A psychogenic form of the disease is also possible. Psychogenic disorders (reactive) are a person’s reactions to difficult life circumstances. Complex of psychogenic disorders

Plan:

1. Psychopathy

2. Personality disorders.

3. Neuroses.

4. Reactive psychoses

5. Anxiety and somatoform disorders.

Psychopathy is a pathological condition manifested by a disharmonious personality pattern, from which either the patients themselves or society suffer (K. Schneider).

General characteristics. Psychopathy arises on the basis of the interaction of congenital or early acquired biological deficiency of the nervous system and the influence of the external environment.

Classification of psychopathy. There is currently no generally accepted classification of psychopathy.

CONSTITUTIONAL DEPRESSIVE TYPE. This includes people with a constantly low mood; these are gloomy, dull, gloomy, dissatisfied and unsociable people. All their reactions are slow. In their work they are conscientious, careful and pedantic, as they are ready to anticipate complications and failures in everything.

HYPERTHYMIC TYPE. Unites people with constantly elevated mood and unbridled optimism. Outwardly, they are sociable, talkative, active and lively people. In their work they are energetic, enterprising, often tireless, but at the same time inconsistent and prone to adventure, which often leads them either to a significant rise or to an unexpected collapse. They are characterized by self-confidence and unceremoniousness, which, with usually high self-esteem, makes them intolerable debaters; They are often deceitful, boastful, prone to risky adventures with a complete lack of a critical attitude towards their shortcomings.

CYCLOID TYPE. Includes the largest group of people with affective instability. Their mood is prone to constant fluctuations from a feeling of mild sadness or slight melancholy to cheerful or joyful. In a calm, average state, they are sociable, friendly and flexible people. They do not have a sharp contrast between their self and their surroundings. They find a common language with people in the shortest and most natural way. These are realists who easily, without moralizing, understand the individuality of others.

EMOTIONALLY LABILE (REACTIVELY LABILE) TYPE

Persons of this type are distinguished by extreme variability and inconstancy of mood, richness and polymorphism of emotional shades, reflecting the content of specific situations. The mood of these people fluctuates over the most insignificant reasons; they react heavily to mental trauma.

ASTHENIC TYPEPsychopathic individuals are distinguished by a combination of irritability, increased impressionability and sensitivity with significant mental exhaustion and fatigue. These are people with low self-esteem, a sense of inferiority, easily wounded, vulnerable and self-loving (“mimosa-like”). They react subtly to the slightest nuances in the behavior of others and are sensitive to rudeness and tactlessness. They feel especially bad in a new environment and unfamiliar company: they become timid, lost, depressed, become silent, more shy and indecisive than usual. Asthenics do not tolerate strong direct irritants (noise, sharp sounds); they often cannot stand the sight of blood or sudden changes in temperature.

HYSTERICAL TYPE. Of the many signs inherent in hysterical psychopathy, the most characteristic is the desire to appear in one’s own opinion and in the eyes of others as a significant person, which does not correspond to real possibilities. Externally, these tendencies are manifested in the desire for originality, demonstrations of superiority, passionate search and thirst for recognition from others, hyperbolization and colorization of one’s experiences, theatricality and panache in behavior. Hysterical individuals are characterized by posturing, deceit, a tendency to deliberate exaggeration, and actions designed for external effect.

EXCITABLE EPILEPTID TYPE. Psychopathic personalities of this type live in constant tension with extreme irritability, leading to attacks of rage, and the strength of the reaction does not correspond to the strength of the stimulus. Usually, following an outburst of anger, patients regret what happened, but under appropriate conditions they do the same again. They are characterized by increased demands on others, unwillingness to take into account their opinions, extreme selfishness and selfishness, touchiness and suspicion.

PARANOIC TYPE. The main feature of this psychopathy is the tendency to form highly valuable ideas that influence the behavior of the individual. These are people with narrow and one-sided interests, distrustful and suspicious, with increased self-esteem and egocentrism, persistent in defending their beliefs, gloomy and vindictive, often rude and tactless, ready to see an ill-wisher in every person.

SCHIZOID TYPE. Psychopathic personalities of the schizoid type are characterized by pathological isolation, secrecy, isolation from reality, and autism. Emotional disharmony in these individuals is characterized by the so-called psycho-aesthetic proportion, i.e., a combination of increased sensitivity (hyperesthesia) and emotional coldness (anesthesia) with simultaneous alienation from people (“wood and glass”). Such a person is detached from reality, prone to symbolism and complex theoretical constructions.

UNSTABLE (WILLWILLLESS) TYPE The instability of the mental life of psychopathic personalities of this type is due to their increased subordination to external influences. These are weak-willed, suggestible and pliable people who easily fall under the influence of the environment, especially a bad one. The realization of motives, desires and aspirations is determined not by internal goals, but by random external circumstances.

PSYCHASTHENIC TYPE: Just like the asthenic type, it belongs to inhibited psychopathy (N.I. Felinskaya). In addition to the traits of irritable weakness, vulnerability and feelings of inferiority, psychopathic personalities of this type are distinguished by pronounced indecision, self-doubt and a tendency to doubt. Psychasthenic individuals are shy, timid, embarrassed, inactive and poorly adapted to life.

Treatment. Understanding psychopathy as a congenital personality anomaly confronts the doctor with the need to use, first of all, compensation mechanisms. In this regard, the most important role in the prevention and treatment of psychopathy belongs to pedagogical measures, as well as social and labor arrangements. Correct, taking into account individual characteristics, professional guidance and work regime, and psychotherapy are of great importance.

Drug therapy is of auxiliary value and is very individual. For exacerbations of excitable type psychopathy, antipsychotics are indicated, especially neuleptil, stelazine, etaprazine. In states of affective tension, anxiety and dysphoria, along with neuroleptics, antidepressants with a sedative or thymoneuroleptic effect (tizercin, etc.) are prescribed. In addition to these drugs, tranquilizers are widely used in the medicinal treatment of psychopathic conditions (affective instability, anxiety, emotional stress, phobias, etc.): elenium, seduxen, tazepam, diazepam, etc.

PERSONALITY DISORDERS

Paranoid personality disorder. Individuals with this disorder are very suspicious and hypersensitive to slights or interpersonal conflicts. They “are usually hypervigilant about the possibility of being harmed or deceived by others, so they are always on guard, secretive, and often unkind to others.

Schizoid personality disorder. Schizoid individuals are usually loners and seem to have little need for the company of other people. They give the impression of being very cold and withdrawn, indifferent to praise or criticism; They tend not to have close friends, so they are often socially reclusive.

Personality disorder of the schizophrenic type (schizotypal). Schizotypal personalities are similar to those with schizophrenia in the eccentricity of thinking, perception of the environment, speech and the nature of interpersonal relationships, however, the degree of expression of these features and their coverage of the individual does not reach the extent when a diagnosis of schizophrenia can be made. They have strange speech (e.g., metaphorical, evasive, detailed), referential ideas (ie: ideas with the inappropriate conclusion that some neutral events have a special relationship to their personality), magical (unrealistic) thinking, and marked suspicion.

Borderline Personality Disorder/Individuals with this personality disorder have been described as “stable-unstable.” They experience constant difficulties in maintaining a stable mood, interpersonal attachments, and also in maintaining a stable self-image. Borderline personality may manifest itself through impulsive behavior, sometimes of a self-harmful nature (for example, self-harm, suicidal behavior). The mood of such persons is usually unpredictable.

“Theatrical” (ostentatious, hysterical) personality disorder./People with a “theatrical” personality type are characterized by very “intense” but in reality superficial interpersonal relationships. They usually come across as very busy people, the events around them are dramatized, and they, of course, are the center of these events.

Narcissistic personality disorder. Narcissistic individuals typically have a heightened sense of self-worth and often view themselves as unique, gifted, and possessing incredible potential. Narcissistic individuals find it difficult to see others in a real light; they either over-idealize them or immediately devalue them.

Antisocial personality disorder. Antisocial behavior is characterized by non-compliance with generally accepted rules of behavior for an individual; he commits actions that are not expected of him, repeatedly violates the rights of others. This diagnosis can only apply to adults (in patients under 18 years of age, traits of antisocial behavior are classified as behavioral disorders) in whom the traits of antisocial behavior appeared before the age of 15 years.

A personality disorder with a tendency to avoid relationships with another person. This personality disorder is characterized by the patient’s inability to respond correctly to rejection or impolite treatment. Therefore, patients often avoid close communication with anyone altogether.

However, secretly they still want to communicate with other people. Unlike individuals of the narcissistic type, their self-esteem is often low, and they tend to exaggerate their shortcomings.

A personality disorder characterized by dependence on others. “Dependent” individuals easily allow others to solve many of their life problems for them. Due to the fact that they feel helpless and unable to resolve any issue on their own, they strive to subordinate their needs and desires to others, so as not to be responsible for themselves.

Passive-aggressive personality disorder. Individuals with passive-aggressive personality disorder typically reject all responsibility, both social and professional. Instead of expressing this directly, they tend to procrastinate and procrastinate, resulting in slacking or ineffective work; their frequent reference is the word “forgot”. Thus, they ruin their potential in work and life.

Compulsive personality disorder. This condition is characterized by the presence of irresistible desires. Such persons usually overload themselves with various rules, rituals and details of behavior

Atypical, mixed and other personality disorders. This last category of DSM-III personality disorders includes those that do not fit neatly into any of the above categories. The term “mixed personality disorder” is most often used. This means that the behavior of a given individual simultaneously corresponds to several categories of personality disorders, and Treatment consists mainly of psychotherapy, used in one form or another. Only in some cases psychopharmacological agents are used.

RECTIVE PSYCHOSES

Reactive psychoses are temporary reversible mental illnesses, varied in clinical picture, occurring in the form of confusion, delirium, affective and motor disorders; arise as a result of mental trauma.

In the development of RP, the nature of the mental trauma and the constitutional characteristics of the patient are of decisive importance. Predisposing factors include pathological changes caused by infectious diseases, intoxications, traumatic brain injuries, as well as periods of age-related crises. According to the characteristics of occurrence and course, acute (shock), subacute and prolonged reactive psychoses are distinguished.

Clinical picture.

Acute (shock) reactive psychoses (psychogenic shock) arise under the influence of a sudden, super-strong mental trauma that poses a threat to existence (for example, a sudden attack by criminals, an earthquake, a flood, a fire), or associated with the unexpected news of the irreparable loss of the most significant values ​​for a person (death loved one, loss of property, arrest, etc.) They occur in hypokinetic and hyperkinetic forms.

In the hypokinetic form, a stuporous state suddenly develops; the patient seems to be numb with horror, he is unable to make a single movement, utter a single word.

The hyperkinetic form is characterized by the sudden appearance of chaotic motor excitation.

In some cases, there is a change from the hyperkinetic form to the hypokinetic one. Both forms are accompanied by twilight stupefaction, complete or partial amnesia (see Memory), autonomic disorders (for example, tachycardia, rare changes in blood pressure, profuse sweat); last for several minutes or hours.

Subacute reactive psychoses occur most often, especially in forensic psychiatric practice.

These include psychogenic depression, hysterical psychosis, psychogenic paranoid, psychogenic stupor.

Psychogenic depression is characterized by a depressed or depressed-anxious mood, usually combined with tearfulness (tearful depression), irritability, dissatisfaction, and irascibility (dysphoric depression). Sometimes psychogenic depression, primarily hysterical, can be complicated by more severe disorders: delusional fantasies, puerilism, pseudodementia.

TO reactive hysterical psychoses include the syndrome of delusional fantasies, Ganser syndrome, pseudodementia (pseudodementia syndrome), puerilism, behavioral regression syndrome (feral syndrome).

The syndrome of delusional fantasies is manifested by unstable, unsystematic or poorly systematized, changeable in content, especially under the influence of external circumstances, ideas of revaluation of one’s self or ideas of greatness, reform, invention, less often persecution or accusation. As psychosis develops, the syndrome of delusional fantasies may be replaced by a state of pseudodementia or puerilism.

Ganser syndrome is a hysterical twilight stupefaction with a predominance of transient phenomena in the clinical picture (simple questions are followed by incorrect answers, usually not related to the content of the question). Patients are disoriented in place, time, surroundings, and their own personality. In some, inhibition predominates, in others - excitement with expressive behavior, emotions are changeable; Everything that happens to the patient during the twilight state is accompanied by complete amnesia. In some cases, Ganser syndrome gives way to pseudodementia.

Pseudo-dementia (imaginary dementia) is manifested by incorrect answers or

actions to simple questions or requests. Patients make mistakes when

basic arithmetic, cannot correctly name the number of fingers on a hand,

are able to list the names of the fingers: instead of showing the nose,

pointing in the ear, putting on clothes incorrectly, etc. Characteristic violations

letters - agrammatism, missing letters, sharp deterioration of handwriting. Reading is often disrupted. Many patients smile meaninglessly. Pseudo-dementia

changes frequently

puerilism. in the clinical picture of which is dominated

behavior and statements characteristic of children. Patients make toys

for example, from paper, they play with them, collect and paste pictures, candy wrappers from

sweets They speak with childish intonations, use diminutives,

lisp, lisp. At the same time, patients retain the skills characteristic of

adults (for example, they skillfully light matches and smoke).

Behavioral regression syndrome (feralization syndrome) is one of the most rare forms of R. p. The patient's behavior seems to be likened to the behavior of an animal. A state of psychomotor agitation is often noted: patients growl, bark, meow, tear their clothes, expose themselves, eat with their hands or lap: in some cases they become aggressive.

Psychogenic paranoid manifests itself as figurative delirium (see Delusional syndromes), the content of which poses a threat to the patient’s life. Characterized by anxiety, fear, motor agitation, often in the form of impulsive actions (flight, seeking protection, in some cases attacking imaginary enemies), and confusion. Occurs in an unusual situation, for example, in a foreign language environment, in conditions of prolonged travel requiring waiting, changing transport, lack of sleep

Psychogenic stupor characterized by speech and motor retardation, usually combined with autonomic disorders. It is accompanied by hysterical, much less often depressive, hallucinatory or delusional symptoms.

Protracted reactive psychoses are characterized by delusional fantasies, hysterical depression, and pseudo-dementia-puerility disorders. In the most favorable cases, these disorders remain unchanged for a year or even longer. A less favorable course is for those prolonged R. p. in which the initial symptoms are complicated by transient stuporous disorders. The most unfavorable course is prolonged R. p., in which the initial hysterical symptoms disappear, and the condition of the patients begins to be characterized by psychomotor inhibition with progressive physical exhaustion.

Treatment is carried out in a psychiatric hospital. Psychotropic drugs are prescribed: after the symptoms disappear, psychotherapy is indicated in all cases. The prognosis is usually favorable. Neurosis (Novolat. neurosis, comes from the ancient Greek vetipov - nerve; synonyms - psychoneurosis, neurotic disorder) - in the clinic: a collective name for a group of functional psychogenic reversible disorders that tend to have a protracted course. The clinical picture of such disorders is characterized by asthenic, obsessive and/or hysterical manifestations, as well as a temporary decrease in mental and physical performance.

The psychogenic factor in all cases is conflicts (external or internal), the effect of circumstances causing psychological trauma, or prolonged overstrain of the emotional and/or intellectual spheres of the psyche.

Causes and mechanics of the development of neurosis

I. P. Pavlov, within the framework of his physiological teaching, defined neurosis as a chronic long-term disorder of higher nervous activity (HNA), caused by overstrain of nervous processes in the cerebral cortex by the action of external stimuli that were inadequate in strength and duration.

Symptoms

Mental symptoms

Emotional distress (often for no apparent reason).

Indecisiveness.

Communication problems.

Inadequate self-esteem: underestimation or overestimation.

Frequent experiences of anxiety, fear, “anxious expectation of something,” phobias, possible panic attacks, panic disorder.

Uncertainty or inconsistency of the system of values, life desires and preferences, ideas about oneself, about others and about life. Cynicism is common. -Mood instability, its frequent and sharp variability, irritability

High sensitivity to stress - people react to a minor stressful event with despair or aggression

Tearfulness

Touchiness, vulnerability

Anxiety - Preoccupation with a traumatic situation

When trying to work, they quickly get tired - memory, attention, and thinking abilities decrease - Sensitivity to loud sounds, bright light, temperature changes - Sleep disorders: it is often difficult for a person to fall asleep due to overexcitement; superficial, disturbing sleep that does not bring relief; I often feel drowsy in the morning

Physical symptoms

Headaches, heart pain, abdominal pain.

Frequently manifested feelings of fatigue, increased fatigue, general decrease in performance

Vegetative-vascular dystonia (VSD), dizziness and darkening of the eyes from pressure changes.

Vestibular disorders: difficulty maintaining balance, dizziness. -Appetite disturbance (overeating; undereating; feeling hungry, but quickly feeling full when eating).

Sleep disorders (insomnia): difficulty falling asleep, early awakening, awakenings at night, lack of feeling of rest after sleep, nightmares.

Psychological experience of physical pain (psychalgia), excessive concern for one’s health up to hypochondria.

Autonomic disorders: sweating, palpitations, fluctuations in blood pressure (usually downward), disruption of the stomach - Sometimes - decreased libido and potency

Frequently associated diseases

Panic attacks, Panic disorder

Phobias, especially social phobia

Vegetative-vascular dystonia (VSD)

Depression

Neurasthenia

There are many methods and theories for treating neuroses. In the treatment of neuroses, psychotherapy and, in fairly severe cases, drug treatment are used.

SOMATOFORM DISORDERS

Somatoform disorders are a group of psychogenic diseases characterized by physical pathological symptoms reminiscent of a somatic disease, but there are no organic manifestations that could be attributed to a medically known disease, although there are often nonspecific functional disorders.

