Adjustment disorder (adaptation disorder). Treatment in the clinic, symptoms

Causes

Adaptation disorder is most often observed , which is explained by the instability of their psyche. But, with prolonged experience of stressful situations, it is diagnosed in people of working age and elderly patients. The pathological condition appears when:

Stress;
Neuroses;
Psychosis.

With these diseases, patients complain of insomnia and deterioration of the person’s general condition, which leads to adaptation disorder. Personality adjustment disorder has varying degrees of severity, depending on the severity of the stress.

The onset of the disease can be observed during a serious single stress, for example, the loss of a prestigious job, the death of a loved one, etc. Pathology develops with periodic stress that occurs against the background of poverty or chronic diseases.

People with a genetic predisposition are at risk of developing pathology. If a person has problems with intimacy or conflicts in the family, this leads to maladjustment. It appears when there are material difficulties or difficulties in relationships with others. If the traditional way of life changes dramatically, this leads to a pathological process.

Borderline mental state in psychiatry and severity of personality disorders

In clinical psychiatry, three levels of mental disorder are traditionally distinguished:

Neurotic
. This includes neuroses of various types, implying reversible temporary conditions that can be treated.
Psychopathic
level. In its plane lie personality disorders, which include character anomalies of various pathogenesis or painful changes in his traits, with which nothing can be done, since they relate to the personal structure of the individual.
And finally, the deepest damage to the psyche manifests itself at the psychotic
level. This includes manifestations such as delusions, hallucinations, and twilight consciousness.

In modern psychoanalysis, there are 4 levels of deviations. Between the state of psychosis and neurosis the “ borderline”

level", also called
borderline state
. A borderline state can mean both the disorder itself and a designation of the level of mental damage.

Signs of pathology

Symptoms of adjustment disorder are not always pronounced and may differ in each individual case, which complicates the diagnosis process. The main symptoms are of an anxious and depressive nature. Maladjustment is accompanied by a feeling of inability to cope with the troubles that appear in life. With pathology, the patient becomes suspicious and irritable. Most people note the appearance of a feeling of internal tension. Psychiatry of adaptation disorder has information that it is accompanied by:

Anxiety;
Persistent anxiety;
Internal discomfort;
Violations in normal behavior.

In patients with pathology, the mood worsens. In especially severe cases, a sad state appears. A person becomes uninterested in his usual activities. A person becomes physically and mentally exhausted, so he cannot make informed decisions. He does not analyze the situation and is not responsible for the decisions made.

Disadaptation has a vague clinical picture, so when the first suspicious symptoms appear, it is recommended to seek help from a specialist who will correctly diagnose and prescribe effective treatment.

How to Reliably Identify Borderline Personality Disorder (BPD)

Borderline personality disorder is extremely difficult to diagnose and differentiate, as it has a high level of comorbidity, in other words, it is combined with a large number of concomitant disorders. For example, panic anxiety, eating disorder, bipolar affective disorder, attention deficit disorder, sociopathy, and so on. Due to the above, the patient has to undergo a lengthy diagnostic process and special tests.

Test for borderline personality disorder BPD

One of the fairly popular tools for identifying the presence of psychopathy are tests, which are essentially a personality questionnaire. The test used in modern clinical psychology to screen for strong signs of BPD was developed in 2012 by a group of scientists. In their work, the authors relied on the basic criteria for differentiating borderline disorder.

The questionnaire edited by them is a fairly effective tool for diagnostic verification and confirmation of symptoms. It is used both in psychiatric and general clinical settings, as well as in other practices that are not directly related to medicine.

The test itself consists of 20 questions and asks the test taker to answer only yes or no. For each answer, the system counts a certain number of points. The likelihood of diagnosing BPD appears if the respondent scores more than 25 points.

