Psychologist instead of antipyretics. How to calculate thermoneurosis?

The temperature has remained at just over 37°C for several weeks. Wait to swallow antipyretics or worse, antibiotics. Perhaps the reasons for this condition are psychological.

Our expert is a leading researcher in the laboratory of pathology of the autonomic nervous system of the Research Institute of Neurology of the Research Center of the First Moscow State Medical University. I. M. Sechenova, Doctor of Medical Sciences Elena Akarachkova :

For a prolonged increase in temperature against the background of emotional problems, there is a special term - thermoneurosis. Neurologists are involved in its correction. However, before this diagnosis is confirmed, the patient will have to go a long way, and must first contact a therapist.

On a note

Prolonged fever is often experienced by:

Women during menopause . Hormonal changes cause an imbalance in the autonomic nervous system, and at this time women are prone to depression and anxiety.

Lovers of strength exercises . After heavy exercise, lactic acid is produced in the muscles. If there is a lot of it, tissue metabolism is disrupted, which leads to a local increase in temperature. In a healthy person it does not last long. But, if there are problems with autonomic regulation, overtraining can become a provoking factor that will lead to long-term low-grade fever.

Sensitive children .
The situation when a child goes to school after the holidays, and a few days later his temperature suddenly rises, is quite common. Involvement in the educational process is stress, due to which the autonomic nervous system fails. Source

Qualitative diagnostics

Naturally, you should not make such a diagnosis yourself. After all, there can be very serious reasons for an elevated temperature. Before diagnosing thermoneurosis, specialists need to rule out a number of other diseases:

– Thyrotoxicosis (with an increase in the level of thyroid hormones, a prolonged increase in temperature slightly above 37 degrees may also occur), you need to be examined by an endocrinologist;

– Pregnancy (sometimes the thermoregulation center reacts with an increase in temperature to the production of gestagen hormones in a woman), the temperature can persist throughout the first trimester of pregnancy and does not require special treatment, you need to be examined by a gynecologist;

– Chronic tonsillitis (palatine tonsils enlarge, “plugs” form in them), you need to be examined by an ENT doctor;

– Foci of chronic infection in the body (the cause of elevated temperature can be untreated diseases that have passed from an acute form to a chronic one - for example, otitis media, sinusitis, hepatitis, tuberculosis and even caries);

– Disturbances in the functioning of the thermoregulation center itself , you need to be examined by a neurologist.

If the above reasons are excluded, the doctor may diagnose “thermoneurosis”.

Sometimes, to confirm or refute the diagnosis, doctors use the so-called “aspirin test”.

When taking aspirin, the body temperature will inevitably decrease if there is an inflammatory process or a source of infection in the body. With thermoneurosis, taking aspirin does not reduce body temperature.

What is thermoneurosis

Thermoneurosis is a condition in which there is a persistent increase in body temperature to +37... +38°C. However, low-grade fever is not a consequence of a viral, infectious or other disease. The condition occurs due to a violation of the thermoregulation process, for which the brain is responsible.

Thermoneurosis is classified as a manifestation of vegetative-vascular dystonia.

A similar pathology occurs in both adults and children. The most common causes in adults are stress and brain injury. In childhood, the disease is provoked by hormonal changes, nervous tension and physical overload.

Causes in children and adolescents

Thermoneurosis in children can occur after a variety of viral diseases, psycho-emotional shocks, stressful situations, or against the background of excessive physical and mental stress.

Often, pathology manifests itself when changing place of residence, family environment and other external changes that can cause discomfort.

Also, the triggering mechanism for thermoneurosis can be traumatic brain injury, brain damage and other physiological factors. In turn, the state of thermoneurosis can be accompanied by pathologies of the endocrine system, which cause hormonal imbalance.

In infants, thermoneurosis develops for the following reasons:

• difficult pregnancy or pathological childbirth;
• birth injuries;
• congenital defects of the central nervous system;
• genetic pathologies;
• abrupt cessation of breastfeeding, and others.

School-age children often suffer from increased mental stress that arises during the learning process.

Problems in the team, conflicts with peers and increased demands from parents often lead to stressful situations.

The combination of the above factors provides the prerequisites for the development of thermoneurosis and other serious pathological conditions.

In adolescents 10 years of age and older, an increase in body temperature may be associated with hormonal changes.

