Mental, somatic and neurological disorders from the point of view of the concept of “disease”

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Many people associate depression with low mood, sadness and an unwillingness to do anything. This is true because these symptoms are consistent with a classic depressive episode. But it happens that a person maintains his emotional state, relying, for example, on his strong volitional qualities, and then the disease is “masked” through bodily symptoms.

Somatic, or more precisely, somatized depression is a mental illness in which the main symptoms of the disease are hidden under the guise of persistent bodily manifestations. This type of depression is also called masked or hidden.

A person has been suffering from body pain for years, complaining of discomfort in the stomach or chest. Or back pain. He undergoes many studies, but doctors shrug their shoulders. Based on the results of the analyses, no deviations were identified that would explain the complaints.

In such cases, a competent therapist or medical specialist recommends consulting a psychotherapist or psychiatrist, since somatic depression syndrome may be hidden under all sorts of pain and discomfort. It often acts as a concomitant syndrome with another somatic pathology, for example, with diabetes mellitus - the reaction to an identified somatic disease in people is often depressive in nature, but the significance and depth of this depressive reaction is often underestimated, or even simply ignored.

According to statistics, about 35% of patients of general practitioners with an unspecified somatic diagnosis have hidden (masked) depression.

Types of psychosomatic disorders

Considering the wide variety of clinical manifestations and the long history of studying this pathology, several classifications of psychosomatic disorders have been developed to date. The most common classification includes 4 main groups:

• Classic psychosomatic diseases;
• Somatoform disorders;
• Nosogenies;
• Somatogeny.

Although this classification is not widely used among practicing doctors, it allows the most logical and understandable systematization of all psychosomatic disorders. In the practice of Western psychiatry, the concepts of “psychosomatic disorders” and “somatoform disorders” are identified.

How to diagnose somatized (somatic) depression

It is difficult to correctly diagnose this condition, since a person is tormented by symptoms from the body, not the psyche. People try not to talk about their bad mood or anxiety because they are afraid of contacting a psychotherapist or psychiatrist. Because of this, questions about mental state cause irritation and negative reactions.

To make a correct diagnosis, the following points are taken into account:

• a complete thorough examination did not reveal any serious abnormalities in the functioning of the internal organs;
• daily fluctuations in somatic disorders in depression are one of the important markers; Seasonal exacerbations of pain are often characteristic; the severity of symptoms may decrease in the evening; analgesics do not provide relief;
• repeated visits to different doctors and undergoing numerous tests, despite previous negative (not confirming the presence of a serious somatic disease) results.

Due to constant pain of unknown origin, such patients have a high risk of developing drug, alcohol or drug addiction. For the occurrence of somatic symptoms of depression, a lack of significant support in life from loved ones is quite characteristic. In this way, people try to get the care and attention they need.

Psychosomatic diseases in classical manifestations

Classic psychosomatic diseases include those diseases caused by psychological trauma, chronic stress, chronic fatigue, lack of proper rest and other psychogenic influences. A person’s personality type and the characteristics of their emotional response to external stimuli also play a huge role in the development of psychosomatic diseases. Initially, classical psychosomatic diseases meant seven pathologies (“Chicago Seven” or “Holy Seven”):

• Essential arterial hypertension;
• Duodenal ulcer;
• Nonspecific ulcerative colitis;
• Bronchial asthma;
• Thyrotoxicosis;
• Rheumatoid arthritis;
• Neurodermatitis.

Later, type 2 diabetes mellitus, obesity and even coronary heart disease were added to psychosomatic diseases. The issue of including radiculitis, migraine, irritable bowel syndrome, gallbladder dyskinesia, psoriasis and some other diseases is currently being considered.

Somatic diseases

Research Disease Prevention

Prevention of somatic diseases and genetics. What do we know about this?

As a rule, most of us turn to a doctor for help either with the first appearance of symptoms of a physical illness, or, even worse, when a developing illness causes significant pain, decreased quality of life, and sometimes irreversible changes in health. And then your doctor has no choice but to prescribe for you an individual program of secondary prevention of the disease, which is aimed, sometimes for life, at preventing the progression of the disease and its complications.

The situation changes dramatically if you focus yourself on knowing all the personal risks of contracting a particular disease even before the first manifestations of the disease, in advance. Despite the fact that almost all of us know the postulate that it is easier to prevent a disease at a pre-symptomatic level than to treat it, not everyone realizes this in life.

