Professional neurosis

Neurotic disorders occupy a leading place in the structure of mental illnesses. The prevalence of psychogenic neurotic disorders necessitates constant improvement of their diagnosis, therapy and prevention. Often, patients with neurotic disorders seek specialized help from neurologists and general practitioners.

At the Yusupov Hospital, this category of patients is treated by experienced psychotherapists who have specialized in leading European clinics and are fluent in psychotherapeutic techniques, including cognitive behavioral therapy. Medical staff treats patients' problems with respect.

ICD 10 code

Stress-related and somatoform neurotic disorders in ICD 10 are classified in categories F40-F48. Neurosis is a disease with reversible mental disorders. The disease is caused by exposure to traumatic factors. Neurotic disorder is characterized by the presence of the following symptoms:

• disturbances of well-being, somato-vegetative, emotional functions;
• mental exhaustion;
• the patient’s awareness of the fact of his illness;
• absence of disruption of the reflection of the real world.

Psychiatrists distinguish the following clinical forms of neurotic conditions: asthenic neurosis (astheno-neurotic disorder or neurasthenia), obsessive-compulsive neurosis, hysterical neurosis, neurotic depression (depressive neurosis).

Neurosis - what is it?

Calm down, this is not a mental illness. Neuroses are different, in general terms they represent disorders in the emotional-volitional sphere, disruption of relationships with society, problems with the autonomic nervous system (a typical example is heart pain of neurotic origin).

Hysteria, neurasthenia (“nervous weakness”), obsessive fears, thoughts, movements - all these are neuroses. But a person realizes that “something wrong” is happening to him and adequately perceives himself and the world around him. This is what distinguishes neurosis from psychosis: a mentally ill person firmly believes in his fictitious reality and believes that those around him are sick and wrong.

Causes

The formation of neurotic disorders is provoked by the influence of many factors. This may be a short-term reactor or chronic stress. Currently, there are two main causes of neuroses:

• insufficient functionality of the body's neurotransmitter and neurophysiological systems, which leads to a pronounced response to stress;
• mental characteristics, personality type and relationships with other people.
• The most common causes for the development of neurological disorders are:
• long-term illnesses, especially those accompanied by intoxication;
• addiction to drinking alcohol or smoking tobacco;
• chronic or acute stress: death or serious illness of a loved one, divorce, dismissal;
• mental overload;
• influence of family and others. Children adopt the habits and behavior of their parents; if the mother or father behaves aggressively, there is a high probability of neurotic disorders in the child.

Classification

The main types of neurosis include:

• Neurasthenia. Develops against the background of difficulties in interpersonal relationships. It is also called “irritable weakness”, such people show dissatisfaction with any reason, they are bothered by headaches and heart pain, tachycardia, heartburn and sleep disturbances;
• Hysteria or conversion neurosis. It is observed more often in females. Such people play along with the created image. Often this is the role of a seriously ill patient, simulating seizures or loss of vision. An attack of hysteria occurs spontaneously, usually after a provoking situation, in order to get what is what. However, the symptoms do not appear at the request of the patient and leave him tormented. Hysteria is observed in spoiled people and people with high self-esteem who are not accustomed to being denied anything;
• Obsessive-compulsive neurosis. The condition manifests itself through the emergence of fear and anxious thoughts even in the absence of a provoking agent. These include fear of society, fear of infection with some kind of disease. To alleviate their condition, patients may resort to special rituals that cause inconvenience and suffering. This group includes phobic neurosis and panic attacks;
• Somatoform disorders. This is the name given to the appearance of complaints that resemble a somatic disease, but no organ pathology is objectively detected.
• This group of neuroses is classified as general, in the clinic of which emotional disorders predominate.
• According to the duration of their course, neuroses are divided into:
• Spicy. They develop in response to short-term stimuli and can go away on their own, without specific therapy. This type of neurosis is also called situational;
• Chronic. They arise under the influence of a long-term stimulus, leading to disadaptation in society and changes in the psycho-emotional background.
• Other types of neurotic disorders:
• Bulimia is an eating disorder. It often occurs in teenage girls with complexes and lack of self-confidence. There are two forms of bulimic neurosis: with and without purging. In the first case, a person periodically overeats, then artificially induces vomiting so as not to gain weight. People suffering from bulimia without purging exhaust their bodies with strict diets and excessive exercise;
• Hypochondriacal neurosis is classified as a somatoform disorder. Such people concentrate their attention even on minor deteriorations in their well-being. They regard any symptoms as a sign of a dangerous disease. Such people usually come to the doctor with a stack of reports from other specialists and the results of many examinations. The diagnosis is made by excluding somatic pathology based on examination data, treatment is carried out by a psychotherapist;
• Autonomic neurotic disorder or VSD is a complex of symptoms caused by dysfunction of the sympathetic and parasympathetic nervous system. Depending on the predominance of the tone of the nervous system, VSD can occur as sympathicotonia or vagotonia. In the first case, symptoms of activation of the sympathetic nervous system (increased blood pressure, tachycardia, pallor) dominate, in the second - parasympathetic (low blood pressure, slow pulse, dizziness, redness of the skin). A separate category is vegetative crisis, which is characterized by increased symptoms and is accompanied by dizziness, weakness, sweating and decreased blood pressure. Against the background of an imbalance in the functioning of the nervous system, muscular or respiratory neurosis may occur;
• Noogenic neurosis has recently become increasingly widespread due to a sedentary lifestyle and the emergence of a virtual network. At the same time, a person loses his life values ​​and regards his existence as meaningless, he has no incentive to work, he is not satisfied with his life and is unable to overcome life’s difficulties;
• Neurogenic bladder syndrome is a neurosis characterized by a fear of voiding in a public place. Such a person takes a long time to adjust to urination, eventually avoids leaving the house, and tries to drink less liquid in a public place;
• Cardioneurosis or cardiac neurosis is a disorder of cardiac activity in response to a mental disorder. A person feels a “fading” heart, pain in the chest, attacks of palpitations or pulsations throughout the body. During an attack, a person is bothered by a feeling of fear and anxiety. After ruling out cardiac pathology, such patients are prescribed a consultation with a psychotherapist;
• Sexual neurosis is a mental disorder that affects a person’s sex life. Sexual disorders are manifested by either an increase or decrease in sexual desire. With increased desire, sexual desire is directed towards another object, and sexual perversion occurs. A decrease in desire leads to the fact that a person avoids sexual contacts, and sometimes even people of the opposite sex;
• Obsessive-compulsive disorder is characterized by the presence of intrusive thoughts (obsessions) and actions (compulsions).
• There is alcoholic neurosis, which occurs against the background of severe alcohol dependence and can become chronic. Symptoms of this condition vary and may include insomnia, fatigue, aggression or depression, headaches and heart pain. The main goal of treatment is to get rid of addiction.