Being on the border between childhood and adulthood, children of this age are extremely sensitive to any stressful situations.

Practice shows that it is teenagers who most often suffer from thermoneurosis.

Therefore, you should not once again reproach your child for simply not wanting to attend school. Perhaps a few days of rest will help solve this problem without making the condition worse.

Again 37.5

As a rule, the temperature during thermoneurosis does not rise above this mark. And episodes of its rise are preceded by severe overwork, physical trauma or troubles in the family. Just as it was with patient Igor Voronov, a first-grader at one of the Moscow schools. On days when he went to school, his temperature rose, but on weekends it was normal.

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Temperature errors: antipyretics should not be taken “for prevention”

A thorough survey and additional research showed that the boy was not pretending or faking illness by heating the thermometer. He has thermoneurosis, which is the body’s response to a stressful situation. Having received a signal located in the hypothalamus, the thermoregulation center, through the autonomic nervous and endocrine systems, dilates or constricts blood vessels, affects the sweat glands and other reactions leading to an increase or decrease in body temperature. It is in this scenario that in a stressful situation most people’s heartbeat quickens, their blood pressure rises, and they feel either hot or cold. Children are more likely than adults to experience temperature reactions, which forces parents to consult a doctor and, as a rule, find answers to alarming questions.

Thermoneurosis as a type of VSD

Most experts attribute the disease to a type of vegetative-vascular dystonia. This is because both diseases cause fatigue, arrhythmia, headaches, weather dependence, fainting, and muscle and joint pain.

In adults, the disease is caused by stress or head trauma. In children, the cause of thermoneurosis can be changes in hormonal levels that occur during puberty, overwork, or nervous disorders.

Due to the fact that an increase in temperature causes even minor stress, the disease should be classified specifically as a subtype of vegetative-vascular dystonia.

Vegetative-visceral disorders in newborns with perinatal brain lesions

The leading link in the formation of vegetative-visceral disorders is damage to the diencephalic structures of the brain, limbic system, medulla oblongata and subsequent disorder of neuroendocrine regulation

Vegetative-visceral disorders in newborns mean a wide range of morphological and functional changes in many organs and systems, referred to as somatoneurological, neurosomatic or neuroendocrine.
This mainly refers to vascular, gastrointestinal disorders, as well as thermoregulation disorders. With any of the clinical and neurological syndromes, somatic disorders of varying severity may be observed. Thus, the syndrome of general depression, as a rule, is accompanied by respiratory disorders, disturbances of vascular tone and thermoregulation, a syndrome of increased neuro-reflex excitability and hypertensive-hydrocephalic - dysregulation of the sphincters, impaired motility of the gastrointestinal tract. The syndrome of vegetative-visceral disorders is often attributed to the recovery period of encephalopathy, when, against the background of the subsidence of the neurological disorders themselves, the normalization of muscle tone and the reflex sphere, these disorders come to the fore and dominate the clinical picture of encephalopathy. According to our clinic, the frequency of vegetative-visceral disorder syndrome in children of the first year of life who have suffered perinatal encephalopathy is about 10%; however, in other recovery period syndromes, along with predominant neurological disorders (motor or psychoemotional), individual somatovegetative abnormalities may be noted.

The leading link in the formation of vegetative-visceral disorders is damage to the diencephalic structures of the brain, limbic system, medulla oblongata, and subsequent disorder of neuroendocrine regulation. In newborns, especially premature infants, the higher autonomic centers are underdeveloped, including the sympathetic system of the spinal cord and borderline sympathetic trunk and the parasympathetic nuclei of the midbrain. In this regard, the role of the hypothalamus and limbic-reticular system (paraventricular and supraoptic nuclei, hippocampus and amygdala nucleus) increases significantly. The hypothalamus, through the regulation system “Pituitary gland - thyroid gland - adrenal glands”, carries out the integration of adaptation processes. Each section of the hypothalamus regulates a specific function of the sympathetic and parasympathetic nervous system.

Experimental studies have established that irritation of the posterior parts of the hypothalamus leads to sympathicotonia, increased blood pressure, and decreased body temperature; pathological processes in the posterior parts of the hypothalamus contribute to trophic disorders and sexual infantilism. The anterior parts of the hypothalamus (primarily the limbic system) are associated with the regulation of water and salt metabolism, sleep and wakefulness.

