Neurosises — functional violations of higher nervous activity of a psychogenic origin. The clinic of neurosises differs in big variety and can include somatic neurotic frustration, vegetative violations, various phobias, a distimiya, obsessiya, kompulsiya, emotional problems. It is possible to establish the diagnosis "neurosis" only after an exception similar to it on clinic of psychiatric, neurologic and somatic diseases. Treatment has 2 main components: psychotherapeutic (psychocorrection, trainings, art therapy) and medicamentous (the antidepressants, tranquilizers, neuroleptics all-strengthening means).
Neurosis as the term was entered in 1776 in Scotland by the doctor by last name bought. It was made as opposed to J. Morganyi's statement stated earlier that the morphological substratum is the cornerstone of each disease. The author of the term "neurosis" meant by it the functional violations of health which do not have under themselves organic defeat of any body. In the subsequent the big contribution in the doctrine about neurosises was brought by the famous Russian physiologist I. P. Pavlov.
In MKB-10 instead of the term "neurosis" the term "neurotic frustration" is used. However today the concept "neurosis" is widely used concerning psychogenic disorders of higher nervous activity, i.e. caused by action of chronic or acute stress. If the same violations are connected with influence of other etiologichesky factors (for example, the toxic influence, a trauma postponed a disease), then carry them to so-called nevrozopodobny syndromes.
In the modern world neurosis is quite widespread frustration. In the developed countries suffers from various forms of neurotic violations from 10% to 20% of the population, including and children. In structure of mental disorders about 20-25% fall to the share of neurosises. As neurosis symptoms often carry not only psychological, but also somatic character, this perspective is urgent both for clinical psychology and neurology, and for some other disciplines: cardiology, gastroenterology, pulmonology, pediatrics.
Causes of neurosis
Despite diverse researches in this area, the true reason of neurosis and pathogenesis of its development are for certain not known. Long time neurosis was considered the information disease connected with intellectual overloads and big rate of life. In this regard, lower frequency of a disease of neurosises at inhabitants of rural areas was explained by quieter image of their life. However, the researches conducted among air traffic controllers disproved these assumptions. It turned out that, despite the hard work requiring constant attention, the bystry analysis and reaction, dispatchers have neurosises not more often than people of other specialties. Among the reasons of their incidence mainly family disorders and the conflicts with the administration, but not overfatigue in the course of work were specified.
Other researches, and also results of psychological testing of patients with neurosises, showed that not quantitative parameters of the psychoinjuring factor (plurality, force), and its subjective importance for a concrete individual have the defining value. Thus, the external trigger situations provoking neurosis are very individual and depend on system of values of the patient. Under certain conditions any, even everyday, a situation can form the basis of development of neurosis. In too time, many experts come to a conclusion that not the stressful situation, namely the incorrect attitude towards her matters, as to destroying the personal safe present or menacing to the personal future.
A certain role in development of neurosis belongs to psychophysiological features of the person. It is noted that with this frustration people with the increased suspiciousness, demonstrativeness, emotionality, a rigidnost, subdepressiveness get sick more often. Perhaps, big emotional lability of women is one of the factors leading to the fact that development of neurosis in them is observed twice more often than at men. Hereditary predisposition to neurosis is implemented through inheritance of certain personal features. Besides, the increased risk of development of neurosis exists during the periods of hormonal reorganizations (a puberty, a climax) and at the persons which had neurotic reactions in the childhood (enuresis, , etc.).
Pathogenetic aspects of neurosis
Modern idea of pathogenesis of neurosis assigns the main role in its development to functional frustration of a limbiko-retikulyarny complex, first of all hypothalamic department of an intermediate brain. These structures of a brain are responsible for ensuring internal communications and interaction between vegetative, emotional, endocrine and visceral spheres. Under the influence of a critical or chronic stressful situation there is a violation of integrative processes in a brain to disadaptation development. At the same time no morphological changes in brain fabrics are noted. As processes of disintegration cover the visceral sphere and the autonomic nervous system, in clinic of neurosis along with mental manifestations somatic symptoms and symptoms of vegeto-vascular dystonia are observed.
Violations of work of a limbiko-retikulyarny complex at neurosises it is combined with neyrotransmitterny dysfunction. So, the alarm mechanism research, revealed insufficiency of noradrenergichesky systems of a brain. There is an assumption that pathological uneasiness is connected with anomaly of benzodiazepinovy and Gamkergichesky receptors or reduction of quantity of the neurotransmitters influencing them. Efficiency of therapy of uneasiness benzodiazepinovy tranquilizers is confirmation of this hypothesis. The positive effect of the antidepressants influencing functioning of serotoninergichesky system of a brain indicates pathogenetic connection of neurosis with violations of exchange of serotonin in cerebral structures.
