Neurosis (neurasthenia) is a type of neurotic disorder characterized by symptoms of mental and physical weakness, easy mental excitement, easy mental fatigue, often accompanied by emotional tension, worry, and psychophysiological symptoms such as tension headache and sleep disorders. These symptoms are not secondary to somatic diseases or organic brain lesions, nor are they part of any other mental disorder. However, patients can have persistent emotional tension and stress prior to the disease. The lack of specificity of the symptoms of neurosis, which are almost always seen in other neurological disorders such as anxiety disorders, depressive neurosis, hypochondriasis, and somatization disorders, makes the diagnosis of this disease more difficult.
I. Symptoms and signs
The original meaning of neurasthenia is: “an excessively debilitating and excessively excitable state of the central nervous system, accompanied by secondary symptoms” (Muller, Handbook of neurasthenia, 1893). This view is now largely shared. Many textbooks, however, describe the symptoms in more detail. For example, according to Kind: the main symptoms of neurasthenia are a decrease in all aspects of ability and an increased response to various stimuli. There is easy fatigue on a psychological level, sleep disturbances, poor concentration, memory loss, and anxiety of a frightening nature. The definition of neurasthenia, which was established in 1985 at the symposium on neurosis in China, states that patients with this disorder are easily aroused by the mind and easily fatigued by the brain, often accompanied by emotional troubles and some psychophysiological symptoms. Some scholars believe that the fatigue of neurasthenia patients is selective, i.e., they are not easily fatigued by emotional experiences of interest, but easily fatigued by those who are not interested or have subconscious resistance to them. The main clinical manifestations can be broadly categorized as follows.
1. debilitating symptoms This is the basic symptom often found in this disease. Patients often feel a lack of energy, depression, inability to use the brain, or brain sluggishness, limb weakness, sleepy and sleepy; especially when working for a long time, they feel that they cannot concentrate, have difficulty in thinking, and their work efficiency is significantly reduced, and even sufficient rest is not enough to restore their fatigue. Many patients complain that they lose things, often make mistakes in their speech, and cannot remember what they have just experienced.
2. Excitement symptoms Patients are easily excited when reading books and newspapers or watching TV, and involuntarily increase their memories and associations; patients feel overwhelmed by directional thinking, but the lack of directional thinking is very active and uncontrollable; this phenomenon is especially obvious before going to sleep, which makes patients deeply distressed. Some patients are also sensitive to sound and light.
3, emotional symptoms mainly manifested as easily annoyed and easily provoked. The content of the worries often involves various conflicts in real life, feeling difficult and unable to solve. On the other hand, the self-control is weakened, and the patient is easily agitated when things happen; or irritable and easily irritated, losing temper with people in the family, and then feeling regretful afterwards; or easily sad and tearful. About 1/4 of the patients have anxiety and have doubts, worries and nervousness about the disease they are suffering from; for example, patients may suspect that they are suffering from heart disease because of palpitations and fast pulse; or worry about stomach cancer because of abdominal distension and anorexia; or think that they are suffering from an incurable disease because of poor treatment results. This kind of suspicion can aggravate patients’ anxiety and tension, forming a vicious circle. About 40% of patients have transient and mild depressive moods during the course of the disease, which are often scored below 10 on the Hamilton Depression Scale. Self-blame may be present, but there is generally no suicidal ideation or attempt. Some patients have resentful feelings and blame others for the cause of the disease.
4. Tension pain is often caused by tension, with tension headache being the most common. Patients feel heavy head, head swelling, tight pressure on the head, or stiff neck; some complain of back pain or muscle pain in the extremities.
5.Sleep disorder The most common is difficulty in falling asleep, tossing and turning, resulting in irritability, making it more difficult to fall asleep. Secondly, they complain of excessive dreaming and waking up easily, or they feel that their sleep is very light and they seem to have not slept the whole night. Some patients may feel tired and still sleepy after waking up, or they may feel sleepy during the day, but feel excited when they go to bed, making it difficult for them to sleep. Some patients fall asleep soundly and snore loudly, but after waking up, they firmly deny that they have slept and lack the real sense of sleep. These patients worry and distress about insomnia, which often exceeds the pain brought by the sleep disorder itself and reflects the patient’s anxious state of mind about sleep.
