Andrey Vladimirovich Kurpatov - Remedy for vegetative-vascular dystonia

Where does this disease come from?

The diagnosis of VSD is made by doctors very often:

• In childhood - from 12 to 25%.
• In adults - up to 70%.

Experts associate such high rates with the avalanche-like growth of psycho-emotional stress experienced by members of modern society, both during study, at work, and in the family circle. And the predisposing factors are:

• A burdened hereditary history, which leads to the manifestation of VSD in young children.
• Pathologies affecting the central and peripheral nervous system (brain stem, limbic system, hypothalamus).
• A number of chronic diseases of organs included in the endocrine, cardiovascular and gastrointestinal systems.
• Chronic stress, overstrain and overwork, both physical and emotional.

In most cases, vascular dystonia has the appearance of a somatomorphic disorder. This is a neurosis that manifests itself mainly or exclusively as a disruption of the functioning of one or more internal organs, imitating the symptoms of various chronic diseases.

The pathogenesis of somatomorphic disorder occurs in several stages:

• A powerful experience, stress, combined in time with severe overstrain or even exhaustion of the patient’s psyche.
• “Repression” by the psyche of a traumatic situation that it can no longer cope with.
• The development against this background of a number of neurotic manifestations, from which various internal organs suffer.

Favorable factors for a somatomorphic disorder to affect a person are:

• The original imperfect autonomic regulator.
• A complex of surrounding cultural and social factors.
• Features of the psychological structure (for example, the presence of alexithymia - the inability to verbally express one’s own internal experiences).

Factors that aggravate the situation include hysteria, depression, anxiety, emotional instability, tobacco smoking, excessive consumption of alcoholic beverages, and hypochondria.

Symptoms of VSD

The complex of manifestations of vegetative-vascular dystonia can spread to almost any organs and systems of the human body, both together and separately. The most common syndromes encountered in medical practice are:

• Cystalgia.
• Cardiovascular.
• Hyperventilation.
• Sexual disorders.
• Irritable bowel.
• Thermoregulation disorders.
• Increased sweating.

And now about each of them in more detail

Cardiovascular syndrome

Manifested by lesions of the cardiovascular system. The patient experiences various types of arrhythmias:

• Extrasystole.
• Bradycardia.
• Tachycardia.

Blood pressure indicators may constantly change, vascular tone is also unstable, which is manifested by “hot flashes”, pallor, even “marbling” of the skin, as well as a feeling of chilliness in the hands and feet. Unpleasant sensations in the heart area manifest themselves:

• Discomfort behind the sternum.
• Stitching, aching or throbbing pain.

Pain during VSD is distinguished from angina by the lack of connection with physical activity, as well as the lack of effect from nitroglycerin.

Hyperventilation syndrome

The main manifestations of this syndrome:

• Tachypnea.
• Feeling of lack of air.
• Feeling of difficulty in breathing or incompleteness.

All this leads to the loss of a large amount of carbon dioxide from the blood, with its further alkalization, which has a depressing effect on the respiratory center. The result is muscle spasms, sensitivity disorders in the feet, hands, area around the mouth, and dizziness.

Irritable bowel syndrome

Its manifestations:

• Pain in the lower abdomen, aching and spastic in nature.
• Flatulence.
• Stool disorders.
• Increased urge to defecate.
• Appetite disorder.
• Nausea to the point of vomiting.
• Dysphagia (swallowing disorder).
• Discomfort and pain in the epigastrium.

At the same time, there are no organic changes in the gastrointestinal tract.

Increased sweating

It manifests itself as excessive sweating (hyperhidrosis), which is most often observed on the soles and palms.

Cystalgic syndrome

The patient urinates more frequently and is accompanied by painful sensations. In this case, there are no diseases of the genitourinary system and no changes in the composition of urine are detected.

Sexual disorders

Manifestations of the syndrome include problems with erection and ejaculation in the male part of patients, and, as for women, in them VSD leads to vaginismus coupled with anargasmia. But sexual desire may remain or decrease.

Violation of thermoregulation

Children most often suffer from this syndrome. It manifests itself with chills and low-grade fever. Patients tolerate hyperthermia quite easily; the temperature is higher at the beginning of the day. Sometimes thermometry of the left and right armpits shows different results.