Types of pathology

In accordance with the causes and characteristics of its course, maladjustment is divided into several types:

Social adjustment disorder. With pathology, the patient cannot communicate with his usual circle of friends and acquaintances. He gradually moves away from them and retires. If the pathology is severe, the patient cannot be in society at all. He may not leave the apartment for months.
Depressive adjustment disorder. The disease develops against the background of depression. A person is constantly depressed. They have no desire to communicate and gradually lose their usual interests.
Mental adjustment disorder. A pathological process occurs in the form of an acute reaction to stress, which develops in the form of psychological shock. It is accompanied by various mental disorders.
Prolonged adjustment disorder. The pathological process is characterized by a long course. The situation is aggravated when a stressful situation of varying severity appears.
Anxious adjustment disorder. With this type of pathology, patients experience alarming symptoms under any circumstances.
Mixed adjustment disorder. This form of pathology combines several of the above.

There are several types of pathology that are recommended to be determined in order to make the correct diagnosis of adaptation disorder .

Symptoms of borderline personality disorder (BPD)

The main symptomatic difference of this type of disorder is the patient’s prolonged abnormal behavior

While in many other psychopathy periods of instability alternate with remission, in the case of BPD the patient behaves destructively over a long period of time. The field of psychological anomalies includes such manifestations as:

aggressive behavior leading to relationship problems,
unstable emotional background and inadequate self-image,
high anxiety,
total fear of loneliness and permanent feeling of boredom,
dichotomous thinking and changeable moods, dividing the world only into “black and white” (today I love, and tomorrow I hate).

Also among the main symptoms can be noted: sociopathy and fear of society, associated with low self-esteem and, as a consequence, separation anxiety (an individual experiences it when separated from home or loved ones). Often, patients exhibit reckless, irresponsible “risky” behavior, the extreme form of which can be self-harm or suicide attempt.

Types of spontaneous actions accompanying mental borderline personality disorders

Due to difficulties in self-identification, lack of personal opinion, and a tendency toward polarity, BPD sufferers are prone to spontaneous destructive behavior.

A panicky fear of loneliness and the lack of an inner core pushes them into connections with sociopathic personalities who are characterized by destructive behavior: gambling, theft, vandalism, promiscuous relationships, drug addiction. This also includes self-harm, which was mentioned above.

One of the reasons for such uncontrolled behavior is the problem of maintaining internal impulse. The level of impulsivity is so high that a person is unable to control it.

Diagnostic measures

Only a qualified specialist can determine maladjustment. It determines the development of somatic symptoms in children and adolescents and alarming signs in older people, which indicate the progression of pathology. The diagnosis is made in accordance with the diagnostic criteria of DSM-III-R:

Reactions to overt psychosocial stresses that occur within three months.
The nature of maladjustment. At this stage of diagnosis, the presence of impairments in school or work and symptoms that should not be present during stress are determined.
The duration of the maladjustment reaction is more than 6 months.

In case of maladaptation, differential diagnosis is recommended. Pathology must be distinguished from conditions such as disorders that appear due to the use of psychoactive drugs, post-traumatic disorders that occur due to stress, and aromatization.

Diagnosis F 43.1 Post-traumatic stress disorder

Occurs as a delayed or protracted response to a stressful event (brief or long-term) of an exceptionally threatening or catastrophic nature, which can cause profound stress in almost anyone. Predisposing factors, such as personality traits (compulsiveness, asthenia) or a history of nervous illness, may lower the threshold for the development of the syndrome or aggravate its course, but they are never necessary or sufficient to explain its occurrence. Typical signs include episodes of repeated reliving of the traumatic event in intrusive memories (“flashbacks”), thoughts, or nightmares that appear against a persistent background of feelings of numbness, emotional inhibition, detachment from other people, unresponsiveness to the environment, and avoidance of activities and situations that remind of the trauma. Overexcitement and severe hypervigilance, increased startle response and insomnia usually occur. Anxiety and depression are often associated with the above symptoms, and suicidal ideation is not uncommon. The onset of symptoms of the disorder is preceded by a latent period after the injury, ranging from several weeks to several months. The course of the disorder varies, but in most cases recovery can be expected. In some cases, the condition may become chronic over many years, with possible progression to permanent personality changes (F62.0).

