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The neurangiosis, is more correct: the vegetovascular dysfunction (VD) — designation, widespread in medical and diagnostic practice, various by origin and to manifestations, but the functional vegetative disorders in the basis caused by disturbance of neuro and humoral regulation of vegetative functions. These disorders are most often observed in neurosises, a hypodynamia, at endocrine disharmony in the pubertal and climacteric periods and also at the neurosis-like states connected with psychological or physical overfatigue, infections, intoxications, abstinency at glue sniffers and other nature.
The autonomic nervous system of the person performs some of the major functions at once, in particular, ensures full functioning of all main life support systems. A vegetative part of nervous system is responsible for regulation of heart rate, level of arterial blood pressure, body temperature, watches activity of biochemical processes. At the slightest changes of external or internal conditions, the autonomic nervous system starts the controlling and compensatory mechanisms in action. For this reason in due time we speed up breath, the tone of blood vessels changes, mental activity is stirred up.
Causes of a neurangiosis
All factors provoking emergence of VSD can be divided into several main groups:
- the psycho-emotional reasons – sleep disorders, a mental overload, strong nervous excitement;
- disturbances of a backbone – hernia, osteochondrosis, functional blockade of segments, a muscular imbalance;
- intoxications of exogenous and endogenous character;
- chronic diseases – at the diagnosis of VSD, symptoms of a disease are often shown after defeat of cardiovascular, gepato-biliary and bronchopulmonary systems;
- disturbances of exchange processes – in particular, water-salt balance or balance of microelements;
- dysfunctions of an endocrine system – pathology, age changes.
Classification of vegeto-vascular dystonia
Today uniform classification of vegeto-vascular dystonia is not developed. According to various authors, vegetative dysfunction differs by a number of the following criteria:
- On prevalence of sympathetic or parasympathetic effects: synpaticotonic, the parasynpaticotonic (vagotonic) and mixed (simpato-parasympathetic) type of vegeto-vascular dystonia;
- On prevalence of vegetative disorders: generalized (with interest at the same time several systems of bodies), system (with interest of one system of bodies) and local (local) forms of vegeto-vascular dystonia;
- On expressiveness of a course: latent (hidden), paroxysmal (paroxysmal) and permanent (constant) options of a course of vegeto-vascular dystonia;
- On weight of manifestations: easy, medium-weight and heavy course;
- On an etiology: primary (konstitutsionalno caused) and secondary (caused by various morbid conditions) vegeto-vascular dystonia.
On the nature of the attacks complicating a course of vegeto-vascular dystonia allocate the sipmpatoadrenalovy, vagoinsulyarny and mixed crises. Slight crises are characterized by monosimptomny manifestations, proceed with the significant vegetative shifts, 10-15 minutes proceed. Moderately severe crises have polisimptomny manifestations, the significant vegetative shifts and duration from 15 to 20 minutes. The heavy course of crises is shown by polysymptomatology, heavy vegetative disorders, hyperkinesias, spasms, lasting attack more than one hour and a poslekrizovy asthenia within several days.
Symptoms of vegeto-vascular dystonia
Manifestations of vegeto-vascular dystonia are diverse that is caused by many-sided influence on an organism of VNS regulating the main vegetative functions - breath, blood supply, sweating, urination, digestion, etc. Symptoms of vegetative dysfunction can be expressed constantly or be shown by attacks, crises (panic attacks, faints, other paroxysmal states).
Allocate several groups of symptoms of vegeto-vascular dystonia on primary disturbances of activity of various systems of an organism. These disturbances can be shown separately or be combined with each other.
Pains in heart, tachycardia, feeling of interruptions and dying down in cardiac performance belong to cardial manifestations of vegeto-vascular dystonia.
At disturbances of regulation of a respiratory system the vegeto-vascular dystonia is shown by respiratory symptoms: rapid breathing (tachypnea), impossibility of implementation of a deep breath and full exhalation, feelings of shortage of air, weight, congestion in a breast, the sharp paroxysmal asthma reminding asthmatic attacks.
Vegeto-vascular dystonia can be shown by various disdinamichesky disturbances: fluctuations of venous and arterial blood pressure, disturbance of blood circulation and a lymph in fabrics.
Vegetative disturbances of thermal control include lability of body temperature (increase to 37-38 °C or decrease to 35 °C), feelings of chill or feeling of heat, perspiration. Manifestation of thermoregulatory disturbances can be short-term, long or constant.