6, other psychophysiological disorders More common ones such as: dizziness, blurred vision, tinnitus, palpitations, panic, shortness of breath, chest tightness, abdominal distension, indigestion, frequent urination, excessive sweating, impotence, premature ejaculation or menstrual disorders. Although these symptoms lack specificity and are also common in anxiety disorders, depression or somatization disorders, they can be the main complaint of patients seeking treatment for this disease, which makes the basic symptoms of neurasthenia conceal.
Second, medication treatment
Most patients think they are “weak”, so they try to take supplements, but the effect is not good. From the feature of selective fatigue, we advocate psychotherapy, mainly adjusting emotions, striving for a balanced state of mind, coupled with physical exercise, physical therapy, and sometimes can receive certain results.
1, psychotherapy is the basic method of treatment of neurasthenia. The following are commonly used.
(1) Group psychotherapy: in a group of 10-20 patients, the doctor will systematically explain to the patient the medical knowledge about neurasthenia, including etiology, pathogenesis, clinical manifestations, disease course, diagnosis and treatment. Patients will have a full understanding of the disease, so that they can analyze the causes of their illness and seek countermeasures to eliminate the influence of unfavorable factors; at the same time, it will help to eliminate the psychological suspicion, reduce anxiety and worries, and break the vicious circle. Detailed explanation of the treatment of this disease requires patients to take the initiative to cooperate and give full play to the treatment. It is more effective if there are patients who have been cured to participate in the discussion and present themselves.
(2) Group treatment: In a group of five to six patients, the doctor guides the patients to analyze their respective conditions, thus achieving mutual inspiration, eliminating doubts and clarifying the direction of their respective efforts. It is more effective if patients who have been cured participate in the discussion and speak from their own experience.
(3) Individual psychotherapy: On the basis of group lectures and group discussions, psychological counseling is then provided for the specific conditions of individual patients to inspire and help them seek ways and means to solve their difficulties and get rid of their dilemmas.
(4) Morita therapy: It is one of the most effective methods to treat neurasthenia, which advocates following nature. Paying attention to the habit of regular living, work and study planning, and combining work and rest can also help recovery.
(5) Supportive psychotherapy: Through explanation and guidance, patients can improve their understanding of the disease, divert their attention from the disease and increase their self-confidence.
(6) Behavioral therapy: self-relaxation training, for patients with obvious tension symptoms, accompanied by pain and discomfort and other symptoms can have a better effect, if necessary, with biofeedback therapy.
2.Medication
(1) Anti-anxiety drugs: benzodiazepines are commonly used: diazepam (Valium) 2.5-5.0mg, chlordiazepoxide (Librium) 10-20mg, eszopiclone (Scholastin) 1-2mg, hydroxyzine (Advil) 25-50mg, alprazolam 0.4-0.8mg, lorazepam (Chlordiazepoxide) 1-2mg, etc., 3 times/d, for 1 to 2 weeks. It can help patients to improve anxiety, tension and sleep disorders.
(2) Sedative-hypnotic drugs: For obvious sleep disorders, use: triazolam 0.25-0.5mg, nitrazepam 5-10mg, eszopiclone 1-2mg, or clonazepam 2-4mg, taken every night before bed, for 1 to 2 weeks. In order to avoid drug dependence, these drugs should not be used for too long; or several drugs alternately or intermittently.
(3) β-blockers: sympathetic hyperfunction, such as nervousness, palpitations, tremor, sweating and other symptoms are obvious, can be tried propranolol (insulin) 10 ~ 20mg, 3 times / d, can have some effect.
(4) tricyclic drugs: anxiety and depression mixed presence, and early awakening, you can use Doxepin (Doxepin) or amitriptyline, 25 ~ 50mg, taken at bedtime, 1 time / d; to relieve anxiety and depression, prolong sleep time. Second-generation antidepressants with fewer side effects, such as SSRIs, are mostly used at low doses.
Anti-psychotic drugs are prone to cause intolerable side effects in patients and should be avoided for the treatment of neurasthenia as much as possible.
3, insulin hypoglycemia treatment for debilitating symptoms and digestive dysfunction, as well as anxiety, wasting patients, has the effect of strengthening and improving the nutritional status, enhance the overall functional recovery. It can be injected 4-20 units of insulin every morning on an empty stomach, and after 3-4 hours of obvious hypoglycemic reaction, it can be treated with 50% sucrose liquid orally or 50-60ml of 50% glucose liquid by sedation. Treat 6 times a week, 30 to 40 times a course.
