Psychovegetative syndrome is a painful condition characterized by cardiac ailments (a feeling of constriction, rapid heartbeat), headaches, heaviness in the stomach, urinary disorders, increased sensitivity to cold, sweating, nausea, dizziness, disorders monthly cycle. In addition, depression, various phobias, internal restlessness, anxiety, irritability, insomnia and apathy are often noted. Patients characterize all these symptoms as pronounced. However, after a thorough medical examination, it turns out that internal organs(heart, stomach, intestines and bladder) patients are absolutely healthy.

Symptoms

• Heart ailments.
• Heaviness in the stomach, disturbances in urination and bowel movements.
• Nausea, dizziness, headaches, sweating.
• Depression, phobias, insomnia.

Causes

The psychovegetative syndrome is based on a dysfunction of the human autonomic nervous system. Predisposition to this disorder is usually inherited, but its true cause is a large psychological burden.

Treatment

For severe symptoms, drug treatment is most often used. Some medications have a calming effect on the autonomic nervous system. Usually, the symptoms of psychovegetative syndrome disappear quite quickly, but the disease is not completely cured.

In uncomplicated cases, when psychovegetative disorders appear only occasionally, you just need to relax. For example, you can take a vacation, go out of town, or go for a walk fresh air. If symptoms are severe and prolonged, you should consider changing your lifestyle. Often, the disappearance of all symptoms of the disease is facilitated by a change of profession, the end of a difficult relationship with a partner, engaging in a completely new type of activity, delving deeper into religion, etc.

As a rule, people suffering from psychovegetative disorders do not try to fight them. However, if somatic disorders occur, you should immediately consult a qualified doctor. Today, many people suffer from mental exhaustion, so it is recommended to contact a psychologist as early as possible and start anti-stress therapy. In severe cases, certain mental disorders may be incurable.

Before diagnosing psychovegetative syndrome, the doctor must find out whether the patient suffers from any organic disease, for example, gastric ulcer. Once the diagnosis is made, medications are prescribed. Then the doctor will definitely ask the patient about his lifestyle, perhaps advise him to change something or refer him to a psychotherapist.

Course of the disease

This syndrome can occur in different ways. Symptoms and their severity also vary. Most often, ailments appear at the age of 40, as well as during periods of hormonal changes. Symptoms of the disease can most often be successfully treated. To avoid relapse, lifestyle changes or psychotherapy are recommended. However, the predisposition to this disorder (which manifests itself with more and more new symptoms) persists throughout life.

Psychovegetative syndrome is an unhealthy human condition that is characterized by:

1. heart ailments (rapid pulse, chest tightness);
2. heaviness in the stomach area;
3. headache;
4. impaired urination;
5. excessive sweating;
6. dizziness;
7. nausea;
8. sensitivity to cold;
9. changes and cessation of the menstrual cycle.

In many cases, a depressed, anxious, irritable state, internal restlessness, various phobias, insomnia and apathy are noticed. This was the main list of symptoms with which people turn to specialists. However, upon careful examination of a person’s condition, his overall health, it turns out that the organs that the patient complained about (stomach, heart, kidneys, and bladder) are absolutely healthy, and the symptoms were false.

Causes of occurrence and development

Psychovegetative disorders are in many cases diagnosed in children who belong to a group close in age to teenagers. Less common in young adolescents and young adults. And in rare cases, the syndrome manifests itself in older people. It is believed that there are “prone” groups of people who have a very high risk of developing or developing a psychovegetative syndrome:

• lack of a permanent job;
• meager wages;
• female;
• poor health of a person, low self-esteem;
• presence of traumatic events or situations;
• difficult family situation (divorced, widowed);
• advanced age;
• chronic neurological disease;
• regularly present in clinics and during hospitalizations.

The syndrome most often manifests itself in adolescents. This is explained by the inhibited development and formation of important hormonal systems in a young body, as well as the development and growth of the human body.

Psychovegetative syndrome is detected under the influence of heredity, human constitution, and disorders of the nervous system. Symptoms of this syndrome may also appear after changes in the body’s hormonal levels, various types stress, disorders of the nervous system of the body, various diseases profession-related, nervous breakdowns and mental disorders.

All of these factors contribute to the emergence and development of psychovegetative syndrome. It is necessary to begin timely treatment, otherwise the development of the disease may be complicated by the manifestation of more serious symptoms and complications, for example, panic attacks.

The syndrome manifests itself as a result of organic diseases of the brain, as well as in the presence of damage to the peripheral nervous system. However, the most common reason for the development of the syndrome is the process of development and restructuring endocrine system V adolescence and during menopause in women. Another form of the syndrome is psychophysiological autonomic dystonia, which can manifest in a person after stress, panic situations, overwork, tiring physical activity and neurotic disorders.

