Neurotic disorders. Etiopathogenesis

The crazy pace of modern life is not good for everyone. A huge number of our contemporaries are constantly in danger of acquiring one or another neurotic disorder. Why is this happening? What is neurosis? Why is he dangerous? What types of this disease are most common? Who is at risk?

Neurotic disorder - a disease of our time

Neurosis of one kind or another (or neurotic disorder) is today called the most common type of mental illness throughout the world. The prevalence of pronounced neuroses in developed countries is approximately 15%, and their latent forms are found in more than half of the population. Every year there is an increase in the number of neurotics. Neurotic disorder cannot be called a disease of any particular age group; it can occur at any age, but the typical age of its manifestation is 25-40 years. Typically, neurotic disorders occur with awareness of the disease, without disturbing the understanding of the real world.

In psychiatry, the diagnosis “Neurosis” includes a variety of functional disorders of the nervous system, which are characterized by passing disturbances in such processes of the human nervous system as excitation and inhibition. This disease is not organic damage to the nervous system or internal organs. In the development of this mental illness, the leading role is given to functional disorders of a psychogenic nature.

From a psychological point of view, the concept of “Neurosis” refers to all reversible disorders of human nervous activity that arise as a result of psychological trauma, i.e. information stimuli. If the disease develops as a result of physical trauma, various intoxications and infections, as well as endocrine disorders, we are dealing with neurosis-like conditions.

Although there are many forms and types of neuroses in ICD-10, the most common neurotic disorders are hysterical neurosis (hysteria), obsessive-compulsive neurosis and neurasthenia. Recently, these neurotic disorders have been supplemented by psychasthenia, which previously belonged to the class of psychoses, as well as phobic (panic) fear.

Causes

The main reason why a person develops neurosis is a high level of civilization. Representatives of primitive cultures (for example, the Australian Bushmen) know nothing about this disease. It is the flow of information that daily bombards the heads of modern people that creates favorable conditions for the development of one of the forms of neurosis.

Scientists cannot come to a consensus on what causes neurotic disorders. Thus, Pavlov considered them chronic disorders of nervous activity. Psychoanalysts believe that neurosis is a subconscious psychological conflict that arises as a result of contradictions between instinctive aspirations and moral ideas of a person. K. Horney called this disease a protection against negative social factors.

Today it is believed that the psychogenic factor causing neurosis is stress, conflicts, traumatic circumstances, prolonged intellectual or emotional stress. These events become the cause of the disease if they occupy a central place in the system of relationships of the individual.

Causes	Explanation
Psychological trauma	Neurosis is caused by anything that threatens a person, creates uncertainty or requires making a decision.
Insoluble conflicts	Tossing between desires and duty, situation and drives, between conflicting feelings (hate-love).
Lack of information	Often this disorder is caused by a lack of information about loved ones.
Anticipation of a negative event, stress	Personal, professional situations.
The presence of constant psychotraumatic stimuli.	Visual (fire), auditory (words), written stimuli (correspondence) must be either very strong or last a long time.
Heredity	If one of the parents is neurotic, then the risk of developing the disease doubles.
Weakness of the ANS	It is constitutionally determined or arises as a result of diseases, intoxications, injuries.
Overvoltage	The disease is caused by any overstrain: physical, emotional or intellectual.
Substance abuse	Drugs, alcohol, smoking.

Classification

A unified classification for neuroses has not yet been developed, since this disease is very diverse. In the latest edition of the ICD there is no section “Neurosis”. All neuroses are classified as mental disorders or behavioral disorders. One well-known classification divides neuroses into 2 groups: general and systemic:

General neuroses are diseases of a psychogenic nature in which emotional and behavioral disorders manifest themselves, such as anxiety, high irritability, phobias, emotional instability, heightened perception of one’s body, and greater suggestibility.

Common disorders include:

• Neurasthenia;
• Hysteria;
• Obsessive-compulsive neurosis, manifested through actions and movements (obsessive-compulsive) or through fears (phobic);
• Depressive neurosis, incl. alcoholic;
• Mental (nervous) anorexia of adolescents;
• Hypochondriacal neurotic disorder;
• Other neuroses.

Systemic neurotic disorders are characterized, as a rule, by one pronounced symptom: speech, motor or autonomic.

Development factors and consequences

Factors in the development of neurosis can be: psychological factors (personality characteristics, its development, level of aspirations), biological factors (functional underdevelopment of neurophysiological systems), social factors (relations with society, professional activity).

The most common factors:

The formation of a neurotic disorder depends not only on the reaction of the neurotic, but also on his analysis of the current situation. An important role is played by fear or unwillingness to adapt to circumstances.

The consequences of any neurotic disorder, if left untreated, are very serious: a person’s intrapersonal contradictions worsen, communication problems intensify, instability and excitability increase, negative experiences deepen and are painfully recorded, activity, productivity and self-control decrease.

Symptoms

Neuroses are a whole group of reversible mental disorders manifested by psychological and somatovegetative symptoms. The symptoms of neurotic disorders are varied and greatly depend on the form of the disease.

Let's look at the symptoms of the three most common forms:

Neurasthenia. The most common neurotic disorder of our time, characterized by a state of irritable weakness. The symptoms of neurasthenia are easily recognizable: increased fatigue, decreased professional productivity and efficiency at home, and inability to relax. This type of neurosis is also characterized by: tightening headache, dizziness, sleep disturbances, irritation, autonomic and memory disorders.

Hysteria. A neurotic disorder characterized by high suggestibility, poor regulation of behavior, and acting in public. Hysterical neurosis is characterized by a combination of depth of experience with vivid external manifestations (screaming and crying, imaginary fainting, expressive gestures). Symptoms: a hysteric can imitate the manifestations of various diseases and conditions (pain of different localizations, false pregnancy, epilepsy). With hysterical neurotic disorder, there may be imaginary paralysis or hyperkinesis, blindness and deafness, etc. The peculiarity of these disorders is that they occur under hypnosis, in contrast to real organic disorders.

Obsessive-compulsive neurosis. It occurs in response to stress and has obsessive symptoms such as phobias (fears and concerns), obsessions (thoughts, ideas, memories) and compulsions (actions). Today, obsessive-compulsive disorder is rare. Often this disease is accompanied by autonomic symptoms, such as a red or pale face, dry mucous membranes, palpitations, high blood pressure, sweating, dilated pupils, etc.

Manifestations of the disease in children

Most neurotic disorders in children are rare. The exceptions are phobias, obsessive and hysterical forms of disorders, as well as systemic neuroses (stuttering, itching, tics). For this reason, Neurosis is diagnosed only after 12 years of age. Children are characterized by great variability and vagueness of symptoms, an indifferent attitude towards the disease, and a lack of desire to overcome the defect. Childhood neurotic disorders are distinguished by the absence of complaints from the child himself and the abundance of them from the people around him.

Treatment

Features of treatment of different types of neuroses are quite specific. Effective therapy for neurotic disorders cannot be carried out with medications, physiotherapy, massage and other conventional methods of treating organic diseases. Since this disease does not include morphological changes, but only causes changes in the human psyche, it must be treated in the same way - using psychotherapy methods.

Neuroses are classified in medicine as a reversible dysfunctional state of the nervous system, provoked by experiences, unstable emotions, chronic fatigue and other factors. This diagnosis is often made to adult patients, which is not surprising in modern conditions of bustle, turmoil, problems and troubles. But doctors are alarmed by the fact that neurosis has become “younger” - more and more often children with symptoms of this disease are being brought to specialists.

Classification of neuroses in childhood

Doctors differentiate several types of neuroses that can manifest themselves in childhood. Each of them has its own characteristics, is distinguished by individual characteristics and must be subjected to professional treatment.

Anxiety (neuroses of fears)

Anxiety is paroxysmal in nature - it occurs only in certain situations. Preschoolers are very often afraid of the dark, this anxiety can also be intensified by their parents - young children are frightened by “a woman, a black old woman.” An anxiety attack occurs only before sleep at night; during the rest of the day there are no manifestations of fear neurosis.

Primary school age children are exposed to fear of the teacher, a new group of children, and bad grades. According to statistics, this type of childhood neurosis is more often diagnosed in those children who did not attend kindergarten and immediately went from their home environment to a large school group with its own rules and responsibilities.

note: fear neurosis in this case is manifested not only by stiffness, tears and whims, but also by active resistance to the onset of the “X-hour” - children run away from home, skip classes, and persistent lies appear.

Childhood obsessive-compulsive disorder

Neurosis of this type in childhood is manifested by involuntary movements that are absolutely not controlled - for example, flinching, blinking one or two eyes, sniffing, a sharp turn of the neck, slapping palms on the knees or table, and more. With obsessive-compulsive neurosis, nervous tics may occur, but they are characteristic only during negative/positive emotional outbursts.

The category of obsessive states also includes phobic neurosis - this is a condition in which a child develops a fear of being called to the blackboard at school, a teacher, visiting a doctor, or a fear of closed spaces, heights or depths. A very dangerous condition is when a child suffers from a phobic neurosis, and parents perceive this neurosis as a whim - reproaches and ridicule can lead to nervous breakdowns.

A specialist talks in more detail about obsessive neuroses:

Depressive psychosis

Depressive psychosis is more common in children during adolescence and has very characteristic symptoms:

• constantly depressed state;
• quiet speech;
• always a sad expression on his face;
• physical activity is reduced;
• Insomnia bothers you at night, and drowsiness during the day;
• privacy.

A psychologist talks about ways to combat depression in teenagers:

Hysterical neurosis

The well-known tantrums of young children in the form of falling to the floor, kicking their feet on the floor, screaming and crying are a manifestation of hysterical neurosis. This condition is typical for preschool children and may first appear at the age of 2 years.

Neurasthenia

Children's neurosis, manifested by irritability, poor appetite, sleep disturbance and restlessness, is classified by doctors as neurasthenia, or asthenic neurosis.

note: this type of reversible disorder in question occurs due to excessive workload at school, kindergarten or extracurricular activities.

Hypochondriacal neurosis

Hypochondriacs are suspicious people who doubt everything. A similar name for neurosis suggests that children experience suspiciousness towards themselves, their mental and physical abilities, and health. Patients experience great fear about identifying any complex, life-threatening disease.