Neuroses

Neurotic disorders include non-psychotic, reversible disorders that arise in a situation of neurotic conflict, towards which patients retain a critical attitude and a desire to free themselves from them. Let us present the criteria for diagnosing neuroses, which were formulated by A.M. Vein in 1982: 1) the presence of a traumatic situation that is individually significant and closely related to the onset and course of the disease; 2) the presence of neurotic personality traits and insufficient psychological defense; 3) identification of a characteristic type of neurotic conflict and 4) identification of neurotic symptoms, characterized by great dynamism and interconnected with the level of tension of the psychological conflict.

It is generally accepted that various factors contribute to the development of neuroses, but first of all it is a constitutional predisposition or “neurotic personality,” i.e., personality anomalies that do not reach the level of psychopathy. According to the terminology of K. Leonhard, future or potential neurotics are distinguished by a pronounced accentuation of personality, thereby indicating the number of possible forms of neurosis.

The concept of neurotic conflict was introduced by V.N. Myasishchev (1960). A hysterical conflict, according to V.N. Myasishchev, is characterized by an inflated level of claims with an underestimation of real conditions and the disproportion of desires to these conditions. In other words, the hysteric wants more than what he can and what real circumstances allow him to achieve. It’s not normal, for example, for everyone to love you. It doesn’t happen like that, you have to be autistic to ignore reality in this way. In addition, the love and respect of others must be earned through work, deeds, and self-restraint, which a hysteric usually does not do, even if he understands this with his mind. The obsessive-psychasthenic conflict is characterized by the contradiction that exists between the individual’s desires and the sense of duty.

In other words, this is a conflict between the unconscious (desire, emotions) and the conscious, if we consider the moral and ethical imperative to be a derivative of conscious activity. Finally, the neurasthenic conflict is represented by the contradiction between the real capabilities of the individual and the demands that he places on himself. In other words, a neurasthenic demands from himself more than what he can, as if not understanding what he is capable of and what he can really do. The autism of a neurasthenic thus manifests itself in the sphere of self-perception. V.N. Myasishchev’s theory of neurotic conflict is based on the postulate that there are three forms of neurosis: hysterical, psychasthenic and neurasthenic. Many authors also identify other neuroses: depressive, hypochondriacal, etc. (Weitbrecht, 1952; Kovalev, 1976, etc.). This may mean that there are other types of neurotic conflicts, for example, depressive, anxious, etc. The result of a neurotic conflict is emotional tension, reflecting the contradiction between the most important attitudes of the individual, and then the appearance of corresponding disorders (emotional, vegetative, etc. ).

​	Treatment of neurosis should be carried out by a psychiatrist

In ICD-10 there is no category “Neuroses”. Instead of neuroses, somatoform and dissociative disorders are described, which only partially cover the manifestations of hysterical neurosis. This approach is probably quite appropriate for psychopathology, but for representing nosological forms it is certainly unacceptable. Refusal from neuroses is not motivated by anything. In this way, you can give up anything, and then return to it again, moving in a vicious circle. The position of A.B. Smulevich in relation to neuroses, expressed in the “Manual of Psychiatry” (1999), does not reflect the position of domestic psychiatry and is ambivalent: the author retains neurasthenia, but replaces hysterical and psychasthenic neuroses with a description of conversion, anxiety-phobic and obsessive ones. compulsive disorders.

V.V. Kovalev (1967), along with neuroses, also distinguishes neurotic reactions and neurotic development. Neurotic reactions are manifested by symptoms of the corresponding neurosis and last within one month if the neurotic conflict has been exhausted or has lost its relevance. The development of neurosis is often preceded by neurotic reactions, which can, under certain circumstances, be repeated several times. Neurosis itself continues for years if traumatic circumstances maintain the tension of a neurotic conflict and the patient does not receive adequate help.

Five years later, characterological changes begin to come to the fore in the clinical picture, sometimes reaching the level of a personality disorder. Neurotic development, therefore, is one of the ways of developing acquired psychopathy. According to N.D. Lakosina (1967), neurotic development occurs in several stages. At the first stage, regardless of the type of neurosis, depressive and asthenic depressive symptoms predominate. At the second stage, pronounced characterological changes are revealed, hysterical features or signs of excitability predominate. Subsequently, hypochondriacal manifestations, dysphoria or asthenization of the personality arise with a tendency to develop obsessions. The topic of neuroses, we believe, is far from complete to be denied or accepted in its present form. Let us briefly describe the different types of neuroses (Bleicher, Kruk, 1995).

