Neuroses

Neuroses are the most common type of psychogeny (painful conditions caused by the impact of psychotraumatic factors); They are characterized by the partiality of mental disorders (obsessive states, hysterical manifestations, etc.), a critical attitude towards them, the preservation of the consciousness of the disease, the presence of somatic and vegetative disorders.

The development of neuroses occurs in different ways. Along with short-term neurotic reactions, there is often a prolonged course of their reactions, not accompanied, however, by marked violations of behavior. Neurotic reactions usually arise on relatively weak but long-acting stimuli, leading to constant emotional stress or internal conflicts (events that require difficult alternative solutions, situations that generate uncertainty of the situation that threaten the future). Along with psychogenic influences, an important role in the genesis of neuroses belongs to a constitutional predisposition.

There are three types of neuroses: neurasthenia, obsessive-compulsive disorder, hysteria.

Neurasthenia (asthenic neurosis). In the first place in the clinical picture are asthenic manifestations: increased mental and physical fatigue, absent-mindedness, dispersal, decreased efficiency, the need for a long rest, not giving, however, a full recovery. The most typical complaints about the decline of strength, lack of vivacity, energy, low mood, weakness, weakness, intolerance to normal loads. Increased mental exhaustion is combined with excessive excitability (the phenomenon of irritable weakness), hyperesthesia. The patients are unrestrained, quick-tempered, complain of a constant feeling of inner tension; Even phone calls, minor misunderstandings, previously passed unnoticed, now cause a violent emotional reaction, rapidly drying out and often ending in tears. The most common neurasthenic symptoms include headaches, sleep disorders, multiple somatovegetative disorders (hyperhidrosis, cardiovascular, gastrointestinal, respiratory, sexual function, etc.).

The obsessive-compulsive disorder manifests itself in numerous obsessions, although the pattern of each particular neurosis is usually relatively monomorphic.In the circle of obsessive-phobic disorders, agoraphobia, claustrophobia, fear of transport, public appearances, nosophobia (cardio phobia, carcinophobia, etc.) prevail. States in comparison with other neuroses shows a much more pronounced tendency to prolonged flow.If there is no significant expansion of the symptomatology, the patients gradually adapt to phobias, learn to avoid situations in which fear arises, the disease thus does not lead to abrupt violations Way of life.

Hysteria. In most cases, the clinical picture is determined by motor and sensory disorders, as well as autonomic disorders that mimic somatic and neurological diseases (conversion hysteria). To the group of motor disorders, on the one hand, there are hysterical pareses and paralysis, and on the other - hyperkinesis, tics, rhythmic tremor, intensifying when attention is fixed, and a number of other involuntary movements. There may be hysterical attacks (see Hysterical Syndrome.) Sensitivity disorders include anesthesia (often occurring in the "amputational type" - in the form of "stockings", "gloves"), hyperesthesia and hysterical pains (the most common headache, defined as "hoop, Tightening the forehead and whiskey, "" driven nail, "etc.). Some neurosurgeons of anorexia, stuttering, and enuresis are related to neuroses.

With neuroses, unlike psychoses, there is always a feeling of alienation of painful disorders, the desire to resist them. Neuro-like conditions observed within endogenous psychoses are characterized by a greater polymorphism of manifestations and a tendency to further expansion of symptoms, an abstract, bizarre, and sometimes absurd content of fears and obsessions, an unmotivated anxiety.

Treatment of neuroses is complex, includes therapy with psychotropic drugs, psychotherapy, aimed at resolving the conflict situation, fortifying means, physiotherapy. Spa treatment is also shown; With persistent neurotic conditions, accompanied by affective (depressive) disorders and resistant to outpatient therapy, hospitalization is indicated.

With drug therapy of neuroses, tranquilizers (diazepam (seduxene), sibazone, relanium, oxazepam (tazepam), chlordiazepoxide (elenium), 10-50 mg / day, phenazepam at 1-3 mg / day, meprotanum (meprobamate) by 200- 800 mg / day]. In more severe cases (persistent obsessions, massive hysterical disorders, etc.), intramuscular is indicated, and intravenous drip of tranquilizers (diazepam, chlordiazepoxide) or the administration of neuroleptics in small doses [etaperazin - 4-12 mg / day, chlorprotixen - 15-20 mg / day, thioridazine (sonapaks) -10-50 mg / day, neuleptil (prepericasin) - 10-20 mg / day, eglonyl - 100-400 mg / day], as well as long-acting drugs [fluorophenazine -decanoate (moden-depot) -12.5-25 mg, fluspirilen-2-4 mg once every 1-2 weeks]. In patients with a predominance of asthenic manifestations, an effective combination of tranquilizers with piracetam (nootropil) or aminalone is effective. When expressed affective (depressive) disorders shows a combination of tranquilizers with antidepressants (amitriptyline in combination with chlordiazepoxide, etc.). In cases with persistent sleep disorders, nitrazepam (eunotin, radedorm) is prescribed for 5-15 mg, reladorm, phlazepam 0.5-1.5 mg, terabol 5-10 mg, chlorprotixen 15 mg. In most cases, neurotic reactions are reversible.

Prophylaxis of neuroses includes a number of social and psycho-hygienic measures, including the creation of favorable family-household and labor conditions, rational professional orientation, prevention of emotional overstrain, elimination of occupational hazards, etc.