Neurasthenia (asthenic neurosis) is a pathological state of the human nervous system resulting from its exhaustion during prolonged mental or physical overload. Most often neurasthenia occurs in people 20–40 years old, in women a little less than in men. It develops during prolonged physical overstrain (hard work, lack of sleep, lack of rest), frequent stressful situations, personal tragedies, long conflicts. The emergence of neurasthenia can contribute to somatic diseases and chronic intoxication.
Neurasthenia is classified by clinical forms as:
- Irritable weakness
These forms can manifest as phases in the course of neurasthenia.
Symptoms of neurasthenia
The most common symptom of neurasthenia is headache. It is diffuse in nature and usually occurs at the end of the day. Characteristic is the feeling of pressure on the head, as if squeezing of the head with a heavy helmet (“neurasthenic helmet”). The second complaint of patients with neurasthenia is dizziness, which is a feeling of rotation in the head, but is not accompanied by a feeling of rotation of the surrounding objects. Often, such dizziness occurs with high anxiety, physical exertion, weather changes, and others. Symptoms associated with cardiovascular disorders are: increased heart rate (tachycardia), palpitations, pressure or stabbing pain in the heart, hypertension, redness or pale skin covers. They may appear at the slightest excitement of the patient, even during a lively conversation.
When neurasthenia may dyspeptic manifestations: heartburn, loss of appetite, belching. Heavy stomach, flatulence, gratuitous diarrhea or constipation. Patients may have frequent urge to urinate (pollakiuria), which increase with agitation and pass at rest. Often reduced sexual desire. In men, premature ejaculation occurs, leading to a reduction in the time of sexual intercourse, which creates a feeling of weakness and dissatisfaction in patients .
Hypersthenic form of neurasthenia is manifested by increased irritability, emotional lability and high excitability. Patients easily lose their temper, shout at colleagues or relatives , are often impatient, unable to control themselves and can even insult others. They are annoyed by extraneous noise, conversation, any sound, a large crowd of people or their rapid movement.
Characterized by a decrease in efficiency, and this is not so much due to fatigue, but rather due to the primary weakness of active attention: absent-mindedness and lack of composure, the inability to “get involved” in work and focus on the work being done.
Having started work, the patient with neurasthenia is not able to withstand the mental stress necessary for its implementation for a long time and is easily distracted (often gets up from the table, leaves his workplace, reacts to extraneous sounds and actions of colleagues). After such a distraction, it is again difficult for him to start work. This is repeated many times during the working day and as a result, the person does not have time to do anything. Patients also complain of sleep disturbances in the form of problems with falling asleep, frequent night awakenings, anxious dreams associated with daytime experiences.
As a result, there is a heavy morning awakening without a feeling of rest, an obscure head, a bad mood, a constant feeling of tiredness and fatigue. Such a morning state of patients with neurasthenia may improve slightly in the evening. A pressing headache (“neurotic helmet”) or a constant feeling of heaviness in the head, memory impairment, and discomfort in various areas of the body are characteristic.
Irritable weakness is the second phase of neurasthenia, which occurs in people of choleric temperament or people with a balanced strong type of nervous system in cases where recovery did not occur in the first stage and the effect of the pathogenic factor continues. For the patient, the character is still very irritable, but it quickly goes out and is replaced by mental exhaustion.
Patients are easily excited and screaming, but this first reaction is replaced by a feeling of powerlessness and resentment and often turns into crying. Mental reactions with opposite emotional states arise on any, even the most trivial, occasion. In the second phase of neurasthenia, the patient begins to perform any work or work with great difficulty; he is unable to concentrate. Trying to concentrate on a lesson, he quickly gets tired, the headache intensifies and he cannot clearly understand what he is doing.
The growing general and nervous weakness makes him quit the job he started with a feeling of complete impotence. After some time, the patient again tries to take up work, but due to nervous exhaustion, she again leaves her. Breaks between such attempts to work do not improve the situation, since they do not bring mental rest to the patient. Therefore, repeated attempts to work can bring a patient with neurasthenia to a state of complete exhaustion.
