Hysterical neurosis: what kind of disease is it and how to treat it. Hysterical paralysis Hysterical hemiparesis treatment

Movement disorders can be expressed, on the one hand, by paresis and paralysis, contractures, the inability to perform complex motor acts, and on the other hand, by various hyperkinesis.

Hysterical paralysis and contractures usually affect a part of the body corresponding to the generally accepted division (arm, hand, finger, etc.), often sharply limiting the lesion along the articular line, regardless of whether this part of the body is innervated by one or more nerves. However, if the patient has suffered organic paralysis in the past (for example, ulnar or radial nerve palsy) or has observed this disease in others, hysterical paralysis may spread to the same muscle groups that were affected by organic paralysis. Hysterical paralysis may involve one limb (monoplegia), both limbs on one side (hemiplegia), both arms or both legs (paraplegia), or all four limbs (tetraplegia). Most often, paralysis of the muscles of the limbs is observed. Paralysis of the muscles of the tongue, neck, or other muscle groups is rare.

Hysterical contractures most often affect the muscles of the limbs, neck (hysterical torticollis) or torso (hysterical camptocormia). Sometimes hysterical spasm of the orbicularis oculi muscle occurs (hysterical blepharospasm). Often, hysterical contractures fix the body in an elaborate pose that is not observed with organic contractures. Tendon reflexes, as well as muscle tone, do not change during hysterical paralysis, paresis and contractures. When examining tendon reflexes, a somewhat deliberate twitch of the whole body or a demonstrative strengthening of the reflex is often noted. It can also be observed when the doctor, after 1-2 studies of the reflex, having made the gesture of hitting the tendon with a hammer, unexpectedly holds the hammer without touching the patient. Skin reflexes that can be voluntarily delayed (plantar) are sometimes not evoked, while reflexes that cannot be voluntarily delayed (m. cremaster reflex) are preserved. Trophic muscle disorders are insignificant even with prolonged hysterical paralysis, and are not accompanied by qualitative disorders of electrical excitability. During sleep, as well as in a state of passion, hysterical paralysis and contractures may disappear.

Paralysis and paresis are usually selective, elective in nature. They appear in one situation and may suddenly disappear in another. So, for example, a “paralyzed” muscle can suddenly contract in a friendly manner when maintaining body balance, during defensive or facial movements, and also if the raised paralyzed limb is lowered (falls smoothly, and not like a whip). All this suggests that with hysteria we are not talking about paralysis in the literal sense of the word, but about the impossibility of voluntarily performing movements, about “not moving.” As S.N. Dotsenko and B.Ya. Pervomaisky (1964) rightly note, there are no isolated hysterical muscle paralysis, for example, m. biceps brachii with intact function of t. brachio-radialis.

In hysterical hemiplegia, unlike organic hemiplegia, paralysis does not extend to the muscles of the face and tongue. It is also not accompanied by a speech disorder, even if the right limbs are affected in right-handed people, and the left limbs in left-handed people. There are no synkinesis, no defensive reflexes, no characteristic Wernicke-Mann posture. The paralyzed body part usually drags or dangles, like a tethered prosthetic limb (“Todd gait”). The leg is often more massively affected than the arm. Unlike spinal paralysis, hysterical lower paraplegia does not impair the function of the pelvic organs.

Often, hysterical paresis and paralysis are layered with mild residual, organically caused dysfunction, i.e. there is a combination of mild organic paresis with massive hysterical paralysis, which can significantly complicate diagnosis.

S. A. Chugunov, having examined 8 patients with hysterical hemiplegia and paraplegia electroencephalographically, found that in all patients the uneven amplitude and frequency of the alpha rhythm was noticeable. Often there were single fast discharges of high amplitude, reminiscent of “epileptic discharges”. Sometimes, usually in the temporal and frontal leads, groups of frequent low-amplitude rhythms (“swirling”) were encountered.

According to E. A. Zhirmunskaya, L. G. Makarova and V. A. Chukhrova, the electroencephalographic picture in hysterical hemiparesis and organic hemiparesis after strokes is fundamentally similar. With organic hemiparesis, pathological potentials may appear in the affected lobe of the brain, just as with hysterical ones; At the same time, destructive brain disorders are not always accompanied by the appearance of shifts in the electrical activity of the brain. We observed 2 patients with hysterical hemiparesis, in whom no deviations from the norm were detected on the electroencephalogram.

The data presented show that hysterically and organically caused central paralysis can give a similar electroencephalographic picture. The absence of detectable pathological changes on the electroencephalogram does not exclude the possibility of both organic and hysterical paralysis.

Hysterical paralysis sometimes occurs as a phase of recovery from a hysterical stupor, less often directly after the action of traumatic stimuli.

Thus, a student expelled from school (the son of respected parents) opened the door to the classroom during a lesson and, standing in the doorway, began to smoke, spitting on the floor. N. did not respond to the teacher’s demand to immediately stop the outrage. Then the teacher, suddenly turning pale, approached him and hit him in the face with his right hand. Immediately N. felt general weakness. He slept restlessly at night and, waking up in the morning, noticed that his right arm was completely paralyzed. The muscles of the hand were tense and did not obey him. Disorder of all types of superficial and deep sensitivity affected the hand and forearm to the elbow.

At the clinic, N. was depressed because he “raised his hand” against a student, and was generally burdened by working at school with children. The comrades who came to visit him treated him sympathetically. On the third day, treatment with an essential mask was carried out. Hysterical paralysis was immediately eliminated, all types of sensitivity were restored. N. went to work at a technical school and was healthy in subsequent years. The emerging disease helped him find a way out of the current situation.

Most often, hysterical paralysis and contractures arise gradually, by fixing one or another temporary disturbance of motor function. Even during the First World War, the following typical occurrence of hysterical paralysis was often described in French and German literature. A soldier wounded in the leg or arm was at first unable to move the injured limb due to pain. He was evacuated to the rear. In the rear hospital the wound was healing. Movements in this limb should have already been restored, but they were not restored - hysterical paralysis developed (Binswanger hospital hysteria). Similarly, sometimes the forced position of the body after a bruise in the lumbar region became the starting point for the development of hysterical camptocormia.

The dysfunction caused by the injury, in these cases, coincided in time with the stay in the rear hospital, in a non-life-threatening environment, acquired the character of “conditional pleasantness or desirability” and in the subject, weak or weakened due to exhaustion, intoxication, etc., was fixed according to the mechanism of conditional communication. I.P. Pavlov called this a case of fatal physiological relationships, pointing out that there is no sufficient reason to talk about deliberate feigning of a symptom.

As noted by English and American authors (Sands, Hill, Harrison, etc.), during the Second World War, hysterical paralysis was not observed in persons on ships. This is explained by the fact that paralysis makes it difficult for a person to escape in the event of an enemy attack on a ship, and therefore ideas about its occurrence were not of the nature of “conditional pleasantness or desirability.” At the same time, there were hysterical symptoms that could not prevent the patient from being saved under these circumstances.

