatment, there is a high risk of developing addiction diseases. In this situation, they also act as methods of psychological escape. The most common diseases of addiction occur: alcoholism, drug addiction, gambling addiction. It is possible to form any of them or their combinations.

Treatment of any type of addiction is a separate, very difficult task. Therefore, it is better to start treatment for depressive neurosis in a timely manner and not expose yourself and your loved ones to the risk of encountering this serious problem.

Depressive neurosis occurs when a difficult life situation exists for a long time, which over time begins to seem hopeless and insoluble. Indeed, there are circumstances that cannot be changed. But even then, you can become healthy again and significantly improve your quality of life. This is possible thanks to psychotherapeutic techniques that will help you get out of the influence of a traumatic situation and learn to live in such a way that it does not provoke the development of the disease.

Forecast depends on the form of neurosis and the age of the patients. It is more favorable for neurasthenia, vegetative neurosis and neurosis-like conditions (if the latter are not caused by a severe and prolonged somatic illness). Hysteria, obsessive-compulsive neurosis and motor neuroses are more difficult to treat. However, with age, many emotional, affective and phobic disorders usually smooth out.

Most patients with neurosis can be treated on an outpatient basis followed by rest in a sanatorium, rest home, tourist center, etc. However, if the debut or exacerbation of the disease is caused by a serious family conflict, then it is better to hospitalize the patient immediately.

Work ability. When determining the duration of sick leave, it should be taken into account that for many patients, participation in work is one of the important switching and distracting therapeutic factors from the traumatic problem.

Patients with severe, often and long-term recurrent forms of neuroses are contraindicated in work associated with great neuropsychic or physical stress. If in production activities Patients have contraindicated factors and employment is associated with a decrease in qualifications, then they are sent to VTEK, where they are usually assigned disability group III with a period of re-examination after 6 months.

Prevention. A number of conditions contribute to reducing the incidence of neuroses and neurosis-like conditions: proper labor education in the family and school, normal relations in the production team, regulation of neuropsychic and physical stress, timely treatment of somatic diseases, widespread sports, tourism, as well as the fight against alcoholism and smoking. .

“Nervous diseases”, Yu.S. Martynov

The main methods of treating neuroses and neurosis-like conditions are psychotherapy (individual and group), rest, exclusion from the environment that provoked the disease, as well as restorative and psychotropic drugs. Depending on the form and severity of the neurosis, they are used in various combinations. For patients with relatively moderate hypersthenic and vegetative-vascular manifestations, milder sedatives are indicated - valerian, motherwort, passionflower, bromides or...

It is always important, during a conversation with a patient, to reveal the cause that is traumatic to the patient’s neuropsychic sphere and try to eliminate it, or, using various methods of psychotherapy, reduce its significance. In cases of neurasthenia, obsessional neurosis, vegetoneurosis and neurosis-like conditions, the method of rational psychotherapy (or persuasion psychotherapy) is used primarily; in those suffering from hysteria and motor neuroses, the method of suggestion is used both in the waking state,...

Possible complications from the use of tranquilizers - drowsiness, decreased psycho-emotional tone and memory (short-term), decreased speed of motor reactions, arterial hypotension, ataxia, impaired potency and sphincter function, nystagmus, double vision, dysarthria - from the use of antipsychotics - early and late extrapyramidal disorders (lingually -buccofacial dyskinesias, choreoathetoid hyperkinesis, parkinsonism) and vegetative-endocrine disorders (weight gain, amenorrhea, arterial hypotension, hyperglycemia, hypothermia or hyperthermia, ...

Neuroses are reversible (functional) neuropsychic disorders, characterized by specific emotional-affective and neurovegetative-somatic disorders, intact criticism and the absence of psychotic phenomena. Essentially, this is a pathological, most often selective, reaction of the individual to disturbances in micro-social and psychological relationships with other people. The term “neurosis” was first used by the Scottish physician Gullen at the end of the 18th century (1776) to refer to disorders that “are not accompanied by fever...

Classification. Many different classifications of neuroses have been proposed. According to the International Statistical Classification of Diseases, Injuries and Causes of Death, Ninth Revision (1975), the following forms of neuroses are distinguished: neurasthenia, hysterical neurosis, obsessional neurosis, neurotic phobias, anxiety neurosis (anxiety), hypochondriacal neurosis, neurotic depression, etc. Most convenient for clinical practice seems to divide neuroses into general ones, which include neurasthenia, hysteria and obsessive neurosis...

www.medkursor.ru

Neuroses: symptoms, classification, consequences and prognosis

Neuroses are a group of diseases in which both mental and physical symptoms. Unlike psychoses, neuroses do not have additional mental inclusions (delusions, hallucinations, affectation).

Main mental symptoms

Tearfulness, anxiety, vulnerability, touchiness, irritability.

Fatigue quickly; when trying to do some work, work efficiency decreases very quickly, memory, concentration, and thought processes deteriorate.

Sleep disorders: can manifest themselves in the form of problems falling asleep, shallow sleep, frequent nightmares during sleep, early awakening, while sleep in most cases does not bring relief or a feeling of rest.

The sensitivity threshold increases, which manifests itself in the form of intolerance to bright light, loud music, and temperature changes.

Decreased mood, frequent mood swings for no apparent reason.

Low self-esteem.

Being fixated on a traumatic situation, a person constantly returns in his thoughts to the situation that led to the emergence of neurosis, thereby further worsening his condition.

Any, even minor, psychotraumatic situation against the background of neurosis can contribute to the deterioration of the patient’s condition.

Sexual disorders in the form of decreased libido and potency.

The appearance of obsessive fears (phobias), memories, thoughts, panic attacks, anxiety.

Physical symptoms of neuroses

Autonomic disorders are always observed with neuroses: sweating, trembling of fingers, palpitations. Changes in blood pressure, with a tendency to decrease, “spots” before the eyes, and dizziness may also occur.

Vegetative symptoms involving the gastrointestinal tract - frequent urination, loose stools, rumbling in the abdomen.

Pain in the head, heart, abdomen.

Increased fatigue.

Impaired appetite, which can manifest itself in either a decrease or overeating.

With neuroses, as with somatized depression, patients consider themselves seriously ill. The physical symptoms observed in neuroses are interpreted by patients as the main ones, so they first of all go to a cardiologist, gastroenterologist, therapist, but not to a psychiatrist.

There are 3 classic forms of neuroses:

• hysterical neurosis;
• neurasthenia;
• obsessive-compulsive neurosis;

The main consequences of neuroses

• Marked decrease in performance. Because of rapid decline concentration, deterioration of thinking abilities and memorization, a person cannot perform previously familiar work, and quickly gets tired. In addition, due to sleep disturbances that accompany neurosis, there is no proper rest, which also contributes to a decrease in performance.
• The appearance of diseases of internal organs, decompensation of existing diseases. Since neuroses affect not only the mental, but also the somatic sphere, leading to a deterioration in the adaptive capabilities of the body, the risk of developing neurosis increases concomitant diseases internal organs, the risk of colds and infectious diseases increases.
• Family problems. Anxiety, tearfulness, and touchiness are frequent companions of neurosis. But it is precisely these qualities that contribute to the emergence of scandals, conflicts in the family, and misunderstandings.
• The appearance of obsessive states (fears, thoughts, memories) disrupts the normal life of sick people; they are forced to avoid traumatic situations and perform the same actions several times (or even dozens) to make sure that they did everything correctly.

The prognosis for neuroses is favorable. Disability of patients is extremely rare. When a traumatic situation is eliminated and treatment is started in a timely manner, the symptoms of neurosis disappear completely and the person can return to a normal, fulfilling life. In addition to medication and psychotherapeutic treatment, patients need proper rest for a quick recovery.

Forecast of neuroses

This section is devoted to general factors influencing the prognosis for all types of neurosis; We will also talk about the outcome of individual neurotic disorders discussed in this chapter.

GENERAL ISSUES

The prognosis of neuroses as a group of diseases should be considered depending on what “level” of the health care system they are identified. Approximately 50% of people aged 20–50 years whose neuroses are identified in population surveys of certain regions recover within three months (Hagnell 1970; Tennant et al. 1981a). Among patients with neuroses observed by general practitioners, about half recover within a year (Mann et al. 1981); in others, the condition remains unchanged for many months. Among patients referred for outpatient or inpatient psychiatric treatment, even after four years, only about 50% achieve a satisfactory level of adaptation (Greer, Cawley 1966). Looking at the problem from another angle, Goldberg and Huxley (1980, p. 104), based on data from Harvey Smith and Cooper (1970), estimated that the turnover of fresh cases seen in general practice was 70% and of chronic cases 3% per year. The mortality rate ranges from 1.5 to 2.0 among outpatients with neuroses and increases to 2.0 to 3.0 among inpatients (Sims 1978). The main causes of death are suicide or accident, but other causes are more common than might be expected, perhaps because the diagnosis of a primary physical illness causing a secondary emotional disorder was missed from the outset.

Of all the neurotic disorders discussed in this chapter, Acute reactions to stress They are, by definition, the most short-term; they make a significant contribution to the high turnover rates of the cases described above. Adaptation disorders By definition, they also generally have a good prognosis; their usual duration is several weeks or months, although sometimes longer. U Post-traumatic stress disorders The flow is similar; cases of prolonged course are in the minority, but their share is quite significant. At Minor affective disorders In almost half of patients, improvement occurs within three months, in three quarters of cases - within six months (Catalan et al. 1984).

It is not easy to predict the outcome of the disease for each individual patient with neurosis, but one must keep in mind that the following points may be associated with a tendency to aggravate the prognosis: symptoms that are severe from the very beginning; persistent social problems with no prospects for change for the better; lack of social support and friendships (Huxley et al. 1979; Cooper et al. 1969); the presence of personality pathology (Mann et al. 1981).



Let's get to know your child better - online children's tests

It is impossible to imagine the life of a modern person without psychology; this science is an indispensable assistant at any age. Thanks to the simplest psychological techniques.



Treatment of nervous tics

This condition occurs quickly and involuntarily, it is expressed in a monotonous muscle contraction, reminiscent of normal movement. Every person has it though.



This disease is characterized by the presence of a symptom such as teeth grinding, which is involuntary. Bruxism can occur due to strong emotions.



The main signs of nervous exhaustion. Treatment methods

With the concept of "nervous exhaustion" or syndrome chronic fatigue Unfortunately, almost every modern person is familiar with it. The causes of nervous exhaustion are:



Neurasthenia: symptoms and treatment

Neurasthenia is a disease accompanied by mental disorders, which are based on nervous overstrain and exhaustion. A mental disorder such as neurasthenia.



The effect of stress on the body

The concept of “stress” was first used by Walter Cannon, denoting a state of emotional tension in connection with an obvious threat. I studied it in more detail.



Neurosis of the stomach. Symptoms

Many people know about such problems, and heaviness in the stomach, belching, and heartburn are a familiar condition. There is also a localized burning sensation.



How to cure neurosis

Throughout their lives, people experience a significant amount of stress, depression and overexertion. Many events are unpredictable, which of course affects the psyche.



Autonomic neurosis

Vegetopathy, autonomic function, autonomic dystonia - all this is a group of diseases that develop when the functioning of the higher autonomic centers is disrupted.



Pain due to neuroses

Neuroses very often disrupt a person’s state of mind, and of course, are accompanied by a lot of unpleasant sensations. In this case, the person complains about.

www.psyportal.net

Holidays and traditions: psychological meaning

Mental processes: why are we not aware of all processes?

Recent comments

Popular queries

Treatment of neuroses

Neuroses- these diseases are chronic, but rarely progressive. Their course is always different and it depends not only on the therapy, but also on various factors.

« The more gifted and cheerful the premorbid personality is than sharper beginning the disease and the more pronounced the emotional radical in the disease, the more favorable the clinical and personal prognosis. Moreover, the long-term prognosis is better than the short-term one. A clear improvement or deterioration is not observed at any time, but, if at all, occurs several years after the onset of the neurotic disease” (K. Ernst). With depressive neurosis, the prognosis is more favorable than with organ neuroses, hypochondriacal developments, anxiety neuroses and obsessional neuroses.

In neurotic conditions it is often observed change of symptoms, for example, the transition from a conversion reaction to neurotic depression. Neuroses rarely turn into psychoses; in such cases, it is believed that the pseudoneurotic stage of the schizophrenic process has been overlooked. The transition from neurosis to drug addiction is considered a rare phenomenon.