Traumatic neurosis

Treatment of the disease

Treatment of adjustment disorders requires the use of psychotherapy. It is recommended to conduct group therapy for patients who experience the same stress, for example, retirees or people with the same chronic illness. Individual psychotherapy is aimed at ensuring that a person begins to understand that the onset of the disease is observed under stress. This is the main cause of the pathology. If treatment methods are selected correctly, the patient gains strength and endurance with which to combat stress.

To avoid secondary gain, proper implementation of psychiatric decision is recommended. Treatment of the disease will be successful if the doctor has an attentive and caring attitude towards the patient. When symptoms of secondary gain appear, the treatment process becomes more complicated.

If anxiety-depressive disorders , then this requires drug therapy. Patients are recommended to take anti-anxiety medications and tricyclic agents, which help relieve depression.

With maladjustment, the patient may become overly aggressive, which leads to conflicts at work or school, committing crimes, etc. Doctors should not justify these actions of patients and try to justify them to law enforcement agencies. With this line of behavior of the doctor, the person’s emotional state does not improve. In addition, he does not criticize himself, and such socially unacceptable behavior becomes the norm for him.

Disadaptation is a dangerous pathological process that has a blurred clinical picture. That is why pathology is often diagnosed untimely. The choice of treatment method should be made by a doctor, which will ensure its effectiveness.

Stress and adjustment disorders

About the article

26685

Regular issues of "RMZh" No. 11 dated May 12, 2009 p. 789

Category: Neurology

Author: Vorobyova O.V. 1 1 Federal State Autonomous Educational Institution of Higher Education First Moscow State Medical University named after. THEM. Sechenov Ministry of Health of Russia (Sechenov University), Moscow, Russia

For quotation:

Vorobyova O.V. Stress and adjustment disorders. RMJ. 2009;11:789.

Stress, anxiety and depression are significant factors in the development and progression of a large number of diseases - from asthma, cardiovascular disease to cancer and HIV infection. This link between stress and neurobiological changes leading to mental and physical disorders has been well documented in the medical literature over the last century.