The child grows, and dystonia “grows”

In adolescence, dystonia can manifest itself in attacks. It is because of these attacks that adolescents are often plagued by increased sweating, redness of the skin, palpitations, dizziness, ringing in the ears, and headaches. Emotionally unstable and often anxious teenagers are most susceptible to such attacks. Often, a mature person leaves his complaints forever in a bygone childhood. But this doesn't happen to everyone. The vast majority of women suffer from attacks of dystonia to one degree or another. In adults, dystonia is more severe and painful. The frequency of attacks also increases, as the elderly body, burdened with chronic illnesses, generally becomes less controllable. If you turn pale and/or blush easily, you often experience dizziness, headaches, excessive sweating, rapid or slow heartbeat, difficulty breathing, sleep disturbances, cold and numb extremities, and at the same time you quickly get tired and feel “wrung out.” lemon,” there is a high probability that we are talking about vegetative dystonia.

Diagnosis of vegetative-vascular dystonia and its treatment

The most important stage of the examination is the differential diagnosis between VSD and various organic pathologies of the relevant organs or their systems. It is carried out by specialized specialists. The next stage of the examination is performed by a psychoneurologist, whose task is to psychologically study the patient in order to find the causes of the development of autonomic disorders.

The main thing in these conversations is complete trust between the patient and the doctor, a comprehensive story about any unpleasant situations that could become an impetus for the development of pathology, the consequences of which must be gotten rid of.

Patients suffering from vegetative-vascular dystonia go to doctors for a number of years and receive a vague diagnosis of VSD along with assurances that everything is fine. For some, the psyche cannot stand it; they begin to doubt the sobriety of their own mind. Therefore, it is so important to have constant support for a patient with VSD from a neurologist who knows how to get rid of this painful disease, as well as self-education, thanks to which a person will better recognize the pathology that he has encountered and will treat it without unnecessary fear.

Andrey Kurpatov - how to cure VSD

Dr. Kurpatov is a highly qualified specialist in the field of medicine and psychology. His treatment methods are based on the impact on the human psyche, and do not require medical assistance or specific training. In one of his most popular, widely read works on the treatment of VSD, this doctor described in detail, but quite simply and clearly for everyone, the characteristics of the disease and effective ways to combat it based on the right psychological attitude.

As Kurpatov writes, vegetative-vascular dystonia is a disease affecting the nervous system, and its root cause lies precisely in the psyche of patients. Moral stress and a depressive state lead to attacks of VSD with characteristic symptoms:

• blood pressure fluctuations;
• headaches and dizziness;
• increased sweating under stress;
• causeless panic attacks, attacks of fear and anxiety.

REFERENCE!

If these symptoms occur, Kurpatov recommends getting rid of not only the disease itself, but also the cause of its occurrence - eliminating conflicts, stress, nervous situations, and normalizing the daily routine.

The main way to defeat VSD, according to Dr. Kurpatov, is to conduct auto-training. Since attacks of pathology occur against a background of stress and anxiety, it is important to learn how to prepare yourself to refuse them and overcome the fear of them. It must be remembered that constant thoughts and fear of an attack only aggravate the course of the disease and stimulate its development. To get rid of fear, the doctor recommends going through 3 stages:

1. Get rid of excess muscle tension, normalize respiratory function to restore normal body condition.
2. Familiarize yourself with objective information about the disease, its symptoms, and the causes of attacks to eliminate negative thoughts and groundless fears.
3. Start auto-training to correctly understand the essence of the disease and set positive thoughts.

Also, VSD, according to Kurpatov’s manual, worsens not only with stress affecting the nervous system, but also with an artificially suppressed stressful state of the body, provoked by disturbances in a person’s usual life activities. Such changes include:

• changing of the living place;
• changes in climate and weather conditions;
• a sharp change in the rhythm of life;
• hormonal imbalances;
• a sharp decrease or increase in physical activity.

In these situations, stress is a natural reaction of the body to a violation of usual living conditions. If the patient restrains this manifestation, the nerve impulse strengthens and hits the body, which causes an attack manifested by:

• rapid increase in pressure;
• dizziness and headaches;
• fever or sweating;
• semi-conscious or fainting state.

IMPORTANT!

In the book “A Remedy for Vegetovascular Dystonia,” Andrei Kurpatov advises not to refuse medical care and going to the hospital, and also strongly recommends taking medications prescribed by a doctor. Psychological attitudes will only help if the problem of VSD attacks lies in the person’s psychological negative mood.