If the course is unfavorable, » chronification» neurosis, which can lead to significant resistance to therapy. Such patients often simultaneously suffer from somatic diseases, which increases the overall soreness with chronic neuroses, and thereby mortality, as a result of suicide.

The course, as well as the very occurrence of neuroses, depends on the environment, which can delay or complicate the effect of therapeutic processing of the conflict and thereby delay its outcome. Favorable changes in the environment, on the other hand, help in overcoming conflict. As a result of targeted tension and satisfying activity, as well as during any threat or need, neuroses weaken.

In middle age, when the patient comes to terms with his problems and symptoms, neuroses often weaken. With age, it is easier for the patient to adapt and maintain peace of mind, and therefore exacerbations occur less frequently. Adaptation can be achieved through narrowing range of problems. Then the final one develops residual neurotic state while mitigating personality disorders.

Treatment of neuroses.

As a rule, patients with neuroses are treated on an outpatient basis. Indications for inpatient psychotherapy: severe anxiety states and obsessional syndromes, severe psychosomatic disorders (for example, anorexia) and the risk of suicide; Next, it is necessary to apply several psychotherapeutic techniques simultaneously, seeking to limit stress factors in the patient in the presence of a critical conflict situation. Hospital treatment treatment of neuroses should be carried out for a short time and in conditions as close as possible to home, since neurotic and psychosomatic patients should not be kept in large departments with a strict regime.

Respectively indications and purposes The following treatment options are possible:

Reassure the patient, ease his suffering, support and stabilize his condition. This is facilitated by medical conversation, advice, active and supportive long-term therapy and measures to relieve tension;

Change behavior, change attitudes towards symptoms, reduce their, retraining. In addition to behavioral therapy, educational activities are needed here;

Reasonable approach, reorientation, conflict resolution, restructuring, maturation. These goals are pursued by psychodynamically oriented types of psychotherapy.

What outcome is possible depends in each case on the type and severity of the disorder, personality structure and life circumstances, treatment and motivation of the patient, and, on the part of the psychotherapist, on his education and experience.

Drug therapy.

In practice, neurotic patients are often prescribed psychopharmacological drugs, which is explained by their mass production and the habits of doctors. Nevertheless, one should think about: for which neuroses, at what stages, which psychopharmacological agents are indicated.

Psychopharmacological drugs are most often prescribed for depressive neuroses, anxiety neuroses and phobias, as well as obsessional neuroses and anorexia - bulimia.

Pharmacotherapy for neuroses is limited to a certain stage of the course and the treatment situation. With severe depressive neurosis, anxiety neurosis or obsessional neurosis, even short-term psychopharmacotherapy brings relief and the use of psychotherapy becomes possible. Finally, pharmacotherapy is indicated for chronic and treatment-resistant neuroses, when the severity of symptoms remains after psychotherapy. In such cases, even long-term pharmacotherapy is useful, which should be combined with supportive and protective psychotherapy. Behavioral, cognitive. as well as relaxation therapy can be combined with pharmacotherapy without any fear. Pharmacotherapy must be prescribed by the doctor who conducts the psychotherapy.

Neuroses belong to a group of diseases that have a protracted course. This disease affects people who are characterized by constant overwork, lack of sleep, anxiety, grief, etc.

What is neurosis?

Neurosis is a set of psychogenic, functional, reversible disorders that tend to last a long time. The clinical picture of neurosis is characterized by obsessive, asthenic or hysterical manifestations, as well as a temporary weakening of physical and mental performance. This disorder is also called psychoneurosis or neurotic disorder.

Neuroses in adults are characterized by a reversible and not very severe course, which distinguishes them, in particular, from psychoses. According to statistics, up to 20% of the adult population suffers from various neurotic disorders. The percentage may vary among different social groups.

The main mechanism of development is the disorder brain activity, which normally ensures human adaptation. As a result, both somatic and mental disorders arise.

The term neurosis was introduced into medical terminology in 1776 by a doctor from Scotland, William Cullen.

Causes

Neuroses and neurotic conditions are considered a multifactorial pathology. Their occurrence is caused by a large number of reasons that act together and trigger a large complex of pathogenetic reactions leading to pathology of the central and peripheral nervous system.

The cause of neuroses is the action of a psychotraumatic factor or a psychotraumatic situation.

1. In the first case, we are talking about a short-term but strong negative impact on a person, for example, the death of a loved one.
2. In the second case, we talk about the long-term, chronic impact of a negative factor, for example, a family conflict situation. Speaking about the causes of neurosis, it is psychotraumatic situations and, above all, family conflicts that are of great importance.

Today there are:

• psychological factors in the development of neuroses, which are understood as the characteristics and conditions of personality development, as well as upbringing, the level of aspirations and relationships with society;
• biological factors, which are understood as functional insufficiency of certain neurophysiological as well as neurotransmitter systems that make patients susceptible to psychogenic influences

Equally often, all categories of patients, regardless of their place of residence, experience psychoneurosis due to such tragic events as:

• death or loss of a loved one;
• serious illness in loved ones or in the patient himself;
• divorce or separation from a loved one;
• dismissal from work, bankruptcy, business collapse, and so on.

It is not entirely correct to talk about heredity in this situation. The development of neurosis is influenced by the environment in which a person grew up and was brought up. A child, looking at parents prone to hysteria, adopts their behavior and exposes his nervous system to injury.

According to the American Psychiatric Association, the incidence of neuroses in men ranges from 5 to 80 cases per 1000 population, while in women it ranges from 4 to 160.

A variety of neuroses

Neuroses are a group of diseases that arise in humans due to exposure to mental trauma. As a rule, they are accompanied by a deterioration in a person’s well-being, mood swings and manifestations of somato-vegetative manifestations.

Neurasthenia

Neurasthenia (nervous weakness or fatigue syndrome) is the most common form of neuroses. Occurs during prolonged nervous overstrain, chronic stress and other similar conditions that cause fatigue and “breakdown” of the protective mechanisms of the nervous system.

Neurasthenia is characterized by the following symptoms:

• increased irritability;
• high excitability;
• rapid fatigue;
• loss of the ability to self-control and self-control;
• tearfulness and touchiness;
• absent-mindedness, inability to concentrate;
• decreased ability to endure prolonged mental stress;
• loss of usual physical endurance;
• severe sleep disturbances;
• loss of appetite;
• apathy and indifference to what is happening.

Hysterical neurosis

Vegetative manifestations of hysteria manifest themselves in the form of spasms, persistent nausea, vomiting, and fainting. Characteristic movement disorders- trembling, tremor in the limbs, blepharospasm. Sensory disorders are expressed by sensory disturbances in various parts of the body, pain, and hysterical deafness and blindness may develop.

Patients strive to attract the attention of loved ones and doctors to their condition; they have extremely unstable emotions, their mood changes sharply, they easily move from sobbing to wild laughter.

There are a specific type of patients with a tendency to hysterical neurosis:

• Impressionable and sensitive;
• Self-hypnosis and suggestibility;
• With mood instability;
• With a tendency to attract external attention.

Hysterical neurosis must be distinguished from somatic and mental illnesses. Similar symptoms occur in schizophrenia, central nervous system tumors, endocrinopathy, and encephalopathy due to trauma.

Obsessive-compulsive disorder

A disease characterized by the occurrence of obsessive ideas and thoughts. A person is overcome by fears that he cannot get rid of. In this condition, the patient often exhibits phobias (this form is also called phobic neurosis).

Symptoms of neurosis of this form manifest themselves as follows: a person feels fear, which manifests itself with repeated unpleasant incidents.

For example, if a patient faints on the street, then in the same place the next time he will be haunted by obsessive fear. Over time, a person develops a fear of death, incurable diseases, and dangerous infections.

Depressive form

Depressive neurosis develops against the background of prolonged psychogenic or neurotic depression. The disorder is characterized by deterioration in sleep quality, loss of the ability to rejoice, and chronic low mood. The disease is accompanied by:

• heart rhythm disturbances,
• dizziness,
• tearfulness,
• increased sensitivity,
• stomach problems,
• intestines,
• sexual dysfunction.

Symptoms of neurosis in adults

Neurosis is characterized by instability of mood and impulsive actions. Mood swings affect all areas of the patient’s life. It affects interpersonal relationships, goal setting, and self-esteem.

Patients experience memory impairment, low concentration attention, high fatigue. A person gets tired not only from work, but also from his favorite activities. Intellectual activity becomes difficult. Due to absent-mindedness, the patient can make many mistakes, which causes new problems at work and at home.

Among the main signs of neurosis are:

• causeless emotional stress;
• increased fatigue;
• insomnia or constant desire to sleep;
• isolation and obsession;
• lack of appetite or overeating;
• weakening of memory;
• headache (long lasting and sudden onset);
• dizziness and fainting;
• darkening of the eyes;
• disorientation;
• pain in the heart, abdomen, muscles and joints;
• hand trembling;
• frequent urination;
• increased sweating (due to fear and nervousness);
• decreased potency;
• high or low self-esteem;
• uncertainty and inconsistency;
• incorrect prioritization.

People suffering from neuroses often experience:

• mood instability;
• a feeling of self-doubt and the correctness of the actions taken;
• overly expressed emotional reaction to minor stress (aggression, despair, etc.);
• increased sensitivity and vulnerability;
• tearfulness and irritability;
• suspiciousness and exaggerated self-criticism;
• frequent manifestation of unreasonable anxiety and fear;
• inconsistency of desires and changes in the value system;
• excessive fixation on the problem;
• increased mental fatigue;
• decreased ability to remember and concentrate;
• high degree of sensitivity to sound and light stimuli, reaction to minor temperature changes;
• sleep disorders.

Signs of neurosis in women and men

Signs of neurosis in the fair sex have their own characteristics that are worth mentioning. First of all, it is typical for women asthenic neurosis(neurasthenia), caused by irritability, loss of mental and physical ability, and also leading to problems in sexual life.

The following types are typical for men:

• Depressive - the symptoms of this type of neurosis are more common in men; the reasons for its appearance are the inability to realize oneself at work, the inability to adapt to sudden changes in life, both personal and social.
• Male neurasthenia. It usually occurs against the background of overstrain, both physical and nervous, and most often it affects workaholics.

Signs climacteric neurosis, developing in both men and women, are increased emotional sensitivity and irritability, decreased stamina, sleep disturbances, and general problems with the functioning of internal organs, starting between 45 and 55 years.

Stages

Neuroses are diseases that are fundamentally reversible, functional, without organic damage to the brain. But they often take a protracted course. This is connected not so much with the traumatic situation itself, but with the characteristics of a person’s character, his attitude to this situation, the level of adaptive capabilities of the body and the system psychological protection.

Neuroses are divided into 3 stages, each of which has its own symptoms:

1. The initial stage is characterized by increased excitability and irritability;
2. The intermediate stage (hypersthenic) is characterized by increased nerve impulses from the peripheral nervous system;
3. The final stage (hyposthenic) is manifested by decreased mood, drowsiness, lethargy and apathy due to the strong severity of inhibition processes in the nervous system.

A longer course of a neurotic disorder, changes in behavioral reactions and the emergence of an assessment of one’s illness indicate the development of a neurotic state, i.e., neurosis itself. An uncontrollable neurotic state for 6 months - 2 years leads to the formation of neurotic personality development.

Diagnostics

So what kind of doctor will help cure neurosis? This is done by either a psychologist or psychotherapist. Accordingly, the main treatment tool is psychotherapy (and hypnotherapy), most often complex.

The patient needs to learn to look objectively at the world around him, to realize his inadequacy in some matters.

Diagnosing neurosis is not an easy task, which only an experienced specialist can do. As mentioned above, the symptoms of neurosis manifest themselves differently in both women and men. It is also necessary to take into account that each person has his own character, his own personality traits, which can be confused with signs of other disorders. That is why only a doctor should make a diagnosis.

The disease is diagnosed using a color technique:

• All colors take part in the technique, and a neurosis-like syndrome manifests itself when choosing and repeating purple, gray, black and brown colors.
• Hysterical neurosis is characterized by the choice of only two colors: red and purple, which 99% indicates the patient’s low self-esteem.

To identify signs of a psychopathic nature, a special test is carried out - it allows you to identify the presence of chronic fatigue, anxiety, indecisiveness, and lack of self-confidence. People with neuroses rarely set long-term goals for themselves, do not believe in success, they often have complexes about their own appearance, and it is difficult for them to communicate with people.