It is not just those who have information about all possible risk factors for the disease who are well “armed” against diseases, but most importantly, they can competently use this information to maintain excellent health and longevity.

This is how a whole medical direction appeared - personalized preventive (precautionary) medicine, which in the 21st century is intended to become the basis of all medical prevention. What distinguishes it from the generally accepted concept of “medical prevention among the population” is that it deals with each specific person. And in essence, this is individual management of the health status and reserves of the body.

The basis for such prevention was laid by modern medical genetics, which discovered individual characteristics of human genomes (gene polymorphisms/unfavorable allelic variants of genes) that manifest themselves only in combination with exposure to pathogenic environmental factors. In other words, gene polymorphisms are a type of mutation in genes when a mutant gene, a predisposition gene, is compatible with birth and life, but under certain unfavorable conditions contributes to the development of a particular disease.

The study of these polymorphisms provides knowledge:

— what diseases a person is predisposed to, what are his personal risks of getting sick;

— what is his personal program for the prevention of those diseases to which a predisposition has been identified;

— what is the prognosis for the course of the disease if it develops, what is the prognosis for the development of its complications;

— how to competently and personalizedly treat a patient, providing him with medication, taking into account his individual drug response.

Somatic diseases (from the Greek - body) are almost all diseases, with the exception of mental illnesses and conditions. Somatic diseases: oncological, cardiovascular, bronchopulmonary, endocrine, diseases of the musculoskeletal system, gastrointestinal tract, organs of vision, hearing, nervous system, genitourinary system, etc.). As medical genetics developed, in relation to the listed diseases, the multifactorial risks of their occurrence were established, one of which is genetic predisposition. The second component is external pathogenic factors . This is the environment around us, what we eat, our bad habits, stress and much more.

The diseases themselves are called multifactorial diseases (MDDs). Despite all the diversity of the clinic, they are united by several common characteristics:

• all of them manifest themselves throughout a person’s life when there is a combined effect of unfavorable external factors and individual characteristics of the genome. This explains why, given equal conditions and lifestyle, some people suffer from the disease, while others do not develop it. When we talk about individual characteristics of the genome, we mean genetic predisposition;
• genetic predisposition to diseases is inherited, and this inheritance does not obey Mendel’s laws, as, for example, in the case of monogenic hereditary diseases;
• the genetic contribution is polygenic in nature , that is, not one, but several genes, dozens of genes, are involved. Moreover, the same gene can be involved in different MDs. Most MDs are related to each other by different genes, this proves the pathogenetic proximity of diseases such as cardiovascular diseases;
• the disease may or may not develop. It all depends on how harmful and harmful environmental factors are eliminated and what the proportion of the contribution of the genetic predisposition factor is (for example, in the case of type I diabetes mellitus, the genetic contribution reaches 60%).

Somatoform disorders

With somatoform disorders, the patient presents a large number of serious complaints from organs and systems with the simultaneous absence of any objective pathological changes in them. This is confirmed by numerous laboratory and instrumental studies, which the patients themselves insist on undergoing. Considering the absence of organic pathology, and sometimes even functional changes, the prescribed therapy turns out to be ineffective. The patient complains about the doctor’s unprofessionalism, and the doctor classifies such a patient into a special category of “annoying” or “undesirable” clients. Unfortunately, this practice is quite common, although incorrect. These patients are not shown a “special category”, but a consultation with a psychotherapist.

Symptoms of depression and somatic sensations

Emotional disorders such as anxiety, apathy and despondency are among the main manifestations. But in latent depression they are ideally disguised as other pathological manifestations. A person is sure that his low mood is associated with an unknown illness, anxiety about health is logically understandable, and it is a somatic illness that causes weakness and fatigue, apathy, and not a mental disorder or depression.

Somatic symptoms of depression include:

1. Chronic pain is a common companion to this condition. Its localization changes quite often (but can also have a long-term constant localization); sometimes pain occurs simultaneously in different parts of the body. The intensity of pain can vary in severity. People describe their health as “heavy head”, “dull pain”, “pulling the back”, “pressure in the chest”, “burning in the hands”, etc., as a condition accompanied by tedious, exhausting pain.
2. Loss of appetite - accompanied by severe loss or gain of body weight. It can be expressed in both anorexic behavior and overeating. A person may not feel hunger at all, or, on the contrary, experience it constantly. Or convey it and not notice it - “I eat out of habit.”
3. Sleep disorders are an important symptom that signals exhaustion of the nervous system. Restless and/or interrupted sleep, difficulty falling asleep, waking up early with anxiety, nightmares, and feeling groggy in the morning are all somatic manifestations of depression.
4. Asthenic syndrome - this symptom is associated with increased fatigue, constant fatigue, and decreased performance. It is difficult for a person to concentrate on everyday activities. With a small load, severe fatigue occurs that does not go away after rest.