Treatment

Treatment with various medications is carried out only in cases where the symptoms do not recede or go away. Some medications have a beneficial effect on the nervous system, calming it. Often, most of the symptoms of mental disorders or psychovegetative syndrome go away very quickly, but the illness is not completely cured.

In the early stages, in uncomplicated cases, when disorders rarely appear, it is enough to simply relax. Many people find it helpful to take a vacation and go to the countryside or take a walk in the fresh air. But with prolonged symptoms and complications, you need to think about changing your lifestyle and a complete change of environment. In many cases, symptoms disappear, even without special treatment, when changing professions, breaking off complex, exhausting relationships with a partner, changing activities, delving deeper into religion, etc.

Often, people who suffer from psychovegetative disorders have pronounced symptoms, they do not even try to fight and go for treatment. And in case of somatic disorders, it is important to consult a doctor as soon as possible. Nowadays, many people suffer from mental exhaustion, as a result of which it is recommended to contact a psychotherapist earlier and begin anti-stress treatment. In advanced cases, some syndromes and mental disorders will not be treatable.

Before a doctor makes a diagnosis of psychovegetative syndrome, he is obliged to find out and make sure that the patient does not have any other disease that could interfere with the course of treatment for a mental disorder. And after that he prescribes medications. The doctor will also ask the patient about his lifestyle, maybe advise him to change something or refer him to a psychotherapist.

The syndrome develops individually in each patient. Both the symptoms and the degree of their exacerbation may vary in variety. Typically, ailments appear in women at the age of forty and in adolescents during hormonal changes. Patients are recommended to change their lifestyle and psychotherapy.

Disruption of the body's activity due to problems in the functioning of the nervous system or changes in the psyche is called psychovegetative syndrome. Synonyms this definition– vegetative dystonia, psychasthenic decline. This is a condition in which vegetative functions change, varying in manifestations and origin.

The patient's complaints about the functioning of certain organs are not confirmed during the examination. But painful manifestations force him to consult a doctor more than once. The patient’s emotional state is fueled by irritation, anxiety, internal restlessness, and apathy.

Possible reasons

The occurrence of psychovegetative disorders is inherited, is associated with the structure of the body, and is also formed as a result of a disorder of the nervous system. In children, the disease manifests itself at an early age. As you get older, the condition stabilizes. But with increased physical stress (stress, strain, climate change, harmful work conditions, hormonal imbalance, somatic diseases), well-being worsens.

Factors that increase the risk of pathology:

• lack of permanent work;
• low salary;
• breakdown of family relationships, loss of a loved one;
• the presence of situations affecting the psyche;
• low self-esteem;
• neurological diseases of a chronic nature;
• female;
• old age.

Children close to the age of adolescence(puberty), young people with an immature neuroendocrine system. In women during pregnancy, breastfeeding and menopause, hormonal imbalance occurs, which can lead to the development of the anomaly in question.

Clinical signs

An important feature of the psychovegetative syndrome is the multiplicity of autonomic disorders. In this case, patients indicate the following disorders:

• feeling of tightness in the chest, changes in heartbeat;
• stomach ache;
• frequent vomiting;
• headache;
• dizziness;
• neuralgia of various localizations;
• problems with urination;
• increased sweating;
• changes in the menstrual cycle;
• feeling of cold.

Typically, psychovegetative syndrome with anxiety manifestations is characterized by the following symptoms:

• tension in the body, muscles are stiff;
• there is no opportunity to relax;
• fussy movements;
• irritation;
• impatience;
• excited state;
• forgetfulness;
• rapid onset of fatigue;
• absent-mindedness;
• poor night sleep;
• problems falling asleep;
• fears.

Symptoms of psychovegetative syndrome are varied and may indicate the presence of other syndromes:

1. Cardiovascular – heartbeat disturbance (tachycardia, bradycardia), arterial hypertension, feeling of cold hands and feet, flushing of the face, pallor.
2. Cardialgic - the appearance of pain of various types in the heart area, which is confused with angina pectoris, but Nitroglycerin does not help.
3. Hyperventilation – shortness of breath, cough, as if there is not enough air. When you breathe frequently, the ratio of oxygen and carbon dioxide in the lungs is disrupted, Airways spasm, pain similar to heart pain appears. Due to lack of air, a pre-fainting state occurs (the eyes become dark, the ears are noisy, the head is dizzy).
4. Irritable bowel syndrome - disruption of the gastrointestinal tract, intestinal upset, vomiting, heaviness in the epigastric region, decreased appetite.

Possible sexual disorders associated with erection and ejaculation in men, in women painful sensations in the vagina due to muscle spasm, anorgasmia develops.