Anagapic neurosis (Greek an - denial, agare - a supper of love in the name of God, i.e. a joint meal of like-minded people). Levi-Bianchini was described in 1953 in lonely, abandoned people who, in childhood, adolescence and adolescence, were unable, for some reason, to overcome the psychological problems characteristic of these age periods (formation of attachment, friendly feelings, achievement of identity status). It manifests itself as a persistent tendency towards self-isolation and suffering from loneliness. Various other neurotic manifestations are observed, and characterological changes can acquire an antisocial orientation.

Asthenic neurosis or neurasthenia, Beard's disease (1869), American disease, managerial disease, etc. It occurs in difficult and/or long-lasting situations for an individual, when in order to overcome them he is forced to act, overcoming himself, thereby driving himself into illness. It is probably a disorder similar to or related to burnout syndrome. It manifests itself as symptoms of irritable weakness (increased excitability, impressionability combined with exhaustion, rapid onset of fatigue). Emotional instability, sharp fluctuations in activity, and sleep disturbances are also typical. There is often a depressed mood, and in severe cases, symptoms of adynamia become pronounced.

Wartime neuroses or traumatic neuroses (Oppenheim, 1889). First described in victims of railway accidents. Interest in them especially intensified with the outbreak of the First World War. It was found that after the acute onset of the disorder (which proceeded as a mental shock), then, after about a week, a depressive-hypochondriacal state arises, in which at the same time pronounced hysterical symptoms (psychogenic mutism, functional paralysis and sensitivity disorders) also occur.

Subsequently, after a few weeks, unconscious rental attitudes come to the fore, which is why patients are often accused of “shameless” simulation. In typical cases, at this stage of the disease, “traumatic” behavior is observed, motivated by the interests of secondary gain. In some cases, however, organic symptoms predominated and even epileptic seizures occurred, in others paranoid pictures appeared or a schizophrenic process manifested itself (Buneev, 1935).

In traumatic neurosis, in modern terms, we are talking about the PTSD syndrome that replaced reactive psychosis, which, in turn, gives rise to the pathological development of personality according to the hysterical type. Meanwhile, the pathological development of the personality in connection with PTSD is not mentioned in the standard descriptions accepted, in particular, in the ICD-10, which, it must be admitted, is a serious omission, and almost universal, if the denial of the role of the personality factor in the development and formation of symptoms in psychogenic and other diseases. In ICD-10, PTSD is associated, according to the contiguity rule, with a condition that occurs during the period of adaptation to a significant change in life or a stressful life event - adjustment disorder. It is not at all necessary that adaptation disorder be preceded by an acute reaction to stress, as well as PTSD. Symptoms of adjustment disorder (depression, anxiety, lack of self-confidence, some decrease in productivity in daily activities, in adolescents - behavioral disorders, in children - symptoms of regression) usually last for about six months.

Depressive neurosis. It was considered more recently as an independent painful form and was included in ICD-9 as such. An important role in the development of depressive neurosis is believed to be played by a long-term psychotraumatic environment, which reveals the main internal conflict of patients - low self-esteem, on the one hand, and high, excessive and unbearable responsibility, on the other. This fact is paradoxical: the more actively and more patients do something on their own initiative, the worse they feel about themselves; to blame themselves less, they must do something even better or more than usual. This is probably due to the fact that sooner or later in some part of the patients a depressive personality attitude is formed or even begins to dominate (“attitude”, i.e. “suitability” - meaning the suitability of some term to explain human behavior - according to A. Reber, 2001).

In the modern interpretation, an attitude includes four components: 1) cognitive, manifested by an opinion about something or a belief in something that the individual consciously thinks he holds; 2) emotional, i.e. readiness to react in a predetermined way, mainly with positive or negative emotions; 3) evaluative, i.e. the willingness to evaluate something in a positive or negative sense and 4) conative or behavioral, i.e. the willingness to behave in one way or another depending on interpretations, emotions and evaluation. If the object towards which the depressive attitude predominates is the patient himself, his own self, then the result may be depressive thoughts, depressed mood, low self-esteem and actions to harm himself, including suicidal thoughts and attempts. A number of authors describe depressive neurosis as a psychogenically caused decrease in mood in combination with asthenic and other symptoms (Storing, 1938; Weitbrecht, 1952; Muller-Hegemann, 1967, etc.). In some cases, the disease turns out to be, as it turns out later, erased or atypical endogenous depression. Differential diagnosis is facilitated by the reaction of patients with depressive neurosis to psychotropic drugs: such patients are insensitive to the action of antidepressants and respond better to the prescription of tranquilizers (Svyadoshch, 1982).

Childhood neuroses. They are observed in childhood, most often up to 9–10 years of age. They are distinguished by incompleteness, rudimentary symptoms, and most importantly, by the predominance of monosymptomatic neuroses, such as neurotic stuttering, tics, sleep disorders, appetite disorders, neurotic enuresis or encopresis, pathological habitual actions (finger sucking, nail biting, masturbation, hair pulling, yactation) - V. V. Kovalev, 1979.

Motor neurosis or kinetic neurosis, motor neurosis. It manifests itself mainly as motor disorders, such as stuttering, functional convulsions, tremor, reversible functional paralysis, and writer's cramp.

Neurosis of desire and fear (Leonhard, 1963). An attempt to systematize neuroses depending on the meaning they have for the patient. In neuroses of desire, the disease is desirable for the patients: it is mainly a hysterical neurosis. With fear neuroses, the disease arises in connection with some fears; this is, for example, obsessive-compulsive neurosis, logoneurosis.