Stuttering of neurotic etiology

Neurotic stuttering can occur between the ages of 2 and 5 years—the period when a child’s speech is developing. It is noteworthy that stuttering of neurotic etiology is more often diagnosed in boys and can be caused by excessive mental stress.

About the causes of stuttering and correction methods - in the video review:

Neurotic tics

They are also more common in boys and can be caused not only by mental factors, but also by diseases. For example, with long-term conjunctivitis, a habit of rubbing your eyes hard appears. The disease is eventually cured, but the habit remains - a persistent neurotic tic will be diagnosed. The same may apply to constant “sniffling” of the nose or dry coughing.

Such movements of the same type do not bring discomfort into the child’s normal life, but can be combined with enuresis (bedwetting).

Sleep disorders of neurotic etiology

The causes of such neurosis have not yet been clarified, but it is assumed that sleep disturbances of a neurotic nature may be caused by sleepwalking, talking in sleep, restless sleep with frequent awakenings. These same signs are also symptoms of sleep disorder neurosis.

Enuresis and encopresis

Neuroses in preschool children can be purely physiological in nature:

• enuresis – bedwetting, most often diagnosed before the age of 12 years, more typical for boys;
• Encopresis is fecal incontinence; it is extremely rare and is almost always accompanied by enuresis.

Doctors say that neuroses accompanied by enuresis and/or encopresis are caused by overly strict upbringing and great demands from parents.

The pediatrician talks about methods of treating enuresis:

Pathological actions of a habitual nature

We are talking about biting fingertips, biting nails, pulling out hair, rocking the body with rhythmic movements. This type of neurosis in children is diagnosed before the age of 2 and is very rarely recorded at an older age.

Causes of childhood neuroses

It is believed that the main reasons for the development of neuroses in childhood lie in the family, in the relationship between the child and his parents. The following factors are identified that can provoke the formation of stable childhood neurosis:

1. Biological. These include features of the child’s intrauterine development (oxygen deficiency), age (the first 2-3 years of life are considered critical for the onset of neurosis), chronic lack of sleep, and overload in mental and physical development.
2. Social. Difficult relationships in the family, the unquestioned authority of one of the parents, the pronounced tyranny of the father or mother, the characteristics of the child as an individual.
3. Psychological. These factors include any negative psychological impact on the child.

note: the listed factors are very conditional. The fact is that for each child the concepts of “psychological impact, psychotrauma” have an individual emotional connotation. For example, many boys and girls will not even pay attention if their parents raise their voices at them, and some children begin to experience panic fear of their own mothers/fathers.

The main causes of neuroses in children:

• miseducation
• difficult relationships between parents;
• parental divorce;
• family troubles, even of a domestic nature.

Pathogenesis of neuroses in children and adolescents:

In no case should you blame a child for having a neurosis of any kind - it is not his fault; you should look for the reason in the family, specifically in the parents.

note: children with a pronounced “I” are more susceptible to the appearance of neuroses, who from an early age can have their own opinion, they are independent and do not tolerate even a hint of dictate from their parents. Parents perceive such behavior and self-expression of the child as stubbornness and whims, they try to influence with force - this is a direct path to neuroses.

How to help your child

Neurosis is considered a reversible process, but it is still a disease - treatment must be carried out at a professional level. Doctors who deal with the problem of childhood neuroses are qualified as psychotherapists and use hypnotherapy, play sessions, treatment with fairy tales, and homeopathy in their work. But first of all, you need to restore order in the family, establish a relationship between the child and the parents.

Very rarely, neuroses in childhood require the prescription of specific medications; usually a competent specialist will find an option for providing assistance at the level of psycho-emotional correction.

As a rule, the results of treatment of childhood neuroses will only be achieved if not only the child, but also his parents go to see a psychotherapist. Healing a child from neuroses will be facilitated by:

• drawing up a clear daily routine and following the recommended regime;
• physical education – often it is sport that helps bring a child out of a neurotic state;
• frequent walks in the fresh air;
• spending free time not in front of the computer or TV, but in communication with parents or friends.

Hippotherapy (horseback riding), dolphin therapy, art therapy—in general, any non-traditional methods of correcting a child’s psycho-emotional state—are very effective in treating childhood neuroses.

note: It is very important that parents also take the path of treatment - in case of selecting therapy for a child, they need to take into account the mistakes of the parents and try to level out the stressful situation in the family. Only through joint work of parents/psychotherapist/child can good results be achieved.

Neuroses of childhood are considered whims, self-indulgence and character traits. In fact, this reversible condition can worsen and over time develop into serious problems with the psycho-emotional state. Patients of neurologists often admit that in childhood they often experienced fears, were embarrassed by large companies and preferred solitude. To prevent such problems from arising in your child, it is worth making every effort to professionally overcome childhood neuroses. And no matter how trivial it may sound, only moderate love, the desire to understand the baby and the willingness to come to his aid in difficult times can lead to a complete cure.

Chapter 5 ETIOLOGY AND PATHOGENESIS OF MENTAL DISORDERS IN CHILDREN'S AGE

MECHANISM OF EMOTIONAL STRESS AND FACTORS CONTRIBUTING TO MENTAL AND PSYCHOSOMATIC DISORDERS

STRESS AND EMOTIONAL STRESS. MECHANISMS OF THEIR DEVELOPMENT

The most characteristic feature of a child is his emotionality. He responds very quickly to negative and positive changes in his environment. These experiences in most cases are positive. They are very important in a child’s adaptation to a changing life. However, under certain conditions, feelings can also play a negative role, leading to neuropsychic or somatic disorders. This occurs in cases where the strength of the emotion reaches such a degree that it becomes the cause of stress.

Emotional stress is a state of a person’s pronounced psycho-emotional experience of conflicting life situations that acutely or long-term limit the satisfaction of his social or biological needs [Sudakov K.V., 1986].

The concept of stress was introduced into the medical literature by N. Selye (1936) and described the adaptation syndrome observed in this case. This syndrome can go through three stages in its development:

1) the stage of anxiety, during which the body’s resources are mobilized;

2) the stage of resistance, in which the body resists the stressor if its action is compatible with the possibilities of adaptation;

3) the stage of exhaustion, during which reserves of adaptive energy are depleted when exposed to an intense stimulus or during prolonged exposure to a weak stimulus, as well as when the body’s adaptive mechanisms are insufficient.

N. Selye described eustress - a syndrome that helps maintain health, and distress - a harmful or unpleasant syndrome. This syndrome is considered as a disease of adaptation that occurs due to a violation of homeostasis (constancy of the internal environment of the body).

The biological significance of stress is the mobilization of the body's defenses. Stress, according to T. Cox (1981), is a phenomenon of awareness that arises when comparing between the demand placed on an individual and his ability to cope with this demand. Lack of balance in this mechanism causes stress and a response to it.

The specificity of emotional stress is that it develops in conditions where it is not possible to achieve a result that is vital for satisfying biological or social needs, and is accompanied by a complex of somatovegetative reactions, and activation of the neuroendocrine system mobilizes the body to fight.

The most sensitive to the action of damaging factors are the emotions that are the first to be included in the stress reaction, which is associated with their involvement in the apparatus of the acceptor of the results of action during any purposeful behavioral acts [Anokhin P.K., 1973]. As a result, the autonomic system and endocrine support are activated, regulating behavioral reactions. A tense state in this case can be caused by a discrepancy in the ability to achieve vital results that satisfy the leading needs of the body in the external environment.

Instead of mobilizing the body's resources to overcome difficulties, stress can cause serious disorders. With repeated repetition or with a long duration of affective reactions due to protracted life difficulties, emotional arousal can take on a stagnant stationary form.

In these cases, even when the situation is normalized, emotional arousal activates the centers of the autonomic nervous system, and through them upsets the activity of internal organs and disrupts behavior.

The most important role in the development of emotional stress is played by disorders in the ventromedial hypothalamus, the basal-lateral region of the amygdala, the septum and the reticular formation.

The frequency of emotional stress increases with the development of scientific and technological progress, the acceleration of the pace of life, information overload, increasing urbanization, and environmental distress. Resistance to emotional stress varies from person to person. Some are more predisposed, others are very resistant. However, the development of neuropsychic or somatic diseases in a child due to life difficulties depends on the mental and biological characteristics of the individual, the social environment and the stressor (event that caused an emotional reaction).

SOCIAL ENVIRONMENT

Repeatedly experiencing difficult situations in the past in the family and outside it has an adverse effect on the consequences of emotional stress. In this case, the frequency and severity of experienced events matter. Not only one tragic incident, such as the death of close relatives, is dangerous for mental and somatic health, but also several less dramatic ones that occur in a short period of time, since this also reduces the possibilities of adaptation. However, it should be taken into account that the child is not alone in the world, that other people can make it easier to adapt to the situation. Along with previous life experience, current everyday circumstances are also significant. When personal reactions to a changing world are disproportionate, a health hazard arises. This approach involves a comprehensive consideration of man and his environment.

The development of the disease after emotional stress is facilitated by a state of helplessness, when the environment is perceived as unsafe, not giving pleasure, and the person feels abandoned. At the same time, if an individual’s environment shares his assessments and opinions and he can always find emotional support from them, then the likelihood of the pathogenic effect of emotional stress decreases. For a person (especially in childhood), the presence of social connections is so important that even their insufficiency can cause the development of stress.

The attachment that arises between children and their parents in the most sensitive period for this - soon after birth, is of enormous importance not only as a cementing mechanism that unites groups of people, but also as a mechanism that ensures their safety.

The formation of this social mechanism is based on innate patterns of behavior, which determines not only the strength of attachments, but also their great protective power. In those cases where parental care was insufficient and social relationships were disrupted or absent, children subsequently lack the necessary social qualities of life. The feeling of defenselessness and inability to protect oneself from danger leads to frequent anxiety reactions and almost constant neuroendocrine changes. This condition increases the risk of adverse effects from emotional stress.

STRESSOR

The causes of emotional stress can be both positive and negative events. Due to the fact that only unfavorable factors are considered harmful, only negative events are systematized as potential stressors.

