Treatment of neurasthenia (CFS), depersonalization, derealization

Many people experienced a condition that they could not really explain. According to them, they felt the unreality of what was happening, the reality around them became two-dimensional, as if drawn. The perception of sounds was also distorted. This disorder is called derealization. Attacks can be prolonged or short-lived, and the frequency of their occurrence can also vary.

Derealization is sometimes called depersonalization, but these are two different pathological conditions. In the first case, a person suffers from a psychosensory perception of the world, and in the second, an internal personality disorder is observed. Simply put, depersonalization refers to processes occurring within a person, while derealization is formed as a result of the loss of the ability to sense external stimuli. But derealization and depersonalization very often accompany each other, so even in the International Classification of Diseases these disorders are combined into one syndrome.

general information

Depersonalization is a syndrome. A person perceives his thoughts and feelings as if from the outside. He stops connecting his own personality with the body.

Depersonalization is almost always a symptom of bipolar disorder, depression, or schizophrenia. Often this condition is accompanied by derealization or mental anesthesia.

Pathology is defined in psychology as a subjective feeling. The alienation experienced by a person with depersonalization distinguishes this disorder from the syndrome of mental automatism.

The patient realizes that his condition cannot be called normal. This pathology differs from other disorders.

Not always a pathology

Depersonalization syndrome is not always a pathological mental disorder. Symptoms occur occasionally in more than 70% of people. It seems to a person that for a short time he does not belong to himself.

Usually this condition manifests itself during the formation of a person’s self-awareness. Even when occurring systematically, cases of depersonalization are not considered a pathology. With a stable form of depersonalization-derealization syndrome, it requires prompt medical intervention.

Basic forms

The following forms of this disorder are distinguished:

1. Autopsychic depersonalization.
2. Somatopsychic depersonalization.
3. Allopsychic depersonalization.
4. Anesthetic depersonalization.

Features of autopsychic depersonalization

In this condition, patients lose the ability to feel adequately. The paradox is that they experience this painfully.

The loss of emotional responses to insults, the illness of a loved one, or good news contributes to spiritual emptiness. Sometimes the patient deliberately goes into conflict in order to feel at least something, but this is useless.

This depersonalization is often found in the clinical picture of depressive syndromes.

Features of somatopsychic depersonalization

The characteristics of a patient with this disorder are quite specific. A person's perception of physiological and bodily manifestations decreases. There are complaints that parts of the body have “become different.”

Healthy, but very tired people can experience similar conditions to a mild degree.

A person suffering from somatopsychic depersonalization does not experience hunger. But when he sits down to eat, satiety does not come either. He may complain that food has no taste and that eating does not give him pleasure.

The process of defecation seems to the patient to be incompletely completed. He doesn't feel satisfied after that. There is no satisfaction during sex.

Elements of this condition may be present in residual organic brain damage.

Features of allopsychic depersonalization

Depersonalization syndrome is characterized by the presence of subjectively painful experiences. There is also alienation of mental acts relating to personally significant external objects. This applies to ordinary desires, interests, attachments and everything with which a person associates a feeling of security and stability.

Relationships with loved ones suffer. Some patients begin to feel burdened by their home. Parents often become objects of deepest hostility.

The sympathetic attitude of a mother or father is perceived inadequately. The patient feels that his parents are encroaching on his safety and freedom. He moves more and more away from loved ones, withdraws into himself, becomes embittered, and sometimes cruel.

Features of anesthetic depersonalization

This form of the disorder is characterized by a painful feeling of emotional alienation. The patient complains of:

• lack of empathy;
• lifelessness of the surrounding world;
• dullness of taste;
• “numbness” in the head.

This state is also characterized by a lack of attachments and emotional resonance. The mother realizes that she should love her child, but she feels nothing for him.

Anesthetic depersonalization is severe and difficult to treat. Pathology often accompanies schizotypal disorders.

If the clinical picture is dominated by anxiety, the disorder is classified as depersonalization and derealization syndrome.

Diagnostics

• Clinical criteria
• Laboratory tests to rule out diseases other than CFS

Diagnosis is made by characteristic findings from the medical history in combination with the results of a standard physical examination and routine laboratory tests. The use of criteria to identify disease may sometimes be useful, but they are primarily a tool for epidemiological studies and should not strictly be applied to individual patients.

