Emotionally stressful conditions and neuroses
Neuroses belong to functional diseases of the central nervous system. The causes of their occurrence are complex and diverse. I.P. Pavlov characterized neurosis as “a clash of nervous activity that occurs when the organism encounters extraordinary conditions of the external environment.” Often, the impetus for the development of neuroses is various "psychotraumatic situations", in which compensation is disrupted: excessive excitement, negative emotions, acute conflicts, bad habits (alcohol, smoking), overwork.
Diseases are promoted by circumstances that weaken the body: irregular and poor nutrition, diseases of internal organs, brain injuries, infectious diseases, intoxications (alcohol, smoking), etc. Somatic diseases (atherosclerosis, hypertension, brain tumor) cause neurosis-like states.
Mental trauma for a person is something that threatens his future, creates an uncertain situation and forces him to make an urgent decision. Mental trauma for a person can be information about family, household and work difficulties, the death of loved ones, a threat to life and health, happiness and well-being, unfulfilled hopes, an unsettled personal life, bad relationships in life, dismissal from an educational institution or from work.
Factors for the development of neurosis can be events that lead to an unresolved conflict for this person between duty and desire, passion and situation, and require a struggle of contradictory feelings (love and hate, etc.).
The cause of the development of neurosis can be the lack of information that is of particular importance for this person (there is no news about loved ones, relatives, loved ones). Waiting for an unpleasant event causes nervous tension, more than the event itself. Psychotraumatic stimuli can be auditory (word), visual (a house is on fire) and written (a note, a sign), etc.
To lead to the development of neurosis, the psychogenic factor must be of great strength and long-lasting action. The strength of the effect on the psyche is not determined by physical intensity, but by the meaning of the information for this person. The same psychogenic factor for one person passes without a trace, and for another causes mental disorders.
Neuroses occur in people of any type of nervous system, but often occur in so-called accented personalities are people with individually enhanced individual character traits, which in themselves are not manifestations of the disease.
Neurosis is a functional disease characterized by psychogenic origin, various neurotic disorders. At the same time, patients do not have impaired awareness of the disease. Neuroses, as a rule, occur without psychotic disorders and pronounced behavioral disorders.
The incidence of neurosis is 21-22 people per 1000 population. Those suffering from neuroses make up 20-30% of the total number of mentally ill people.
The pathophysiological mechanisms of neurosis development were discovered by experimental studies on animals by I.P. Pavlov and his students. The role of hypnoid-phase states in the cerebral cortex in the mechanism of neurosis occurrence was determined, against the background of which, under the influence of psychogenic stimuli, “sick points” can form – foci of pathological stagnant excitation and inhibition. When studying the strength and mobility of the main nervous processes - excitation and inhibition, it was found that the pathophysiological basis is a "breakdown" of higher nervous activity, which occurs either in the case of overstrain of one of these processes, or as a result of their "collision".
So, the cause of neurosis is acute or chronic stress. Neurosis is divided into 3 types: neurasthenia, obsessive-compulsive neurosis and hysterical neurosis. The main symptoms of the disease: irritability, fever, weakening of inhibitory processes, sleep disorders, various vegetative disorders. The earliest signs: increased excitability, incontinence, tendency to conflicts, decreased performance. Night sleep becomes superficial, intermittent, and drowsiness appears during the day. From vegetative disorders, palpitations, headaches, unpleasant sensations in the heart, stomach, intestines occur. Appetite is disturbed, body weight decreases, from time to time vomiting and constipation appear, which are replaced by diarrhea.
Treatment at the initial stage is outpatient. It is necessary to teach the patient to adhere to the work and rest regime. Valerian preparations, bromine with caffeine are prescribed, sleeping pills, neuroleptics in small doses, tranquilizers, antidepressants, vitamins are used. Autogenic training, gymnastics, psychotherapy are used.
The following depression and anxiety syndromes are characteristic of this disease:
Group 1 is anxiety-phobic disorders, in which anxiety associated with an external situation dominates and depression F 40 appears. The intensity of the disorder ranges from mild discomfort to horror and panic. The appearance of fear in the patient: agoraphobia - fear of open space or social phobias - fear in certain situations, specific phobias (fear of heights).
Group 2 - panic disorders. The patient has a fear of death, a fear of being alone, he is very anxious, he is trembling all over, his face is red, his heart beats, pain in the heart area...
Group 3 - obsessive-compulsive disorders. The patient has obsessive experiences and thoughts, and he understands his condition, is critical of thoughts, but cannot overcome them.
Group 4 - these are disorders associated with a reaction to severe stress. F 43. is divided into: a) acute reaction to stress. The patient is stunned, disoriented, can freeze like a pillar, or, conversely, run away. The duration of this state is 1 hour to 3 days.
b) adaptation disorders - impaired adaptation in life after stress. This state after stress lasts a long time from 1 month to 2 years. The person is anxious, depressed.
Group 5 – dissociative disorders – these are symptoms that are characterized by a sudden disruption of the normal interaction of the functions of consciousness or control over body movements and sensations.
Group 6 – somatoform disorders. F 45. After a psychotrauma, the patient develops somatic disorders, which he treats, but depression needs to be treated.
The patient complains of gastrointestinal disorders, or respiratory and cardiovascular system disorders, pain and sexual disorders. Objectively, there are no symptoms of a somatic disease. The patient distrusts treatment and is immersed in his illness. The leading complaint is constant pain, accompanied by depression. The patient has increased fatigue for physical and mental work, reduced working capacity. He is tired, anxious, depressed, irritable.
Treatment is aimed at treating depression.
Antidepressants are prescribed - amitriptyline, melipramine (individual doses). If necessary, tranquilizers, small doses of neuroleptics in combination with antidepressants.
Autogenic training, gymnastics, psychotherapy are used.