S. A. Razumov (1976) divided the stressors involved in organizing the emotional-stress reaction in humans into four groups:

1) stressors of vigorous activity: a) extreme stressors (combat); b) production stressors (associated with great responsibility, lack of time); c) stressors of psychosocial motivation (exams);

2) assessment stressors (performance assessment): a) “start” stressors and memory stressors (upcoming competitions, memories of grief, anticipation of a threat); b) victories and defeats (victory, love, defeat, death of a loved one); c) spectacles;

3) stressors of discrepancy between activities: a) dissociation (conflicts in the family, at school, threat or unexpected news); b) psychosocial and physiological limitations (sensory deprivation, muscle deprivation, diseases that limit communication and activity, parental discomfort, hunger);

4) physical and natural stressors: muscular loads, surgical interventions, injuries, darkness, strong sound, pitching, heat, earthquake.

The mere fact of exposure does not necessarily imply the presence of stress. Moreover, the stimulus acts, as P.K. Anokhin pointed out (1973), at the stage of afferent synthesis of summated stimuli that are very diverse in quantity and quality, so it is extremely difficult to assess the role of one of the factors. At the same time, people's susceptibility to certain stressors can vary greatly. New experiences are intolerable for some, but necessary for others.

ADVERSE PSYCHOSOCIAL FACTORS

Psychosocial adverse factors.

Among the global psychosocial factors, children’s fears of the outbreak of war appear partly as a reflection of the anxieties of parents and grandparents, partly as their own impressions received through the media about already ongoing armed clashes. At the same time, children, unlike adults, incorrectly assessing the degree of real danger, believe that war is already on their doorstep. Due to soil, water and air pollution, the expectation of an environmental disaster is becoming a new global fear, affecting not only adults, but also children. Among the harmful ethnic factors may be interethnic confrontations, which have become so aggravated in recent years. When exposed to regional psychosocial factors such as natural disasters - earthquakes, floods or industrial accidents, along with physical factors leading to injuries, burns and radiation sickness, panic arises, affecting not only adults, but also children. In this case, the psychogenic effect can be delayed in time and appear after the immediate danger to life has disappeared.

In some localities, vital local difficulties are observed. For example, voluntary or forced departure from their usual habitats. At the same time, refugee children, both under the influence of their own difficulties and under the influence of the anxieties of loved ones, find themselves seriously mentally traumatized. These difficulties are greatly aggravated when migration takes place in an area where people have different relationships, raise children differently, or speak a different language. A high risk of mental disorder arises if the family's move entails a loss of the child's social status. This happens at a new school, where he may not be accepted and is rejected.

In the area in which a child lives, he or she may be exposed to attacks, bullying or sexual abuse outside the home. No less, but a greater danger for a child is posed by episodic or constant threats that one has to endure from peers or older children from the same educational institution or a nearby area. Persecution or discrimination in a group of children for belonging to a certain ethnic, linguistic, religious or some other group leaves a heavy mark on a child’s soul.

Adverse factors associated with child care institutions. School, which constitutes the social environment in which children spend a significant part of their time, is often the cause of four sets of problems. The first of them is associated with entering school, due to the transition from play to work, from family to team, from unfettered activity to discipline. Moreover, the degree of difficulty of adaptation depends on how the child was prepared for school.

Secondly, the student has to adapt to the pressure exerted on him by the demands of the educational process. The pressure from parents, teachers, and classmates is stronger the more developed the society and the more aware of the need for education.

Thirdly, the “technization” of society, which requires the complication of educational programs, its computerization sharply increases the difficulties of mastering school knowledge. The student’s situation is even more complicated if he suffers from developmental delay, dyslexia, impaired perceptual-motor functions, or was brought up in conditions of social deprivation, in an unfavorable socio-cultural environment. The child’s situation is worsened by “labeling him a patient”, since the attitude towards him in accordance with the diagnosis changes, and the responsibility for his successful studies is shifted from teachers to doctors.

Fourthly, due to the presence of an element of competition in school associated with a focus on high performance, lagging students are inevitably condemned and are subsequently treated with hostility. Such children easily develop a self-defeating reaction and a negative view of their own personality: they resign themselves to the role of losers, underachievers and even unloved, which hinders their further development and increases the risk of mental disorders.

To school stressful situations, you can add rejection by the children's team, manifested in insults, bullying, threats, or coercion to one or another unsightly activity. The consequence of a child’s inability to conform to the desires and activities of his peers is almost constant tension in relationships. A change in school staff can cause serious mental trauma. The reason for this lies, on the one hand, in the loss of old friends, and on the other, in the need to adapt to the new team and new teachers.

A big problem for a student can be the negative (hostile, dismissive, skeptical) attitude of the teacher or the unrestrained, rude, overly affective behavior of an ill-mannered or neurotic teacher who tries to cope with children only from a position of strength.

Staying in closed children's institutions - nurseries, children's homes, orphanages, boarding schools, hospitals or sanatoriums - is a great test for the child's psyche and his body. These institutions provide education to a rotating group of people, rather than just one or two relatives. A small child cannot become attached to such a kaleidoscope of faces and feel protected, which leads to constant anxiety, fear, and worry.

Family adverse factors. Parental upbringing can be unfavorable when a child is raised by adoptive parents, a stepfather or stepmother, strangers, as well as parents who do not live with them permanently. Growing up in a single-parent family, in particular, becomes unfavorable when the parent feels unhappy and, withdrawing into the family, is unable to create for his son or daughter the necessary conditions for the formation of positive feelings and satisfaction from life.

Children themselves gain a lot from communication outside the family. At the same time, social isolation of the family can become a risk factor for the child, as it prevents his contacts with the environment. Family isolation usually arises as a consequence of changes in the personality of the parents or their rigid preferences, which differ sharply from those accepted in the environment. An overprotective parent makes decisions for the child, protecting him from even minor or imagined difficulties instead of helping him overcome them. This leads to the child’s dependence and prevents him from developing responsibility, acquiring social experience outside the family, and isolating him from other sources of social influence. Such children have difficulties communicating with others, and therefore have a high risk of neurotic breakdowns and mental disorders.

The family provides the child with life experience. Insufficient communication between the child and his parents, the lack of joint games and activities not only limits the possibilities of his development, but also puts him on the brink of psychological risk.

Constant parental pressure that does not correspond to the needs and wants of the child is usually aimed at causing him to become something other than who he really is or who he can be. Requirements may not be appropriate for gender, age or personality. Such violence against a child, attempts to remake his nature or force him to do the impossible, are extremely dangerous for his psyche. Distorted relationships in the family due to insufficient frankness, fruitless disputes, inability to agree among themselves to solve family problems, hiding family secrets from the child - all this makes it extremely difficult for him to adapt to life. Such an uncertain and usually stressful environment in which a child is raised is fraught with risks to his mental health.

Mental disorders, personality disorders, or the disability of one of the family members pose a potential risk for a child to have a mental disorder. This may be due, firstly, to the genetic transmission of increased vulnerability to the child and, secondly, to the influence of mental disorders in parents on family life. Their irritability deprives the child of peace and a sense of confidence. Their fears can cause restrictions on children's activities. Their delusional and hallucinatory experiences can frighten children and even cause sick parents to encroach on the health and lives of their children. Neuropsychiatric disorders can make it impossible for parents to care for their children. Thirdly, due to identification with parents, the child, like them, may experience anxiety or fears. Fourthly, the harmony of family relationships may be disrupted.

Mental or physical disability, sensory defect (deafness, blindness), severe epilepsy, chronic somatic disease, life-threatening illness of the parent make him unable to care for and raise the child. He is also unable to run the household, which obviously compromises the child’s well-being and poses a risk to his mental health.

These states of parental mental or physical disability impact the child due to clear social stigma; due to insufficient care and supervision of the child; due to changes in parental feelings of attachment and decreased responsibility caused by failure to understand children's needs and difficulties; due to family disagreements and tensions; due to socially unacceptable behavior; due to the child’s limitations in activity and contacts. Antagonistic interactions and relationships between family members also lead to adverse consequences for the child's social and emotional development.

A child may be exposed to one, more, or all of these factors at the same time. All bilateral relationships between people depend on the behavior of each of them. Accordingly, varying in degree, disrupted intrafamily relationships may arise partly as a result of the reactions, attitudes or actions of the child himself. In each individual case, it is difficult to judge his actual participation in intra-family processes. Common cases of disturbed family relationships include a lack of warmth in the relationship between parents and child, disharmonious relationships between parents, hostility towards the child or abuse of the child.

Disharmonious relationships between adult family members, manifested by quarrels or an atmosphere of emotional tension, lead to uncontrollable and hostile behavior of individual family members, which persistently maintains cruel attitudes towards each other. After serious conflicts, family members do not communicate with each other for a long time or tend to leave the house.

The hostility of some parents manifests itself in constantly placing responsibility on the child for the misdeeds of others, which actually turns into mental torture. Others subject the child to systematic humiliation and insults that suppress his personality. They reward the child with negative characteristics, provoke conflicts, aggression, and undeservedly punish.

Abuse of a child or physical torture by his parents is dangerous not only for physical, but also for mental health. The combination of pain, somatic suffering with feelings of resentment, fear, despair and helplessness due to the fact that the closest person is unfair and cruel can lead to mental disorders.

Forced sexual activity, depraved acts, seducing behavior of parents, stepfathers, and other relatives, as a rule, are combined with serious problems in family relationships. In this situation, the child finds himself defenseless against sexual abuse; his experiences of fear and resentment are aggravated by the inevitability of what is happening, the impunity of the offender and the conflicting feelings of the offended person towards him.

The ability of an event to cause distress is determined by the individual's perception of it. When assessing the difficulties experienced by the degree of adaptation or the level of distress, it turned out that the subjective and objective meaning of events for an adult and a child is different. For young children, even a temporary separation from their parents can be the most significant experience. Older children have a hard time experiencing their inability to satisfy their parents' expectations of high academic performance or exemplary behavior. In a teenager, the development of stress is often associated with rejection or rejection by the peer group to which he wants to belong.

The fact that not everyone exposed to stress gets sick is explained by the resilience of some individuals. At the same time, some people have increased sensitivity to stress.

Among the individual personality characteristics that contribute to the occurrence of diseases as a result of external influences, temperament stands out. Such aspects as a low threshold of sensitivity to stimuli, the intensity of reactions, difficulties in adapting to new impressions with a predominance of negative emotions, and others, make the child very sensitive to stress. At the same time, the child’s activity, rhythm of physiological functions, accessibility and good adaptability to new things, along with a prevailing even mood and low intensity of reactions to changes in the environment, prevent the development of diseases in the presence of potentially stressful events.