Disorder of vegetative regulation of digestive function is expressed by dispeptic disturbances: pain and spasms in a stomach, nausea, eructation, vomiting, constipations or ponosa.
Vegeto-vascular dystonia can cause different appearance of urinogenital disorders: an anorgazmiya at the kept sexual desire; the painful, speeded-up urination in the absence of organic pathology of urinary tract, etc.
Psychoneurological manifestations of vegeto-vascular dystonia include slackness, weakness, fatigue at insignificant loading, reduced working capacity, acrimony and tearfulness. Patients have headaches, meteodependence, sleep disorder (insomnias, a superficial and uneasy dream).
Treatment of vegeto-vascular dystonia
Prevention and treatment of vegetative dysfunction has to begin in the childhood and youth. The opinion is wrong that vegetative dysfunction is the state reflecting features of the growing organism which independently passes over time. It is already proved that the vegetative dysfunction which arose at children's or teenage age, is an adverse background and a harbinger of many diseases. Existence of symptoms of vegeto-vascular dystonia demands from adults, first of all, an exception of various diseases which course is followed by dysfunction of VNS. Among them there are various diseases of closed glands (a thyroid gland, adrenal glands, disturbance of the sexual sphere); many mental disorders (since neurosis, and finishing a neurasthenia with the diseases caused by significant changes in structures of a brain). Besides, almost all chronic diseases are followed by symptoms of vegeto-vascular dystonia. That is why the timely address to the expert is so necessary. At timely correction of vegetative disorders at 80-90% of women the dream and appetite are normalized, disappear or many complaints are reduced significantly, adaptation opportunities of an organism are restored. At treatment of vegeto-vascular dystonia , non-drug methods are widely used: the normalization of lifestyle, physiotherapy exercises, country walks, tourism, sanatorium treatment tempering procedures, a psychophysical training, rest in the fresh air. Complex use of medicines, physiotherapeutic procedures is carried out on doctor's orders.
- Day regimen. It is necessary to get enough sleep. Duration of a dream can be varied individually, but it has to average not less than 8-9 hours a day. The chronic sleep debt in itself serves as the cause of various disorders in work of nervous and endocrine systems or can cause emergence and aggravation of symptoms of the available VD. In the bedroom should not be hot or stuffy. You should not have a rest on too soft or rigid mattresses and pillows. It is better to sleep on the orthopedic mattresses and pillows promoting the most physiological position of a body, head.
- Optimization of work and rest. It is necessary to alternate intellectual and physical activities, to apply various methods of psychological unloading, auto-training. Whenever possible to reduce time of viewing telecasts, works at the computer. In the absence of such opportunity - preventive breaks are obligatory during the work with the computer, exercises for eyes and so forth. The refusal of smoking is obligatory.
- Exercises. At VD the swimming, water aerobics, walking, skiing, country walks, tourism are optimum. At such types of loadings there is a training of a cardiac muscle, vessels, arterial blood pressure stabilizes. The woman becomes less dependent on a weather changing, transfers physical activity better, adaptation of an organism to the environment, external irritants increases. Game sports are good if they are carried out in the fresh air, not for result, and just for the hell of it. They promote psychoabreaction, render fortifying effect on an organism. Among exercise machines it is the best of all to use the stationary bicycle, the racetrack, the stepper, the rowing exercise machine. Exercises on exercise machines where the head appears lower than the level of a breast are contraindicated and exercises upside down in connection with danger of development of faints, deteriorations in health are carried out. Classes oriental martial arts, power gymnastics, bodybuilding, aerobics with high jumps, a somersault, render considerable load of a cardiovascular system. It is necessary to avoid exercises with a big amplitude of the movement of the head and trunk, sharply and quickly carried out movements, exercises with long static effort. If you after all do these sports in vegetative disorders, - as much as possible reduce intensity of loading, refuse sparrings, control the rate of respiration and pulse when performing exercises. In any serious competitions it is not recommended to participate. Besides, during the classes you should not have unpleasant feelings, excessive fatigue, irritability. The main criterion of control - your health. The physical education has to give you only positive emotions and pleasure from the physical movement.