Etiology Among the risk factors for the development of somatoform disorders, two large groups are distinguished: internal and external.

Internal factors include the innate properties of emotional response to distress of any nature. These reactions are regulated by subcortical centers. There is a large group of people who respond to emotional distress with physical symptoms.

External factors include:

microsocial - there are families in which external manifestations of emotions are considered not worthy of attention, not accepted, a person is taught from childhood that attention, love, and support from parents can only be obtained by using “sick behavior”; he uses the same skill in adult life in response to emotionally significant stressful situations;

cultural-ethnic - different cultures have different traditions of expressing emotions; the Chinese language, for example, has a relatively small set of terms to denote various psycho-emotional states; this corresponds to the fact that depressive states in China are represented to a greater extent by somatovegetative manifestations; This can also be facilitated by rigid upbringing within the strict framework of any religious and ideological fundamentalism, where emotions are not so much poorly verbalized as their expression is condemned.

Classification

Somatoform disorders today include:

I Somatization disorder

II Undifferentiated somatoform disorder

III Hypochondriacal disorder

IV Somatoform autonomic dysfunction

1. heart and cardiovascular system: cardiac neurosis;

Da Costa syndrome; cardiopsychoneurosis.

2. upper gastrointestinal tract: gastric neurosis;

psychogenic aerophagia;

dyspepsia;

pylorospasm.

3. lower gastrointestinal tract: psychogenic flatulence;

irritable bowel syndrome; gas diarrhea syndrome.

4. respiratory system: psychogenic forms of cough and shortness of breath.

5. urogenital system:

psychogenic increase in frequency of urination; psychogenic dysuria.

6. other organs and systems

V Chronic somatoform pain disorder: psychalgia;

psychogenic back pain or headache; somatoform pain disorder.

The clinical manifestations of somatoform disorders are varied. Patients, as a rule, turn first to local therapists, then, being dissatisfied with the lack of treatment results, to specialized specialists. However, behind all these complaints there are mental disorders that can be identified with careful questioning: low mood, not reaching the level of depression, loss of physical and mental strength, in addition, irritability, a feeling of internal tension and dissatisfaction are often present. An exacerbation of the disease is provoked not by physical activity or changes in weather conditions, but by emotionally significant stressful situations.

Somatization and undifferentiated somatoform disorder

Somatization disorder (Briequet syndrome) usually begins at the age of about 20 years, and by the age of 30, patients are already confident that they have a serious illness and have extensive experience communicating with doctors, healers, and healers. The main symptom is multiple, recurrent, often changing somatic symptoms that occur over several years. Patients constantly or periodically complain about a wide variety of disorders; usually, with a sequential survey, it is possible to identify at least 13 complaints. This is characterized by a constant change in the leading somatic syndrome.

Somatics is framed by emotional instability, anxiety, and low mood. Patients constantly complain about something, complaints are presented very dramatically. Patients cannot be reassured or convinced that painful manifestations are associated with mental factors.

Criteria for somatization disorder^

1. The presence of multiple, changing somatic symptoms in the absence of any somatic diseases that could explain these symptoms.

2. Constant concern about a symptom leads to prolonged suffering and many (3 or more) consultations and examinations in the outpatient service; if consultation is unavailable for any reason, multiple visits to paramedics.

3. Stubborn refusal to accept a medical opinion about the absence of sufficient somatic causes for the existing symptoms or only short-term agreement with it (up to several weeks).

4. Presence of at least 6 symptoms from two or more different groups

A. Cardiovascular symptoms:

Shortness of breath without exertion

Chest pain

B. Gastrointestinal symptoms:

Abdominal pain

Feeling of heaviness in the abdomen, fullness, bloating - Bad taste in the mouth or an unusually coated tongue

Vomiting or regurgitation of food

B. Genitourinary symptoms:

Dysuria or increased frequency of urination - Unpleasant sensation in or around the genitals

Unusual or very heavy vaginal discharge

D. Skin and pain symptoms:

Appearance of spots or changes in skin color

Pain in limbs and joints

Numbness or paresthesia

In somatization disorder, the above symptoms last for at least two years.

Hypochondriacal disorder

Hypochondria is the patient’s belief in the presence of a serious illness, manifested by obsessive overvalued ideas or delusions. Unlike patients with somatized and undifferentiated somatoform disorders, patients with hypochondria are not only burdened by somatic discomfort, but also experience fear of having an as yet undiscovered serious, life-threatening disease. Symptoms are varied, most often affecting the gastrointestinal and cardiovascular systems. Ordinary sensations and phenomena are interpreted as unpleasant. The patient can name a suspected somatic disease, however, the degree of conviction in the presence of a severe pathology varies from consultation to consultation, and the patient considers one disease or another to be probable. Often the patient assumes that in addition to the main disease, there is an additional one. Also, hypochondriacal disorder is characterized by a monotonous, emotionally inexpressive presentation of complaints, supported by extensive medical documentation. Usually the patient flares up when trying to dissuade him.

Somatoform autonomic dysfunction

Unlike other somatoform disorders, the clinical picture consists of a clear involvement of the ANS and subjective complaints regarding a specific organ or system as the cause of the disorder, and if they are similar in nature to those of the disorders discussed above, then their localization does not change with the course of the disease.

One of the most common in the structure of somatoform autonomic dysfunction of the cardiovascular system is cardialgia syndrome, which is characterized by polymorphism and variability, lack of clear irradiation, occurrence at rest against the background of emotional stress, lasting hours to days, physical activity does not provoke, but relieves pain. Cardialgia is often accompanied by anxiety; patients cannot find a place for themselves, moan and groan. The feeling of palpitations in this type of disorder is only in half of the cases accompanied by an increase in heart rate to 110 - 120 beats per minute, which intensifies at rest, especially in the lying position. An unstable increase in pressure up to 150-160/90-95 mm Hg, which appears against the background of stress, can also occur with somatoform disorders. It is characteristic that tranquilizers are more effective in treatment compared to antihypertensive drugs. In addition, recently the so-called excited heart syndrome or Da Costa syndrome, which includes palpitations, shortness of breath, fatigue and chest pain.

The structure of somatoform autonomic dysfunction of the gastrointestinal tract includes dysphagia, which occurs against the background of acute psychotrauma and is accompanied by painful sensations in the retrosternal region. Its peculiarity is that, as a result of a functional spasm of the esophagus, it is usually easier to swallow solid food than liquid food. Gastralgia is characterized by instability and lack of connection with food intake. Also characteristic of somatoform disorders are aerophagia, accompanied by a feeling of tightness in the chest and frequent belching of air, and hiccups, which usually appear in a public place and resemble the crowing of a rooster. Noteworthy is the absence of signs of pulmonary heart failure even with a long course of the disease and the discrepancy between complaints and often normal pneumotachometry indicators.

Chronic somatoform pain disorder

The leading complaint in chronic somatoform pain disorder is persistent, severe, and mentally depressing pain in any area of ​​the body that lasts more than 6 months and that cannot be explained by a physiological process or physical disorder. It appears when there is an emotional conflict, which can be regarded as its main cause. The onset is usually sudden and increases in intensity over weeks to months. A characteristic feature of this pain is its strength, persistence, and inability to relieve with conventional analgesics.

The uniqueness of reactions to diagnostic interventions and symptomatic therapy also testifies in favor of somatoform disorder: paradoxical relief from diagnostic manipulations;

a tendency to change the leading somatic syndrome (from exacerbation to exacerbation, and sometimes within one phase);

instability of the obtained therapeutic effect; tendency towards idiosyncratic reactions.

Treatment should be preceded by a thorough search for a possible organic cause of suffering, the absence of which supports the diagnosis of somatoform disorder. Patients are almost never able to accept the idea of ​​the mental nature of painful somatic sensations. Therefore, the treatment program must be strictly individualized with an optimal combination of pharmacotherapy, psychotherapy, behavioral methods, social support and carried out in collaboration with a psychiatrist and psychotherapist, mainly on an outpatient basis. Only with a long-term non-remission course of the disease, resistance to standard therapeutic regimens, treatment is possible in a specialized department. Pharmacotherapy:

tranquilizers - short-term (up to 1.5 weeks) or intermittent course of treatment; beta blockers;

tricyclic antidepressants - small and medium doses in combination with tranquilizers and/or beta-blockers;

selective serotonin reuptake inhibitors (small and medium doses) in combination with tranquilizers, citalopram is preferable, fluvoxamine can also be used. Among other antidepressants - mianserin.

Associate Professor, Ph.D. K.K.Teliya

Psychogeny (psycho - soul, related to the soul, geneya - generation, generating) is a painful state in the form of a short-term reaction or a long-term condition (illness), which owes its occurrence to the influence of factors that traumatize the psyche (psychotrauma).

According to their clinical manifestations, psychogenic disorders can appear in the form of mental disorders of the neurotic level - neuroses (neurotic and somatoform disorders), and psychotic level - reactions to stress (reactive psychosis), as well as in the form of manifestations of somatic suffering - psychosomatic variants of somatic diseases.

Under psychotrauma understand an emotionally negatively colored experience about a life event (phenomenon, situation) that is traumatic to the psyche and has subjective personal significance (emotional significance).

In some cases, psychotraumatic life events (phenomena, situations) can act as leading etiological factors ( productive factor), in others - as etiological conditions ( predradetermining, manifesting and supporting factor). More often, their combinations acquire a pathogenic role.

There are acute and chronic psychotraumas.

Under acute Psychotrauma is understood as a sudden, one-time (limited time) impact of psychotrauma of significant intensity. They are divided into: shocking, depressing and disturbing. Based on them, as a rule, arise reactive states and psychoses (acute reactions to stress).

Under chronic Psychotrauma is understood as psychotrauma of less intensity, but existing for a long time. They usually lead to the development neuroses (neurotic and somatophoric disorders).

Psychotraumas are also identified universal significance (threat to life) and individually significant(professional, family and intimate-personal).

Life situations in the process of experiencing them by a specific person can lead to a state of stress, with the possibility of developing diseases (psychogenies). However, stress can be overcome (and psychogeny prevented) if the individual's reaction to such a life situation changes flexibly in accordance with the conditions. This becomes possible thanks to mechanisms coping (coping) And psychological protection .

When psychotraumatic conditions arise, the mechanisms are activated first of all. coping mechanisms . These are various conscious or partially conscious strategies aimed at solving the problem that has arisen.

“Coping” (“overcoming stress”) - is considered as the activity of the individual to maintain or maintain a balance between the requirements of the environment and the resources that satisfy these requirements

With insufficient development of constructive forms of coping behavior, the pathogenicity of life events increases, and these events can become “trigger mechanisms” in the process of the emergence of mental disorders.

In general, they distinguish: 1) the strategy of mobilization and aggression (active influence on the situation, victory in an acceptable way of activity), which includes active preparation for what awaits a person, forces him to formulate a problem, look for the optimal way out and is the most productive and constructive strategy, 2 ) strategy for seeking social support (avoiding social isolation), i.e. seeking help from other participants in society (including, for example, seeking special help from a psychologist, psychotherapist), 3) strategy of avoidance (retreat) - leaving the situation if it is impossible to cope with it (for example, avoiding failures). In addition, various private coping mechanisms are distinguished in the behavioral (for example, cooperation with other people), cognitive (for example, problem analysis or religiosity) and emotional (for example, optimism) spheres.

When coping mechanisms are ineffective, mechanisms are activated psychological protection . The concept of psychological defense was first formulated within the framework of classical psychoanalysis.

Psychological protection- this is an automatic reaction of the psyche to various threats to the individual, unconscious or partially conscious ways of reducing emotional stress, in connection with the refusal of activity.

With the help of psychological protection, psychological discomfort is reduced. In this case, however, a distortion of the reflection of oneself or the environment may occur, and a narrowing of the range of behavioral reactions. Psychological defense mechanisms are aimed at maintaining psychological homeostasis. They can also participate in the formation of pathological symptoms.

Most often, the following psychological defense mechanisms are distinguished: repression, denial, isolation, identification, rationalization, projection, sublimation, etc.

The presence (combination) of certain mechanisms of “coping” and psychological defense depends on the innate properties of the individual and the conditions of his formation (upbringing).

(All these issues are discussed in more detail in the medical psychology course).

Thus, in the formation of mental trauma the following are important:

1) the nature (severity, content) of the psychotraumatic factor (conditions),

2) weakness or inadequacy of coping mechanisms and psychological defenses,

3) personal characteristics,

4) emotional significance of the traumatic factor (conditions).

The whole variety of psychogenic mental disorders is divided into two large groups - reactive psychoses And neuroses.

This category includes disorders that arise as a direct consequence of acute or prolonged severe (massive) psychosocial stress (psychotrauma), causing significant changes in life and leading to long-lasting unpleasant circumstances. This kind of stress is the primary and main causative factor, and the disorder would not have arisen without its influence.

This is a group of painful mental disorders that arise under the influence of mental trauma and manifest themselves in the form of reactions and (or) states reaching psychotic level :

• affectively altered consciousness
• loss of the ability to adequately assess the situation and one’s condition
• conduct disorder
• the presence of productive psychopathological symptoms (hallucinations, delusions, psychomotor disorders, etc.)

As a rule, they all end in complete recovery. More often this happens through the so-called stage. post-reactive asthenia. However, in some cases, they can become protracted and turn into the so-called . abnormal post-reactive personality development (psychopathy).

In general, to distinguish this group of mental disorders of a psychogenic nature from other mental disorders, they use the criteria proposed by Jaspers for diagnosing reactive psychoses.

Jaspers Triad:

1) the state is caused (follows in time the situation) - mental trauma,

2) a psychogenic-traumatic situation is directly or indirectly reflected in the clinical picture of the disease, in the content of its symptoms.

3) the condition ceases with the disappearance of the cause that caused it.

However, the relativity of these criteria should be taken into account, since: a) reactive states can arise later, b) a psychotraumatic situation can be reflected in the content of diseases of a different nature (for example, schizophrenia) and, finally, c) the cessation of the impact of psychological trauma does not always lead to final recovery.

The whole variety of reactive (psychogenic) mental disorders associated with psychotrauma (stress), depending on the nature of the psychotrauma and clinical manifestations, is conventionally divided into:
(in parentheses hereinafter the qualification of the condition is given according to ICD-10)

1. Acute reaction to stress).
2. Dissociative disorders)
3. Protracted reactive psychoses
   A) Reactive depression (Adaptation disorder. depressive episode).
   B) Reactive delusional psychoses (Acute predominantly delusional disorders associated with stress)
4. Post-traumatic stress disorder (this type of disorder was first identified in ICD-10)

Affective-shock psychogenic reactions ( Acute reaction to stress).

These are, as a rule, short-term (transient) reactions of a psychotic level, occurring in persons who previously had no visible mental disorder, in situations of acute, sudden, massive psychotraumatization.

In terms of content, psychotraumatic situations most often appear in the form of: a) a threat to the safety or physical integrity of the individual himself or a loved one (in case of natural disasters, accidents, war, rape, etc.) or b) an unusually sharp and threatening change in social status and (or) the patient’s environment (loss of many loved ones or fire in the house, etc.)

However, not everyone in such situations develops the above disorders.

The risk of developing the disorder increases in people: a) weakened by a somatic disease, b) prolonged lack of sleep, c) fatigue, d) emotional stress, e) the presence of organically defective soil (the elderly).

The personal characteristics of the individual, with this kind of disorder, are of less importance, especially when there is a threat to life (the so-called extrapersonal response). Although, it should be said that vulnerability and adaptive abilities vary from person to person. In addition, they can be improved through targeted training and preparation for such situations (professional military, firefighters).

Clinical manifestations reveal a typically mixed and changing pattern (often resulting in the need to qualify the status within multiple related diagnoses).

A state of acute horror, despair arises, with abundant vegetative manifestations (“hair standing on end”, “turned green with fear”, “heart almost burst out of my chest”), against the background of which it occurs affective (affectogenic) narrowing of the field of consciousness. Because of this, adequate contact with the environment is lost (inability to adequately respond to external stimuli), and disorientation occurs.

In its further development, this condition may be accompanied by two opposite variants of manifestations, which gave grounds to distinguish hypo- and hyperkinetic variants of affective-shock reactions.

Hypokinetic option ( dissociative stupor as part of an acute reaction to stress according to ICD-10) - manifested by sudden motor retardation (“numb with horror”), reaching in some cases complete immobility (stupor) and inability to speak ( mutism). In a state of stupor, patients do not perceive their surroundings, do not respond to stimuli, have an expression of horror on their faces, and their eyes are wide open. More often, pale skin, profuse cold sweating are observed, and involuntary urination and defecation may occur (vegetative component). This response (since it is generally transpersonal) is the result of the revival of the evolutionarily earliest forms of defensive actions in living organisms in a situation of threat, the meaning of which is the strategy “if you freeze, then maybe they won’t notice” (the so-called “imaginary death”) .

Hyperkinetic variant ( flight reaction as part of an acute reaction to stress according to ICD-10) - manifested by severe agitation and psychomotor agitation. Quite often, a large number of people at the same time - the so-called. "crowd panic" Patients rush about aimlessly, run somewhere, movements are completely undirected, chaotic, often screaming something, sobbing with an expression of horror on their face. The condition, just like in the first option, is accompanied by abundant vegetative manifestations (tachycardia, pallor, sweating, etc.). The early evolutionary strategic meaning of such a reaction in the form of a “motor storm” - “maybe some movement will save you.”

The duration of such reactions is on average up to 48 hours while the stressor effect persists. When it is stopped, symptoms begin to decrease after an average of 8-12 hours. After the transferred condition, complete or partial amnesia develops. If this disorder persists for a longer period, the diagnosis is revised.