The predisposition to stress is also associated with the presence of a discrepancy between the demands of the environment and the individual’s ability to adequately respond to them. A stress reaction is understood as an imbalance in the relationship between the individual and the environment and as a manifestation of the discrepancy between his expectations and the possibilities for their implementation. However, the final result of this implementation depends on the activities of other people who can increase stress or reduce its pathogenic effect by supporting the experiencer. This explains, for example, why one child, finding himself in equally difficult conditions of an educational institution, successfully adapts, while another, without the support of parents or friends, cannot resolve his difficulties except through a neuropsychic disorder.

Among those who fall ill after suffering stress, those individuals predominate who are distinguished by great nihilism, a feeling of powerlessness, alienation, and lack of enterprise. The pathogenic effects of stressors are reduced by the presence of high self-esteem, an energetic position in relation to the environment, the ability to accept obligations, and confidence in the ability to control events. Activity increases the chance of a favorable outcome in dealing with stress, but refusal to look for a way out of the situation makes the body vulnerable to the occurrence of diseases.

Catastrophic events are often followed by a state of “refusal”, “surrender” in the person who experienced them, and less often - a premonition of this state. The individual reacts with an affect of helplessness or hopelessness, realizing his inability to act, to overcome the difficulties that have arisen without the help of others or sometimes even with help. Such people become preoccupied with the sad events they have experienced. They perceive these memories as if everything unpleasant from the past has returned, overwhelming them and threatening them. At this time it is difficult for them to imagine the future or try to look for ways out. They turn away from their surroundings and immerse themselves in their past experiences. This condition puts individuals at risk of disease and makes them extremely vulnerable.

The appearance of mental disorders is also associated with the content of the individual’s experiences. Such an experience may be actual, threatened, or imagined “object loss.” Moreover, by “object” we understand both animate beings and inanimate objects, which, due to his attachment, the individual cannot refuse. An example could be a short-term or - especially - long-term loss of contact with relatives or with usual activities (playing with peers).

Note the significance of a particular life situation and the corresponding cultural influence. Moreover, social development and technological revolution in recent years are changing all the norms in society. In this regard, tension arises between the individual and the environment, which is one of the main factors in the development of neuropsychiatric diseases.

During the action of a stressor on ligence, its primary assessment occurs, on the basis of which the threatening or favorable type of the situation created is determined. From this moment on, personal defense mechanisms (“co-control processes”) are formed, i.e., the means of an individual exercising control over situations that threaten or upset him. Coping processes, being part of the affective reaction, are aimed at reducing or eliminating the current stressor.

The result of the secondary assessment is one of three possible types of coping strategy:

1) direct active actions of an individual in order to reduce or eliminate danger (attack or flight);

2) mental form - repression (“this doesn’t concern me”), revaluation (“this is not that dangerous”), suppression, switching to another form of activity;

3) coping without affect, when a real threat to the individual is not expected (contact with means of transport, household appliances).

The third assessment arises in the process of changing judgment as a result of received feedback or one's own reactions. However, the origin of emotional reactions cannot be understood without taking into account physiological mechanisms. Mental and physiological processes should be considered in their mutual dependence.

PSYCHOLOGICAL DEFENSE AND BIOLOGICAL PROCESSES

Psychological protection is important to prevent disorganization of mental activity and behavior and thereby to create the individual’s resistance to the possible development of the disease. It arises in the form of interaction between conscious and unconscious psychological attitudes. If, as a result of mental trauma, it is impossible to implement a previously formed attitude in behavior, then the created pathogenic tension can be neutralized by creating another attitude, within which the contradictions between the initial desire and the obstacle are eliminated. An example would be coping with grief in a child who has lost his beloved dog. Due to the impossibility of returning the pet, you can console the child only by giving him another living creature, developing in him a new attitude towards caring for his newly made friend. Instead of the described transformation of a negatively influencing attitude, one may observe the substitution of an unrealizable attitude by some other one that does not encounter obstacles in its expression in action. It is with the collapse of psychological defense that favorable conditions are created for the pathogenic effects of psycho-emotional stress - the development of not only functional, but also organic disorders.

Biological processes that occur during the period of stress and have pathogenic significance arise the more easily, the more pronounced the hereditary predisposition to neuropsychic disorders. The special sensitivity of some people to emotional stress, explained by a general hereditary-constitutional weakness or a type of higher nervous activity, is currently specified by indicating the mechanism of vulnerability of the body - increased activity of the hypothalamic-pituitary-adrenal system, impaired transformation of blood monoproteins and immunological characteristics of the body. The absence of stimuli or their excessive flow, acting on the hypothalamus, disrupts the hypothalamic-cortical relationship and changes the individual’s reactivity to stress. The occurrence of physiological changes under the influence of stress depends on the level of emotional arousal, the quality and sign of emotions, the types of physiological responses of individuals and differences in responses in the same person at different times, as well as the state of the autonomic nervous system.

The stress-limiting systems existing in the individual’s body through the adrenergic and pituitary-adrenal systems create mechanisms that facilitate adaptation to the environment. These systems not only protect the body from direct damage, but also shape emotional behavior.

One of the mechanisms of resistance to emotional stress is the activation of the opioidergic system in the brain, which can eliminate negative emotional arousal. The accumulation of serotonin in the brain during adaptation to difficult situations also suppresses the stress response. Activation of the GABAergic system suppresses aggressiveness and regulates behavior.

SOMATIC CHANGES DURING STRESS

Stress, being an interaction between a person and the environment, is a complex process based on the integration of almost all parts of the brain. In this case, the brain plays a decisive role: the cerebral cortex, the limbic system, the reticular formation, the hypothalamus, as well as peripheral organs.

The stress response in response to a psychosocial stimulus begins with the perception of the stressor by receptors in the peripheral nervous system. Information is received by the cerebral cortex and reticular formation, and through it by the hypothalamus and limbic system. Each stimulus can reach a particular brain structure only through activation, which depends on the subjective significance of this stimulus and the situation preceding its impact, as well as on previous experience with similar stimuli. Thanks to this, events receive an emotional overtones. The received signals and their emotional accompaniment are analyzed in the cortex of the frontal and parietal lobes. Information accompanied by emotional evaluation from the cerebral cortex enters the limbic system. If a psychosocial stressor is interpreted as dangerous or unpleasant, intense emotional arousal may occur. When the satisfaction of biological, psychological or social needs is blocked, emotional stress occurs; it is expressed, in particular, by somatovegetative reactions. During the development of stress, excitation of the autonomic nervous system occurs. If a useful adaptive reaction is not formed in response to changes in the environment, then a conflict situation arises and emotional tension increases. An increase in excitation in the limbic system and hypothalamus, which regulates and coordinates the activity of the autonomic-endocrine system, leads to activation of the autonomic nervous system and endocrine organs. And this leads to an increase in blood pressure, increased heart rate, the release of hormones into the blood, etc. Thus, stress reactions to psychosocial difficulties are not so much a consequence of the latter as an integrative response to their cognitive assessment and emotional arousal.

The first somatic manifestations of stress arise due to the rapid reaction of the autonomic nervous system. After a psychosocial stimulus has been assessed as threatening, nervous stimulation passes to the somatic organs. Stimulation of autonomic centers leads to a short-term increase in the concentration of norepinephrine and acetylcholine at nerve endings, normalizing and activating the activity of organs (heart, blood vessels, lungs, etc.). To maintain stress activity for a longer period of time, the neuroendocrine mechanism is activated, which implements the stress response through adreno-cortical, somatotropic, thyroid and other hormones, as a result, for example, a rise in blood pressure, shortness of breath, palpitations, etc., persist for a long time.

The control center for the neuroendocrine mechanism is the septal-hypothalamic complex. From here the impulses are sent to the median eminence of the hypothalamus. Here hormones are released that enter the pituitary gland, the latter secretes adrenocorticotropic hormone, somatotropic hormone, which enter the adrenal cortex, as well as thyroid-stimulating hormone, which stimulates the thyroid gland. These factors stimulate the release of hormones that act on bodily organs. The pituitary gland, having received nerve signals from the hypothalamus, releases vasopressin, which affects kidney function and oxytocin, which, together with melanocyte-stimulating hormone, affects the processes of learning and memory. During the stress response, the pituitary gland also produces three gonadotropic hormones that affect the reproductive and mammary glands. Under stress, under the influence of an appropriate concentration of testosterone, sex-appropriate behavior is determined.

Thus, during periods of stress, thanks to the interaction of the cortex, limbic system, reticular formation and hypothalamus, the external demands of the environment and the internal state of the individual are integrated. Behavioral or somatic changes are the result of the interaction of these brain structures. If these structures are damaged, this leads to the impossibility or disorder of adaptation and disruption of relationships with the environment.

In a stress response, brain structures interact with each other and manifest themselves differently. When basic biological needs are at risk, the hypothalamus and limbic system play a major role. Difficulties in fulfilling social needs require the greatest activity of the cerebral cortex and limbic system.

PATHOGENICITY OF STRESS

A state of stress leads to increased interaction between the hypothalamus and the reticular formation, a deterioration in the connection between the cortex and subcortical structures. When the cortical-subcortical relationship is disrupted, both during acute and chronic stress, typical disorders of motor skills, sleep and wakefulness rhythm, disturbances of drives and mood occur.

Along with this, the activity of nerve transmitters is disrupted, and the sensitivity of neurons to transmitters and neuropeptides changes.

The pathogenicity of stress (the ability to cause somatic and neuropsychic disorders) depends on its intensity or duration, or both. The occurrence of a psychosomatic disease, neurosis or psychosis is explained by the fact that the individual tends to form similar psychophysiological reactions to various stressors.

Stress does not develop according to the “all or nothing” law, but has different levels of manifestation. It occurs as a compensatory process in relationships with the outside world, as somatic regulation. With a constant increase in the activity of functional systems, there may be wear and amortization.

M. Poppel, K. Hecht (1980) described three phases of tegeny of Chronigian stress.

inhibition phase - with an increase in the concentration of adrenaline in the blood, inhibition of protein synthesis in the brain, a decrease in learning ability and a strong inhibition of energy metabolism, which is interpreted as a decrease in protection from stressors.