With psychovegetative syndrome with cerebrovascular disorders, a person experiences pain and dizziness, noise in the ears, and a state close to fainting occurs. This situation is caused by changes in the blood vessels of the brain. The narrowing of the lumen of the arteries reduces cerebral blood flow, resulting in the development of atherosclerosis and increased blood pressure.

• breathing problems, feeling of lack of air;
• pain in the heart area;
• increased heart rate;
• increased blood pressure;
• increased sweating.

The patient develops a fear of cardiac arrest and stroke. The patient thinks that he will go crazy and die. Such symptoms are called psychovegetative syndrome with panic attacks.

Diagnostic methods

Determining the disease requires consultation with doctors of various specializations, as well as a thorough examination of the patient. What events are held:

1. Autonomic disorders are determined in conversation with the patient using a special questionnaire.
2. Somatic diseases are excluded based on patient complaints.
3. Find out how difficult life situations and the occurrence of vegetative symptoms are connected.
4. Clarify how autonomic disorders occur.
5. Determine whether there are mental symptoms: sleep disturbances, deterioration in emotional mood, changes in appetite, fatigue.

For examination the following is prescribed:

1. Dopplerography of blood vessels;
2. computed tomography;
3. blood test for hormones;
4. Ultrasound of the heart.

Differential diagnosis is aimed at excluding diseases with similar symptoms. For example, anxiety states appear with increased thyroid function, and cardialgia syndrome is confused with angina pectoris.

If the heart malfunctions, the patient undergoes a specialized examination. This is a necessary measure when diagnosing this syndrome. At the same time, the examination should be understandable and uncomplicated for patients. Otherwise, patients will worry and come up with a catastrophic diagnosis.

Treatment methods used

To stabilize emotional state the patient is referred to psychotherapy sessions. It is important for him to understand the essence of what is happening. The patient must know that there is no threat to life and the disease is curable. The doctor explains the origin of the symptoms and their connection with mental disorders. To do this, he uses the following methods: suggestion, persuasion, psychoanalysis.

When the treatment of psychovegetative syndrome does not require medications, the patient is prescribed:

• reflexology;
• massage;
• physical therapy;
• breathing exercises;
• physiotherapeutic measures.

To escape from reality and improve your health, sanatorium treatment is recommended. Changes in climatic and everyday conditions force the body to rebuild and adapt. A new rhythm appears, they train protective forces, disease resistance increases.

If the disease occurs in an acute form, drug therapy is included:

1. Analgesics – to relieve persistent pain.
2. Beta blockers reduce blood pressure, relieve heart pain, and stabilize the pulse.
3. Tinctures from medicinal plants- to increase pressure.
4. Tinctures of valerian and ginseng equalize blood pressure.

In most cases, these remedies are ineffective. It is necessary to treat using psychotropic drugs:

1. Benzodiazepines - for a short time to relieve anxiety and normalize sleep (Clonazepam, Lorazepam).
2. Sedative antidepressants relieve anxiety.
3. Antidepressants with double action - to increase the level of serotonin in the brain (Fluoxetine or Prozac, Paroxetine or Paxil, Sertraline or Zoloft).
4. Minor antipsychotics are effective and safe (Teraligen).
5. The anxiolytic “Strezam” does not have a depressing effect, is not addictive, and is highly effective.

When prescribing psychotropic drugs, you need to carefully select the dosage and determine the period of use. Long-term treatment causes fear of drug withdrawal and provokes the return of symptoms of the disease.

Ph.D. A.V. Moskvin

T The term “psychovegetative disorders” brings together many symptoms, the most common of which are anxiety, feelings of internal tension, sleep disturbances, irritability, and inadequate and different emotional reactions. Often there are so-called paroxysmal psychovegetative disorders - phobias, panic attacks.

Descriptions of such disorders have been repeatedly found in fiction and medical literature for many centuries. Thus, already in 1894, S. Freud, in his work “Justification for separating certain syndromes from neurasthenia: anxiety neuroses,” pointed out the specific clinical manifestations of psychovegetative disorders, in particular, pointing out that anxiety and panic, as the maximum degree of its severity, can be associated with disruption of one or more body functions. In this case, the patient may feel palpitations, compression of the throat, a feeling of lack of air, pain in the heart area, and so on. Currently, one can observe a significant prevalence of these disorders in the population, which may be associated with a stressful rhythm modern life, as well as a decrease in stress resistance in conditions of lack of time, excess information as a consequence of rapid urbanization. The frequency of these disorders is quite high and, according to various authors, is 10-20% in the population. It should be noted that adequate treatment of these disorders has great social significance . Thus, a number of studies have shown that patients suffering from permanent or paroxysmal psychovegetative disorders have more high level cholesterol, the risk of stroke doubles, and the risk of hypertension and myocardial infarction significantly increases compared to the general population. A comparative analysis of the risk of suicide showed that it is 20% for people with psychovegetative disorders and about 6% for patients with other mental pathology. Suicidal tendencies are especially common in patients in whom feelings of irritation and anxiety are combined with episodic panic attacks and in patients with long-term psychovegetative disorders, in particular, when transformed into anxious depression.

