Neurasthenia (asthenic neurosis) is a pathological condition of the human nervous system that occurs as a result of its exhaustion during prolonged mental or physical overload. Neurasthenia is most often found in people 20-40 years old, in women a little less often than in men. It develops with prolonged physical overstrain (strenuous work, insufficient sleep, lack of rest), frequent stressful situations, personal tragedies, prolonged conflicts. Somatic diseases and chronic intoxication can contribute to the occurrence of neurasthenia. The treatment of neurasthenia depends on its type. The fundamental point is to eliminate the causal factor of neurasthenia.
ICD 10
F48.0 Neurasthenia
Classification
Neurasthenia is classified by clinical forms as:
- Hypersthenic form
- Irritable weakness
- Hyposthenic form
These forms can manifest as phases of neurasthenia.
Symptoms
The most common symptom of neurasthenia is headache. It is diffuse in nature and, as a rule, occurs at the end of the day. Characteristic is the feeling of pressure on the head, as if squeezing the head with a heavy helmet (“helmet of a neurotic”). The second complaint of patients with neurasthenia is dizziness, which consists in a sensation of rotation in the head, but is not accompanied by a sense of rotation of surrounding objects. Often such dizziness occurs with strong excitement, physical exertion, changes in the weather, etc. Symptoms associated with cardiovascular disorders are characteristic: increased heart rate (tachycardia), palpitations, pressing or stabbing pain in the heart area, arterial hypertension, redness or pallor of the skin. They can appear at the slightest agitation of the patient, even during a lively conversation.
With neurasthenia, dyspeptic phenomena are possible: heartburn, loss of appetite, belching. Heaviness in the stomach, flatulence, causeless diarrhea or constipation. Patients may have frequent urge to urinate (pollakiuria), which increases with excitement and passes at rest. Sexual desire is often reduced. Premature ejaculation occurs in men, 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, often show impatience, cannot control themselves and are even able to offend others. They are annoyed by extraneous noise, conversation, any sound, a large crowd of people or their rapid movement. A decrease in efficiency is characteristic, and this happens not so much due to fatigue, but due to the primary weakness of active attention: distraction and lack of concentration, the inability to “get involved” in the work and focus on the task at hand. Having started work, a patient with neurasthenia is not able to withstand the mental stress necessary for its performance 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 difficult for him to start working again. 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 disorders in the form of problems falling asleep, frequent night awakenings, disturbing dreams associated with daytime experiences. As a result, a heavy morning awakening without a sense of rest, an unclear head, a bad mood, a constant feeling of fatigue and exhaustion. Such a morning condition of patients with neurasthenia may improve somewhat by the evening. It is characterized by a pressing headache (“neurasthenic helmet”) or a constant feeling of heaviness in the head, memory impairment, a feeling of discomfort in various areas of the body.
Irritable weakness is the second phase of neurasthenia, which occurs in persons of choleric temperament or people with a balanced strong type of nervous system in cases where recovery has not occurred at the first stage, and the effect of the pathogenic factor continues. The patient is still characterized by severe irritability, but it quickly fades and is replaced by mental exhaustion. Patients are easily excited and scream, 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 for any, even the most trivial, reason. In the second phase of neurasthenia, the patient begins to perform any task or work with great difficulty, he is unable to concentrate. Trying to concentrate on some activity, he gets tired quickly, the headache gets worse and he can’t think clearly 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 tries to get to work again, but due to nervous exhaustion, he throws it again. 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 the 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, decreased mood, lack of interests. Patients experience a feeling of sadness and some kind of indefinite anxiety, but pronounced attacks of anxiety or melancholy are not characteristic of them. Low mood is combined with severe asthenia and is often manifested by emotional instability and tearfulness. Due to the feeling of constant fatigue and general weakness, patients cannot get together at all to start any physical or mental work. They are focused on their inner feelings and thoughts about their condition suppress them even more. Hypochondriac complaints about various sensations emanating from the internal organs are characteristic.
After some time, when the pathological factor ceases to act or adequate therapy is carried out, sleep begins to recover in patients with neurasthenia and recovery gradually takes place. With the repeated occurrence of neurasthenia attacks, their duration increases, and depressive states worsen.
Diagnostics
The diagnosis of neurasthenia is made by a neurologist based on the characteristic complaints of the patient, the history of the disease and examination. During 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 organic brain damage (tumor, inflammatory diseases, neuroinfections), therefore, to exclude it, the patient is examined on a computer (CT of the brain) or magnetic resonance (MRI of the brain) tomograph. Rheoencephalography is performed to assess cerebral circulation in neurasthenia.
Treatment
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 burden on the patient, introduce a strict work and rest regime. It is important to observe the correct daily routine, going to bed and waking up at the same hours. Walking before going to bed, fresh air, fortified food, and a change of scenery are useful for patients with neurasthenia. They are recommended rational psychotherapy and autogenic training.
General restorative treatment is carried out, hopanthenic acid, calcium glycerophosphate are prescribed, sometimes in combination with iron preparations. Bromine and caffeine are effective in individually selected dosages. Therapy of cardiovascular disorders is carried out with tincture of hawthorn, valerian and motherwort preparations.
In the hypersthenic form of neurasthenia, tranquilizers are indicated: chlordiazepoxide, nitrazepam; in sleep disorders, sleeping pills: zopiclone, zolpidem. In the treatment of hyposthenic neurasthenia, small doses of diazepam, pyritinol, eleutherococcus, and fonturacetam are used. They recommend coffee, strong tea, preparations with a tonic effect: ginseng, Chinese lemongrass, Manchurian aralia root, pantocrine.
With all forms of neurasthenia, the appointment of thioridazine is possible. In small doses, it acts as an antidepressant and has a stimulating effect on the nervous system, therefore it is used in hyposthenic form. In large doses, it has a sedative effect, which allows it to be used in the treatment of hypersthenic form.
Patients with neurasthenia are recommended to consult a physiotherapist for the selection of effective physiotherapeutic methods of treating the disease. With neurasthenia, electroson, massage, reflexotherapy, aromatherapy and other procedures can be used.
Prognosis and prevention
Neurasthenia has the most optimistic forecasts among all neuroses. However, there is often a transition to a chronic form that is difficult to treat.
The main thing in preventing the development of neurasthenia is compliance with the correct work and rest regime, the use of relaxing techniques after nervous overstrain, avoiding physical overload and stressful situations. It is important to change activities, complete disconnection from work, active recreation. In some cases, a vacation and a vacation trip helps to prevent the development of an incipient neurosis.