Treatment of neuroses

There are many theories and methods of treating neuroses in adults. Therapy takes place in two main directions - pharmacological and psychotherapeutic. The use of pharmacological therapy is carried out only in extreme cases. severe forms diseases. In many cases, qualified psychotherapy is sufficient.

In the absence of somatic pathologies, patients are necessarily recommended to change their lifestyle, normalize work and rest, sleep at least 7-8 hours a day, eat right, give up bad habits, spend more time on fresh air and avoid nervous overload.

Medicines

Unfortunately, very few people suffering from neuroses are ready to work on themselves and change something. Therefore, medications are widely used. They do not solve problems, but are intended only to relieve the severity of the emotional reaction to a traumatic situation. After them it just becomes easier on the soul - for a while. Maybe then it’s worth looking at the conflict (within yourself, with others or with life) from a different angle and finally resolving it.

With the help of psychotropic drugs, tension, tremors, and insomnia are eliminated. Their appointment is permissible only for a short period of time.

For neuroses, the following groups of drugs are usually used:

• tranquilizers – alprazolam, phenazepam.
• antidepressants – fluoxetine, sertraline.
• sleeping pills – zopiclone, zolpidem.

Psychotherapy for neuroses

Currently, the main methods of treating all types of neuroses are psychotherapeutic techniques and hypnotherapy. During psychotherapy sessions, a person gets the opportunity to build a complete picture of his personality, to establish cause-and-effect relationships that gave impetus to the emergence of neurotic reactions.

Treatment methods for neuroses include color therapy. The right color for the brain is beneficial, just like vitamins are for the body.

• To extinguish anger and irritation, avoid the color red.
• When you are in a bad mood, eliminate black and dark blue tones from your wardrobe and surround yourself with light and warm colors.
• To relieve tension, look at blue, greenish tones. Replace the wallpaper at home, choose the appropriate decor.

Folk remedies

Before using any folk remedies for neurosis, we recommend consulting with your doctor.

1. For restless sleep, general weakness, or those suffering from neurasthenia, pour a teaspoon of verbena herb into a glass of boiling water, then leave for an hour, take small sips throughout the day.
2. Tea with lemon balm - mix 10 g of tea leaves and herbal leaves, pour 1 liter of boiling water, drink tea in the evening and before bed;
3. Mint. Pour 1 cup boiling water over 1 tbsp. a spoonful of mint. Let it brew for 40 minutes and strain. Drink a cup of warm decoction in the morning on an empty stomach and in the evening before bed.
4. Bath with valerian. Take 60 grams of root and boil for 15 minutes, leave to brew for 1 hour, strain and pour into a bathtub with hot water. Take 15 minutes.

Forecast

The prognosis of neurosis depends on its type, stage of development and duration of course, timeliness and adequacy of the psychological and medicinal assistance provided. In most cases, timely initiation of therapy leads, if not to cure, then to a significant improvement in the patient’s condition.

The long-term existence of neurosis is dangerous due to irreversible personality changes and the risk of suicide.

Prevention

Despite the fact that neurosis is treatable, it is still better to prevent than to treat.

Prevention methods for adults:

• The best prevention in this case would be to normalize your emotional background as much as possible.
• Try to eliminate irritating factors or change your attitude towards them.
• Avoid overload at work, normalize your work and rest schedule.
• It is very important to give yourself proper rest, eat right, sleep at least 7-8 hours a day, take daily walks, and play sports.

Neuroses

Neuroses are functional disorders of higher nervous activity of psychogenic origin. The clinical picture of neuroses is very diverse and may include somatic neurotic disorders, autonomic disorders, various phobias, dysthymia, obsessions, compulsions, and emotional and mental problems. A diagnosis of “neurosis” can be made only after excluding clinically similar psychiatric, neurological and somatic diseases. Treatment has 2 main components: psychotherapeutic (psychocorrection, training, art therapy) and medication (antidepressants, tranquilizers, antipsychotics, restoratives).

Neuroses

Neurosis as a term was introduced in 1776 in Scotland by a doctor named Couplen. This was done in contrast to the previously stated statement by G. Morgagni that the basis of each disease is a morphological substrate. The author of the term “neurosis” meant functional health disorders that did not have organic damage to any organ. Subsequently, the famous Russian physiologist I.P. made a great contribution to the doctrine of neuroses. Pavlov.

In ICD-10, instead of the term “neurosis,” the term “neurotic disorder” is used. However, today the concept of “neurosis” is widely used in relation to psychogenic disorders of higher nervous activity, i.e., caused by the action of chronic or acute stress. If the same disorders are associated with the influence of other etiological factors (for example, toxic exposure, trauma, past illness), then they are classified as so-called neurosis-like syndromes.

In the modern world, neurosis is a fairly common disorder. In developed countries, 10% to 20% of the population suffers from various forms of neurotic disorders, including children. In the structure of mental disorders, neuroses account for about 20-25%. Since the symptoms of neurosis are often not only psychological, but also somatic in nature, this issue is relevant both for clinical psychology and neurology, and for a number of other disciplines: cardiology, gastroenterology, pulmonology, pediatrics.

Causes of neurosis

Despite extensive research in this area, the true cause of neurosis and the pathogenesis of its development are not known for certain. For a long time, neurosis was considered an information disease associated with intellectual overload and a fast pace of life. In this regard, more low frequency diseases of neuroses among residents of rural areas were explained by their calmer lifestyle. However, studies conducted among air traffic controllers refuted these assumptions. It turned out that, despite the intense work that requires constant attention, quick analysis and response, dispatchers suffer from neuroses no more often than people in other professions. Among the reasons for their illness were mainly family troubles and conflicts with superiors, rather than overwork during work.

Other studies, as well as the results of psychological testing of patients with neuroses, have shown that it is not the quantitative parameters of the traumatic factor (multiplicity, strength) that are of decisive importance, but its subjective significance for a particular individual. Thus, external trigger situations that provoke neurosis are very individual and depend on the patient’s value system. Under certain conditions, any, even everyday, situation can form the basis for the development of neurosis. At the same time, many experts come to the conclusion that it is not the stressful situation itself that matters, but the incorrect attitude towards it, as destroying a personal prosperous present or threatening the personal future.

A certain role in the development of neurosis belongs to the psychophysiological characteristics of a person. It has been noted that people with increased suspiciousness, demonstrativeness, emotionality, rigidity, and subdepression are more likely to suffer from this disorder. Perhaps the greater emotional lability of women is one of the factors leading to the fact that the development of neurosis in them is observed 2 times more often than in men. Hereditary predisposition to neurosis is realized precisely through the inheritance of certain personal characteristics. In addition, an increased risk of developing neurosis exists during periods of hormonal changes (puberty, menopause) and in persons who had neurotic reactions in childhood (enuresis, logoneurosis, etc.).

Pathogenetic aspects of neurosis

The modern understanding of the pathogenesis of neurosis assigns the main role in its development to functional disorders of the limbic-reticular complex, primarily the hypothalamic part of the diencephalon. These brain structures are responsible for ensuring internal connections and interaction between the autonomic, emotional, endocrine and visceral spheres. Under the influence of an acute or chronic stressful situation, integrative processes in the brain are disrupted with the development of maladaptation. However, no morphological changes were noted in the brain tissue. Since disintegration processes cover the visceral sphere and the autonomic nervous system, in the clinic of neurosis, along with mental manifestations, somatic symptoms and signs of vegetative-vascular dystonia.

Disruption of the limbic-reticular complex in neuroses is combined with neurotransmitter dysfunction. Thus, a study of the mechanism of anxiety revealed a deficiency of noradrenergic systems of the brain. There is an assumption that pathological anxiety is associated with an abnormality of benzodiazepine and GABAergic receptors or a decrease in the amount of neurotransmitters acting on them. The effectiveness of treating anxiety with benzodiazepine tranquilizers confirms this hypothesis. The positive effect of antidepressants that affect the functioning of the serotonergic system of the brain indicates a pathogenetic connection between neurosis and disorders of serotonin metabolism in cerebral structures.

Classification of neuroses

Personal characteristics, the psychophysiological state of the body and the specific dysfunction of various neurotransmitter systems determine the variety of clinical forms of neuroses. In domestic neurology, there are three main types of neurotic disorders: neurasthenia, hysterical neurosis (conversion disorder) and obsessive-compulsive disorder. All of them are discussed in detail in the corresponding reviews.

Depressive neurosis, hypochondriacal neurosis, and phobic neurosis are also distinguished as independent nosological units. The latter is partly included in the structure of obsessive-compulsive disorder, since obsessions are rarely isolated and are usually accompanied by obsessive phobias. On the other hand, in ICD-10, anxiety-phobic neurosis is included as a separate item called “anxiety disorders.” By features clinical manifestations it is classified as panic attacks (paroxysmal autonomic crises), generalized anxiety disorder, social phobias, agorophobia, nosophobia, claustrophobia, logophobia, aichmophobia, etc.

Neuroses also include somatoform (psychosomatic) and post-stress disorders. With somatoform neurosis, the patient’s complaints fully correspond to the clinical picture of a somatic disease (for example, angina pectoris, pancreatitis, peptic ulcer, gastritis, colitis), however, with a detailed examination with laboratory tests, ECG, gastroscopy, ultrasound, irrigoscopy, colonoscopy, etc. this pathology is not detected. There is a history of a traumatic situation. Post-stress neuroses are observed in people who have survived natural disasters, man-made accidents, fighting, terrorist attacks and other mass tragedies. They are divided into acute and chronic. The first are transient and appear during or immediately after tragic events, usually in the form of a hysterical attack. The latter gradually lead to personality changes and social maladaptation (for example, Afghan neurosis).

Stages of development of neurosis

In their development, neurotic disorders go through 3 stages. In the first two stages, due to external circumstances, internal reasons or under the influence of treatment, neurosis may cease to exist without a trace. In cases of prolonged exposure to a traumatic trigger, in the absence of professional psychotherapeutic and/or medicinal support for the patient, the 3rd stage occurs - the disease passes into the stage of chronic neurosis. Persistent changes occur in the structure of the personality, which remain in it even with effectively carried out therapy.

The first stage in the dynamics of neurosis is considered to be a neurotic reaction - a short-term neurotic disorder lasting no more than 1 month, resulting from acute psychological trauma. Typical for children. As an isolated case, it can occur in completely mentally healthy people.

A longer course of a neurotic disorder, changes in behavioral reactions and the emergence of an assessment of one’s illness indicate the development of a neurotic state, i.e., neurosis itself. An uncontrollable neurotic state for 6 months - 2 years leads to the formation of neurotic personality development. The patient’s relatives and the patient himself talk about a significant change in his character and behavior, often reflecting the situation with the phrase “he/she was replaced.”

General symptoms of neuroses

Autonomic disorders are multisystem in nature and can be either permanent or paroxysmal (panic attacks). Disorders of the nervous system function are manifested by tension headaches, hyperesthesia, dizziness and a feeling of unsteadiness when walking, tremors, shudders, paresthesias, muscle twitchings. Sleep disturbances are observed in 40% of patients with neuroses. They are usually represented by insomnia and daytime hypersomnia.

Neurotic dysfunction of the cardiovascular system includes: discomfort in the cardiac region, arterial hypertension or hypotension, rhythm disturbances (extrasystole, tachycardia), cardialgia, pseudocoronary insufficiency syndrome, Raynaud's syndrome. Respiratory disorders observed in neurosis are characterized by a feeling of lack of air, a lump in the throat or suffocation, neurotic hiccups and yawning, fear of suffocation, and an imaginary loss of respiratory automaticity.

On the part of the digestive system, dry mouth, nausea, loss of appetite, vomiting, heartburn, flatulence, vague abdominal pain, diarrhea, and constipation may occur. Neurotic disorders of the genitourinary system cause cystalgia, pollakiuria, itching or pain in the genital area, enuresis, frigidity, decreased libido, and premature ejaculation in men. Thermoregulation disorder leads to periodic chills, hyperhidrosis, and low-grade fever. With neurosis, dermatological problems may arise - rashes such as urticaria, psoriasis, atopic dermatitis.