The hyposthenic form develops as a third phase of neurasthenia. It can occur from the very beginning of the disease in asthenic, anxious and suspicious people with a weak type of nervous system. This form or phase of neurasthenia is characterized by constant lethargy, physical and mental weakness, passivity, low mood, lack of interest. Patients experience a feeling of sadness and some kind of uncertain anxiety, but pronounced bouts of anxiety or depression are not characteristic of them.
Decreased mood is combined with severe asthenia and is often manifested by emotional instability and tearfulness. Because of the feeling of constant fatigue and general weakness, patients generally cannot gather to begin any physical or mental work. They are focused on their inner feelings and thoughts about their condition further suppress them. Hypochondriacal complaints of various sensations emanating from internal organs are characteristic.
After some time, with the termination of the pathological factor or the provision of adequate therapy in patients with neurasthenia, sleep begins to recover and gradually recovery occurs. With the recurrence of attacks of neurasthenia, their duration increases, and depressive states are aggravated.
Diagnosis of neurasthenia
The diagnosis of neurasthenia is made by a neurologist on the basis of the patient’s characteristic complaints, the history of the disease and examination. At clinical examination it is necessary to exclude the presence of chronic infections, intoxications or somatic diseases, the initial manifestation of which may be neurasthenia.
Neurasthenia can also develop as a manifestation of an organic brain lesion (tumor, inflammatory diseases, neuroinfection), therefore, to exclude it, the patient is examined using a computer (brain CT) or magnetic resonance (MRI) scan. To assess cerebral circulation with neurasthenia,reoencephalography is performed .
Treatment of neurasthenia
In the treatment of neurasthenia, great importance belongs to the identification of the etiological factor under the influence of which it arose, and, if possible, its elimination. It is necessary to reduce the mental and physical stress on the patient, to introduce a strict regime of work and rest.
It is important to maintain the correct daily routine, going to bed and waking up at the same hours. Patients with neurasthenia benefit from walking before bedtime, fresh air, fortified food, and a change of scenery. They are recommended to rational psychotherapy and autogenic training.
Conduct a restorative treatment, prescribed hopantenic acid, calcium glycerophosphate, sometimes in combination with iron preparations. Effective bromine and caffeine in individually selected dosages.Therapy of cardiovascular disorders is carried out with hawthorn tincture, preparations of valerian and motherwort.
With hypersthenic form of neurasthenia, tranquilizers are indicated: chlordiazepoxide, nitrazepam; for sleep disorders – hypnotics: zopiclone, zolpidem. In the treatment of hypostenic forms of neurasthenia, small doses of diazepam, pyritinol, eleutherococcus, fonturacetam are used. They recommend coffee, strong tea, preparations with a tonic effect: ginseng, Chinese lemongrass, Manchurian root of Aralia, pantocrinum.
In all forms of neurasthenia, thioridazine may be prescribed. In small doses, it acts as an antidepressant and has a stimulating effect on the nervous system, therefore, it is used for hyposthenic form. In large doses, it has a sedative effect, which allows its use in the treatment of hypersthenic form.
Patients with neurasthenia are advised to consult a physiotherapist for the selection of effective physiotherapeutic methods of treating the disease. For neurasthenia, electrosleep, massage, reflexotherapy, aromatherapy and other procedures can be used.
Prognosis and pros lactic neurasthenia
Neurasthenia has the most optimistic predictions of all neuroses. However, often there is a transition to a chronic form that is difficult to treat.
The main thing in preventing the development of neurasthenia is the observance of the correct mode of work and rest, the use of relaxing techniques after nervous tension, the avoidance of physical overload and stressful situations. Important is the change of activity, complete disconnection from work, active rest. In some cases, to prevent the development of incipient neurosis helps vacation and a trip to rest.