Primitive hysterical psychoses ( Dissociative disorders)

This group of disorders occurs most often in situations that threaten personal freedom. They are also figuratively called “prison psychoses.” Forensic psychiatrists often deal with them. Although, in principle, such a condition can develop under other conditions.

Most often, such disorders occur in individuals with hysterical character traits, the main of which are a pronounced tendency to suggestibility and self-hypnosis.

The disease arises through hysterical defense mechanisms (dissociation) from a situation intolerable to the individual: “flight into illness,” “fantasizing,” “regression” and reflects the individual’s idea of ​​madness (“became like a child,” “became stupid,” “turned into an animal.” etc.). Today, such primitive forms of response are rare.

Under the influence of psychotraumatic influence, a complex, negative affective state arises, which, including hysterical defense mechanisms, leads to the state hysterical twilight narrowing of the field of consciousness, against the background of which various variants of hysterical psychoses unfold. They, in turn, can appear as independent forms or stages (phases). At the end of the psychosis, amnesia is revealed.

Clinical manifestations in this group of psychoses are very diverse (as, indeed, with all hysteria). These include the following conditions.

Therapeutic measures for reactive states and psychoses include, first of all, if possible, eliminating the cause - the traumatic situation, which is sometimes enough. In other cases, active therapy is necessary, often in a hospital setting.

Affective-shock reactions due to their short duration, they either end or turn into another type of reactive disorder. Only in some cases does there become a need for treatment, especially in the hyperkinetic variant in order to relieve agitation, for which they use, for example, injection of antipsychotics (aminazine, tizercin, olanzapine), tranquilizers (Relanium).

Reactive depression are treated actively with medications (antidepressants, tranquilizers) followed by psychotherapy.

At hysterical psychoses and reactive delusional states Treatment in a hospital with the use of medication (neuroleptics) is necessary.

For PTSD, a combination of drug therapy (antidepressants, tranquilizers) and psychotherapy is used, aimed at correctly accepting and responding to the traumatic experience.

During the period of reactive psychosis, patients are unable to work. In some cases of abnormal personality development, the question of temporary disability may be raised.

Forensic psychiatric examination of patients with reactive psychoses recognizes them as insane if they commit a crime during a painful state. In the event of the development of reactive psychosis during the investigation or trial, it is possible to suspend investigative and judicial actions until recovery with their subsequent resumption.

The disorders presented in ICD-10 under the heading “Neurotic, stress-related and somatoform disorders” are the most difficult to clinically classify.

Thus, in the section “Neurotic disorders” diseases different in their etiopathogenic nature are combined: psychogenic, endogenous, exogenous-organic and independent (hereditary) variants of neurotic disorders. Common to all of them are clinical manifestations in the form of certain neurotic(rather than psychotic) syndromes.

Neurotic syndromes include:

a) neurotic asthenia syndrome(see Neurasthenia )

b)obsessive-compulsive syndrome(see obsessive-compulsive disorder)

c) phobic syndrome ( see Anxiety-phobic disorder ),

d) hysterical-conversion (dissociative) syndrome(see Hysteria)

e) neurotic hypochondria syndrome- excessive care and concern (and not conviction, as in delusional hypochondria) about one’s health with the experience of unpleasant sensations in the body against the background of anxious suspiciousness with emotional disturbances,

f) neurotic depression syndrome - represented by an asthenic-depressive state, which manifests itself mainly when a traumatic topic is touched upon in conversation

g) neurotic sleep disorder in the form of difficulty falling asleep, shallow night sleep and frequent awakenings.

g) neurotic anxiety syndrome (vegetative anxiety), which can manifest itself:

· Somato - vegetative symptoms:

• increased or rapid heartbeat;
• sweating;
• shaking or tremor;
• dry mouth;
• difficulty breathing;
• feeling of suffocation;
• chest pain or discomfort;
• nausea or abdominal distress (such as a burning sensation in the stomach).

· Symptoms related to mental state:

• feeling of dizziness, unsteadiness, fainting;
• the feeling that objects are unreal (derealization) or that the self is distant or “not here” (depersonalization);
• fear of loss of control, madness, or impending death;
• fear of dying.

· General symptoms:

• hot flashes or chills;
• numbness or tingling sensation.

A particular manifestation is neurotic vegetative crisis (VC) and (or) “panic attack” (PA)(see Panic disorder) . IN Unlike other similar states, VC (PA) are characterized by: a) a connection with emotional stress, b) different durations of states, c) the absence of stereotypical manifestations.

Among the diverse, by nature, neurotic disorders, presented in ICD-10, the most important place is occupied by independent, according to their etipathogenetic patterns, diseases - neuroses.

Neurosis(Greek Neuron - nerve, osis - suffix denoting disease) - psychogenic, (usually conflictogenic) neuropsychic borderline disorder, which is based on a violation of higher nervous activity, resulting from a violation of particularly significant life relationships of a person and manifested in specific clinical phenomena in the absence of psychotic (hallucinations, delusions, catatonia, mania) phenomena.

Diagnostic criteria.

The main diagnostic criteria for neurosis consist of the following parameters:

A) psychogenic I nature (caused by psychotrauma), which is determined by the existence of a connection between the clinical picture of neurosis, the characteristics of the individual’s system of relationships and a protracted pathogenic conflict situation. Moreover, the occurrence of neurosis is usually determined not by a direct and immediate reaction of the individual to an unfavorable situation, but by a more or less prolonged processing by the given individual of the current situation and its consequences and the inability to adapt to new conditions,

b) reversibility of pathological disorders, regardless of its duration, i.e. functional the nature of the disorder (which is a reflection of the nature of neurosis, as a breakdown of higher nervous activity that can last days, weeks and even years),

V) neurotic level of disorders : there are no psychotic symptoms (see above), which distinguishes neurosis from psychosis and, including, psychogenic nature,

d ) partiality disorders (in contrast to totality in psychopathy),

f) specificity of clinical manifestations, consisting in dominance emotional-affective and somato-vegetative disorders on compulsory asthenic background, which is reflected in the main neurotic syndromes(see above).

and) critical attitude towards illness - the desire to overcome the disease, to process the current situation and the resulting painful symptoms by the individual.

h) presence of a characteristic type intrapersonal neurotic conflict . Conflict is the existence of simultaneously oppositely directed and incompatible tendencies in the psyche of an individual or between people, occurring with acute negatively colored emotional experiences with possible trauma to the psyche.

There are three main types of neurotic conflicts:

1) hysterical - an inflated level of aspirations with an underestimation of real conditions and an inability to inhibit desires (“I want and they don’t give”);

2) obsessive-psychasthenic - the contradiction between desire and duty (“I don’t want, but I have to”);

3) neurasthenic - discrepancy between the individual’s capabilities, aspirations and inflated demands on oneself (“I want and I can’t”)

Dynamics of neurosis.

In general, the dynamics of neurosis, as a disease that developed after and as a result of psychotraumatization of the individual, includes a number of stages of development (also known as severity levels):

• stage (level) psychological, at which there is a tension in adaptive mental mechanisms and an attempt to cope with psychotrauma using coping mechanisms or psychological defense mechanisms
• stage (level) vegetativemanifestations (tachycardia, sensations of cardiac arrest, hyperemia or pallor of the skin, etc.)
• stage (level) sensorimotormanifestations (fussiness, increased sensitivity to external stimuli)
• stage (level) emotional-affectivemanifestations (anxiety, emotional stress).

If the state has reached the last stage, then it is designated asneurotic reaction. In further dynamics joins:

• stage (level) of ideational (intellectual) design (processing, evaluation) of what happened

In this case, the state is denoted as neurotic state or actually neurosis.

If psychotraumatic effects persist for a long time and in the absence of treatment, neurosis can become a protracted, chronic condition, which is characterized by independent further dynamics.

Thus, with a long-term (many years) course of neurosis, the so-called " neurotic personality development" In this case, the clinical picture of neurosis becomes more complicated (the clinic becomes polysyndromic) and the reactivity of the psyche increases (the individual becomes more sensitive to various stressful effects on the body and psyche).

With a chronic course of more than 5 years, the so-called " acquired psychopathization" personalities, i.e. the personality becomes psychopathic.

However, it should be pointed out that with favorable changes in situations, a reduction in painful manifestations (recovery) is possible at any stage of the dynamics.

Neurasthenia

The name is from the Greek Neuron (nerve) and asthenia (powerlessness, weakness). This type of neurosis was clinically identified as a separate nosological unit in 1869 by the American psychiatrist G. Beard (this name was retained in ICD-10).

According to genesis, 3 groups of neurasthenic neurosis are distinguished:

1) Reactive neurasthenia- owes its emergence to massive (or serial) psychotraumatization

2) Neurosis of exhaustion, overwork- a consequence of overwork and (or) prolonged overwork, with persistent labor overstrain (primarily mental, intellectual, emotional)

3) Information neurosis- develops in the case of an attempt to assimilate a large volume of highly significant information against the background of a lack of time with a high level of motivation (significance of success) behavior ( NB students!).

However, it should be noted that mental stress itself can never be reduced to “overwork,” but always carries a complex combination fatigue, exhaustion And experiencing the situation. Those. the combination of mental trauma with a change in mental state of situational (including work overstrain), intoxication or somatogenic origin usually creates the conditions for the occurrence of neurasthenia.

This neurotic disorder, according to I.P. Pavlov’s theory of GNI, most often occurs in individuals with a weak or strong unbalanced (uncontrolled) and hyperinhibitory type, average in relation to signaling systems.

Incorrect upbringing also plays a role, with excessive demands that exceed the child’s capabilities and unnecessary restrictions, which creates an intrapersonal conflict of the neurasthenic type (“I want and I can’t”).

According to modern concepts, the picture of this disorder is subject to significant cultural variations. In addition, there are two main similar types.

At first type the main symptom is increased fatigue after mental work, decreased professional productivity or efficiency in everyday activities. Mental fatigue is usually described as the unpleasant interference of distracting associations or memories, the inability to concentrate, and therefore thinking becomes unproductive.

At second type the main ones are physical weakness and exhaustion after minimal effort, a feeling of muscle pain and the inability to relax.

Both options are generally characterized by quite diverse clinical manifestations. At the same time, there are symptoms that can be observed in all patients with neurasthenia in the advanced stage of its course, which is a manifestation neurotic asthenic syndrome.

The most typical symptoms include a variety of changes in sensitivity. Moreover, these changes are not expressed equally in different afferent systems and hyperesthesia in some analyzers may be accompanied normesthesia or even relative hypoesthesia in others. All this creates an endless variety of neurasthenia clinics.

Sensitivity can be so severe that the patient may suffer from the effects of ordinary physical irritations ( hyperacusis- painful hearing loss, hyperosmia- sense of smell, hyperalgesia- pain sensitivity, etc.)

For example, the sensitivity of the visual analyzer sometimes reaches such a degree that even scattered light “cuts”, irritates the eyes, and causes lacrimation. In especially severe cases, outside of any stimulus may appear phosphenes(stripes, glare, etc.)

The attempts often made to overcome optical hyperesthesia lead to asthenopia(painful eye fatigue) due to increased fatigue of the eye muscles. As a result, the patient finds it difficult, and sometimes cannot, fix objects of vision for a long time, for example, when reading, which leads to blurring of the text and failure to assimilate what was read. Trying to read again can eventually cause a headache. Asthenopia sharply increases when reading specialized, unfamiliar, complex literature.

Hyperacusis may be accompanied by acoasms, noise, buzzing in the head, and dizziness.

Extremely diverse and hyperalgia, of which the most pronounced myalgia(muscle pain) and cephalgia(headache).

At the height of myalgia, difficulties in movement may even occur. Cephalgia has a varied nature (burning, pressing, pulling, stabbing, sharp, dull, etc.) and different localization (back of the head, crown, temples, etc.). Quite often, cephalgia with neurasthenia is accompanied by paresthesia in the form of encircling compression in the head - the so-called. " neurasthenic helmet" Headache increases with pressure on the scalp in combination with hyperesthesia of the scalp. By their nature, cephalgia with neurasthenia belongs to the type tension ( neuromuscular) cephalgia.

Along with headaches, they often occur dizziness, subjectively experienced by the patient as states close to fainting. Moreover, any stress in activity, temperature changes, driving in transport contribute to the occurrence or intensification of dizziness. Sometimes dizziness takes the form of attacks with nausea and tinnitus.

Almost obligate symptoms of neurasthenia should be considered somato-vegetative disorders. They especially clearly act as vascular lability(hypo - or hypertension, tachy - or dysrhythmia, red persistent dermographism, slight redness or blanching, etc.).

The neurasthenia clinic is richly represented dyspepsia(belching, nausea, difficulty swallowing, dry mucous membranes, a feeling of pressure, fullness in the stomach even in the absence of fullness, etc.), which previously prompted the identification of even a special gastrointestinal form of neurasthenia.

One of the typical manifestations of autonomic disorders in neurasthenia is hyperhidrosis(increased sweat secretion). Any worries and mental conflicts easily lead to hyperhidrosis (in the form of sweating of the forehead, palms, head during sleep, etc.).

There are also such vegetative manifestations as: paradoxical salivation (with excitement it decreases, causing dry mouth), increased secretion of mucus in the nose and secretion of the lacrimal glands (with excitement there is nasal congestion, watery eyes), transient or persistent dysuric manifestations (polyuria, weakness streams, difficulty in starting the act of urination, frequent urges, etc.).

There are also more pronounced disorders in the form of neurotic vegetative crises.

One of the early and constant manifestations of the clinic of neurasthenia are a variety of neurotic sleep disorders.

These may be manifestations of mild drowsiness during the day and a tendency to sleep for long periods of time in the first periods of the disease to insomnia in its various manifestations. More often these are disturbances in falling asleep, a shortening of the total duration of night sleep, shallow, restless sleep with frequent awakenings. After such nights, patients feel exhausted, unrested, and have difficulty getting out of bed and getting down to business.

The picture of the disease contains complex and diverse disorders affectivity and higher mental functions.

The subjective feeling of constant tiredness and exhaustion is accompanied by increased exhaustion of mental processes and experience of the situation. There is a feeling of loss of ability to work, intellectual capabilities, and ability to remember (due to absent-minded attention). And because of all this, there is a drop in productivity in business. Easily occurs irritability for any reason, sometimes reaching the point of anger with a tinge of malice toward others (thereby creating tension in relationships with others). All this against the background of a general decrease in tone, depression, despondency, a pessimistic assessment of the state of one’s health (which in the future can form hypochondriacal manifestations) and (or) life circumstances, sometimes reaching the level neurotic depression. However, when shifting attention to exciting events, being distracted, the patient easily disconnects from painful experiences, and his well-being levels out. At the same time, his mood is very unstable and can fluctuate over the course of hours and even minutes.

Often, with a long course, unstable, undeveloped manifestations are added anxious-phobic, obsessive-compulsive And hysterical inversion (dissociative) syndromes.

Of significant importance among the clinical manifestations of neurasthenia are sexual disorders. In men, this is premature ejaculation and weakening of erection, as well as decreased libido, in women - decreased libido, incomplete sensation of orgasm, anorgasmia.

In Russian literature, it is customary to divide neurasthenia into hypersthenic, transitional (irritable weakness) and hyposthenic forms that are simultaneously considered as stages.

For hypersthenic forms (stages) are characterized by: excessive irritability, incontinence, impatience, tearfulness, impaired attention, increased sensitivity to minor stimuli.

For hyposthenic : the components of asthenia proper (weakness), decreased performance, interest in the environment, fatigue, lethargy, exhaustion are more pronounced.

Form (stage) irritable weakness occupies an intermediate position with a combination of excitability and weakness, transitions from hypersthenia to hyposthenia, from activity to apathy.

“Histera” (uterus) is a term that came to us from ancient Greek medicine, introduced by Hippocrates. The name reflects the views of that time on the cause of the disease, as manifestations of “wandering” through the body of the uterus, “withered” from sexual abstinence. As a neurotic disorder, it is the second most common form of neurosis (after neurasthenia) and is much more common in women than in men.

According to the concept of I.P. Pavlov, hysteria most often occurs in people who are weak, nervous, artistic type Living primarily an emotional life, they are characterized by the dominance of subcortical influences over cortical ones.

More often these are persons with hysterical features character, which is characterized by increased suggestibility (suggestion) and self-hypnosis (autosuggestion)), increased need for recognition, being in the center of attention, theatricality, demonstrativeness in behavior. Such personal characteristics can be formed as a result of improper upbringing as a “family idol” and combined with mental infantilism.

Based on such features, a hysterical intrapersonal neurotic conflict (“I want, but they don’t give”) is formed, which is actualized under the influence of psychotrauma.

Specific hysterical mechanisms of intrapersonal response (“ repression", "flight into illness", "regression", "fantasizing", and conversion And dissociation), as if “helping” to find a “way out” of a difficult situation (by eliminating from the field of attention an unacceptable motive for the patient, a real assessment of one’s own role in a conflict situation), are reflected in clinical manifestations.

So the following are characteristic of hysteria:

· desire to attract attention;

· state " conditional pleasantness, desirability, profitability” of the symptom, helping to fix the hysterical reaction;

Suggestibility and self-hypnosis;

· brightness of emotional manifestations;

Demonstration and theatricality.

Although it should be noted that the modern pathomorphosis of hysteria has led to more blurred clinical manifestations.

According to the psychoanalytic concept, the main role in the pathogenesis of hysteria is played by: sexual complexes (primarily the Oedipus complex) and mental traumas of the period of early childhood, which were repressed into the unconscious.

These repressed complexes and traumatic experiences create a certain “constitutional predisposition” to the development of neurosis, the emergence of which requires the development of an internal conflict between the desire to satisfy the sexual instinct and the refusal of the external world to allow this satisfaction. There is a regression of libido to the period of formation of the Oedipus complex, which causes an increase in the psychic energy of long-standing sexual complexes, which contradict conscious control (“superego”) and are therefore again (as in childhood) subject to suppression.

