NEUROSES

NEUROSES - functional (psychogenic) disorders of mental activity, caused by psychotraumatic factors and having multiple clinical manifestations, which are largely determined by the personality of the patient. Painful violations never reach the psychotic (the presence of delirium, hallucinations, etc.) level, reversible and do not lead to severe maladaptation; The patient usually retains a critical attitude towards the disorders that he has. As a rule, neurosis is accompanied by vegetovascular or functional somatic disorders. All neuroses are divided into three large groups.

Hysteria (hysterical neurosis) is a psychogenically conditioned neurotic state with somatovegetative, sensory and motor impairments. Appears, as a rule, in people with hysterical traits (the desire to be in the center of attention, heightened impressionability and emotional instability). Currently, the main place in the clinical picture of a hysterical neurosis is occupied by somatovegetative disorders, and a hysterical fit (especially the classical "hysterical arc") is manifested by peculiar cardiovascular disorders, digestion, breathing, sexual function, total tremor ("shaking"), The result of which patients can be hospitalized in general hospitals. Movement and sensitivity disorders are observed: patients are unable to stand and walk; Spasm of eyelids, aphonia, paralysis of hands or feet may occur. Sensitivity disorders (numbness) do not correspond to the zones of innervation and are manifested more often by the type of "gloves", "stockings", etc. Affective disorders are characterized by lability of emotions, rapid change of mood, a tendency to violent affective reactions with tears, often turning into sobbing. Strengthening of symptoms is noted in unfavorable circumstances for the patient. In the intellectual sphere, "emotional logic" begins to prevail, behavior is becoming more demonstrative and theatrical. Quite often there are psychogenic amnesia, when under the influence of a psychotraumatic situation, everything that is associated with it is superseded from memory. Hysterical amnesia is usually not long and ends with a complete memory recovery. Occurring episodic hallucinatory disorders are bright, imaginative and always associated with a psychotraumatic situation.

Treatment of neuroses begins with the elimination (if possible) of the psychotraumatic factor, sometimes simply changing the situation. The main place is given to rational psychotherapy, you can apply and suggestion in a wakeful or hypnotic state. Certain physiotherapeutic procedures should be prescribed, as otherwise the patient will feel that he is "not treated properly" and treat his sufferings lightly. Various sedatives, tranquilizers and mild antidepressants are recommended.

Neurasthenia is the most common form of neurosis, characterized by a state of irritable weakness: inadequate emotional excitability is noted in combination with rapid exhaustion, fatigue, tearfulness, complaints of a constrictive headache ("neurasthenic helmet"), difficulty concentrating, loss of appetite, decreased efficiency. Violated sleep (the phase of falling asleep), which does not bring rest, sexual functions; Emotional instability with irritability lead to loss of habitual interests. Abundant autonomic symptomatology can give the impression of a somatic disease, in connection with which, even "neurosis of the heart", "neurosis of the stomach", etc., are distinguished.

With prolonged flow (more than 5 - 7 years) there are changes that are characteristic of neurotic development. Usually, complex treatment of neuroses (elimination of emotional tension, normalization of the working and sleeping regime, tranquilizers, physiotherapy, rational psychotherapy) brings success.

The neurosis of compulsive states unites various neurotic states, accompanied by obsessive thoughts, drives, actions, fears (see Phobias, Obsessive states). This type of neurosis is prone to long-term course, is resistant to therapy, sometimes can lead to disability of patients, as obsessions begin to determine not only behavior, but the entire lifestyle of the patient. The cause, conducive to the manifestation of the neurosis, is the case of Another and insignificant circumstance, which is reflected And the clinical picture (vegetative vascular reaction, which arose in the crowdedness of a crowded bus, causes later a fear and a vegetative-vascular crisis with one thought about the necessity of any trip, which leads to a complete refusal to use transport).

The arising obsessions are insurmountable, although the patient treats them as criticism, understands their alienity and soreness, seeks to overcome them and, in connection with this, appeals for medical help. The disease is prone to recurrence.

Among the various forms of phobias dominate fear of closed (claustrophobia) or open (agoraphobia) space, anxious expectation of failure (neurosis of expectation), fear of public speaking, etc. To obsessions are often attached various protective actions - rituals.

For example, washing hands at the fear of pollution, a trip in transport only ..... the conduct of a loved one who "in case of what" will be able to help, etc.

The treatment of neuroses is complex and strictly individual. In mild cases, preference can be given to psychotherapeutic and restorative methods. You should not hurry with the issuance of a sick leave sheet, which can serve to the patient as an extra proof of the seriousness of his alleged illness. In more severe cases, the use of sedative (up to small doses of neuroleptics) or tonic in accordance with the characteristics of the clinical picture; Sometimes it becomes necessary and inpatient treatment (in the departments of neuroses, etc.). Typically, neuroses are characterized by the complete reversibility of painful phenomena, but in a number of cases they can acquire a prolonged course and become neurotic personality development.

The task of average medical workers is to convince the patient of the possibility of complete liberation from obsessive manifestations. If the patient has fears to commit an antisocial action, they explain to him that he will never do anything like this, because the idea of ​​the tragic consequences of such an act will completely suppress any possibility of its implementation. Patients suffering from claustrophobia should be in the most spacious chambers, where at first the door does not close and only later the patient learns to be in the ward first with a half-closed and then completely closed door.

The patient must obey the established hospital regime, which the nurse expresses directly. This psychological complex - neediness, dependence, subordination can cause unconscious internal protest in patients, increase irritability, conflict. Therefore, a lot of tact and patience ("soft hardness") is required to neutralize such moods, which are a serious obstacle to the implementation of the therapeutic process. Patients with neuroses with their sensitive sensitivity usually react sharply to any manifestation of insincerity and falsity in the relationship with the medical staff. Here, a special role is played by internal benevolence and the desire to help the patient, which always manifests itself in the expression of the person, in the voice and in all the behavior of the average paramedic.