Autonomic dysfunction syndrome in children. Autonomic dysfunction syndrome: causes and treatment

Somatoform disorders include psychogenic conditions that are accompanied by symptoms of existing somatic diseases, but do not have the organic changes characteristic of these diseases. Often, isolated functional changes are detected that do not relate to one disease and are nonspecific.

Somatoform autonomic dysfunction is characterized by specific complaints characteristic of disruption of the autonomic nervous system.

Most often, general practitioners and employees of somatic departments of hospitals encounter such patients. Patients with somatoform autonomic dysfunction present vague, varied complaints of pain, dysfunction of various organs, and shortness of breath. These complaints often replace each other, as a result of which the patient is treated by different specialists. Due to the fact that the diagnoses are not confirmed during the examination, patients with somatoform autonomic dysfunction tend to change doctors, be examined in private clinics, and insist on an in-depth examination or hospitalization. Most accusations of medical incompetence come from such patients.

When communicating with such patients, the doctor may form the opinion that they are faking the symptoms of the disease. However, all the symptoms are absolutely real, they cause the patient a lot of physical suffering and at the same time are entirely psychogenic in nature.

Etiology

The variety of manifestations from internal organs is due to the fact that somatophoric dysfunction is a malfunction in the parasympathetic or sympathetic nervous system. Its etiology has not been definitively established, however, many versions have been put forward and considered by doctors.

Primary causes of somatoform illness:

• negative hereditary predisposition – there have already been cases of autonomic disorder in the patient’s family;
• complicated pregnancy - the expectant mother suffered from severe infections that affected the development of the fetus;
• injuries – directly to the brain or spinal cord, innervated by the autonomic system of internal organs;
• chronic diseases that affect the branches of peripheral autonomic fibers;
• individual characteristics of a person's personality.

Prerequisites for secondary dysfunction may be:

• an abundance of stress factors - at work, in the family;
• excessive physical overload;
• psycho-emotional shocks;
• improper dieting.

Laboratory and instrumental examination methods help to establish the true causes and prerequisites of autonomic neurosis.

Symptoms

The main difference between somatoform disorder of the autonomic nervous system and other somatic lesions is the non-specific nature of the complaints. In general, the picture of dysfunction is a set of subjective sensations about changes in one organ or in several of them at once.

Thus, cardiovascular signs of manifestation are pain of a compressive or stabbing type, but without a clear area of ​​their presence. The person describes them as migratory - moving from one part of the chest to another. Variability of discomfort is possible - from aching to burning. However, there is always an element of panic, fear of death. Pain occurs at rest; it is provoked by traumatic situations. Therefore, relief comes from taking sedatives.

Along with heart pain, heart rhythm disturbances – arrhythmias – may occur. Most often in the form of rapid heartbeat - tachycardia. Whereas fluctuations in blood pressure - with an increase to high values ​​- are less typical.

If the respiratory system suffers, then people complain of a feeling of lack of air, compression in the chest. It is difficult for them to breathe, so they constantly ventilate the room. Shortness of breath of this type is hardly noticeable from the outside, but is extremely unpleasant for the patient himself. It is eliminated only during deep sleep. Whereas during daylight hours it may either intensify or subside. Against the background of changes in the respiratory system, people more often suffer from respiratory infections, sometimes they are mistakenly diagnosed with bronchial asthma or COPD.

Common vegetative manifestations include increased fatigue, decreased appetite, frequent headaches, dizziness, and sleep disturbances. It is the abundance of complaints that alarms specialists and makes them suspect somatoform abnormalities.

Symptoms of autonomic dysfunction of the heart

The symptoms of autonomic dysfunction are quite easy to identify, but to make a final diagnosis, the doctor needs to accurately answer the following questions: are these symptoms a sign of an independent disease or a manifestation of another, somatic, neurological, or mental disease? Could they mean the presence of cardiovascular system (cardiovascular system) pathology: hypertension, coronary artery disease, valve defects, myocardial inflammation?

When establishing a diagnosis of autonomic dysfunction, the following are taken into account:

• multiplicity and variety of complaints, mainly related to the cardiovascular system;
• prolonged course with episodes of exacerbations and attenuation of symptoms;
• does not lead to complications (heart failure);
• discrepancy between complaints and objective data, examination results.

