Hypersthenic neurasthenia: symptoms and treatment

Modern people lead a very intense, highly rhythmic lifestyle.
Stressful situations, constant tension, work that requires significant mental and physical stress - these are not all the factors that do not have the most favorable effect on the human nervous system. Neurasthenia is the logical result of that tense atmosphere, the environment into which a person consciously drives himself. It is called an atypical state of the nervous system associated with the physical state of the individual. Moreover, this disorder has a significant negative impact on a person’s psychological health. This dual nature of the disease leads to the need to use a whole range of measures in order to effectively treat it.

Relevance of the problem of neurasthenia

Symptoms

• Asthenic syndrome. Characterized by deterioration of attention and memory. A neurotic person is not capable of solving complex problems - general discomfort interferes, which results in an attack of irritability and anger. The perception of all senses is heightened.

• Shallow sleep. The patient cannot “switch off” from stimuli, falls asleep for a long time, and wakes up periodically. Gets up feeling tired and groggy.

• Headache. It is encircling in nature - the so-called “neurasthenic helmet”. The pain occurs most often at the end of the day. This is the starting syndrome, but during the transition to the next phase of neurasthenia, stabbing pain in the heart and neuralgia may appear.

• Decreased potency. Emotional stress cannot but affect the quality of sex. The time of sexual intercourse is reduced, morning erections disappear. Psychological impotence and neurasthenia almost always go hand in hand.

Epidemiology

Neurasthenia is observed in all categories of the population, being one of the disasters of our time due to its influence on the physical and intellectual abilities of a person. Neurasthenia significantly disrupts people's daily lives and reduces its quality. It has been revealed that women suffer from neurasthenic syndrome 2-3 times more often than men; It affects not only people of working age, but also older people who, on the one hand, have several chronic diseases, and on the other, have impaired adaptation mechanisms.

Modern Russian studies examine the epidemiology of not only neurasthenic syndrome in various age and social groups, but also preasthenia. For example, the average prevalence of senile asthenia is 12.9%, and senile preasthenia is 48.9%.

Pathophysiology of neurasthenia

Classification

Depending on the duration of existence of the neurasthenic syndrome, acute and chronic forms are distinguished.

Acute neurasthenia is usually functional in nature, developing after severe stress, an acute illness or infection.
Chronic neurasthenia has a long course and is usually organic. Chronic functional neurasthenia includes chronic fatigue syndrome.

Causes

The main cause of neurasthenia is exhaustion of the nervous system due to overwork of any kind. Most often it occurs when mental trauma is combined with hard work and deprivation.
Modern people are constantly in tension, waiting for something, doing boring, same-type work that requires responsibility and attention.
Factors contributing to asthenic neurosis:

somatic diseases;
endocrine disorders;
chronic lack of sleep;
malnutrition and lack of vitamins;
irregular working hours;
frequent conflicts in the environment;
infections and intoxications;
bad habits;
increased anxiety;
heredity

Clinical picture

The symptom complex of neurasthenic syndrome includes three components:

actual clinical manifestations of asthenia;
disorders associated with an underlying pathological condition;
disorders caused by the patient's psychological reaction to the disease.

There are two main types of disorder, which largely overlap each other.

The main characteristic feature of the first type is complaints of increased fatigue after mental stress, which is often associated with some decrease in performance or productivity in daily activities. Mental fatigue is described by patients as an unpleasant occurrence of absent-mindedness, weakened memory, inability to concentrate and ineffective mental activity.
In another type of disorder, the emphasis is on a feeling of physical weakness and exhaustion even after minimal exertion, accompanied by a feeling of muscle pain and an inability to relax. Both types of the disorder are characterized by a number of common unpleasant physical sensations, such as dizziness, tension headaches and a feeling of general instability.

Common features also include concern about decline in mental and physical abilities, irritability, loss of the ability to enjoy joy, and mild depression and anxiety. Sleep is often disturbed in its initial and middle phases, but drowsiness can also be severe.

Neurasthenia should be distinguished from ordinary fatigue , which occurs after excessive physical or mental stress, change of time zones or climate, and failure to comply with the work and rest regime. Unlike physiological fatigue, neurasthenia develops gradually, persists for a long time, does not go away after proper rest, and requires medical intervention to eliminate it.