Stress is a state of tension in the adaptation mechanisms. The concept of “stress” was first described by TR Glynn in 1910 and, thanks to the classic works of H. Selye (1936), became firmly established in everyday life. Stress in a broad sense can be defined as a nonspecific reaction of the body to a situation that requires greater or lesser functional restructuring of the body, corresponding adaptation to the given situation. Not only negative events, but also psychologically favorable events require adaptive costs and, therefore, are stressful. It is important to keep in mind that any new life situation causes stress, but not every one of them is critical. Critical situations are caused by distress, which is experienced as grief, unhappiness, exhaustion of strength and is accompanied by a violation of adaptation, control, and interferes with the self-actualization of the individual. All critical situations, from relatively easy to the most difficult (stress, frustration, conflict and crisis), require a person to perform various internal work, certain skills to overcome them and adapt to them. The degree of severity of a reaction to stress of the same strength can be different and depends on many factors: gender, age, personality structure, level of social support, various circumstances. Some individuals with extremely low stress tolerance may develop a painful condition in response to a stressful event that is not beyond normal or everyday mental stress. Stressful events that are more or less obvious to the patient cause painful symptoms that disrupt the patient’s usual functioning (professional activities and social functions may be disrupted). These painful conditions are called adaptation disorders. Clinical picture The disease usually develops within three months after exposure to a psychosocial stressor or multiple stresses. The clinical manifestations of adaptive disorder are extremely variable. Nevertheless, psychopathological symptoms and associated autonomic disorders can usually be distinguished. It is vegetative symptoms that force the patient to seek help from a doctor. Feelings of heat or cold, tachycardia, nausea, abdominal pain, diarrhea and constipation can be a consequence of the autonomic response to stress. An autonomic response inadequate to the stimulus (stress) is the basis for many psychosomatic disorders. Knowledge of the pattern of the autonomic response to psychological stress allows us to understand stress-related diseases (Table 1). The autonomic response to stress can be a trigger for somatic illness (psychosomatic illnesses). For example, the cardiovascular response to stress increases myocardial oxygen consumption and can cause angina in individuals with coronary artery disease. Most patients present exclusively organ complaints, based on their own or cultural ideas about the importance of a particular organ in the body. Autonomic disorders can manifest themselves predominantly in one system (usually the cardiovascular system), but in most cases, active questioning of the patient allows us to identify less pronounced symptoms from other systems. As the disease progresses, autonomic disorders acquire a distinct multisystem character. It is natural for autonomic dysfunction to replace one symptom with another. In addition to autonomic dysfunction, patients quite often experience sleep disorders (difficulty falling asleep, light shallow sleep, night awakenings), asthenic symptom complex, irritability, and neuroendocrine disorders. Mental disorders obligately accompany autonomic dysfunction. However, the type of mental disorder and its severity vary widely among different patients. Mental symptoms are often hidden behind a “façade” of massive autonomic dysfunction and are ignored by the patient and those around him. The doctor’s ability to “see” psychopathological symptoms in a patient, in addition to autonomic dysfunction, is decisive in the diagnosis of adaptation disorders. Most often, maladjustment is characterized by an anxious mood, a feeling of inability to cope with the situation, and even a decrease in the ability to function in everyday life. Anxiety is manifested by a diffuse, extremely unpleasant, often vague feeling of fear of something, a feeling of threat, a feeling of tension, increased irritability, and tearfulness (Table 2). The patient experiences “anticipation anxiety,” a future-oriented preoccupation that reflects a readiness to cope with upcoming negative events. Sometimes the patient expresses fears regarding real and/or perceived unpleasant events. For example, to those around him, such a patient may express various catastrophic thoughts related to the global economic crisis: “... and by spring in our country everyone will eat exclusively black bread and water. And there will be no cars on the street - there will be no money to refuel. Can you imagine – empty streets...” If the listener is also prone to anxiety, then the patient’s words have fallen on fertile soil, anxiety begins to cover (“infect”) the patient’s environment. This spread of anxiety is especially typical during periods of social disadvantage. At the same time, anxiety in this category of patients can manifest itself as specific fears, primarily concerns about their own health. Patients are afraid of the possible development of stroke, heart attack, cancer and other serious diseases. This category of patients is characterized by frequent visits to the doctor, numerous