Identifies the main and additional diagnostic signs of autonomic dysfunction

. A diagnosis can be considered reliable if there are two or more main and 2 additional signs.

Main features:

• pain in the precordial area of ​​various types (pressing, stabbing, burning, cutting, drilling, aching);
• respiratory disorders - shortness of breath, feeling of lack of air, dissatisfaction with breathing, not associated with physical activity;
• instability of blood pressure and pulse, their inadequate change in response to physical activity, attacks of rapid heartbeat;
• nonspecific modifications of the ST segment, T wave on the electrocardiogram, early ventricular repolarization syndrome;
• restoration of a negative T wave on the electrocardiogram after physical activity, positive orthostatic and hyperventilation tests with beta-blockers.

Additional signs:

• tachycardia or bradycardia, interruptions in heart function;
• lability of body temperature, low-grade fever, hot flashes, chills, muscle pain, paresthesia;
• dizziness, presyncope and syncope (fainting);
• emotional instability, feelings of anxiety, fear, increased irritability, tearfulness;
• general weakness, fatigue, decreased performance; absence of signs of organic pathology from the cardiovascular system, nervous system, mental disorders.

There are also signs, the presence of which with one hundred percent probability excludes the diagnosis of autonomic dysfunction. They are revealed during examination and additional examination. These are swelling of the legs, moist rales in the lungs, auscultatory noises in diastole, enlargement of the heart (hypertrophy, dilatation), changes on the ECG (left bundle branch block, AV block II-III degree, focal changes, ST segment displacement, rhythm disturbances except for a single extrasystole), changes in blood tests.

Classification

Somatovegetative disorders are distinguished by the type of predominant dysfunction - the parasympathetic/sympathetic part of the autonomic nervous system. More often you can observe the clinical picture of a mixed form of the disease.

Somatoform dysfunction can be:

• of cardio-vascular system;
• digestive structures;
• respiratory organs;
• urinary system;
• many internal organs.

Possibly stable or paroxysmal - with periods of exacerbation and subsidence of symptoms, the course of somatoform autonomic disorder.

Whereas, according to the degree of severity, it is traditional to distinguish:

• mild course - with rare, vague unpleasant sensations that are eliminated independently, without taking medications;
• moderate - clinical signs appear when overwork, receiving unpleasant news, they require seeking medical help, relief comes from taking herbal sedatives;
• severe deterioration in the patient’s well-being - an almost daily crisis state, for example, the psychogenic situation has already been eliminated, but the person is still in distress, he has a tingling, pinching, or pressing sensation somewhere, so he is forced to resort to the help of medications, including antidepressants and neuroleptics.

Self-diagnosis and self-medication of autonomic dysfunctions only aggravate the situation. Experts recommend contacting doctors in a timely manner.

Formation mechanism

The autonomic nervous system is the main regulator of the activity of internal organs, blood vessels and glands. Therefore, this system is often called visceral. The ANS regulates the functioning of organs in accordance with changes in environmental conditions.

The autonomic system is represented by two departments: sympathetic and parasympathetic, which have mutually opposite effects:

• The sympathetic nervous system mobilizes the body's defense reactions, preparing it for vigorous activity. Intensifies metabolism, increases arousal;
• The parasympathetic nervous system restores wasted energy. Stabilizes the body's condition. Supports its work during sleep.

Both departments have opposite effects on internal organs.

The opposite influence of systems with balanced work helps to balance the condition of the internal organs. The ANS is not subject to human will. For example, we cannot make the heart stop beating. But vegetative activity is subject to the influence of stress factors. This is easy to check. Remember how your heart begins to “rumble” when you are scared. The mouth becomes dry, intestinal colic appears, and the urge to urinate increases. This activates the sympathetic department, mobilizing the body's protective resources.

The fear went away - the heart calmed down, breathing returned to normal. This is the merit of parasympathetics.

Problems begin when the activities of both departments are separated. There are several reasons for this imbalance:

• heredity;
• hormonal changes;
• chronic stress;
• powerful simultaneous stress impact;
• overwork;
• chronic intoxication;
• alcohol abuse;
• radiation;
• action of high temperatures.