Classification of neurosises
Personal features, psychophysiological condition of an organism and specifics of a disfunktsionirovaniye of various neyrotransmitterny systems define a variety of clinical forms of neurosises. In domestic neurology the main 3 types of neurotic frustration are allocated: neurasthenia, hysterical neurosis (conversion frustration) and neurosis of persuasive states (obsessivno-compulsive frustration). All of them are in detail considered in the corresponding reviews.
As independent nosological units also allocate depressive neurosis, ipokhondrichesky neurosis, fobichesky neurosis. The last is partially included into structure of obsessivno-compulsive frustration as persistence (obsessiya) seldom have the isolated character and usually are followed by persuasive phobias. On the other hand, in MKB-10 disturbing neurosis is taken out by a separate position with the name "disturbing frustration". By features of clinical manifestations it is classified as the panic attacks (paroksizmalny vegetative crises), generalized disturbing frustration, social phobias, an agarofobiya, a nozofobiya, claustrophobia, a logofobiya, an aykhmofobiya, etc.
Also refer somatoformny (psychosomatic) and poststressful frustration to neurosises. At somatoformny neurosis of the complaint of the patient completely correspond to clinic of a somatic disease (for example stenocardias, pancreatitis, stomach ulcer, gastritis, colitis), however at detailed inspection with carrying out laboratory analyses, ECG, gastroscopy, ultrasonography, an irrigoskopiya, kolonoskopiya and so forth this pathology does not come to light. In the anamnesis there is an existence of the psychoinjuring situation. Poststressful neurosises are observed at the persons who endured natural disasters, technogenic accidents, fighting, acts of terrorism, etc. mass tragedies. They are subdivided on sharp and chronic. The first it is passing and are shown in time or directly after the tragic events, as a rule, in the form of a fit of hysteria. The second gradually lead to change of the personality and social disadaptation (for example, neurosis of the Afghan).
Stages of development of neurosis
Neurotic frustration take place 3 stages in the development. At the first two stages owing to external circumstances, the internal reasons or as a result of the carried-out treatment neurosis can completely stop the existence. In cases of long influence of the psychoinjuring trigger (a chronic stress), in the absence of professional psychotherapeutic and/or medicamentous support of the patient, there is the 3rd stage — the disease passes into a stage of chronic neurosis. There are permanent changes in structure of the personality which remain in it even on condition of effectively performed therapy.
The first stage in dynamics of neurosis neurotic reaction — the short-term neurotic frustration lasting not more than 1 month resulting from a sharp psychotrauma is considered. It is typical for children's age. As an isolated case it can be noted at absolutely healthy people in the mental plan.
Longer course of neurotic frustration, change of behavioural reactions and emergence of assessment of the disease speak about development of a neurotic state, i.e. actually neurosis. Not stopped neurotic state within 6 months — 2 years leads to formation of neurotic development of the personality. Relatives of the patient and he speak about essential change of its character and behavior, often reflecting a situation the phrase "him / her as changed".
General symptoms of neurosises
Vegetative violations have polysystem character, can be both permanent, and paroksizmalny (the panic attacks). Disorders of function of nervous system are shown by tension headache, a giperesteziya, dizziness and feeling of instability when walking, a tremor, starts, paresteziya, muscular twitchings. Sleep disorders are observed at 40% of patients with neurosises. Usually they are presented by an insomniy and day gipersomniya.
Neurotic dysfunction of cardiovascular system includes: discomfortable feelings in warm area, arterial hypertension or hypotonia, violations of a rhythm (premature ventricular contraction, tachycardia), a kardialgiya, a syndrome of pseudo-coronary insufficiency, Reynaud's syndrome. The disorders of breath which are noted at neurosis are characterized by feeling of shortage of air, a lump in a throat or suffocation, a neurotic hiccups and yawning, fear to choke, imaginary loss of respiratory automatism.
From digestive organs dryness in a mouth, nausea, a loss of appetite, vomiting, heartburn, a meteorizm, not clear abdominalgiya, diarrhea, a lock can take place. Neurotic violations of work of urinogenital system cause a tsistalgiya, a pollakiuriya, an itch or pains in genitals, enuresis, frigidity, decrease in a libido, a premature ejaculation in men. Disorder of thermal control brings to periodic a fever, to a gipergidroz, a subfebrilitet. At neurosis there can be dermatological problems — rashes as urticaria, psoriasis, atopic dermatitis.