Complex drug treatment includes taking the following types of tablets and injectable medications:

• Barbiturates - for people over 65 years of age in extremely rare cases, since the drugs are addictive and have a negative effect on brain activity (Corvalol, Valocordin, Barboval).
• Benzodiazepines and tranquilizers are anti-anxiety drugs, before using which it is important to consult a doctor and become familiar with the side effects of each drug: the more of them, the higher its effectiveness, and vice versa (“Phenazepam”, “Seduxen”, “Xanax”).
• Antidepressants - with the correct individual selection of medication, the drug helps relieve panic attacks and restores the normal functioning of the nervous system, but requires regular course use (Maprotiline, Pyrazidol, Tryptophan).
• Herbal antidepressants - relieve the symptoms of dystonia, relieve anxiety, panic attacks and depression, stabilize the performance of the nervous system, which is especially effective in the general stressful state of the body due to changes in habitual living conditions (Negrustin).
• Neuroleptics - relieve unnecessary anxiety, stabilize the functioning of the autonomic nervous system, are not addictive, but require individual selection of the drug for each patient by the attending physician (Atarax, Eglonil, Clozapine).
• Nootropics of synthetic and plant origin - improve the condition of nervous tissues, but do not affect the emotional background (Nootropil, Ginkgo Biloba, Neuromultivit).

ATTENTION!

Since many medications are addictive and have side effects, their use is necessary only when prescribed by a doctor and in strictly limited dosages.

An alternative effective remedy, according to positive reviews, is a herbal decoction according to the prescription of Dr. Kurpatov. To prepare it you need the following ingredients:

• birch buds - 100 g;
• dried chamomile flowers - 100 g;
• St. John's wort herb - 100 g;
• rose hips - 100 g;
• honey - 3 tbsp. l.;
• water (boiling water) - 600–800 ml.

All medicinal plants must be ground, mixed, added honey and poured boiling water. The medicine should be allowed to brew for 1 hour, after which you should drink it regularly before each meal and after dinner, 1 glass.

The herbal decoction helps relieve and calm the nervous system, normalizes heart rate and heart function, stabilizes blood pressure, and reduces the risk of panic attacks and causeless anxiety. The result will be noticeable within a month of regular use of the product. The medicine must be stored in a jar or other glass container at room temperature.

ATTENTION!

Before deciding to start treating VSD using traditional medicine, it is important to discuss the possibility of their use with your doctor!

Information weapons in the fight against VSD

Several years ago, a book appeared in the public domain, the author of which, Andrei Kurpatov, is a doctor who has been treating autonomic dysfunction for many years. He decided to present his invaluable experience on the pages of a small book. Its target audience is very wide: people who have been exhausted by long-term and unsuccessful treatment for VSD, patients who first discovered the symptoms of this disease and have just begun an endless visit to specialists in search of the cause of their illness, even those people who managed to achieve stable remission. After all, most of those who read this work by Dr. Kurpatov, for the first time in their lives, learn that you can get rid of VSD once and for all.

It contains information about the way to regain lost health and peace of mind, about means that can activate the hitherto hidden resources of the human body that can overcome most of the symptoms of VSD.

What is VSD from the point of view of Dr. Kurpatov

Vegetative neurosis, neurocirculatory dystonia and vegetative-vascular dystonia are diagnosed quite often. All these names are united by one thing - the incomprehensibility of the wording and the fear of the impossibility of being cured of this disease forever.

The book that Kurpatov wrote, “The Remedy for VSD,” will help everyone quickly and easily understand the variety of manifestations of the disease:

• Changes in blood pressure.
• Dizziness when riding in public transport.
• Sweating when in a stressful situation.
• The emergence of fear for no apparent reason.

The author slowly and methodically convinces readers that the main cause of all troubles lies in their own thoughts, in the self-programming of their own organisms for negativity.

Vegetative-vascular dystonia is most often based on three pillars:

• Fear.
• Stress.
• Chronic lack of sleep.

The pathology occurs in the same way for everyone - there is an accumulation of negative factors, gradually leading to problems with well-being:

• Changes in blood pressure.
• Gradually increasing weakness.
• Fatigue in response to even minor physical or mental activity.

The result of this is walking from one doctor's office to another in search of a solution to the problem. Standard examination schemes by therapists, and then by cardiologists and endocrinologists, do not reveal any deviations from the norm. Eventually, patients are diagnosed with VSD and referred to psychologists or psychiatrists. And the next stage begins - training or antidepressants, which bring relief only during the course of treatment, and after its completion all the sensations return again.