Hysterical paralysis and contractures can occur only if their development is “conditionally pleasant or desirable” for the patient. In this case, either the mechanism of hysterical fixation described above, or suggestion and self-hypnosis, plays a role in the pathogenesis of the disease.

The issue of so-called physiopathic or reflex paralysis, first observed by Mitchell (1864) during the American War and further described by Babinski and Froment during the First World War, is controversial. These paralysis occurred in persons who received minor skin wounds. They were most often combined with contracture of the muscles of the hand, in which it took the form of an obstetrician’s hand, and were accompanied by severe autonomic disturbances and sensitivity disorders in the form of a “stocking” or “glove”. Electrical excitability usually changed slightly and only quantitatively; chronaxy increased slightly. With sufficiently deep ether anesthesia, these paralysis disappeared. A number of neurologists (V.K. Khoroshko, S.N. Davidenkov, P.M. Sarajishvili, etc.) join the opinion of Babinski and Froment about the physiogenic, non-hysterical nature of these functional paralysis. However, their occurrence only in wartime and only in military personnel, in the absence of these paralysis in peacetime, including with injuries to nerve trunks, gives reason to assume the role of “flight into illness” and, therefore, speaks in favor of their hysterical nature. In our opinion, in these cases we are talking about a special group of severe hysterical paralysis, characterized by a sharp severity of autonomic disorders.

S. N. Davidenkov draws attention to the fact that hysterical paralysis should be differentiated from concomitant paralysis, which is expressed in the inability to make any movement only because the usual synergists have fallen out and the patient does not yet know how to use this muscle in a new motor combination. If, due to the destruction of the tendon, it becomes impossible, for example, for active extension of the main phalanx of the finger, then all other movements of the finger may also fall out, due to a general lack of development of motor skills. The resulting disorder may be mistaken for hysterical.

Impaired ability to perform complex motor acts can lead to hysterical astasia-abasia - the impossibility or impairment of the act of standing and walking while all other leg movements are intact. The following observation is typical.

The young woman, active, powerful, and energetic by nature, gave in to her husband’s persistent requests and moved to live with her three children in the house of his relatives. She was received very well and formally treated well, but in this house she felt like a “poor relative.” At night she cried and dreamed of returning to the village, to her mother’s house. Soon she fell ill with a serious infectious disease and was admitted to the clinic. When the temperature dropped and her physical condition improved, it was discovered that in bed the patient could move her legs freely, but as soon as she tried to get up, her legs gave way and she fell. Hysterical astasia abasia developed. Along with it, increased fatigue was detected, especially when reading, and emotional lability, which was absent before the illness.

Ideas about illness became “conventionally pleasant or desirable,” since illness relieved the patient of the need to return to a house she hated. These ideas led, through the mechanism of self-hypnosis, to the emergence of astasia-abasia. The patient was explained the nature of her illness. The husband was told that “due to his wife’s health” he needed to move to live in the village with her mother. After receiving consent to move, the phenomena of astasia-abasia began to quickly pass.

Hysterical hyperkinesis is very diverse. They can be expressed in the form of trembling of varying amplitude and frequency of both the whole body and its individual parts and are often combined with pseudospasm of the muscles that produce the trembling. This trembling intensifies with excitement and can disappear in the absence of a doctor in a calm environment. As a rule, it disappears during sleep. It should be noted that intensification under the influence of emotions and disappearance during sleep is also typical for choreic hyperkinesis and athetosis, caused by organic damage to the subcortical nodes. The absence of hyperkinesis in an affectively charged situation (for example, during an argument with comrades) is uncharacteristic of either hysterical or organically caused hyperkinesis and speaks of their attitudinal nature. Often during hysteria, hyperkinesis of the right hand and rotatory movements of the head are observed.

N.K. Bogolepov and A.A. Rastvorova emphasize that hysterical and organic excessive movements are often so similar in form to each other that even with careful clinical observation it is difficult to differentiate them. This difficulty is further enhanced by the fact that hysterical hyperkinesis can sometimes occur against an organic background and that in turn organic hyperkinesis in 29% of cases occurs suddenly and is associated with excitement or fear. In general, in their opinion, hysterical hyperkinesis, more than organic ones, is characterized by the emergence in connection with mental trauma of dependence on the emotional state and disappearance at rest, the originality of the hyperkinesis itself, manifested in a form unknown to the doctor; insufficient severity of organic symptoms; the presence of exaggerated movements - unusual postures - and other neurotic symptoms; reduction or temporary disappearance of hyperkinesis under the influence of treatment, in particular psychotherapy, as well as under the influence of changes in a traumatic situation.

Hysterical hyperkinesis also includes some tics - rapid coordinated clonic convulsive contractions of a certain muscle group, stereotypically repeated. Most often, this involves the muscles of the face, but sometimes other muscle groups are involved, for example, with tics in the form of a sharp bending of the torso, which has a cartoonish character, a “sniffing” movement, throwing up the head with gaze upward, etc.

Hysterical neurosis- a group of psychogenically caused neurotic conditions with somatovegetative, sensory and motor disorders, more often at a young age, in women.

Patients are characterized by increased sensitivity, impressionability, suggestibility and self-hypnosis, mood instability and a tendency to attract the attention of others.

Clinical manifestations: 1. mental disorders– emotional and affective disorders in the form of fears, asthenia, hypochondriacal manifestations, depressed mood. Psychogenically arising amnesia is observed; under the influence of a psychotraumatic situation, everything connected with it “falls out”, is “repressed” from memory.

movement disorders

sensory disturbances

vegetative-somatic disorders: breathing disorders, cardiac activity, gastrointestinal tract.

Hysterical motor dysfunction.

Inhibition of motor function :

Hysterical paralysis and paresis (monoplegia, monoparesis), (hemiplegia, hemiparesis), (paraplegia and paraparesis), (tetraplegia, tetraparesis).

General signs of hysterical paralysis.

Before the onset of paresis or paralysis, pain or a feeling of weakness of the limb is noted.

Tendon reflexes do not change. When examining the tendon reflex, a deliberate flinch of the whole body or a demonstrative strengthening of the reflex is noted (you can make several blows with a hammer, and then just swing your hand without touching the limb, the movement of the limb will be observed, as if a blow was made with a hammer).

There are no pathological reflexes.

Muscle tone is reduced or normal.

There is no muscle atrophy.

By diverting the patient's attention from the symptoms, the function of the paralyzed limb is restored.

The patient actively resists during passive movements (all affected muscles are involved).

The localization of paralysis does not correspond to physiology. For example, with paralysis of the flexors and extensors of the hands, the full range of movement of the shoulder is preserved.

Paralysis, appearing in one situation, suddenly disappears in another. A “paralyzed” muscle may suddenly contract in a friendly manner while maintaining balance. If you take a “paralyzed” limb and let it go, it falls smoothly, and not like a whip, which is typical for organic paralysis.

When attempting active movements of a paralyzed limb, there is a demonstration of efforts to do this (exaggerated grimaces, redness of the face, muscle tension in the unaffected area).