Third, dietary care
Neurasthenia food therapy formula (for reference only).
Celery date soup: 90 grams of fresh celery, 8 grams of date palm, add the right amount of water to boil for soup, discard the celery and date palm dregs drink soup. This is the amount of a day, divided into noon after the meal and night before bedtime two divided. This remedy has the effect of calming the liver and clearing heat, nourishing the heart and tranquilizing the mind, and is suitable for the illnesses such as insomnia and forgetfulness caused by false annoyance, neurasthenia, and dizziness when blood pressure is high.
Wheat and black beans and nightshade soup: 45 grams of wheat, 30 grams of black beans, nightshade 10 grams, put the same pot, add the appropriate amount of water decoction into soup, discard the wheat and black beans and nightshade dregs to drink soup. This is the daily amount, divided into two drinks. This remedy has the effect of nourishing the heart and kidneys and calming the mind, and is suitable for insomnia and heart trouble caused by heart and kidney disorder.
Lilies and dates turtle soup: 50 grams of turtle meat, 15 grams of lilies, 10 red dates, and the right amount of seasoning. Cut the turtle meat into pieces, remove the core of jujube, cook with lily, add seasoning, cook until the turtle meat is cooked and rotten, drink soup and eat meat. This is the amount for one day, divided into two servings. This remedy has the effect of nourishing yin and nourishing blood, nourishing the heart and benefiting the kidneys, and is suitable for insomnia, heart trouble and palpitations caused by heart and kidney yin deficiency.
Flowering peanut leaf soup:15 grams of flowering peanut leaf, 30 grams of adzuki beans, two tablespoons of honey. Wash the peanut leaves and adzuki beans, put them into a pot, add water and decoct for soup, discard the peanut leaves, mix in honey, drink the soup and eat the beans. This is the daily amount, divided into two drinks. This remedy has the effect of nourishing blood and calming the mind, and is suitable for neurasthenia, insomnia and dreaminess.
The date and onion soup: 20 dates, two bearded white onion. The dates are washed and soaked in water, and the scallions are washed and cut into inch sections. Put the dates into a pot, add water to the right amount, first boil with a martial fire, then change to a civil fire stew for about 20 minutes, add the white onion with the beard and continue to stew for 10 minutes that is, eat dates and drink soup. This is the amount for one day, divided into two servings. This remedy has the effect of nourishing blood and calming the mind, and is suitable for neurasthenia, insomnia and dreaminess, memory loss and other evidence.
Longan Ginger Jujube Soup:10 grams of longan meat, 5 slices of ginger, 15 jujubes. Choose thick flesh, large slices, soft, oily, brownish-yellow, translucent, sweet taste of longan meat, fresh ginger scraped off the outer skin, slices, dates washed and spare. Put the longan meat, ginger slices and jujube into a pot, add two bowls of water and decoct into a small bowl. Discard the dregs and drink the soup, this is the daily amount, divided into two drinks. This remedy has the effect of nourishing the blood, nourishing the blood and calming the mind, and is suitable for middle-aged and elderly people with heart and blood deficiency, insomnia, forgetfulness, neurasthenia, anemia and other evidence.
Lotus seeds and cinnamon soup: lotus seeds (remove the core), poria, gorgonians 8 grams each, longan meat 10 grams, stewed for 50 minutes, discard the dregs, until cooked into a sticky consistency, then stir into the red pond, cool and drink soup, this is the amount of a day, divided into two drinks. This remedy has the effect of tonifying the heart and spleen, nourishing blood and calming the mind, and is suitable for palpitations and palpitations, insomnia and forgetfulness, weakness and tiredness, anemia, and neurasthenia.
IV. Preventive care
At present, the etiology of many mental diseases is not well understood. Over the years, professional workers have formed some simple concepts based on continuous and careful observation of many mental diseases in their life and work practice. It is recognized that many mental illnesses are the result of anomalies arising from the interaction between the human individual and the social or natural environment. In many cases, although the external conditions are similar, the occurrence of disease can be very different, suggesting that individual characteristics play an important role in the occurrence of disease. Therefore, in order to prevent the occurrence of this type of disease, people advocate to improve the level of mental health of people so that they can resist the attack of external harmful factors. This is done by.