Information neurosis (Khananashvili, 1974). A neurotic state, the main conditions for the development of which are: 1) the need to process or assimilate an excessive amount of information for the individual, 2) a constant lack of time allotted for working with information; excessive level of motivation, i.e. an individual’s overestimation of the importance of information. The author does not indicate any specific clinical manifestations of this variant of neurosis; at a minimum, they are probably similar to the symptoms of neurasthenia. Considering the important fact that the information received by an individual can also be assimilated and personalized, the symptoms of the disease should presumably be associated with the content aspects of the information. Only in recent decades have they begun to talk about this, mainly to argue, because data has appeared on the connection between the information received by an individual and behavioral disorders, in particular with aggression.

Hypochondriacal neurosis. It is characterized by anxious concerns about the state of one’s health, the degree of which clearly does not coincide with the real grounds for this, and most often occurs in anxious and asthenic individuals who tend to exaggerate the seriousness of any personal problems. Patients complain of a variety of unpleasant sensations that they had not previously noticed, sleep disorders, depressed and anxious mood. They are worried about the possibility of a serious illness and think about one or another illness if they have heard or know anything about it. More often, of course, thoughts about heart disease, tumor or insanity come up, since in public opinion these disorders are the most common and dangerous. Patients are most likely guided not by public opinion, which may exert some kind of pressure on them, but by their personal experience if one of their relatives and other close people suffers, much less becomes disabled or dies from one of these diseases.

There is no indication in the literature of what internal psychological conflict could lead to the development of hypochondriacal neurosis under certain external conditions. Taking into account that such patients, on the one hand, are afraid of some kind of disease, and on the other hand, for some reason they are looking for it in themselves, we can assume that this conflict lies in an ambivalent attitude towards the disease: it frightens the patient, but at the same time time is somehow attractive. To some extent, this assumption is confirmed by observations in which hypochondriacal fears of neurotics are later differentiated into hysterical disorders or disorders associated with anxiety (Svyadosch, 1982).

Fear neurosis. It is associated with receiving information about a threat or with the appropriate interpretation of generally harmless information, so that as a result, the individual’s concerns about his own well-being arise and are maintained in a particularly sensitive area of ​​life. Here it is perhaps appropriate to recall neurotic antithesis - a concept introduced by A. Adler in 1917. A. Adler noted that neurotics tend to evaluate objects, events and phenomena through their opposites. At the same time, in neurotics, not only contrasting ideas in their generally accepted understanding are updated (for example, when perceiving the signal “up”, the alternative “down” pops up in consciousness; if “woman” - then, accordingly, “man”, etc.).

In a neurotic, individual alternatives are also updated: “inferior” - “female”, “strong” - “male”, etc. A neurotic may be afraid of something that a normal person does not perceive as some kind of threat. It is believed that fear neurosis more often occurs in individuals with an asthenic neuropsychic constitution, as well as in individuals with rigid mental processes. It is emphasized that the psychogenia that causes neurosis is sudden, unexpected and therefore super-strong for the patient, so that he is completely unprepared for its perception, even if he had prepared for something similar in advance.

Hysterical neurosis . Today it is difficult to say to whom the honor of first describing hysterical neurosis belongs, but it can be stated with certainty that this disorder has always received much more attention than any other in this chapter. E. Bleuler writes, for example, that “the hysterical symptom complex is the most important of all psychogenic forms of reactions.” This is probably due to the research attitude of psychiatrists and has nothing to do with the personal qualities of the latter. The causes and manifestations of hysterical neurosis are described in a surprisingly monotonous manner, which contrasts with such a wealth of symptoms of the disorder, for which hysteria has long earned itself the laurels of “the great malingerer.” The diagnosis of hysterical neurosis, due to the loaded term with emotional connotations, requires solid evidence, perhaps even more than any other diagnosis.

Obsessive-compulsive neurosis. Manifests itself in a variety of obsessions. Obsessions are psychologically understandable, consonant with the personal qualities of patients, on the one hand, and the content of a traumatic situation, on the other. The neurotic conflict, hypothetically, is represented by the contradiction between the desire for accuracy, objectivity, perfection and the desire to get by with “little blood” in important matters without straining too much; this is the opposite conflict of what leads to neurasthenia. To a certain extent, the clinical manifestations of obsessive-compulsive neurosis are the opposite of those characteristic of neurasthenia. If a neurasthenic makes every effort to overcome external obstacles, then a neurotic with obsessions wastes his mental energy fighting himself. The constitutional basis for the development of obsessive-compulsive neurosis is the psychasthenic personality. A psychotraumatic situation, in which the development of obsessive-compulsive neurosis is more likely, provokes the desire to do something in the best possible way, but at the same time has a paralyzing effect on patients, since there is no point in “giving their best.” That is why a psychasthenic suffers from doubts about some trifles, but when he really needs something, he can be very sthenic, persistent and even authoritarian.

Anticipation neurosis (Kraepelin). The disease, which E. Kraepelin refers to as ponopathy, is a disorder that occurs in connection with work and activity, and is characterized by a feeling of anxious anticipation of failure to perform any usual function (speech, writing, walking, swallowing, etc.). The expectation of failure usually arises after patients once experience some kind of trouble (difficulty urinating, pronouncing a difficult word, etc.). A further increase in the fear of failure increasingly upsets one or another function, and this, in turn, further increases the disorder. The forms of the latter are varied: speech hesitation and stuttering, “stuttering gait”, “stuttering writing”, “stuttering urination”, anxious anticipation of insomnia, memory loss during public speaking, sexual weakness, intolerance to some food and many others. etc.

Develops in individuals who are characterized by anxious suspiciousness, emotional lability, and timidity. Neurotic conflict seems to be a contradiction between low self-esteem and excessive sensitivity to failure. The disease was also considered as a variant of obsessive-compulsive neurosis, as a syndrome of anxious anticipation in the clinic of various forms of borderline pathology, especially neurasthenia and psychasthenia (Svyadoshch, 1971; Ushakov, 1978). Sometimes the disease tends to have a periodic course. Its monosymptomatic nature is emphasized.