repeated instrumental studies, and a thorough study of the medical literature. Adaptation disorder with depressive mood is characterized by a low background mood, sometimes reaching the level of melancholy, and a limitation of usual interests and desires. Patients express pessimistic thoughts regarding current events, uniformly negatively interpret any events, blame themselves and/or others for their inability to influence events. The future seems to them exclusively in black colors. This category of patients is characterized by mental and physical exhaustion, decreased concentration, memory impairment, and loss of interests. Patients note that it is difficult for them to gather their thoughts, any undertaking seems impossible, and a strong-willed effort is required to maintain everyday activities. They note difficulty concentrating on one issue, difficulty in making decisions, and then in putting it into practice. Patients, as a rule, are aware of their failure, but try to hide it, citing various reasons to justify their inaction. The main symptom of depression, low mood (sadness), is often actively denied by the patient or considered by him as an insignificant secondary symptom associated with somatic pathology. In some cases, depressive affect may be hidden behind additional mental symptoms: irritability, hypochondriacal ideas, anxiety, phobic symptoms. More than half of patients with adjustment disorders do not realize that they suffer from a mental disorder and present only somatic complaints. When a doctor tries to discuss the patient’s emotional experiences, the latter almost always shows a negative reaction. These patients are usually extremely sensitive to any hint that their complaints are “unfounded,” so all questions regarding mood and other mental symptoms should be asked in an extremely friendly manner. It is pointless to argue with such patients, and it can also traumatize them. A narrowing of interests and loss of pleasure (the second most important symptom of depression) may also be ignored by the patient; or certain life limitations are considered by him as an inevitable consequence of a somatic illness. In such cases, to understand the reasons for the patient’s maladjustment, objective information from close relatives is necessary. The most important stage in the (positive) diagnosis of maladjustment in general somatic practice is to identify the characteristic features of complaints associated with depression and their characteristic environment. Somatic complaints, pathogenetically associated with depression and anxiety, are primarily characterized by polymorphism, variability, and inconsistency (there is no logical clinical connection between the complaints). Patients who have unexplained somatic symptoms should primarily be considered at risk for adjustment disorder. The risk is especially high in patients who have several somatic symptoms and evaluate their condition as very bad in the absence of objective organ pathology. These patients tend to report feelings of dissatisfaction after a visit to the doctor, and it is these patients that doctors most often regard as “difficult.” Most often, these complaints are manifestations of: 1) autonomic dysfunction (mainly in the cardiovascular system, gastrointestinal tract, respiratory system); 2) chronic pain syndrome (cardialgia, cephalgia, back pain); 3) hysterical disorders (lump in the throat, tremor, dizziness, gait disturbance, senestopathic paresthesia). Specially conducted studies have shown that, in addition to actual (“organ”) complaints for the patient, the following disorders are most often observed: • dyssomnia (and the classic “morning insomnia” with characteristic early awakenings does not always occur; there may be difficulties falling asleep, shallow sleep or hypersomnia, which does not bring a feeling of morning vigor); • a feeling of severe fatigue, which already precedes mental or physical stress; • irritability, grumpiness, low self-esteem, feelings of self-pity, feelings of hopelessness, exaggeration of the severity of a real somatic illness; • difficulty concentrating when necessary, which may be regarded by the patient as memory impairment; • sexual dysfunctions, most often decreased libido; • change in appetite (lack of appetite/increased appetite) with weight change of more than 5% per month; • painful health, accompanied by unpleasant bodily sensations, vague forebodings with a peak of symptoms in the morning; • rejection of negative physical examination results. The described depressive symptoms surrounding current complaints must be identified through active questioning, since, as a rule, it is difficult for patients to verbally express their state of mind and they “prefer” to describe to the doctor only understandable somatic sensations. Many of the described accompanying symptoms relate to motivational disturbances in patients with adjustment disorder with anxious and/or depressive mood. This is a predominance of feelings of fatigue, weakness, eating disorders (fluctuations in appetite, including during the day). Sleep disorders may include difficulty falling asleep, shallow sleep with frequent awakenings, frightening dreams, early awakenings with unexplained anxiety, dissatisfaction with sleep, and lack of rest after sleep. Disturbances in the sphere of intimate relationships in men can manifest themselves as premature ejaculation and a secondary decrease in libido; in women - a