① fostering the development of the organism as a whole, including brain function, and fostering its constant state of health, so that people are physically fit and mentally full.
② Foster the healthy development of personality and strengthen exercise, so that it is compatible with the social environment, unified. We should develop habits of living at regular intervals, work and study with a plan, combining work and rest, and relaxation.
Pathogenesis
Since Beard, neurasthenia has been seen as a holistic disease that can be caused by many factors such as quality, somatic, psychological, social and environmental.
1, Pavlov believed that people whose higher neural activity type is weak and intermediate are susceptible to neurosis. These individuals tend to be withdrawn, timid, sensitive, suspicious, impatient or easily tense when things go wrong.
2, excessive tension in the function of the nervous system, long-term psychological conflict and trauma caused by negative emotional experience, irregular life, excessive fatigue without adequate rest, etc. can be the cause of the disease. In China in the late 1950s and early 1960s, a large number of studies were conducted on the causes of neurasthenia, and it was believed that excessive tension in the nervous system was one of the main causes of the disease. Li Congpei et al. (1959) and Liu Xiehe et al. (1960) investigated the data of neurasthenia in different occupational groups and showed that the prevalence was highest in brain workers. More than half of the patients reported that work or study, mainly brain activity, was overly stressful. Not only are the hours of mental activity too long and the work tasks too heavy; learning or working is difficult. Especially demanding, attention needs to be highly focused on the brain work, more likely to cause excessive tension and fatigue.
3, infection, poisoning, malnutrition, endocrine disorders, cranio-cerebral trauma and somatic diseases can also become the cause of the disease.
4, long-term psychological conflict and trauma caused by negative emotional experience is another more common cause of the disease. Maladjustment in study and work, family disputes, mishandling of marital and romantic problems, and interpersonal tensions mostly cause conflicts and inner conflicts in patients’ minds, which become the root cause of long-term pain. Another example is the sudden death of a loved one, major family misfortune, life setbacks, etc., will also cause sadness, pain and other negative emotional experiences, resulting in neurasthenia.
Fifth, the busy and disorderly life, the disruption of work and rest patterns and sleep habits, as well as the lack of adequate rest, so that tension and fatigue are not restored, also for the susceptibility of neurasthenia factors.
Sixth, the disease diagnosis
Diseases that need to be differentiated from neurasthenia include
1, organic brain and somatic diseases: neurasthenia symptoms are common in various organic brain diseases, such as cerebral arteriosclerosis, intracranial occupying lesions, intracranial infections, after cranio-cerebral injury; various acute and chronic industrial poisoning; and various chronic somatic diseases, such as tuberculosis, ulcer disease, chronic hepatitis, sinusitis, thyroid and adrenal gland diseases, etc. If the symptoms of neurasthenia occur after the above diseases, the diagnosis should be the corresponding brain or somatic diseases mentioned above.
2.Severe mental illness: neurasthenia symptoms can be seen in the early, middle and remission stages of severe mental illnesses such as schizophrenia and depression. These patients can have neurological symptoms in the early stage, often do not actively care about their health, do not actively request treatment, and have corresponding psychotic symptoms, which can be distinguished.
3, other neurological disorders: neurasthenia symptoms are also common in anxiety disorders, bad mood, somatization disorders, hypochondria, etc.. If the patient has the typical symptoms of these disorders, according to the principle of hierarchical diagnosis, it is no longer diagnosed as neurasthenia, but as various corresponding diseases.
The problem of maladjustment needs to be especially mentioned here, especially since college students are far away from their hometowns and relatives, their learning methods are different from those of secondary schools, and their living environment is also different. Especially in the boarding students, they feel very uncomfortable with the group life, and the occurrence of a group of symptoms similar to neurasthenia is actually maladjustment. In the past, maladjustment was not sufficiently recognized and was often diagnosed as neurasthenia. Some patients seek medical help everywhere, take medicine, but the effect is not good, and by psychotherapy, short course of psychological analysis, the effect is remarkable.