Under these conditions, suppression leads to the appearance of neurotic hysterical symptoms, which are a substitute form of satisfaction of the sexual instinct. The process of transforming libido into sensorimotor symptoms is called conversion.

To date conversion the mechanism of occurrence of hysterical symptoms is understood more broadly - as the suppression to the point of unconsciousness (“repression”) of unreacted affective reactions to negative experiences with their simultaneous separation from the content and direction from the mental to the somatic sphere in the form of a symptom.

Another described mechanism of hysterical symptom formation is dissociation. With this mechanism, a violation of the function of personality synthesis occurs, which is expressed, first of all, by the loss of the ability to synthesize mental functions and consciousness, which is characterized mainly by a narrowing of the field of consciousness, which in turn allows dissociation, splitting off (and not splitting, as in schizophrenia) of some mental functions, i.e. their loss from the control of the individual, due to which they acquire autonomy and begin to independently (“regardless of the will”) control a person’s behavior. The dissociation mechanism operates only automated mental functions.

All of the above concepts are reflected in modern views on the essence of hysteria, which unites a large group of disorders under the heading “D associative (conversion) disorders"(according to ICD-10).

Common symptoms include partial or complete loss of normal integration between memory of the past, awareness of identity and immediate sensations, on the one hand, and control of body movements, on the other. In these disorders, conscious and selective control is impaired to such an extent that it can vary from day to day and even from hour to hour.

It is precisely because of such versatility of pathogenetic mechanisms that the clinical picture of hysteria is characterized by excessively variegated, polymorphic and changeable symptoms, which gave rise to calling it the “great Proteus”, “a chameleon changing its colors”, “the great simulator”.

Dissociative (hysterical) disorders mental areas of hysteria can be very diverse.

Dissociative disorders of psychotic level - Hysterical psychoses discussed above.

The leading clinical syndrome in hysterical neurotic disorder is hysteroneurotic (hysteroconversion, dissociative) syndrome, which in turn can manifest itself in different clinical variants.

Emotional-affective disorders - phobias, asthenia And hypochondriacal manifestations.

The common features of these disturbances in hysteria are shallow depth, demonstrativeness, deliberateness of experiences and their completely definite situational conditioning. In addition, affective disorders are characterized by lability of emotions, rapid mood swings, and a tendency to violent reactions with tears, often turning into sobs.

Dissociative disorders motor sphere (motility) in cases of a full picture of the illness, they are usually presented with hysterical paralysis(astasia-abasia, hemi-, para-, tetraplegia, facial paralysis and much more), contractures(systemic, localized and generalized, thoracic with breathing problems, diaphragmatic with the illusion of pregnancy, etc.) and spasms(unilateral or bilateral blepharospasm, aphonia, stuttering, mutism, etc.). But the similarity can be close with almost any option ataxia, apraxia, akinesia, aphonia, dysarthria, dyskinesia or paralysis

One of the most striking and typical manifestations of hysteria in the past is hysterical attack(dissociative seizures), which at first glance very accurately imitates a grand mal seizure, but clearly differs from it in such typical signs as:

1. appearance in traumatic situations,
2. lack of aura,
3. a careful, slow fall (more like a descent), usually on a soft one, due to which there are no bruises or injuries,
4. duration of the attack (from several minutes to an hour or even more),
5. absence of a sequence typical for epilepsy,
6. erratic, sweeping and uncoordinated movements of the limbs, grimaces, theatrical poses, bending of the body in an arc (the so-called “hysterical arc”), screaming, crying or laughing,
7. preservation of pupillary reaction to light,
8. absence of tongue biting, involuntary urination (although in some cases it may occur in one stream, and not in small portions in the interval between clonic convulsions, as in epilepsy) and stool,
9. no loss of consciousness, only a narrowing of it,
10. variability of symptoms when others show interest in a seizure,
11. the ability to interrupt a seizure with a strong negative or unexpected stimulus,
12. sudden cessation of a seizure with rapid restoration of physical strength and without drowsiness - absence of post-seizure stupor,
13. absence of amnesia or only selective amnesia during the seizure period,
14. absence of convulsive bioelectrical activity on the EEG.

However, at the present stage, a complete hysterical attack is extremely rare. Rudimentary and atypical forms of seizures predominate in the form of:

• shaking state;
• syncope;
• attacks of hiccups, tremors, laughter, crying, rocking, coughing, tachypnea, etc.

Sensitivity disorders are very diverse and most often appear in the form anesthesia(like socks, stockings, gloves, sleeves, low shoes, etc.), less often in the form hyper- or paresthesia in different systems and reflect the patient’s empirical understanding of possible disorders and therefore their boundaries do not correspond to the innervation zones. Moreover, at the present stage of the pathomorphism of hysteria, such disturbances increasingly resemble the sensations of patients with somatic diseases.

Sensory disorders can be observed in all analyzers. More often, however, the visual analyzer is presented (concentric, circular, tubular narrowing of the visual field, amblyopia, asthenopia, scotomas, blindness, etc.) and auditory (deafness with concomitant muteness or surdomutism). Less commonly, disturbances of smell and taste in the form of weakening or distortion of sensations.

Disorders of the autonomic sphere (smooth muscles of the viscera, sphincters) are the most common manifestations of hysteria at the present stage. This pathomorphosis became possible due to the increase in the general educational level of modern patients with awareness of the medical aspects of health.

Thus, patients with hysteria may experience spasms of the pharynx with difficulty in eating; spasms of the esophagus are a common cause hysterical lump (globehystericus), as well as: spasms of the urethra and bladder, vaginismus, spastic constipation, vomiting, respiratory spasms and tics, etc.

The symptoms of hysteria are widely represented pain(hysteroalgia) in internal organs, membranes, mucous membranes. Almost all types of pain and various localizations occur.

Sometimes, against the background of hysterical paralysis, even trophic And vasomotor violations.

NB! Due to the fact that the modern pathomorphosis of hysteria has led to a shift in clinical manifestations with an emphasis on somatic complaints, this group of patients initially sees internists. And more often they are given an incorrect diagnosis and receive inadequate treatment, which lasts for years and becomes a factor in the chronicity of the condition.

In this regard, it is necessary to pay attention to the fact that with hysteria, patients, on the one hand, emphasize the special exclusivity of their suffering (“terrible,” “unbearable” pain, “shaking chills”), emphasize the extraordinary, unique nature of the symptoms, on the other the parties seem to show indifference to the “paralyzed limb”, as if they are not burdened by “blindness” or the inability to speak.

In the case of a chronic course, the above disorders may be present for years with the possible formation of hysteroid psychopathization.

According to the theory of I.P. Pavlov, this type of disorder often develops in people of the thinking type with a painful predominance of cortical activity over subcortical. The basis of obsessions are foci of stagnant excitation or inhibition.

These people are distinguished by such character traits as self-doubt, indecisiveness, suspiciousness, timidity, an inflated sense of responsibility, or a combination of excessive impressionability and sensitivity with a tendency to delay external manifestations of emotions. They are brought up in conditions of increased anxiety, excessive responsibility, suppression of natural childish liveliness and spontaneity, which forms an intrapersonal conflict of a correspondingly psychasthenic type (“I want, but I can’t”).

All the variety of obsessions with N.N.S. are represented by different types phobias(obsessive fears) obsessions(obsessions, ideas, doubts, memories, etc.) and compulsions(obsessive actions), as well as their combination.

In clinical manifestations, they can appear independently (isolated or in combination) and (or) as a stage of clinical dynamics, which gave rise to the identification of different clinical forms and stages of N.N.S.

Most often, the clinical picture of N.N.S. appears in the form of various kinds of phobias - phobic stage (anxiety-phobic disorder according to ICD-10).

Of all the variety of phobias in the clinical picture of N.N.S. often included: oxyphobia ( fear of sharp objects), to laustrophobia(fear of enclosed spaces), gypsophobia(Fear of heights), misophobia(fear of pollution).

Obsessive fears of illness are common - nosophobia. The most common types of nosophobia are cardiophobia(obsessive fear for the state of the heart), lissophobia(obsessive fear of “craziness”, the emergence of a state that he cannot control), cancerophobia(fear of a tumor process), AIDSphobia, syphilophobia and etc.

NB! Fears of certain diseases according to the modern classification (ICD-10) are classified as “hypochondriacal disorder”, unless they are associated with specific situations in which the disease can be acquired - “specific phobias” (see below)

Phobias when neurosis in contrast to phobias schizophrenia, are characterized by the presence of: a) a clear plot, b) aggravation in situations of conflict, c) the presence of criticism, d) a pronounced component of struggle, e) the simple, psychologically understandable nature of rituals.

The formation of phobias goes through several independent stages characteristic of all neuroses.

At the initial stages, the clinic is represented by autonomic disorders, which is a manifestation autonomic anxiety. Then sensorimotronic and affective (anxiety) disorders are added. And finally, the ideational (content) component is added and this completes the formation of a phobic neurosis.

Subsequently, the disease goes through a number of stages and undergoes clinical complication.

Thus, at the beginning of the disease, phobias arise through the mechanism of a conditioned reflex in identical situations, then the conditions for their occurrence expand.

As a result, the phobic stage of N.N.S goes through 3 stages: 1) phobias arise during a direct encounter with a traumatic situation (for example, in transport, where the fear arose), 2) phobias arise already while waiting for a meeting with a traumatic situation (while waiting for a trip on transport), 3) phobias arise with just the idea of ​​the possibility of a traumatic situation.

The dynamics of the phobic stage are also characterized by an expansion of situations that cause phobia, which is one of the indicators of the unfavorable course of the disease. As a result, the clinical picture may reveal a combination of primary, secondary and even tertiary phobias (for example, cardiophobia leads to the secondary appearance of claustrophobia, and later agorophobia).

Since we are talking about obsessions, patients usually maintain a critical attitude towards obsessive fears. However, on height of phobia(acute attack) for a short period of time patients may lose their critical attitude towards the condition.

In the dynamics of obsessive-compulsive neurosis, obsessive phobias are joined by a variety of protective measures(obsessive-compulsive stage, according to ICD10), used by patients to combat obsessions.

At the beginning, this can only be logical self-persuasion or mental avoidance of obsessive fears. Later, with a more severe course of the disease, patients begin to avoid encounters with traumatic moments and often involve loved ones in their protective actions.

There is a formation of protective actions - rituals, which may undergo further complication, which is another indicator of an unfavorable course. At neurotic In phobias, rituals are always justified and specific (unlike, for example, symbolism in schizophrenia).

The phobic syndrome itself may undergo dynamics and may join it obsessive contrastive attraction(the desire to commit some illegal action that contradicts the attitudes of a given individual), which also indicates an unfavorable course (obsessive-compulsive stage, obsessive-compulsive disorder according to ICD10).

In widespread clinical practice, a combination of phobias and obsessions is often noted, i.e. We are talking about various variants of obsessive-phobic syndrome.

Currently, according to the latest international classification of diseases (ICD-10), different variants of obsessions are distinguished separately: a) anxious-phobic, b) anxious and c) obsessive-compulsive neurotic disorders.

Anxiety-phobic disorders - a group of disorders in which anxiety is caused exclusively or predominantly by certain situations or objects (external to the subject) that are not currently dangerous. All such situations are usually avoided or endured with a feeling of fear. Anxiety can range in intensity from mild discomfort to horror.

This group of disorders includes various variants of phobias, the general diagnostic criteria of which are:

• psychological or autonomic symptoms must be the primary manifestation of anxiety(and at least two symptoms must be presented as manifestations of general anxiety and one of them must be a manifestation of vegetative anxiety ), and not secondary to other symptoms such as delusions or intrusive thoughts,
• anxiety should be limited only or predominantly to certain phobic objects or situations that cause fear or when thinking about them,
• avoidance of a phobic situation (object) must be a pronounced feature,
• awareness of the excessive or unreasonable desire to avoid a situation

Agoraphobia - a group of phobias associated with situations of being outside the home, in open (or closed) spaces and (or) with movements in it and similar situations, such as the presence of a crowd combined with the experience of helplessness and the inability to immediately return to a safe place ( usually home).

That. this includes a whole set of interrelated and usually overlapping phobias, covering fears of leaving the house: entering shops, crowds or public places, or traveling alone on trains, buses, subways or airplanes. Lack of immediate access to an exit is one of the key features of agoraphobic situations.

The intensity of anxiety in these situations can be so severe (with a feeling of shortness of breath, clouding of the head and other autonomic symptoms) that many patients become completely housebound. Women are more often affected. Onset in early adulthood. The course is usually chronic and undulating.

Social phobias - a group of phobias centered around the fear of experiencing attention from others in relatively small groups of people (party, meeting, in a classroom - as opposed to a crowd) with the experience of failure in something, which leads to the avoidance of certain public (social) situations.

Examples of social phobias are: fear of eating in public, fear of public speaking, fear of meeting the opposite sex, fear of blushing, fear of sweating, fear of vomiting in public, etc. They can be isolated, but can also be diffuse, including almost all social situations outside the family circle.

In especially severe cases, this kind of phobia can lead to complete social isolation. Such phobias are usually combined with low self-esteem and fear of criticism. May manifest as complaints of anxiety (hand tremors, facial flushing, nausea, urinary urgency) with these complaints assessed as the main problem. Often begins in adolescence. They are equally common in men and women.

Specific (isolated) phobias - a group of phobias limited to strictly defined situations, such as: heights, thunderstorms, darkness, flying in airplanes, being near animals, urinating or defecating in public toilets, eating certain foods, seeing blood or injuries, examinations, closed spaces , dental treatment, medical procedures.

NB! This group also includes options nosophobia, associated with the fear of contact with infection (sexually transmitted diseases and AIDS) and fears associated with radiation sickness. The criterion for classifying these nosophobias as specific phobias is "external origin in relation to the subject", unlike other nosophobias related to hypochondriacal disorders.

Typically onset in childhood or young adulthood and if untreated can persist for many years.

Obsessive-compulsive disorder . The main feature of this disorder is unpleasantly recurring obsessive thoughts or compulsive actions and their combinations.

General diagnostic criteria:

• they are regarded as their own (and not imposed by surrounding influences)
• the patient resists these manifestations unsuccessfully
• the thought of performing an action is not in itself pleasant
• thoughts, images or impulses must be unpleasantly, stereotypically repetitive.

Obsessions in the form of " predominantly obsessive thoughts or ruminations (mental chewing)" are ideas, mental images or drives that come to the patient’s mind again and again in a stereotypical form.

They are very different in content, but almost always painful and unpleasant. They can be: a) aggressive (for example, a mother may have an obsessive desire to kill a child), b) obscene or blasphemous and alien to the “I” repeated images (obsessive presentation of indecent images), c) simply useless (endless quasi-philosophical reasoning on unimportant alternatives) combined with the inability to make trivial but necessary decisions in everyday life. In all these cases, the patient tries to resist them unsuccessfully.

“Predominantly compulsive actions (obsessive rituals)” most often relate to: a) maintaining cleanliness (especially hand washing), b) continuous monitoring to prevent a potentially dangerous situation, or c) maintaining order and neatness.

Behavior is based on fear, and ritual actions are a futile or symbolic attempt to avert danger. Such rituals can take many hours each day and are sometimes accompanied by indecisiveness and procrastination.

More often, however, the clinical picture is a combination of obsessive thoughts and compulsive actions. They occur equally in men and women. Onset usually occurs in childhood or adolescence. The course is variable and can become chronic.

According to the modern classification, neurotic disorders also include the group anxiety disorders , in which the manifestations of anxiety are the main symptom and are not limited to a particular situation (unlike anxiety-phobic disorders), although obsessive and even some elements of phobias may be present, but they are clearly secondary and less severe.

This group of disorders includes: panic disorder and generalized anxiety disorder.

Panic disorder (episodic paroxysmal anxiety).

The main symptom is repeated attacks of severe anxiety ( panic attack) that are not limited to a specific situation or circumstance and are therefore unpredictable.

Panic attack - it is a discrete period in which there is a sudden onset of intense anxiety, fear or terror, often associated with a feeling of impending doom.

Typical panic attack must have all of the following characteristics:

• discrete episode of intense fear, panic, or discomfort
• begins suddenly (paroxysm)
• peaks within a few minutes and lasts for at least several minutes
• at least 4 symptoms related to manifestations of anxiety must be present (see above), and one of them must be from the groupvegetative symptoms.

Depending on which somato-vegetative manifestations dominate during the attack, panic attacks are distinguished: a) cardiovascular type, b) respiratory type, c) gastrointestinal type.

NB! In widespread medical practice there are so-called atypical variants of panic attacks.

So, with some, there are no emotional and affective manifestations in the form of fear or panic at all - the so-called. " panic without panic" In others, these manifestations are not typical and appear, for example, in the form of a feeling aggression or irritability. In addition, there are panic attacks, in which symptoms not associated with panic are detected, i.e. those that cannot be classified as vegetative, emotional-affective, or cognitive (for example, pain).

To make a diagnosis " Panic disorder" It is necessary for several panic attacks to occur over a period of about 1 month:

• under circumstances not associated with an objective threat or appreciable tension
• attacks should not be limited to known or predictable situations
• between attacks, the state should be free from anxiety symptoms (there may be anxiety in anticipation of an attack).

And, of course, for the reliability of the diagnosis, any other causes of such manifestations (physical, mental, intoxication, etc.) must be excluded, because not every vegetative crisis is a panic attack and not every panic attack is psychogenic.

In the dynamics of the disease, the main manifestations in the form of panic attacks are often accompanied by secondary manifestations in the form of: a) constant fear of a new attack, b) fear of being alone, c) fear of appearing in crowded places, d) avoidance of specific situations (if this often occurs in them).