Text of the book “Beyond vegetative-vascular dystonia”

Andrey Kurpatov On the other side of vegetative-vascular dystonia

Introduction

These patients are too well recognized by doctors.
Unlike most others, these patients do not shy away from the attention of medical workers, but, on the contrary, insistently demand comprehensive medical care; they do not sabotage the treatment, like many other patients, but, on the contrary, significantly intensify and diversify it; they love examinations and research, they are ready to consult with everyone ad infinitum; they uncontrollably convince doctors that they are seriously ill. And although doctors themselves, having no reason to agree with such an assessment of the situation, think differently, they are often unable to refuse a diagnosis to this category of patients. The name of this diagnosis is vegetative-vascular (neurocirculatory) dystonia. Many practicing doctors, admittedly, quite reasonably doubt that this is truly a somatic and not some other pathology. What is confusing is the young or relatively young age of these patients who claim to be a “heart patient”, the absence of any more or less significant objective signs of somatic suffering and, most importantly, the behavior that is strange for a “sick” person. here the specialist’s embarrassment exceeds all conceivable and inconceivable limits. Complaints resemble festive fireworks, pouring as if from a cornucopia - they are numerous, figurative, polysystemic, bizarre, and each of the symptoms worries the patient extremely, while any other patient might not have paid any attention to it.

During attacks of the “illness”, these patients behave in an amazing way: literally “dying” for the umpteenth time from another “heart attack”, they can run like crazy around the apartment, or even around the city - either waiting for, or looking for medical help. help. In this madness, they are ready to involve everyone - from relatives and doctors, to their own young children or random passers-by. Finally, when a doctor, satisfied with the negative results of research, informs such a patient about his complete and unconditional health, he, instead of exclaiming: “Lord, what happiness! I am well! Thank you Doctor!" - rushes at the doctor with accusations of unprofessionalism, callousness and violation of some points of the Hippocratic Oath known only to him.

These patients, as a rule, are extremely knowledgeable about medical issues; they have read a lot of reference books, manuals and other special publications (it is thanks to these patients that many doctors are sure that the most harmful of magazines is the Health magazine). they literally juggle with medical terminology, know everything in advance, are afraid of everything and sometimes seem to crave all this, without, however, realizing it. Despite their outward – sometimes exceptional – openness, they are very secretive: if you ask them to talk about their illness, then it will take at least an hour to present even the hundredth part of it. The doctor can only wonder: how can you remember all these details and nuances?! however, a very simple question (for example, “How long after taking nitroglycerin do you feel the effects?”) can really stump these patients.

These patients certainly have in their hands a dozen (or even more than one!) various conclusions, certificates, test results and studies, which, as they claim, are either “incomprehensible” or “were made just when the condition returned to normal”, or with “significant violations of research techniques.” It may happen that they will tell the doctor that they “forgot” or “left at home” these medical documents. However, such references to forgetfulness in some cases are a simple reluctance of patients to demonstrate to their next doctor the conclusions of previous doctors about their excellent health.

These patients never doubt that they are sick, and seriously sick; in their opinion, you can doubt anything, but not this. The disease - “severe”, “incurable”, “terrible” and “deadly” - is present, it is pointless and absurd to dispute this fact. That is why you should always have a telephone at hand (for an emergency call for an ambulance), as well as a whole list of drugs, of which the most effective and favorite are Corvalol, Valocordin, Validol and, for those who are more experienced, phenazepam. How phenobarbital, isovarianic acid or a benzodiazepine drug provide such strong and irreplaceable help to the heart and blood pressure is unknown, but for some reason these patients are not confused by this question - “heart drugs”, and that’s all!

Many of these patients do not dare to go out without this kind of medicine, or without the accompaniment of relatives or friends.

It is especially difficult for them to be present in public places - shops, government institutions, even theaters or museums. sometimes their fear of death is so great that for years they are in a state of panic waiting for the “quick end”, turning into real invalids - and against the backdrop of such health, it seems that a corps of astronauts would envy them.

Finally, nothing helps these patients more than the attentive attitude of a doctor. Often, a pleasant conversation with a specialist (even over the phone) turns out to be much more effective for these patients from a therapeutic point of view than any of the most modern medications. Surprisingly, the very appearance of a doctor can stop a “severe heart attack,” when the patients “couldn’t find a place for themselves,” “almost died,” “they didn’t know how they would survive.” The very fact of hospitalization or the prescription of some “ultra-modern”, preferably “herbal” drug, has an equally healing effect.