Ponopathies should not include the complex of disorders that arise when losing a job (depression, anxiety, decreased self-esteem, resentment and irritability, aggressiveness, the emergence of suicidal tendencies, a tendency to abuse alcohol), as well as the disorder known as retirement neurosis. The fact is that job loss, and often retirement, is a very serious stressor that undermines a sense of security, confidence in the future and a sense of personal freedom. Separation from work is not an economic problem, but an existential, fundamental problem of human existence, which even has a religious dimension. Olof Palme, the author of the Swedish model of socialism, writes about it this way: “Freedom presupposes a sense of security. Fear of the future, of pressing economic problems, of illness and unemployment turns freedom into a meaningless abstraction... The most important factor in confidence is work. Full employment represents a huge step forward in giving freedom to people. Because other than war and natural disasters, there is nothing that people fear more than unemployment.”

Systemic neuroses (Myasishchev, 1959). They are believed to be associated with an uneven load on the physiological systems of the body. Violations occur in systems subject to systematic overload. Psychogenic as well as conditioned reflex factors also play a role in the development of the disorder. Previously, the term “organ neuroses” was used to refer to the disease.

Social neuroses (Weizsecker, 1929). The author describes three types of “social neuroses”:

a) take-off neuroses, observed in people who rapidly ascended the ladder of the social hierarchy and were unable to adapt to their new social status;

b) neuroses of falling that occur when the patient’s social status decreases;

c) neuroses of righteousness, when the patient seeks the triumph of justice.

School neurosis. It occurs mainly among elementary school students and is associated with such reasons as fear of separation from mother, fear of learning difficulties, ridicule of peers, and dissatisfaction of strict teachers. It manifests itself as a persistent fear of going to school, accompanied by reactions of passive protest and hysterical reactions (vomiting, coughing, etc.).

Iatrogenic neurosis. It manifests itself as fears and anxiety about one’s health. It occurs in people with an anxious-fearful character, for whom the doctor is an indisputable figure. In such cases, one careless statement from a doctor is enough for these violations to appear.

There are different approaches to the taxonomy of neuroses, some of which have already been mentioned. We will also present the taxonomy of Schulz (1919), since it has not lost its significance to this day.

The author distinguishes:

1) nuclear neuroses, in which the deepest layers of the personality are affected and the treatment of which seems difficult and unpromising;

2) marginal neuroses, in which there is no damage to the core of the personality; correspond to conversion neuroses;

3) alienation neuroses, when a person, for example a child, finds himself in a mentally pathological environment, in particular in a family of adoptive parents;

4) layered neuroses that arise as a result of insurmountable internal conflicts. Actually, neuroses are layered and partly regional; they are divided according to the principle of double-entry bookkeeping. Nuclear neuroses, as K. Jaspers notes, are better defined by the term “neurotic personality.” Alienation neuroses probably exist, but the author raises here another very important problem of the influence on mental health of raising children by psychiatric patients.

In the classical theory of psychoanalysis, neuroses are presented in a different way, very different from the clinical-realist approach, but, nevertheless, had a beneficial effect on it. There are different types of neuroses (Rycroft).

Psychoneurosis. Caused by reasons from the past. Can only be explained from the perspective of the patient’s personality and life history. There are three types of psychoneurosis: conversion hysteria, anxiety hysteria (phobia) and obsessive-compulsive neurosis. Obsessive thoughts differ from normal ones in that the patient himself perceives them as non-spontaneous, distracting, repetitive, and, moreover, monotonous and coming from somewhere outside. Their content is usually absurd, extremely strange, inappropriate, obscene. Compulsive behavior is repetitive, stereotyped, ritualistic and superstitious.

Current neurosis. Due to current reasons.

Traumatic neurosis . Caused by shock, that is, a reaction to a completely unexpected experience for which the patient was not prepared by anxiety or vigilance. Its manifestations contain stereotypical actions or “attacks” of partial repetition of the traumatic event and stereotypical dreams in which the experiences are repeated. Traumatic neurosis is devoid of unconscious meaning. Its purpose is to give the patient the opportunity to retrospectively cope with an unexpected experience, re-evoking it and processing it, that is, getting used to the new state of affairs.

Narcissistic neurosis. This is a neurosis of a patient who is incapable of forming a transfer, i.e., an overestimating ego.

Character neurosis. The symptoms of this neurosis are not individual character traits, but those that determine whether the character belongs to one or another type (oral, phallic, genital or hysterical, phobic, schizoid, obsessive).

Organ neurosis. A rarely used term for psychosomatic disorders.

Infantile neurosis. Neurosis of childhood. The classical theory suggests that all neuroses in adult life are preceded by some neurosis in childhood.

Transference neurosis. This is a neurosis in which the patient is capable of forming a transference, or a neurosis with the patient’s all-consuming interest in the analyst, developing during treatment with psychoanalysis.

Anxiety neurosis. This is any neurosis in which the main symptom is anxiety (i.e., irrational fear of something, phobia), or one of the actual neuroses (i.e., neurasthenia and fear neurosis; the cause of the first is sexual excess, the second is sexual arousal, not received a discharge).