Combination with other hysterical disorders (anesthesia, seizures, etc.).

The sudden appearance or disappearance of symptoms under the influence of strong emotional experiences.

To detect the hysterical nature of paralysis or paresis, it is necessary to observe the patient during sleep.

Hysterical neurosis is a group of psychogenically caused neurotic conditions with somatovegetative, sensory and motor disorders, more often at a young age, in women.

Patients are characterized by increased sensitivity, impressionability, suggestibility and self-hypnosis, mood instability and a tendency to attract the attention of others.

Clinical manifestations: mental disorders - emotional and affective disorders in the form of fears, asthenia, hypochondriacal manifestations, depressed mood. Psychogenically arising amnesia is observed; under the influence of a psychotraumatic situation, everything connected with it “falls out”, is “repressed” from memory.

movement disorders

sensory disturbances

vegetative-somatic disorders: breathing disorders, cardiac activity, gastrointestinal tract.

Characteristic properties of hysterical disorders of the motor and sensory sphere.

Excessiveness, atypicality, intensity (manifestations are bright, violent, pronounced).

Special dynamics of disorders (sudden appearance and disappearance).

The variability of the clinic depending on the historical era, level of culture and level of medical knowledge.

Symptoms reflect the patient’s understanding of the disease and may contradict physiological or anatomical principles.

Imitation of any diseases.

Enrichment and expansion of the range of symptoms under the influence of new information, under the influence of suggestion by others or self-suggestion.

Demonstrative character in the presence of other persons. Conversion disorders practically do not occur alone or in the absence of interest from others. Behavior is aimed at attracting attention.

The appearance of conversion symptoms when using provocation methods (compression of the cervical vessels).

The physical condition with symptoms observed in the patient may be present in relatives and friends (identification mechanism).

Disappearance or weakening of symptoms upon receipt of a certain reward (exemption from work, subjugation of loved ones, care of others). Conversions are instrumental in nature.

Hysterical symptoms are conditionally pleasant and desirable for the patient.

Hysterical disturbances of motor functions.

Inhibition of motor function:

- Hysterical paralysis and paresis (monoplegia, monoparesis), (hemiplegia, hemiparesis), (paraplegia and paraparesis), (tetraplegia, tetraparesis).

General signs of hysterical paralysis.

Before the onset of paresis or paralysis, pain or a feeling of weakness of the limb is noted.

Tendon reflexes do not change. When examining the tendon reflex, a deliberate flinch of the whole body or a demonstrative strengthening of the reflex is noted (you can make several blows with a hammer, and then just swing your hand without touching the limb, the movement of the limb will be observed, as if a blow was made with a hammer).

There are no pathological reflexes.

Muscle tone is reduced or normal.

There is no muscle atrophy.

By diverting the patient's attention from the symptoms, the function of the paralyzed limb is restored.

The patient actively resists during passive movements (all affected muscles are involved).

The localization of paralysis does not correspond to physiology. For example, with paralysis of the flexors and extensors of the hands, the full range of movement of the shoulder is preserved.

Paralysis, appearing in one situation, suddenly disappears in another. A “paralyzed” muscle may suddenly contract in a friendly manner while maintaining balance. If you take a “paralyzed” limb and let it go, it falls smoothly, and not like a whip, which is typical for organic paralysis.

When attempting active movements of a paralyzed limb, there is a demonstration of efforts to do this (exaggerated grimaces, redness of the face, muscle tension in the unaffected area).

Combination with other hysterical disorders (anesthesia, seizures, etc.).

The sudden appearance or disappearance of symptoms under the influence of strong emotional experiences.

To detect the hysterical nature of paralysis or paresis, it is necessary to observe the patient during sleep.

Hysterical movement disorders include various forms of hysterical gait.

Varieties of hysterical gait.

Zigzag gait - movement along a broken line.

A dragging gait is a dragging of the limb with a characteristic turn of the foot inward, resting on the heel and the base of the 3rd toe.

Stilted gait - legs are rigidly straightened and slightly apart.

Sliding gait - the limbs move forward with the sole sliding along the floor (like on ice skates).

Kneeling gait - when moving forward - kneeling with each step.

Balancing gait - bending, swaying to the sides, as if it is difficult to maintain balance.

Chore-like gait - arching the body in different directions, crossing the legs, dancing movements of the arms.

Jumping gait - jumping on one leg.

Flapping gait - swinging a limb before placing it.

Pseudotabetic gait - awkward movement on widely spaced legs; legs rise too high, feet hit the floor.

Astasia - abasia

Astasia is the inability to stand. Abasia is the inability to walk. Astasia - abasia refers to hysterical (conversion) disorders.

Diagnostic criteria for astasia - abasia.

Lying or sitting movements are performed in full.

The patient squats freely, walks easily on all fours or with widely spaced limbs.

The patient may hop on one or both legs.

In some cases, with unexpressed manifestations, a balancing, choreo-like or jumping gait is observed.

Hysterical spasm.

- Hysterical paralysis of the eyelids or eyelids (inability to open the eyes), with functional (hysterical) paralysis - lack of compensatory tension of the forehead muscles, slight folding of the upper eyelid and resistance when trying to passively lift it.

With functional paralysis - complete closure or significant narrowing of the palpebral fissure.

— Blepharospasm is a strong bilateral spasm of the circular muscles of the eye, which prevents or complicates the opening of the eyelids.

Trismus is the inability to open the mouth or significant resistance when opening the mouth passively. Typically, there is no increased tension in the masticatory muscles.

- Hysterical contractures of joints - constant maintenance of a limb in a certain position, which is combined with increased muscle tension.

Differential diagnosis.

Pain during hysterical joint contracture is diffuse in nature, covers soft tissues and is not limited to the joint area;

The skin in the joint area is usually not changed, its temperature is normal;

There are usually other accompanying symptoms. A combination of hysterical joint contracture with sensory disturbances is often observed;

Contracture goes away when the patient's attention is distracted, during anesthesia or during hypnosis.

Professional dyskinesia is the inability to perform some learned professional actions due to spasm of the corresponding muscles. A characteristic feature is that other movements of the same muscle groups are not affected.

Symptoms depend on the nature of the professional activities performed by the patient (in dancers - spasm of the lower leg muscles, in students - writer's cramp, etc.; they include telegraph operators' spasm, pianists' spasm, milking cramp, violinists' spasm).

Writer's cramp is difficulty or inability to write while the function of the hand is fully preserved during other actions.

There are 5 clinical forms of writer's cramp.

Spastic (fingers that hold a pencil or pen.)

Painful (any attempt to write causes pain in the hand)

Trembling (the hand trembles when writing.)

Paralytic (relaxation of the fingers, which causes the pen or pencil to fall out)

Atactic (impaired coordination of movements that causes writing problems)

Spasm of the pharynx - it occurs in paroxysms and can be combined with the symptom of a hysterical lump in the throat. Pharyngeal spasm is characterized by difficulty swallowing. These disorders are more pronounced when taking liquid than solid food, and are accompanied by severe pain.