- Correction of food. It is necessary to increase receipt in an organism of salts of potassium and magnesium. These substances participate in carrying out nervous impulses, improve work of vessels and heart, promote recovery of the broken balance between departments of VNS. Potassium and magnesium contain in buckwheat, oat porridges, soy, haricot, peas, apricots, a dogrose, dried apricots, raisin, carrots, eggplants, onions, salad, parsley, nuts. At the VD hypotonic type the products raising a tone of vessels are recommended: milk, kefir, tea, coffee. At the VD hypertensive type it is recommended to limit consumption of table salt, tea, coffee, marinades and a pickles and to include the products reducing a tone of vessels in the diet: barley porridge, haricot, carrots, salad, spinach, cottage cheese. At the VD normotonic type the diet has to include the products improving a blood stream and reducing an angiospasm: vegetable oils, citrus, moderate amount of spices.
- Physical therapy. The range of physiotherapeutic procedures is various: an electrophoresis on a cervical spine with medicinal solutions; the sinusoidal modulated currents, appliques of paraffin and ozokerite on cervicooccipital area. These procedures are also directed to recovery of balance in activity of the main departments of VNS, normalization of work of vessels and nerve conduction, on improvement of a metabolism and blood circulation in bodies and fabrics. Recently for treatment of patients with VD are used red and infrared laser radiation in combination with magnetotherapy (on area of a liver, paravertebral, subscapular zones). It improves a metabolism in cells, a blood stream, reduces pain in heart, however, not to apply such type of influence better at the VD hypotonic type as it can provoke development of a faint, dizzinesses. Hydrotherapeutic procedures make fortifying impact on an organism therefore at all VD types contrast bathtubs, fan and circular souls, a hydromassage, swimming are recommended. Besides, at the VD parasynpaticotonic type salty and coniferous and radonic bathtubs are applied, and at synpaticotonic - carbonic, chloride and sulphidic.
- Acupuncture and different types of massage: at the VD parasynpaticotonic type - superficial massage at fast speed, grinding, vibration massage. At synpaticotonic type - the calming massage at slow speed, puddling of a collar zone. At the mixed type of vegetative disorders - a combination of data the technician of massage.
- Phytotreatment. In disorders on parasynpaticotonic type vegetable stimulators are applied: eleuterococcus, ginseng, wolfberry, aralia, levzeya, various diuretic herbs and collecting (bearberry, juniper, cowberry). In disorders on the synpaticotonic and mixed types - the sedative (calming) herbs and collecting: valerian, motherwort, sage, mint, melissa, hop, peony root. Schemes of treatment phytodrugs are appointed by the attending physician.
- Psychological correction. The personal factor plays one of leading roles in development and a course of VD. The sanguine person, for example, is the type, most resistant to emergence of VD. It is least of all subject to stresses, transfers a disease easier, recovers quicker. Melancholiacs and choleric persons are most vulnerable concerning development of vegetative disturbances. Such patients should avoid whenever possible excessive emotional loadings, it is correct to react to stressful situations. They will be helped by the calming herbs, auto-training, relaxation methods, psychotrainings, permission of psychological problems. Sometimes the family psychotherapy which purpose - normalization of the relations of the person with people around, removal of psychological tension is required.
- Good results are yielded by sanatorium treatment.
- Drug treatment has to be carried out only under control of the doctor. It includes: drugs of potassium, calcium, vitamin and mineral complexes, vascular drugs, nootropa (the means improving food, a metabolism and functioning of cells of a brain), antidepressants and so forth.
Not to be helpless in a difficult situation, it is the best of all to learn to cope with vegeto-vascular attacks (crises) independently.
- To accept 20 drops of valocordin or CORVALOL.
- At heartbeat and increase in pressure - to take one pill (40 mg) of PROPRANOLOL (other name of drug ANAPRILIN, OBZIDAN).
- For removal of nervous excitement it is necessary to accept under language (for fast and full absorption) 1-2 tablets of DIAZEPAM (RELANIUM).
- In rapid breathing it is the best of all to take a paper package where you will exhale and from there to inhale the air enriched with carbon dioxide that will lead to breath normalization.