Disharmony in the activity of the ANS triggers the formation of somatoform dysfunction of the autonomic nervous system. Vegetative control over organs decreases. Their work is disrupted, giving rise to painful symptoms, but there are no organic changes. The main reason is stress.

Somatic symptoms are a way of experiencing stressful situations at a physiological level. This was also discussed by Adler, who developed the concept of the symbolic language of organs. The theory said: organ systems specifically mirror mental processes.

Diagnostics

To make a diagnosis of somatoform dysfunction, it is necessary to conduct a complex of laboratory and instrumental examinations in a person. The specialist begins by carefully collecting an anamnesis - when the first unpleasant sensations appeared, how they were expressed, what could have served as a provoking factor, which led to an improvement in well-being.

For the differential diagnosis of autonomic dysfunctions, the following clinical and laboratory tests will be necessary:

• for pain in the left half of the chest - ECG, as well as ECHO KG;
• for changes in the respiratory system - chest x-ray, spirometry, less often - bronchoscopy;
• with a predominance of gastrointestinal disorders - ultrasound examination of internal organs, fibrogastroscopy, colonoscopy, less often - tomography or magnetic resonance imaging.

A psychotherapist must talk to the patient and conduct a series of tests. As a rule, the information that the doctor receives from all instrumental studies does not confirm the seriousness of the person’s condition - changes in the internal organs do not correspond to what should be, based on the complaints.

Why does the disorder develop?

Somatoform disorder is a disease of a psychological nature in which the symptoms of damage to internal organs are functional, not organic.

Such dysfunction is detected in 0.5% of the world's population, and it affects mainly women. The reason lies, first of all, in the psychological state of a person.

The first group of factors influencing the occurrence of the syndrome is heredity and character traits. For example, people with asthenoneurotic and hysterical types of character are more likely to develop it. They are characterized by hypersensitivity, timid or demonstrative behavior. Such people are characterized by rapid nervous exhaustion; as a rule, they are pessimistic.

The second group is psychogenic traumatic external influences. These include acute stress factors, when a powerful psychological blow at once leads to a disorder of nervous activity. This could be the loss of a loved one, a decrease in social status, or a situation of severe fear.

Chronic stress occurs as a result of systematic mental and physical overstrain, lack of positive emotions, unmet needs and excessive demands on oneself.

It is worth noting that somatoform disorder very often develops in people who are emotionally stingy, hide their feelings, and do not know how to express them. And since emotions need a way out in any case, they find it in this unique way. A similar state can accompany members of religious families, where an atmosphere of strict morality reigns.

Other factors that provoke the disorder include complicated pregnancy, trauma, infections, and some somatic diseases.

Treatment tactics

People tend to have difficulty believing that they have somatoform dysfunction and not a life-threatening illness. More often, they continue to turn to other specialists and conduct new examinations. Whereas timely started therapy can significantly improve well-being in a short time.

The gold standard for getting rid of autonomic dysfunction is a carefully selected combination of psychotherapy and pharmacotherapy. In most cases, the person undergoes treatment on an outpatient basis. Hospitalization is required if remission cannot be achieved otherwise.

The therapeutic tactics of dysfunctions consists of two large blocks:

Non-drug therapy:

• sleep correction;
• diet therapy;
• correction of work and rest schedules;
• avoidance of stressful situations;
• support from friends and relatives;
• psychotherapy with a competent specialist.

Pharmacotherapy:

• nootropic drugs - to improve blood supply to brain structures;
• sedatives – improve a person’s psycho-emotional state;
• cardioprotectors – replenish the lack of nutrients and oxygen in the heart tissue;
• bronchodilators - to correct the functioning of the respiratory structures;
• according to individual needs - antidepressants, tranquilizers, antipsychotics.

There are no standard schemes for combating somatoform dysfunctions. The doctor selects them taking into account the complaints that the patient has - in direct dependence on the prevailing disorder.

Treatment

Non-drug treatment

Patients are advised to normalize their diet and daily routine, give up smoking and alcohol, get proper rest, strengthen the body, walk in the fresh air, go swimming or play sports.