Hysterical lump - a feeling of constriction in the throat due to the presence of a certain “lump” or “lump”.

Hysterical speech disorders.

hysterical muteness - hysterical mutism.

Manifestations of hysterical aphonia:

Absence of pathological anatomical changes in the larynx.

Variability of the laryngoscopic picture over a short period.

Sudden appearance and disappearance of aphonia.

Combination with other hysterical sensitivity disorders in the pharynx, conjunctiva and neck skin.

Hysterical stuttering.

Typical signs of hysterical stuttering:

Later age of onset of symptoms (not before puberty).

Instability and short duration of the disorder.

Combination with other hysterical speech disorders.

Grimaces and facial expressions do not correspond to the difficulty in pronunciation.

Atypical loud and exaggerated intake of air when breathing.

There is no emotional reaction to the defect.

Combination with various hysterical symptoms.

Hysterical hyperkinesis - trembling, involuntary movements and convulsive seizures.

Hysterical trembling (often found) is alternating rhythmic movements of small amplitude that cover the distal parts of the extremities, most often the upper ones (can involve the head and tongue).

Forms of hysterical trembling.

Static tremors - observed at rest.

Positional tremors occur when a limb assumes a certain position.

Kinetic jitter - appears during voluntary movement with
approaching the goal.

The hysterical nature of the trembling is evidenced by:

Variability.

Moving.

Disappearing when distracted or under the influence of strong emotions.

Disappears during sleep.

Presence of other hysterical symptoms.

Hysterical tics are rapid, coordinated patterns limited to one muscle group, voluntary simple or complex movements.

With concentration, the tics disappear. The muscles of the face, head, neck and upper extremities are most often involved.

Tics appear:

Squinting your eyes or eyes.

Wrinkling the nose.

Shrug a shoulder or 2 shoulders.

Various involuntary movements of the lips or head.

Sniffing, snorting.

Coughing, grinding teeth.

Dissociative anesthesia and loss of sensory perception

Characteristic signs of hysterical anesthesia:

The area of ​​anesthesia does not correspond to the peripheral innervation. The boundaries of anesthesia are clear, arbitrary, in accordance with the patient’s ideas. They can be like short gloves, they can cover the shoulder - long gloves, the lower leg - socks, they can be on one half of the body exactly along the midline (hemianesthesia), there can be areas of skin anesthesia of a certain shape (ellipse, circle, triangle, etc. .).

The boundaries of anesthesia are easily shifted depending on the distraction of the patient's attention or on the suggestion of the examiner.

In the absence of pain sensitivity, injuries and thermal damage never occur.

Despite. to complete anesthesia of the fingers, the accuracy of their small and complex movements (impaired.

Reflex dilation of the pupil during painful stimulation is preserved.

Hysterical pain.

Features of hysterical pain are:

Lack of precise localization.

Variability.

Mismatch with the innervation zone.

Absence of vegetative symptoms and dysfunctions that usually accompany organic pain (limited movements, forced position).

Good sleep despite intense suffering.

Absence of typical emotional reactions characteristic of organic pain.

Relief of pain by taking a placebo and its persistence despite the use of analgesics.

Often hysterical pain can imitate an acute abdomen, etc., which leads to surgical interventions.

Hysterical visual disturbances.

Concentric narrowing of visual fields or their expansion.

Multiple visions, double vision, triplicity.

Macropsia, micropsia.

Colorblindness.

Impaired visual acuity.

Night blindness.

Complete one- and two-sided blindness.

Distinctive signs of hysterical blindness.

Preserved reaction of the pupils to light.

Presence of evoked potentials to visual stimuli.

Maintaining visual control over behavior, avoiding obstacles when walking.

Tendency to relapse.

Suddenness of appearance and disappearance.

A feature of hysterical concentric narrowing of the visual field is that the duration of the study increasingly narrows the visual field.

In hysterical diploia, closing one eye does not relieve double vision.

A hysterical decrease in visual acuity is combined with photophobia and blepharospasm, often accompanied by hysterical hemianesthesia, and the decrease in visual acuity is more pronounced on the anesthesia side.

Hysterical deafness is predominantly bilateral, appears and disappears suddenly.

Signs of hysterical deafness.

No otoscopic changes.

Good audibility of a whisper, often from a great distance, with simultaneous deafness to ordinary speech.

Disappearance of deafness under the influence of loud noise.

Variability and incompleteness of deafness (sometimes he cannot hear at all, sometimes he hears worse or better).

Grand hysterical seizure (dissociative seizures, pseudo-seizure).

This is a combination of motor dysfunctions of the type of excitation with a decrease in the level of consciousness. This is a classic manifestation of hysteria.

A hysterical seizure must be differentiated from an epileptic one.

Distinctive signs of a hysterical seizure from an epileptic one:

Appearance in traumatic situations (psychotraumatic).

During a hysterical attack there is no aura.

A careful slow fall, rather a descent, usually onto something soft, which prevents bruises and injuries,

The duration of a seizure is from several minutes to an hour (epileptic - up to 3-5 minutes).

During a hysterical seizure, there is no sequence typical for epilepsy - a short-term tonic phase, a longer clonic phase.

Movements of the limbs are erratic, sweeping, uncoordinated. There are grimaces, which can be combined with convulsive squeezing of the eyelids. Characteristic are theatrical poses, movements, bending of the body in an arc (hysterical arc), screaming, laughter, crying.

Breath holding with cyanosis.

Preservation of pupillary reaction to light.

Absence of biting the lips and tongue, involuntary urination and stool, foaming at the mouth (these symptoms may exist, it all depends on the patient’s awareness of the seizure).

There is no loss of consciousness, only a narrowing of consciousness. - the main sign.

Variability of symptoms in cases where others show interest in the seizure. The manifestations intensify in the presence of spectators.

The ability to interrupt a seizure with a strong negative or unexpected stimulus.

Sudden cessation of a seizure with rapid restoration of physical strength and lack of drowsiness.

Absence of amnesia, or only selective amnesia during the seizure period.

Absence of convulsive bioelectrical activity on the EEG during a seizure.

There are minor hysterical fits and hysterical fainting.

Hysterical neurosis is a type of neurosis and most often manifests itself in the form of demonstrative emotional reactions (sudden screaming, laughter, intense crying), as well as convulsive hyperkinesis, loss of sensitivity, hallucinations, transient paralysis, fainting, etc. The basis of hysteria is the increased suggestibility and self-hypnosis of a person, the desire to attract the attention of others.

ICD-10 code

F60.4 Histrionic personality disorder

Causes of hysterical neurosis

The word “hystera” is of Greek origin and translated means “uterus,” which is due to the opinion of ancient Greek doctors about the prevalence of this pathology among women due to dysfunction of the uterus. Scientific research into the nature of the disease was initiated by Charcot back in the 19th century. The scientist believed that the causes of the disease were hereditary and constitutional factors. As a type of neurosis, hysteria began to be considered by medical science only at the beginning of the 20th century.