Another equally important social factor is increased risk of alcohol and benzodiazepine use , as well as abuse of these substances in the syndrome of psychovegetative disorders. Thus, constant alcohol consumption in such patients is 24.3%, dependence occurs in 8.7% of patients, benzodiazepine abuse is observed in approximately 26% of patients, and other narcotic drugs in 17% of patients.

The factors leading to the development of psychovegetative disorders are not completely clear at present. Undoubtedly, there is a certain significance personality traits . The possible role of adrenergic regulation disorders is discussed. It is known that the locus coeruleus, being one of the suprasegmental structures of autonomic regulation, is afferently and efferently projected onto a large number of brain structures, creating a wide network of behavioral and autonomic regulation. Experimental evidence suggests that anxiety disorders, in particular, may be caused by sympathetic hyperactivity. This is also indirectly confirmed by the fact that in patients with psychovegetative disorders there is a decrease in the number of presynaptic a 2 -adrenergic receptors, which can be explained by the inclusion of protective, anskiolytic mechanisms. . Research has suggested that psychovetetative disorders may develop as a result of genetic transformation of adrenergic receptors and the emergence of a population of adrenergic receptors with altered sensitivity. Unfortunately, multiple studies have not confirmed this hypothesis.

A significant role in the development of psychovegetative disorders is given to a decrease in the level of g-aminobutyric acid (GABA), which is one of the main inhibitory transmitters of the brain (Fig. 1). As is known, GABA is metabolized into glutamate (in this case, both direct and reverse reactions are possible), then glutamate, under the action of glutamate dehydrogenase, is broken down to the level of a-ketoglutaric acid. For physiological conditions, the reverse reaction is typical, that is, the formation of glutamate and then GABA. It is assumed that in patients with psychovegetative disorders there may be a special form of glutamate dehydrogenase, which under physiological conditions gives a direct reaction, which leads to the accumulation of glutamate and a decrease in the formation of GABA. An additional role in the formation of these disorders may be played by a decrease in the sensitivity of benzodiazepine receptors and a change in their ability to bind to the corresponding mediators.

Rice. 1. Metabolism of g-aminobutyric acid in patients with psychovegetative disorders

Mediator disorders in psychovegetative disorders can be widely represented in various parts of the brain, while the predominance of anxiety disorders may be the result of dysfunction of the predominantly limbic system . Paroxysms of psychovegetative disorders may be caused by a change in the regulatory influence of the reticular formation and its connection with other suprasegmental formations of autonomic regulation.

Phobias , as a rule, have a more complex formation mechanism. The genesis of phobias is associated, among other things, with the formation of altered behavior and altered ideas. Thus, in this case we can talk about the interest of the cerebral cortex. It should be noted that the peripheral autonomic system can not only serve as a mechanism for the implementation of clinical manifestations of psychovegetative disorders, but also independently participate in their formation. Thus, the possible participation of the metasympathetic system in the development of psycho-vegetative syndrome is currently being discussed. In particular, it has been shown that the administration of cholecystokinin significantly increases the level of anxiety not only in patients with psychovegetative disorders, but also in healthy subjects. These changes may be due to both the competitive interaction of this mediator with benzodiazepine receptors and direct stimulation of the metasympathetic system. In this case, primary anxiety manifestations can be realized at the peripheral level. Only with the long-term existence of anxiety disorders can central mechanisms be involved in the pathological process.

Based on the supposed pathogenesis of psychovegetative disorders, it is obvious that the main place in the treatment of these disorders is given to tranquilizers - benzodiazepine derivative . Currently, we have to admit that this method of treatment is far from ideal, primarily due to developing side effects. The most common side effects include increased drowsiness, decreased concentration, and impaired coordination. Considering the fact that psychovegetative syndrome develops mainly in working people, the influence of this therapy on the performance of patients is obvious. The often developing decrease in performance while taking benzodiazepines can lead to social maladaptation of patients. In addition, long-term use of benzodiazepine drugs can lead to drug dependence. As mentioned above, the factor of the possible development of drug dependence is especially serious in patients with psychovegetative disorders, given their primary personal predisposition to the formation of drug, alcohol and drug addiction. When assessing the effectiveness of treatment with benzodiazepines, it was shown that a good therapeutic effect develops after 8 weeks of therapy and lasts about 3 months, after which, even with an increase in the dose of drugs taken, as a rule, a persistent deterioration occurs. When prescribing benzodiazepine drugs, there are limits to the therapeutic dose due to the side effects of drugs of this pharmacotherapeutic group in the form of inhibition of the respiratory center and a decrease in myocardial contractility. Specified side effects also do not allow achieving adequate doses in patients with pathologies of the respiratory and cardiovascular systems.

