Lecture
Autonomic Disorder Syndrome
Psychic disorders of the neurotic level, formed by psychogenic mechanisms and proceeding with functional disturbances of various organs, are regarded by some authors as «organ neuroses»
V.N. Myasishchev [1960], alongside the reversibility of psychic disturbances obligatory for neuroses and the inseparable substantive link between the clinical manifestations of the neurosis and the conflict situation, noted a characteristic predominance of emotional-affective and viscero-autonomic disorders.
Disturbances localized in one or another organ (system) come to the fore.
V.N. Myasishchev proposes abandoning the concept of «organ neurosis», since, in his view, the pathological process underlying such disturbances is realized first and foremost at the cortical level (i.e., it remains uniform across all forms of neurosis), and only subsequently, owing to a number of additional factors (disturbance of processes in the cortical representation of the given organ, the involvement of local dyskinesias, etc.), manifests itself as a neurosis of the organ.
Developing his views on the nature of functional disturbances in neuroses, the author allows for the possibility of emotion being expressed through the reaction of an organ and of painful tendencies being symbolically expressed in various organs. According to V.N. Myasishchev, the more adequate term in such cases is «systemic neurosis».
Later, Karvasarsky B.D. [1980] introduces the concept of «autonomic disorder syndrome», which unites diverse forms of relatively localized dysfunctions
of the cardiovascular (cardialgic syndrome),
of the respiratory (syndrome of respiratory rhythm disturbance),
of the digestive (neurotic hiccups, esophageal spasm, vomiting, gastralgia, irritable bowel) system,
sexual dysfunctions.
Further, summarizing the accumulated data on functional disorders relatively confined to the limits of a particular anatomo-physiological system, B.D. Karvasarsky and V.F. Prostomolotov, in the monograph «Neurotic Disorders of Internal Organs» [1988], conclude that it is clinically expedient and justified to regard all psychogenic viscero-autonomic disturbances as complex symptom complexes within general neuroses.
Numerous terms (synonyms) have been used:
Neurocirculatory asthenia,
diencephalosis,
vegetonosis,
vegetopathy,
autonomic dysfunctions,
vegetative-vascular dystonia,
autonomic dysregulation,
NCD,
autonomic neurosis,
angioneurosis,
cortico-visceral neurosis.
Terms indicating a predominant dysfunction of internal organs:
«organoneuroses» (cardiac neurosis, gastric neurosis, respiratory neurosis).
This concerns polyetiological and polymorphic disturbances of central neuro-vegetative regulation, which it is expedient to consider within the framework of
1) vegetative dystonia of psychogenic (neurotic) origin;
2) vegetative dystonia of a functional character of non-psychogenic origin (for example, somatogenically conditioned);
3) vegetative dystonia in organic diseases of the CNS.
One can also classify paroxysmal disturbances of autonomic regulation arising against the background of vegetative dystonia – autonomic crises, or paroxysms.
two directions: psychocentric and somatocentric
Psychocentric direction
- Relative disregard for the role of somatic pathology (subclinical in cases of organ neuroses) both in the formation and in the dynamics of functional disturbances. The somato-vegetative symptom complexes under consideration are predominantly assessed as secondary (subordinate) in relation to psychic disorders.
Summarizing the works presented within the psychocentric direction, one can distinguish the following main concepts - psychogenesis (represented predominantly in works of the psychoanalytic direction), the realization of psychic pathology in the register of bodily disorders, and characterologically (personality) oriented concepts.
Concepts of psychogenesis
Historically linked to the concept of conversion, developed by S. Freud
Within conversion theory, neurotic dysfunctions of internal organs are interpreted as the result of the "displacement of energy" of an unresolved and subjectively unbearable emotional conflict into the somatic sphere. Such displacement may have a bidirectional significance for the subject - both as «gratification» (including in the form of reducing the distressing affective tension associated with the psychotraumatic situation) and as «punishment».
The theory of specific psychodynamic conflict (Alexander F., 1951) considers as a causal factor neurotic complexes repressed into the subconscious, the formation of which (unlike conversion disorders) is accompanied by persistent physiological and emotional disturbances.
Somatic symptoms, unlike conversion neurosis, are not formed as a substitutive symbolic expression of repressed emotions, but rather serve as a natural physiological correlate of a particular emotional state.
Somatic symptoms in vegetative neurosis do not eliminate the subjectively distressing emotional state, but accompany it, since they represent an integral component of it
Within the psychocentric approach, the concept of somatization as a «basic mechanism» of the human stress response is formulated.
Somatization
Somatization often develops as a result of the physiological accompaniment of an emotional stimulus, an essential part of the primary mental disorder: the patient's attention becomes fixed on typical somatovegetative manifestations of anxiety, such as respiratory disturbances (hyperventilation), chest pain, palpitations, and gastrointestinal disorders.
The persistent persistence of functional disturbances in patients with neurotic disorders is traditionally associated with the chronification of comorbid mental pathology, primarily – anxiety-phobic disorders.
Characterologically oriented concepts
In E. Kretschmer's psychological theory of constitution, a connection is established between physique characteristics, psychological traits, and predisposition to somatic pathology: the leptosomic constitution is associated with pulmonary tuberculosis and gastritis, the pyknic – with chronic rheumatism, atherosclerosis, and biliary tract diseases, the athletic – with epilepsy and migraines.
In the works of F. Dunbar [1943], a personality type is identified (subsequently designated as type A) that is prone to anginal complaints and the development of myocardial infarction.
The development of this approach leads to the elaboration of typological schemes identifying «at-risk personalities».
However, the results of empirical studies [Brautigam et al., 1999; Wyszynsky, 1996] do not confirm a specific connection between the identified personality types and disturbances (functional, organic) of particular organs and systems.
Somatocentric approach
Certain pathophysiological deviations, whether latent or minimally expressed (subclinical) manifestations of somatic pathology, are considered as the basis of functional disturbances of internal organs
Among such factors are cited structural changes resulting from past (or current) acute or focal infections, intoxications, hereditary morphological anomalies, hormonal dysfunctions, and foci of irritation.
+At the same time, mental disorders as such are either not analyzed at all, or are treated as secondary (or intermediate) links in the pathogenesis of organ neuroses.
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