Typical symptom of many neurosises is the adynamy — increased fatigue as in the mental sphere, and physical character. Often there is a disturbing syndrome — constant expectation of the forthcoming unpleasant events or danger. Phobias — fears of persuasive type are possible. At neurosis they usually concrete, concerning a certain subject or an event. In some cases neurosis is followed by kompulsiya — stereotypic persuasive motive acts which can be the rituals corresponding to certain obsessiya. Obsessiya — burdensome persuasive memoirs, thoughts, images, inclinations. As a rule, are combined with kompulsiya and phobias. At some patients neurosis is followed by a distimiya — the lowered mood with feeling of a grief, melancholy, loss, despondency, grief.
Forgetfulness, deterioration in storing, big otvlekayemost, carelessness, inability to concentrate, affective type of thinking and some narrowing of consciousness belong to the mnestichesky frustration often accompanying neurosis.
Diagnosis of neurosis
The leading role in diagnosis of neurosis is played by identification in the anamnesis of the psychoinjuring trigger, given psychological testing of the patient, a research of structure of the personality and patopsikhologichesky inspection.
In the neurologic status at patients with neurosis no focal symptomatology comes to light. Perhaps general revival of reflexes, palms, a tremor of finger-tips at a pulling of hands forward. The exception of cerebral pathology of organic or vascular genesis is carried out by the neurologist by means of EEG, MRT of a brain, REG, UZDG of vessels of the head. At the expressed sleep disorders consultation of the somnologist and carrying out a polisomnografiya is possible.
Differential diagnosis of neurosis with similar on clinic psychiatric (schizophrenia, a psychopathia, bipolar disorder) and somatic (stenocardia, a cardiomyopathy, chronic gastritis, enteritis, glomerulonefrit) diseases is necessary. The patient with neurosis significantly differs from psychiatric sore subjects that he well realizes the disease, precisely describes the symptoms disturbing him and wishes to get rid of them. In difficult cases the plan of inspection joins consultation of the psychiatrist. For an exception of pathology of internals depending on the leading symptomatology of neurosis it is appointed: consultation of the cardiologist, gastroenterologist, urologist, gynecologist, etc. experts; ECG, ultrasonography of abdominal organs, FGDS, ultrasonography of a bladder, KT of kidneys, etc. researches.
Treatment of neurosis
The basis of therapy of neurosis is made by elimination of influence of the psychoinjuring trigger. It is possible or at permission of the psychoinjuring situation (that is observed extremely seldom), or at such change of the relation of the patient to current situation when it stops being for it the injuring factor. In this regard, in treatment the psychotherapy is leading.
Traditionally mainly complex treatment combining psychotherapeutic methods and pharmacotherapy is applied to neurosises. In mild cases there can be sufficient only a psychotherapeutic treatment. It is directed to revision of the relation to a situation and permission of the internal conflict of the patient with neurosis. From techniques of psychotherapy application of psychocorrection, a cognitive training, art therapy, psychoanalytic and cognitive and behavioural psychotherapy is possible. Training in relaxation methods is in addition provided; in certain cases — hypnotherapy. Therapy is performed by the psychotherapist or the medical psychologist.
Drug treatment of neurosis is based on neyrotransmitterny aspects of its pathogenesis. It carries a supporting role: facilitates work on itself during psychotherapeutic treatment and sets its results. At an adynamy, a depression, phobias, uneasiness, the panic attacks antidepressants are leading: , , , St. John's Wort grass extract; more modern — , fluoxetine, , to tsitalopra, . In therapy of disturbing frustration and phobias in addition use medicines of anxiolytic action. At neurosises with soft manifestations the grass calming collecting and short courses of soft tranquilizers are shown (). At the developed violations preference is given to tranquilizers of a benzodiazepinovy row (an alprazolam, clonazepam). At hysterical and ipokhondrichesky manifestations purpose of small doses of neuroleptics is possible (a tiaprida, a sulpirida, thioridazine).
As the supporting and all-strengthening therapy of neurosis polyvitamins, adaptogens, glycine, reflexotherapy and physical therapy (an electrodream, a darsonvalization, massage, balneotherapy) are applied.
Forecast and prevention of neurosis
The forecast of neurosis depends on its type, a stage of development and duration of a current, timeliness and adequacy to the given psychological and medicamentous assistance. In most cases in time the begun therapy brings if not to treatment, then to considerable improvement of a condition of the patient. Long existence of neurosis dangerously irreversible changes of the personality and risk of a suicide.
Good prevention of neurosises is the prevention of emergence of the psychoinjuring situations, especially at children's age. But the best way education in itself the correct relation to the coming events and people, development of adequate system of life priorities, disposal of delusions can be. Strengthening of mentality is also promoted by a sufficient dream, a dobrotvorchestvo and a mobile way of life, healthy food, a hardening.