Thus, the listed facts do not allow the method of treating psychovegetative disorders with benzodiazepine drugs to be considered completely satisfactory and force doctors to explore alternative treatment options for these disorders.

It is advisable to include various psychotherapeutic techniques , in particular, rational and cognitive therapy, a method of psychosemantic correction that allows one to effectively transform the patient’s socio-biological system. In a number of cases, biofeedback methods have been effective and successfully used. A particular problem is posed by patients with organic diseases, accompanied by a wide range of psychopathological reactions and autonomic disorders. When correcting them, it is necessary to identify the dominant cause that triggers the vegetative cascade.

The most effective and safe methods for correcting psychosemantic disorders caused by information stress are systemic psychotechnologies , correcting the influence of information stimuli (verbal and non-verbal) and psychosemantic elements (semantic meanings that determine the patient’s internal picture of the world), and optimizing the patient’s socio-biological system. An important result of the method used is the optimization of information fields and socio-biological systems surrounding the patient. The use of systemic psychotechnologies in 72 patients showed a persistent positive effect of stabilizing autonomic functions in 84%. There was a significant decrease in the intensity and duration of periods of situational and personal anxiety, unmotivated aggression, and a significant improvement in the quality of life. There was a decrease in the intensity of obsessive states and reactions of obsessive-phobic symptoms. Thus, this method of treatment should be considered effective and useful.

Conducting psychotherapeutic correction in patients, if necessary, can be combined with taking medicines, which do not have side effects such as slowing down cognitive and mental activity. Such drugs, in particular, include non-chemical compounds and plant derivatives. In this aspect, it is of great interest Persen , which contains extracts of valerian, lemon balm, and peppermint, which have pronounced anxiolytic activity.

The studies have shown high effectiveness of Persen against anxiety disorders within the psychovetative syndrome . Thus, a placebo-controlled clinical trial of the effectiveness of this drug was conducted in 93 patients with psychovegetative syndrome in the structure of neurotic anxiety disorders. The study included 62 women and 31 men. Patients ranged in age from 16 to 62 years, with the average age of patients included in the trial being 34.5 years. All patients were divided into 2 groups. The first group included 47 patients (30 women, 17 men, average age 34.8 years) who received Persen Forte at a dose of 1 capsule (125 mg) 2 times a day. The second group consisted of 46 patients (32 women, 14 men, average age 35.0 years) who received placebo, 1 capsule 2 times a day. Placebo and Persen Forte were identical in dosage form and type of packaging. The course of treatment was 28 days. A prerequisite for inclusion in the clinical trial was the absence of any medications for 2 weeks prior to the appointment of Persen.

As part of this study, patients underwent a neurological examination, a questionnaire method was used - questionnaires for assessing the state of the autonomic nervous system, assessing the quality of sleep, assessing the quality of life, as well as the Holmes and Ray life events scale, a visual analogue scale for subjective assessment of well-being, the Spielberger and Beck scales. The level of attention and performance of patients was analyzed using the Bourdon correction test and the Schulte test.

The main clinical manifestations in patients included in the study were increased anxiety, feelings of internal tension, irritability, and phobias. A significant number of patients had symptoms such as tension headaches (74%), general weakness (67%), increased fatigue (53%), a feeling of shortness of breath (80%), non-systemic dizziness (68%), difficulty falling asleep (74). %), psychogenic cardialgia (62%).

Analysis of questionnaire data showed that patients in the study groups had severe anxiety disorders, significant autonomic disorders and sleep disorders, and a mild level of depression. All patients noted a decrease in quality of life against the background of existing disorders.

Analysis of clinical manifestations after one week of treatment showed a decrease in the level of reactive anxiety, which significantly decreased in both study groups. On the 28th day of therapy, both groups showed a decrease in general weakness, fatigue, irritability, anxiety, feeling of lack of air, as well as psychogenic cardialgia. The improvement in well-being on the visual analogue scale reached significance in both groups, however, a comparative analysis of the data obtained showed that the dynamics of this indicator were significantly greater in patients receiving Persen. During treatment with Persen, there was a significant decrease in anxiety levels , and the severity of this effect directly depended on the duration of therapy. There was a significant decrease in depressive disorders in the group of patients receiving Persen. These patients also showed a significant decrease in the severity of tension headaches and the severity of autonomic disorders. Analysis of questionnaire data showed a significant improvement in the quality of life in patients receiving Persen. In the placebo group, this indicator did not reach statistical significance.