It is necessary to eliminate sources of stress: normalize family and household relations, prevent conflicts at work, in children's and school groups. Patients should not be nervous and should avoid stressful situations. Positive emotions are simply necessary for patients with vegetative dystonia. It is useful to listen to pleasant music, watch only good films, and receive positive information.

Meals should be balanced, small and frequent. Patients are advised to limit the consumption of salty and spicy foods, and in case of sympathicotonia, to completely eliminate strong tea and coffee.

Insufficient and inadequate sleep disrupts the functioning of the nervous system. You need to sleep at least 8 hours a day in a warm, well-ventilated area, on a comfortable bed. The nervous system has been weakened for years. To restore it requires persistent and long-term treatment.

Medications

They switch to individually selected drug therapy only if general strengthening and physiotherapeutic measures are insufficient:

• Tranquilizers – “Seduxen”, “Phenazepam”, “Relanium”.
• Neuroleptics – “Frenolon”, “Sonapax”.
• Nootropic drugs – “Pantogam”, “Piracetam”.
• Sleeping pills - Temazepam, Flurazepam.
• Heart medications – “Korglikon”, “Digitoxin”.
• Antidepressants - Trimipramine, Azafen.
• Vascular agents - Cavinton, Trental.
• Sedatives - Corvalol, Valocordin, Validol.
• Autonomic dysfunction of the hypertensive type requires the use of hypotensive drugs - Egilok, Tenormin, Anaprilin.
• Vitamins.

Physiotherapy and balneotherapy provide a good therapeutic effect. Patients are recommended to undergo a course of general and acupressure massage, acupuncture, visit the pool, engage in exercise therapy and breathing exercises.

Among the physiotherapeutic procedures, the most effective in the fight against autonomic dysfunction are electrosleep, galvanization, electrophoresis with antidepressants and tranquilizers, water procedures - medicinal baths, Charcot's shower.

Phytotherapy

In addition to basic medications, herbal medicines are used to treat autonomic dysfunction:

1. Hawthorn fruits normalize heart function, reduce the amount of cholesterol in the blood and have a cardiotonic effect. Preparations with hawthorn strengthen the heart muscle and improve its blood supply.
2. Adaptogens tone the nervous system, improve metabolic processes and stimulate the immune system - tincture of ginseng, eleutherococcus, lemongrass. They restore the body’s bioenergy and increase the body’s overall resistance.
3. Valerian, St. John's wort, yarrow, wormwood, thyme and motherwort reduce excitability, restore sleep and psycho-emotional balance, normalize heart rhythm, without causing damage to the body.
4. Melissa, hops and mint reduce the strength and frequency of attacks of autonomic dysfunction, ease headaches, and have a calming and analgesic effect.

Prevention

You can avoid the occurrence of somatoform autonomic dysfunction if you adhere to the basic principles of a healthy lifestyle. Since stressful situations most often serve as a provoking factor, it is better to avoid them - change jobs in case of frequent conflicts in the team, move to another apartment with uncooperative neighbors.

The correct daily routine and physical activity play a huge role in the psychological balance of people. Depletion of the autonomic system and dysfunction in it is a natural result of the life of workaholics. Those who allow themselves proper rest - trips to the countryside, visiting exhibitions and cinemas - develop vegetative abnormalities less frequently.

A sober assessment of your relationship with tobacco and alcohol products is an indispensable condition for the health of the nervous system. Giving up bad habits is the best preventative measure for any disease, including the somatoform type.

Causes of VSD:

• stressful situations, overwork. As a rule, at school a child experiences great emotional and mental stress. Nowadays, school lessons occupy almost all of a student’s free time;
• hormonal storms. This applies to teenagers from 11 to 12 years old. Puberty begins when the child begins to “bloom” and emotional swings appear. They last up to 16 years;
• birth injuries, postpartum complications. Especially injury to the cervical vertebrae leads to circulatory disorders in the brain;
• dysregulation of brain centers. This means that all organs of our body are regulated by the work of the nervous system and the slightest disturbance in it affects the work of internal organs and systems;
• intense physical activity.

It may be incorrect to consider VSD as a disease, because it is just a collection of symptoms of organ dysfunction.