4, fatigue reaction: normal people after mental or physical overwork, often produce fatigue reaction, headache, dizziness, drowsiness, lack of energy, lack of concentration, insomnia, or irritability, irritability and other symptoms. However, these symptoms are short-lived, and after the elimination of the factors causing fatigue, the patient can quickly return to normal after sufficient rest; generally, they do not cause excessive worries or unpleasant emotional experiences. If the workload has been reduced, after proper rest, the above symptoms still persist, or are sometimes mild and heavy, and persist for more than 3 months, then the diagnosis of neurasthenia should be made. In the epidemiological investigation, in addition to the requirement to meet the symptomatology criteria and severity criteria, the duration of the disease must last for more than 3 months, which is very important to exclude other diseases.
5, chronic fatigue syndrome: chronic fatigue syndrome (chronic fatigue syndrome) which is the U.S. Centers for Disease Control (Centers for Disease Control, CDC) recommended the use of a class of etiology is not known, characterized by chronic fatigue syndrome name. The diagnostic criteria for this syndrome are as follows.
Primary criteria: (i) a recent onset of severe and debilitating fatigue that lasts at least 6 months; (ii) no medical or psychiatric disorders found to be causing the fatigue.
Secondary criteria: including widespread headache, myalgia, arthralgia, fever, sore throat, lymph node pain, muscle weakness, persistent fatigue after activity, neuropsychological symptoms (such as irritability, forgetfulness, inattention, difficulty in thinking, depression, etc.), sleep disorders, and sudden onset of fatigue. (At least 8 of these symptoms are required).
Objective criteria: These include low fever (37.6 to 38.0°C on the oral surface or 37.9 to 38.8°C on the anal surface), non-exudative pharyngitis, and enlarged and tender anterior cervical or axillary lymph nodes.
This type of disease is suspected to be Epstein-Barr virus infection or immune abnormalities. It is distinguished from neurasthenia because of objective signs such as hypothermia, sore throat and lymph node growth.
Since many of the symptoms of neurasthenia are similar to anxiety disorders or depressive neurosis or insidious depression, depression and anxiety disorders should be ruled out first in clinical practice and judged by the evolution of symptoms and treatment effects to avoid treating neurasthenia as a “garbage can”. It should also be distinguished from early symptoms of schizophrenia, post-cranial trauma syndrome, maladjustment, and overexertion. Overexertion causes fatigue, dizziness, inability to concentrate and other symptoms, which can be recovered after rest.
VII. Examination methods
Laboratory tests.
There are no specific laboratory tests for this disease. When there are comorbidities, such as infections, laboratory tests show positive results for complications.
Other ancillary tests.
There are no specific auxiliary laboratory tests for this disease.
VIII. Complications
No relevant information is available
IX. Prognosis
Most of the cases have a slow onset and can be traced to stress factors that lead to prolonged mental stress and fatigue. Occasionally, sudden insomnia or headache may occur, and no obvious external cause can be found. The course of the disease persists, or it may be mild or severe at times. Most cases resolve within six months to two years if appropriate treatment is given in a timely manner. Chronic cases with a duration of more than 2 years, or those with personality disorders, have a poor prognosis.
X. Pathogenesis
1, physiological quality and personality characteristics Pavlov believes that the personality characteristics of people with weak and intermediate types of higher neural activity are withdrawn, timid, sensitive and suspicious, impatient, and easily stressed. According to the Pavlovian school, the main pathophysiological basis of the disease is the weakening of the cortical inhibition process. When the internal inhibition process is weakened, the excitability of nerve cells is relatively high, and the response to external stimuli can be strong and rapid, thus causing a large amount of energy consumption of nerve cells. Clinically, these patients often show easy excitement and fatigue. On the other hand, the cortical function is weakened, and the function of regulating and controlling the subcortical autonomic nervous system is also weakened, which leads to various symptoms of autonomic hyperfunction.
2, infection, poisoning, malnutrition, endocrine disorders and other adverse effects on the nervous system, Beard envisages the onset of neurasthenia caused by the dephosphorylation of central nervous cells (dephosphorization).
Dejerine and Gauckler (1913) suggested that it was caused by psychological factors. The neurasthenia is caused by excessive stress, especially unpleasant emotions caused by excessive stress, while Laughlin (1967) considered neurasthenia as a state of fatigue caused by excessive psychological conflicts. The psychoanalytic school believes that neurosis is caused by frustration of sexual instincts, suppression of aggression, struggle with unconscious dependency needs, reinforcement of repression, and other unresolved infantile conflicts.