The doctrine of neuroses, although it is going through hard times, was clearly in a hurry to be buried by the compilers of ICD-10. Refusal of neuroses leaves a large number of problems without any explanation. It is naive to consider neuroses a far-fetched problem, and it is completely unforgivable to say that the work of many researchers, including outstanding figures, is not worthy of modern enlightened attention. In our opinion, the negative attitude towards the problems of neuroses was the result of the excessive and unfounded influence of American behaviorism, for which there is no consciousness or personality, and the difference between a rat and a person is vanishingly small. It remains to express confidence that the growth of interest in the human personality will inevitably lead to an increase in interest in the most incomprehensible, but also the most human disease - neurosis.

Back to contents

Symptoms

In patients with neurosis, two groups of symptoms are distinguished:

• Somatic. They arise as a result of uncoordinated work of the sympathetic and parasympathetic nervous systems. In this case, the person has complaints about his health, but there is no pathology of the internal organs;
• Psychological symptoms are different for different types of neurosis.

Somatic symptoms Neurosis can be suspected if the following symptoms are present:

• increase or decrease in blood pressure;
• tinnitus, hand tremors;
• insomnia;
• decreased concentration, memory impairment;
• tachycardia or bradycardia;
• muscle pain, twitching, even cramps;
• nausea, vomiting;
• increased or decreased appetite;
• unsteadiness of gait;
• pain in the left side of the chest;
• difficulty urinating;
• increased sweating;
• tingling sensation, numbness in the limbs, changes in sensitivity in various parts of the body;
• gastrointestinal disorders: constipation, diarrhea;
• trembling in the body;
• headache;
• feeling of pulsation in various parts of the body;
• darkening of the eyes;
• stomach ache;
• decreased potency;
• pale or red skin;
• feeling of lack of air when breathing;
• skin rashes, scratching, burning.

When the first symptoms appear, patients go to the hospital and only after a long examination and consultations with various specialists do they see a psychiatrist.
Prolonged absence of diagnosis leads to increased severity of symptoms and the transition of the disease to a chronic form. The Yusupov Hospital employs specialists of the highest category with scientific degrees and extensive experience in treating neurotic disorders.

Make an appointment

Psychological The presence of psychological symptoms indicates that with neurosis there is a disorder of the psycho-emotional sphere. Signs of a neurotic disorder include:

• Decreased self-esteem. A person in a state of neurosis is indecisive in his actions, avoids crowds of people;
• Irritability. Any difficulties and situations provoke a violent reaction, anger, aggression, hysteria;
• Touchiness. A neurotic takes any criticism literally;
• Depression. The state of neurosis leads to a constantly depressed mood, lack of desires and drives, up to complete apathy and self-deprecation;
• Self-criticism. Neurotics treat even the slightest shortcomings strictly;
• Anxiety. Such people are constantly afraid of something, especially with regard to obsessive-compulsive disorder. Sometimes panic attacks can occur - an attack of anxiety and fear, accompanied by somatic symptoms;
• Instability of the emotional background is a change in mood, either for the good or for the bad, for no apparent reason. A bad mood can manifest itself as tearfulness and powerlessness for no reason;
• Difficulty communicating with other people. The state of neurosis provokes the emergence of internal conflict and alienation from the outside world.

Symptoms of neurosis in men and women Signs of a neurotic disorder in men may include disturbances in sexual desire and sexual function.
The stronger sex is more likely to experience depression due to lack of fulfillment and lack of work. Hysterical neuroses are more typical for women. This condition is often accompanied by severe somatic complaints. Typically, this condition occurs in people with a demonstrative personality type, when trying to attract attention.

Symptoms of respiratory neurosis

Neurosis of the respiratory tract can occur in the form of spontaneous crises, but more often hyperventilation disorders are continuous. Respiratory neurosis is characterized by a classic triad of symptoms:

• Respiratory disorders;
• Emotional disturbances;
• Muscular-tonic disorders (neurogenic tetany).

The following types of respiratory disorders in neurosis are known:

• "Empty Breath";
• Labored breathing;
• Impaired breathing automaticity;
• Hyperventilation equivalents.

Emotional disorders are manifested by feelings of fear, anxiety, and internal tension. Muscular-tonic disorders are represented by the following disorders:

• Sensory disorders;
• Convulsive phenomena;
• Chvostek syndrome II–III degree;
• Positive Trousseau test.

In the first type of respiratory disorder, “empty breathing,” the main sensation is a feeling of lack of air, dissatisfaction with inhalation, which leads to deep breaths. Patients constantly lack air; they open vents and windows. Respiratory disorders intensify in agoraphobic situations (subway) or social phobia (during an exam, during a public speaking). Breathing in such patients is deep and frequent.

If the automaticity of breathing is disrupted, patients feel a cessation of breathing, so they continuously monitor the act of breathing and are constantly actively involved in its regulation. Difficulty breathing syndrome differs from the first variant of respiratory disorders in that breathing is felt by patients as difficult and performed with tension. They have a feeling of a “coma” in the throat, air not passing into the lungs, and constricted breathing. This variant of respiratory neurosis is called “atypical asthma.” Objectively, increased and abnormal breathing rhythm is noted. The act of breathing uses the respiratory muscles. The patient is tense and restless, but examination of the lungs fails to detect any pathology.

Hyperventilation equivalents are manifested by periodically observed sighs, coughing, yawning, and sniffling. These manifestations are sufficient to maintain prolonged hypocapnia and alkalosis in the blood.

Emotional disturbances in respiratory neurosis are mainly phobic or anxious in nature. The most common disorder is generalized anxiety disorder. It is not associated with a specific stressful situation. The patient has been experiencing various mental (anxiety over trifles, inability to relax, a feeling of constant internal tension) and somatic manifestations for a long time (more than six months).

During a panic attack, respiratory disturbances reach a significant degree - a so-called hyperventilation crisis develops. Difficulty breathing and loss of automatic breathing are more common, and the patient has a fear of suffocation. An effective method of stopping a hyperventilation crisis is breathing into a paper or plastic bag. The patient breathes his own exhaled air with a high content of carbon dioxide. This leads to a decrease in respiratory alkalosis and symptoms of neurosis.

