Somatogenic asthenia, concept, clinic, dynamics, treatment.

Almost everyone at least once in their life has experienced a condition in which everything falls out of their hands, you don’t want to do anything, and general exhaustion of the body sets in. Such manifestations are possible after prolonged physical or mental stress, time zone change, or improper daily routine.

If you experience signs such as constant fatigue, apathy, irritability, then you should visit a doctor, especially if the symptoms progress. This is how an asthenic state can manifest itself. If such a diagnosis is made, special treatment will be required. Most often it is impossible to cope with the problem on your own.

Asthenic condition - what is it?

As a rule, many diseases begin with general malaise, lethargy and apathy. The disease passes and the symptoms disappear. In many patients, excessive fatigue, weakness and irritability are the only complaints, so a detailed examination cannot reveal any diseases.

All this may be a manifestation of the described malaise. Asthenic condition is a syndrome that is characterized by increased fatigue, irritability and nervous excitability, mood swings, severe fatigue even when performing usual work. As a rule, these signs increase, especially in the evening. Night sleep and rest do not bring relief to a person.

Asthenic syndrome is currently the most common form of neurosis. No one is immune from such a disease, especially considering the modern rhythm of life. Asthenic reactions and conditions are most often observed in schoolchildren, students, and mental workers.

What is asthenia

Asthenia is a psychopathological functional disorder, the main symptoms of which are prolonged, chronic and very severe fatigue. A person with asthenia feels powerless, a high degree of fatigue, and exhaustion.

The pathology is common and is observed more often in women than in men. It occurs in people of completely different ages, less often in children.

Its danger is that it often begins unnoticed and progresses gradually.

Asthenia is not a disease, as many people think. This is a disorder of nervous and mental activity that can be caused by many factors. Asthenic syndrome can last for months and even years. If the sufferer does not receive timely help, the condition may worsen to such an extent that hospitalization is required.

Types of asthenic conditions

Asthenia can be classified according to various criteria. If we take into account the factor of its development, the following types are distinguished:

Organic asthenia. This form usually accompanies many somatic diseases or organic pathologies that develop rapidly. These include: brain injuries, Parkinson's disease, Alzheimer's.
Functional asthenic states. This reaction occurs in stressful situations, an infectious disease, or severe fatigue. This phenomenon is temporary and passes quickly.

Asthenia also manifests itself in different ways, therefore they distinguish:

Hypersthenic asthenia, which is manifested by increased excitability, intolerance to loud sounds, bright light. This form, gradually worsening, can move into the next stage.
Hyposthenic asthenia. It is characterized by: drowsiness, lethargy, indifference to the outside world, problems with memory and attention.

The duration of the asthenic condition varies for everyone - for some it may be an acute form, which goes away after treatment, and there are cases of transition to the chronic stage. In this case, a person cannot get out of this state for a long time. As a rule, it is impossible to do without the help of a doctor.

An asthenic emotional state is not the same as ordinary fatigue; one must be able to distinguish between them. With asthenia, fatigue is observed without connection with physical labor and it is not possible to get rid of it even after a long rest.

Autonomic system disorder

The various functions performed by the autonomic system of the human body provide vital processes. For various reasons, these processes may be disrupted, which will not manifest itself in the most pleasant way for the patient. So, the vegetative system is responsible for:

correct heart rhythm;
maintaining tone in blood vessels;

The autonomic system is responsible for the correct heart rhythm

proper movement of air in the lungs, smooth and comfortable breathing;
production of bile and gastric juice.

Any malfunction in the autonomic system can cause problems with vital organs: heart, lungs, stomach. Most often, astheno-vegetative syndrome is observed in adults, but it is also often found in adolescents. Once a pathology is detected, it is important to eliminate it in a timely manner.

Types of conditions that can manifest as asthenia

Modern medicine identifies several conditions in which asthenic manifestations will occur:

Exhaustion. This refers to the mental reaction to exhaustion of the nervous system. This can happen as a result of prolonged stress, emotional and physical overload, and chronic lack of sleep.
Astheno-depressive syndrome. An asthenic state may be the first step towards the formation of “exhaustion depression” (or “neurotic depression”). This happens when exposed to traumatic factors against the background of nervous overstrain. One of the manifestations of this condition is a disturbance in the rhythm of sleep and wakefulness.
Somatogenic asthenia. Such manifestations usually begin and end many infectious, cardiovascular, oncological, and endocrine diseases.
Organic asthenic conditions. Suprasegmental autonomic disorders lead to this. They manifest themselves especially clearly in cases of brain damage and cerebrovascular accidents. Frequent companions of this condition: headache, problems with memory and attention, inability to concentrate on anything, dizziness.
Endogenous vital asthenia. This is most often a youthful asthenic condition, which is more typical for boys. It manifests itself as severe fatigue during any type of intellectual activity, headaches, and sleep disturbances. The peak of exacerbation usually occurs at 14-15 years.
Asthenia when using psychoactive drugs. Characteristic of people who are psychologically dependent on drugs. In this case, not only fatigue is observed, but also exhaustion, pain throughout the body, and the inability to sleep with an unbearable desire to sleep. The person becomes emotionally unbalanced and embittered.

