Adynamy (asthenic syndrome) — gradually developing psychopathological frustration accompanying many diseases of an organism. The adynamy is shown by fatigue, decrease in the mental and physical working capacity, sleep disorders increased by irritability or on the contrary slackness, emotional instability, vegetative violations. Careful poll of the patient, a research of its psycho-emotional and mnestichesky sphere allows to reveal an adynamy. Full diagnostic inspection is also necessary for detection of the main disease which served as the adynamy reason. The adynamy is treated by selection of the optimum labor mode and rational diet, application of adaptogens, neuroprotectors and psychotropic drugs (neuroleptics, antidepressants).
The adynamy undoubtedly is the syndrome, most widespread in medicine. It accompanies many infections (a SARS, flu, food toksikoinfektion, viral hepatitis, tuberculosis, etc.), somatic diseases (sharp and chronic gastritis, stomach ulcer of 12 items of a gut, enterokolit, pneumonia, arrhythmia, a hypertension, glomerulonefrit, neurocirculator dystonia and so forth), psychopathological states, the postnatal, post-traumatic and postoperative period. For this reason experts practically of any area face an adynamy: gastroenterologies, cardiology, neurology, surgery, traumatology, psychiatry. The adynamy can be the first symptom of the beginning disease, accompany its heat or be observed in the period of a convalescence.
It is necessary to distinguish an adynamy from usual fatigue which arises after the excessive physical or mental tension, change of time zones or climate, non-compliance with a work-rest schedule. Unlike physiological fatigue the adynamy develops gradually, the long time (months and years) remains, does not pass after good rest and needs intervention of the doctor.
Reasons of development of an adynamy
According to many authors the overstrain and exhaustion of higher nervous activity is the cornerstone of an adynamy. Insufficient intake of nutrients, an excessive expenditure of energy or disorder of exchange processes can become an immediate cause of emergence of an adynamy. Any factors leading to organism exhaustion can exponentiate development of an adynamy: sharp and chronic diseases, intoxications, bad food, mental disorders, intellectual and physical excessive activity, chronic stress, etc.
Classification of an adynamy
On the cause in clinical practice the organic and functional adynamy is allocated. The organic adynamy meets in 45% of cases and is connected with available for the patient chronic somatic diseases or the progressing organic pathology. In neurology the organic adynamy accompanies infectious and organic damages of a brain (encephalitis, abscess, a tumor), severe craniocereberal injuries, demiyeliniziruyushchy diseases (disseminated encephalomyelitis, multiple sclerosis), vascular frustration (chronic ischemia of a brain, a hemorrhagic and ischemic stroke), degenerate processes (Alzheimer's disease, Parkinson's disease, senile to a trochee). The functional adynamy makes 55% of cases and is a temporary reversible state. The functional adynamy also carries the name jet as in fact represents reaction of an organism to a stressful situation, physical overfatigue or the postponed acute disease.
On an etiologichesky factor allocate also somatogenic, post-traumatic, postnatal, post-infectious adynamy.
On features of clinical manifestations the adynamy is subdivided into hyper - and a hyposthenic form. The hyper sthenic adynamy is followed by the increased touch excitability owing to which the patient is irritable and badly transfers loud sounds, noise, bright light. The hyposthenic adynamy opposite differs in decrease in a susceptibility to external irritants that results in slackness and drowsiness of the patient. The hyper sthenic adynamy is easier form and at increase of an asthenic syndrome can pass into a hyposthenic adynamy.
Depending on duration of existence of an asthenic syndrome the adynamy is classified on sharp and chronic. The sharp adynamy usually has functional character. It develops after a severe stress, the postponed acute disease (bronchitis, pneumonia, pyelonephritis, gastritis) or infections (measles, flu, a rubella, an infectious mononukleoz, dysentery). The chronic adynamy differs in a long current and often is organic. The syndrome of chronic fatigue belongs to a chronic functional adynamy.
Separately allocate the adynamy connected with exhaustion of higher nervous activity — a neurasthenia.
Clinical manifestations of an adynamy
The simptomokompleks characteristic of an adynamy includes 3 components: own clinical manifestations of an adynamy; the violations connected with the pathological state which is its cornerstone; the frustration caused by psychological reaction of the patient to a disease. Manifestations of actually asthenic syndrome often are absent or are poorly expressed in the morning, appear and accrue during the day. In the evening the adynamy reaches the maximum manifestation that forces patients to do without fail rest before to continue work or to pass to household chores.
Fatigue. The main complaint at an adynamy is the fatigue. Patients note that they are tired quicker, than before, and the feeling of fatigue does not disappear at them even after long rest. If it is about physical work, then the general weakness and unwillingness to perform the usual work is observed. In case of intellectual work the situation is much more difficult. Patients complain of difficulties at concentration, a memory impairment, decrease in attentiveness and ingenuity. They note difficulties at the formulation of own thoughts and their verbal expression. Patients with an adynamy often cannot concentrate on considering of one specific problem, hardly are at loss for words for the statement of any idea, differ in absent-mindedness and some block at decision-making. To perform work feasible before, they are forced to do breaks, for the solution of an objective try to consider it not in general, and having segmented. However it does not bring desirable results, strengthens feeling of fatigue, increases concern and causes confidence in own intellectual insolvency.