An increase in neuromuscular excitability in patients suffering from respiratory neurosis is manifested by tetany. Signs of tetany include sensory disorders in the form of numbness, tingling, crawling, buzzing or burning sensations, and convulsive muscle-tonic phenomena:

• Spasms;
• Information;
• Tonic cramps in the hands;
• The phenomenon of the “obstetrician’s hand”;
• Carpopedal spasms.

Along with the classic manifestations of respiratory syndrome, paroxysmal and permanent, there are other disorders that are characteristic of the psychovegetative syndrome as a whole.

Signs of other psychogenic neurotic disorders

Obsessive-compulsive neurosis actually includes obsessions (obsessions) and phobias (obsessive fears).
Obsessive disorders are represented by obsessive thoughts that are stereotypically repeated and extremely painful for the patient. Compulsions are repeated behaviors that purport to prevent harmful or dangerous events that are extremely unlikely to occur. The patient is formally critical of ritual actions, but cannot overcome them on his own. Phobic disorders include fear of certain situations. The patient is critical of his own phobic experiences, understands their alienness, strives to overcome them, but cannot free himself from them. The following obsessive fears are encountered:

• Agoraphobia is a persistent fear of being in crowds of people, fear of public places (workplaces, shops, streets, open squares, theaters, concert halls), and independent long trips on various types of transport;
• Claustrophobia – fear of closed spaces;
• Thanatophobia – fear of death;
• Cancerophobia – fear of cancer;
• Cardiophobia is the fear of severe heart disease.

Hysterical neurosis includes conditions that arise in patients with an obvious or objectively proven conflict situation (violation of interpersonal relationships, insoluble problems), even if the patient denies it.
More often, such conditions arise and stop suddenly. Some of them (anaesthesia and paralysis) gradually develop and persist for a long time. There is no connection between the mental disorder and neurological or physical disorders. The “benefits” for the patient and the clearly psychogenic nature of the disorders raise suspicions about attitudinal behavior. These specific psychopathological manifestations are disease states with specific pathogenetic mechanisms. Hysterical amnesia is manifested by impaired memory for recent stressful events, accompanied by depressive feelings. Memory loss is often partial. It is not caused by intoxication or organic brain damage.

Hysterical movement disorders reflect the patient’s subjective ideas about an alleged neurological disease, but the nature of the complaints does not correspond to real organic disorders. The presence of movement disorders allows the patient to avoid a difficult psychotraumatic situation. The intensity of the manifestation of disorders is closely related to the number of people who are present near the patient. Patients use the violations themselves to attract the attention of others.

Hysterical neurosis can be manifested by the following motor disorders:

• convulsive seizures;
• paralysis (complete and partial);
• hyperkinesis (excessive violent motor acts that occur against the patient’s will);
• contractures (stiffness of joints);
• mutism (a condition when the patient does not answer questions and does not even make it clear that he hears them);
• hysterical stupor (depressed mental state, manifested in silence, inhibition, inactivity).

The patient may experience convulsions similar to epileptic seizures.
All these disorders are not caused by organic damage to the organ or other disease. There are no signs such as tongue biting, involuntary urination, consequences of sudden falls, or loss of consciousness. Sensory disturbances during hysteria are manifested by a variety of sensitivity disorders:

• anesthesia (loss of sensitivity to pain);
• hyposthesia (decreased pain sensitivity);
• hyperesthesia (increased pain sensitivity);
• paresthesia (sensation of itching, burning, crawling).

Sensory disturbances often correspond to areas of innervation.
Patients experience bright, unusual hysterical pains. There is loss of hearing and vision. Depressive neurosis is a condition that is determined by the depressive triad: decreased mood, mental and motor retardation. Symptoms of the disease are moderately expressed, affect the patient’s behavior, but allow the individual to maintain social adaptation. Patients' ability to concentrate and self-esteem decreases. Night sleep disturbances and anxiety are typical.

Make an appointment

Classification of pathology

Neuroses are classified according to the nature of their course. The most commonly observed is hysterical neurosis. This is a complex pathology, which is manifested by such behavioral features as the desire to constantly be in the center of attention and evoke the constant admiration of others. As a rule, the risk group includes women aged 20-40 years. Neurosis of this type does not allow events in the surrounding world to occur correctly, so the character of people becomes unstable and changeable.

In addition, there are:

• Neurasthenia. It is characterized by fatigue combined with irritability to any external factors. The cause of the pathological condition, as a rule, is nervous exhaustion or overwork. Additionally, there is a deterioration in appetite, tachycardia, and sleep disorders.
• Motor neurosis. This condition is characterized by dysfunctions such as stuttering, tics, and seizures. Additionally, headaches, increased irritability and fatigue, sleep disturbances, etc. occur.
• Autonomic neurosis. The pathological condition occurs due to dysfunction of internal organs. Typically, symptoms include problems with the cardiovascular system, but problems with digestion and breathing may also occur.
• Obsessive-compulsive neurosis. In this case, in combination with general neurological symptoms, obsessive-phobic manifestations are observed. This, for example, could be a fear of a heart attack, a fear of developing a malignant tumor, or claustrophobia.

Diagnostics

Only a highly qualified specialist can diagnose neurosis, since the symptoms are very nonspecific. This may require consultation with doctors of various specialties:

• therapist;
• endocrinologist;
• gastroenterologist;
• cardiologist;
• neurologist.