Thus, an asthenic state is a signal to establish the cause of its occurrence. First of all, it is necessary to exclude somatic and endocrine diseases, as well as organic brain lesions. Whatever the cause of this condition, treatment will still be required.

Causes of asthenia

Often, severe asthenia occurs after illnesses or against their background, after prolonged stress.

Asthenia is considered by experts to be a psychopathological condition and is considered to be the initial stage of the development of serious neurological and mental diseases.

This disorder should be able to be differentiated from ordinary weakness or fatigue after illness. The main distinguishing criterion is the fact that after fatigue and illness, the body independently and gradually returns to normal after proper sleep and nutrition, and good rest. And asthenia without complex therapy can last for months, and in some cases, years.

Common causes of asthenia include:

- overstrain of higher nervous activity;

- lack of supply of nutrients and essential microelements;

- pathological disorder of metabolic processes.

In most cases, all of these factors arise in the life of each individual at different age periods, but they do not always provoke the development of asthenic disorders. The development of asthenia can be caused by disturbances and injuries in the functioning of the nervous system, and somatic diseases. Moreover, symptoms and signs of asthenia can be observed both at the very height of the disease, and before the disease itself or during the recovery period.

Among the diseases that lead to asthenia, experts distinguish several groups:

- gastrointestinal diseases - severe dyspeptic disorders, gastritis, ulcers, pancreatitis, enterocolitis;

- infections - food poisoning, ARVI, viral hepatitis, tuberculosis;

- diseases of the cardiovascular system - arrhythmias, heart attack, hypertension;

- neurological disorders;

- renal pathologies - chronic pyelonephritis, glomerulonephritis;

- diseases of the bronchopulmonary system - chronic bronchitis, pneumonia;

- injuries, postoperative period.

This disorder often develops in individuals who cannot imagine their existence without work and for this reason do not sleep enough and deny themselves rest. This condition can develop in the initial period of a disease of internal organs, for example, with coronary disease, and accompany it, being one of its manifestations (for example, with tuberculosis, peptic ulcer disease and other chronic diseases), or reveal itself as a consequence of an acute disease that has ended ( flu, pneumonia).

Signs of asthenia also appear when changing jobs, places of residence, or after serious experiences and troubles.

Causes of asthenic conditions

Many factors can provoke neuroses and asthenic conditions, especially if there is such a mental predisposition. You can name factors that can contribute to the development of asthenia:

Poor hygienic working conditions.
Prolonged stay in conditions of physical, mental or mental stress.
Failure to comply with sleep and rest schedules, frequent lack of sleep.
A radical change in lifestyle, for example, retirement, divorce, etc.
Excess weight.
Addiction to alcohol.
Drinking large quantities of strong coffee and chocolate.
Maintaining strict dietary restrictions.
Lack of fluid in the body.
Impact on the body of toxic and poisonous substances.
Use of medications.

Any of the listed factors can trigger the development of asthenia, and if there are several of them together, the risk increases.

Asthenia due to adaptation disorder

This group includes asthenic conditions caused by exposure to extreme factors on specific analyzers and effectors, as well as on nonspecific activating systems of the brain. Of the asthenias caused by adaptation disorders, a number of variants are distinguished: partial asthenia (perceptor-optical; perceptor-acoustic; perceptor-optical-acoustic); asthenia due to desynchronosis and general asthenia (asthenia as the next partial phase); asthenic reaction due to disadaptation in new conditions of life and activity; fatigue asthenia.

It should be noted that the term “adaptation asthenia” is not entirely appropriate; it would be more logical to call this type of asthenia maladaptive asthenia or asthenia caused by exposure to extreme factors, because the intensity or nature of such effects are on the verge of or beyond the physiological capabilities of adequate adaptation.

Drugs that most often cause asthenic disorders

Sometimes, for a variety of reasons, we are forced to take medications that affect the nervous and endocrine systems. Taking them can lead to asthenic and anxiety-neurotic conditions. A big risk in this regard is taking medications from such groups as:

β-blockers;
sleeping pills;
antihypertensive drugs;
sedatives;
tranquilizers;
antiallergic medications;
glucocorticosteroids;
hormonal contraceptives.

Since asthenia often develops against the background of other diseases, it is very important to correctly determine the cause of such manifestations. This is especially necessary when a person finds himself in a difficult life situation. It is very important to get advice from a competent specialist in the following cases:

The onset of menopause in women.
Pregnancy.
Long-term loss of appetite.
Sharp weight loss.
Severe mood swings.
The appearance of asthenic signs after injury.
If asthenia does not go away for a long time.