There were no side effects in the group taking Persen. It is important to note that patients receiving Persen did not experience decreased attention or increased daytime sleepiness. Thus, the drug was well tolerated and its use did not affect the patients’ ability to work.

Thus, we can conclude that Persen can be effective in the treatment of psychovegetative and post-traumatic stress disorders. Mainly, the degree of manifestations of the disease such as reactive and personal anxiety, sleep disturbance, and depression decreases, which allows us to conclude that the drug has pronounced anxiolytic and vegetotropic properties. An improvement in the quality of life indicates the achievement of social adaptation of patients during therapy with this drug, and may be an indirect indicator of the persistence of the obtained therapeutic effect. Data on no effect of taking Persen on the level of performance of patients , and also the fact that Persen does not cause daytime sleepiness. All this allows us to draw a conclusion about the safety and feasibility of using this drug in the treatment of psychovegetative disorders, in clinical picture which are dominated by manifestations of anxiety.

It should be noted that a prerequisite for achieving a lasting positive effect from the therapy is the provision of psychotherapeutic correction methods to patients, of which individual psychosemantic correction can be considered the most effective today.

Catad_tema Autonomic dysfunction syndrome (AVS) - articles

Possibilities for treating psychovegetative syndrome

O.V.Kotova
Department of Pathology of the Autonomic Nervous System, Research Center of the First Moscow State Medical University named after. I.M.Sechenova

The principles of diagnosis and treatment of psychovegetative syndrome are considered. An integrated approach significantly improves treatment results: it is advisable to combine any psychotropic drugs with vegetotropic therapy.

Keywords: psychovegetative syndrome, psychotropic drugs, vegetotropic therapy, ethyl-methylhydroxypyridine succinate.

Possibilities of treatment of psychovegetative syndrome
O.V.Kotova
First Moscow Medical State University named by I.M.Sechenov, Moscow
Principles of diagnosis and treatment of psychovegetative syndrome are considered. Complex approach may significantly improve results of treatment: it is reasonable to combine any psychotropic medications with vegetotropic therapy.
Key words: psychovegetative syndrome, psychotropic medications, vegetotropic therapy, ethylmethylhydro-xypyridine succinate.

Vegetative dystonia syndrome (VDS) is a diagnosis that is made by doctors of various specialties to a huge number of patients.
Unfortunately, doctors often forget that SVD is a combination of several clinical units, namely:

Psychovegetative syndrome (PVS) is the most common form of SVD;
peripheral autonomic failure syndrome;
angiotrophoalgic syndrome.

This article will focus primarily on PVS.

In the middle of the last century, the German researcher W. Thiele proposed the term “psychovegetative syndrome” to refer to suprasegmental autonomic disorders. In Russian literature this term gained a foothold thanks to the work of Academician A.M. Wayne, and is still used to refer to SVD associated with psychogenic factors, and as a manifestation of emotional and affective disorders.

According to statistics, more than 25% of patients in the general somatic network have PVS. In certain territories of Russia, the volume of the diagnosis of SVD is 20-30% of the total volume of registered data on morbidity, and in the absence of the need to refer the patient for consultation to specialized psychiatric institutions, it is coded by doctors and statisticians of outpatient clinics as a somatic diagnosis. In more than 70% of cases, SVD is included in the main diagnosis under the heading of somatic nosology G90.9 - disorder of the autonomic (autonomic) nervous system, unspecified or G90.8 - other disorders of the nervous system. Based on the results of a survey of 206 neurologists and therapists in Russia, participants in conferences held by the Department of Pathology of the Autonomic Nervous System of the Scientific Research Center and the Department of Nervous Diseases of the Federal Faculty of Physics of the First Moscow State University medical university named after I.M. Sechenov for the period 2009-2010, 97% of respondents use the diagnosis “SVD” in their practice, of which 64% use it constantly and often.

Despite the fact that PVS is not an independent nosological entity, most doctors use this term for a syndromic description of psychogenically caused multisystem autonomic disorders. The latter include disorders of somatic (autonomic) functions of various origins and manifestations, associated with a disorder of their neurogenic regulation. Therefore, the terms “neurocirculatory dystonia” or “vegetative-vascular dystonia” are a special case of PVS and indicate autonomic disorders with an emphasis on disorders in the cardiovascular system.

Most often, patients with this pathology are characterized by a high probability of repeated visits to specialists due to dissatisfaction with the prescribed treatment.

When visiting a doctor, patients complain primarily of somatovegetative disorders: persistent cardialgia, prolonged and “unexplained” hyperthermia, constant shortness of breath, persistent feeling of nausea, debilitating sweating, dizziness, dramatic vegetative paroxysms for patients or, in modern terminology, “panic attacks" (PA), etc.