In the practice of a pediatrician, special importance is attached to the following functions of the autonomic system: regulation of vascular tone and cardiac activity, regulation of the secretory activity of the endocrine glands, thermoregulation, regulation of metabolism, influence on smooth muscles, adaptive-trophic influence on receptors and synapses.

Violation of any of these functions (isolated or in combination with other disorders) is possible with perinatal encephalopathies. The morphological substrate of the lesion can be either a transient circulatory disorder in the diencephalic-hypothalamic region or persistent ischemic disorders and hemorrhages. As a rule, we are talking about circulatory disorders in the middle and posterior cerebral arteries. Severe somato-vegetative disorders develop with intraventricular hemorrhages, typical of perinatal brain lesions in extremely low birth weight children (deep coma, respiratory disorders, hypo- and hyperthermia, cardiac disorders, trophic dysfunctions). Among hemorrhages of other localizations, subependymal hemorrhages should be mentioned, which can be observed when small veins rupture between the caudate nucleus and the optic thalamus; they can destroy the head of the caudate nucleus, which leads to severe disorders of vegetative-trophic functions.

The clinical manifestation of the syndrome of vegetative-visceral disorders in newborns is vegetative-vascular dysfunction (lability of vascular tone and heart rate). The child has a “marble” skin pattern and transient cyanosis. In premature babies, due to the immaturity of the centers regulating vascular tone, changes in skin color, cyanosis of the feet and hands are more pronounced than in full-term babies. It is believed that even practically healthy premature babies in the first weeks of life are prone to hypostasis, that is, to the accumulation of blood in the underlying sections. Very premature infants may experience Finkelstein's (or Harlequin's) sign. If this symptom is observed in more mature children, it indicates damage to the diencephalic vasomotor centers or insufficiency of adrenal function.

The disturbances in vascular tone described above in the syndrome of autonomic-visceral disorders are accompanied by changes in blood pressure and pulse rate lability. The level of blood pressure during a single measurement can be either increased or decreased: for an adequate assessment of blood pressure, it is necessary to measure it at least 8 times a day, during the day and at night.

Equally important is the measurement of CO2 and pCO2. It has been established that in healthy children, in the first weeks of life, a gradual formation of the blood pressure biorhythm occurs - an increase in its amplitude, a shift in maximum blood pressure values ​​to the second half of the day. With mild and moderate manifestations of perinatal encephalopathy, a delay in the formation of daily and weekly rhythms in hemodynamic parameters is possible, with severe ones - a significant disruption in the formation of biorhythms, a decrease in average daily indicators with a shift in systolic and diastolic blood pressure - a very small amplitude, sharp fluctuations in blood pressure amplitudes; all this indicates a violation of autoregulation of blood circulation. Lability of blood pressure in the syndrome of vegetative-vascular disorders is accompanied by lability of heart rate and heart rate.

The number of heartbeats varies from minute to minute within 5-10%. Unlike tachycardias associated with cardiac conduction disturbances, there are no corresponding R and T waves on the ECG and no rigid stability of the R-R intervals. Increased intracranial pressure may be accompanied by persistent bradycardia. Sometimes these heart rhythm disturbances in perinatal encephalopathies are accompanied by metabolic changes in the myocardium (according to ECG data), systole-diastolic murmurs (in the absence of persistent fetal communications).

Respiratory disorders in the syndrome of vegetative-visceral dysfunctions are usually combined with cardiovascular disorders (attacks of bradypnea and periodic apnea, or tachycardia and tachypnea, respectively) and with lability of vascular tone. This is due to the general mechanisms of disruption of neuroendocrine regulation in the hypothalamus-pituitary-adrenal system and the thyroid gland. Severe forms of respiratory disorders [respiratory disorder syndrome (RDS) of central origin], as a rule, are not classified as vegetative-visceral disorders. The latter include milder functional changes that are not accompanied by serious disturbances of homeostasis. In premature infants, apnea of ​​10 to 12 seconds combined with periods of bradycardia may be due to general immaturity.

Closely related to disturbances in vascular tone is a manifestation of vegetative-visceral syndrome such as a violation of thermoregulation. In full-term infants, it can manifest itself in the form of prolonged low-grade fever, a distortion of the nature of the temperature curve (morning is higher than evening); in premature infants in incubators, most often in the form of a tendency to overheat. Local hypothermia (cold extremities at normal or elevated body temperature) and asymmetry of skin temperature are also possible (Fig. 1).