If a person is given appropriate help in a timely manner, he will get back into his usual healthy groove much faster.

Manifestations of asthenia

It is necessary to understand that this is a whole complex of symptoms, so it is not surprising that the symptoms of an asthenic state are quite diverse:

Increased fatigue and general weakness.
Constant dissatisfaction with others.
Irritability.
The appearance of sexual disorders.
Inability to concentrate.
Tearfulness.
Sleep disturbance.
Intolerance to loud sounds and bright lights.
Frequent headaches.
Loss of appetite.
Constant feeling of anxiety.
Increased sweating.
Trembling in the body and feeling of lack of air.

In order to make a correct and accurate diagnosis, it is necessary to understand that this asthenic condition in adults does not go away after a long rest and can be associated with certain psychophysical stress. Everyone, in principle, can independently diagnose such a syndrome, but making an accurate diagnosis is the prerogative of a doctor.

Asthenia due to fatigue

Its main reason is work that is excessive in duration and intensity for a given person, leading to a decrease in working capacity and labor efficiency. It is usually observed in people with mental work when there is a violation of the work-rest regime and nutrition. The most common symptoms are feelings of fatigue, heaviness in the head and limbs, general weakness, fatigue, lethargy, malaise, sleep disturbance, decreased memory and attention, deterioration of concentration, slower perception, increased number of errors, nervousness, irritability. Typically, the painful manifestations of overwork go through several phases - anxiety, agitation and exhaustion. These symptoms are reversible, but without rest they can turn into exhaustion.

In addition, there are frequent complaints of pain in the heart area, palpitations, shortness of breath, and “lack of air.” These sensations are more pronounced at rest, when patients pay attention to them, and decrease significantly during work. Typically, headaches, dizziness, excessive impressionability, impatience, incontinence, touchiness, mood instability, decreased appetite, and sweating are noted.

Unlike patients with neuroses, patients in this category are critical of their painful sensations, associate them with overwork and consider them temporary.

In most cases, fatigue asthenia develops gradually, going through a number of stages. There are four degrees of overwork.

Differential diagnosis of asthenia, fatigue and neurasthenia is often very difficult; their symptoms are largely similar. There is a set of diagnostic criteria that make it possible to diagnose asthenia due to overwork with sufficient reliability. It is characterized by a direct connection between the development of the disease and hard work, disruption of rest and nutrition; gradual pace of development of asthenic manifestations; clear but unstable somatic symptoms; decreased performance during mental and physical stress; increased asthenic manifestations during hard work, anxiety and troubles; reduction of asthenia phenomena after sleep and rest or their elimination after proper rest; increased asthenia in the evening; adequate attitude of patients to their condition; absence of organic diseases; effectiveness of symptomatic treatment and psychotherapy.

Diagnostic difficulties in determining the etiology of asthenic conditions arise when overwork occurs against the background of an infectious disease.

Differential diagnosis. EMG results are of some importance: in patients with neurasthenia, even with severe asthenia and depression, a clear activation of striated muscles and an increase in muscle tone are determined, and in patients with asthenic conditions, a decrease in muscle tone and activity of striated muscles is always detected.

Electromyograms of patients with asthenic syndrome of vascular etiology revealed a decrease in the amplitude and bioelectrical activity of muscles. Decreased motor activity and muscle hypotonia are characteristic of asthenia due to lesions of the diencephalic region.

Asthenia in children

If in adults an asthenic emotional state is most often a problem due to difficulties at home and at work, mental and physical stress, then in children the disease develops differently. Doctors distinguish two options for the development of asthenic conditions in children.

In the first case, children with asthenic conditions are very excited. This is usually observed if parents put a lot of stress on the child. After school, he immediately goes to classes or clubs; in the evening, you can observe overexcitement, which does not allow the child to fall asleep. There is overstimulation of the nervous system, and the help of a specialist is needed. If you reduce the load, adjust the daily routine and resort to medications to support the nervous system, then this condition goes away quite quickly.
In the second scenario, everything happens the other way around. The child becomes lethargic, apathetic, does not learn school material well, and wants to sleep during the day. You also need to adjust the load and take a course of medications that will support the nervous system.

Asthenic conditions in children are often caused by brain damage. Unfortunately, quite a lot of such children are being born today. Everything happens as in the first case. Parents and grandparents expect too much from their child and try to send him to various sections. In addition, they also require good academic performance.

There comes a moment when the child simply ceases to know what he has already done and what he has not. You should not demand high achievements from your children; each child is individual and learns the material at his own pace. If you begin to notice that your baby has begun to bite his nails, blinks frequently, or has tics, then this is a serious cause for concern.

