The concept of “neurosis” appeared in the medicine back in the seventies of the eighteenth century, uniting a whole set of neuropsychiatric disorders. The prevalence of neurotic processes in the modern world is steadily growing due to the accelerated pace of life, high mental and physical burden put on the average citizen, excessive workload for adults and a necessity to learn actively for children.
While working on his physiological doctrine, I.P. Pavlov called neurosis a result of overstrain of the nerve centers of the higher nervous activity, arising from prolonged exposure to irritants, inadequate in strength. At the moment, the opinion of the scientific world as for the underlying causes of the disease has not undergone fundamental changes.
Neurotic disorders are manifested not only in the form of psychomotor reactions and deterioration of the psychological state of the patient. Occurrence of neurotic functional disorders of the internal organs is also a common deal. Therefore, one of the most common somatic pathologies of psychogenic nature is a gastric neurosis, which is clinically manifested in the form of gastrooesophageal reflux disease.
It should be noted that mental disorders and somatic state disorders of neurotic character are functional and are completely reversible with proper treatment. However, in many cases, patients prefer to avoid visiting a specialist. This is due to the prevalence of negative stereotypes in society regarding a person who visits a psychiatrist or neurologist.
- The etiological factors of neurosis
- Neurosis: symptoms and signs
- Neurosis: treatment and therapy
- Prevention of neuroses
1The etiological factors of neurosis
Depending on the form of the disease, the causes of neurosis may lie in a variety of physical and psychological factors. Professionals in their clinical practice usually encounter the following ethiopathogenetic impacts:
- Mental overload or prolonged emotional distress. This is how children suffer from neuroses due to the high academic load, and the young and middle-aged people – due to divorce, job loss, and dissatisfaction with their life.
- Inability to solve their problems. This impact is a variation of the first one in the list. An example would be the situation with people who have loans in arrears. Long psychological pressure on the part of the bank is fully capable to provoke neurotic disorders.
- Forgetfulness, which once led or miraculously did not lead to negative consequences – for example, if a person forgot to turn off the iron and the fire broke out, may cause an obsessive-compulsive disorder which makes the patient constantly doubt if he/she didn’t forget to do something important.
- The pathology of the development of the central nervous system, accompanied by an inability to stand long-term mental and physical labor (congenital asthenia).
- Intoxication and diseases accompanied by general exhaustion of the organism. Consequently, neuroses often develop as a result of the long-term ongoing infectious diseases (tuberculosis, in milder cases – flu). In addition, the neurosis often develops in people who are addicted to tobacco or alcohol, and in most cases these two always go together.
In addition to the foregoing, neurotic disorders can occur for no apparent reason, as a consequence of the patient’s painful perception of his/her inner world and the power of autosuggestion. This form of the disease is most common in women who have hysteroid type of character.
2Neurosis: symptoms and signs
Available clinical picture of neurosis can be divided into two major groups: symptoms of mental and physical nature. Both can be present in almost all varieties of neuropathic disorders, but each type of neurosis has its own features, allowing for the differential diagnosis.
Common symptoms of neuroses of psychopathic nature
Psychological tests, conducted among patients with neurosis, detected such signs of the disease as indecision, lack of confidence in their abilities, chronic anxiety and fatigue. In this case the patients, usually, do not set goals for further life, they are not aimed for success, they simply don’t believe in it. Also, quite often they develop inferiority complexes, mainly, concerning their appearance and ability to communicate.
Subjectively, the patient experiences a significant reduction in capacity for work, constant fatigue, and unwillingness to make any active steps to advance at work or school. Sleep disturbances, drowsiness or, on the contrary, insomnia are often observed.
In addition to the above, the symptoms of neurosis include inadequate self-esteem. It is ironic that self-esteem may be either too low or too high. In the latter case the patient feels much better, smarter, and more capable than the people around him. The reason for worries in this case is the alleged failure of other people to understand and evaluate the patient “according to their merits”.
Common symptoms of somatic neurosis
The complex of symptoms of functional somatic disorders, occurring in patients with neurosis, is very broad, and can affect functioning of almost all body systems. Therefore, mental illness often causes an episodic pain in the heart, resembling unstable angina, which emerges during exercise as well as at rest. Such cases are denoted by a term such as cardiac neurosis.
In addition to coronary manifestations, mental disorders often manifest themselves in the form of tremor of limbs, excessive sweat, and apparent anxiety. Patients are showing signs of vegetative-vascular dystonia, accompanied by hypotonic syndrome. In case of critical reduction of blood pressure patient may lose consciousness and pass out.
The symptoms of neurosis may lie in the occurrence of the so-called psychalgia – the feeling of pain in the absence of any actual pathology. The pain in this case is the psychic reaction to the panic expectation of it by the patient. The emerging situation is that a person is experiencing precisely what he/she is afraid of and subconsciously keeps it in mind.
