Neuroses

Experimental models and types of higher nervous activity

Fundamental concepts of the pathophysiology of neuroses were established in the laboratory of Academician I.P. Pavlov during animal experiments. The basic principle of creating a neurosis is setting an insoluble (unbearable) task. To achieve this, overstrain of the excitation or inhibition process is applied, as well as impairment of their mobility.

The classical modeling method is "clash" (shishka). This is a collision in the cerebral cortex of excitation and inhibition processes based on opposing instincts. For example, the application of a strong painful stimulus (electric current) at the time of eating or sexual intercourse.

The probability of process breakdown depends on the type of higher nervous activity (HNA):

• Weak type (Melancholic): both processes are depleted, passive-defensive reactions dominate.
• Strong unbalanced type (Choleric): weakness of inhibition leads to an excitation-type neurosis with active-search reactions.
• Strong balanced inert type (Phlegmatic): pathological mobility of nervous processes is formed.
• Strong balanced mobile type (Sanguine): most resistant, breakdown is possible only under severe "clash" and ultra-strong stimuli.

Etiology and pathogenesis

The main cause of development is psychic trauma. However, a situation becomes pathogenic only in the presence of certain personality traits: hyper-actualization of the problem and imparting excessive biological or social significance to it. The pathogenesis is based on a neurotizing conflict — an attitude where a rational solution becomes unbearable.

The formation of neurosis includes ideational processing — a prolonged process of analyzing the situation and fear of the inability to adapt to it. The most important feature of the pathology is that this stage of thinking does not yield a positive result.

At the microstructural level, prolonged insoluble conflict leads to physical damage to the central nervous system:

• Membranes of dendritic spine apparatuses are destroyed.
• The number of ribosomes in cortical neurons decreases.
• Degeneration of individual hippocampal cells occurs.
• Local microcirculation disorders arise.

Stages of development and autonomic manifestations

The development of neurosis has a clear ontogenetic sequence. The body's reactions are engaged in stages:

1. Autonomic (primary response).
2. Sensomotor.
3. Affective.
4. Ideational.

Autonomic disorders (vegetative neurosis, neurocirculatory dystonia) are the earliest component. They arise due to centrogenic regulation disorders. Patients complain of cardialgia, arrhythmias, dyspnea, blood pressure fluctuations, and dyspepsia.

The pathophysiological essence of these reactions lies in their inadequacy: a discoordination of the body's integrated reaction occurs (dissociation between locomotor and autonomic components) and the loss of adaptive significance. Symptoms often develop against the background of asthenia — weakness, irritability, and insomnia.

Clinical Forms

In the modern classification (ICD-10), neuroses are categorized under F4 (neurotic, stress-related, and somatoform disorders). Traditionally, three main forms are distinguished:

• Obsessive-compulsive neurosis (obsessive-compulsive disorder). Cause: conflict between desire and the impossibility of its realization. A pathological focus of excitation is formed in the cortex. The trigger may be fear or a situation where a person doubts their actions (for example, whether they forgot to turn off the iron).
• Hysteria. A defense reaction to an insoluble situation. Characterized by a "mosaic" of variable symptoms: from dissociative amnesia and suicidal blackmail to hysterical seizures, transient blindness, and mutism (refusal to speak, which does not distress the patient). Vegetosomatic manifestations are psychogenic in nature.
• Neurasthenia. Chronic fatigue syndrome, often found in college and high school students under excessive loads.

Class and exam questions

What else to study on this topic

• Pathophysiological mechanisms of neurocirculatory dystonia (NCD)
• Image dissociation and conversion disorders in hysteria
• Microstructural hippocampal damage in neuroses
• Modern classification of neurotic disorders (ICD-10 rubric F4)

Other topics in "Chapter 28. Standard forms of pathology of the nervous system"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.