Children also experience very strongly various conflict situations in the family: divorce of parents, quarrels. They often don’t show it, but inside there is constant nervous tension. In such situations, the help of a specialist is important to bring the child out of an asthenic state.

Somatogenic asthenia

Yu.P. Uspensky, Yu.A. Fominykh

The concept of somatogenic asthenia

In the literature, physiogenic, psychogenic and multifactorial asthenia are most often distinguished. The combined influence of physical and psychological factors plays a role in the genesis of multifactorial asthenic disorders. Taking into account the etiology, pathogenesis and clinical manifestations of B.I. Laskov et al. (1981) described the following types of physiogenic asthenia: 1. cerebrogenic asthenia (brain damage of traumatic, vascular, infectious, intoxication origin); 2. somatogenic asthenia; 3. cerebrosomatogenic asthenia; 4. adaptation asthenia (asthenia of negative adaptation), in turn subdivided into:

partial asthenia (perceptual-optical, perceptual-acoustic, perceptual-optical-acoustic);
asthenia with desynchronosis;
fatigue asthenia.

The appearance of asthenic disorders is due to more diverse reasons, often associated with other existing pathologies. The symptom complex of the asthenic state itself as “pathological exhaustion after normal activity, decreased energy when solving problems requiring effort and attention, or a generalized decrease in the ability to act” consists of three components:

manifestation of asthenia itself;
disorders caused by the underlying pathological condition of asthenia;
disorders caused by the personality's reaction to illness.

The second component of asthenic disorder, namely the underlying pathological conditions, is the main feature, taking into account which the modern classification of asthenic conditions is proposed.
According to the classification of A.S. Avedisova (2003), asthenic conditions are divided into organic (somatogenic) - 45% of cases and functional (reactive) asthenia - 55%. The next chapter will discuss the concept of functional asthenia and its types. “Somatogenic asthenia”, according to the diagnostic criteria of ICD-10, belongs to section F06.6 – Organic emotionally labile (asthenic) disorder caused by somatic illness. In the literature you can also come across the following synonyms for somatogenic asthenia: somatic asthenia, organic asthenia, secondary asthenia, symptomatic asthenic disorder. Somatogenic asthenia occurs as a consequence of various somatic diseases, against the background of chronic diseases of internal organs, the consequences of acute somatic diseases, surgical interventions and many other reasons, and are a manifestation of these diseases. The dynamics of asthenia manifestations depend on the severity of the symptoms of the underlying somatic disease. An important sign in these cases is the presence or absence of somatic distress in patients. Clinical criteria for somatogenic asthenia

It is known that the structure of asthenic syndrome includes the following components:

increased exhaustion of mental functions: fatigue, weakness, decreased performance, drowsiness and sleep disturbance;
emotional-hyperesthetic manifestations: anxiety, irritability, emotional lability, feeling of internal tension, hyperesthesia (increased sensitivity to various stimuli, such as light, sound);
somatovegetative disorders: tachycardia, hyperhidrosis, hyperventilation disorders;
cognitive disorders: impaired attention, absent-mindedness, memory loss;
motivational and metabolic-endocrine disorders: decreased libido, dysmenorrhea, changes in appetite, weight loss.

Somatic asthenia is characterized by a number of specific criteria (Smulevich A.B., Andryushchenko A.V., Beskova D.A., 2009):

the main symptoms are the predominance of physical (somatic) asthenia with muscle weakness and polymorphic vegetative disorders, hyperesthetic reactions with refusal of manipulation and continuation of treatment, etc.;
to violations of socio-professional adaptation in somatogenic asthenia

include a noticeable decrease in professional productivity, a decrease in usual activity, with a transition to a “gentle mode” of professional activity.

Insomnia disorders with somatic asthenia are characterized by hypersomnia, i.e. daytime sleepiness with lack of usual alertness.
psychosomatic disorders are determined by a tendency to intensify and complicate somatized manifestations: urinary retention, obstipation, diarrhea, as well as pain - common manifestations with somatic diseases: cerebralgia, myalgia, arthralgia, spondyloalgia, gastralgia, cardioalgia, etc.
psychosomatic parallelism and chronification factors are determined by increased asthenia, which is associated with the severity and course of the somatic disease: increased asthenic disorders - with complications, deterioration of the patient’s somatic condition, decrease - with its compensation.