The mobilization phase is an adaptive process with a strong increase in protein synthesis, an increase in blood supply to the brain and an expansion of the types of metabolism in the brain.

Premorbid phase - with the formation of energy, which is associated with dysregulation in many systems, with a limitation in the development of new conditioned reflexes, increased blood pressure, changes in blood sugar under the influence of insulin, elimination of the action of catecholamines, disruption of the sleep phase, rhythm of physiological functions and weight loss bodies.

The ways of implementing the stress reaction are different. The variety of stress reactions is associated with implementation through various “initial links” of the nervous system and further paths of distribution of stimuli.

Somatic stress (impact of physical or chemical factors) is carried out through subcortical structures (anterior tuberal region), from where corticotropin-releasing factor enters the anterior pituitary gland through the hypothalamus.

Psychological stress is realized through the cerebral cortex - limbic-caudal region of the subthalamic region - spinal cord - abdominal nerves - adrenal medulla - adrenaline - neurogi-pophysis - ACTH - adrenal cortex.

Stress can be a mechanism for the development of neurotic, mental and psychosomatic (cardiovascular, endocrine and other disorders, joint diseases, metabolic disorders). The basis for the development of the disease under prolonged stress is the prolonged influence of hormones involved in the formation of the stress response and causing disturbances in the metabolism of lipids, carbohydrates, and electrolytes.

Short-term acute exposure to stress leads to increased adaptive abilities. However, if the prepared “fight-flight” reaction (fighting difficulties) is not carried out, then stress has a negative effect on the body and can cause an acute affective reaction.

SOMATIC ETIOLOGICAL FACTORS

Physical illnesses, injuries, poisonings cause neuropsychic disorders. However, traditionally, the study of somatogenic neuropsychic disorders, i.e. those associated with physical damage and illness, in children, as in adults, was carried out in psychiatric clinics. In this regard, the analysis was carried out, as a rule, on severe mental disorders with a protracted or periodic course. It seemed that the only reason for their occurrence was physical hazards affecting the human body. It was believed that the clinical manifestations of mental illnesses could depend only on the severity, pace and strength of their impact. Cases of short-term disorders that did not require hospitalization in a psychiatric hospital were described much less frequently. Recently, pronounced and especially severe forms of somatogenic mental disorders in children have become rare. At the same time, cases of mild forms of psychosis, neurosis-like (clinical manifestations similar to neuroses), and endoform (resembling endogenous diseases) disorders have become more frequent. The need to prevent and treat mental disorders and associated complications required the study of this fairly common somatogenic psychopathology observed outside psychiatric hospitals.

In patients who applied to a children's clinic or were treated in children's somatic hospitals and sanatoriums, the entire spectrum of neuropsychic symptoms was identified: from initial manifestations to severe psychoses. To understand the origin and characteristics of their symptoms, they studied hereditary burden, biological hazards, premorbid state (mental and somatic health before the disease), personality changes during the course of the disease and its reaction to the mental somatic state, the influence of micro- and macrosocial conditions.

As a result of studying these shallow mental disorders, it was found that the symptoms of neuropsychic disorders in the vast majority of cases are combined with personal reactions to both somatic and mental illness. These reactions depend on the personality of the child or adolescent, his age, gender, and the more clearly expressed, the less severe the psychopathological symptoms.

In order to gain a deeper understanding of personal response, an analysis of the internal picture of the disease (IPI) was carried out. Special methodological techniques made it possible to assess the role of the intellectual level of children, knowledge about health and illness, the experience of suffering, the prevailing emotional attitudes of parents to the child’s illness and the patient’s perception of it in the formation of ICD.

Bearing in mind the complexity of the pathogenesis (mechanism of development) of neuropsychiatric diseases, it is still necessary to separately consider the characteristics of the factors acting on the body and causing mental disorders. These “somatogenic” factors include exogenous (external) factors: somatic and general infectious diseases, brain infectious diseases, intoxication (poisoning), traumatic brain damage. It is assumed that exogenous (for example, somatogenic) disorders arise due to external causes, and endogenous (for example, schizophrenia) - due to the deployment of internal mechanisms and the implementation of hereditary predisposition. In fact, between “pure” endogenous and exogenous disorders there are transitions from those in which there is a very pronounced genetic predisposition, easily provoked by a minor external influence, to those in which no noticeable predisposition can be noted, and the etiological factor turns out to be a powerful external harmfulness.

The prevalence of exogenous hazards can be judged from the data of V.I. Gorokhov (1982). Among the patients he observed who fell ill in childhood, 10% were exogenous organic diseases. The cause in 24% of cases was head injuries, in 11% - meningitis, encephalitis, in 8% - somatic and infectious diseases. However, most often - in 45% of cases - combinations of the listed factors were found, which confirms the predominance in real life of the complex effect of various harmful effects on the body and psyche.

Among the etiological factors of infectious psychoses, we note, for example, diseases such as influenza, measles, scarlet fever, hepatitis, tonsillitis, chickenpox, otitis media, rubella, herpes, polio, whooping cough. Neuroinfections (infectious diseases of the brain) cause mental disorders during the development of meningitis, encephalitis (meningococcal, tuberculosis, tick-borne, etc.), rabies. It is also possible that complications (secondary encephalitis) may occur with influenza, pneumonia, measles, dysentery, chicken pox and after vaccinations. Rheumatism and lupus erythematosus can also lead to acute and chronic mental disorders. Diseases of the kidneys, liver, endocrine glands, blood, and heart defects can be complicated by neuropsychic disorders. Mental disorders can be caused by poisoning with tricyclic antidepressants, barbiturates, anticholinergic drugs, hormonal drugs, as well as gasoline, solvents, alcohol and other chemicals. The cause of mental disorders may be traumatic brain damage (concussions, bruises and, less commonly, open head injuries).

It is very difficult to associate the occurrence of the disorders discussed with one single cause. “It is impossible to single out one main factor, much less the only one, and reduce the etiology of the phenomenon to it” [Davydovsky I.V., 1962]. The complex of exogenous hazards that cause mental disorders is usually preceded by factors that weaken the body, reducing its reactivity, i.e., the ability to protect itself from the disease. These include features of the child’s somatic development, immune reactivity, as well as increased vulnerability of some parts of the brain, endocrine-vegetative, cardiovascular disorders that are involved in resistance to harmful influences. In weakening the body's defenses, inflammatory or traumatic brain damage, repeated somatic diseases, severe moral shock, physical stress, intoxication, and surgical operations can also play a role.

The characteristics of the impact of an exogenous “causal factor” are determined by its strength, rate of impact, quality and characteristics of the interaction of predisposing and producing causes.

Let's consider the impact of exogenous factors using the example of infections. According to B. Ya. Pervomaisky (1977), three types of interaction between the body and infection can occur. In the first of them, due to the great severity (virulence) of the infection and the high reactivity of the body, as a rule, there are no conditions for the occurrence of mental disorders. With a prolonged infectious disease (type two), the possibility of developing mental disorders will depend on additional (debilitating) factors. In this case, the right diet and treatment are decisive. The third type is characterized by both low reactivity of the body and insufficiency of the thermoregulatory system. The protective inhibition that occurs in the brain plays the role of protecting the body, and the mental disorders in which it manifests itself play a positive role.

To understand the pathogenesis of exogenous neuropsychiatric disorders, it is necessary to take into account the importance of developing a lack of oxygen supply to the brain, allergies, disorders of cerebral metabolism, water and electrolyte balance, the acid-base composition of the cerebrospinal fluid and blood, increased permeability of the barrier that protects the brain, vascular changes, edema brain, destruction in nerve cells.

Acute psychoses with clouding of consciousness occur under the influence of intense, but short-lived harmful effects, while protracted psychoses, which are close in clinical manifestations to endogenous ones, develop under the long-term influence of harmful effects of weaker intensity [Tiganov A. S., 1978].

HEREDITARY FACTORS UNDERLYING THE APPEARANCE OF SOME DISEASES OR DEVELOPMENTAL DISORDERS

Hereditary causes are involved in the origin of a number of diseases and mental development disorders. In diseases of genetic origin, genes produce abnormal enzymes, proteins, intracellular formations, etc., due to which the body's metabolism is disrupted and, as a result, one or another mental disorder may occur. The mere presence of deviations in the hereditary information transmitted by parents to children is usually not enough for the occurrence of a disease or developmental disorder. The risk of developing a disease associated with a hereditary predisposition, as a rule, depends on unfavorable social influences that can “trigger” the predisposing factor, realizing its pathogenic effect. Knowledge of this fact by special psychologists and teachers will allow them, for example, to better assess the likelihood of mental disorders in children who have parents suffering from mental disorders or mental retardation. Creating favorable living conditions for such children can either prevent or mitigate the clinical manifestations of mental disorders.

Here are some hereditary syndromes of mental disorders that develop under certain chromosomal or genetic, and sometimes under conditions unknown to us.

Fragile X syndrome (Martin-Bell syndrome). With this syndrome, one of the long branches of the X chromosome narrows towards the end, there is a gap and separate fragments on it, or small protrusions are found. All this is revealed by culturing cells with specific supplements that lack folate. The frequency of the syndrome among mentally retarded people is 1.9-5.9%, among mentally retarded boys - 8-10%. One third of heterozygous female carriers also have an intellectual defect. 7% of mentally retarded girls have a fragile X chromosome. The frequency of this disease in the entire population is 0.01% (1:1000).

Klinefelter's syndrome (XXY). In this syndrome, males have an additional X chromosome. The frequency of the syndrome is 1 in 850 male newborns and 1-2.5% in patients with mild mental retardation. In this syndrome, there may be several X chromosomes, and the more there are, the deeper the mental retardation. A combination of Klinefelter syndrome and the presence of a fragile X chromosome in the patient has been described.

Shereshevsky-Turner syndrome (monosomy X). The condition is determined by a single X chromosome. This syndrome occurs in 1 in 2,200 girls born. Among the mentally retarded, 1 in 1,500 are female.

Trisomy 21 syndrome (Down syndrome). This syndrome is the most common chromosomal pathology in humans. It has an extra 21st chromosome. The frequency among newborns is 1:650, in the population - 1:4000. Among patients with mental retardation, this is the most common form, accounting for about 10%.