However, this effect, as a rule, is short-lived, since for them – patients with vegetative-vascular (neurocirculatory) dystonia – “nothing helps.” they will again begin to wait for the next deterioration, prepare for it and suffer. Moreover, if the disease from a therapeutic point of view is not worth a damn, the suffering of these patients is genuine and painful. F.M. Dostoevsky, who was sentenced to death in his youth for his connection with the Petrashevites, as is known, was spared from this fate at the very last moment, but the fear experienced by the great Russian writer was genuine.

The suffering and horror of patients with vegetative-vascular (neurocirculatory) dystonia are just as real, although, of course, nature has mercy on some...

If there is some kind of organic lesion, then, firstly, it must communicate itself with a certain specific list of symptoms and syndromes, forming a single “picture of the disease”; secondly, it can be identified using special research methods; thirdly, effective treatments should already have been created for it. Patients with so-called vegetative-vascular (neurocirculatory) dystonia have neither the first, nor the second, nor the third. However, they have an affect, and a pronounced one, often reaching the level of “panic attacks”, there are personal characteristics, the full weight of which their doctors are forced to feel on themselves, and also - but this part is already covered in a veil of secrecy - a kind of “neurotic core”, that is the basis of this pseudosomatic disease, which constitutes the main engine of this entire tireless human being.

As a rule, the patients in question have already been treated by all possible doctors - cardiologists, pulmonologists, neurologists, endocrinologists, even osteopaths, and have also visited psychics, healers and fifth-generation sorcerers. The latter, by the way, provide such patients, paradoxically, with the most effective assistance. However, whoever hasn’t seen these patients is a psychiatrist, and getting them to go to the “right address” of doctors, either by spirit, or by opportunity, or by competence, is not enough. Strictly speaking, these patients do not need to see a psychiatrist; their doctor is a psychotherapist. however, this specialist is so rare that it is both difficult and scary to refer him to him, since “what” he is and “who” he is, and most importantly, “how” and “why” he is - is unknown to practically no one.

Well, the stated topic is certainly relevant: doctors suffer, patients suffer, and no one knows what to do. Therefore, the objectives of this work are to clarify the essence of the disease, which bears the notorious name “vegetative-vascular (neurocirculatory) dystonia,” as well as to present the possibilities and methods of its effective treatment. What is psychotherapy for patients with vegetative-vascular (neurocirculatory) dystonia and what is the correct psychopharmacological effect in the case of this disease - things are extremely important for any doctor practicing in the vast Russian expanses.

Part One: Problems of Definition

“We must think that changes in the function of the heart often do not go in proportion to the anatomical changes in the heart itself, but are often dependent on the central nervous apparatus, the state of which in turn depends largely on environmental conditions.”
S.P. Botkin

The position of this disease, to put it mildly, is somewhat strange, since with equal success, with equal confidence and, most importantly, with equal right, it is considered both a purely mental and a purely somatic illness. The same condition, the same phenomenon is called completely differently: in somatic medicine this disease was called vegetative-vascular (neurocirculatory) dystonia, in psychiatry it was previously most often under the guise of obsessive-phobic neurosis, now, according to ICD-10 , is called somatoform autonomic dysfunction.

However, it probably doesn’t matter much what name we are looking for for this or that painful phenomenon; the main thing is to decide on the tactics of its treatment. However, how can you decide if even the definition of this disease seems so vague? Remembering and paraphrasing the textbook expression about judges, I just want to exclaim: “And who is the doctor?!” Apparently, only by answering this question will we be able to understand the essence of this disease and the possibilities of its treatment. But let's start with definitions, with the elimination of existing nomenclature issues and a little historical background.

Therapeutic and psychiatric definitions

Vegetative-vascular (neurocirculatory) dystonia is defined as a polyetiological functional disease of the cardiovascular system, which is based on disorders of neuroendocrine regulation with multiple and varied clinical symptoms that arise or worsen against the background of stress, characterized by a benign course, good prognosis, not leading to cardiomegaly and heart disease. failure (Chirkin A.A., Okorokov A.N., Goncharik I.I., 1993).

Somatoform autonomic dysfunction is defined as a mental disorder [1]1

They would probably say that it is a “disease” and not a “disorder,” but the modern ideology of psychological correctness required such a replacement of the term (ICD-10), which, however, did not change the essence of the matter, of course.