decrease in the frequency and degree of orgasm, as well as interest in sexual activity. All of the above disorders are often not assessed as somatic manifestations of stress, and further increase the feeling of helplessness. The consequence of painful symptoms is social maladjustment. Patients begin to cope poorly with their usual professional activities, they are haunted by professional failures, as a result of which they prefer to avoid professional responsibility and refuse the opportunity for professional growth. A third of patients completely stop their professional activities. Communication disorders complicate normal social activity and lead to conflicts in personal life (Table 3). Currently, diagnostic criteria for adaptation disorders have been proposed (Table 4). In ICD-10, related disorders are designated as adjustment disorder (F43.2). Characteristics of the stressor factor and response Stressful events that cause maladjustment disorder are events that do not reach the quantitative and qualitative characteristics of extreme stress, but cause the need for psychological adaptation. Most often, patients indicate conflicts in interpersonal relationships, in particular marital conflicts, divorce, travel, as well as work problems. Women react painfully to stressful events in their personal lives, while for men the most significant factor is professional failures. An individual's illness can become a significant stressor regardless of gender. The consequences of the disease, possible disability, threat of pain, severe disability, fear of becoming a heavy burden for family members can lead to the development of a maladaptive disorder that requires medical intervention. The increase in psychopathological manifestations and somatic disorders in critical years of social development indicates the pathogenic influence of public social factors on health. “Exorbitant environmental pressure,” an unstable society that places increased demands on people, become chronic stressors. The constant threat posed by the environment and the person's inability to cope or manage future negative events leads to distressed anxiety and autonomic activation. Some researchers even identify social stress disorders. The term “social disease” was first proposed by A.M. Rosenstein in 1923. Since then, the pathogenic role of social stressors has been convincingly proven. It is believed that threat stress more often causes anxiety reactions, and loss stress – depressive reactions. Important factors in the development of adaptive disorders are the amount of stress and their individual significance. It is well known that given equal levels of stress, some people get sick and others do not. Factors that predispose to the development of the disease in response to stress are now known. These factors include a person's personality characteristics, defense mechanisms and strategies for coping with stress, and the presence or absence of social support. A person’s preliminary prognostic assessment of a stressful event is also important. An exclusively negative assessment of a stressful event and exaggeration of the danger cause greater harm to the body. Psychological or biological stress causes a normal (physiological) response of the body in the form of a psychophysiological reaction, manifested by anxiety symptoms and autonomic dysfunction, which is caused by a cascade of neuroendocrine changes. In response to stress, corticotropin-releasing factor (CRRF) is released from the hypothalamus, which stimulates the anterior pituitary gland, where ACTH begins to be synthesized intensively. ACTH, in turn, stimulates the release of glucocorticoids (cortisol) from the adrenal cortex. The sympathetic nervous system is activated in all forms of stress, and, among other things, adrenaline is released from the adrenal medulla into the blood, which serves as an active stimulator of ACTH secretion by the pituitary gland and enhances the action of other mechanisms that activate the function of the pituitary gland under stress (Table 5). Normally, these processes soon stop, since the hypothalamic-pituitary-adrenal system is regulated by a feedback mechanism. Glucocorticoid receptors of the anterior pituitary gland play a key role in inhibiting the hypothalamic-pituitary-adrenal axis and further secretion of glucocorticoids under stress. This psychovegetative response is very important for overcoming an acute physical threat. But in modern society, stress is more often of a psychosocial nature, and this type of response is more likely to cause harm than benefit to health. Modern society is characterized by a fast pace of life, an abundance of information, a requirement for high productivity, efficiency, constant competition, a decrease in the share of hard physical labor, and a lack of time and opportunity for rest and recovery. The stress on the nervous system and mental fatigue increase. Inadequate rest and recovery causes more harm than absolute stress levels. Previous trauma plays a special role. Chronic psychosocial stress, even of low intensity, prolongs the changes caused by acute stress, causing prolonged ACTH stimulation and depletion of the adrenal cortex. For example, in conditions of uncontrolled protracted stress in healthy volunteers, an increase in plasma concentrations of norepinephrine and ACTH is observed. On the other hand, premorbide also affects adaptive disorders. Presumably, the breakdown of the reverse mechanism of