One of the most common manifestations of autonomic-visceral dysfunction syndrome is various dyskinesias of the gastrointestinal tract. Depending on the predominant damage to the sympathetic and parasympathetic parts of the autonomic nervous system, hyper- and hypomotor types of intestinal dyskinesia and various dysfunctions of the sphincters (gaping or spasm) may be observed.

Often there are such forms of dysfunction of the gastrointestinal tract as persistent vomiting and regurgitation (functional obstruction), which can be caused by chalasia cardia and incoordination of the esophagogastric sphincter. Persistent dilatation of the cardiac sphincter leads to gastroesophageal reflux and esophagitis. In turn, esophagitis can cause cardiovascular failure, since it increases the sympathicotonia characteristic of newborns and provokes viscero-visceral reflexes, which reduce coronary blood flow.

Vomiting and regurgitation during perinatal encephalopathy can also be caused by a lack of inhibition of gastric motility during and immediately after feeding, as shown by ultrasound and electrogastrography. A dangerous complication of regurgitation and vomiting is aspiration syndrome with the subsequent development of aspiration pneumonia. Pylorospasm and, less commonly, duodenospasm can also lead to the syndrome of regurgitation and vomiting; As a rule, these types of gastrointestinal dyskinesias are accompanied by stool retention.

With irritation of the parasympathetic departments, increased frequency of stools and increased intestinal motility are possible; for spinal lesions, flatulence and weakened peristalsis are more typical. As a rule, with pronounced vegetative-visceral disorders, changes in the gastrointestinal tract quickly lose their purely functional character - dysbiosis, secondary enzymatic deficiency, malabsorption, and nutritional disorders are layered. All of the above-described systemic disorders in perinatal encephalopathy can be observed both in combination and in isolation.

The leading importance in establishing the diagnosis of the syndrome of autonomic-visceral disorders of cerebral origin is the corresponding clinical picture and the exclusion of organ pathology (pyloric stenosis in regurgitation syndrome; cardiopathy in cardiovascular disorders, etc.). However, in neonatology, additional methods for diagnosing and assessing the severity of autonomic dysfunctions can be used.

The most informative indicators of the child’s vegetative status are: the condition of the skin, heart rate, blood pressure on the right and left arms, and respiratory rate (RR). The following tests help to identify the characteristics of autonomic disorders: orthostatic, epigastric, oculocardiac (Aschner test).

More severe forms of encephalopathy are accompanied by more pronounced asymmetry of skin temperature (in both central and peripheral areas, while in milder forms - only in the upper half of the body). The most persistent and pronounced changes in functional tests were observed in the least mature (very premature) children.

In order to assess the nature of autonomic dysfunctions, select therapy and predict long-term pathology, long-term monitoring of hemodynamic parameters and ultrasound monitoring of the dynamics of cerebral blood flow, especially in the middle and posterior cerebral arteries (Doppler study), are advisable. Due to the widespread use of ultrasound in newborns, REG research is relegated to the background, although with the help of REG it is possible to evaluate the child’s reactions to an orthostatic test.

Follow-up observations in severe encephalopathy have shown that autonomic disorders can persist for several years, while being combined with various motor disorders, astheno-neurotic conditions, and minimal cerebral dysfunction (MCD). These disorders are most often characterized by vegetative-vascular dystonia of the hypertonic (less often hypotonic) type, thermoneuroses, and perverted reactions to functional tests. Almost all children have long-term asymmetry of skin temperature; some have persistent heart rhythm disturbances and mild systolic murmur. Most of these children belong to the group of people who suffer from ARVI frequently and for a long time.

Premature children born to mothers with VSD and having a sharp “marbling” of the skin in the neonatal period at the age of 6 - 14 years have a high probability of developing functional hypothalamic syndromes, accompanied by emotional-volitional and neuroendocrine disorders (thyroid dysfunction, obesity, delayed puberty and so on.).