Doctors also include problems in the sexual sphere as somatic signs of depression. This is a decrease or complete absence of sexual desire, erectile dysfunction in men. Women often complain of menstrual irregularities or increased premenstrual syndrome.

There are no mood swings observed. People usually describe their mood as “usual”, “not important”, “nothing”, “what kind of mood can you be in when you’re sick?” There is irritability, dissatisfaction, grumpiness, confusion. Physical symptoms are more eloquent and varied: there may be tachycardia, dizziness, shortness of breath, numbness, tremors in the limbs.

Diagnosis of pathologies

In order to identify the cause of somatic symptoms, the doctor will need to conduct a number of tests, including:

• a complete collection of the patient’s medical history, including interviewing relatives and collecting previous medical histories;
• visual examination of the victim, palpation of problem areas;
• urine test;
• analysis of stool, blood from a finger or vein;
• sputum collection;
• soft tissue biopsy;
• use of functional diagnostic methods - MRI, CT, X-ray;
• surgical intervention.

Treatment options

To relieve the condition of somatic (somatized) depressive disorder, the doctor will recommend a course of treatment with antidepressants and/or anti-anxiety drugs. This will help improve the quality of sleep, first reduce and then relieve pain, and reduce the severity of asthenic syndrome. Pharmacotherapy is indicated and recommended by the doctor, but the final decision to take or not take medication rests with the patient; the doctor always asks the patient for consent to drug therapy.

The basis of masked depressive disorder is always psychological, so-called. psychogenic factors, internal psychological contradictions and/or stressful external factors, even if the person denies it. Therefore, taking medications alone will not be effective in terms of complete cure. It is very important to understand together with a psychotherapist and understand the psychological reasons for the appearance of somatic symptoms, therefore, for somatic (somatized) depression, treatment necessarily includes psychotherapy (first individual, then group).

Psychotherapeutic sessions allow you to understand your feelings, emotional attitude towards various moments of your life, and express hidden feelings and desires. Often, stressful situations that could precede the development of a depressive disorder are not recognized by the patient or are devalued and denied. Having realized the cause of his condition, a person gets the opportunity to find psychological solutions and learns to effectively cope with psychological stress in his life.

Don't let illness take away the joyful moments of your life. If treatment with different general practitioners does not bring a positive result, then consult a psychiatrist or psychotherapist yourself.

SDVNS in children

Often, somatoform autonomic disorder appears in children at puberty, that is, during the period of maturation. This is due to a hormonal surge and intensive growth of the body.

The following factors can provoke the process:

• heredity;
• stress;
• mental, physical stress;
• infections;
• bad habits;
• surgical interventions;
• large body weight;
• sedentary lifestyle;
• staying at the computer for a long time.

The appearance of teenagers is typical. If sympathy predominates, then the skin of such children is moist and oily, with acne. She alternately turns red and pale. A bluish tint appears. Cold, with a marbled pattern called a vascular necklace. When pressed with a finger, the skin turns pale and red dermographism is observed.

When parasympathetics dominate, the skin is dry, with pink or white dermographism. These children have an increased appetite, but they do not gain weight.

The disorder is accompanied by a sudden rise in temperature under the influence of stress. A typical occurrence is fainting.

All characteristic changes in internal organs are present.

The psycho-emotional sphere is also undergoing changes. Such a child becomes distracted and nervous. He quickly gets tired, drowsiness and apathy appear, and his memory deteriorates.

In most cases, the course of the disease is stable. But periodically panic attacks and crises occur:

• sympatho-adrenal - accompanied by tachycardia, elevated blood pressure, headaches, thirst, chills and hyperthermia. Anxiety and feelings of fear develop;
• vagoinsular – migraine-like attacks, nausea, vomiting, pain in the abdominal area. Hyperhidrosis, decreased blood pressure and fainting, slow heart rate, increased urine output, breathing disorders;
• mixed.

The attack can last up to several hours.