Before scheduling a consultation with a psychiatrist, the patient is prescribed an examination. Taking into account the complaints, the doctor selects the necessary studies:

• MRI, CT;
• Ultrasound of the thyroid gland, genital organs;
• ECG;
• Echocardiography;
• Fibrogastroduodenoscopy.

Early diagnosis makes it possible to treat neurotic disorders in the early stages.
The Yusupov Hospital has its own diagnostic center with modern equipment of European quality. Doctors at our clinic regularly attend conferences, receive scientific titles and master new treatment methods. When diagnosing neurosis, differential diagnosis is carried out with other diseases:

• enteritis, gastritis;
• psychopathy;
• angina pectoris;
• hypothyroidism;
• adrenal tumor.

The main difference between neurotic disorders and somatic pathology is that as a result of examinations of internal organs, no deviations from the norm are observed. To confirm neurosis, special psychological tests are carried out: anxiety, the Zung and Beck depression test, the K. Leonhard questionnaire.

Differential diagnosis of neuroses

Successful diagnosis of neurotic disorders primarily depends on the contact between doctor and patient. Since neurosis, unlike diseases of the body, cannot be confirmed simply by examining the patient, taking a cardiogram or an x-ray, the patient’s complaints come first in this case.

For example, constant fatigue, loss of strength and a feeling of the meaninglessness of life may indicate depressive neurosis, an irresistible need to repeat certain actions may indicate obsession, and acute attacks of anxiety and fear may indicate panic disorder.

When visiting a psychotherapist, people are sometimes embarrassed to talk openly about their problems. Of course, an experienced doctor will certainly recognize this or that disorder, even if the patient is not completely frank with the doctor. But, nevertheless, such secrecy causes some difficulties and interferes with the establishment of confidential contact and the selection of the most adequate treatment methods.

Therefore, when turning to a specialist for help, try to discard your own prejudices and preconceptions. Remember: what may seem uncomfortable, shameful, or abnormal to you is, in fact, just symptoms of illness. And the more you tell the doctor, the more accurate and effective the therapy will be.

Treatment

Treatment of neurosis has two main directions:

• medicinal;
• psychotherapeutic.

Usually, for complete recovery, only psychotherapy is sufficient, but if this method is ineffective, drug treatment is required. Psychotherapy For neurosis, psychotherapy makes it possible to find the cause of the disorder and choose the most effective method of therapy. The following areas of psychotherapy are used to treat neurosis:

• Cognitive behavioral therapy allows you to learn to identify and manage negative thoughts, discover and change beliefs that cause maladjustment in the environment;
• Art therapy is aimed at the patient mastering various types of art: dancing, drawing, modeling, music. In the process of training, a person masters new possibilities, and this also allows him to throw out his emotions and negativity. This allows you to relax and take your mind off problems and get rid of complexes. With the help of art, a person gets to know himself, discovers new abilities, which is very important in the treatment of neurotic disorders. Art therapy is also used to diagnose mental disorders. In the process of sculpting or drawing, a person involuntarily projects his thoughts and emotions, which helps to identify hidden aggression and a depressive state;
• Psychoanalysis is a treatment method in which, based on associations, fantasies and dreams, the doctor can determine the presence of an internal conflict. With its help, the instinctive behavior of a person, drives and desires at the level of consciousness and the unconscious are studied;
• With the help of Gestalt therapy, a person acquires the ability to make decisions independently and control their behavior.
• Psychotherapy improves the patient’s general condition and normalizes the emotional background. Getting rid of anxiety, depression, fears and phobias in most cases is only possible with the help of treatment from a psychiatrist. Explanation of behavior and identification of the provoking agent is the basis of therapy for psychoneurosis. In addition to a psychiatrist, sessions with a psychologist can help. At your appointment, you will be able to learn relaxation techniques that will help you overcome stress.

Make an appointment

Drug treatment Despite the high effectiveness of psychotherapy, it does not always allow you to completely get rid of neurosis. Drug treatment of neurotic disorders involves normalizing the function of the nervous system and enhancing the effect of treatment by a psychotherapist. In pharmacotherapy, the following groups of drugs are used:

• Sedatives are used as a remedy for mild neurosis. They have a calming effect and reduce emotional stress. They practically do not cause side effects and addiction;
• Tranquilizers have an anti-anxiety effect and a strong sedative effect. They reduce fear, anxiety, eliminate obsessive thoughts and actions;
• Antidepressants normalize the levels of serotonin, dopamine and norepinephrine. They improve mood, have virtually no side effects and are highly effective, especially in people with hypothymia;
• General strengthening treatment is achieved by taking vitamins B, A, D, E and antioxidants.

Other commonly used treatments include:

• Massage for neurosis can be acupressure or individual segments. It increases blood circulation, improves skin nutrition, relieves muscle spasms;
• Physiotherapeutic procedures such as inductothermy, electrophoresis, galvanization and electrosleep help improve overall well-being and normalize mood.

Prognosis and prevention

Many people wonder how to live with neurosis.
The prognosis depends on the stage of development, type of disorder, timely detection and initiation of treatment. A significant improvement in the condition is observed with an integrated approach and a combination of medication and psychological assistance. Timely identification of the disorder guarantees the success of treatment, therefore, if you have symptoms of neurosis, you should immediately consult a doctor. Preventive measures to prevent neuroses and their relapses include:

• proper nutrition with sufficient fruits and vegetables will cover the body’s need for vitamins and minerals;
• a favorable atmosphere in the team and at home helps to improve vitality and strengthen the nervous system;
• getting rid of bad habits;
• healthy sleep and rest;
• regular walks in the fresh air;
• playing sports is one of the main ways to combat depression.

High modern standards are the basis for providing quality customer service at the Yusupov Hospital.
To schedule a consultation, call or leave a request on the website, and we will call you back. Make an appointment