At the patient who learned to cope independently with an attack the alarm of expectation of new attacks decreases. One of forms of vegetative attacks is the syncope - the sudden short-term loss of consciousness which is followed by sharp pallor, considerable weakening of breath and blood circulation. It is caused by temporary disturbance of a tone of vessels, outflow of blood from a brain and falling of arterial blood pressure. Usually faints happen at tumult, in the stuffy room, etc. Harbingers of a faint are the pallor of skin, difficulty of a breath, feeling of shortage of air, dizziness, a blackout, a ring and sonitus, nausea. Then there is a loss of consciousness and falling (some women can have a presentiment of approach of a faint and manage to prevent falling, i.e. in time to sit down with a support on a back, to undo the squeezing clothes and so forth). On a forehead cold sweat acts, breathing becomes shallow, slowed down, pulse frequent, weak, hands and legs cold. Most often the syncope is short. In a few minutes consciousness is restored.
The drugs used at treatment of this disease:
Dmitry Klevtsov, psychotherapist, Moscow.
Now there is a confusion when using terms NCD and VSD.
Many patients look for answers to questions:
- What terms, their origin and relevance of use are?
- NCD (VSD) is a disease, a syndrome or a physiological state?
- Who has to treat?, therapist, neurologist or psychotherapist?
One after another I will answer these three, often set a question.
The first answer.
The term<нейроциркуляторная астения> was introduced for the first time by the American doctor B. Oppenheimer in 1918.
In 1954 the domestic cardiologist N.N. Savitsky, having a little altered the term, offered the name<нейроциркуляторная дистония>, having allocated three clinical options: hypertensive, hypotonic and cardial NCD types.
After that, the definition became widespread in the scientific and clinical circle of cardiologists and therapists (internist); acquired various synonyms (a disregulyatorny cardiopathy; functional cardiopathy; neurotic cardiovascular syndrome).
Outstanding cardiologists G.R. Lang and A.L. Myasnikov called this disorder-<невроз сердечно-сосудистой системы>.
However, the neurologist-vegetologist, the academician Alexander Moiseevich Vane, in the works devoted to diagnostics and treatment of vegetative dystonia criticizes use of the term<нейроциркуляторная дистония>.
-<Нейроциркуляторную дистонию, отражающую неустойчивость артериального давления, лабильность пульса, нарушение вегетативной регуляции ритма сердца правильней считать лишь одним, хотя и наиболее постоянным компонентом вегетативной дистонии> (1).
-<Нейроциркуляторная дистония является лишь частью вегетативной дистонии, а врач, поставивший диагноз НЦД либо не заметил более широкого вовлечения в процесс вегетативной дизрегуляции других систем организма, либо не придал этому значение> (1).
Further A.M. Vane writes:
-<Совершенно недопустимо чтобы одно заболевание по разному обозначалось представителями разных медицинских специальностей> (1).
I will sum up, inadmissibly to use NCD as the independent term as this concept is only a part of more general and better systematized concept-vegetative dystonia.
The academician Vane also did not recommend to use the term<вегетососудистая дистония>: - The Syndrome of Vegetative Dystonia (SVD) is manifestation of all forms of disorder of vegetative regulation. In recent years we give it preference before a syndrome of vegeto-vascular dystonia as then there is an opportunity to speak also about a syndrome of vegetovistseralny dystonia, and the last can be divided into diverse system dystonias (vegetokardialny, vegetogastralny, etc.). Therefore it seems to us correct more general termin-SVD (1).
The second answer.
As for nosological self-sufficiency of the term<вегетативная дистония>, here Alexander Moiseevich as you already understood, is unambiguous:<Вегетативная дистония-является синдромом>.
Definition: a syndrome complex of steady symptoms of disorder which meets in various diseases and morbid conditions.
I.e., the syndrome, is not a disease yet.
- What disease today, is a source of complaints of the patient which symptoms qualified as NCD or VSD earlier?
- According to the International Classification of Diseases of the 10th revision (accepted in 1989; in Russia the bodies and healthcare institutions carried out transition to MKB-10 in 1997), such diagnoses<нейроциркуляторная дистония> as well as<вегетососудистая дистония> are included in a concept: somatoformny dysfunction of the autonomic nervous system.
As is a basic disease and treats the section of mental diseases (F MKB-10 letter).
F45.3 of Somatoformnaya dysfunction of the autonomic nervous system.