A typical symptom of many neuroses is asthenia - increased fatigue, both mental and physical. Anxiety syndrome is often present - a constant expectation of upcoming unpleasant events or danger. Phobias are possible - obsessive-type fears. With neurosis, they are usually specific, related to a specific object or event. In some cases, neurosis is accompanied by compulsions - stereotypical obsessive motor acts, which can be rituals corresponding to certain obsessions. Obsessions are painful intrusive memories, thoughts, images, desires. As a rule, they are combined with compulsions and phobias. In some patients, neurosis is accompanied by dysthymia - low mood with feelings of grief, melancholy, loss, despondency, sadness.

Mnestic disorders that often accompany neurosis include forgetfulness, impaired memory, greater distractibility, inattention, inability to concentrate, an affective type of thinking and some narrowing of consciousness.

Diagnosis of neurosis

The leading role in the diagnosis of neurosis is played by identifying a traumatic trigger in the anamnesis, data from psychological testing of the patient, studies of personality structure and pathopsychological examination.

The neurological status of patients with neurosis does not reveal any focal symptoms. There may be a general revival of reflexes, hyperhidrosis of the palms, tremor of the fingertips when stretching the arms forward. The exclusion of cerebral pathology of organic or vascular origin is carried out by a neurologist using EEG, MRI of the brain, REG, and ultrasound scanning of the vessels of the head. In case of severe sleep disturbances, it is possible to consult a somnologist and conduct polysomnography.

A differential diagnosis of neurosis with clinically similar psychiatric (schizophrenia, psychopathy, bipolar disorder) and somatic (angina pectoris, cardiomyopathy, chronic gastritis, enteritis, glomerulonephritis) diseases. A patient with neurosis differs significantly from psychiatric patients in that he is well aware of his illness, accurately describes the symptoms that bother him and wants to get rid of them. In difficult cases, the examination plan includes a consultation with a psychiatrist. To exclude pathology of internal organs, depending on the leading symptoms of neurosis, the following is prescribed: consultation with a cardiologist, gastroenterologist, urologist, gynecologist and other specialists; ECG, ultrasound of the abdominal organs, FGDS, ultrasound of the bladder, CT scan of the kidneys and other studies.

Treatment of neurosis

The basis of neurosis therapy is the elimination of the impact of a traumatic trigger. This is possible either by resolving a traumatic situation (which is extremely rare), or by changing the patient’s attitude towards the current situation in such a way that it ceases to be a traumatic factor for him. In this regard, psychotherapy is the leading treatment option.

Traditionally, in relation to neuroses, complex treatment is used, combining psychotherapeutic methods and pharmacotherapy. In mild cases, only psychotherapeutic treatment may be sufficient. It is aimed at revising the attitude towards the situation and resolving the internal conflict of a patient with neurosis. Among the methods of psychotherapy, it is possible to use psychocorrection, cognitive training, art therapy, psychoanalytic and cognitive behavioral psychotherapy. Additionally, training in relaxation techniques is provided; in some cases - hypnotherapy. Therapy is carried out by a psychotherapist or medical psychologist.

Drug treatment of neurosis is based on the neurotransmitter aspects of its pathogenesis. It has a supporting role: it facilitates work on oneself during psychotherapeutic treatment and consolidates its results. For asthenia, depression, phobias, anxiety, panic attacks, the leading antidepressants are: imipramine, clomipramine, amitriptyline, St. John's wort extract; more modern ones - sertraline, fluoxetine, fluvoxamine, citalopram, paroxetine. In the treatment of anxiety disorders and phobias, anxiolytic drugs are additionally used. For neuroses with mild manifestations, herbal sedatives and short courses of mild tranquilizers (mebikar) are indicated. In case of advanced disorders, preference is given to benzodiazepine tranquilizers (alprazolam, clonazepam). For hysterical and hypochondriacal manifestations, it is possible to prescribe small doses of antipsychotics (tiapride, sulpiride, thioridazine).

Multivitamins, adaptogens, glycine, reflexology and physiotherapy (electrosleep, darsonvalization, massage, hydrotherapy) are used as supportive and restorative therapy for neurosis.

Forecast and prevention of neurosis

The prognosis of neurosis depends on its type, stage of development and duration of course, timeliness and adequacy of the psychological and medicinal assistance provided. In most cases, timely initiation of therapy leads, if not to cure, then to a significant improvement in the patient’s condition. The long-term existence of neurosis is dangerous due to irreversible personality changes and the risk of suicide.

A good prevention of neuroses is to prevent the occurrence of traumatic situations, especially in childhood. But the best way may be to cultivate the right attitude towards upcoming events and people, develop an adequate system of life priorities, and get rid of misconceptions. Strengthening the psyche is also facilitated by adequate sleep, good work and an active lifestyle, healthy eating, and hardening.

Forecast of neuroses

GENERAL ISSUES

The prognosis of neuroses as a group of diseases should be considered depending on what “level” of the health care system they are identified. Approximately 50% of older adults found to have neuroses in local population surveys recover within three months (Hagnell 1970; Tennant et al. 1981a). Among patients with neuroses observed by general practitioners, about half recover within a year (Mann et al. 1981); in others, the condition remains unchanged for many months. Among patients referred for outpatient or inpatient psychiatric treatment, even after four years, only about 50% achieve a satisfactory level of adaptation (Greer, Cawley 1966). Looking at the problem from another angle, Goldberg and Huxley (1980, p. 104), based on data from Harvey Smith and Cooper (1970), estimated that the turnover of fresh cases seen in general practice was 70% and of chronic cases 3% per year. The mortality rate ranges from 1.5 to 2.0 among outpatients with neuroses and increases to 2.0 to 3.0 among inpatients (Sims 1978). The main causes of death are suicide or accident, but other causes are more common than might be expected, perhaps because the diagnosis of a primary physical illness causing a secondary emotional disorder was missed from the outset.

Of all the neurotic disorders discussed in this chapter, Acute stress reactions are, by definition, the most short-lived; they make a significant contribution to the high turnover rates of the cases described above. Adaptation disorders, by definition, generally also have a good prognosis; their usual duration is several weeks or months, although sometimes longer. Post-traumatic stress disorder has a similar course; cases of prolonged course are in the minority, but their share is quite significant. In minor affective disorders, almost half of patients improve within three months, in three quarters of cases - within six months (Catalan et al. 1984).

Let's get to know your child better - online children's tests

It is impossible to imagine the life of a modern person without psychology; this science is an indispensable assistant at any age. Thanks to the simplest psychological techniques.

Treatment of nervous tics

This condition occurs quickly and involuntarily, it is expressed in a monotonous muscle contraction, reminiscent of normal movement. Every person has it though.

Bruxism

This disease is characterized by the presence of a symptom such as teeth grinding, which is involuntary. Bruxism can occur due to strong emotions.

The main signs of nervous exhaustion. Treatment methods

Unfortunately, almost every modern person is familiar with the concept of “nervous exhaustion” or chronic fatigue syndrome. The causes of nervous exhaustion are:

Neurasthenia: symptoms and treatment

Neurasthenia is a disease accompanied by mental disorders, which are based on nervous overstrain and exhaustion. A mental disorder such as neurasthenia.

The effect of stress on the body

The concept of “stress” was first used by Walter Cannon, denoting a state of emotional tension in connection with an obvious threat. I studied it in more detail.

Neurosis of the stomach. Symptoms

Many people know about such problems, and heaviness in the stomach, belching, and heartburn are a familiar condition. There is also a localized burning sensation.

How to cure neurosis

Throughout their lives, people experience a significant amount of stress, depression and overexertion. Many events are unpredictable, which of course affects the psyche.

Autonomic neurosis

Vegetopathy, autonomic function, autonomic dystonia - all this is a group of diseases that develop when the functioning of the higher autonomic centers is disrupted.

Pain due to neuroses

Neuroses very often disrupt a person’s state of mind, and of course, are accompanied by a lot of unpleasant sensations. In this case, the person complains about.

Neuroses: symptoms, classification, consequences and prognosis

Neuroses are a group of diseases in which both mental and physical symptoms are simultaneously observed. Unlike psychoses, neuroses do not have additional mental inclusions (delusions, hallucinations, affectation).

Main mental symptoms

• Tearfulness, anxiety, vulnerability, touchiness, irritability.
• Fatigue quickly; when trying to do some work, work efficiency decreases very quickly, memory, concentration, and thought processes deteriorate.
• Sleep disorders: can manifest themselves in the form of problems falling asleep, shallow sleep, frequent nightmares during sleep, early awakening, while sleep in most cases does not bring relief or a feeling of rest.
• The sensitivity threshold increases, which manifests itself in the form of intolerance to bright light, loud music, and temperature changes.
• Decreased mood, frequent mood swings for no apparent reason.
• Low self-esteem.
• Being fixated on a traumatic situation, a person constantly returns in his thoughts to the situation that led to the emergence of neurosis, thereby further worsening his condition.
• Any, even minor, psychotraumatic situation against the background of neurosis can contribute to the deterioration of the patient’s condition.
• Sexual disorders in the form of decreased libido and potency.
• The appearance of obsessive fears (phobias), memories, thoughts, panic attacks, anxiety.

Physical symptoms of neuroses

• Autonomic disorders are always observed with neuroses: sweating, trembling of fingers, palpitations. Changes in blood pressure, with a tendency to decrease, “spots” before the eyes, and dizziness may also occur.
• Vegetative symptoms involving the gastrointestinal tract - frequent urination, loose stools, rumbling in the abdomen.
• Pain in the head, heart, abdomen.
• Increased fatigue.
• Impaired appetite, which can manifest itself in either a decrease or overeating.

With neuroses, as with somatized depression, patients consider themselves seriously ill. The physical symptoms observed in neuroses are interpreted by patients as the main ones, so they first of all go to a cardiologist, gastroenterologist, therapist, but not to a psychiatrist.

There are 3 classic forms of neuroses:

• hysterical neurosis;
• neurasthenia;
• obsessive-compulsive neurosis;

The main consequences of neuroses

• Marked decrease in performance. Due to a rapid decrease in concentration, deterioration of thinking abilities and memorization, a person cannot perform previously familiar work and quickly gets tired. In addition, due to sleep disturbances that accompany neurosis, there is no proper rest, which also contributes to a decrease in performance.
• The appearance of diseases of internal organs, decompensation of existing diseases. Since neuroses affect not only the mental, but also the somatic sphere, they lead to a deterioration in the adaptive capabilities of the body, the risk of the appearance of concomitant diseases of internal organs against the background of neurosis increases, and the risk of colds and infectious diseases increases.
• Family problems. Anxiety, tearfulness, and touchiness are frequent companions of neurosis. But it is precisely these qualities that contribute to the emergence of scandals, conflicts in the family, and misunderstandings.
• The appearance of obsessive states (fears, thoughts, memories) disrupts the normal life of sick people; they are forced to avoid traumatic situations and perform the same actions several times (or even dozens) to make sure that they did everything correctly.

The prognosis for neuroses is favorable. Disability of patients is extremely rare. When a traumatic situation is eliminated and treatment is started in a timely manner, the symptoms of neurosis disappear completely and the person can return to a normal, fulfilling life. In addition to medication and psychotherapeutic treatment, patients need proper rest for a quick recovery.

Forecast of neuroses

This section is devoted to general factors influencing the prognosis for all types of neurosis; We will also talk about the outcome of individual neurotic disorders discussed in this chapter.

The prognosis of neuroses as a group of diseases should be considered depending on what “level” of the health care system they are identified. Approximately 50% of people aged 20–50 years whose neuroses are identified in population surveys of certain regions recover within three months (Hagnell 1970; Tennant et al. 1981a). Among patients with neuroses observed by general practitioners, about half recover within a year (Mann et al. 1981); in others, the condition remains unchanged for many months. Among patients referred for outpatient or inpatient psychiatric treatment, even after four years, only about 50% achieve a satisfactory level of adaptation (Greer, Cawley 1966). Looking at the problem from another angle, Goldberg and Huxley (1980, p. 104), based on data from Harvey Smith and Cooper (1970), estimated that the turnover of fresh cases seen in general practice was 70% and of chronic cases 3% per year.

The mortality rate ranges from 1.5 to 2.0 among outpatients with neuroses and increases to 2.0 to 3.0 among inpatients (Sims 1978). The leading causes of death are suicide or accident, but other causes are more common than might be expected, perhaps because the diagnosis of a primary physical illness causing a secondary emotional disorder was missed from the outset.