SVD can develop as a result of many reasons and have different nosological affiliations.

SVD may have a hereditary-constitutional nature. In this case, autonomic disorders debut in childhood and are often familial and hereditary in nature. With age, vegetative instability can be compensated, however, this compensation is, as a rule, unstable and is disrupted under any load (stressful situations, physical exercise, change in climatic conditions, occupational hazards, as well as big number internal factors- hormonal changes, somatic diseases, etc.).

SVD can occur as part of psychophysiological reactions in healthy people under the influence of extraordinary, extreme events and in an acute stressful situation.

SVD can occur during periods of hormonal changes (puberty, premenopause and menopause, pregnancy, lactation), as well as when taking hormonal medications.

SVD occurs in different occupational diseases, organic somatic and neurological diseases. Treatment of the underlying disease leads to a decrease or complete disappearance of signs of VDS.

In the vast majority of cases, the cause of PVS is mental disorders of an anxious or anxious-depressive nature within the framework of neurotic, stress-related disorders, or, less commonly, an endogenous disease. Mental disorders - anxiety and depression, along with mental symptoms, have somatic or autonomic disorders in their clinical picture. In some patients, vegetative symptoms are leading in the clinical picture of the disease, in others, mental disorders come first, which are accompanied by pronounced vegetative disorders, but such patients consider them a natural reaction to an existing “severe somatic illness.” For this reason, patients seek help from a general practitioner, cardiologist, gastroenterologist or neurologist, which makes the problem of PVS interdisciplinary, and doctors of different specialties need not only to be able to diagnose the disease, but also to be able to help the patient get rid of his suffering.

Analysis of the characteristics of subjective and objective somatic or vegetative manifestations helps to assume their psychosomatic or psychovegetative nature.

One of the most important features of PVS is the polysystemic nature of autonomic disorders. The doctor’s ability to see, in addition to the leading complaint, the naturally accompanying disorders of other systems, allows one to understand the pathogenetic essence of these disorders already at the clinical stage. For example, cardialgia with PVS is most often associated with muscle tension in the pectoral muscles and is closely related to increased breathing and hyperventilation.

Sinus tachycardia from 90 to 130-140 beats/min is a common manifestation of PVS. Subjectively, patients feel not only a rapid heartbeat, but also that the heart “hits the chest,” interruptions, tremors, and fading (extrasystoles). In addition to these cardioarrhythmic disorders, patients experience general weakness, dizziness, lack of air, and paresthesia.

Gastrointestinal tract (GIT) disorders of a psychogenic nature are detected in 30-60% of patients in the gastroenterology department. The most serious manifestation is abdominalgia. A feature of abdominalgia with PVS is their tendency to paroxysms, as well as strong psycho-vegetative accompaniment (hyperventilation, increased neuromuscular excitability, increased gastrointestinal motility).

The presence of a certain connection between the patient’s subjective experiences, the dynamics of the psychogenic situation and the appearance or aggravation of certain somatic symptoms is one of the criteria for PVS. Reduction of somatic complaints usually occurs under the influence of sedatives - validol, corvalol, valerian, benzodiazapines, etc.

Careful questioning of the patient can reveal the unusualness of clinical manifestations and dissimilarity to known somatic suffering. If there are complaints about the presence of pain - cardiagia or abdominalgia - the nature of the pain can vary widely. The pain can be stabbing, pressing, squeezing, burning or throbbing. These may also be sensations that are far from pain in their characteristics (discomfort, unpleasant feeling"feelings of the heart"). They may have atypical localization for organic pain and wider irradiation. For example, with cardialgia, pain radiates to left hand, left shoulder, left hypochondrium, under the shoulder blade, in the axillary region, in some cases it can spread to the right half chest; it lasts longer than with angina pectoris. With abdominal pain, pain is localized, as a rule, along the midline of the abdomen.

The correlation between the patient’s ideas about his illness (in patients with PVS the internal picture of the disease is “developed” and is fantastic) and the degree of their implementation in behavior allows us to determine the role of mental disorders in their pathogenesis.

When examining a patient with PVS, there are no objective clinical and paraclinical signs indicating the presence of organic pathology in a particular system.

The differential diagnosis of SVD should be made with thyrotoxicosis, since with an increase in thyroid function, secondary anxiety disorders may appear, which have the necessary objective and subjective manifestations.

The most important is the differential diagnosis of cardialgic and cardiarrhythmic syndromes with angina pectoris, especially its atypical variants, and arrhythmias. In such cases, the patient should undergo a specialized cardiac examination. This is a necessary stage in the negative diagnosis of SVD. At the same time, when examining this category of patients, it is necessary to avoid multiple, uninformative studies, since their conduct and inevitable instrumental findings can support the patient’s catastrophic ideas about his disease.