[Close], the main symptom of which is the repeated resumption of physical symptoms and the constant demands of patients for additional medical examinations, despite confirmed negative results and assurances from doctors about the absence of a physical basis for the symptoms presented. Complaints are presented by patients in such a way that they are caused by a physical disorder of a particular system or organ, which is mainly or completely under the influence of the autonomic nervous system. The most frequent and striking examples relate to the cardiovascular (“neurosis of the heart”), respiratory (psychogenic shortness of breath and hiccups), gastrointestinal (“gastric neurosis”, “nervous diarrhea”) and genitourinary (“bladder neurosis”) systems ( ICD-10).

Psychiatric definition of “vegetative-vascular dystonia”

According to ICD-10, “somatoform disorders” (P45) are psychogenic and functional, characterized by physical pathological symptoms that resemble a physical disease in the absence of corresponding organic disorders, while the detected organic disorders do not explain the nature and severity of the symptoms or the distress and preoccupation of the patient. A specific feature of somatoform disorders should be considered the conviction of patients that they have somatic diseases, which decreases, although it does not disappear, under the influence of argumentation, reassurance and when conducting new examinations.

Somatoform autonomic dysfunction (P45.3) is considered as a particular manifestation of somatoform disorder and is defined as a mental disorder characterized by complaints and symptoms from one or another organ system (cardiovascular, gastrointestinal, respiratory, genitourinary, etc.), which, however, they are determined by the state of the autonomic nervous system.

Somatoform autonomic dysfunction of the heart and cardiovascular system (P45.30), that is, vegetative-vascular dystonia itself, in turn is considered as a particular manifestation of somatoform autonomic dysfunction, characterized by pain in the heart (possible irradiation), palpitations, interruptions in heart function (extrasystole , often in the form of bodily sensations), fluctuations in blood pressure, weakness, headaches (heaviness in the head), dizziness, unsteadiness of gait, sweating, etc.

These quotes from ICD-10 describe a mental disorder, but non-psychiatric doctors can easily recognize their patients in the description of this clinic.

As is easy to see, the definitions presented have something in common with each other in the most direct way, but they differ in the fundamental point: in the first case we are talking about a “disease of the cardiovascular system”, in the second – about a “mental disorder”. Another significant difference seems to be the fact that in the case of somatoform disorder, not only autonomic disorders of cardiovascular activity are observed, but also other body systems. However, similar symptoms (sweating, difficulty breathing, functional disorders of the gastrointestinal tract, etc.) are also taken into account in the clinical picture of vegetative-vascular (neurocirculatory) dystonia, so this difference is only apparent. At the same time, another, rather strange feature of the given definitions is obvious: in the definition of vegetative-vascular (neurocirculatory) dystonia, the emphasis is on the neurogenic nature of the disease, and in the definition of somatoform disorder, on the contrary, the somatic manifestations of this mental illness are emphasized.

In the description of the etiology of vegetative-vascular (neurocirculatory) dystonia, the first place is traditionally given to “acute and chronic emotional-stressful situations”, followed by “mental and physical fatigue”, then chronic infections of the nasopharynx, smoking, brain injuries, exposure to occupational hazards, alcohol abuse etc., that is, everything that can be indicated with equal success as “etiological factors” of anything, including cancer. The predisposing factor is called “hereditary-constitutional”. What do you mean by it? – remains a mystery. Perhaps we are talking about a “hysteroid radical”, the importance of which within the framework of this pathology is clearly indicated by the authors of the corresponding psychiatric heading of ICD-10. Let us note in passing that each of us has this “radical”; all the differences lie only in its “specific weight” in the mental organization of a given person, so there is nothing special about it.

The pathogenesis of vegetative-vascular (neurocirculatory) dystonia, however, at first glance looks even less certain. Here we talk about disintegration of neurohumoral-metabolic regulation at the level of the cerebral cortex, limbic zone and hypothalamus, which leads to dysfunction of the autonomic nervous system, functional disorders in the microcirculation system and in the endocrine glands. To non-specialists in the field of neurophysiology, such passages sound like complete gibberish. However, the simplicity of this formulation after translating it into Russian cannot but captivate with its laconicism, since we are talking only about the fact that thoughts (derivatives of the cerebral cortex) and emotions (derivatives of the limbic zone of the brain and hypothalamus) of a person lead to the occurrence of certain vegetative shifts. Of course, we are talking about not the most, so to speak, successful thoughts and emotions of the patient we are considering...