Neurasthenia is often accompanied by disorders of the autonomic nervous system: tachycardia, pulse lability, changes in blood pressure, chilliness or a feeling of heat in the body, generalized or local hyperhidrosis, loss of appetite, constipation, pain along the intestines. Headaches and dizziness are possible. Men experience a decrease in potency.

Depending on the form of neurasthenia, it may be accompanied by sleep disturbances of various types. Hypersthenic asthenia is characterized by difficulty falling asleep, restless and intense dreams, night awakenings, early awakening and a feeling of weakness after sleep. Hyposthenic asthenia is characterized by daytime sleepiness. At the same time, problems with falling asleep and poor quality of night sleep persist.

Sleep is a natural physiological process, the average sleep duration in humans is 7–8 hours. With a lack of sleep, immunity, activity, ability to work, quality of life, psycho-emotional state decrease, neurasthenia and other diseases can develop. The prevalence in the population of insomnia, disturbances of night sleep and daytime wakefulness, according to Russian and foreign data, has increased sharply in the last 5 years from 8–15% to 20%, and in some regions even higher. Many researchers associate this with psycho-emotional tension and a stressful situation in the world.

There are modifiable and non-modifiable risk factors for the development of insomnia.

Non-modifiable include genetic predisposition, female gender, and age.
Modifiable factors include acute stress, prolonged psycho-emotional overload, and the nature of work (sliding schedule with night shifts and intense rhythm). Many medications, such as antibiotics, hormonal drugs, antiarrhythmics, antihypertensives, antidepressants, diuretics, nootropic drugs, can disrupt sleep.

Acute and chronic somatic and neurological diseases provoke the development of insomnia. Patients with insomnia feel tired in the morning, and in the afternoon, on the contrary, in an excited state, which is due to an increase in the secretion of cortisol, which contributes to the hyperactivity of the renin-angiotensin system, an increase in heart rate and temperature. Manifestations of insomnia can be any disturbances in the sleep process - its initiation (presomnic), maintenance (intrasomnic) or completion (postsomnic).

With presomnia disorders, a person cannot fall asleep immediately. Presomnia disorder is characterized by difficulty falling asleep over a long period of time. Anxious thoughts, evening hyperactivity caused by various reasons prolong the period of falling asleep to 3-4 hours.
Intrasomnia disorders are manifested by frequent awakenings at night and difficulty falling asleep after such awakenings.
Postsomnia disorders are characterized by early, premature (1–2 hours) awakening.

Forms of the disease

Neurasthenia can manifest itself in several forms, which can replace each other. In practice, there are three main ones.

The hyposthenic form usually occurs at the final stage of the disease. It is characterized by pronounced nervous exhaustion and weakening of all nervous processes, accompanied by bad mood, lethargy, passivity, and indifference. Most often occurs in people with a congenital weak nervous system. Such patients have a low level of ability to work, which negatively affects the social aspects of their lives.

Untimely and incorrect diagnosis can lead to complete isolation of a person from his usual social circle.

The hypersthenic form is characterized by mild temper and increased irritability. Such people cannot control their emotions, are impatient, often lose their temper, and at the same time take their anger out on others. Their concentration on something can be disrupted by any external stimulus (noise, light, sound, etc.). This pathology leads to the fact that the people around the patient exhaust him so much that the person begins to consciously avoid society as much as possible.

Characteristic signs of this type of mental pathology: difficulty paying attention, inability to concentrate, exhaustion, overwork, forgetfulness associated with absent-mindedness.

Irritable weakness is a form of neurasthenia with moderate manifestations. Most often found in people with choleric temperament. Irritability in such patients is quickly replaced by resentment and general sensory weakness. Such neurasthenics more often than others suffer from headaches combined with dizziness.

These symptoms significantly reduce the level of performance, and if measures are not taken, they can lead to serious physical and mental illnesses.

Diagnostics

Diagnosis of neuroses is difficult due to the smoothness of symptoms and the difficulty of objectively confirming the diagnosis, while the doctor may miss the initial signs of more severe diseases.

characteristic of neuroses can be observed in almost any mental illness; it is necessary to carry out a differential diagnosis of the asthenic syndrome inherent in neurasthenia with masked depression.
Depression is characterized by pessimism, a feeling of melancholy, decreased vitality, apathy, low self-esteem, increased symptoms in the morning, and early awakening.
Manifestations of neurasthenic syndrome , on the contrary, increase in the evening, drowsiness is observed in the morning, sleep does not bring a feeling of rest, appetite is not impaired, and patients do not feel sick. With neurasthenia, inhibition processes are weakened, a person incorrectly assesses his capabilities and overestimates them.