Of all the neurotic disorders discussed in this chapter, acute reactions to stress are, by definition, the most short-lived; they make a significant contribution to the high turnover rates of the cases described above. Adaptation disorders, by definition, also generally have a good prognosis; their usual duration is several weeks or months, although sometimes longer. Post-traumatic stress disorder has a similar course; cases of prolonged course are in the minority, but their share is quite significant. With minor affective disorders, almost half of the patients improve within three months, in three quarters of cases - within six months (Catalan et al. 1984).

It is not easy to predict the outcome of the disease for each individual patient with neurosis, but one must keep in mind that the following points may be associated with a tendency to aggravate the prognosis: symptoms that are severe from the very beginning; persistent social problems with no prospects for change for the better; lack of social support and friendships (Huxley et al. 1979; Cooper et al. 1969); the presence of personality pathology (Mann et al. 1981).

Epidemiology of neuroses

Epidemiology of neuroses Neurotic disorders can occur at three “levels”: as individual symptoms, as minor neurotic disorders and as specific neurotic syndromes. Some symptoms may occur from time to time in some people with

Etiology of neuroses

Etiology of neuroses This section is devoted to an analysis of the common causes of neuroses. Factors specific to the etiology of individual neurotic syndromes are discussed in the next chapter. GENETIC FACTORS Obviously, the tendency to develop neurosis, revealed by psychological

Course and prognosis

Course and prognosis It is more convenient to consider the course and prognosis of bipolar and unipolar disorders separately, since more information is available regarding bipolar cases. Bipolar disorders As stated earlier, with bipolar disorders observed by

Course and prognosis

Course and Prognosis Although it has become generally accepted that outcome in schizophrenia is worse than in most other mental disorders, there have been surprisingly few long-term follow-up studies of patients with schizophrenia. There have been even fewer studies

Psychological prognosis

Psychological prognosis professional look activity of a psychologist, whose goal is to formulate a conclusion about the future state of a person at the level of individual mental characteristics or at the level of practically important parameters of his activity based on

The concept of neuroses, their essence, main forms, course and causes of occurrence. The role of educational defects in the incorrect formation of personality. Characteristics of neurasthenia, obsessive-compulsive neurosis and hysterical neuroses, their prognosis and treatment.

Send your good work in the knowledge base is simple. Use the form below

Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.

FEDERAL EDUCATION AGENCY

VLADIVOSTOK STATE UNIVERSITY OF ECONOMICS AND SERVICE

INSTITUTE OF CORRESPONDENCE AND DISTANCE LEARNING

in the discipline "Clinical Psychology"

Classification of neuroses: forms, course, therapy, prognosis

gr. ZPS04 T.A. Karpova

1 Neuroses, their forms and course………………………………………. ……….6

1.2 Obsessive-compulsive neurosis………………………………………………………….9

List of sources used……………………………………. 18

At the end of the 19th century, psychology began to gradually lose the character of a speculative science; methods of natural science were introduced into its research. The experimental methods of W. Wundt and his students penetrated psychological clinics. Experimental psychological laboratories were also opened in Russia - the laboratory of V.M. Bekhterev in Kazan (1885), S.S. Korsakov in Moscow (1886), then the laboratories of V.F. Chizh in Yuryev, I.A. Sikorsky in Kyiv and etc.

Already at the turn of this century, some scientists talk about the emergence of a new branch of psychological science. Thus, V.M. Bekhterev writes in 1904: “The latest advances in psychiatry, due largely to the clinical study of mental disorders at the patient’s bedside, served as the basis for a special department of knowledge known as pathological psychology, which has already led to the resolution of many psychological problems and from which, no doubt, even more in this regard can be expected in the future.”

Mental disorders were considered as an experiment of nature, and affecting mostly false psychological phenomena, to which experimental psychology has not yet had an approach. The principle adopted at the school of V.M. Bekhterev qualitative analysis disorders of psychological activity became a tradition in Russian psychology. V.M. Bekhterev, S.D. Vladychko, V.Ya. Anfimov and other representatives of the school developed many methods for experimental psychological research of mentally ill people, some of which were among the most used in Soviet pathopsychology.

A prominent role in determining the direction of domestic experimental psychology was played by Bekhterev’s student A.F. Lazursky, the organizer of his own psychological school. L.S. Vygotsky wrote that Lazursky was one of those researchers who were on the path of transforming empirical psychology into scientific psychology. A.F. Lazursky was an innovator in the experimental and methodological field: he pushed the boundaries of experiment in psychology, applying it under normal conditions Everyday life, and made it a subject experimental research specific forms of activity and complex manifestations of personality. A natural experiment developed by A.F. Lazursky, initially for educational psychology, was introduced into the clinic. In the clinic, the “natural experiment” was used in the organization of leisure time for patients, their activities and entertainment - with special purpose Counting problems, puzzles, riddles, and tasks to fill in missing letters and syllables in the text were given.

The second center in which it developed clinical psychology, there was a psychiatric clinic of S.S. Korsakov in Moscow. In this clinic, the second psychological laboratory in Russia was organized in 1886, headed by A.A. Tokarsky. Like all representatives of progressive trends in psychiatry, S.S. Korsakov was of the opinion that knowledge of the fundamentals of psychological science makes it possible to correctly understand the disintegration of the mental activity of a mentally ill person. It is no coincidence that he began teaching a course in psychiatry by presenting the foundations of psychology.

A major role in the formation of pathopsychology as a specific field of knowledge was played by the ideas about the subject activity of the outstanding Soviet psychologist L.S. Vygotsky, which were further developed in general psychology by his students and collaborators A.N. Leontiev, A.R. Luria, P.Ya .Galperin, L.I.Bozhovich, A.V.Zaporozhets and others.

Vygotsky expressed the position that 1) the human brain has different principles for organizing functions than the animal brain; 2) the development of higher mental functions is not predetermined by the morphological structure of the brain alone; mental processes do not arise as a result of the maturation of brain structures alone, they are formed during life as a result of training, education, communication and appropriation of the experience of mankind; 3) damage to the same zones of the cortex has different meaning at different stages mental development. These provisions largely determined the path of pathopsychological and neuropsychological research.

By changing a person’s mental activity, the disease leads to various forms of pathology of personal characteristics. In the psychiatric literature there are exceptionally vivid and truthful descriptions of personality disorders characteristic of various diseases and states. However, the analysis of these violations is carried out mainly in terms of everyday or outdated empirical psychology. Therefore, the study of personality shifts in the concepts of modern materialistic psychology is currently one of the most promising tasks. These studies are needed not only for psychiatric practice, they are also useful for resolving theoretical issues in personality psychology.

Currently, extensive research is being carried out on changes in the hierarchical structure of motives and their meaning-forming function; The so-called internal picture of the disease in various mental illnesses is studied. Using the theory of attitude of D.N. Uznadze, a number of psychologists and psychiatrists in Georgia study attitude disorders in various forms mental illness. All these studies allow us to approach the study of the question posed in his time by L, S, Vygotsky about the relationship between the development and decay of the psyche, a question of methodological significance.

The participation of psychologists is now becoming not only necessary, but often a leading factor both in rehabilitation work and in the field of prevention of mental illness.

1 Neuroses, their forms and course

Neuroses are reversible borderline mental disorders, recognized by patients, caused by exposure to traumatic factors and occurring with emotional and somatovegetative disorders.

The main cause of neurosis is mental trauma, but post-morbid personality characteristics are also important. The greater the predisposition to the development of neurosis, the less mental trauma matters. The concept of “premorbital personal predisposition to neuroses” includes character traits inherited from parents such as emotional instability, anxiety, vulnerability; features of personality formation and its level of maturity; various asthenic factors that precede the onset of neurosis (for example, somatic diseases, overwork, lack of sleep).

The peculiarities of personality formation are of great importance. Thus, it has been noted that mental trauma suffered in childhood contributes to the appearance of neurosis in adults. In this case, the age at which the child found himself in a traumatic situation also plays a role, since the traits characteristic of this period can be preserved in an adult. For example, an older adult who has lost his parents, suffered a long separation from them, or has suffered from a severe somatic illness with a long stay in the hospital may exhibit such personal characteristics as excessive spontaneity in communication, emotional lability, that is, traits characteristic of children of one year. Their presence in an adult creates difficulties in communicating with others and leads to adaptation disorders.

As people get older, intellectual activity develops. From this period, the teenager can independently build complex conclusions and plan actions. Typically, the development of intellectual activity is associated with a complication of the emotional sphere. In psychotraumatic situations, liveliness, activity, and interest in what is happening, which are observed normally, are suppressed by unpleasant experiences. Developing intellectual activity can acquire an abstract character. A teenager who has experienced mental trauma becomes, as it were, more mature. He begins to read a lot, talk about complex problems to the detriment of contacts with peers and interests typical of children of his age. In this case, there are no mental disorders, but the harmony of the process of personality formation is disrupted.

Defects in upbringing play a large role in the incorrect formation of personality. Parents who are overly protective of a child suppress his activity, impose their own interests on him, solve all his problems for him, often make increased demands for school success, and humiliate him. In such conditions, character traits such as timidity, indecisiveness, lack of self-confidence are formed, and difficulties arise in communicating with peers. These traits, preserved in adults, may predispose to neuroses. When a child becomes the idol of the family, he knows no prohibitions, his every action is admired, all desires are immediately satisfied, he does not develop sense of purpose, the ability to overcome difficulties, restraint and other qualities necessary in communicating with others.

It is customary to distinguish three main clinical forms of neuroses: neurasthenia, hysterical neurosis, and obsessive-compulsive neurosis. Over the years, domestic psychiatrists also began to distinguish neurotic depression (depressive neurosis). The International Classification of Diseases presents a larger number of neuroses. For example, neurotic phobias, fear neurosis (anxiety), hypochondriacal neurosis. Clinical practice and long-term follow-up observations indicate that these forms can be assessed as stages in the dynamics of the main forms of neuroses.

Neurasthenia, accompanied physical exhaustion, characterized by dysfunction of the autonomic nervous system, increased irritability, fatigue, tearfulness, and depressed mood (depression).

In the initial period of the disease, lethargy, passivity or motor restlessness occur with fussiness, distractibility and exhaustion of attention, fatigue increases towards the end of the day or week. Unreasonable fears, dissatisfaction, depressed mood, intolerance to sharp or loud sounds, smells, temperature fluctuations and other irritants appear. Complaints of headache, discomfort in various parts of the body. Sleep disorders in the form of difficulty falling asleep, persistent insomnia, and dreams with night terrors are also characteristic. Sometimes patients with neurasthenia experience loss of appetite, nausea, unexplained stool disorders, neurodermatitis, enuresis, tic, stuttering, and fainting. The main symptoms of neurasthenia are irritable weakness and increased exhaustion; due to the predominance of the first or second, the following are distinguished:

a) hypersthenic form of neurasthenia, the basis of which is the weakening of internal inhibition, which manifests itself in irritability, explosive reactions, incontinence, impulsiveness;

b) hyposthenic, which is based on the exhaustion of the irritable process with phenomena of extreme protective inhibition. The clinic is dominated by feelings of fatigue, weakness, drowsiness, some psychomotor retardation. These forms may be in different stages.

The course is usually favorable. A chronic psychotraumatic situation can be the cause of protracted forms of neurasthenia, leading to neurotic asthenic personality formation.

1.2 Obsessive-compulsive disorder

Obsessive-compulsive neurosis is characterized by the appearance after severe psychotrauma of obsessions of varying content, phobias, increased anxiety, depressed mood, and various autonomic disorders.

Obsessive-compulsive neurosis is less common than neurasthenia and more often occurs in people with anxious and suspicious character traits, especially when the body is weakened by somatic and infectious diseases. Dominant in the picture of obsessive-compulsive neurosis are various obsessive-compulsive disorders. Depending on the nature of the prevailing obsessive disorders, three types of neurosis are somewhat conventionally distinguished: obsessive - characterized by obsessive thoughts, ideas, ideas; compulsive - obsessive desires and actions; phobic - obsessive fears.

In childhood, neurosis of obsessive movements, neurosis of obsessive thoughts and fears, and obsessive-compulsive neurosis of a mixed type are distinguished.