Phenylketonuria. The syndrome is associated with a hereditary, genetically transmitted deficiency of the enzyme that controls the transition of phenylalanine to tyrosine. Phenylalanine accumulates in the blood and causes mental retardation in 1 in 10,000 newborns. In the population, the number of patients is 1: 5000-6000. Patients with phenylketonuria make up 5.7% of mentally retarded people who seek help from genetic counseling.

Syndrome *elf face* is a hereditary genetically transmitted hypercalcemia. In the population, it occurs with a frequency of 1:25,000, and at a genetic consultation appointment it is the most common form after Down's disease and phenylketonuria (almost 1% of children attending).

Tuberous sclerosis. This is a hereditary systemic (tumor-like lesion of the skin and nervous system) disease associated with a mutant gene. In the population, this syndrome occurs with a frequency of 1:20,000. At a genetic consultation, such patients make up 1% of all patients attending. Often found in severely mentally retarded patients.

Alcoholic encephalopathy. Fetal alcohol syndrome, caused by parental alcoholism, accounts for 8% of all cases of mental retardation. Alcohol abuse and smoking during pregnancy increases the incidence of intrauterine and perinatal deaths, prematurity, birth asphyxia, and increases the morbidity and mortality of children in the early years of life. Alcohol has an intense effect on cell membranes, on the processes of cell division and DNA synthesis of nerve cells. In the first weeks after conception, it leads to gross malformations of the central nervous system and mental retardation. After the 10th week of pregnancy, alcohol causes cellular disorganization and disrupts further development of the central nervous system.

Later, alcohol disrupts the fetal brain metabolism and neurogenic effects on the endocrine system, which causes endocrine disorders, in particular growth disorders. The severity of the syndrome depends on the severity of maternal alcoholism and the period of exposure to alcohol on the fetus.

Neuroses – psychogenic diseases, which are based on disorders of higher nervous activity, clinically manifested by affective non-psychotic disorders (fear, anxiety, depression, mood swings, etc.), somato-vegetative and movement disorders, experienced as alien, painful manifestations and tending to reverse development and compensation .

Etiology. In the etiology of neuroses as psychogenic diseases, the main causal role belongs to a variety of psychotraumatic factors: acute shock mental effects, accompanied by severe fear, subacute and chronic psychotraumatic situations (divorce of parents, conflicts in the family, school, situations associated with drunkenness of parents, school failure, etc.). etc.), emotional deprivation (i.e. lack of positive emotional influences - love, affection, encouragement, encouragement, etc.). Along with this, internal and external factors are important in the etiology of neuroses. Internal factors: Personality characteristics associated with mental infantilism (increased anxiety, fearfulness, tendency to fear). Neuropathic conditions, i.e. a complex of manifestations of vegetative and emotional instability. Changes in age-related reactivity of the nervous system during transitional (crisis) periods, i.e. at the age of 2-4 years, 6-8 years and during puberty.

External factors: Wrong upbringing. Unfavorable microsocial and living conditions. Difficulties in school adaptation, etc.

Pathogenesis. The actual pathogenesis of neuroses is preceded by the stage of psychogenesis, during which the individual psychologically processes traumatic experiences infected with negative affect (fear, anxiety, resentment, etc.). An important place in the pathogenesis of neuroses belongs to biochemical changes.

Systemic neuroses in In children, common neuroses are somewhat more common. Neurotic stuttering- P sygenically caused disturbance of the rhythm, tempo and fluency of speech associated with muscle spasms that are involved in the speech act. More often in boys than in girls. Develops during the period of speech formation (2-3 years) or at the age of 4-5 years (phrasal speech and inner speech). The causes are acute and chronic mental trauma. Neurotic tics - automated habitual movements (blinking, wrinkling of the skin of the forehead, wings of the nose, licking lips, twitching of the head, shoulders, various movements of the limbs, torso), as well as “coughing”, “grunting”, “grunting” sounds (respiratory tics) that arise in as a result of fixing one or another defensive movement, it is initially appropriate. NT (including obsessive ones) are found in boys in 4.5% and in girls in 2.6% of cases. NT is most common between the ages of 5 and 12 years. Manifestations of NT: tic movements predominate in the muscles of the face, neck, shoulder girdle, and respiratory tics. Neurotic sleep disorders. They are very common in children and adolescents. Reason: various psychotraumatic factors, especially in the evening hours. LDS clinic: sleep disorders, restless sleep, sleep depth disorder, night terrors, sleepwalking and sleep-talking. Neurotic appetite disorders (anorexia).N Eurotic disorders, characterized by various eating disorders due to a primary decrease in appetite. Observed in early and preschool age. Clinic: the child has no desire to eat any food or pronounced selectivity to food with refusal of many common foods, a slow process of eating with long chewing of food, frequent regurgitation and vomiting during meals. Low mood is observed during meals. Neurotic enuresis - unconscious loss of urine, mainly during night sleep. Etiology: psychotraumatic factors, neurotic states, anxiety, family burden. The clinic is characterized by a pronounced dependence on the situation. NE becomes more frequent during exacerbation of a traumatic situation, after physical punishment, etc. already at the end of preschool and beginning of school age, the experience of lack, low self-esteem, and anxious anticipation of another loss of urine appear. Neurotic encopresis - involuntary release of small amounts of feces in the absence of spinal cord lesions, as well as anomalies and other diseases of the lower intestine. Enuresis occurs 10 times less frequently in boys aged 7 to 9 years. Etiology: prolonged emotional deprivation, strict demands on the child, intrafamily conflict. The pathogenesis has not been studied. Clinic: violation of the skill of neatness in the form of the appearance of a small amount of bowel movements in the absence of the urge to defecate. It is often accompanied by low mood, irritability, tearfulness, and neurotic enuresis. Pathological habitual actions - fixation of voluntary actions in young children. Finger sucking, genital manipulation, head and body rocking before sleep in children of the first 2 years of life.

General neuroses. Neuroses of fear. The main manifestations are objective fears associated with the content of a traumatic situation. Characterized by paroxysmal occurrence of fears, especially when falling asleep. Attacks of fear last 10-30 minutes, are accompanied by severe anxiety, often hallucinations and illusions. The content of fears depends on age. Children of preschool and preschool age are dominated by fears of the dark, loneliness, animals that frighten the child, characters from fairy tales, or those invented by parents for “educational” purposes (“black guy”, etc.). In children of primary school age, a variant of fear neurosis is observed, called “school neurosis.” Children who were raised at home before school are prone to the occurrence of “school neurosis.” The course of fear neuroses can be short-term or protracted (from several months to 2-3 years). Obsessive-compulsive neurosis. The predominance of obsessive phenomena that arise relentlessly against the wishes of the patient, who, aware of their unreasonably painful nature, unsuccessfully strives to overcome them. The main types of obsessions in children are obsessive movements and actions (obsessions) and obsessive fears (phobias). Depending on the predominance of one or the other, neurosis of obsessive actions (obsessive neurosis) and neurosis of obsessive fears (phobic neurosis) are conventionally distinguished. Mixed obsessions are common. Obsessive neurosis is expressed by obsessive movements. In phobic neurosis, obsessive fears predominate. Obsessive-compulsive neurosis tends to recur. Depressive neurosis. Depressive mood shift. In the etiology of neurosis, the main role belongs to situations associated with illness, death, divorce of parents, long-term separation from them, orphanhood, and the experience of one’s own inferiority due to a physical or mental defect. Typical manifestations of depressive neurosis are observed during puberty and prepuberty. Characterized by somatovegetative disorders, loss of appetite, weight loss, constipation, insomnia. Hysterical neurosis. A psychogenic disease characterized by various (somatovegetative, motor, sensory, affective) disorders of a neurotic level. In the etiology of hysterical neurosis, an important contributing role belongs to hysterical personality traits (demonstrativeness, “thirst for recognition,” egocentrism), as well as mental infantilism. In the clinic of hysterical disorders in children, the leading place is occupied by motor and somatovegetative disorders: astasia-abasia, hysterical paresis and paralysis of the limbs, hysterical aphonia, as well as hysterical vomiting, urinary retention, headaches, fainting, pseudoalgic phenomena (i.e. complaints of pain in certain parts of the body) in the absence of organic pathology of the corresponding systems and organs, as well as in the absence of objective signs of pain. Neurasthenia (asthenic neurosis). The occurrence of neurasthenia in children and adolescents is facilitated by somatic weakness and overload with various additional activities. Neurasthenia in a pronounced form occurs only in school-age children and adolescents. The main manifestations of neurosis are increased irritability, lack of restraint, anger and, at the same time, exhaustion of affect, an easy transition to crying, fatigue, poor tolerance of any mental stress. Vegetative-vascular dystonia, decreased appetite, and sleep disorders are observed. In younger children, motor disinhibition, restlessness, and a tendency to unnecessary movements are noted. Hypochondriacal neurosis. Neurotic disorders, the structure of which is dominated by excessive concern for one’s health and a tendency to unfounded fears about the possibility of the occurrence of a particular disease. Occurs mainly in teenagers. Prevention of neuroses in children and adolescents First of all, it is based on psychohygienic measures aimed at normalizing intrafamily relationships and correcting improper upbringing. Considering the important role of the child’s character traits in the etiology of neuroses, educational measures for the mental hardening of children with inhibited and anxious-suspicious character traits, as well as with neuropathic conditions, are advisable. Such activities include the formation of activity, initiative, learning to overcome difficulties, de-actualization of frightening circumstances (darkness, separation from parents, meeting strangers, animals, etc.). An important role is played by education in a team with a certain individualization of the approach, the selection of comrades of a certain character. A certain preventive role also belongs to measures to strengthen physical health, primarily physical education and sports. A significant role belongs to the mental hygiene of schoolchildren and the prevention of their intellectual and information overload.

The etiology and pathogenesis of neurotic disorders are determined by the following factors.

Genetic are primarily constitutional features of the psychological tendency to neurotic reactions and features of the autonomic nervous system.

Factors influencing in childhood. Research conducted in this area has not proven an unambiguous effect, however, neurotic traits and the presence of neurotic syndromes in childhood indicate an insufficiently stable psyche and a delay in maturation. Psychoanalytic theories pay particular attention to the influence of early childhood psychotrauma on the formation of neurotic disorders.