In addition, secondary hypochondriacal mood and depressive manifestations.

Onset often occurs at a young age. Women get sick more often.

Generalized anxiety disorder.

The main feature is anxiety, which is generalized and persistent. This anxiety is not limited to any specific environmental circumstances, e.g. is "unfixed".

Leading symptoms are very variable. They must be present for at least several months, with most days over a period of at least several weeks.

These symptoms usually include:

• various fears (about future failures, about the state of health of relatives, about a possible accident, other forebodings)
• symptoms of tension: a) fidgetiness, b) muscle tension or pain, c) inability to relax, d) feeling nervous, on edge or mental tension, e) feeling of a lump in the throat or difficulty swallowing
• autonomic hyperactivity (as a mandatory manifestation of anxiety) and any of the symptoms of general anxiety (see above)
• other nonspecific symptoms: a) increased reactivity to small surprises or startles, b) difficulty concentrating or being “blank in the head” due to anxiety or worry, c) constant irritability, d) difficulty falling asleep due to anxiety.

To make a diagnosis, at least four of the above symptoms must be present, and one of them must be from the group of autonomic anxiety.

This disorder is more common in women and is often associated with chronic stress. The course is variable, with a tendency to waveform and chronicity.

Based on the nature of neurotic disorders (both psychogenic and conflict-related), the main treatment method is psychotherapy. Although, in the initial stages of treatment, drug therapy is also used.

Mostly tranquilizers and antidepressants are used in small doses. With their help, there is a primary relief of anxiety, relief of acute clinical manifestations, reassurance of the patient, weakening of asthenic manifestations so that in the future the patient can participate in a psychotherapeutic conversation.

The choice of methods of drug therapy and psychotherapy depends on the clinical form of neurosis.

So, for example, when neurasthenia use rational psychotherapy and methods autogenic training, at hysteria methods based on suggestion (hypnotherapy) and psychoanalysis, at obsessive states methods behavioral (conditioned reflex), autogenic training. Both individual, family and group models of psychotherapy are used.

trogeny

Iatrogenesis- a private, special version of psychogeny, in the formation of which the leading role is played by doctor(his words and actions).

As you know, a very specific interaction arises between a doctor and a patient. The patient sometimes depends entirely on the actions of the doctor. The doctor may be the patient's only hope. Trust in the doctor often plays a leading role in the effect of therapy.

All this (along with other factors) leads to the fact that doctor's word for the patient and his relatives to become special. Therefore, any carelessly spoken word by a doctor (out of ignorance or carelessness) can traumatize the psyche of the patient and (or) his relatives - cause psychotrauma - and form a clinic of some kind of psychogenicity (iatrogenicity).

Clinical manifestations of the iatrogenic variant of psychogenicity can potentially be any of those described above.

Control questions:

• H That's what psychogeny is. What are the clinical variants of psychogenic disorders?
• What is psychotrauma? What are the types of psychotrauma?
• What is “coping” and “psychological protection”?
• Under what conditions is the psyche damaged?
• What are the diagnostic criteria for reactive psychoses?
• What are the types of reactive psychoses?
• What is the prognosis for reactive psychoses?
• What reactive psychoses can occur in the doctor's practice is not psychiatrist. What is the doctor’s tactics with them?
• U Who may experience PTSD?
• What are the criteria for diagnosing neurosis?
• How do neurotic disorders relate to neurosis?
• What are the somato-vegetative manifestations of neuroses?
• What neurosis can “represent” a somatic illness?
• WITH what type of obsessive fear the patient may turn to a doctor or a psychiatrist?
• In which type of neurotic disorder do they complain of attack with somatic complaints?
• The doctor as a source of psychogenicity.

Psychogenia refers to emotional and behavioral disorders caused by strong or trauma to the human psyche.

This type of disorder is classified as a psychogenic disease, and the term “psychogeny” itself unites many disorders.

General nature of causes and etiology

The causes of psychogenicity lie in psychological trauma of varying severity. An individual’s experiences can be acute or chronic, characterized by a state of shock, depression or anxiety.

In many ways, the course of the disease and the patient’s condition are determined by the severity of the injury and the degree of mental instability. A person who is sensitive by nature to emotional shocks experiences this condition much more difficult than someone whose psyche is more stable.

More often, psychogenic disorders occur in vulnerable and infantile people who react sharply to what is happening, as well as in people with mental retardation.

In addition, unfavorable life circumstances, the death of loved ones and long-term family troubles, a humiliating position of a person or awareness of physical deformity and inferiority can give impetus to the development of mental disorders. In this case, the disease develops slowly, gradually reducing vitality and leading the individual to a state of apathy.

It is not possible to find out how widespread such a disorder is, since many people do not assess their condition as painful, considering what is happening as a “everyday situation” and a “dark streak.”

However, it is safe to say that cases of the development of psychogenicity become significantly more frequent during mass upheavals in the form of wars and natural disasters.

Complex of psychogenic disorders

The reaction to unfavorable external factors largely depends on the individual characteristics of the person and the specific situation as a result of which the disorder developed. For this reason, it is quite difficult to identify a clear classification of psychogenic diseases.

In general, the following conditions fall under this definition:

In order to most specifically determine this or that form of psychogenicity, it is necessary to understand on what basis the disorder developed. In addition, due to the individual characteristics of the psyche, the same type of disease can manifest different symptoms in different people.

Each type of disorder manifests itself with certain signs, which makes it possible to identify one or another type of mental disorder.

Jet nonsense

Psychogenic stupor

In such a situation, the individual is inhibited and unkempt, there is no appetite and interest in the world around him. The patient does not react to what is happening and does not show motor activity. With psychogenic stupor, cases of sharp vegetative deviations are not uncommon.

Affective-shock psychosis

Affective-shock psychosis appears due to acute shocks, for example, severe fear during a disaster or during natural disasters. disasters, sometimes from unexpected sad news.

In this state, a person may be overly excited, performing many meaningless and useless actions, or, conversely, fall into a state of depression. Often patients subsequently cannot remember what happened to them at that moment.

People with increased sensitivity, as well as in conditions weakened by previous mental shocks, are most susceptible to affective-shock reactions. A person can remain in this state for up to 1 month.

Psychogenic depression

Psychogenic depression is the most common of all psychogenic spectrum disorders.

This deviation is characterized by increased tearfulness, depression, anxiety and fear. The patient may be lethargic, or, conversely, be overly excited. All a person’s thoughts are subordinated to the event that occurred, which was the cause of mental deviation; suicidal attempts are possible.

Often, against the background of depression, disturbances occur in various body systems, and chronic diseases become aggravated. A person can remain in this state for 1–3 months, and for persons over 40 years of age much longer.

Reactive psychosis of hysterical type

Psychogenic disorders of the hysterical type are of several types:

These forms of the disease can develop independently, but more often there is a transition from one type of psychosis to another.

Twilight disorder of hysterical type

This type of mental disorder is associated with traumatic situations and manifests itself in a stupor or trance.

A person can commit ridiculous actions, suffer from the situation that happened, and see vivid images. In addition, the patient is unable to remember the current date and realize where he is.

After a person’s condition stabilizes, he does not remember what happened to him during the exacerbation period.

Neuroses

A neurotic disorder can also be triggered by mental trauma.

Often occurs as a result of a feeling of psychological discomfort in the environment where a person is located.

In a state of neurosis, the patient realizes that disturbances are occurring in his psyche and he is unhealthy.

Post-traumatic stress disorder

This condition is associated with severe shocks: death of loved ones, catastrophes, natural disasters and others. Once the traumatic situation is resolved, the patient can fully recover.

But often the consequences of this are nightmares and memories of the event.

Features of psychogenic disorders in children and adolescents

Any of the listed types of mental disorders may occur in childhood and adolescence. The difference is that a fragile child’s psyche can react to traumatic situations more acutely, but recovery in children with proper treatment is faster.

Factors that indicate a child or adolescent’s predisposition to the development of psychogenics include the following features:

The personality characteristics of a child largely determine the type of disorder that may arise in a stressful situation.

For example, children suffering from increased anxiety are more prone to overvalued content, and an easily excitable child reacts to mental trauma with manifestations.

Complex of therapeutic measures

In the process of treating psychogenics, it is important to establish the cause of the disorder and take measures to eliminate circumstances that are traumatic to the psyche.

Patients are most often hospitalized because they exhibit unpredictable behavior and can be dangerous to others. In addition, people with mental disorders are often suicidal. For this reason, medical supervision is necessary.

In some cases, just a change of environment has a beneficial effect on a person, but this is not enough for recovery. During the treatment, medications are used, such as:

If the patient is overly excited, it is advisable to use the following drugs for intramuscular administration:

• Tizercin;

The drugs should be administered 2-3 times a day, and drug therapy should be continued until the patient’s adequate condition is restored.

In addition, patients need psychotherapeutic influence. This is necessary for the psychological, social and labor adaptation of the victim.

The duration of treatment depends on the severity of the condition and the individual characteristics of the patient. In some cases, 10 days of hospital treatment is enough for a person, but in other situations, recovery takes 2 or more months.

Implications for general health

Our psyche is sometimes unpredictable, and the same applies to prognoses for various disorders. The chances of recovery and possible consequences directly depend on the situation that caused the mental disorder, as well as on the individual characteristics of the body.

In addition, one should not miss such a moment as the timeliness of assistance - the earlier treatment is started, the higher the chance of a favorable outcome.

In some cases, the patient fully recovers from the shock, but it also happens that what happened leaves a mark for life.

In addition, psychogenic and reactive mental states can cause somatic diseases, for example:

• disruption of the gastrointestinal tract;
• problems with the respiratory system;
• heart and vascular diseases;
• enuresis and difficulty urinating;
• hormonal imbalances.

Also, as a result of mental disorders, frigidity occurs in women, and impotence in men.

Preventive measures

No one is immune from shock or emotional distress, especially in cases where traumatic situations arise unexpectedly: the death of loved ones, car accidents or attacks. In this situation, there is no need to talk about prevention, but if a shock is expected (war, natural disaster, etc.), there are a number of measures for this case.

Prevention involves 3 stages: primary, secondary and ternary.

Primary prevention measures include:

• informing about the upcoming situation;
• training in necessary skills.

As part of secondary prevention, the following activities are carried out:

• measures to ensure public safety;
• early diagnosis of possible disorders;
• psychotherapy and provision of necessary medical care.

Tertiary prevention involves:

• drug and psychotherapeutic treatment of disorders;
• assistance in social adaptation.

These measures, in situations that are expected and obviously harmful to the human psyche, will help reduce the number of possible severe mental disorders.

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Moscow State University for the Humanities

ABSTRACT

in psychopathology

“Psychogenic diseases.

Neuroses"

Plan

1. Introduction

2. Hysterical neurosis

3. Obsessive-compulsive disorder

4. Neuroses in children

5. Neuroses of fear

6. Obsessive-compulsive disorder

7. Depressive neurosis

8. Hysterical neurosis in children

9. Neurasthenia (asthenic neurosis)

10. Hypochondriacal neurosis

11. Neurotic stuttering.

12. Neurotic tics

13. Neurotic sleep disorders

14. Neurotic appetite disorders (anorexia)

15. Neurotic enuresis

16. Neurotic encopresis

17. Pathological habitual actions

Conclusion

Literature

1. Introduction

Neuroses are neuropsychic diseases characterized by a moderate degree of neuropsychic disorder. With these diseases, not only mental incoordination and imbalance come to the fore, but also disturbances in sleep, wakefulness, sense of activity, as well as symptoms of neurological and imaginary internal diseases.

The main cause of neuroses is a mental factor, which is why neuroses are called psychogenic diseases. Such factors may include acute mental trauma or long-term failures, when a background of prolonged mental stress arises.

Emotional stress finds its expression not only in a person’s mental activity, but also in the functions of his internal organs, cardiac activity, respiratory function, and gastrointestinal tract. Typically, such disorders may be limited to functional and transient forms.

However, in some cases, against the background of emotional stress, diseases may arise in the development of which mental stress and the stress factor are of great importance, for example, gastric ulcer, bronchial asthma, hypertension, neurodermatitis and some others.

The second factor is autonomic disorders (unstable blood pressure, heartbeat, pain in the heart, headaches, sleep disorders, sweating, chills, trembling of fingers, discomfort in the body). Having appeared as a result of mental stress, such disorders are subsequently recorded, and it is difficult for a person to get rid of a state of anxiety or tension.

The third factor is human characteristics. This factor is of paramount importance for neurosis. There are people who, by their nature, are prone to instability, emotional imbalance; they tend to experience the minor circumstances of their relationships with loved ones and colleagues for a long time. In such people, the risk of developing neurosis is quite high.

The fourth factor is periods of increased risk. Neuroses occur with varying frequency at different periods of a person’s life. Periods of increased risk are the ages of 3-5 years (formation of the “I”), 12-15 years (puberty and pinching pain in the heart, shortness of breath, etc.

Autonomic disorders in neurasthenia are manifested by vasomotor lability, pronounced dermographism, sweating, twitching in certain muscle groups, a tendency towards hypotension or hypertension, etc. With neurasthenia, “loss of the thread of thought”, “temporary freezing of brain activity” are possible. Unlike epilepsy, with neurasthenia they always develop against the background of nervous overstrain; they are short-lived and disappear without a trace.

With the initial signs of neurasthenia, it is enough to streamline the regime of work, rest and sleep. If necessary, the patient should be transferred to another job and the cause of emotional stress should be eliminated. For the hypersthenic form (stage) of neurasthenia, restorative treatment, regular nutrition, a clear daily regimen, and vitamin therapy are indicated. For irritability, hot temper and incontinence, tincture of valerian, lily of the valley, bromine preparations, tranquilizers are prescribed; for physiotherapeutic procedures - warm general or salt-pine baths, foot baths before bed. In cases of severe neurasthenia, rest (up to several weeks) and sanatorium treatment are recommended. In severe hyposthenic form of neurasthenia, treatment is carried out in a hospital: a course of insulin therapy in small doses, restoratives, stimulating drugs (sydnocarb, lemongrass, ginseng), stimulating physiotherapy, hydrotherapy. Rational psychotherapy is recommended. In cases where low mood, anxiety, restlessness, and sleep disturbances predominate in the clinical picture, antidepressants and tranquilizers with an antidepressant effect (azafen, pyrazidol, tazepam, seduxen) are indicated. The dose is selected individually.

2. Hysterical neurosis

This is a group of psychogenically caused neurotic conditions with somatovegetative, sensory and motor disorders. It is much more common in women than in men, and occurs especially easily in persons suffering from hysterical psychopathy.

Hysterical neurosis manifests itself in various ways. Two main groups of disorders are emotional imbalance (attacks of emotional reactions, attacks of crying, laughing) and imaginary neurological and somatic diseases. These include muscle weakness, loss of sensitivity, a feeling of a ball in the throat, difficulty breathing, hysterical blindness, deafness, loss of voice, etc. It is not without reason that doctors of almost every medical specialty have to deal with this neurosis. First of all, we note that hysterical neurosis is a disease. Hysteria is never a pretense or a simulation.

Motor disturbances in hysterical neurosis are varied. Currently, patients with hysterical paralysis, symptoms of weakness in the legs, and difficulty walking are rare. Sometimes such movement disorders continue for more than one year and leave the patient bedridden. But in those cases where the nature of the illness turns out to be undeniably hysterical, a cure is possible.

Hysterical disorders also include writer's cramp, when, when writing, tension in the muscles of the hand and fingers does not go away, remains and interferes with writing. A similar disorder occurs among telegraph operators and typists.

Speech impairments may manifest as stumbling speech, stuttering, silent speech, or refusal to speak (hysterical silence). Such symptoms can appear during sudden and strong mental impacts on a person, for example, during a fire, earthquake, shipwreck, etc.

Hysterical disorders also include those states of ecstasy, irrepressible delight, which are observed in some religious people during prayer.

First of all, it is necessary, if possible, to eliminate circumstances that are traumatic to the psyche or to mitigate their influence. Sometimes a change of environment has a positive effect. The main place in the treatment of hysteria is given to psychotherapy, in particular rational. Repeated, persistent and targeted conversations with the patient help him develop the correct attitude towards the causes of the disease. To eliminate individual symptoms of hysteria, suggestion is used in a waking or hypnotic state. In some cases, narco-hypnosis, autogenic training, and indirect suggestion are effective, consisting in the fact that the verbal factor is combined with the use of physiotherapeutic procedures or medications (novocaine blockade, massage, various types of electrotherapy with an explanation of their therapeutic role). In the treatment of certain movement disorders, mutism, and surdomutism, amytal-caffeine disinhibition has a beneficial effect (subcutaneous administration of 1 ml of a 20% caffeine solution and after 4-5 minutes intravenous administration of 3-6 ml of a freshly prepared 5% amytal-sodium solution) with appropriate verbal suggestion aimed at eliminating painful symptoms, for a course of 15-10 sessions every other day. For increased emotional excitability and mood instability, various sedatives, tranquilizers and mild antidepressants are recommended. Prolonged hysterical attacks make the administration of hydrochloride in an enema indicated. For hysteria, restorative therapy, vitamin therapy, sanatorium treatment, and physical therapy are prescribed.

The prognosis is usually favorable. In some cases, during a prolonged conflict situation, a transition of hysterical neurosis into hysterical personality development with a protracted neurotic state and hysterical hypochondria is possible.

3. Obsessive-compulsive disorder

Obsessive-compulsive neurosis is characterized by the fact that in a person’s mind certain thoughts, desires, fears, and actions take on a persistent, irresistible character. They are characterized by repetition, as well as by a person’s inability to influence his condition, although he understands the irregularity and even strangeness of his behavior. For example, compulsive hand washing may cause a person to wash their hands for hours. The fear of leaving an electrical appliance unplugged or a door unlocked forces a person to check himself repeatedly. Similar conditions also occur in healthy people, but they are expressed to a weak degree. In neurosis, such fears are clearly obsessive in nature. There are fears of the street, open space, heights, moving traffic, pollution, infection, illness, death, etc.