But let's return to somatoform autonomic dysfunction. Explaining its definition of this mental pathology, ICD-10 in particular notes that this disease is characterized by two types of symptoms, “neither of which indicates a physical disorder of the affected organ or system.” The first type of symptoms is characterized by complaints reflecting objective signs of autonomic arousal, such as palpitations, sweating, redness, tremors, etc. The second type is characterized by more idiosyncratic, subjective and nonspecific symptoms, such as sensations of fleeting pain, burning, heaviness, tension, bloating or sprains, etc. Thus, the specific clinical picture of a somatoform disorder consists of a clear involvement of the autonomic nervous system, additional nonspecific subjective complaints and constant references by the patient to a specific organ or system (cardiovascular, gastrointestinal tract, respiratory, etc.) as the cause of your disorder.

So, in the description of vegetative-vascular (neurocirculatory) dystonia we find indications of the psychogenic nature of the disorder (including, however, a lot of accompanying indications), and in the presentation of somatoform autonomic dysfunction, on the contrary, the emphasis is on the presence of a whole list of “somatic” complaints in the patient. Apparently, the essence of this “legal subtlety” is that the authors of manuals on vegetative-vascular (neurocirculatory) dystonia consider this disease to be somatic with a mental background, and the compilers of definitions of somatoform autonomic dysfunction consider this disease to be mental, but manifested by complaints of a somatic nature. So is there a contradiction here? Apparently, there is no, except for one, as it turns out, serious circumstance: patients with this disease turn to doctors of a somatic specialty, and the psychiatrist finds these patients, if he has such an opportunity, among those who have already turned to a therapist.

Whose patient is this – a therapist’s or a psychiatrist’s? In such cases, the answer can only be obtained ex juvantibus. What are the results and data here? Ex juvantibus, we can say the following: therapists consider this disease to be benign and with a good prognosis, since the “somatic” symptoms here actually, although often after a very long period of illness, are reduced, making room for “normal” diseases of the cardiovascular system. Psychiatrists, on the contrary, are inclined to think that this disease progresses rather than passes, since the personality of such patients, their psyche actually undergoes significant pathological development over time, and the disease itself turns from an essentially innocent disorder of a neurotic level into low-impact forms of neurotic development and psychopathization. In addition, ex juvantibus (in the context of symptomatic therapy), we can say that the symptoms of this disease are well relieved by psychotropic drugs, ranging from phenazepam to phenobarbital-containing corvalol, valocordin, etc. At the same time, the effectiveness of somatic-oriented therapy in reducing the manifestations of this disease is not exceeds 20-25%, which is the stable figure for the placebo effect in psychiatry.

Pathocharacterological development of personality according to the hypochondriacal type

The most dramatic scenario for the development of mental disorders in the case of initial somatoform pathology is the pathocharacterological development of the patient’s personality according to the hypochondriacal type. His psyche is undergoing a deep restructuring of personal structures, mainly in the aspect of socio-psychological relations and in the motivational sphere, due to a persistent and expressed overvalued idea of ​​​​hypochondriacal content.

This disorder is considered as “acquired psychopathy”, when, after the cessation of the psychogenic reaction, a complex of dominant, negatively colored ideas is formed, sharpening psychopathological personality traits, strengthening and stabilizing around the overvalued idea of ​​​​hypochondriacal content. These patients, as a rule, already demonstrate a minimum of somatic disorders (which, of course, does not apply to the complaints they present), however, mental disorders become evident and acquire paramount importance.

In other words, neither therapists nor psychiatrists can boast of the effectiveness of treating vegetative-vascular (neurocirculatory) dystonia or somatoform autonomic disorder. However, there is probably nothing strange in this, since if we assume that when we say “this disease”, we are talking about a borderline mental disorder, that is, simply put, about neurosis, then the main means of treating it is psychotherapy . With the help of psychotherapeutic techniques (systemic behavioral psychotherapy), subject to the active participation of the patient, this disease is cured in 75-80% of cases, and in combination with psychopharmacological effects in almost all 100% (Kurpatov A.V., Kovpak D.V., 2000). Well, for assessment by the ex juvantibus method, the result is quite satisfactory, proving, as it seems to us, the essence and nature of the disease, which, in fact, will be discussed in this work.