At the present time, a feature of asthenic conditions is an undeniable increase in somatization, and one of the most common forms of somatization disorders is headache (Foltz EL, 1962). Tension headaches (TTH) are a common reason for patients with asthenia to see a doctor. Among other forms of cephalgia, tension headaches occur in 88% of women and 69% of men. Among patients with tension headaches, the first signs of the disease most often occur before the age of 20 years in 40% of cases, at the age of 20-40 years - in 40% of cases, and at the age of 40-50 years - in 18% of cases. The International Headache Association has created the following diagnostic criteria for tension-type headaches: 1. The duration of the headache episode must be at least 30 minutes. Typically, for episodic TTH – from 30 minutes to 7 days. In the chronic form of tension headaches, daily, almost continuous headaches are possible; 2. the nature of the headache is not pulsating, but squeezing, tightening, squeezing; 3. The localization of headache is always bilateral. In this case, one side may hurt more intensely. The localization of the headache is figuratively reflected in the patients’ descriptions: “the head feels as if it’s being squeezed in a vice,” “compressed by a hoop, a helmet, a helmet”; 4. the headache does not get worse from the usual daily physical activity, but it negatively affects the professional and daily activities of patients; 5. As the headache intensifies, accompanying symptoms may appear, such as phonophobia or photophobia, anorexia or nausea. It is important that the accompanying symptoms are not presented all together, as with migraine, but occur in isolation, are observed rarely and are clinically mild. According to the frequency of occurrence, tension headaches are usually divided into the following types:

infrequent tension-type headache - less than once a month;
frequent tension headache - the average frequency of episodes of tension-type headache is 1-15 pain days per month (or 12-180 days per year) with a disease duration of at least 3 months. Previously, this condition was called episodic tension headache;
chronic tension headache - the average frequency of headache episodes is more than 15 painful days per month (or more than 180 days per year) with a disease duration of at least 6 months.

At the heart of the occurrence of tension headaches, a significant role is played by the presence of chronic emotional stress, which is formed under the influence of individually significant psychogenic factors in people with certain personality characteristics, as well as functional insufficiency of antinociceptive systems.
Other complaints in patients with asthenic disorders often include various sleep disorders: difficulty falling asleep, shallow sleep with an abundance of dreams. According to the results of a polysomnographic study, in patients with asthenic conditions, compared with healthy people, a longer duration of shallow stages of sleep is recorded. After sleep, patients with asthenia do not feel cheerful and fresh. By the middle of the day, health improves, and in the evening it worsens again (Svyadoshch A.M., 1997). Among typical sleep disorders, there are 3 clinical variants: presomnic, intrasomnic and postsomnic. According to the observations of Yu.Ya. Tupitsyn (1973), presomnia disorders predominate in patients: shallow sleep with awakenings and shortened sleep due to early awakening. Features of somatogenic asthenia in various diseases of internal organs.