Treatment should be comprehensive and strictly individualized, taking into account not only the clinical picture of the disease, but also the personal characteristics of the patient. In mild cases, preference is given to psychotherapeutic and restorative methods. Sometimes a good effect is achieved by simple training in suppressing obsession. If this does not bring success, then suggestion is used in a hypnotic state. In severe and persistent cases of neurosis, along with psychotherapeutic measures and restorative treatment, sedatives or tonics are indicated in accordance with the stage of the disease and the characteristics of the clinical picture.

In the initial period of obsessional neurosis, as well as when phobias with anxiety, emotional stress and sleep disturbances predominate in the clinical picture, tranquilizers with a mild antidepressant effect are recommended. Doses of medications are selected individually depending on the severity of neurotic disorders.

If obsessions significantly weaken or disappear under the influence of treatment, then maintenance therapy is recommended for 6-12 months.

Simultaneously with drug treatment, psychotherapy should be carried out, explaining the need for treatment and adherence to sleep and rest patterns. It is known that with somatic weakening and deterioration of sleep, neurotic obsessions become more intense and painful.

In more severe cases of neurosis, especially with neurotic depression, treatment in a hospital is recommended, where antidepressants, antipsychotics in small doses at night, hypoglycemic doses of insulin, etc. can be added to the treatment measures mentioned above. During the recovery period, in addition to maintenance therapy, patient involvement is indicated into the life of the team, strengthening its work attitudes and switching attention from disappearing obsessions to real life interests. For persistent but relatively isolated obsessions (fear of heights, darkness, open space, etc.), suppression of fear through self-hypnosis is recommended.

4. Neuroses in children

Neuroses are psychogenic diseases based on disorders of higher nervous activity, clinically manifested by affective non-psychotic disorders (fear, anxiety, depression, mood swings, etc.), somato-vegetative and movement disorders, experienced as alien, painful manifestations and with a tendency to reverse development and compensation.

Neurotic disorders are observed at any age, but they usually acquire the form of clinically defined diseases (neuroses proper) only after 6-7 years of age. Before this, neurotic disorders usually manifest themselves in the form of individual symptoms, which are little recognized and experienced by the individual due to his immaturity.

Epidemiology. Neuroses are among the most common forms of neuropsychiatric diseases. According to V.A. Kolegova (1973), based on dispensary records in Moscow, patients with neuroses make up 23.3% of the total number of children and adolescents (up to 17 years old inclusive) under the supervision of psychiatrists. Data from individual sample epidemiological studies show that the true prevalence of neurotic disorders in childhood exceeds dispensary records by 5-7 times (Kozlovskaya G.V., Lebedev S.V., 1976). According to research by the same authors, neurotic disorders in school-age children are 2-2.5 times more common than in preschoolers. At the same time, boys predominate in both age groups of children.

Etiology. In the etiology of neuroses as psychogenic diseases, the main causal role belongs to various psychotraumatic factors: acute shock mental effects accompanied by severe fear, subacute and chronic psychotraumatic situations (divorce of parents, conflicts in the family, school, situations associated with drunkenness of parents, school failure, etc.). etc.), emotional deprivation (i.e. lack of positive emotional influences - love, affection, encouragement, encouragement, etc.).

Along with this, other factors (internal and external) are also important in the etiology of neuroses.

Internal factors

1. Personality characteristics associated with mental infantilism (increased anxiety, fearfulness, tendency to fear).

2. Neuropathic conditions, i.e. a complex of manifestations of vegetative and emotional instability.

3. Changes in age-related reactivity of the nervous system during transitional (crisis) periods, i.e. at the age of 2-4 years, 6-8 years and during puberty.

External factors

1. Incorrect upbringing.

2. Unfavorable microsocial and living conditions.

3. Difficulties in school adaptation, etc.

The pathogenic influence of psychotraumatic factors also depends on the psychological significance of the psychotraumatic situation, which is determined by the content of significant traumatic experiences in the anamnesis (experiences related to the illness or death of loved ones, accidents, etc., cases of serious failures in his life, etc. ). However, the leading causative factor is psychotraumatic effects.

Pathogenesis. The actual pathogenesis of neuroses is preceded by the stage of psychogenesis, during which the individual psychologically processes traumatic experiences infected with negative affect (fear, anxiety, resentment, etc.). This process involves protective-compensatory psychological mechanisms (switching, suppression, etc.). In cases of relative strength and persistence of negative affect, weakness of “psychological defense” mechanisms, and the presence of conducive internal and external conditions, a psychological “breakdown” occurs, leading to a “breakdown” higher nervous activity as a result of the physiological mechanisms of “overstrain of nervous processes and their mobility” established by I.P. Pavlov. Subsequent neurophysiological studies by N.I. Grashchenkov (1964) and P.K. Anokhin (1975) showed the multi-level nature of the pathodynamic functional system in neuroses, in which, along with cortical mechanisms, the mechanisms of the limbic-reticular complex and the hypothalamus are involved. An important place in the pathogenesis of neuroses belongs to biochemical changes. Certain changes in the metabolism of adrenaline, norepinephrine, a decrease in the content of DOPA and dopamine in biological fluids due to depletion of the sympathetic-adrenal system during chronic stress in patients with neuroses have been identified (Chugunov V.S., Vasiliev V.N., 1984) and biochemical changes as a result of disturbances in system hypothalamus - pituitary gland - adrenal cortex (Karvasarsky B.D., 1980).

Taxonomy. In general psychiatry in our country, the main forms of neuroses are considered to be neurasthenia (asthenic neurosis), hysteria (hysterical neurosis) and obsessive-compulsive neurosis. Due to the insufficiency of these 3 main forms of neuroses, and also taking into account the nomenclature of neuroses in the International Statistical Classification of Diseases, Injuries and Causes of Death (1975), a working classification of neuroses in children and adolescents was proposed (Kovalev V.V., 1976, 1979) , which unites all the main clinical forms of these diseases in childhood and adolescence. Two subgroups of neuroses have been identified: general neuroses (psychoneuroses), characterized by a predominance of general neurotic mental and autonomic disorders, and systemic neuroses. The first subgroup, based on the leading psychopathological syndrome, includes fear neuroses, hysterical neurosis, obsessive-compulsive neurosis, depressive neurosis, neurasthenia and hypochondriacal neurosis. A subgroup of systemic neuroses includes neurotic tics, neurotic stuttering, neurotic sleep disorders, neurotic lack of appetite, neurotic enuresis and encopresis, as well as pathological habitual actions of childhood (finger sucking, nail biting, yactation, masturbation, trichotillomania).

Clinical picture. Manifestations of neuroses in children and young adolescents are distinguished by great originality, which is associated with incompleteness, rudimentary symptoms, the predominance of somatovegetative and movement disorders, weakness or lack of personal awareness of existing disorders. These features explain the predominantly monosymptomatic nature of neurotic disorders and the statistically significant predominance of systemic neurotic disorders (Kozlovskaya G.V., Lebedev S.V., 1976).

5. Neuroses of fear

The main manifestations of fear neuroses are fears of overvalued content, i.e. objective fears associated with the content of a traumatic situation and causing a special overvalued and fearful attitude towards objects and phenomena that caused the affect of fear. Characterized by paroxysmal occurrence of fears, especially when falling asleep. Attacks of fear last 10-30 minutes and are accompanied by severe anxiety, often affective hallucinations and illusions, and vasovegetative disorders. The content of fears depends on age. In children of preschool and preschool age, fears of the dark, loneliness, animals that frighten the child, characters from fairy tales, movies, or those invented by parents for “educational” purposes (“black guy”, etc.) prevail. Variants of fear neuroses, the occurrence of which is associated with direct fear , called fear neurosis (Sukhareva G.E., 1959).

Children of primary school age, especially first-graders, sometimes experience a variant of fear neurosis called “school neurosis”; an overvalued fear of school arises with its unusual discipline, regime, strict teachers, etc.; is accompanied by refusal to attend, leaving school and home, violations of neatness skills (daytime enuresis and encopresis), and low mood. Children who were raised at home before school are prone to developing “school neurosis.”

The course of fear neuroses, according to research by N.S. Zhukovskaya (1973), can be short-term and protracted (from several months to 2-3 years).

6. Obsessive-compulsive disorder

It is distinguished by the predominance in the clinical picture of wound-like obsessive phenomena, i.e. movements, actions, fears, apprehensions, ideas and thoughts that arise relentlessly against the wishes of the patient, who, aware of their unreasonably painful nature, unsuccessfully strives to overcome them. The main types of obsessions in children are obsessive movements and actions (obsessions) and obsessive fears (phobias). Depending on the predominance of one or the other, neurosis of obsessive actions (obsessive neurosis) and neurosis of obsessive fears (phobic neurosis) are conventionally distinguished. Mixed obsessions are common.

Obsessive neurosis in children of preschool and primary school age is expressed mainly by obsessive movements - obsessive tics, as well as relatively simple obsessive actions. Obsessive tics are a variety of involuntary movements - blinking, wrinkling of the skin of the forehead, nose bridge, turning the head, twitching the shoulders, sniffing the nose, grunting, coughing (respiratory tics), patting the hands, stamping the feet. Tic obsessive movements are associated with emotional stress, which is relieved by a motor discharge and intensifies when the obsessive movement is delayed.

Obsessive actions consist of a combination of a number of movements. Actions of an obsessive nature, performed in a strictly defined sequence, are called rituals.

With phobic neurosis in younger children, obsessive fears of pollution, sharp objects (needles), and closed spaces predominate. Older children and adolescents are more likely to have obsessive fears of illness (cardiophobia, cancerophobia, etc.) and death, fear of choking while eating, fear of blushing in the presence of strangers, fear of giving an oral answer at school. Occasionally, adolescents experience contrasting obsessive experiences. These include blasphemous and blasphemous thoughts, i.e. ideas and thoughts that contradict the desires and moral principles of a teenager. An even rarer form of contrasting obsessions are obsessive compulsions. All these experiences are not realized and are accompanied by anxiety and fear.

Obsessive-compulsive neurosis has a pronounced tendency towards a protracted relapsing course. The protracted course of obsessive-compulsive neurosis, as a rule, leads to neurotic personality development with the formation of such pathological character traits as anxiety, suspiciousness, and a tendency to obsessive fears, doubts and concerns.

7. Depressive neurosis

Unites a group of psychogenic neurotic diseases, in the clinical picture of which the leading place is occupied by depressive mood swings. In the etiology of neurosis, the main role belongs to situations associated with illness, death, divorce of parents, long-term separation from them, as well as orphanhood, raising an unwanted child like a “Cinderella,” and experiencing one’s own inferiority due to a physical or mental defect.

Typical manifestations of depressive neurosis are observed during puberty and prepuberty. A depressed mood comes to the fore, accompanied by a sad facial expression, poor facial expressions, quiet speech, slow movements, tearfulness, a general decrease in activity, and a desire for loneliness. The statements are dominated by traumatic experiences, as well as thoughts about one’s own low value and low level of abilities. Somatovegetative disorders are characteristic: loss of appetite, weight loss, constipation, insomnia. An age-related feature of depressive neurosis is its atypicality with the dominance of equivalents of depression: on the one hand, psychopathic states with irritability, anger, rudeness, aggressiveness, and a tendency to various protest reactions; on the other hand, a variety of somatovegetative disorders: enuresis, encopresis, loss of appetite, dyspeptic disorders, sleep-wake rhythm disturbances in young children and persistent headaches, vasovegetative disorders, persistent insomnia in older children and adolescents.

8. HystericalEuropean neurosisin children

A psychogenic disease characterized by various (somatovegetative, motor, sensory, affective) disorders of the neurotic level, in the occurrence and manifestation of which the leading role belongs to the psychogenetic mechanism of conditioned pleasantness or desirability of these disorders for the patient. This mechanism provides pathological protection of the individual from difficult situations.

In the etiology of hysterical neurosis, an important contributing role belongs to hysterical personality traits (demonstrativeness, “thirst for recognition,” egocentrism), as well as mental infantilism. In the clinic of hysterical disorders in children, the leading place is occupied by motor and somatovegetative disorders: astasia-abasia, hysterical paresis and paralysis of the limbs, hysterical aphonia, as well as hysterical vomiting, urinary retention, headaches, fainting, pseudoalgic phenomena (i.e. complaints of pain in certain parts of the body) in the absence of organic pathology of the corresponding systems and organs, as well as in the absence of objective signs of pain. In younger children, rudimentary motor seizures are often encountered: falling with screaming, crying, throwing limbs, hitting the floor and affect-respiratory attacks that arise in connection with resentment, dissatisfaction with refusal to fulfill the child’s demands, punishment, etc. The most common hysterical sensory disorders in children and adolescents are: hyper- and hypoesthesia of the skin and mucous membranes, hysterical blindness (amaurosis).

9. Neurasthenia (asthenic neurosis)

The occurrence of neurasthenia in children and adolescents is facilitated by somatic weakness and overload with various additional activities. Neurasthenia in a pronounced form occurs only in school-age children and adolescents. The main manifestations of neurosis are increased irritability, lack of restraint, anger and at the same time - exhaustion of affect, an easy transition to crying, fatigue, poor tolerance of any mental stress. Vegetative-vascular dystonia, decreased appetite, and sleep disorders are observed. In younger children, motor disinhibition, restlessness, and a tendency to unnecessary movements are noted.

10. Hypochondriacal neurosis

Neurotic disorders, the structure of which is dominated by excessive concern for one’s health and a tendency to unfounded fears about the possibility of the occurrence of a particular disease. Occurs mainly in teenagers.

11. Neurotic stuttering

Psychogenically caused disturbance of the rhythm, tempo and fluency of speech associated with muscle spasms that are involved in the speech act. Boys stutter much more often than girls. The disorder mainly develops during the period of speech formation (2-3 years) or at the age of 4-5 years, when there is a significant complication of phrasal speech and the formation of internal speech. The causes of neurotic stuttering can be acute, subacute and chronic mental trauma. In young children, along with fear, a common cause of neurotic stuttering is sudden separation from parents. At the same time, a number of conditions contribute to the emergence of neurotic stuttering: family weakness of the cerebral speech mechanisms, manifested in various speech disorders, neuropathic conditions, information overload, attempts by parents to speed up the speech and intellectual development of the child, etc.

12. Neurotic tics

They combine a variety of automated habitual movements (blinking, wrinkling the skin of the forehead, wings of the nose, licking lips, twitching the head, shoulders, various movements of the limbs, torso), as well as “coughing”, “grunting”, “grunting” sounds (respiratory tics), which arise as a result of fixation of one or another defensive movement, initially expedient. In some cases, tics are attributed to manifestations of obsessional neurosis. At the same time, often, especially in children of preschool primary school age, neurotic tics are not accompanied by a feeling of internal lack of freedom, tension, or a desire for obsessive repetition of movements, i.e. are not intrusive. Such habitual automated movements belong to psychopathologically undifferentiated neurotic tics. Neurotic tics (including obsessive tics) are a common disorder in childhood; they are found in boys in 4.5% and in girls in 2.6% of cases. Neurotic tics are most common between the ages of 5 and 12 years. Along with acute and chronic mental trauma, local irritation (conjunctivitis, foreign body of the eye, inflammation of the mucous membrane of the upper respiratory tract, etc.) plays a role in the origin of neurotic tics. The manifestations of neurotic tics are quite similar: tic movements in the muscles of the face, neck, shoulder girdle, and respiratory tics predominate. Combinations with neurotic stuttering and enuresis are common.

13. Neurotic sleep disorders

They are very common in children and adolescents, but have not been studied enough. Various psychotraumatic factors play a role in their etiology, especially those acting in the evening hours. The clinical picture of neurotic sleep disorders is expressed by difficulty falling asleep, restless sleep with frequent movements, deep sleep disorder with night awakenings, night terrors, vivid frightening dreams, as well as sleepwalking and sleep-talking. Night terrors, which occur mainly in children of preschool primary school age, are rudimentary, extremely valuable experiences with an affect of fear, the content of which is directly or symbolically related to traumatic circumstances. Neurotic sleepwalking and sleep-talking are closely related to the content of dreams.

14. Neurotic raappetite disorders (anorexia)

A group of systemic neurotic disorders characterized by various eating disorders due to a primary decrease in appetite. Most often observed in early and preschool age. The immediate cause of anorexia neuroticism is often the mother’s attempt to force-feed the child when he refuses to eat, overfeeding, the accidental coincidence of feeding with some unpleasant experience (fear associated with the fact that the child accidentally choked, a sharp cry, a quarrel among adults, etc.). P.). Clinical manifestations include the child's lack of desire to eat any food or marked food selectivity with refusal of many common foods, very slow eating with a long chewing of food, frequent regurgitation and vomiting during meals. Along with this, low mood, moodiness, and tearfulness during meals are observed.

15. Neurotic enures

Psychogenically caused unconscious loss of urine, mainly during night sleep. In the etiology of enuresis, in addition to psychotraumatic factors, neuropathic conditions, traits of inhibition and anxiety in character, as well as identical family history play a role. The clinical picture of neurotic enuresis is markedly dependent on the situation. Bedwetting becomes more frequent during exacerbation of a traumatic situation, after physical punishment, etc. Already at the end of preschool and beginning of school age, the experience of lack, low self-esteem, and anxious anticipation of another loss of urine appear. This often leads to sleep disturbances. As a rule, other neurotic disorders are observed: mood instability, irritability, moodiness, fears, tearfulness, tics.