Special forms of neuroses and their clinical signs
There are several varieties of the disease having their own psychiatric symptoms. In this case clinical picture is rarely observed in full. Typically, in each case there is one certain predominant clinical sign.
Hysterical neurosis. People suffering from this form of the disease exhibit nervousness and irritability even in a quiet environment. Their behavior is often inadequate, and the reaction may be unpredictable. Somatically, hysterical neurosis manifests itself in motor and autonomic disorders such as hypotension and compulsive movements.
Bouts of hysteria are usually manifested in the form of affective mental seizure, during which the patient can roll on the floor, screaming, trying to physically affect others or attempt to commit suicide. However, this behavior in some cases is not a true hysterical neurosis but a latent symptom of the following form of the disease.
Hypochondriacal neurosis is the result of fear to become ill with any serious disease or get into a situation which seems to be hopeless for a patient. This disease often manifests itself as hysteria, either in the form of obsessive-compulsive neurosis. At the same time, as a rule, patients show many mental symptoms from the list above. A person can undergo regular medical check-ups, read medical literature, but anyway continue suspecting to be in an incurable condition. Similar phenomena are sometimes observed among medical students or people working in the field of lethal diseases (hospices).
Depressive neurosis. It may be the result of both, psychogenic and neurotic depression. In the latter case, the symptoms of the disease are weak and are not fully manifested. Often, the patient shows only a slight decrease in workability. In the presence of psychogenic depressive state the patient feels abandoned, useless, complains of sadness and dejection, he develops an inferiority complex. Somatically, sexual dysfunction, hypotension and sluggishness may be observed.
Neurasthenia. There are three stages of this variety of neurosis. The first phase of development of the disease is characterized by severe irritability without any somatic symptoms. Mental and physical performance, as a rule, is preserved. At the second stage the patient feels a slight decrease in workability, which becomes another factor aggravating his condition. The final stage of the disease is characterized by severe weakness, lethargy, and apathy. The asthenic syndrome develops.
3Neurosis: treatment and therapy
Due to the fact that neuroses, in general, are psychosomatic states, the treatment goes in two main directions – psychotherapeutic and pharmacological. However, pharmacological therapy is carried out only in case of an extremely severe form of the disease. In most cases a competently conducted psychotherapy is enough.
Psychotherapy for neurotic patients
The aim of psychotherapy in neurotic disorders is to normalize the patient’s views on the world around us, identify the causes of the disease, and expand the range of interests of the patient.
Typically, the recovery occurs in case the patient with the help of the psychotherapist succeeds to recognize the cause of their fears and anxieties. After that, all that previously didn’t let the patient live a normal life does not seem so important and meaningful.
Modern psychologists and psychiatrists use three basic methods of influence in the treatment of neurotic states: conversation, cognitive therapy and hypnosis. The term “cognitive therapy” refers to a recreation in a safe environment of the situation, which caused the patient’s anxiety. This allows you to sensibly assess what is happening and draw the necessary conclusions. Cognitive therapy is often carried out in the course of hypnotic trance.
After helping the patient to find his way out of a neurotic condition, the conversation on the further way of life, normalization of well-being and finding of his/her place in the world is carried out. The patients are recommended that they find their “area of freedom”, which may be any hobby and passion, as well as find ways to relaxation and distraction from reality.
Pharmacological treatments for neuroses
In cases where the techniques of psychotherapy do not bring the desired effect, it is necessary to cure the neurosis by means of pharmacological correction of states of mind. To do this several groups of drugs are used:
Antipsychotics (aminazine) are a group of drugs of antipsychotic action. They show wonderful calming and sedative effects, effectively eliminating the hallucinations; however, long-term use can cause depression. They are used in hysteroid form of neurosis.
Tranquilizers (diazepam) are similar to antipsychotics as for their pharmacological effect, however, have a different mechanism of influence, stimulating the release of gamma-aminobutyric acid. They have a sedating and relaxing effect. These drugs are prescribed to be taken in short courses in case of obsessive-compulsive disorders.
Antidepressants (amitriptillin) have a pronounced sedative effect. These drugs are prescribed in case of nervousness, accompanied by anxiety and fear. They can be used in the form of tablets or parenterally.
Psychostimulants and nootropics (nootropil) have a stimulating effect, improving mental performance and emotional state. They are used in case of forms of depressive neurosis.
4Prevention of neuroses
Despite the fact that the prognosis of neurotic states tends to be favorable, it takes a lot of time, effort, and sometimes costs to be cured completely. Therefore, the prevention of the disease in question is of considerable importance.
Measures to prevent neurosis include finding balance between work and rest, the presence of any hobby, regular walks in the fresh air. In addition, you should find a suitable opportunity for the relief of mental stress. Keeping a diary may work.
It is also important to carefully track your own condition, and turn to a specialist when the first symptoms of psychological overload occur.