Neurasthenia. Neurasthenia is characterized by four main groups of clinical manifestations: neuropsychiatric, dissomic , cephalgic and vegetovisceral . The most typical are asthenic disorders in the form of increased physical and mental fatigue. Characterized by a decrease in memory and attention, increased irritability, unstable mood, hypochondria. The leading neurotic syndromes are asthenic, asthenodepressive , astenoipochondria. It is important to emphasize that asthenia often acts as a leading manifestation of depression. Hypersensitivity to all external irritations (auditory, sound, olfactory, tactile), meteofactors, ambient temperature is characteristic.
Headaches are diffuse, compressive in nature (“helmet neurasthenic”) and are based on muscle tension of the aponeurosis. Sleep disorders are characterized by difficulty falling asleep and lack of deep, subjective reports, sleep. Vegetative disturbances in the cardiovascular, respiratory, gastrointestinal systems are clearly represented, sweating is increased. Often there are sexual disorders in the form of decreased libido and impaired sexual function. Often, neurasthenic disorders develop against the background of an asthenic constitution.
Neurasthenia should be differentiated from asthenic syndromes in case of overwork, somatic diseases and organic brain lesions.
In the clinical picture, obsessive fears (phobias) and obsessive states ( obsessions ) are leading . Among the first vydelyayutsyag cardiophobia , cancerophobia , thanatophobia (obsessive fear of death), lissofobiya (obsessive fear of going insane) oksifobiya (obsessive fear of sharp objects), agoraphobia (fear of open spaces), claustrophobia (fear of enclosed spaces), hypsophobia (the height of fear) , misophobia – (fear of pollution), erythophobia (fear of redness). Often they act in a combined form. Obsessive states are characterized by obsessive thoughts, memories, doubts, movements and actions, while maintaining a critical attitude towards them. Obsessive movements and actions often take on the character of rituals, are not corrected by the sick, and are used to prevent imaginary misfortune. Neurotic syndromes are obsessive- phobic or phobic-obsessive in nature. They are combined with asthenic manifestations described with neurasthenia. Characteristic is the development of this form of neurosis against the background of psychasthenic character traits (self-doubt, indecision, suspiciousness, timidity, increased sensitivity)
Hysteria (hysterical neurosis)
Hysteria is characterized by the presence of emotionally-affective, pseudo – neurological and vegetovisceral disorders.
The former are typically characterized by a lack of depth, demonstrativeness , simplicity of experiences and their certain situational conditioning. They are manifested by mood swings, asthenic, phobic , hypochondriacal disorders.
Pseudo-neurological disorders occupy an important place in the clinic of hysteria. Recently, views on reducing the frequency of these disorders in hysteria have become traditional. Experience in a neurological clinic indicates their high frequency. Unfortunately, we have to admit that they, as a rule, are considered for a long time in the framework of organic disease.
These include motor disorders (paralysis, paresis, impaired coordination when walking, sitting, standing, performing special tests, hyperkinesis), double vision (often monocular diplopia); speech disorders (aphonia, mutism , stuttering), sensitive disorders (hypesthesia, anesthesia, hyperesthesia, paresthesia), convulsive seizures of a clonic- tonic nature. Often these disorders are preceded by hysterical “stigmas” – difficulty swallowing due to a constant “lump in the throat”, hoarse voice during unrest, fleeting visual or hearing impairment.
The features of all these pseudo -neurological symptoms are the absence of objective neurological disorders, the predominant involvement of the left half of the body, the inclusion of “paralyzed” parts of the body in integral motor acts, especially the topography of sensitive disorders (hypesthesia or anesthesia with a midline border, “amputation” nature of the disorders, persistent pain in both halves of the face.) Often, the dynamic nature of these symptoms is noted, their intensification in certain situations. There are observations, where psevdonevrologicheskie disorders occur in the background have or had in the past failure of the nervous system (hysterical lower paraplegia in patients who had a few years ago, the deletion of the spinal cord tumors, and so on. d.). It is characteristic and hysterical sleep. Patients are in a state of behavioral sleep for several hours or days. They cannot be awakened, but there are no signs of sleep during an EEG study, and activity characteristic of wakefulness is recorded. Typical increases in these states of blood pressure, a rise in body temperature, and an increase in heart rate. When trying to examine the pupils, the eyeballs are taken up. Thus, the features characteristic of physiological sleep are absent. Vegetovisceral disturbances are
also expressed , which are in the nature of permanent vegetative dystonia and vegetative-vascular crises.
The personality traits of patients with hysteria are impressionability, suggestibility and self-suggestibility , selfishness, self-centeredness , the desire to attract attention, and often a certain “artistic” personality. Among hysteria patients, women predominate.