Personality. Childhood factors can shape personal characteristics, which subsequently become the basis for the development of neuroses. In general, the significance of personality in each case is inversely proportional to the severity of stressful events at the time of the onset of neurosis. Thus, in a normal personality, neurosis develops only after serious stressful events, for example, wartime neuroses.

Predisposing personality traits are of two types: a general tendency to develop neurosis and a specific predisposition to develop a certain type of neurosis.

Neurosis as a learning disorder. There are two types of theories presented here. Proponents of the first type of theory recognize some of the etiological mechanisms proposed by Freud and try to explain them in terms of learning mechanisms. Thus, repression is interpreted as the equivalent of learning to avoid; emotional conflict is equated to an approach-avoidance conflict, and displacement is equated to associative learning. Theories of the second type reject Freud's ideas and try to explain neurosis based on concepts borrowed from experimental psychology. In this case, anxiety is considered as a stimulating state (impulse), while other symptoms are considered a manifestation of learned behavior, which is reinforced by the decrease in the intensity of this impulse that they cause.

Environmental factors (living conditions, working conditions, unemployment, etc.). Unfavorable environment; at any age, there is a clear relationship between psychological health and indicators of social disadvantage, such as low-prestige occupation, unemployment, poor home environment, overcrowding, limited access to benefits such as transport. It is likely that an unfavorable social environment increases the degree of distress, but is unlikely to be an etiological factor in the development of more severe disorders. Adverse life events (one of the reasons is the lack of protective factors in the social environment, as well as unfavorable factors within the family).

All these factors were summed up quite clearly in the theory of the “barrier of mental resistance” (Yu.A. Aleksandrovsky) and the development of a neurotic disorder in cases where this barrier is insufficient to counteract psychotrauma. This barrier, as it were, absorbs all the features of a person’s mental makeup and response capabilities. Although it is based on two (divided only schematically) foundations - biological and social, it is essentially their single integrated functional-dynamic expression.

Morphological basis of neuroses. The dominant ideas about neuroses as functional psychogenic diseases, in which there are no morphological changes in the brain structures, have undergone significant revision in recent years. At the submicroscopic level, cerebral changes accompanying changes in IRR in neuroses have been identified: disintegration and destruction of the membrane spiny apparatus, a decrease in the number of ribosomes, expansion of the cisterns of the endoplasmic reticulum. Degeneration of individual cells of the hippocampus has been noted in experimental neuroses. Common manifestations of adaptation processes in brain neurons are considered to be an increase in the mass of the nuclear apparatus, mitochondrial hyperplasia, an increase in the number of ribosomes, and membrane hyperplasia. The indicators of lipid peroxidation (LPO) in biological membranes change.

Etiology of neurotic and somatoform disorders

Psychodynamic and cognitive-behavioral theories of personality and the origin of neuroses are currently most widespread.

According to the first [Freud A., 1936; Myasishchev V.N., 1961; Zakharov A.I., 1982; Freud 3., 1990; Eidemiller E.G., 1994], neurotic disorders are a consequence of unresolved neurotic conflict, both intra- and interpersonal. Conflict of needs creates emotional tension accompanied by anxiety. Needs that are linked to each other for a long time in conflict do not have the opportunity to be satisfied, but persist for a long time in the intrapersonal space. Persistence of conflicts requires a large amount of energy, which, instead of being aimed at the development of the personality/organism, is spent on its energetic maintenance. That is why asthenia is a universal symptom for all forms of neuroses in children, adolescents and adults.

An outstanding contribution to understanding the nature of neuroses within the framework of the psychodynamic paradigm was made by V. N. Myasishchev (1961), who is a major figure who predetermined the development of “pathogenetic psychotherapy” (person-oriented, reconstructive psychotherapy of B. D. Karvasarsky,

G. L. Isurina and V. A. Tashlykov) and family psychotherapy in the USSR.

In modern psychoneurology, a prominent place has been occupied by the theory of multifactorial etiology of neurotic and somatoform disorders, in which the psychological factor plays a leading role.

To the greatest extent, the content of the psychological factor is revealed in the pathogenetic concept of neuroses and the “psychology of relationships” developed by V. N. Myasishchev, according to which the psychological core of the personality is an individually holistic and organized system of subjective-evaluative, active, conscious, selective relationships with the environment. Nowadays it is widely believed that relationships can also be unconscious (unconscious).

V. N. Myasishchev saw in neurosis a deep personality disorder due to violations of the system of personality relationships. At the same time, he considered “attitude” as the central system-forming factor among many mental properties. “The source of neurosis, both physiologically and psychologically,” he believed, “are difficulties or disturbances in a person’s relationships with other people, with social reality and with the tasks that this reality sets for him” [Myasishchev V.N., 1960].

What place does the concept of “relationship psychology” have in history? This concept developed in a totalitarian society. V. N. Myasishchev, having inherited the scientific methodological potential of his teachers - V. M. Bekhterev, A. F. Lazursky and his colleague M. Ya. Basov, turned to what was alive in the philosophy of K. Marx - to the thesis of K. Marx that “the essence of man is the totality of social relations.” According to L. M. Wasserman and V. A. Zhuravl (1994), this circumstance helped V. N. Myasishchev to return into scientific use the theoretical constructs of A. F. Lazursky and the famous Russian philosopher S. L. Frank about the relationship of the individual to himself and to the environment.

If the concept of “relationship” for I. F. Garbart, G. Gefting and V. Wundt meant “connection”, dependence between parts within the whole - “psyche”, then for V. M. Bekhterev the concept of “relationship” (“correlation”) meant not so much integrity as activity, that is, the ability of the psyche not only to reflect the environment, but also to transform it.

For A.F. Lazursky, the concept of “attitude” had three meanings:

1) at the level of the endopsyche - the mutual connection of the essential units of the psyche;

2) at the level of the exopsyche - phenomena that appear as a result of the interaction of the psyche and the environment;

3) interaction of endo- and exopsychics.

M. Ya. Basov, until recently almost unknown to a wide circle of the psychiatric community, a student of V. M. Bekhterev and a colleague of V. N. Myasishchev, sought to create a “new psychology” based on the approach that was later called the systemic one. He considered “the division of the single real process of life into two incompatible halves - physical and mental - one of the most amazing and fatal illusions of humanity.” The relationship between the organism/person and the environment is reciprocal, with the environment representing an objective reality in its relation to the organism/person.

Schematically it may look like this (Fig. 19).

Rice. 19. Relationships between the organism and the environment.

O - possibilities of the object in the role of mother

C - possibilities of the object in the role of son

O1 - new capabilities of the object in the role of mother

C1 - new capabilities of the object in the role of son

In his teaching, V.N. Myasishchev not only integrated the ideas of V.M. Bekhterev, A.F. Lazursky and M.Ya. Basov, but also put forward his own. He identified the levels (sides) of relationships that are formed in ontogenesis:

1) to other persons in the direction from the formation of an attitude towards the neighbor (mother, father) to the formation of an attitude towards the distant;

2) to the world of objects and phenomena;

A person’s attitude towards himself, according to B. G. Ananyev (1968, 1980), is the most recent formation, but it is precisely this that ensures the integrity of the system of personal relationships. The relationships of the individual, united among themselves through the attitude towards oneself, form a hierarchical system that plays a guiding role, determining the social functioning of a person.

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Neurotic personality disorders in children and adults

Neurotic personality disorders (neuroses, psychoneuroses) are diseases of the central nervous system, classified as a special group. They disrupt the normal activity of only selective areas of the human psyche and do not cause serious deviations in personal behavior, but can significantly worsen the patient’s quality of life.

Statistics show a constant increase in the disease over the past 20 years. Scientists attribute this to a greater acceleration of the rhythm of life and a manifold increase in the information load. Women are more susceptible to developing neurotic disorders: they are diagnosed with such disorders twice as often as the male population (7.6% of men and 16.7% of women per 1000 people). With timely access to specialists, most neurotic disorders can be successfully cured.

Neurotic disorders in clinical practice refer to a large group of functional reversible mental disorders that occur predominantly in a protracted manner. Clinical manifestations of neuroses are obsessive, asthenic and hysterical states of patients, accompanied by a reversible decrease in performance, both mental and physical. Psychiatry studies and treats neuroses. In the history of pathology research, various scientists believed that its development was caused by completely different reasons.

The world-famous Russian neurophysiologist I.P. Pavlov defined neurosis as a chronic disorder of higher nervous activity, developing as a result of extremely intense nervous tension in areas of the cerebral cortex. This scientist considered the main provoking factor to be excessively strong or prolonged external influences. The no less famous psychiatrist S. Freud believed that the main reason was the internal conflict of the individual, consisting in the suppression of the drives of the instinctive “Id” by morality and generally accepted norms of the “Super-ego”. Psychoanalyst K. Harney based neurotic changes on the contradiction of internal methods of defense (based on the movement of the individual “toward people,” “against people,” “from people”) from unfavorable social factors.

The modern scientific community agrees that neurotic disorders have two main directions of occurrence:

1. Psychological - includes the individual characteristics of a person, the conditions of his upbringing and development as a person, the development of his relationships with the social environment, the level of ambition.

2. Biological - associated with the functional deficiency of certain parts of the neurotransmitter or neurophysiological system, which significantly reduces psychological resistance to negative psychogenic influences.

The provoking factor for the onset of the development of any form of disease is always external or internal conflicts, life circumstances that cause deep psychological trauma, prolonged stress or critical emotional and intellectual overstrain.

According to the type of manifestation and symptoms, according to ICD-10 (International Classification of Diseases), neurotic disorders are divided into the following groups:

F40. Phobic anxiety disorders: This includes agoraphobia, all social phobias, and other similar disorders.

F41. Panic disorders (panic attacks).

F42. Obsessions, thoughts and rituals.

F43. Reactions to severe stress and adaptation disorders.

F44. Dissociative disorders.

F45. Somatoform disorders.

F48. Other neurotic disorders.

It should be noted why neurotic disorders are classified as a separate group of mental pathologies. Unlike other psychiatric diseases, neuroses are characterized by: the reversibility of the process and the possibility of complete recovery, the absence of dementia and increasing personality changes, the painful nature of the pathological manifestations for the patient, the preservation of the patient’s critical attitude towards his condition, the prevalence of psychogenic factors as the cause of the disease.