Obsessive movement neurosis is more common at the age of 3-7 years, decreases and is expressed in tic hyperkinesis or movements (rapid blinking, repeated grimaces, licking or biting lips, head movements, twitching shoulders, grunting or grunting sounds, jumping, shuffling or periodically stopping when walking). Obsessive movements are a “cleansing act” that frees a child at the age of conscious childhood from an unpleasant feeling of internal tension, anxiety, and fear, which are based on conflicting neurotic experiences. With a prolonged course, obsessive movements become habitual, lose their protective meaning and the emotional attitude towards them disappears. Obsessive movements are often combined with increased exhaustion, fatigue, irritability, emotional lability, motor disinhibition, sleep disturbance, and appetite. With age, there is a tendency towards the gradual disappearance of habitual actions. Approximately 2/3 of patients adolescence turn out to be practically healthy.

Neurosis of obsessive thoughts and fears can manifest itself as fear of illness and death, sharp objects, heights, closed spaces, infection, pollution, “missing” urine or feces in society, giving an oral response at school, etc. To temporarily reduce the intensity of fears, patients perform obsessive protective (ritual) actions, directly or symbolically related to the content of fears (obsessively washing hands, shaking them off, spitting, repeating actions a certain number of times, circling, underlining letters when writing, etc.) . This neurosis also includes expectation neurosis, which is manifested by an anxious expectation of failure when performing habitual actions and physiological functions - speech, reading, walking, swallowing, urination - and difficulties in performing them when necessary. Over a long period of time, there is a persistent decline in mood and a transition to the neurotic development of an obsessive-phobic personality type. Full recovery by adolescence is observed in half of the patients.

Obsessive-compulsive neurosis of a mixed type manifests itself more often in children aged 10-13, and is less likely to be a combination of ideational obsessions (ideas, counting, memories, thoughts, etc.) with affective and motor ones. Fears such as apprehensions, frightening ideas, memories, disturbing doubts are noted; protective actions of a symbolic nature or complex multi-stage construction (hours-long rituals of dressing, undressing, going to bed, etc.), less often ideational rituals such as “making wishes” and “spells”. Just as with other forms of obsessive-compulsive neurosis, depressive and hypochondriacal syndromes and signs of vegetative-vascular instability occur. In most cases, neurosis turns into neurotic (obsessive) personality development with traits of indecision, uncertainty and pedantry, anxiety, and a tendency to get stuck on unpleasant experiences that inhibit the patients’ usual activities.

Patients cannot free themselves from obsessive experiences by force of will, although they retain a clear critical attitude towards obsessive experiences, awareness of their absurdity and painfulness. Conditions combined into obsessional neurosis, in comparison with other types of neuroses, tend to have a protracted course. It can manifest itself in relapses, alternating with periods of complete recovery, or occur continuously with periodic weakening and exacerbation of painful symptoms. Sometimes the manifestation of neurosis can be limited to a single attack.

1.3 Hysterical neurosis

Hysterical neurosis is much more common in at a young age, and more often in women than in men, and occurs more easily in psychopathic individuals of the hysterical circle. The variety and variability of hysterical disorders are to a certain extent explained by the basic hysterical features characteristic of these patients - great suggestibility and self-hypnosis.

The clinical picture of hysterical neurosis includes motor, sensory and autonomic disturbances.

Motor disorders manifest themselves in the form of hysterical seizures, hyperkinesis, paralysis and paresis. Since ancient times, a hysterical attack has been considered one of the classic manifestations of hysteria. The latter most often occurs after a quarrel, unpleasant news, excitement, etc., as a rule, in the presence of “spectators” and extremely rarely when the patient is alone. During a hysterical attack, consciousness is not completely lost. Unlike an epileptic seizure, during a hysterical seizure there is no general tonic muscle contraction, so the fall occurs in the form of an exhausted gradual descent to the floor. Then clonic convulsions occur. During a seizure, the patient arches, leaning on the back of his head and heels (hysterical arch), knocks his legs, screams monotonously, shouts individual phrases, and tears out his hair. A hysterical attack is also chaotic, theatrical and sweeping, and “requires” a lot of space. The reactions of the pupils to light, to painful and olfactory stimuli are preserved. So, if you pour cold water on a patient or let him smell ammonia, then you can stop the attack.

Currently, due to the pathomorphosis of hysterical disorders, full-blown hysterical seizures are rare. In modern manifestations they resemble hypertensive crisis, angina pectoris, diencephalic disorders arising in connection with a traumatic situation.

Examples of functional hyperkinesis include tics, rough and rhythmic tremor of the head, choreiform movements and twitching, trembling of the whole body, which intensifies with fixation of attention, weakens in a calm environment and disappears in sleep.

Hysterical paresis and paralysis in some cases resemble central spastic paralysis, in others - peripheral flaccid paralysis. Here, despite the apparent complete paralysis of the limbs, involuntary automatic movements are possible in them. Gait disorders, known as astasia-abasia, often occur. In this case, patients are not able to stand or walk, but at the same time, in a supine position, they can make any movements with their legs. The basis of hysterical aphonia - loss of voice - is paralysis of the vocal cords. Unlike organic ones, in hysterical paralysis, tendon reflexes are preserved, and muscle tone does not change.

Sensory disorders include psychogenically caused disorders that simulate disorders of one or another sensory organ: hysterical blindness, deafness, loss of smell and taste.

Frequent sensitivity disorders in the form of anesthesia, hypo- and hyperesthesia usually do not correspond to the laws of innervation and are localized according to the type of “gloves”, “stockings”, “jackets”, etc. Sometimes disorders of skin sensitivity, characterized by a bizarre location and configuration, are localized in the extremities.

Hysterical pain (algia) can be localized in any part of the body: headaches in the form of a hoop, tightening the forehead and temples, a driven nail, pain in the joints, limbs, abdominal area, etc. There are numerous indications in the literature that such pain can cause not only erroneous diagnoses, but also surgical interventions.

With hysterical neurosis, patients, on the one hand, always emphasize the uniqueness of their suffering, speaking about “terrible”, “unbearable” pain, the extraordinary, unique, previously unknown nature of the symptoms, on the other hand, they seem to show indifference to the “paralyzed limb”, they are not burdened "blindness" or inability to speak.

Symptoms associated with disorders of the autonomic nervous system vary greatly. These include: a hysterical lump in the throat with excitement, a feeling of obstruction of food through the esophagus, psychogenic vomiting, combined with spasm of the pyloric stomach, spasms in the throat accompanied by shortness of breath and a feeling of lack of air (hysterical asthma), palpitations and painful painful sensations in the area of ​​the heart (hysterical angina), etc. It should be especially noted that patients with hysterical neurosis are easily susceptible to self-hypnosis. The literature describes a case of pseudopregnancy caused by self-hypnosis. The patient, who tried in this way to achieve a mitigation of the court sentence, experienced an enlargement of the abdomen (hysterical flatulence) and mammary glands.

2 Therapy and prognosis

Treatment of patients with neuroses should be comprehensive, including, along with psychotherapy, drug treatment with psychopharmacological and restorative agents (vitamins, nootropic drugs, a rational diet, walks, exercise, massage, etc.), and the prescription of psychotropic drugs. Social measures aimed at eliminating psychotraumatic factors and normalizing psychological climate around the patient. To achieve this, it is advisable to carry out treatment in a hospital setting. Psychotherapeutic influence is applied differentially, taking into account the characteristics of the manifestation of neurosis. It includes both individual conversations, suggestions in a state of wakefulness and hypnosis, as well as group and family psychotherapy. If, at the height of an acute neurotic state, psychotherapy is designed to promote calm, reduce internal tension and anxiety, then at subsequent stages it should be aimed at restructuring disturbed interpersonal relationships.

The prognosis for life is favorable. Restoring working capacity and social adaptation requires a long time, but with proper organization of complex treatment, complete recovery can occur.

So, the main cause of neuroses is mental trauma. Here, in contrast to reactive states, neurotic reactions arise from long-acting psychotraumatic factors, leading to constant emotional stress. The emergence of neurosis is often caused not by a person’s direct and immediate reaction to an unfavorable situation, but by his prolonged processing of the current situation and his inability to adapt to new conditions. In other words, for the development of neurosis, in addition to mental trauma, the presence of a unique personality structure is necessary. The greater the predisposition, the less mental trauma is sufficient for the development of neurosis.

According to I.P. Pavlov, an important role in the pathogenesis of neuroses belongs to the influence on the central nervous system of external factors that are excessive in strength or duration, causing disruption of higher nervous activity.

With the development of neurosis, a certain sequence of symptoms appears. Thus, in the first stages the leading ones are vegetative disorders, later sensorimotor (somatic), emotional and ideational ones are added. These disorders with different neuroses have their own characteristics. For example, ideation disorders with neurasthenia are expressed in the inability to concentrate, increased distractibility, exhaustion of intellectual activity, and the inability to assimilate the necessary material. In hysterical neurosis - in emotional logic, when the basis of actions, assessments and conclusions is an emotional assessment of the environment, and not an adequate analysis of events. With obsessive-compulsive neurosis - in the complication of obsessions, joining “mental chewing gum” to phobias, obsessive doubts. The significant severity of ideation disorders indicates the protracted nature of the neurosis and their transition into neurotic personality development.

List of sources used

1 Popov Yu.V., Vid V.D. Modern clinical psychiatry. - M., 1997

2 Kjell L., Ziegler D. Theories of personality. - Peter, 2005

3 Gulyamov M.G. Psychiatry. - Dushanbe, 1993

4 Child psychoneurology / Ed. prof. L.A. Bulakhova. Kyiv, 2001

5 Jaspers K. General psychoatology. - M., 1997

This section is devoted to general factors influencing the prognosis for all types of neurosis; We will also talk about the outcome of individual neurotic disorders discussed in this chapter.

GENERAL ISSUES

The prognosis of neuroses as a group of diseases should be considered depending on what “level” of the health care system they are identified. Approximately 50% of people aged 20–50 years whose neuroses are identified in population surveys of certain regions recover within three months (Hagnell 1970; Tennant et al. 1981a). Among patients with neuroses observed by general practitioners, about half recover within a year (Mann et al. 1981); in others, the condition remains unchanged for many months. Among patients referred for outpatient or inpatient psychiatric treatment, even after four years, only about 50% achieve a satisfactory level of adaptation (Greer, Cawley 1966). Looking at the problem from another angle, Goldberg and Huxley (1980, p. 104), based on data from Harvey Smith and Cooper (1970), estimated that the turnover of fresh cases seen in general practice was 70% and of chronic cases 3% per year. The mortality rate ranges from 1.5 to 2.0 among outpatients with neuroses and increases to 2.0 to 3.0 among inpatients (Sims 1978). The main causes of death are suicide or accident, but other causes are more common than might be expected, perhaps because the diagnosis of a primary physical illness causing a secondary emotional disorder was missed from the outset.

Of all the neurotic disorders discussed in this chapter, Acute reactions to stress They are, by definition, the most short-term; they make a significant contribution to the high turnover rates of the cases described above. Adaptation disorders By definition, they also generally have a good prognosis; their usual duration is several weeks or months, although sometimes longer. The current is similar; cases of prolonged course are in the minority, but their share is quite significant. At Minor affective disorders In almost half of patients, improvement occurs within three months, in three quarters of cases - within six months (Catalan et al. 1984).

It is not easy to predict the outcome of the disease for each individual patient with neurosis, but one must keep in mind that the following points may be associated with a tendency to aggravate the prognosis: symptoms that are severe from the very beginning; persistent social problems with no prospects for change for the better; lack of social support and friendships (Huxley et al. 1979; Cooper et al. 1969); the presence of personality pathology (Mann et al. 1981).