16. Neurotic encopresis

It manifests itself in the involuntary release of a small amount of feces in the absence of lesions of the spinal cord, as well as anomalies and other diseases of the lower intestine or anal sphincter. Enuresis occurs approximately 10 times less frequently, mainly in boys aged 7 to 9 years. In etiology, the main role belongs to long-term emotional deprivation, excessively strict demands on the child, and intra-family conflict. The pathogenesis of encopresis has not been studied. The clinic is characterized by a violation of the skill of neatness in the form of the appearance of a small amount of bowel movements in the absence of the urge to defecate. It is often accompanied by low mood, irritability, tearfulness, and neurotic enuresis.

17. Patological habitual actions

A group of psychogenic behavioral disorders specific to children and adolescents, which are based on painful fixation of voluntary actions characteristic of young children. The most common are finger sucking, nail biting (onychophagia), and genital manipulation (stimulation of the genitals resulting in orgasm), reminiscent of masturbation (masturbation). Less common are a painful urge to pull out or pluck hair on the scalp and eyebrows (trichotillomania) and rhythmic rocking of the head and body (yactation) before falling asleep in children of the first 2 years of life.

Conclusion

Prevention of neuroses in children and adolescents is primarily based on psychohygienic measures aimed at normalizing family relationships and correcting improper upbringing. Considering the important role of the child’s character traits in the etiology of neuroses, educational measures for the mental hardening of children with inhibited and anxious-suspicious character traits, as well as with neuropathic conditions, are advisable. Such activities include the formation of activity, initiative, learning to overcome difficulties, de-actualization of frightening circumstances (darkness, separation from parents, meeting strangers, animals, etc.). An important role is played by education in a team with a certain individualization of the approach, the selection of comrades of a certain character. A certain preventive role also belongs to measures to strengthen physical health, primarily physical education and sports. A significant role belongs to the mental hygiene of schoolchildren and the prevention of their intellectual and information overload.

Literature

1. Karvasarsky B. D. Neuroses. M., 1980.

2. Kempinski A. Psychopathology of neuroses. Warsaw, 1975.

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Psychogenic diseases (psychogenies) are a class of mental disorders caused by exposure to unfavorable mental factors. This includes reactive psychoses, psychosomatic disorders, neuroses, abnormal reactions (pathocharacterological and neurotic) and psychogenic personality development that occurs under the influence of mental trauma or in a traumatic situation. It should be emphasized that in cases of psychogenic illness, the disease occurs after mental trauma to a person. It is accompanied, as a rule, by a range of negative emotions: anger, intense fear, hatred, disgust, etc. In this case, it is always possible to identify psychologically understandable relationships between the features of a psychotraumatic situation and the content of psychopathological manifestations. In addition, the course of psychogenic disorders depends on the very presence of a traumatic situation and when it is deactualized, as a rule, a weakening of symptoms occurs.

Neuroses- mental disorders that arise as a result of disruption of particularly significant life relationships of a person and are manifested mainly by psychogenically caused emotional and somatovegetative disorders in the absence of psychotic phenomena.

In V. A. Gilyarovsky’s definition, several signs are given that characterize neuroses: the psychogenic nature of their occurrence, the patient’s personal characteristics, vegetative and somatic disorders, the desire to overcome the disease, the individual’s processing of the current situation and the resulting painful symptoms. Usually, when defining neurosis, the first three signs are assessed, although very important for diagnosing neurosis are the criterion that characterizes the attitude towards the situation of the illness that has arisen and the struggle to overcome it.

Within the framework of psychodynamic theory, the definition of neuroses is based on the established relationship between the symptom, the triggering situation and the nature of early childhood traumatization.

Neurasthenia is the most common form of neurotic disorder. It is characterized by increased excitability, irritability, fatigue and rapid exhaustion. Neurasthenia occurs against a background of nervous exhaustion caused by overwork. The cause of this overwork is intrapersonal conflict. The essence of this conflict lies in the discrepancy between a person’s neuropsychic capabilities and the requirements that he places on himself in the process of performing an activity. The state of fatigue acts in this case as a signal to stop it. However, the demands that a person places on himself force him through an effort of will to overcome this fatigue and continue, for example, to complete a large amount of work in a short time. All this is often combined with a reduction in sleep time, and as a result the person finds himself on the verge of complete nervous exhaustion. As a result, symptoms appear that are considered as a core disorder in neurasthenia - “irritable weakness” (as defined by I. P. Pavlov).

The patient reacts violently to the most insignificant reason, which was uncharacteristic for him before; emotional reactions are short-lived, as exhaustion quickly sets in. Often all this is accompanied by tears and sobs against the background of autonomic reactions (tachycardia, sweating, cold extremities), which pass quite quickly. As a rule, sleep is disturbed, becoming restless and intermittent.

A neurasthenic person feels worst in the morning, but may improve in the evening. However, the feeling of exhaustion and tiredness accompanies him almost all the time. Intellectual activity becomes difficult, absent-mindedness appears, and ability to work decreases sharply. Sometimes the patient has short-term and frightening sensations that his mental activity has stopped - “thinking has stopped.” Headaches appear that are of a tightening, pressing nature (“neurasthenic helmet”). Sensitivity to external stimuli increases, the patient reacts to bright light and noise with irritation and increased headaches. Both men and women experience sexual dysfunction. Appetite decreases or disappears.

Mild neurasthenic manifestations can be observed in any person due to overwork. When treating neurasthenia, psychotherapy is indicated, aimed at identifying the external and intrapersonal causes that caused this neurosis.

Hysterical neurosis (hysteria) is a disease that the famous French psychiatrist J. M. Charcot called the “great malingerer,” since its symptoms can resemble manifestations of a wide variety of diseases. He also identified the main symptoms of this form of neurosis, which in terms of frequency ranks second among neuroses after neurasthenia.

Hysterical neurosis most often occurs at a young age, its development is due to the presence of a certain “hysterical” personality set of traits. First of all, these are suggestibility and self-suggestibility, personal immaturity (infantilism), a tendency to demonstrative expression of emotions, egocentrism, emotional instability, impressionability and “thirst for recognition.”

Neurosis is a mental disorder that arises as a result of a violation of particularly significant life relationships of a person and is manifested mainly by psychogenically caused emotional and somatovegetative disorders in the absence of psychotic phenomena.

E. Kraepelin believed that with hysteria, emotions spread to all areas of mental and somatic functions and transform them into symptoms of illness, which correspond to distorted and exaggerated forms of mental experiences. He also believed that in every person, with very strong excitement, the voice can disappear, the legs will give way, etc. In a hysterical person, as a result of mental lability, these disorders arise very easily and just as easily become fixed.

Manifestations of hysterical neurosis are varied: from paralysis and paresis to loss of the ability to speak. The sensations that patients experience and describe may be similar to organic disorders, which makes timely diagnosis difficult.

However, the previously typical paralysis and paresis, astasia-abasia are now rarely observed. Psychiatrists talk about the “intellectualization” of hysteria. Instead of paralysis, patients complain of weakness in the arms and legs, usually arising from anxiety. They note that the legs become weak, they give way, one leg suddenly weakens, or heaviness and swaying appear when walking. These symptoms are usually demonstrative: when the patient is no longer observed, they become less pronounced. Mutism (inability to speak) is also less common nowadays; instead, stuttering, hesitations in speech, difficulties in pronouncing certain words, etc. are more often observed.

With hysterical neurosis, patients, on the one hand, always emphasize the exceptionality of their suffering, talk about “terrible,” “unbearable” pain, and in every possible way emphasize the unusual, previously unknown nature of the symptoms. Emotional disorders are characterized by lability, mood changes quickly, and violent affective reactions often occur with tears and sobbing.

The course of hysterical neurosis can be wavy. Under unfavorable circumstances, hysterical neurotic symptoms intensify, and gradually affective disorders begin to come to the fore. In intellectual activity, traits of emotional logic, an egocentric assessment of oneself and one’s condition appear, in behavior - elements of demonstrativeness, theatricality with the desire to attract attention to oneself at any cost. Hysterical neurosis must be treated by a psychotherapist, especially paying attention to deontological aspects.

Obsessive-compulsive neurosis (psychasthenia, or obsessional neurosis) manifests itself in the form of obsessive fears (phobias), ideas, memories, doubts and obsessive actions. This neurosis, compared to hysteria and neurasthenia, is much less common and, as a rule, occurs in people of a thinking type with an anxious and suspicious character.

The disease, as with other forms of neuroses, begins after exposure to a psychotraumatic factor, which, after personal “working through,” can be difficult to determine during psychotherapeutic treatment. The symptoms of this neurosis consist of obsessive fears (phobias), intrusive thoughts (obsessions) and compulsive actions (compulsive disorders). What these symptoms have in common is their constancy and recurrence, as well as the subjective impossibility of getting rid of them if the patient is critical of them. Phobias in obsessive-compulsive neurosis are varied, and their combination with obsessive actions makes the condition of such patients very difficult. Psychotherapy is also used in treatment.

Under reactive psychosis understand a mental disorder that arises under the influence of mental trauma and manifests itself entirely or predominantly as an inadequate reflection of the real world with behavioral disturbances, changes in various aspects of mental activity with the occurrence of phenomena not characteristic of the normal psyche (delusions, hallucinations, etc.).

All reactive psychoses are characterized by the presence of productive psychopathological symptoms, an affectively-narrowed state of consciousness, as a result of which the ability to adequately assess the situation and one’s condition is lost.

Reactive psychoses can be divided into three groups, depending on the nature of the mental trauma and the clinical picture:

1) affective-shock reactions, which usually occur during a global threat to the lives of large populations of people (earthquakes, floods, disasters, etc.);

2) hysterical reactive psychoses, which arise, as a rule, in situations that threaten personal freedom;

3) psychogenic psychotic disorders (paranoid, depression), caused by subjectively significant mental trauma, i.e., mental trauma that is significant for a certain person.

· Reactive psychosis is a mental disorder that occurs under the influence of mental trauma and manifests itself entirely or predominantly as an inadequate reflection of the real world with behavioral disturbances, changes in various aspects of mental activity with the occurrence of phenomena not characteristic of the normal psyche (delusions, hallucinations, etc.).

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Psychogenic disorders

Psychogenic disorders include various pathologies of mental activity: acute and prolonged psychoses, psychosomatic disorders, neuroses, abnormal reactions (pathocharacterological and neurotic) and psychogenic personality development that occurs under the influence of mental trauma or in a traumatic situation.
By its nature, mental trauma is a very complex phenomenon, at the center of which is a subclinical reaction of consciousness to the mental trauma itself, accompanied by a kind of defensive restructuring occurring in the system of psychological attitudes in the subjective hierarchy of the significant. Such a protective restructuring usually neutralizes the pathogenic effect of mental trauma, thereby preventing the development of a psychogenic illness. In these cases, we are talking about psychological defense, which acts as a very significant form of reaction of consciousness to the suffered mental trauma.
The concept of “psychological defense” was formed in the psychoanalytic school, and according to the views of representatives of this school, psychological defense includes specific techniques for processing experiences that neutralize their pathogenic influence. They include phenomena such as repression, rationalization, sublimation.
Psychological defense is a normal everyday psychological mechanism that plays a large role in the body’s resistance to disease and can prevent disorganization of mental activity.
As a result of the research, people were identified as “well psychologically protected, capable of intensive processing of pathogenic influences, and poorly psychologically protected, who are not able to develop this protective activity. They develop clinically defined forms of psychogenic diseases more easily.
A common feature of all psychogenic disorders is that they are conditioned by an affective psychogenic state - horror, despair, wounded pride, anxiety, fear. The sharper and more pronounced the affective experience, the more distinct the affectively narrowed change in consciousness. A feature of these disorders is the unity of the structure of all observed disorders and their connection with affective experiences.
Among psychogenic disorders, productive and negative ones are distinguished. To distinguish productive disorders of a psychogenic nature from other mental illnesses, K. Jaspers’ criteria are used, which, despite their formal nature, are important for diagnosis:
1) the disease occurs after mental trauma;
2) the content of psychopathological manifestations follows from the nature of mental trauma, and there are psychologically understandable connections between them;
3) the entire course of the disease is associated with a traumatic situation, the disappearance or deactualization of which accompanies the cessation (weakening) of the disease.

Psychogenic abnormal reactions
The term “psychogenic reaction” refers to pathological changes in mental activity that occur in response to mental trauma or mental stress and are in psychologically understandable connections with them.
A characteristic sign of abnormal reactions is inadequacy of the stimulus both in strength and content.
Neurotic (psychogenic) are also reactions, the content of which is critically assessed by the patient and which are manifested mainly by vegetative and somatic disorders.
Psychopathic (situational) reactions are characterized by a lack of critical attitude towards them. Psychopathic reactions are assessed as personality reactions, but personality reactions are a broader concept. The reaction of an individual is understood as a time-limited state of altered behavior, caused by certain situational influences that are subjectively significant for the individual. The nature and severity of the reaction are determined, on the one hand, by environmental influences, and on the other, by the characteristics of the individual, including the history of its development, socially and biologically determined components.
Pathocharacterological reactions manifest themselves in pronounced and stereotypically repeated deviations in behavior, accompanied by somatovegetative and other neurotic disorders and leading to temporary disturbances in social adaptation.
Conventionally, reactions of opposition, refusal, imitation, compensation, and overcompensation are distinguished.
Opposition reactions arise when excessive demands are placed on a child or adolescent and as a result of the child or adolescent losing the usual attention and care from loved ones and especially the mother. The manifestations of such reactions are varied - from leaving home, skipping school to suicide attempts, often of a demonstrative nature.
Refusal reactions are observed in children when they are suddenly separated from their mother, family, or placed in a child care facility and are manifested in refusal of contacts, games, and sometimes food. In adolescents, such reactions are rare and indicate pronounced infantilism.
Imitation reactions are manifested in imitation of the behavior of a certain person, literary or cinematic hero, leaders of teenage companies, youth fashion idols.
The negative reaction of imitation is manifested in the fact that all behavior is constructed as the opposite of a certain person; in contrast to a rude father who drinks and makes constant scandals, the teenager develops restraint, goodwill, and caring for loved ones.
Compensation reactions consist in the fact that adolescents seek to compensate for failures in one area in another. For example: a physically weak boy compensates for his inferiority with academic success, and, conversely, learning difficulties are compensated by certain forms of behavior, bold actions, and mischief.
Pathological behavioral reactions are characterized by the following signs:
1) a tendency to generalization, i.e. they can arise in different situations and due to inadequate reasons;
2) a tendency to repeat the same type of actions for different reasons;
3) exceeding a certain threshold of behavioral disorders;
4) violation of social adaptation (A. E. Lichko).

Classification according to the International Classification of Diseases-10
Since the International Classification of Diseases is structured according to a syndromological type, it does not have a section “Psychogenic diseases”, and therefore psychogenic psychoses are presented in various sections corresponding to the leading syndrome.
Affective-shock reactions are classified in the section “Neurotic, stress-related and somatoform disorders” F 40-F 48 and are coded as “Acute reaction to stress”. It is a transient disorder of significant severity that develops in individuals with no apparent previous mental disorder in response to exceptional physical and psychological stress and which usually lasts for several hours or days.
Hysterical psychoses (pseudodementia, puerilism, mental regression) are not reflected in the International Classification of Diseases-10, only hysterical twilight states of consciousness (fugue, trance, stupor) and Ganser syndrome occur.
Reactive depression is classified in the section “Mood disorders (affective disorders)” F 30-F 39 and is considered as “Severe depressive episode with psychotic symptoms”: psychotic symptoms mean delusions, hallucinations, depressive stupor associated with a mood disorder; “Recurrent depressive disorder, current episode of severe severity with psychotic symptoms,” in this case we mean repeated severe episodes of reactive depressive psychosis.
Acute reactive paranoids are classified in the section “Schizophrenia, schizotypal and delusional disorders” F 20-F 29 and are designated as “Other acute, predominantly delusional psychotic disorders” and “Induced delusional disorder”.

Etiology and pathogenesis
The cause of reactive psychoses is mental trauma. It should be noted that mental trauma does not cause reactive psychosis in every person, and not even always in the same person. Everything depends not only on the mental trauma, but also on its significance at the moment for a given person and also on the state of that person’s nervous system. Painful conditions occur more easily in people weakened by somatic diseases, prolonged lack of sleep, fatigue, and emotional stress.
For such reactive psychoses as affective-shock reactions, premorbid personal characteristics are not of great importance. In this situation, the power and significance of mental trauma is at work - a threat to life.
In hysterical psychoses, the disease arises through the mechanisms of suggestion and self-hypnosis and through mechanisms of defense against a situation intolerable to the individual. In the occurrence of hysterical psychoses, the mechanism of thinking about mental illness, common among insufficiently literate and educated people, apparently plays a role: “went crazy,” “turned into a child.” Hysterical psychoses have lost their originality and clarity. In situations of subjective significance, the main role belongs to premorbid personality characteristics.

Differential diagnosis
Diagnosis of reactive psychoses for the most part does not cause difficulties. Psychosis develops after mental trauma; the clinical picture reflects experiences associated with mental trauma. These signs are not indisputable, since mental trauma can provoke another mental illness: manic-depressive psychosis, schizophrenia, vascular psychosis. The structure of psychogenic disorder syndromes is of great importance for diagnosis. The centrality of all experiences and the close connection of all disorders with affective symptoms, which is determined by a more or less pronounced affective narrowing of consciousness, are typical. If another plot appears in delusional disorders that is not associated with mental trauma, this gives reason to suspect a disease of a non-psychogenic nature.