The leading signs of hysteria are seizures with convulsions, a squeezing headache, numbness of some areas of the skin and pressure in the throat. The main cause of this condition is considered to be a mental experience, as a result of which there was a breakdown in the mechanisms of higher nervous activity due to some external factor or intrapersonal conflict. The disease can develop suddenly as a consequence of severe mental trauma, or due to a prolonged unfavorable situation.

Hysterical neurosis can arise as a result of a person prone to hysterical psychopathy getting into an unfavorable environment or situation that severely traumatizes his psyche. Most often, this is a violent reaction to a family or domestic conflict, as well as conditions in which there is a real threat to life. The disease can develop under the influence of negative factors that arise suddenly or act over a long period of time and constantly depress the human psyche.

The causes of hysterical neurosis are of a stressful nature and are associated with various problems and conflicts that throw a person out of balance, cause a feeling of fear and self-doubt, and an inability to cope with the situation. People with an overly excitable or immature psyche, who are characterized by lack of independence of judgment and impressionability, sudden emotional swings, and increased suggestibility, are most often prone to hysterical reactions.

Freud believed that the main factors provoking the development of hysteria were sexual complexes and mental trauma that arose in early childhood. The true cause of pathology can be considered the predominance of human emotions over reason. Negative emotions that arise as a result of a certain psychotraumatic situation “result” in bodily (somatic) symptoms. Thus, a so-called “conversion mechanism” appears, which is aimed at reducing the level of negative feelings and enabling the self-protective function.

Pathogenesis

Hysterical neurosis in most cases occurs in people who are often suggestible, sensitive, vulnerable and prone to worry.

The pathogenesis of the disease is determined by both exogenous and endogenous causes. The basis of each neurosis is the peculiarities of personality development, its psyche and behavior, which often depend on increased emotionality. We are talking about psychogenicity as a consequence of stress, frequent conflicts, emotional burnout, and neuropsychic overstrain. The main risk factors for the occurrence of hysterical neurosis include physical and mental stress, alcohol abuse, dysfunction in family life, various somatic diseases, professional dissatisfaction, as well as uncontrolled use of medications (in particular, tranquilizers and sleeping pills).

Hysteria most often develops in individuals with pronounced premorbid character traits (prone to overvalued education, perseverance, uncompromisingness, obsessions, pedantry, rigidity). Practice shows that neurasthenic disorders are also possible in persons lacking neurotic character traits - with vegetoneurosis (impaired functioning of the autonomic nervous system), reactive state and excessive neuropsychic stress.

Symptoms of hysterical neurosis

Hysterical neurosis is a classic form of neurosis and often develops as a result of a strong psychotraumatic factor. This disorder is accompanied by various somatovegetative, sensory and motor manifestations. Most often, this disease occurs in people with hysterical psychopathy.

Hysteria as a mental disorder has a code according to ICD 10 and, according to it, is diagnosed against the background of general factors of personality disorder, which can be combined with three or more signs. Among these signs, first of all, we can highlight:

• exaggerated expression of emotions;
• easy suggestibility;
• self-dramatization;
• constant desire for increased excitement;
• a person’s excessive preoccupation with his physical attractiveness;
• emotional lability;
• easy susceptibility of a person to the influence of circumstances and others;
• inadequate seductiveness (in behavior and appearance), etc.

Additionally, one can identify such features of a hysteric as manipulative behavior aimed at immediate satisfaction of personal needs, the desire to be recognized, self-centeredness and self-indulgence, excessive touchiness, etc. With hysterical neurosis, the symptoms are pronounced and are used by the patient to attract the attention of others to their problems.

Hysterical neurosis manifests itself in the form of disorders of the nervous system, sensory, autonomic and somatic disorders, and therefore has different variations in symptoms.

The main symptoms of hysterical neurosis are associated with a seizure that occurs in response to various traumatic situations, for example, a quarrel or unpleasant news. The classic manifestation of hysteria is a demonstrative fall, a pained expression on the face, flailing movements of the limbs, screams, tears and laughter. At the same time, consciousness is preserved, and the person can be brought back to his senses with a slap in the face or cold water. Before an attack of hysteria, symptoms such as dizziness, nausea, chest pain, and a lump in the throat may occur. Typically, an attack of hysteria occurs in crowded places or near those people whom the patient is trying to manipulate.

As a result of a motor disorder, loss of voice, complete or partial paralysis of the limbs, tremors, impaired motor coordination, tic, and paralysis of the tongue may occur. Such disorders are short-term and are caused by the emotional state of a person. Most often they are combined with fainting states, “theatrical” wringing of hands, unusual poses and lamentations. Emotional disturbances manifest themselves in the form of depressed mood, repetition of stereotypical movements, and panic fears.

Somatic manifestations of hysteria are most often observed in the gastrointestinal tract, respiratory and cardiovascular systems. Disturbances in the functioning of the autonomic nervous system manifest themselves in the form of convulsive seizures. The manifestation of sensory disorders is associated with decreased sensitivity in the limbs, deafness and blindness, narrowing of the field of vision, hysterical pain, which can be localized in various parts of the body.

First signs

Hysterical neurosis most often manifests itself under the influence of a strong mental experience associated with some event or situation (conflict in the family or at work, stress, emotional shock).

The first signs of hysterical neurosis can occur as self-hypnosis. A person begins to listen to his body and the work of his internal organs, and any increase in heart rate or the occurrence of pain in the chest, back, abdomen and other parts of the body can plunge him into panic. As a result, thoughts about illnesses appear, often serious, life-threatening, incurable. In addition, a clear sign of hysteria is hypersensitivity to external stimuli. The patient may be irritated by loud noises and bright lights. There is increased fatigue, deterioration of attention and memory. The patient finds it increasingly difficult to perform simple tasks, performs job duties worse, and cannot cope with work.

Despite the fact that a person feels unwell, a medical examination, as a rule, does not reveal any serious pathologies in the functioning of the internal organs. According to statistics, neurotics make up a larger percentage of outpatient patients.

Hysterical neurosis in children

Hysterical neurosis can occur in people of different age categories. Children are no exception, and they are absolutely healthy physically and mentally. Among the most common factors that cause hysteria in a child are errors in upbringing, excessive demands from parents, and frequent stress associated with conflicts in the family. With constant exposure to a psychotraumatic factor on a child, hysteria becomes chronic.

Hysterical neurosis in children manifests itself in the form of:

• crying and screaming;
• moodiness;
• rapid heartbeat;
• headaches;
• loss of appetite and nausea;
• abdominal cramps;
• poor sleep;
• attacks of respiratory arrest;
• defiantly falling and hitting the floor.

Children diagnosed with hysteria are characterized by displaying their fears and wanting adults to pay more attention to them. Often an attack of hysteria is a method of achieving what you want, for example, getting a toy you like.