Symptoms characteristic of neuroses in general can be divided into two groups. So, physically this state manifests itself as follows:

the person feels dizzy;

he lacks air;

he shudders or, conversely, gets hot;

there is a rapid heartbeat;

the patient's hands are shaking;

he breaks into a sweat;

there is a feeling of nausea.

Psychological symptoms of neurosis are as follows:

anxiety;

anxiety;

tension;

a feeling of unreality of what is happening;

memory impairment;

fatigue;

sleep disturbance;

difficulty concentrating;

fears;

feeling nervous;

stiffness.

Anxiety disorders in neurotic conditions are one of the most commonly diagnosed forms of neurotic changes. In turn, they are divided into three types:

1. Agoraphobia - manifested by fear of a place or situation from which it is impossible to leave unnoticed or immediately get help when immersed in an extremely anxious state. Patients susceptible to such phobias are forced to avoid encounters with specific provoking factors: large open city spaces (squares, avenues), crowded places (shopping centers, train stations, concert and lecture halls, public transport, etc.). The intensity of the pathology varies greatly, and the patient may lead an almost normal life, or may not even be able to leave the house.

2. Social phobia - anxiety and fear are caused by fear of public humiliation, demonstration of one’s weakness, and failure to meet other people’s expectations. The disorder manifests itself in the inability to express one’s opinion to a large number of listeners, as well as to use public baths, swimming pools, beaches, and gyms for fear of being ridiculed.

3. Simple phobias are the most extensive and diverse type of disorder, since any specific objects or situations can cause pathological fear: natural phenomena, representatives of the animal and plant world, substances, conditions, diseases, objects, people, actions, the body and its parts, colors , numbers, specific places, etc.

Phobic disorders manifest themselves with a number of symptoms:

• strong fear of the object of the phobia;
• avoidance of such an object;
• anxiety in anticipation of meeting him;
• increased sweating;
• increased heart rate and breathing;
• dizziness;
• chills or fever;
• difficulty breathing, lack of air;
• nausea;
• loss of consciousness or faintness;
• numbness.

Patients with this type of disorder experience recurrent attacks of extreme anxiety—called panic attacks. They manifest themselves in the patient’s complete loss of self-control and an attack of severe panic. A characteristic feature of the pathology is the absence of a specific cause of the attack (a specific situation, object), suddenness for others and the patient himself. Attacks can be rare (several times a year) or frequent (several times a month), their duration varies from 1-5 minutes to 30 minutes. In severe cases, frequently recurring attacks lead to self-isolation and social isolation of patients.

This neurotic condition is usually diagnosed in childhood and adolescence, in women - 2-3 times more often than in men. With timely and adequate complex therapy, in most cases, complete recovery occurs. In the absence of treatment, the disease takes a protracted course.

The following symptoms are typical for panic disorder:

• uncontrollable fear;
• dyspnea;
• tremor;
• sweating;
• fainting;
• tachycardia.



Obsessive-compulsive disorders, or obsessive-compulsive disorders, are characterized by the patient's periodic intrusive, frightening thoughts or ideas (obsessions) and/or repeated, also intrusive, seemingly aimless and tiresome actions in an attempt to get rid of the obsessive thought (compulsions). The disease is more often diagnosed in adolescence and young adulthood. Compulsions often take the form of a ritual. There are four main types of compulsions:

• 1. Cleansing (expressed mainly in washing hands and wiping surrounding objects).
• 2. Prevention of potential danger (multiple checks of electrical appliances, locks).
• 3. Actions in relation to clothes (a special sequence of dressing, endless tugging, smoothing clothes, checking buttons, zippers).
• 4. Repetition of words, counting (often listing objects out loud).

Performing one’s own rituals is always associated with the patient’s internal feeling of incompleteness of any action. In normal everyday life, this manifests itself in the constant double-checking of documents drawn up with one’s own hand, the desire to constantly refresh makeup, repeatedly arranging things in the closet, etc. In adolescents, a combination of checking and cleansing is often observed, manifested in compulsive touching of the face and hair.

This group includes disorders that are identified on the basis not only of characteristic symptoms, but also of an obvious cause: an extremely unfavorable and negative event in the patient's life that caused an extreme stress reaction. Exist:

• 1. Acute stress reaction - a quickly passing disorder (several hours or days) that occurs in response to an unusually strong physical or mental stimulus. Symptoms include: a state of “stunning”, disorientation, narrowing of consciousness and attention.
• 2. Post-traumatic stress disorder - is a delayed or prolonged response to a stress factor of exceptional strength (various disasters). Symptoms include: repeated intrusive memories of the traumatic episode in thoughts or nightmares, emotional inhibition, sleep disturbances (insomnia), alienation, hypervigilance, overarousal, depression, suicidal thoughts.
• 3. Disorder of adaptive reactions - characterized by a state of subjective distress that occurs during the adaptation period after exposure to a stress factor or significant changes in the patient’s life (loss of a loved one or separation from him, forced migration to an alien cultural environment, enrollment in school, retirement, etc. .d.). This type of disorder creates difficulties for normal social life and natural actions, and is characterized by the following manifestations: depression, wariness, feelings of helplessness and hopelessness, depression, culture shock, hospitalism in children in the context of deviant development (lack of communication of the child in the first year of life with adults ).

Dissociative (conversion) disorders are changes or disturbances in the functioning of basic mental functions: consciousness, memory, sense of personal identity and impaired control over the movements of one’s own body. The etiology of its occurrence is recognized as psychogenic, since the onset of the disorder coincides in time with a traumatic situation. Divided into the following forms:

• 1. Dissociative amnesia. A characteristic feature is partial or selective memory loss, aimed specifically at traumatic or stress-related events.
• 2. Dissociative fugue - manifested by the patient’s sudden move to an unfamiliar place with a complete loss of personal information down to the name, but with the preservation of universal knowledge (languages, cooking, etc.).
• 3. Dissociative stupor. Symptoms: reduction or complete disappearance of voluntary movements and normal reactions to external stimuli (light, noise, touch) in the absence of physical pathology.
• 4. Trance and obsession. It is characterized by an involuntary temporary loss of personality and a lack of awareness of the surrounding world in the patient.
• 5. Dissociative movement disorders. They manifest themselves in the form of complete or partial loss of the ability to move limbs, up to a seizure or paralysis.

A distinctive feature of this type of disorder is the patient’s repeated complaints about somatic (bodily) symptoms in the absence of somatic diseases and persistent demands for repeated examinations. A similar clinical picture is observed in neurosis-like conditions. Highlight:

• somatization disorder - patient complaints of numerous, frequently changing physical symptoms in any organ or system, repeating for at least two years;
• hypochondriacal disorder - the patient is constantly concerned about the possible presence of a serious illness or its appearance in the future; at the same time, normal physiological processes and sensations are perceived by him as unnatural, disturbing signs of a progressive disease;
• Somatoform dysfunction of the autonomic nervous system manifests itself in two types of symptoms characteristic of ordinary ANS dysfunction: the first contains objective patient complaints of sweating, tremors, redness, palpitations, the second includes subjective complaints of a non-specific nature of pain throughout the body, feelings of fever, bloating ;
• persistent somatoform pain disorder - characterized by persistent, sharp, sometimes excruciating pain in the patient, arising under the influence of a psychogenic factor and not confirmed by a diagnosed physical disorder.

There are many methods for treating neurotic disorders. Therapeutic measures depend on the form and severity of the disease and always involve an integrated approach, including the following techniques and methods:

1. 1. Psychotherapy is the main method in the treatment of neuroses. It has basic pathogenetic techniques (psychodynamic, existential, interpersonal, cognitive, systemic, integrative, Gestalt therapy, psychoanalysis) that influence the causes that provoke the development of the disorder; as well as auxiliary symptomatic techniques (hypnotherapy, body-oriented, exposure, behavioral therapy, various breathing exercises techniques, art therapy, music therapy, etc.) to alleviate the patient’s condition.
2. 2. Drug therapy is used as an auxiliary method of treatment. Prescription of medications can only be done by a qualified specialist - a psychiatrist or neurologist. Serotonergic antidepressants (trazodone, nefazodone) are used to treat obsessive-compulsive disorder. Patients with mild forms of conversion neuroses are often prescribed tranquilizers (Relanium, Elenium, Mezapam, Nozepam, etc.) in small doses in short courses. Acute conversion states (severe seizures), combined with dissociative disorders, are treated with intravenous or drip administration of tranquilizers. In case of a protracted course of the disease, therapy is supplemented with antipsychotics (Sonapax, Eglonil). For patients with somatoform neuroses, general strengthening nootropics (phenibut, piracetam, etc.) are added to psychotropic drugs.
3. 3. Relaxation treatment. It combines a whole range of auxiliary methods to achieve relaxation and improve the patient’s condition: massage, acupuncture, yoga.

Neurotic disorders are reversible pathologies and, with adequate treatment, are mostly curable. Sometimes it is possible to cure neurosis on your own (the conflict loses its relevance, the person actively works on himself, the stress factor completely disappears from life), but this rarely happens. The majority of cases of neuroses require qualified medical care and observation, and it is preferable to carry out treatment in special specialized departments and clinics.

Neurotic disorders (neurosis), classification and statistics

A neurotic disorder, or neurosis, is a functional, that is, inorganic, disorder of the human psyche that occurs under the influence of stressful events and traumatic factors on the psyche, personality and body of a person.

Neurotic disorders can strongly influence behavior, but do not cause psychotic symptoms and gross impairment of quality of life. A separate group of neurotic disorders are those that accompany psychotic disorders. However, they are included in the classification under a separate code and will not be considered further.

According to the latest WHO data, the number of people with neurotic disorders has increased greatly over the past 20 - 30 years: up to 200 people per 1000 population, depending on the region, social and military living conditions. Neurotic disorders in children and adolescents have almost doubled.

Classification of neurotic disorders

One of the best classifications can be found in International Classification of Diseases, 10th edition (ICD-10), based on the DSM classification system. Neurotic disorders are included in this classification under the code from F40 before F48. This refers to the following neurotic level disorders:

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