Prevalence and prognosis
There is no specific information on the prevalence of reactive psychoses. Women suffer from them twice as often as men. There is evidence that among reactive psychoses, reactive depression is the most common, and in recent decades they have accounted for 40–50% of all reactive psychoses.
The prognosis of reactive psychoses is usually favorable; after the disappearance or deactualization of mental trauma, the manifestations of the disease disappear. Full recovery is preceded by more or less pronounced asthenic manifestations.
It has been noted that some variants of reactive depression during recovery go through the stage of hysterical symptoms, while patients more often experience hysterical forms of behavior.
In a small proportion of patients, complete recovery does not occur, the course of the disease becomes chronic, and gradually the psychogenic symptoms of the disease are replaced by character disorders, the patient becomes psychopathic, or post-reactive abnormal personality development begins. Depending on the predominance of pathocharacterological disorders, asthenic, hysterical, obsessive, explosive and paranoid development are distinguished. Symptoms of abnormal development indicate that the picture of the disease is determined by negative symptoms, with the appearance of which the prognosis significantly worsens.

Treatment
Treatment of reactive psychoses is complex and depends on the leading clinical syndrome and the timing of the disease.
In case of affective-shock reactions and acute reactive paranoids with severe psychomotor agitation, the patient needs immediate admission to a psychiatric hospital. Affective disorders and agitation are relieved by intramuscular administration of neuroleptics - aminazine at a dose of 100-300 mg/day, tizercin - 50-150-200 mg/day.
For hysterical psychoses, phenothiazine derivatives are prescribed: Melleril, Sonapax, Neuleptil in medium therapeutic doses, intramuscular administration of aminazine and tizercin in doses of 100 to 300 mg/day is recommended.
Psychotherapy is carried out at all stages of the development of reactive psychoses. At the first stage of the development of reactive depression, the psychotherapeutic effect is calming in nature; in the future, the doctor is faced with the task of creating a new life goal for the patient, a new life dominant. In this case, one should take into account the patient’s capabilities and orient him towards completely achievable goals.
For severe reactive depression with anxiety, it is recommended to prescribe amitriptyline in doses of up to 150 mg/day with Sonapax up to 30 mg/day. For milder depressive states, pyrazidol is indicated up to 100–200 mg/day with the addition of small doses of antipsychotics (for example, Sonapax at a dosage of 20 mg/day). In some cases, it is advisable to add a few drops of a 0.2% solution of haloperidol to the antidepressant, with the help of which a calming effect is achieved for anxiety, but there is no sedative effect, as with tranquilizers. For mild depression in the elderly, especially men, it is advisable to prescribe azafen in doses of up to 200–300 mg/day.
For reactive paranoids, intensive therapy with antipsychotic drugs is necessary.
When treating reactive psychoses in people of involutionary age, psychotropic drugs are used carefully and in smaller doses, since increased sensitivity to drugs is often observed at this age. This also applies to the treatment of elderly patients.
Reactive depression in adolescents is difficult to treat with antidepressants; active psychotherapy is of great importance. You can soften the tense affect of a teenager with small doses of amitriptyline or tranquilizers (tazepam, seduxen, elenium).
For the delinquent equivalent of reactive depression, it is advisable to prescribe behavior correctors: neuleptil, melleril in doses of up to 40 mg/day.
Psychotherapy for adolescents should be aimed at finding a way out of the current situation, and if it is unsolvable, at creating a new life goal in a different direction accessible to the teenager.
For reactive paranoids, it is necessary to prescribe antipsychotics intramuscularly to suppress anxiety and fear. Psychotherapeutic conversations should initially be calming in nature, and later cognitive psychotherapy should be aimed at developing a critical attitude towards delusional symptoms.
Group and family psychotherapy is of great importance for adolescents.

Expertise
Labor expertise. During reactive psychosis, patients are unable to work. With prolonged reactive psychoses or abnormal post-reactive (especially hypochondriacal) personality development, patients may need disability, but this issue must be resolved individually in each case.
Forensic psychiatric examination. The question of a forensic psychiatric examination can arise in two cases: when the patient, being in reactive psychosis, committed a socially dangerous act and when reactive psychosis arose after the commission of such an act.
Socially dangerous actions in a state of reactive psychosis are rarely committed; in these cases, patients are recognized as insane in relation to the acts accused of them.
If reactive psychosis occurs after the commission of an offense, then for the period of illness a temporary suspension of the criminal case is possible until the defendant recovers, after which he must again appear in court.

PSYCHOGENIC DISORDERS

Scientific and technical encyclopedic dictionary.

See what “PSYCHOGENIC DISORDERS” are in other dictionaries:

Psychogenic disorders- Types of abnormal behavior caused primarily by psychological or emotional factors. such as anxiety, stress at work, or unconscious desires. Psychology. A Ya. Dictionary reference book / Transl. from English K. S. Tkachenko. M.:... ... Great psychological encyclopedia

Psychogenic disorders- include various pathologies of mental activity: acute and prolonged psychoses, psychosomatic disorders, neuroses, abnormal reactions (pathocharacterological and neurotic) and psychogenic personality development arising under the influence of... ... Encyclopedic Dictionary of Psychology and Pedagogy

Psychogenic reactions- painful mental disorders that arise under the influence of moral trauma. Etc. can develop in healthy people, but more often arise due to pre-existing mental instability (psychopathy, ... ... Encyclopedia of Law

Psychogenic reactions- painful mental disorders that arise under the influence of moral trauma. Etc. can develop in healthy people, but more often arise due to pre-existing mental instability (psychopathy,... ... Large legal dictionary

Psychogenic diseases- mental disorders that owe their occurrence to the influence of psychogenically traumatic factors. These include most neurotic reactions, neuroses, functional psychosomatic disorders, reactive states, psychogenic... ... Encyclopedic Dictionary of Psychology and Pedagogy

PSYCHOGENIC REACTIONS- – painful disorders of mental activity that arise under the influence of mental trauma. Etc. can develop in healthy people, but more often arise on the basis of pre-existing mental instability (psychopathy, ... ... Soviet legal dictionary

Psychosomatic disorders- I Psychosomatic disorders (Greek: psychē soul, consciousness, sōmatos body) psychogenic or predominantly psychogenically caused dysfunctions of internal organs or physiological systems (circulation, breathing, digestion, ... ... Medical encyclopedia

“F51” Sleep disorders of non-organic etiology- This group of disorders includes: a) dyssomnia: primary psychogenic conditions in which the main one is an emotionally caused disturbance in the quantity, quality or time of sleep, that is, insomnia, hypersomnia and sleep cycle disorder... ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic guidelines. Research diagnostic criteria

psychosomatic disorders- An ill-defined term with a holistic connotation and dual meaning, applied primarily to conditions in which emotional disorders play a significant role in the etiology, aggravation or maintenance of pathological ... ... Great psychological encyclopedia

DISSOCIATIVE DISORDERS- a group of mental disorders characterized by changes or disturbances in a number of mental functions of consciousness, memory, sense of personal identity, awareness of the continuity of one’s own identity. Usually these functions are integrated in the psyche... Collier's Encyclopedia

Psychogenic depression

Psychogenic depressionI - a disorder that occurs under the influence of external negative or positive factors (both long-term and one-time) after situations of loss/change of values ​​that are significant to a person. Individuals suffering from this disorder are characterized by increased sensitivity, impressionability, timidity, suspiciousness, and pedantic traits. Psychogenic depression can develop immediately after a traumatic situation, although in some patients a depressive episode occurs some time after the stressful event.

Patients often have a fixation on the fact that happened; they are characterized by intense and constant internal tension that cannot be weakened by efforts of will. Persons suffering from psychogenic depression show irrational concern for the fate, health, and well-being of themselves and their loved ones.

Patients note mental retardation, difficulty concentrating, and a predominance of thoughts of their own worthlessness. They describe their past and present in pessimistic colors and are convinced that future existence is hopeless and meaningless. They often consider suicide ideas to be the only correct solution and a “reasonable” way out of the current situation. People diagnosed with psychogenic depression lack the desire to overcome difficulties and solve problems. They prefer to hide the emotions they experience, not express their dissatisfaction, but “go with the flow.”

Individuals with predominant hysterical character traits exhibit symptoms of depression in demonstrative moodiness, nervousness, irritability, and fussiness. Such persons often attempt suicide, and all their actions are characterized by feigned, unnatural “theatrics.”

Depression of a psychogenic nature has recently been considered within the framework of dysthymic disorder - a chronic disease of moderate severity of symptoms with asthenic and neurasthenic manifestations. They have a certain similarity with psychogenically provoked forms of recurrent depression: psychological clarity of the cause of the experience, chronological and semantic connection with the stressful event, lack of autochthony (the ability to develop without the presence of a causal factor).

Provoking stressors that precede and/or accompany psychogenic depression indicate their diversity and heterogeneity. However, in most patients, the development of depressive syndrome was preceded by unfavorable latent causes of personal, domestic, and professional aspects.

A distinctive feature of psychogenic depression is a change in the patient’s condition when exposed to external factors of varying content. The opposite of typical endogenous depression, which does not change its structure under the influence of external factors, is diverse variations in the methods of emotional response and behavioral reactions. The prospect of the possibility of compensating for painful sensations using psychotherapeutic methods has also been established.

As a rule, the dominant in the emotional aspect of a psychogenic disorder is oppressive melancholy and irrational anxiety, although dysphoric manifestations and sensory hyperesthesia are often recorded. In most cases, the clinical picture contains manifestations of lability of the autonomic nervous system:

frequent fluctuations in blood pressure,

changes in heart rate,

increased sweating,

dryness of the oral mucosa.

Moreover, vegetative-vascular fluctuations intensify and are more clearly expressed in situations of physical or emotional overload that occur in the afternoon, and are combined with feelings of lethargy, muscle weakness, and bodily discomfort.

Vital drives, depletion of interest in current events, loss of interest in previous hobbies and pleasures are represented, as a rule, rudimentary and are characterized by fluctuations in intensity. It is worth noting that with psychogenic depression in patients, anesthesia of vital sensations is combined with an exacerbation of methods of emotional response upon the occurrence of circumstances that are particularly significant for the individual, often associated with a traumatic situation.

The classification of psychogenic depression is a rather difficult diagnostic decision, since the illness can be a manifestation of dysthymia, a severe form of adaptation disorder, or act as a primary depressive episode.

Psychogenic depression is divided into diseases of a neurotic and psychotic nature. A neurotic level disorder is a relatively shallow depressive state with a predominance in the clinical picture of melancholy mood, tearfulness, feelings of inferiority, hysterical manifestations, and asthenic states. A disorder of the psychotic level (reactive psychosis) is characterized by irrational pathological anxiety, pronounced psychomotor agitation and/or inhibition, phenomena of depersonalization and derealization, hypochondriacal moods, puerile manifestations, delusional ideas of persecution and accusation, and suicidal thoughts.

For psychogenic depression:

• there is no hereditary (genetic) predisposition;
• there is a connection with a specific traumatic event;
• a primary depressive episode develops as a result of a stressful situation;
• the intensity of depressive reactions depends on the individual sensitivity threshold;
• the condition worsens in the evening;
• awareness of the disease remains;
• there is no motor retardation;
• depressed mood is expressed by tearfulness;
• accusations are directed at others.

Psychogenic depression: causes

This disease occurs as a result of prolonged or single exposure to psychotraumatic (stressful) external factors that cause a strong emotional reaction, which is subsequently recorded in the subconscious.

One of the leading factors provoking psychogenic depression is the individual’s emotional dissatisfaction due to a moral conflict with the demands of society, the neglect of others towards the needs of the individual, excessive criticism, humiliation or indifference on the part of others. Personal character traits: suspiciousness, vulnerability, impressionability, humility, along with the accentuated trait of being stuck (fixated) on events, forces a person to put up with the demands of modernity. Instead of adequately resisting negative pressure, the category of timid, shy, pedantic people prefer to restrain their anger and suppress their disagreement with what is happening. In order to meet the standard requirements of the norm, to be accepted, understood and in demand by society, people try to repress negative emotions by outwardly demonstrating agreement, submission and pleasure. The result of repressing experienced emotions is that the person begins to reside in a fantasy, fictitious world, living someone else’s life and hiding real feelings not only from others, but also from himself. The consequence of such “playing by someone else’s rules”: excessive demands on oneself, low self-esteem, dissatisfaction with oneself and the resulting feeling of loneliness are direct prerequisites for the occurrence of depressive disorder.

Unable to adapt, that is, to effectively change the way of adapting to stressors, in unusual situations the individual feels a state of strong emotional stress. In moments of crisis, the significance of which does not correspond to the intensity of the subsequent reaction, a person falls into a depressive state and feels painful symptoms of the disease.

Factors provoking the development of psychogenic depression can be both negative and positive life situations. In terms of the power of influence on the human psyche, the leading positions are occupied by the following events:

• death of a spouse or close relative;
• divorce or separation from a loved one;
• own illness or injury;
• imprisonment;
• marriage;
• job loss;
• reconciliation of spouses;
• retirement;
• deterioration in the health of a family member;
• pregnancy or the arrival of a new family member;
• sexual problems;
• change in social status or financial situation;
• change of activity;
• inability to repay loan obligations;
• outstanding personal achievements;
• change in living conditions or place of residence;
• changes in personal habits, routine or working conditions, usual type of leisure;
• change in social activity or change in religious beliefs;
• start or end of training.

It is worth noting that the symptoms of psychogenic depression can be delayed, that is, they can appear after a certain period of time after a traumatic situation.

Psychogenic depression: symptoms

This disease manifests itself as:

• causeless tearfulness;
• oppressive feeling of loneliness;
• depression, feeling of inner emptiness;
• disturbances in the “wake-sleep” mode;
• insomnia;
• thoughts about the purposelessness of existence and the futility of the future;
• feelings of worthlessness;
• suicidal thoughts;
• increased negative feelings in the evening.

Often, those suffering from psychogenic depression have low self-esteem, but patients do not engage in self-blame, but place all the responsibility and blame for the trauma on the people around them.

With psychogenic depression that occurs after a significant loss, there is a natural dynamics of manifestations and changes in sensations. During the first stage, most people are in a state of shock, feeling detached and empty. The second stage, quite long in time, can be characterized as a period of searching and realizing what has been lost. During the third stage, feelings of loss and sadness are often joined by rage, anger, and aggression. Moreover, depressive and manic manifestations can alternate and change several times a day.

Psychogenic depression deprives patients of the joy of existence; no usual activities and pleasures inspire or inspire them. Often, behind an external artificial mask of success, people suffering from this disorder mask a painful feeling, fear of loneliness and a feeling of spiritual emptiness, internal vacuum. Most patients categorically refuse to take part in or even observe any entertainment events, preferring to be left alone with themselves and “chew mental cud,” analyzing their past mistakes and criticizing their present.

In addition to changes in their usual lifestyle and behavioral reactions, such people’s gestures and facial expressions change radically: their faces never light up with a smile, the corners of their lips are drooping, and aging wrinkles are clearly visible. Patients evaluate the past and present from a pessimistic point of view, and are confident that their future is meaningless, hopeless and aimless.

The neurotic stage of the development of the disease is characterized by the absence of vital components of depression, lability (variability and instability) of the manifested symptoms and physiological equivalents of the disorder, which often mask the main components of depression. Therefore, at this stage, most patients are not under the supervision of psychotherapists and psychiatrists, seeking medical help from general practitioners or other specialists.

Psychogenic depression: treatment

When choosing methods for treating psychogenic depression, the severity and duration of exposure to psychotraumatic factors on the individual, the characteristics of the premorbid course (the state preceding and contributing to the development of the disease), and the personal characteristics of the patient are taken into account.

The leading, mandatory component of the treatment of psychogenic depression is psychotherapy. Psychotherapeutic techniques are very effective and efficient, they help overcome the manifestations of the disease, get out of a state of depression, prevent the occurrence of a new depressive episode, and restore vitality. Psychotherapy techniques help the patient work productively on developing, changing and improving a new worldview and a different model of more universal behavior. By remembering, reliving and rethinking the wounds received, a person can completely get rid of a depressive state.

Modern methods of various teachings direct the patient to rethink and reassess the significance of the traumatic event; they allow the individual to look at the past and present from a different point of view and help to form a new picture of a realistic perception of the world. The process of psychotherapeutic treatment is not quick; it requires the investment of mental strength and willpower, the support of an experienced doctor and the attention of loved ones.

In combination with psychotherapeutic consultations, to achieve a lasting positive result in psychogenic depression, antidepressants are used for a course of at least 6 months. These drugs restore the necessary level of neurotransmitters: serotonin, dopamine, norepinephrine, which are responsible for the emotional sphere of a person.

Since antidepressants differ in their mechanism of action, only a qualified specialist should choose and determine the dosage of the drug. Self-medication for depression is fraught with negative consequences, including increased suicidal thoughts and actions.

SUBSCRIBE TO THE VKontakte GROUP dedicated to anxiety disorders: phobias, fears, depression, obsessive thoughts, VSD, neurosis.

There is currently no unified classification of depressive disorders. Most Russian and foreign psychiatrists use several systematization options. Among them are the following types: Classification by type of depression: simple (apathetic, melancholic, anxious); complex (conditions accompanied by obsession, delusions). Classification according to the variants of the course of depression (ICD-10): a single depressive episode, recurrent (repeating) depression, bipolar disorder (alternation of depressive and manic phases), […].



There is a direct connection between alcohol dependence and depressive disorders: depression also affects the worsening of alcoholism, just as excessive drinking of alcohol causes anxious, melancholic, manic states.



Causes of depression

Research conducted by experts from the University of Kansas, examining the causes of depression in over 2,500 patients in US psychiatric clinics, identified the main risk factors for the development of depression. These include: Age from 20 to 40 years; Change in social status; Divorce, break in relationship with a loved one; Presence of acts of suicide in previous generations; Loss of close relatives under the age of 11; Predominance […].

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