Complaints are shown to patients thus as if they are caused by physical disorder of that system or body which generally or completely are under the influence of the autonomic nervous system, that is a cardiovascular, gastrointestinal or respiratory system. (Here partially also the urinogenital system belongs). The most frequent and striking examples belong to a cardiovascular system ("heart neurosis"), a respiratory system (psychogenic asthma and a hiccups) and a gastrointestinal system ("stomach neurosis" and "a nervous diarrhea"). Symptoms usually happen two types, any of which does not point to physical disorder of the affected body or a system. The first type of symptoms on which diagnostics in many respects is based is characterized by the complaints reflecting objective signs of vegetative excitement, such as heartbeat, sweating, reddening and tremor. The second type is characterized by more idiosyncratic, subjective and nonspecific symptoms, such as feelings of fleeting pains, burnings, weights, tension, feelings of inflating or stretching. These complaints belong the patient to a certain body or a system (to which also the vegetative symptomatology can belong). The characteristic clinical picture consists of distinct involvement of the autonomic nervous system, additional nonspecific subjective complaints and permanent links of the patient on a certain body or a system as the cause of the disorder.
Many patients with this disorder have instructions on presence of a psychological stress or difficulty and a problem which are represented connected with disorder. Nevertheless, at a considerable part of the patients answering to criteria of this disorder, the burdening psychological factors do not come to light.
In certain cases there can be also insignificant disturbances of physiological functions, such as hiccups, a meteorism and an asthma, but in itself they do not break the main physiological functioning of appropriate authority or a system.
For the authentic diagnosis all following signs are required:
1.simptomy vegetative excitement, such as heartbeat, sweating, a tremor, reddening which have chronic character and cause trouble;
2.dopolnitelnye the subjective symptoms relating to a certain body or a system;
3.ozabochennost and chagrin concerning possible serious (but often uncertain) diseases of this body or a system, and repeated explanations and dissuasions in this respect of doctors remain sterile;
4.otsutstvuyut data about essential structural or functional: disturbance of this body or system.
Differentiation from a generalized anxiety disorder is based on prevalence of psychological components of vegetative excitement in a generalized anxiety disorder, such as fear and disturbing presentiments and also lack of constant reference of other symptoms to a certain body or a system. Vegetative symptoms can arise also at the somatized disorders, but in comparison with some other feelings they have neither expressiveness, nor constancy and also are not attributed to one body or a system all the time.
• cardial neurosis;
• syndrome da Costa;
• neurocirculatory asthenia;
• psychogenic form of an aerophagia;
• psychogenic form of cough;
• psychogenic form of diarrhea;
• psychogenic form of dyspepsia;
• psychogenic form of a dysuria;
• psychogenic form of a meteorism;
• psychogenic form of a hiccups;
• psychogenic form of deep and frequent breath;
• psychogenic form of urination;
• psychogenic shape of the angry intestines;
• psychogenic form of a pylorospasm. (5).
The third answer.
Tasks of the therapist (internist) and the neurologist at identification at the patient of the syndrome of vegetative dystonia (SVD) the following:
1) to confirm or exclude presence of an organic lesion of visceral systems or peripheral / the central nervous system;
2) at an exception of the organic reasons, it is necessary to direct the patient to the psychotherapist (according to G.G. Osokina, 1988, 78% examined with VSD have no organic pathology), for establishment of the nosological diagnosis and purpose of etiotropic treatment.
Thus, all work on final diagnostics and treatment of somatoformny vegetative dysfunction is undertaken by the psychotherapist after consultation of the patient at doctors of a therapeutic profile.
The used literature:
1. A.M. Vane, N.A. Yakovlev, T.A. Slyusar. Vegetative dystonia. 1996.
2. V.Ya. Gindikin. Lexicon of small psychiatry. 1997.
3. Information and methodical letter: use of the international statistical classification of the diseases and problems connected with health, the tenth revision (MKB-10) in practice of domestic medicine. Russian Ministry of Health., 2002.
4. A.N. Okorokov. Diagnosis of diseases of internals: T.7. Diagnosis of heart troubles and vessels. 2003.
5. Mental disorders and disorders of behavior (F00 - F99), (Class 5 MKB-10 adapted for use in R.F.) / Under the general edition of Kazakovtsev B.A., V.B. Gollanda, 2003
tell me please! I am 26 years old of Izz Trvma the heads of me vegeto-vascular dystonia, strongly jumps pressure! and when a weather changing too, tell there is a way will recover completely. what pressure would not disturb!
Tell me please!32 of years because of later rodd back 10 years. dizziness heat vomiting began. Shas sometimes dizziness when for the night when eyes I close eyes, still when an inclination the head I get up down spinning began. I do not work 10 years I am afraid to go one by transport and on shops. help please...
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