In the treatment of autonomic-visceral dysfunctions in newborns, two approaches are combined - pathogenetic and syndromic. The first includes effects aimed at correcting metabolic disorders, disorders of cerebral blood flow and improving the rheological properties of blood. For severe lesions with pronounced changes in metabolism, respiratory and cardiovascular disorders, intensive therapy is carried out, including oxygenation, antioxidant therapy, infusions of antihemorrhagic and antihypoxic drugs, hormones and antibiotics, and vitamin-energy mixtures.

The leading place in pathogenetic therapy belongs to non-drug effects. Various types of therapeutic massage, exercises in water and dry immersion have a complex regulatory effect on the mechanisms of neuroendocrine regulation and autonomic centers.

Among the traditional physiotherapeutic methods of treatment, electrophoresis is used (with magnesia, aminophylline, vitamins), often on the cervical (“collar”) area.

Conventionally, physical methods of influence can include aeroion therapy (Chizhevsky lamp), aromatherapy, and it is possible to use music therapy, the choice of which is determined by the predominance of depression in the child (in particular, with arrhythmia of breathing) or agitation (for example, with regurgitation syndrome). In the first case, a program of activating music is used (Mozart, the first part of “A Little Night Serenade”, Schubert, etc.), in the second - a calming program (lullabies, some works by Bach, etc.). When alternating lethargy and excitement, the effectiveness of V.V. Kiryushin’s program (alternating pitch exercises of different types) has been established.

Syndromic therapy of some vegetative-visceral disorders involves the use of various medications. Thus, for gastrointestinal dyskinesia syndrome, drugs are used that act on diencephalic structures and peripheral receptors - cerucal, bimoral, no-spa, nouspasm, pipolfen, aminazine. For the hypomotor type of dyskinesia of the stomach and intestines, prozerin is sometimes used. To correct concomitant dysbiosis, eubiotic drugs and enzymes are used. When a combination of slowing cerebral blood flow, according to ultrasound, and lability of the general vascular tone (“marbling” of the skin), Cavinton or Vinpocetine, piracetam are used. However, it should be noted that drug therapy is rarely the mainstay. To correct mild vegetative-visceral disorders, sometimes it is enough to normalize environmental conditions (routine, nutrition, walks, quiet environment).

Diagnosis and treatment of thermoneurosis

A rise in temperature can be caused by various diseases. Therefore, before making a diagnosis of thermoneurosis, it is necessary to exclude viral and infectious pathologies, as well as the presence of pregnancy, diseases of the thyroid gland and oral cavity, the presence of neoplasms, etc. Thermoneurosis in children is diagnosed after an additional examination by an immunologist.

To diagnose the disease, an aspirin test is done. While taking acetylsalicylic acid, the temperature decreases if it is caused by viral or infectious diseases. If there is no reduction, then there is a high probability of thermoneurosis.

Additional diagnostic methods include:

• ultrasound examination;
• clinical blood and urine tests;
• examination by narrow specialists;
• electrocardiogram;
• encephalogram.

Drug treatment of thermoneurosis

For drug treatment, 3 types of drugs are used: sedatives, nootropics and vitamin complexes.

Taking sedatives normalizes sleep and relieves increased anxiety and feelings of fear. Most often, doctors prescribe drugs based on herbal components, such as hawthorn, motherwort, valerian extract, etc. These are the most effective and safe means that have a gentle effect on the body. Improvement is observed after 3-4 weeks.

Nootropic drugs are aimed at improving cerebral circulation. Such drugs include Glycine, Cortexin, Nootropil, etc. Dietary supplements and vitamins are general strengthening, enhance immunity, and improve the functioning of the central nervous system. They are especially necessary in the treatment of post-infectious thermoneurosis.

When treating a child, it is important to maintain a sleep-wake schedule, frequent walks in the fresh air, and hardening activities.

Treatment of thermoneurosis with folk remedies

In addition to medications, there are folk methods of combating autonomic neurosis:

1. Herbal mixtures based on plantain leaves, nettles, horsetail and lingonberry leaves. An infusion is prepared from these herbs, which must be consumed daily, 100 ml until the condition normalizes.
2. Infusions of mint, sweet clover, violet and licorice. The plants are infused for 6-7 hours, and the resulting liquid is consumed before meals.
3. Therapeutic baths with decoctions of juniper and rose hips. You can add a decoction of lemon balm, wormwood and pine buds. Therapeutic baths should not be taken daily, the frequency should not exceed 3 times a week.