Psycho-emotional violations. Decrease in efficiency in professional activity causes emergence of the negative psycho-emotional states connected with the patient's relation to the arisen problem. At the same time patients with an adynamy become quick-tempered, intense, captious and irritable, quickly lose self-control. They note sharp differences of mood, a condition of depression or uneasiness, an extreme in events assessment (unreasonable pessimism or optimism). Aggravation of frustration of the psycho-emotional sphere, characteristic of an adynamy, can lead to development of a neurasthenia, depressive or ipokhondrichesky neurosis.
Vegetative frustration. Almost always the adynamy is followed by violations from the autonomic nervous system. Tachycardia, lability of pulse, differences of arterial pressure, a chill or feeling of heat in a body, generalized or local (palms, axillary hollows or a foot) , a loss of appetite, locks, pain on the intestines course concern to them. At an adynamy headaches and the "heavy" head are possible. At men decrease in a potentiality is often noted.
Sleep disorders. Depending on a form the adynamy can be followed by sleep disorders various in character. The hyper sthenic adynamy is characterized by difficulties with falling asleep, uneasy and saturated dreams, night awakenings, an early prosypaniye and feeling of weakness after a dream. At some patients the feeling is formed that they practically do not sleep at night though actually it not so. The hyposthenic adynamy differs in emergence of day drowsiness. At the same time problems with falling asleep and bad quality of a night dream remain.
Diagnostics of an adynamy
The adynamy in itself usually does not cause diagnostic difficulties in the doctor of any profile. In cases when the adynamy is a consequence of the postponed stress, injuries, diseases or acts as a harbinger of the pathological changes beginning in an organism, its symptoms are brightly expressed. If the adynamy arises against the background of the existing disease, then its manifestations can fade into the background and to be not so noticeable behind symptoms of the main disease. In such cases signs of an adynamy can be revealed by poll of the patient and specification of his complaints. Special attention should be paid to questions of mood of the patient, a condition of its dream, its relation to work and other duties, and also to own state. Not each patient with an adynamy will be able to tell the doctor about the problems in the sphere of intellectual activity. Some patients are inclined to exaggerate the existing violations. To receive an objective picture, the neurologist along with neurologic survey needs to conduct a research of the mnestichesky sphere of the patient, to estimate his emotional condition and response to various external signals. In certain cases it is necessary to differentiate an adynamy from ipokhondrichesky neurosis, a gipersomniya, depressive neurosis.
Diagnostics of an asthenic syndrome demands obligatory inspection of the patient regarding the main disease which served as the reason of development of an adynamy. Additional consultations of the gastroenterologist, cardiologist, gynecologist, pulmonologist, nephrologist, oncologist, traumatologist, endocrinologist, infectiologist and other narrow experts can be for this purpose held. Delivery of clinical analyses is obligatory: blood test and urine, koprogramma, definition of sugar of blood, biochemical blood test and urine. Diagnosis of infectious diseases is carried out by bacteriological researches and performing PTsR-diagnostics. According to indications appoint tool methods of a research: Ultrasonography of abdominal organs, gastroscopy, duodenal sounding, ECG, ultrasonography of heart, fluorography or X-ray analysis of lungs, ultrasonography of kidneys, MRT of a brain, ultrasonography of bodies of a small pelvis and so forth.
Treatment of an adynamy
The general recommendations at an adynamy come down to selection of an optimum work-rest schedule; to refusal of contact with various harmful effects, including of alcohol intake; to introduction to a day regimen of the revitalizing physical activities; to observance of the diet vitaminized and corresponding to the main disease. An optimal variant is long rest and change of a situation: holiday, sanatorium treatment, trip, etc.
Food rich with tryptophane (bananas, meat of a turkey, cheese, bread of a rough grinding), vitamin B (a liver, eggs) and other vitamins (a dogrose, blackcurrant, a sea-buckthorn, a kiwi, strawberry, a citrus, apples, crude vegetables salads and fresh fruit juice) is useful to the patients having an adynamy. The quiet working situation and psychological comfort of the house is important for patients with an adynamy.
Drug treatment of an adynamy in all-medical practice comes down to purpose of adaptogens: ginseng, rhodiola pink, Chinese magnolia vine, eleuterokokk, pantokrin. In the USA practice of treatment of an adynamy is accepted by high doses of vitamins of group B. However this method of therapy is limited in application high percent of collateral allergic reactions. A number of authors considers that the complex vitamin therapy including not only vitamins of group B, but also C, PP, and also the minerals (zinc, magnesium, calcium) participating in their metabolism is optimum. Often in treatment of an adynamy nootropa and neuroprotectors are applied (a ginkgo of a bilob, piracetam, gamma aminooleic acid, cinnarizine + piracetam, , gopantenovy acid). However their efficiency at an adynamy is finally not proved because of lack of large researches in this area.
In many cases the adynamy demands symptomatic psychotropic treatment which only the narrow expert can pick up: neurologist, psychiatrist or psychotherapist. So, in an individual order at an adynamy antidepressants — inhibitors of the return capture of serotonin and dopamine, neuroleptics (anti-psychotics), medicines of prokholinergichesky action are appointed ().
Success of treatment of the adynamy which arose owing to any disease in many respects depends on efficiency of treatment of the last. If it is possible to cure the main disease, then adynamy symptoms, as a rule, pass or considerably decrease. At long remission of a chronic disease, manifestation of the adynamy accompanying it are also minimized.