In older children, including teenagers, hysteria may cause changes in skin sensitivity and, less commonly, blindness and signs found in adults. It should be noted that hysterical neuroses worsen during the child’s puberty (the so-called age crisis) and generally have a favorable prognosis.

Hysterical neurosis in adolescents

Hysterical neurosis often appears in adolescents who are experiencing an age crisis - i.e. period of puberty. Symptoms of the pathology are rapid heartbeat, headaches, and insomnia. The child has no appetite, nausea and abdominal cramps, in some cases – phobias (fears), an unrealistic experience of the present, depression, isolation and alienation, as well as confusion of thoughts.

Hysterical neurosis in adolescents is characterized by a change in symptoms depending on the situation. Most often, the development of hysteria is associated with prolonged exposure to psychotrauma that infringes on the child’s personality. Clinical manifestations of the disease are observed in pampered, weak-willed children, in whose upbringing the moments of instilling hard work, independence, and an understanding of what is possible and what is not allowed were missed. For such teenagers, the “I want” – “give” principle dominates; desires contradict reality; dissatisfaction with their position in the school community and family arises.

According to I.P. Pavlov, the causes of hysteria are the predominance of the first signaling system over the second, i.e. The “hysterical subject” is subjected to emotional experiences that suppress reason. The result is a condition similar to the symptoms of schizophrenia (gaps in thoughts or the presence of two streams of thinking).

Hysterical neurosis in women

Hysterical neurosis manifests itself in sensitive, receptive and emotional natures, and therefore is more common in women than in men. This explains the origin of the word “hystera”, which means “uterus” in Greek.

Hysterical neurosis in women has the following symptoms:

• sexual relationship disorders;
• blood pressure disorder;
• sleep pathologies;
• pain in the heart area
• nausea;
• pain in the abdomen;
• tendency to fatigue;
• trembling in hands;
• the appearance of sweating;
• strong emotional experiences;
• tendency to conflict;
• respiratory system disorders;
• depressed mood;
• severe sensitivity to bright light and loud sounds;
• obsessive thoughts and actions;
• severe irritability;
• darkening of the eyes;
• angina attacks;
• convulsive seizures (less often).

Hysteria in women is characterized by increased suggestibility; a distinctive feature of the disease is pronounced demonstrativeness. The root cause may be a severe emotional shock or mental experience that arose as a result of any external circumstances (quarrels, stress, a series of failures), as well as internal conflict. Nervous shock can be associated with mental overload and fatigue, weakened immunity after illness, and lack of proper sleep and rest. An attack of hysteria in women is accompanied by a lump in the throat, lack of air, heaviness in the heart and strong heartbeat.

Complications and consequences

Hysterical neurosis leads to unpleasant consequences that are associated with psycho-emotional exhaustion, obsessive states, and depression. It is important to help the patient in time to prevent the development of concomitant diseases.

The consequences of hysteria can be very diverse:

• Marked decrease in working capacity. It is difficult for a person to perform his usual work due to deterioration of thinking abilities and poor memorization, decreased concentration, fatigue, sleep disturbances, and lack of proper rest.
• Conflict. Due to accompanying symptoms (touchiness, tearfulness, fear, anxiety), problems arise in the family and at work, the person enters into conflicts with other people, which leads to misunderstanding.
• The emergence of obsessive states (thoughts, memories, fears). Because of this symptom, a person is afraid of repeating a mistake, is forced to avoid traumatic situations and constantly monitor the situation to make sure that his decisions are correct.
• Decompensation of existing diseases and development of new ones. Due to the negative impact of hysterical neurosis on the somatic sphere, the adaptive capabilities of the body deteriorate, which leads to the risk of concomitant diseases of internal organs, infectious and colds.

Thus, neurosis negatively affects the patient’s quality of life, significantly worsening well-being and relationships with others. Often a person feels useless and deeply unhappy.

Complications

Hysterical neurosis occurs against a background of excessive anxiety, psycho-emotional stress, and if the disease is not diagnosed in time, the patient may develop complications. Only an experienced doctor can make the correct diagnosis. Without medical care, the patient will suffer for a long time and think that he is terminally ill.

Complications of hysterical neurosis most often concern the functioning of internal organs. Due to increased excitability, irritability, and attacks of hysteria, cardiac neurosis may develop, which will lead to panic attacks. The main signs of panic are lack of air, fear of death against the background of a strong heartbeat, and semi-fainting. Often such conditions are accompanied by disorders of the autonomic nervous system.

A person prone to hysteria may experience complications in the form of a malfunction of the gastrointestinal tract (nausea, cramps, constipation), as well as other organs. If the disease has entered the chronic stage, then the person may experience changes in behavior and character, loss of ability to work, apathy, deterioration in general well-being, and fatigue.

After a seizure, hysterical hemiplegia (unilateral paralysis of a limb) may occur, which passes without a trace without disturbances in muscle tone and changes in reflexes. Another complication that should also be noted is dysphagia - difficulty swallowing, discomfort or inability to swallow (saliva, liquid, solid food).

In addition, a person prone to hysteria experiences problems with labor and social adaptation due to various neurological disorders (muscle weakness, blindness, deafness, unsteady gait and memory loss). Depression is the extreme degree of emotional depression of the patient.

Diagnosis of hysterical neurosis

Hysterical neurosis is diagnosed on the basis of clinical manifestations that are characteristic of this pathological condition. When examining a patient, a neurologist may detect tremor of the fingers, increased tendon and periosteal reflexes in the patient.

Diagnosis of hysterical neurosis is carried out using instrumental studies to confirm the presence or absence of organic disorders of the internal organs. For movement disorders, MRI of the spinal cord and CT scan of the spine are prescribed, the same methods confirm the absence of any organic pathology. To exclude vascular pathology, ultrasound examination of the vessels of the neck and head, rheoencephalography, and angiography of cerebral vessels are performed. EMG (electromyography) and EEG (electroencephalography) also help confirm the diagnosis of hysteria.

Consultations with other doctors – an epileptologist, a neurosurgeon – may be necessary, depending on the patient’s complaints and clinical picture. An important role is played by the analysis of the medical history (clarification of questions about what preceded the onset of hysteria, whether there are currently any traumatic factors).

A neurological examination is aimed at searching for signs that would confirm organic pathology. These include pathological reflexes, nystagmus, autonomic skin disorders (numbness, thinning of the skin). An examination by a psychiatrist allows you to find out the nature of the disease (presence of stress, depression).

Differential diagnosis

Hysterical neurosis requires diagnosis to confirm that the patient does not have any organic disorders. The patient’s neurasthenic-like complaints force one to differentiate the disease with neurasthenia or obsessive-phobic neurosis (the differences lie in the display of phobias, demonstrative expression of dissatisfaction and presentation of complaints, and the demand for increased attention to one’s person).

Differential diagnosis is aimed at comparing similar pathological conditions and establishing a final diagnosis. A picture similar to hysteria can be observed in a patient with sluggish schizophrenia, in which hysterical symptoms are stable and “rough,” and there is no change in symptoms characteristic of hysteria according to a particular situation.