Dynamics of somatogenic asthenia in the pathogenesis of diseases of various nosologies.
Asthenia is a core or cross-cutting syndrome in various diseases of internal organs. It can be both the debut and the outcome of the disease. Asthenic disorders are rarely observed in their pure form; they are combined with anxiety, depression, fears, unpleasant sensations in the body and hypochondriacal fixation on one’s illness. At a certain stage, asthenic disorders can appear in any disease. It is known that acute colds, such as influenza, are accompanied by similar phenomena, and the asthenic “tail” often persists even after recovery, for a month. With a complicated course of acute respiratory disease, for example the development of pneumonia, asthenia continues in patients for up to several months after their convalescence. Somatogenic asthenia occurs against the background of chronic diseases of internal organs, consequences of acute somatic diseases or surgical interventions. The dynamics of asthenia manifestations depend on the severity of the symptoms of the underlying somatic disease. An important sign in these cases is the presence or absence of somatic distress in patients. As described by A.S. Avedisova (2003), somatic asthenia can occur against the background of various nosologies: infectious, cardiac, endocrine, hematological, neurological, neoplastic, hepatological, psychiatric, etc. The range of diseases, often accompanied by asthenic disorders, is extremely diverse. For example, in cardiology - coronary heart disease, chronic heart failure, chronic rheumatic heart disease, heart defects, inflammatory heart diseases, etc., pulmonology and phthisiology - pulmonary and extrapulmonary tuberculosis, pneumonia, chronic obstructive pulmonary disease, diffuse lesions of lung tissue, etc. ., infectious diseases - HIV, ARVI, viral hepatitis, etc., gastroenterology - peptic ulcer disease, chronic hepatitis, inflammatory bowel diseases, etc., oncology - malignant neoplasms of various etiologies, neurology - multiple sclerosis, cerebral atherosclerosis, traumatic brain injury, etc. Let us give examples of some manifestations of somatogenic asthenia in the clinic of internal diseases: Asthenic conditions accompanied by elevated temperature. In the clinic of internal medicine, the definition of chronic weakness syndrome is sometimes used (a more detailed description is presented in the next chapter), which is understood as severe asthenia lasting more than 6 months, associated with fever, muscle pain, nausea, mood and sleep disorders, sweating, cervical lymphadenopathy. Asthenic conditions accompanied by elevated temperature are often the only clinical manifestation of indolent encephalitis of viral origin. Often, chronic weakness syndrome develops after infectious mononucleosis, acute respiratory viral infections, especially due to enteroviral and adenoviral infections. Tuberculosis is also often the cause of prolonged asthenic syndrome with fever. Severe asthenia is most typical for extrapulmonary forms of tuberculosis - urogenital, articular. Acute brucellosis is now rare, but infectious disease doctors should remember that it is usually accompanied by a vital-asthenic symptom complex. Asthenic syndrome can be observed in anicteric forms of acute viral hepatitis A, B, C, and with exacerbation of chronic viral hepatitis. For chronic viral hepatitis in the cirrhotic stage, with alcoholic liver disease, asthenic disorders are often manifest. Asthenia is often the only clinical manifestation of HIV seropositivity. The greatest difficulty in diagnosis in an internal medicine clinic is caused by infective endocarditis. It is usually caused by streptococci, but cases of infection with other bacterial flora, such as Coxiella and Chlamydia, have also been described. The inflammatory process often develops on prosthetic heart valves. Especially in young patients, the disease often begins with asthenic manifestations. Patients receive symptomatic therapy for months aimed at correcting the asthenic symptom complex. Such treatment is not only ineffective, but also significantly lengthens the time before the correct diagnosis is made and the start of etiological and pathogenetic therapy, which worsens the prognosis of the disease. The most common causes of asthenia of metabolic origin are metabolic disorders in the body of patients: hypercreatinemia in renal failure, hypercalcemia in multiple myeloma or hyperparathyroidism, hyponatremia when taking diuretics or inadequate secretion of antidiuretic hormone. Asthenia of endocrine origin most often occurs in diabetes mellitus, hypothyroidism and Addison's disease. Determining the level of glycemia, the concentration of thyroid-stimulating hormone and cortisol in the blood serum allows us to identify these diseases. A decrease in the level of cortisol in the blood serum may be associated not only with endocrine, but also with mental pathology, in particular, indicate the presence of depression or vital asthenia in the patient. Cortisol modifies the course of most behavioral, cognitive, homeostatic processes: sleep, motivational sphere, concentration function of attention, memory, appetite, libido. The concentration of glucocorticoids in the hippocampus and blood serum depends on how the first three weeks of the child’s life proceeded: on the level of satisfaction of basic needs, deficit of maternal care and sense of security. The role of emotional deprivation, childhood trauma, for example, sexual abuse in girls, and pathological childbirth has also been proven (Martsenkovsky I.A., 2007). Asthenia of hematological origin most often occurs in chronic iron deficiency anemia, chronic myeloid leukemia, myelodysplastic syndrome, multiple myeloma. The hemoglobin level in iron deficiency anemia, occurring with the presence of an asthenic symptom complex, is usually less than 80 g/l. In chronic myeloid leukemia, asthenic disorders are constantly observed and are a manifest symptom of this disease. In the case of myeloma, asthenia without hypercalcemia is the only symptom of the disease. In myelodysplastic syndrome, pronounced asthenic syndrome is detected more often in the stage of its transformation into leukemia. Asthenia of tumor origin. Asthenic disorders are observed in varying degrees of severity in all malignant tumor processes. Asthenic syndrome may be the only symptom in some malignant neoplasms, for example, with deep primary cancer localized in the kidneys, ovaries, liver, lungs, lymphoid system, with metastases to the lungs or liver. Literature Avedisova A.S. Therapy of asthenic conditions. – 2003. – Pharmaceutical Bulletin. No. 33 (312). – pp. 15-16. Martsenkovsky I.A. Asthenic syndrome. Continuum of conditions: from mental and physical exhaustion to chronic weakness and asthenic failure Medical aspects in a woman’s life No. 2(5) 2007 P. 1-5. Svyadoshch A.M. Neuroses. St. Petersburg: Peter Publishing, 1997. - 448 p. Smulevich A.B., Andryushchenko A.V., Beskova D.A. A new approach to the treatment of neurasthenia and somatogenic asthenia (results of a multicenter study of the effectiveness and safety of Ladasten) // Psychiatry and psychopharmacotherapy v. 11 2009 No. 1, pp. 17-25. Foltz EL, White LE Pain “relief by frontal cingulotomy” // J Neurosurg 19: 89, 1962. Functional asthenia and its types Attention! Once you have studied the lecture, you need to press the f5 key.

Diagnosis of asthenia

Most often, a competent specialist always accurately diagnoses “asthenic condition.” Symptoms appear clearly against a background of overexertion, stress and general fatigue. But in the case when the signs of asthenia are slightly hidden behind the symptoms of the underlying disease, problems may arise with making a diagnosis. Only a detailed conversation with the patient can clarify the situation.