An examination is necessary to check for any of the signs not included in the causative series of CFS if, based on objective clinical data, the presence of this syndrome is suspected. If there is a suspicion of this syndrome, but no obvious or potential causes, it is advisable to evaluate using laboratory tests, which include a complete blood count and determination of the levels of electrolytes, blood urea nitrogen, creatinine, ESR (erythrocyte sedimentation rate) and TSH (thyroid-stimulating hormone). If individual patients are clinically indicated, they undergo further evaluation, which may include chest X-ray, sleep study, and adrenal insufficiency testing. Without objective signs of the disease established by examination (and not just on the basis of subjective complaints) or according to basic initial tests, serological tests for infections, testing for antinuclear antibodies, and neuroimaging should not be performed; in such cases, the clinical predictability of the test result is low and the risk of false-positive results (and therefore unnecessary treatment and/or confirmatory testing) is correspondingly high.

Why is it developing?

It is believed that specific signs appear more often in young women who have crossed the thirty-year barrier. Cases of diagnosing this pathology in adolescence have become more frequent.

The reasons why depersonalization occurs are quite varied.

This disorder is almost always associated with repetitive stressful situations. The human psyche begins to resist, his attention switches to the view “from the outside.” This helps reduce emotional stress.

The patient does not lose the ability to reason logically. Sensory perception of the world becomes dull, a person begins to reflect.

Main provoking factors

Derealization and depersonalization appear against the background of:

1. Disorders of the pituitary gland.
2. Epilepsy.
3. Schizophrenia.
4. Presence of a tumor in the brain.
5. Alcohol abuse.
6. The use of drugs that influence the psyche.
7. Impaired functioning of the adrenal glands.

Depersonalization is often diagnosed in neurosis. Specific symptoms occur in people with obsessive-compulsive disorder.

Predisposing factors

Symptoms of derealization and depersonalization occur due to:

1. Neurological diseases.
2. Vegetative vascular dystonia.
3. Frequent fainting.
4. Regular increase in blood pressure.

Key points

• Chronic fatigue syndrome (CFS) is a life-disrupting condition of fatigue lasting > 6 months that typically occurs in previously healthy and active people; however, it is not a simulation of the disease.
• The etiology of the disease is unclear but likely involves several factors, including genetic predisposition, microbial exposure, and environmental and psychological factors.
• Diagnosis of CFS is based on the patient's characteristic symptoms, as well as the results of a standard physical examination and routine laboratory tests; The Institute of Medicine (now the Division of Health and Medicine of the National Academies of Sciences, Engineering, and Medicine) criteria may be useful but should not strictly be applied to individual patients.
• The task of doctors is to diagnose, confirm the patients' symptoms with objective examination results, encourage them to accept the idea of ​​their partial disability and come to terms with it, and possibly try to treat using cognitive-behavioral psychotherapy and/or an exercise program with increasing load.
• Medications should be used as needed to treat specific symptoms of the disease (eg, pain, depression, insomnia).

How it manifests itself

The presence of a violation of adequate physical perception of the surrounding reality is indicated by the following signs:

• dulling of pain;
• decreased perception of cold and heat;
• lack of taste sensations.

Sounds seem unclear to a person. Telling the doctor about his feelings, he says that he feels as if he is “underwater.” Objects do not have clear boundaries and look blurry. The colors fade and turn gray. Against this background, color blindness sometimes develops.

Symptoms of VSD

Depersonalization with VSD manifests itself:

• lack of oxygen;
• increased temperature;
• depressed mood;
• frequent dizziness;
• migraines.

Dystonia is combined with chronic fatigue and weakness. A person may complain of mild pain in the lower extremities. Many patients become weather dependent.

Difference from mental pathologies

It is not difficult to understand that a person does not suffer from severe mental disorders, but is only in dereal.

The attacks are not accompanied by hallucinations. To one degree or another, a person can control his behavior. The world around him seems unreal to the patient, but he defines it correctly. He realizes that something is wrong with him. A mentally ill person does not understand this.