inhibition of glucocorticoid secretion leads to protracted psychophysiological reactions to stress. It is possible that patients with anxiety and/or depression have a certain defect in the feedback mechanism. At least, there is convincing evidence that anxious personalities are characterized by a certain psychobiological vulnerability, characterized by a super -chocious neurobiological reaction to life stresses. Clinical anxiety, when increasing this vulnerability or the severity of current stressful factors, can progress to depression. The pathogenic role of ordinary stress begins to manifest itself with its prolonged effect on people with low stressfulness, possessing such personal features as nihilism, anxiety, social alienation, and improvingiveness, which have insufficient social support. Pathogenic is stress during periods of hormonal and psychophysiological restructuring (puberty, the onset of sexual activity, pregnancy and childbirth, abortion, menopause). The line between the “normal” response to stress and pathological anxiety disorder is often very blurry and it is difficult for a person to understand when it is necessary to seek professional help. These subsindromically expressed alarming disorders are most difficult for diagnosis, often remain absurd, while having an extremely negative impact on the quality of life of the patient and the people around him. At least, you should consult a doctor when anxiety about ordinary events is not amenable to control. For example, when, in addition to nervousness, fussiness, impaired concentration, irritability, sleep disturbance, dizziness, tachycardia, epigastric discomfort, dry mouth, sweating, headache, chills and other symptoms of autonomic dysfunction are observed. Treatment despite the bondness of autonomic dysfunction and the often masked nature of emotional disorders, the basic method of treating adaptation disorders is psychopharmacological treatment. The therapeutic strategy must be built depending on the type of dominant disorder and the degree of its severity. The choice of the drug depends on the severity of the level of anxiety and the duration of the disease. If painful symptoms exist for a short time (up to two months) and slightly disrupt the functioning of the patient, then both medicinal (anxiolytic therapy) and non -changing methods can be used. Non -valuable therapy is, first of all, the possibility of patients expressing their fears in an atmosphere of psychological support that the doctor can provide. Of course, the professional help of a psychologist can activate the methods of adaptation characteristic of the patient. Medicinal treatment methods include primarily tranquilizing drugs. Benzodiazepine anxiolytics are used to stop acute symptoms of anxiety and should not be used for more than 4 weeks due to the threat of forming a dependence syndrome. With a short -term subsindromic or mild anxious adapt disorder, vegetable soothing fees or drugs based on them, antihistamines (hydroxyzine) are used. For many years, Valerian has been used in traditional medicine due to hypnotic and sedative effects and to date remains a very popular medicine. Particularly successful were drugs containing valerian and additional phyto -extracts that enhance the anxiolytic effect of valerian. The drug Persen, which, in addition to valerian, contains widely used, the lemon balm and mint extract, which enhances the anxiolytic effect of valerian and adds an antispasmodic effect. Particularly proven in the treatment of subsindromic alarming and soft alarming disorders of Persus - containing 125 mg of valerian extract in a capsule versus 50 mg in a tablet form, due to which the Persus -fort provides a high and rapid anxiolytic effect. The spectrum of the use of Perseen - in the practice of the clinician is extremely wide - from the use in monotherapy for the treatment of subsindromic and soft alarming disorders to a combination with antidepressants for leveling anxiety with anxious and depressive disorders. There are no clear recommendations for the duration of the treatment of soft and subsindromic alarming syndromes. Nevertheless, most studies have proved the benefits of long -term therapy courses. It is believed that after the reduction of all symptoms, at least 4 weeks of drug remission should pass, after which an attempt is made to cancel the drug. On average, treatment with sedative plant fees is 2-4 months. The preparations of the first stage of choice for the treatment of chronic anxiety disorders are selective serotonin requa inhibitors (SIOS). In case of adaptation disorders, the question of the prescription of the SIOS arises in case of risk of chronic disorder (progression of symptoms of more than three months) and/or the risk of adaptive disorder into clinical forms of psychopathology. In addition, an indication for the appointment of antidepressants is an adaptation of adaptation with an alarming -depressive mood or the dominance of a depressive mood. Many drugs used to treat mood disorders, anxiety and sleep disturbances can be poorly tolerated by patients due to side effects, which ultimately leads their effectiveness. Official preparations of plant origin, having significantly less side effects, can be considered as alternative therapy or used to enhance the effectiveness of prescription drugs (in particular, with intolerance to tranquilizers and antidepressants).

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