Specialists are armed with a scale of asthenic state, which was created by L. D. Malkova. It has already been adapted on the basis of clinical and psychological observations. The scale contains 30 statements that characterize this state.

Each patient must read all statements carefully and assign the required number of points. If he categorically “disagrees”, then 1 point, “perhaps so” - 2 points, 3 points - “true” and 4 - “absolutely true”.

For the accuracy of the results, everyone must be responsible for themselves; it is not allowed for someone to do this for you. After all answers, the scores are summed up; the entire scale can be divided into 4 ranges:

1st - from 30 to 50 points - no asthenia.
2nd - starts with 51 and ends with 75 points - a weak manifestation of asthenic conditions.
3rd - from 76 to 100 points - moderately severe asthenia.
4th - more than 101 points - severe condition.

Thus, the asthenic state scale (ASS) provides true results that facilitate diagnosis.

Therapy of asthenic syndrome

The treatment of asthenia must be approached comprehensively. Using only one method, it is impossible to achieve a positive result. If there is a diagnosis of “asthenic condition”, treatment should include:

Adjustment of work and rest schedules.
Preparing a proper diet.
Elimination of bad habits.
Introduction of dosed physical activity.
Treatment with medications.
Use of physical therapy.
Creating and maintaining a normal psychological climate in the family.

Since the nervous system is exhausted in patients, tranquilizers and sleeping pills are prescribed first of all to normalize sleep and relieve stress. For these purposes, it is best to use herbal preparations that have such effects. For example, taking such remedies gives good results.

Medicine "Valerian P". It has a positive effect on the functioning of the autonomic and central nervous systems.
Motherwort P product. Normalizes blood pressure, calms and normalizes sleep.
Complex "Nervo-Vit". Relieves irritability, tearfulness, increases the body's protective functions.
The Leveton P complex is made on the basis of Leuzea and helps eliminate daytime drowsiness and reduces fatigue from mental and physical work.

For a speedy recovery, it is also important to take restorative complexes of vitamins and minerals. The doctor will advise which one is better to choose, taking into account the patient’s condition.

Only a whole range of drugs, taken on the recommendation of a doctor, can alleviate a person’s condition and normalize the functioning of his nervous system.

During treatment, you need to pay attention to your diet, include more foods rich in proteins, for example, meat, legumes. It is useful to eat cheese, bananas, turkey meat (these products contain tryptophan), consuming fresh fruits and vegetables, you can replenish the supply of vitamins and minerals in the body.

Therapeutic gymnastics, physiotherapeutic procedures, massage, walks in the fresh air will become indispensable aids in the treatment of asthenic conditions.

How and with what to treat asthenia with VSD

Both with asthenic syndrome and with a disorder of the autonomic system, an integrated approach is always required. These pathological conditions are very difficult to treat with medication. Most medications used in such cases only eliminate the symptoms, but do not treat the cause.

Physiotherapeutic and psychotherapeutic methods are much more effective.

Treatment with drugs

The following types of medications are used to treat asthenia in VSL:

Sedatives. Most often, sedative herbal medicines are prescribed. They help improve sleep, relax the nervous system, and reduce the effects of stress.
Tranquilizers. Relieve anxiety, eliminate frequent manifestations of panic attacks, and inhibit nervous system excitation.
Drugs that stabilize blood pressure.
Adrenaline receptor blockers. Prescribed for tachycardia, arrhythmia. They reduce the pulse and make the receptors insensitive to the release of adrenaline.
Antidepressants. They improve your mood and level out your psycho-emotional state.
Nootropics. Improves oxygen supply to the brain. They increase mental abilities and have a positive effect on overall well-being.
Vitamins for nourishing the nervous system and the body as a whole.

The choice of drugs, dosage, timing of administration can only be prescribed by a doctor.

Physiotherapy

In comparison with medications, physiotherapeutic procedures have a therapeutic effect, and do not simply mask and smooth out symptoms. Most of these procedures improve the condition of blood vessels, accelerate blood flow, and relieve muscle tension.

The following types of physiotherapy are very effective for VSD and asthenia:

Acupuncture.
Massage (manual, lymphatic drainage, hardware).
Sharko's shower.
Electrophoresis.
Magnetotherapy.
Detensor therapy.

Very good results are achieved after sanatorium treatment and a full-fledged spa holiday.

Psychotherapy

If asthenia and autonomic disorder are caused by stress, psychological trauma, and internal experiences, psychotherapy can become key in the entire treatment.

Our psyche is inextricably linked with the body. And when negative processes occur in the mental and spiritual spheres of a person, they certainly affect the physical state.

Scientists have long confirmed the fact that many diseases are psychogenic in nature. This factor is called psychosomatics.

Folk recipes for asthenic conditions

Traditional medicine can be called upon to help in the fight against asthenia; in its bins there are recipes to reduce the symptoms of the disease. You can use the following; they have already been tested in practice by more than one patient.