Autonomic crises, which are characteristic of organic brain lesions, can be difficult for the differential diagnosis of hysteria. Such crises often occur spontaneously; they either lack a psychogenic factor or it does not have selective significance. To clarify the diagnosis, it is necessary to conduct a neurological and electroencephalographic study of the patient. The doctor makes a differential diagnosis of the classic picture of hysterical neurosis (attacks of aggression, blindness, deafness, nervous attacks with falling, paralysis of the limbs) with organic diseases of the central nervous system and epilepsy.

Treatment of hysterical neurosis

Hysterical neurosis requires an integrated approach to treatment and the selection of the most effective methods aimed at eliminating psychotraumatic factors, creating favorable conditions for proper sleep and rest, psychotherapy and restorative therapy. The main goal is to relieve the patient of obsessive states, phobias, and restore the psycho-emotional background.

Treatment of hysterical neurosis includes:

• taking medications (tranquilizers, sedatives and hypnotics, antidepressants, antipsychotics);
• occupational therapy;
• manual therapy and massage;
• physical therapy;
• general strengthening procedures;
• auto-training;
• herbal medicine and traditional medicine.

Psychotherapy, of course, occupies a central place in treatment. At individual sessions, the doctor will try to find out the reasons that provoked the development of hysteria, help the patient deal with the problems that led to this condition, and identify the main psychotraumatic factor in order to eliminate it.

With the protracted nature of hysterical neurosis, tranquilizers (Phenazepam, Diazepam) are combined with antipsychotics (Eglonil, Neuleptil, Chlorprothixene), which have a corrective effect on human behavior. In severe forms of the disease, the patient requires hospitalization.

Medicines

Hysterical neurosis is treated with various medications, the administration of which requires responsibility and purposefulness. The doctor will select the most effective medications depending on the degree of development of the disease, the clinical picture, and the patient’s condition.

Medicines that are most often prescribed for neuroses, including the hysterical type:

• tranquilizers in tablets and capsules (Elenium, Sibazon, Diazepam, Relanium, Oxazepam, Phenazepam, etc.);
• tranquilizers by injection (Diazepam, Chlordiazepoxide) - in difficult situations accompanied by persistent obsessions, massive hysterical disorders);
• neuroleptics in small doses (Neuleptil, Etaperazine, Thioridazine, Eglonil);
• long-acting drugs (Fluspirilene, Fluorphenazine decanoate);
• antidepressants (Amitriptyline, Doxepin, Melipramine, Anafranil; Fluoxetine, Sertraline, Citalopram, etc.);
• sleeping pills for insomnia (Nitrazepam, Melaxen, Donormil, Chlorprothixene);
• biogenic stimulants - as a tonic (Apilak, Pantocrine);
• vitamin complexes (Apitonus P, group B drugs).

In cases of motor dysfunction, mutism, and surdomutism, amytal-caffeine disinhibition (injections of a solution of caffeine 20% and amytal-sodium 5%) has a good effect. When observing a patient with prolonged hysterical seizures, enema administration of chloral hydrate is indicated, as well as slow intravenous administration of solutions of magnesium sulfate 25% and calcium chloride 10%. Therapy includes restorative methods, sanatorium treatment, massages, etc.

Traditional treatment

Hysterical neurosis can be well treated with medications in combination with traditional methods aimed at strengthening the immune system, eliminating irritation, attacks of aggression, insomnia, etc. These are infusions of medicinal herbs, consumption of fresh juices, milk, bee products (royal jelly).

For example, to relieve tension and fatigue during hysteria, you can use the following herbal mixture: mix hop cones (3 tablespoons) with mint and lemon balm (2 tablespoons each), as well as chamomile (1 tablespoon) and chop using a meat grinder. Then 3 tbsp. spoons of the resulting mixture should be poured with boiling water (800 g), kept in a water bath for 20 minutes, left to brew and strain. It is recommended to take this remedy 0.5 cup three times a day for 30 minutes. before meals.

Traditional treatment also comes down to hydrotherapy in the form of salt wraps, therapy with mud, clay, earth, oils, sand, etc. For example, compresses with hot sand, which are applied to the feet for 20 minutes, help relieve nervous tension. In this case, the patient must be put to bed and wrapped up; it is good if after such a procedure he falls asleep.

Essential oils of lavender, ginger, rosemary, and nutmeg have a beneficial effect on the nervous system. Every evening before going to bed, the patient is recommended to drink 1 glass of warm milk - this promotes sound, healthy sleep.

Herbal treatment

Hysterical neurosis responds well to treatment with herbs, in combination with drug therapy, as well as restorative methods, massage, physical therapy and other types of treatment. The main focus of herbal therapy is to restore the functions of the nervous system, reduce irritability and anxiety, strengthen the immune system, improve general well-being, eliminate symptoms of depression, and get rid of insomnia.

Herbal treatment involves the use of various decoctions and infusions of valerian, hawthorn, motherwort, St. John's wort, viburnum, lemon balm - medicinal plants that are famous for their calming properties. Below are the most effective recipes for the treatment of hysterical neurosis.

• Infusion of valerian root. 1 tablespoon of the plant (crushed roots) should be poured with a glass of boiling water and left for 12 hours (you can leave the decoction overnight) using a thermos. The finished product must be taken 1 tbsp. spoon three times a day for no more than 1 month; the dose can be increased with severe excitability.
• Decoction of lemon balm (mint). Pour 1 tablespoon of the plant into a glass of boiled water, boil for 10-15 minutes, then strain. Take half a glass in the morning and at night.
• Hawthorn infusion. For the recipe you will need dry fruits of the plant (2 tablespoons), which need to be ground, then pour one and a half glasses of boiling water and leave. Divide the finished infusion into three doses, take 30 minutes before. before meals.
• Decoction of viburnum bark. To prepare the recipe, you need to pour 10 g of crushed viburnum bark into a glass of boiling water, then boil for 30 minutes, strain, add boiled water to the resulting decoction to a volume of 200 ml. Take the product three times a day, a tablespoon before meals.
• Motherwort remedies. To treat hysterical neurosis, you can use a decoction from the plant (15 g of shoot tips per glass of boiling water), as well as juice (30-40 drops taken several times a day).

Homeopathy

Hysterical neurosis responds well to treatment based on the use of homeopathic medications (in combination with drug therapy and other methods). Thus, to improve mental performance, attentiveness and physical endurance during hysteria, which is accompanied by asthenic syndrome, the so-called. "adaptogens". They have a mild stimulating effect, which manifests itself in reducing fatigue, accelerating recovery processes, and increasing immunity. Both aquatic and terrestrial plants, various microorganisms and even animals act as sources of natural adaptogens. Today, the most common adaptogens of plant origin include tinctures of medicinal plants: Schisandra chinensis, ginseng, aralia and zamaniha, as well as extracts of Eleutherococcus and Leuzea. Adaptogens of animal origin include complex preparations Pantocrine, Rantarin, Apilak, Panta-Forte, etc.