Signs of hypochondria

1. Obsessive worry about health. All conversations with such a person will boil down to his health, well-being and new symptoms. Even in social network posts, phrases will flash about the possible fatal or severe outcome of an imaginary disease.
2. Obsession. Hypochondriacs can spend hours listening to their sensations, paying special attention to even minor pain or discomfort.
3. Suspiciousness. At the slightest discomfort or minor pain, the brain makes the most terrible assumptions. So, a mild headache can be regarded as a tumor or stroke.
4. Selectivity. People with such a psychological disease carefully study information about their diagnosis and select only facts indicating its presence, and ignore those that refute the presence of the disease.
5. Aggravation. This phenomenon is often observed in hypochondriacs. This is an exaggeration of the severity of the disease to the point where a person cannot get out of bed due to supposedly unbearable pain in the body.
6. Psychosomatics. Hypochondriacs often experience symptoms of self-hypnosis: shortness of breath, rapid heartbeat, dizziness or nausea.
7. Mood. People suffering from hypochondria often fall into severe depression, accompanied by thoughts of imminent death.

Clarifying the diagnosis

The doctor begins to treat depersonalization only after establishing an accurate diagnosis. The diazepam Nuller test helps differentiate between this disorder, depression and anxiety.

For this, the patient is given 20 to 30 mg. Diazepam solution. The doctor expects 3 reactions:

• anxious;
• depressed;
• depersonalization.

With an alarming reaction, affective symptoms quickly disappear. They give way to euphoria. With a depressive reaction, the symptoms do not change. The patient quickly falls asleep. With a depersonalization reaction, a positive effect occurs for 20 minutes. Pathology can be reduced completely or partially.

How you can help

Treatment for depersonalization depends on the severity of symptoms. If the signs have not been present for long, the patient is referred for psychoanalysis. Additional therapeutic methods include:

1. Use of antidepressants.
2. Passage of massage procedures.
3. Acupuncture.
4. Undergoing physiotherapeutic procedures.

Treatment in hospital

If depersonalization only worsens, then treatment is carried out in a hospital. The complex of therapeutic measures comes down to the destruction of the sources of fear that provokes the “disconnection” of the individual.

In especially severe cases, the patient is prescribed the use of potent sedatives, antipsychotics, tranquilizers and neurotropic medications.

Psychological help

The patient will be told how to get rid of depersonalization during psychotherapy sessions. If he has no history of other pathologies, treatment is aimed specifically at this disorder.

The lesson begins with an explanation of the nature of the pathology. The specialist also talks about ways to combat it. The prescribed psychological techniques consist of switching the patient’s attention from his experiences to the world around him.

The doctor undertakes to teach the patient ways of harmonious interaction with the surrounding reality. The most effective therapeutic methods include:

• motivating technique of suggestion;
• auto-training;
• hypnosis.

This reduces the intensity of symptoms. Upon completion of the course of psychotherapeutic treatment, the disorders are eliminated and the patient’s condition is stabilized.

Drug therapy

Drug therapy helps to get rid of the symptoms of the pathology. The patient is prescribed medications such as:

1. Quetiapine.
2. Amitriptyline.
3. Clopyramine.
4. Sonapax.

These medications are taken simultaneously with vitamin C. If the disorder is combined with depression, the use of nootropics with an antioxidant effect is prescribed. The best medicines are Cytoflamin and Cavinton.

In order to normalize the functioning of the opioid function of the brain, the use of Naloxone and Naltrexone is prescribed. To relieve anxiety and panic, it is recommended to take Seroquelem and Anafranil. Impaired functioning of the adrenal glands can be eliminated with the help of Decorten.

The use of serotonin reuptake inhibitors is also prescribed.

Self-help methods

Everyone should know how to get rid of an attack of depersonalization on their own. This can help quickly relieve symptoms at home, without the use of medications.

You need to relax as much as possible, try to breathe more evenly and calmly. Then you need to concentrate on the thought that this is a temporary state. It is successfully treated and the symptoms will soon disappear.

The patient's attention should be concentrated on some phenomenon or object. It is not necessary to look at every detail. Then you need to try to concentrate your attention on neutral thoughts.

The occurrence of hypochondria in VSD

Hypochondria is a condition that involves constant and unreasonable worry about one's health. Often there are obsessive thoughts about a possible illness - serious and fatal. Typically, a person with hypochondria becomes so convinced of their suspicions that they actually experience pain, weakness, and other symptoms.

After the manifestation of certain symptoms, the “patient” is immediately sent to the doctors. And even if the results of the examination turn out to be negative, the patient will be sure that the medical personnel are unqualified and that the equipment is faulty. This will force him to go to another clinic, and then to the next. As a result, there is a high chance of ending up in debt or in the hands of scammers who promise to cure you using “alternative methods.”