The content of the article

Interest in the problem neuroses determined primarily by the high prevalence of this suffering. According to official WHO data, the number of neuroses has increased 24 times over the past 65 years, while the number of mental illnesses has increased only 1.6 times. Mass epidemiological studies conducted by G. K. Ushakov et al. (1972), found various shapes neurotic disorders in the vast majority of people. Now the expansionary trends that existed in the past, in which the group of neuroses included epilepsy, hyperkinetic syndromes, tetany, and cataplexy, have been completely overcome. The difficulties of the modern stage are associated with differential diagnosis between neuroses, on the one hand, and neurosis-like organic syndromes, psychopathy and initial forms of endogenous mental illnesses, on the other. To overcome these difficulties, it is necessary to develop certain criteria for diagnosing neuroses. The most important point is the recognition of the psychogenic genesis of neuroses, their development following mental trauma. It should be emphasized that this approach is practically key, and without a psychotraumatic factor it is difficult to imagine the development of a neurotic state. The history of patients with neurosis includes both current psychotraumas (work-related, family, intimate) associated with the development of the disease, as well as unfavorable living conditions during childhood. The latter include an incomplete family, improper upbringing, family conflicts, and dramatic situations. In response to an unfavorable situation that is psychotraumatic in nature, childhood neuroses (logoneurosis, hyperkinesis, bedwetting) may develop. U large number Children during this period have no neurotic manifestations. Such children remain, as it were, especially sensitive, sensitized; unfavorable life circumstances later, in adulthood, lead to the emergence of neurosis. However, psychological trauma alone is often not enough for the development of neurosis. There are practically no people who have not gone through mental trauma. To explain the factor of individual-selective impact of psychotraumas, attempts were made to classify them by severity. This is a very difficult task, and each person demonstrates an individual, unique reaction to seemingly identical situations encountered in life.
The second important link in the genesis of neuroses is personality traits. V. N. Myasishchev (1966) defined neuroses as a disease of personality disorder. After all, a person’s personality is primarily manifested in his attitude towards the environment. In order for a psychotraumatic factor to become pathogenic, it must be given significance. It is not the objective severity of psychogenicity, but its importance and difficulty of tolerance for the individual that leads to the emergence of neurotic disorders. The characteristics of a person’s personality are formed as an alloy of hereditary-constitutional traits and external environmental factors determined by living conditions and upbringing. The main personality traits are formed in the childhood period of life, hence the role that is given to childhood psychotrauma.
The combination of a psychogenic factor and certain personality characteristics is a favorable condition for the formation of the main ptogenetic link - mental conflict. At the same time, difficulties arise in implementing correct behavior. There are several types of characteristic conflict when “incompatibility, a clash of contradictory personality relationships” arises [Myasishchev V.N., 1966]. Thus, inflated claims of an individual can be combined with an underestimation or complete ignorance of objective real conditions; contradictory tendencies are formed between desire and duty, moral principles and personal attachments; contradictions between the real capabilities of the individual, his aspirations and inflated demands on himself. A person's behavior is determined by his needs. In patients with neuroses, the presence of unsatisfied needs is revealed (adequate social assessment, self-expression and self-affirmation, friendly communication, in the love-erotic sphere) [Karvasarsky B. D., et al., 1976]. The formation of a mental conflict entails the emergence of neurotic disorders, the most common manifestations of which are emotional, autonomic and dyssomnic disorders.
Thus, an adequate definition of neuroses may be the following: neurosis is a psychogenic disease that occurs against the background of personality characteristics, which leads to the formation of a psychological conflict and is manifested by reversible disorders in the emotional, somatic and vegetative spheres.
Based on this, the criteria for diagnosing neuroses should be:
1) psychotraumatic situation;
2) features of personality structure;
3) presence of psychological conflict;
4) clinical manifestations of the disease.
It is quite difficult to evaluate these criteria correctly. A detailed and focused anamnesis, clinical and experimental psychological examinations can provide material for assessing the role of the two criteria. In connection with them, the dynamics of the disease as a whole and the dynamics of the appearance and disappearance of existing disorders in various body systems should be analyzed. The most difficult approach to identifying psychological conflict. In addition to the need for special qualifications, there are also objective difficulties: the patient’s lack of understanding of his existing contradictory personality tendencies, their formation on an unconscious level.
In the genesis of neuroses, the factor of psychological defense must also be taken into account. Personal defense mechanisms have been discussed for a long time from a psychoanalytic position and have been reduced to the concept of repressing psychological conflict into unconscious sphere. Naturally, no one can now deny the importance of the unconscious in the mental life of the individual. In this direction there are ongoing interesting research. D. N. Uznadze (1961) identified the role of the system of attitudes existing at the unconscious level and showed that the presence of flexible attitudes that quickly adapt to changing environmental conditions is a factor that counteracts the emergence of neuroses. Modern research on the psychophysiology of sleep has acquired great importance, one of the purposes of which is the processing of information entering the brain and adaptation, adapting it to the attitudes of the individual.
The presence of quantitative and qualitative sleep disturbances in neuroses is not only a consequence of emotional disturbances, but also possibly reflects the insufficiency of the protective function of sleep in these patients. It should be emphasized that protective psychological mechanisms take place not only in the sphere of the unconscious. These include strong social attitudes in the form of relationships that develop in the family and at work.
The combination of all these factors leads to the fact that in response to a traumatic influence, either mild neurotic reactions, or a certain form of neurosis, or neurotic personality development may occur. The latter are characterized by a long course, low curability, polysyndromic emotional manifestations, separation of the course of the disease from the initial psychotraumatic influence, and the formation of disorders approaching psychopathic ones.
Currently, clinical and physiological studies of neuroses and experimental neuroses are being conducted, which began with the classical works of I. P. Pavlov. At the same time, the role of not only cortical fields is shown, but also the deep structures of the brain that make up the limbicoreticular functional system. A difficult issue is the taxonomy of neuroses. The International Statistical Classification of Diseases, Injuries and Causes of Death, 9th revision (1975) identifies 10 forms: fear neurosis, hysterical neurosis, neurotic phobias, obsessive-compulsive neurosis, depressive neurosis, neurasthenia, depersonalization syndrome, hypochondriacal neurosis, other neuroses, unspecified neuroses.
In Russian literature, three classical forms of neuroses are traditionally distinguished: neurasthenia, obsessive-compulsive neurosis, hysteria (hysterical neurosis). At the same time, the clinical picture of neurasthenia includes asthenic, depressive and hypochondriacal syndromes; obsessive-compulsive neurosis consists of obsessive-phobic and obsessive-compulsive syndromes. Thus, both forms and syndromes of neurotic disorders are distinguished. Recently, undifferentiated forms of neuroses have been quite often described, in which several neurotic syndromes occur simultaneously and with approximately the same intensity.
The differentiation of neurotic and psychopathic disorders is essential. In a somewhat generalized form, the latter are diagnosed in patients with constitutional personality characteristics, pronounced character anomalies, difficulty in social adaptation and frequent antisocial manifestations. To this we can add the preservation of consciousness of the disease and the partiality of disorders in neuroses. However, in clinical practice such a polar separation of these groups is often difficult. O. V. Kerbikov (1971) emphasized the well-known convention of separation, considering psychopathy a neurosis prolonged for a significant part of the patient’s life.
Quite difficult, but necessary differential diagnosis with neurosis-like syndromes. Analysis of clinical manifestations is often unpromising, and only the use of selected criteria for diagnosing neuroses (the role of a psychotraumatic factor, premorbid personality traits, the formation of mental conflict), as well as the connection of clinical syndromes with organic damage to the brain or somatic sphere, allows us to come to the right conclusion.

Clinical forms of neuroses

Neurasthenia. Neurasthenia is characterized by four main groups of clinical manifestations: neuropsychic, dyssomnic, cephalgic and vegetovisceral. The most typical are asthenic disorders in the form of increased physical and mental fatigue. Characterized by decreased memory and attention, increased irritability, unstable mood, and hypochondriacal manifestations. The leading neurotic syndromes are asthenic, asthenodepressive, asthenohypochondriacal. It is important to emphasize that asthenia often acts as a leading manifestation of depression. Characterized by increased sensitivity to all external irritations (auditory, sound, olfactory, tactile), meteorological factors, and ambient temperature.
Headaches are diffuse, compressive in nature (“neurasthenic helmet”) and are based on tension in the muscles of the aponeurosis. Sleep disorders are characterized by difficulty falling asleep and a lack of subjectively reported deep sleep. Autonomic disorders in the cardiovascular, respiratory, and gastrointestinal systems are clearly represented, and sweating is increased. Sexual disorders in the form of decreased libido and deterioration of sexual function are often observed. Often, neurasthenic disorders develop against the background of an asthenic constitution.
Neurasthenia should be differentiated from asthenic syndromes with fatigue, somatic diseases and organic brain lesions.

Obsessive-compulsive disorder

In the clinical picture, the leading ones are obsessive fears (phobias) and obsessive states (obsessions). Among the first are cardiophobia, cancerophobia, thanatophobia (obsessive fear of death), lyssophobia (obsessive fear of going crazy), oxyphobia (obsessive fear of sharp objects), agoraphobia (fear of open spaces), claustrophobia (fear of enclosed spaces), gypsophobia (fear of heights) , mysophobia - (fear of pollution), ereitophobia (fear of redness). They often appear in combination.
Obsessive states are characterized by obsessive thoughts, memories, doubts, movements and actions while maintaining a critical attitude towards them. Obsessive movements and actions often take on the character of rituals, are not corrected by patients and are used to prevent imaginary misfortune. Neurotic syndromes are obsessive-phobic or phobic-obsessive in nature. They are combined with asthenic manifestations described in neurasthenia.
The development of this form of neurosis against the background of psychasthenic character traits (self-doubt, indecisiveness, suspiciousness, timidity, increased impressionability) is typical.

Hysteria (hysterical neurosis)

Hysteria is characterized by the presence of emotional-affective, pseudo-neurological and vegetative-visceral disorders.



The features of all these pseudoneurological symptoms are the absence of objective neurological disorders, the predominant involvement of the left half of the body, the inclusion of “paralyzed” parts of the body in integral motor acts, and topographical features sensory disorders(hypesthesia or anesthesia with a border along the midline, “amputation” nature of the disorders, persistent pain in both halves of the face). The dynamic nature of these symptoms is often noted, their intensification in certain situations. There are observations where pseudoneurological disorders arise against the background of an existing or existing in the past, insufficiency of the nervous system (hysterical lower paraplegia in a patient who several years ago underwent surgery to remove a spinal cord tumor, etc.). Hysterical hibernation is also characteristic. Patients are in a state of behavioral sleep for several hours or days. It is not possible to awaken them succeeds, however, during an EEG study there are no signs of sleep, and activity characteristic of wakefulness is recorded. In these states, an increase in blood pressure, a rise in body temperature, and an increase in heart rate are typical. When trying to examine the pupils, the eyeballs move upward. Thus, characteristic of physiological There are no sleep features.

Neurological problems of neuroses

It was previously emphasized that characteristic manifestations of neuroses are autonomic disorders and sleep disorders. All this leads to the fact that patients primarily turn to neurologists. Neurological analysis is necessary in the presence of pseudoneurological symptoms (motor and sensory), which are also widely represented in this group of patients. Quite characteristic manifestations of neuroses may include symptoms of increased neuromuscular excitability in the form of generalized hyperreflexia of tendon and skin reflexes, Chvostek’s symptom, and proboscis reflex, which cannot be attributed to a local, topicable lesion of the nervous system. Quite traditional is the view of the absence of clear organic disorders from the nervous system, which is reflected in the principle of diagnosing neuroses, widely used in practice, as diseases without an organic substrate.