Homeopathy, used in the treatment of hysteria, has a beneficial effect on all organs and systems, promoting better absorption of oxygen by tissues, as well as stimulating cellular activity in the human body and restoring metabolism.

The Ginsana preparation has proven itself well in this regard in the form of a highly standardized ginseng extract without alcohol. It is made from carefully selected ginseng rhizomes using a special technology, which helps preserve the maximum amount of beneficial substances.

The drug Leuzea in the form of a liquid extract has psychostimulating activity and is used in the treatment of hysterical neurosis. It contains useful components: essential oils, alkaloids, organic acids and resins, a complex of vitamins. Stimulates the functioning of the nervous system, increasing reflex excitability, as well as motor activity.

Ginseng tincture, as well as Eleutherococcus liquid extract, has a tonic and stimulating effect on the body and has proven effective against overwork, stress, neurasthenia, asthenia, as well as weakened sexual function arising from neurosis. Both drugs have no side effects, but are contraindicated for insomnia, hypertension and increased excitability.

Surgical treatment

Hysterical neurosis is a pathological condition that combines motor, autonomic and sensory disorders. In this case, the patient may experience disturbances in the functions of sensitivity and perception.

Sometimes surgical treatment takes place, that is, surgical operations (laparotomy) for “Munchausen syndrome”, when the patient deliberately feigns the disease and demands treatment from doctors, moving from one hospital to another. This condition is caused by severe emotional disturbance. In most cases, people who suffer from this mental disorder are resourceful and quite intelligent. They not only skillfully simulate the symptoms of the disease, but also have reliable information about the signs and diagnostic methods, so they independently “manage” their treatment, requiring doctors to conduct a thorough examination and intensive therapy, including surgical intervention for the so-called. "hysterical pain" Against the background of conscious deception, subconscious motivations and an increased need for attention from medical staff arise.

Sensory disorders in hysteria are characterized by various sensory disturbances (hypostesthesia, hyperesthesia and anesthesia), which can occur in different parts of the body. Hysterical algias can also be observed in different parts of the body - both in the joints and limbs, and in the abdominal organs, in the heart, etc. Such patients are often referred to surgeons, who give them erroneous surgical diagnoses and perform abdominal operations.

Prevention

Hysterical neurosis can be prevented if you resort to preventive methods in time. First of all, a person needs to avoid in every possible way situations that have an adverse effect on his emotional system and psyche. Automotive training, listening to relaxing music, yoga, walks in the fresh air, hobbies, sports (for example, playing tennis or badminton, swimming, morning and evening jogging) are recommended.

Prevention is aimed at preventing attacks of hysteria, strengthening the nervous system and includes:

• normalization of working and rest conditions;
• ensuring adequate nutrition and sleep;
• rejection of bad habits;
• establishing family and interpersonal relationships;
• prevention of stress;
• adequate sports activities;
• healthy lifestyle.

People prone to hysteria should avoid sudden climate changes, since they have developed weather dependence. Relatives and friends need to take care of the patient, protecting him from shocking news, quarrels, and conflicts that can cause an emotional outburst. Restraint and absolute calm are in this case the best way to cope with an attack of hysteria. If the patient behaves rudely, you cannot respond with the same “coin” - this will only aggravate the situation.

The prognosis of the disease depends on the severity and personality characteristics of the patient. Thus, patients with signs of somnambulism, anorexia, and suicidal tendencies require longer treatment. An unfavorable outcome is observed if hysteria is combined with somatic diseases and organic lesions of the nervous system. In such cases, additional research, the prescription of complex therapy, and constant monitoring of the patient are required. Disability in hysterical neurosis is extremely rare.

If the psychotraumatic situation is successfully eliminated and treatment is started in a timely manner, the symptoms of neurosis disappear almost completely, and the person will again be able to lead a normal, fulfilling life.

Hysterical neurosis, in addition to medication and psychotherapeutic treatment, requires maintaining a healthy lifestyle and proper rest for rapid recovery of the body. The key role is played by disease prevention, which is based on compliance with measures to prevent nervous processes and mental disorders, preparing the nervous system for upcoming overstrains.

With hysterical paralysis there are no signs of organic damage to the nervous system. Monoparesis, hemiparesis, lower paraparesis and a state of immobility with tetraparesis (hysterical stupor) are observed. Monoparesis (monoplegia) can be proximal and distal. They are often accompanied by sensory disorders: hypoanesthesia or anesthesia with an “amputation” border, most often at the level of the wrist, elbow, shoulder joints of the arm and ankle, knee, hip (groin fold) joints of the leg.

With lower paraplegia, the level of sensitivity disturbance corresponds to the inguinal folds on both sides. With hemiplegia, the sensitivity disorder passes strictly along the midline anteriorly and posteriorly without “clearance” in the anogenital area, as happens with organic processes. While walking, the patient drags his leg like a log. In patients with hysterical paralysis, one can identify psychogenic moments that caused movement disorders, and note increased emotiveness, mannerisms, and theatricality. A discrepancy is discovered between the severity of the motor defect and the patient’s inadequately calm attitude towards it. With hysterical stupor, the patient is motionless, but reflexes are evoked, pathological reflexes are absent, the pupils react to light.

Emergency care for paralysis and paresis

Cerebrovascular accident. Regardless of the nature of the stroke, in the prehospital period it is necessary to create peace for the patient, undress him and put him to bed so that the head and upper body are slightly elevated. For arterial hypertension, antihypertensives are used (1 - 3 ml of 1% dibazole solution intravenously and intramuscularly, reserpine - 0.25 mg, 10 ml of 2.4% aminophylline solution intravenously slowly with 10 ml of 40% glucose solution or 1 - 2 ml of 12% aminophylline solution intramuscularly), decongestants (10 ml of 25% solution of magnesium sulfate intramuscularly, hypothiazide - 0.05 g orally), vasodilators (1 - 2 ml of 2% solution of papaverine subcutaneously, 1 ml of 1% solution of nicotinic acid intravenously).

Rapid and intense lowering of blood pressure should be avoided. For agitation and arterial hypertension, administer 1 ml of a 2.5% solution of aminazine intramuscularly in combination with 2 ml of a 1% solution of diphenhydramine; for low blood pressure, weak and rapid pulse - 2 ml of a 10% solution of caffeine subcutaneously, 1 ml of a solution of cordiamine subcutaneously or 2 ml of a 20% camphor solution subcutaneously, for acute heart failure - 0.25 - 0.5 ml of a 0.05% solution of strophanthin in 20 ml of a 40% glucose solution.

“Handbook for emergency care”, E.I. Chazova

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Compression of the neck with a noose is performed primarily for suicidal purposes. Occasionally, compression of the neck between dense objects occurs accidentally (for example, the neck is pinched by a car door during an accident, in children while playing, etc.). The severity of the victim’s condition depends on the duration of strangulation and is largely determined by the method of applying the loop. With a typical position of the loop, when the node is located in the occipital region, the clinical…

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