In cases where asthenia is a consequence of stress, injury, illness, or acts as a harbinger of a pathology beginning in the body, its symptoms are pronounced. If neurasthenia occurs against the background of an existing disease, then its manifestations may fade into the background and not be so noticeable behind the symptoms of the underlying disease. To get an objective picture, it is necessary to conduct a study of the patient’s mnestic sphere, assess his emotional state and response to various external signals. In some cases, it is necessary to differentiate asthenia from hypochondriacal neurosis, hypersomnia, and depressive reactions.

Diagnosis of neurasthenic syndrome requires mandatory examination of the patient for the underlying disease that caused the development of asthenia. Consultations with specialized specialists are often necessary. Clinical blood and urine tests are required. Diagnosis of infectious diseases is carried out through bacteriological studies and PCR diagnostics. According to indications, instrumental research methods are prescribed.

To objectify the asthenic state, use the “Asthenic State Scale” (ASS), adapted by T.G. Chertovoy, L.D. Malkova . The asthenic state scale was developed on the basis of clinical and psychological observations and the well-known MMPI questionnaire (Minnesota Multidimensional Personality Inventory) and is intended for diagnosing the asthenic state.

The scale consists of 30 statement items reflecting the characteristics of the asthenic state. The study is carried out individually in a separate, well-lit room, isolated from extraneous sounds:

from 30 to 50 points - “absence of asthenia”;
from 51 to 75 points - “weak asthenia”;
from 76 to 100 points - “moderate asthenia”;
from 101 to 120 points - “severe asthenia.”

Neurasthenia - a malfunction of the brain

Neurasthenia does not cause changes in the anatomical structure of cells, such as cancer, but their functionality suffers, and seriously. Let us give an example of the work of the psyche of a healthy person and a patient with neurasthenia.

Colleagues talk and interfere with work. A loud sound activates an arousal area in the hypothalamus (the part of the brain responsible for emotions). Very little time passes and inhibitory neurons begin to act, extinguishing this process. The person calms down and no longer reacts so emotionally to the conversation. In a neurasthenic, the processes of inhibition are greatly slowed down, and the spread of foci of excitation occurs like an avalanche. He wants to calm down, but his brain won't let him. Neurons restore their energy balance only during inhibition, when all functions are slowed down. The ideal time for this process is sleep. But patients with neurasthenia, with their exhausted nervous system, sleep poorly, their sleep is light and superficial. It turns out to be a vicious circle, and it is impossible to break out of it without treatment.

Prerequisites for the development of the disease: many days of mental stress, mental trauma, lack of a normal daily routine, stress. Neurasthenia is more common among middle-aged men and women employed in mental work.

Treatment

With neurasthenia, it is necessary to select a work and rest schedule, the patient to refuse various harmful influences, including drinking alcohol, to introduce health-improving physical activity into the daily routine, and to follow a fortified diet that corresponds to the underlying disease.

It should be noted that with neurasthenia, usually even a long rest does not provide tangible benefits, since after returning to normal, the symptoms of asthenic syndrome resume. A calm work environment and psychological comfort at home are of great importance for patients . In these cases, psychotherapy, training in “increasing personal effectiveness” and proper distribution of personal time will be useful.

Symptomatic therapy includes sedatives to relieve symptoms of neurasthenia and normalize sleep .

Hyposthenic phase

Develops as a result of extreme depletion of the nervous system. The primary development of the hyposthenic phase is possible in people with a weak type of higher nervous activity. In this case, patients have a constantly reduced background mood, with pronounced apathy, anxiety and negativism. There are mood swings and tearfulness. Patients are fixated on their feelings, hypochondriacal, and require attention from others.

The question “how to cure neurasthenia?” at this stage requires the active intervention of specialized specialists - psychologist, psychiatrist, therapist. In case of severe disturbances in the functioning of somatic organs, hospitalization may be required. The range of medications for the treatment of neurasthenia is expanding. In addition to those used in the second stage, it may be necessary to add antipsychotics.