It is also important to remember that manifestations of SVD in some cases may be associated with side effect medications: amphetamines, bronchodilators, caffeine, ephedrine, levodopa, levoteroxine, antidepressants with a pronounced activating effect. When they are cancelled, autonomic disorders regress.

In most cases, autonomic disorders are secondary and occur against a background of mental disorders. It must be remembered that psychovegetative syndrome is the first stage of a doctor’s diagnostic deliberations, which can be completed by making a nosological diagnosis. In this case, a psychiatrist will provide invaluable assistance to a general practitioner or neurologist by determining the type of mental disorder.

Currently, the following groups of drugs are used in the treatment of psychovegetative syndrome:

Vegetotropic agents;
antidepressants;
tranquilizers (benzodiazepines, typical and atypical);
minor neuroleptics.

In the treatment of PVS, given its predominantly psychogenic origin, psychotropic therapy has priority. It is not the symptom or syndrome that needs to be treated, but the disease. In the case of PVS, these are anxiety and depressive disorders.

It should be noted that it is advisable to combine the use of any psychotropic drugs with vegetotropic therapy, since an integrated approach significantly improves treatment results. Among the agents widely used for these purposes is ethylmethylhydroxypyridine succinate (2-ethyl-6-methyl-3-hydroxypyridine succinate) (ES), an inhibitor of free radical processes. The spectrum of action includes membrane-protective, antihypoxic, stress-protective, nootropic, antiepileptic, and anxiolytic effects. Ethylmethylhydroxypyridine succinate modulates the activity of membrane-bound enzymes, receptor complexes (benzodiazepine, GABA, acetylcholine), which promotes their binding to ligands, preservation of the structural and functional organization of biomembranes, transport of neurotransmitters and improvement of synaptic transmission. ES, although not GABA, increases the amount of this neurotransmitter in the brain and/or improves its binding to GABAA receptors.

ES increases the concentration of dopamine in the brain through increased activity of dopamine neurons in the central nervous system, and dopamine levels are important for emotions such as satisfaction, joy, etc. .

ES increases the body's resistance to the effects of various damaging factors in pathological conditions (shock, hypoxia and ischemia, cerebrovascular accidents, intoxication with ethanol and antipsychotic drugs).

ES has cerebroprotective, anti-alcohol, nootropic, antihypoxic, tranquilizing, anticonvulsant, antiparkinsonian, anti-stress, vegetotropic effects. What are the indications for use: treatment of acute cerebrovascular accidents, dyscirculatory encephalopathy, psychovegetative syndrome, neurotic and neurosis-like disorders with anxiety, treatment of acute intoxication with neuroleptics and a number of other diseases.

If we talk about PVS therapy, then ethylmethylhydroxypyridine succinate has a pronounced tranquilizing and anti-stress effect, the ability to eliminate anxiety, fear, tension, and restlessness. ES has a potentiating effect on the effects of other neuropsychotropic drugs; under its influence, the effect of tranquilizing, neuroleptic, antidepressant, hypnotics and anticonvulsants is enhanced, which makes it possible to reduce their doses and reduce side effects.

According to the spectrum of action, ES can be classified as a daytime tranquilizer, which is effective both in a hospital setting and in outpatient practice, while there are no sedative, muscle relaxant or amnesic effects.

Another equally valuable drug for the treatment of PVS, which is used as a vegetoprotector, pyridoxine (vitamin B 6) is a precursor of glutamate and GABA, the main neurotransmitters in the central nervous system.

Severe pyridoxine deficiency may be accompanied by the development of seizures, which usually cannot be treated with conventional means. In addition, there is increased irritability, symptoms such as dermatitis, as well as cheilosis, glossitis and stomatitis. In psychiatry, the state of B6-dependent anxiety is described.

A doctor in his practice always tries to choose effective drugs with a combined effect, having different points of application on the pathogenesis of the disease, as this increases the patient’s adherence to treatment. Among such medicines is MexiV 6. This is a combined drug, which is available in tablets (No. 30), contains 125 mg of ethylmethylhydroxypyridine succinate and 10 mg of pyridoxine, and thanks to this unique composition it has vegetotropic, anxiolytic and anti-stress effects without sedative or addictive effects, which allows you to effectively normalize the patient’s psycho-emotional background.

In addition to pharmacological treatment, it is extremely important to explain to the patient the essence of the disease, and it is necessary to convince the patient that it is curable; explain the origin of symptoms, especially somatic ones, their relationship with mental disorders; convince that there is no organic disease (after a thorough examination). In addition, it is necessary to recommend regular physical exercise, stopping smoking, reducing coffee and alcohol consumption.

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