2) neuroses and disorders are not corrected by patients and are used to prevent imaginary misfortune.
Neurotic syndromes are obsessive-phobic or phobic-obsessive in nature. They are combined with asthenic manifestations described in neurasthenia.
The development of this form of neurosis is typical against the background of psychasthenic character traits (self-doubt, indecisiveness, suspiciousness, timidity, increased impressionability).
Hysteria (hysterical neurosis). Hysteria is characterized by the presence of emotional-affective, pseudo-neurological and vegetative-visceral disorders.
The former are characterized by a lack of depth, demonstrativeness, artificiality of experiences and their certain situational conditionality. They manifest themselves as mood swings, asthenic, phobic, and hypochondriacal disorders.
Pseudoneurological disorders occupy an important place in the clinic of hysteria. Recently, views about reducing the frequency of these disorders in hysteria have become traditional. Experience in neurological clinic indicates their high frequency. Unfortunately, we have to admit that they, as a rule, are considered for a long time within the framework of an organic disease.
These include motor disorders (paralysis, paresis, impaired coordination when walking, sitting, standing, performing special tests, hyperkinesis), double vision (often monocular diplopia); speech disorders(aphonia, mutism, stuttering), sensory disorders (hypoesthesia, anesthesia, hyperesthesia, paresthesia), convulsive seizures of a clonic-tonic nature. Often these disorders are preceded by hysterical “stigmas” - difficulty swallowing due to a constant “lump in the throat”, hoarseness of the voice during excitement, fleeting deterioration of vision or hearing.
The features of all these pseudoneurological symptoms are the absence of objective neurological disorders, the predominant involvement of the left half of the body, the inclusion of “paralyzed” parts of the body in integral motor acts, the topography of sensory disorders (hypesthesia or anesthesia with a border along the midline, the “amputation” nature of the disorders, persistent pain in both sides of the face). The dynamic nature of these symptoms and their intensification in certain situations are often noted. There are observations where pseudoneurological disorders arise against the background of existing or past insufficiency of the nervous system (hysterical lower paraplegia in a patient who suffered several years of
back surgery to remove a spinal cord tumor, etc.). Hysterical hibernation is also characteristic. Patients are in a state of behavioral sleep for several hours or days. It is not possible to awaken them, but during an EEG study there are no signs of sleep, and activity characteristic of wakefulness is recorded. An increase in blood pressure, a rise in body temperature, and an increase in heart rate are typical in these conditions. When trying to examine the pupils, the eyeballs are pulled upward. Thus, there are no features characteristic of physiological sleep.
Vegetative-visceral disorders are also expressed, having the character of permanent vegetative dystonia and vegetative-vascular crises.
The personality traits of patients with hysteria are impressionability, suggestibility and self-suggestibility, selfishness, self-centeredness, the desire to attract attention, and often a certain “artistic” personality. Among patients with hysteria, women predominate.
Neurological problems of neuroses. It was previously emphasized that characteristic manifestations of neuroses are autonomic disorders and sleep disorders. All this leads to the fact that patients primarily turn to neurologists. Neurological analysis is necessary in the presence of pseudoneurological symptoms (motor and sensory), which are also widely represented in this group of patients. Quite characteristic manifestations of neuroses may include symptoms of increased neuromuscular excitability in the form of generalized hyperreflexia of tendon and skin reflexes, Chvostek’s symptom, and proboscis reflex, which cannot be attributed to a local, topicable lesion of the nervous system. A fairly traditional view is the absence of clear organic disorders of the nervous system in neuroses, which is reflected in the principle of diagnosing neuroses, widely used in practice, as diseases without an organic substrate.
However, recent thorough neurological studies have shown that with neuroses, cerebral insufficiency is also detected in a sufficient number of observations. The latter can be detected by clinical and paraclinical (PEG, EEG, arteriography) methods. All this made it possible to propose a neurological classification of neuroses, indicating the presence of transitional groups between neuroses and neurosis-like conditions.
This classification consists of 4 groups:
1) neuroses in which the indicated methods fail to identify cerebral organic insufficiency;
2) neuroses that developed against the background of residual, persistent, non-progressive brain failure (residual effects of past neuroinfections, traumatic brain injuries, dysraphic status, compensated hypertensive-hydrocephalic syndrome);
3) neuroses (neurotic syndromes) that arose against the background of a current neurological disease (hypothalamic insufficiency, vestibulopathy, epilepsy). The analysis of this group is the most difficult. Charcot also described hysteroepilepsia, in which epileptic and hysterical attacks occurred separately in the same patient or replaced each other in the picture of a general attack. Then, against the backdrop of the brilliant development of the doctrine of epilepsy, a tendency emerged to interpret all functional disorders in this disease as neurosis-like, and, finally, in last years major studies have appeared again, making it possible to show the possibility of coexistence of epileptic and neurotic disorders in one patient;
4) pseudoneurotic or neurosis-like syndromes in organic neurological and somatic diseases.
This classification aims to emphasize a number of important points:
1) the diagnosis of neurosis cannot be rejected if focal neurological symptoms are detected;
2) the criteria for diagnosing neurosis lie in the area of ​​identifying important psychological factors (psychotrauma, personality traits, mental conflict);
3) it is essential to study the role and mutual influence of organic and neurotic syndromes;
4) when treating a patient, it is important to take into account all aspects of the pathological process.
First of all, we will discuss the role of detectable brain failure in the genesis and course of neurotic syndromes. Their analysis allowed us to come to an assessment of two factors: the topic of the lesion and its intensity. Almost all neurological disorders in neuroses reflect the insufficiency of the rhinencephalic-hypothalamic-stem structures, i.e., deep formations of the brain, functionally united by the concept of the limbicoreticular complex. In this case, as a rule, we are talking about a fairly mild brain organic pathology. The whole experience clinical neurology indicates the absence of neurotic syndromes in the presence of severe local brain damage, which seems to protect against the occurrence of reversible neurotic disorders. Thus, cerebral insufficiency in neuroses is characterized by mild damage to certain structural parts of the limbicoreticular complex. Accumulated great experience in relation to clinical phenomenology when these brain structures are damaged, designated by Konorski (1970) as the “emotional brain.” One of the leading manifestations of this is emotional and personal disorders. In this regard, a hypothesis arises that this brain dysfunction is an additional factor in the formation of personality traits and the nature of emotional response, which are an important link in the pathogenesis of neuroses. One might think that under the influence of a significant psychotraumatic factor, neurosis can arise both in people with and without a cerebral organic predisposition. The non-randomness of the combination of neurotic and epileptic syndromes is emphasized by the well-known fact about the intensification of epileptic manifestations against the background successful treatment neurosis and vice versa. Analysis of neurological disorders in neuroses is important for diagnostic purposes, understanding the pathogenesis and prescribing complex therapy for this disease.

Autonomic disorders in neuroses

Autonomic disorders are obligatory in neuroses, constituting a characteristic psychovegetative syndrome. It is important to emphasize that complaints of a vegetative-visceral nature often dominate in the clinic of neuroses; patients give them leading importance and turn to general practitioners. With neuroses I. there is a developed syndrome of vegetative-vascular dystonia, manifested by permanent and paroxysmal disorders. The latter are in the nature of delineated vegetative-vascular paroxysms. The most common are sympathoadrenal and mixed crises. The clinic of the first consists of unpleasant sensations in the area chest, increased blood pressure, tachycardia, chill-like hyperkinesis, intense anxiety-phobic manifestations, increased temperature, increased urination with light-colored urine (usually at the end of an attack). In mixed crises, these symptoms are combined with difficulty breathing, dizziness, nausea, and increased intestinal motility. Vagoinsular paroxysms occur less frequently - dizziness, nausea, decreased blood pressure and blood sugar levels. In the specialized literature, there are still indications of the pathognomonic significance of these crises for the diagnosis of hypothalamic syndrome, which is reflected in their designation as “diencephalic”.
It should be emphasized that this point of view is erroneous. Much more often, full-blown vegetative crises occur during neuroses, but the role of hypothalamic formations in their implementation should not be denied.
Autonomic-visceral disorders most often occur in the cardiovascular system and are manifested by algic, dysrhythmic and dysdynamic disorders.
Cardialgic syndrome is manifested by a variety of unpleasant pain sensations in the left half of the chest. Their peculiarity is the duration of their course, their occurrence during emotional rather than physical stress, and the lack of effect from antispasmodic therapy. Patients are usually fixated on their feelings, often go to the doctor, are afraid to go to places where they will be deprived of medical care, and constantly carry medicine with them. In severe cases, severe cardiophobic syndrome develops. The lability of blood pressure and its pronounced fluctuations during the first and subsequent measurements are objectively determined. Sinus tachycardia is typical; bradycardia is less common. Rhythm disorders are of the nature of extrasystole.
ECG changes in neuroses are minimal, satisfactory tolerance to physical activity is determined.
The respiratory system is characterized by hyperventilation syndrome, which occurs against the background of a feeling of insufficient inhalation and lack of air. Attacks of “canine” breathing, simulating an attack of bronchial asthma, may also occur. The most demonstrative paroxysms of neurotic laryngospasm (spasm of the muscles of the larynx), often associated with the act of eating.
In the gastrointestinal tract, increased salivation and spasm of the esophageal muscles with difficulty may be observed; passage of food and vivid subjective sensations, aerophagia - belching as a result of swallowing air with food, neurotic regurgitation or vomiting, pain in the abdominal area - gastralgia, or abdominalgia, intestinal disorders in the form of diarrhea, diarrhea, changes in peristalsis.
There is a violation of vascular permeability in the form of symmetrical or lateralized hemorrhages in the skin, erosion in the gastrointestinal tract. An extreme form is the rare "bloody sweat" syndrome.
Moderate neuroendocrine disorders are identified: dysfunction of the thyroid, genital, and pancreas. Motivational disorders are characteristic - changes in appetite, up to anorexia, decreased libido.

Treatment of neuroses

Treatment of advanced forms of neuroses and neurotic developments is a very difficult task, therefore, naturally, special attention should be paid to the prevention of neuroses. G.K. Ushakov highlights the social, psychological and medical aspects of prevention and sets out a broad program. Among the social activities he considers is the improvement of the training of doctors in the field of mental hygiene and psychoprophylaxis, the study of conditions that ensure mental health and contribute to the emergence of neuroses, and psychohygienic education of the population. Among psychological aspects The leading ones are the streamlining of interpersonal relationships, ensuring group compatibility in the family and work team, the scientific organization of work, psychological preparation that ensures the neutralization and de-actualization of stress, the cultivation of a level of aspirations that is adequate to the circumstances, and the development of a sense of collectivism. Medical aspects include women's health, pregnancy protection, qualified medical care and early diagnosis of neurotic disorders. Issues of broad prevention go beyond clinical medicine and require the participation of teachers, sociologists, hygienists, etc. The task of prevention is to reduce the number of unfavorable stress factors, harmonious education of the individual, and the ability to neutralize emerging psychotraumatic situations.
Patients with existing neurotic disorders turn to psychiatrists and neurologists, which poses the following tasks: correct and earliest possible diagnosis, reducing the degree of painful disorders and rehabilitation. The most adequate method of treating neuroses is psychotherapy. For this purpose, various methods are used: rational, autogenic training, hypnosis, family psychotherapy, etc. The objectives of psychotherapy are to eliminate or deactualize the existing psychotraumatic factor and influence the essence of the psychological conflict. An ideal, but not always realistic, factor is the exclusion of a traumatic situation. If this is not possible, then a restructuring of the attitude towards the existing situation is necessary. Elimination or neutralization of a psychogenically significant factor is extremely important, but does not always solve the problem of recovery, since the course and development of neurosis can “break away” from the cause that caused it and continue after the elimination of the trigger factor. Hence the need to influence the patient’s personality, change the system of his attitudes, and correct the level of aspirations. Psychotherapeutic tasks also include explaining to the patient the essence of his illness. The leading elements are often autonomic disorders, headaches, and sleep disorders. At the same time, the patient not only does not connect them with changes in the emotional sphere, situations in his own life, but also actively resists the doctor’s attempts to determine the correct cause-and-effect relationships. Psychotherapy serves not only to eliminate neurotic manifestations, but also to prevent them. At the same time, it is necessary to emphasize the role of autogenic training, which can become an important psychohygienic factor.
In second place is the proper organization of work and rest. Standardized work outside the conditions of industrial hazards and interpersonal conflicts is an important protective and healing factor. It is very important that the work is loved and brings a sense of satisfaction. An essential factor is the organization of leisure time. Rest should be active and include sufficient physical activity. This especially applies to people engaged in intellectual or sedentary work. Morning exercises, water procedures, long walks should become a habit and a necessity. It is also important to form and develop any hobbies or interests that switch attention and distract from everyday worries.
Modern psychopharmacology also plays a major role, the object and target of which are neurotic syndromes. In the presence of anxiety and phobic disorders, tranquilizers are used - diazepam (Seduxen), chlordiazepoxide (Elenium), oxazepam (Tazepam). Depressive disorders require the prescription of antidepressants. For anxious agitated forms, amitriptyline is indicated for apathetic and asthenic conditions - drugs such as imizinum (melipramine). The leading hypochondriacal disorders determine the prescription of teralen and thioridazine (Melleril). The dose of the agents used must be sufficient and individually selected.
In the presence of concomitant neurological disorders in complex therapy include drugs that reduce vestibular excitability, antiepileptic drugs, and dehydration agents.
Symptomatic treatment also plays an important role. At autonomic disorders B- and α-adrenergic blockers (pyrroxan, anaprilin - obzidan), ganglioblockers (gangleron), antispasmodics (platifillin, halidor) can be used. Sleep disorders, in addition to the general measures indicated, require the selection of minimum doses. sleeping pills. For morning headaches associated with tension in the muscles of the aponeurosis of the head, muscle relaxants are prescribed (scutamil-S, mydocalm). It is important to emphasize the need for an integrated approach to treatment, including pathogenetic and symptomatic aspects. Physiotherapy and sanatorium-resort treatment are indicated for patients.