Prepare a mixture of equal quantities of hawthorn, chamomile and St. John's wort flowers. Take 1 tsp. mixture and pour a glass of boiling water, leave for 15 minutes. Strain and drink in small sips before going to bed. The course must be continued for 2 months. This remedy increases vitality and returns interest in life.
To invigorate a person, you need to mix an equal amount of lavender, linden, hop cones and St. John's wort flowers. Then 1 tsp. pour boiling water over it and you can drink it like regular tea (2-3 times a day).
If you really have no strength at all, then this remedy will help. You need to take 1 tsp. hawthorn flowers, calendula, burdock, rosemary leaves and mix with a small amount of ground coffee. Pour 0.5 liters of hot water and leave for a couple of hours. You need to drink in the morning after meals and in the evening.

These simple recipes will help you cope with asthenia.

Features of the treatment of asthenia in children

A child's body is much more susceptible to various external influences, so therapy should be prescribed only by a doctor. The following can be advised to parents.

Bring your child’s study and rest routine back to normal. It is necessary to adjust the activities in clubs and sections, maybe it is worth giving up something at least for a while.
Do not purchase any medications without the advice of a doctor. In this situation, even completely harmless means can only aggravate the condition.
After making a diagnosis, the doctor prescribes medications not only taking into account the symptoms, but also the age of the child.
The main task of parents is to follow all recommendations.

If all wishes are fulfilled, then, as a rule, the treatment is successful, and the baby’s nervous system returns to normal.

Recommendations for patients with asthenic conditions

After visiting a doctor, were you diagnosed with an “asthenic condition”? That this is quite serious should become clear after talking with the doctor, so it is necessary to take treatment with all seriousness and responsibility. It is advisable to adhere to the following recommendations:

Include feasible physical activity in your life - running in the evenings, swimming, cycling.
Optimize your work and rest schedule.
Avoid contact with hazardous chemicals whenever possible. If this is related to the type of your activity, then you will have to change it.
Include protein-rich foods in your diet.
Eat more fresh vegetables and fruits.
Pay attention to eggs and liver - these foods improve memory.
In winter, you should think about taking vitamin complexes.
Maintain a normal microclimate in the family and in the work team.

If you add all this to drug treatment, you will get rid of the asthenic condition much faster.

Primary

Muscle weakness (myasthenia gravis) is manifested by a significant decrease in muscle strength, due to the fact that the muscles cannot contract quickly and forcefully. A person does not get full movements provided by this muscle in case of myopathy, muscular dystrophy and myasthenia gravis. In myasthenia gravis, muscle strength is normal when a person is sedentary. But as soon as physical activity is required (washing dishes, going to the store, etc.) true weakness occurs.

Neurologists believe that muscle weakness has different etiologies.

Violation in:

Main symptoms of primary muscle weakness

Decreased muscle strength.
Difficulties arise when performing daily tasks: walking, climbing stairs, holding a mug, writing with a pen, carrying medium-heavy packages.
Drooping eyelid.
Swallowing disorders.
Speech or chewing problems.

Clinical symptoms of primary weakness in the arms

Neurologists: the main known causes of constant muscle weakness in the arms include various types of degenerative-dystrophic injuries of the spinal cord, which are associated with its compression, i.e. compression.

Doctor Nikonov

My opinion: the cause of degenerative-dystrophic damage to the spinal cord is associated with its compression, that is, with compression - these are swollen muscles of the neck, collar area and back, which put pressure on between the vertebral discs and the roots of the spinal cord.

Clinical symptoms of arm muscle weakness

Long-term decrease in muscle tone.
Fatigue quickly with light loads.
Feeling of stiffness in the limbs in the morning (with arthritis).

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Paresthesia (feeling of “pins and needles”, tingling of the fingertips).
Episodic or regular pain in the joints or muscles of the hands.
Reduced range of motion in the hands.

Prevention of asthenic syndrome

Many people wonder whether it is possible to prevent the development of asthenia? This begs the question: is it necessary? After all, an asthenic state is a kind of protective reaction of the body that protects the nervous system from destruction. If the number and strength of external stimuli reaches a critical level, then protective reflexes of “exorbitant inhibition” are activated, which manifest themselves in asthenic states.

To prevent overstrain of your nervous system, it is recommended:

Get enough sleep regularly. If there are problems with sleep, then they need to be addressed immediately.
Lead a healthy lifestyle.
Do not take on overwhelming physical and mental work.
Alternate any stress with rest.
Maintain normal relationships in the family and in the team.

Even if it was not possible to avoid overexertion, and asthenic syndrome overtook you, then a timely visit to the doctor will quickly return everything to its place. The initial stages of the disease are very treatable. You should not self-medicate or hope that gradually everything will go away on its own.