Psychotherapy in the treatment of neurological diseases - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Neurology

feasibility of using psychotherapeutic methods in organic diseases of the nervous system.

In connection with the transformation of clinical neuroinfections all more common forms of central nervous system lesions, which are of minor severity of neurological disorders are characterized, as a rule, lengthy, long-term course and treatment resistance.Under these conditions, disorders of cortical neurodynamics organic process secondary neuroticism as a personality reaction to the underlying disease and related psychogenic in many cases are inevitable companions of organic pathological process.The widespread introduction into clinical practice of electrophysiological, contrast radiographic studies, computed tomography, magnetic resonance imaging, and others. Greatly facilitated the diagnosis erased, unexpressed form of a number of organic diseases of the nervous system.In this regard, more often than before, it is possible to properly evaluate each case, the ratio of the organic components and neurotic in thi

s disease and accordingly determine the location and somato- therapy in the most rational therapeutic and rehabilitative complex.Diagnostic difficulties, underestimation of neurologists methods of clinical-psychological research often lead to misinterpretation of neuropsychiatric disorders in organic diseases.Neurotic Syndromes due to psychogenic, considered as a manifestation of the destructive process, so that the possible reassessment of the role somatoterapii and ignoring or underestimating psychotherapy.This is all the more necessary to stress that, in addition to the therapeutic value of psychotherapy in these cases it is useful for the differential diagnosis of organic lesions delimitation of violations occurring psychogenic.However, other kinds of mistakes when neurosis debuts at organic lesions of the nervous system (multiple sclerosis, brain tumors and others.) Elimination of psychotherapeutic techniques related functional disorders results in a belated, late diagnosis.

The effectiveness of hypnotherapy in patients respond well to hypnosis, aimed at easing such purely organic manifestations as paresis, paralysis, dysarthria, intention tremor, disorders of muscle tone, phantom pain, etc., According to the study of many authors.Referring to his own observations, known domestic therapist Platonov noted weakening of fresh organic and chronic paresis and paralysis of various etiologies under the influence of training exercises with physiotherapy exercises conducted in a state of hypnotic sleep.This accelerates the process of recovery of movement in the affected limb.On the possible neurophysiological explanation for the effectiveness of hypnotherapy in organic diseases of the nervous system pointed out by Bekhterev.In 1911 he wrote that "... if any organic disease of the nervous system disorder has caused the associated functional changes in neighboring or more remote areas of the nervous system," and that, therefore, it is possible "some influence on the hypnotic suggestions nerve lesions of organic origin".On the regression of not only subjective complaints and objective neurological symptoms in hypnotherapy patients with traumatic lesions of the nervous system, vascular, infectious, toxic origin indicated Shoham.The author believes that in this case the psychotherapeutic influence is realized through non-specific structures of limbic-reticular complex, affecting the functional state of the nervous system at its different levels indirectly through speech (vtorosignalnye) neocortical areas.Emphasizes the effectiveness of hypnotherapy when stem diencephalic forms of organic brain disease.When focal brain lesions, involving, for example, spastic hemiparesis, according to the author, it is possible to reduce their clinical manifestations - some improvement in muscle strength, reduced tone, restore to some extent the sensitivity, etc. -. In particular, through the mobilization of reserve compensatory possibilities by nonspecificstructures of limbic-reticular complex.The effectiveness of hypnotic suggestions in patients with Parkinson's, explains the special role of nonspecific brain systems in the pathogenesis of diseases and disorders primarily neurodynamic lying in the basis of a given symptom of organic disease, pointed Golubev.Hypnotherapy, as well as all other types of suggestive therapy can be successfully used to relieve symptoms of neurosis nepsihogennoy nature in organic diseases of the nervous system.

effectiveness of these methods for sleep disorders and appetite, worsening of mood disorder, memory, attention, reduced mental performance is well known.

During the psychotherapy in the whole complex of medical measures (dehydration, resolving, anti-inflammatory therapy) is essential during the hospital stay.Doubtless psychotherapeutic value for the patient acquires the finding of his particular disease after carefully conducted survey.The primary goals of therapy at this stage the patient is a belief in the big compensatory possibilities of the nervous system, activation of the individual to overcome the painful disorders, and adaptation to the conditions of life.For this purpose it can be used, in addition to rational therapy, all forms of suggestion including hypnotherapy narkogipnoterapiyu et al. Is of great importance in the therapy group, especially in the form of "medical perspectives."Using this technique it is expedient, as diagnosis of organic brain disease usually scares patients.It is necessary to give them the opportunity to see the prospects for their therapy.To this end, the group invited patients with similar painful disorders who completed treatment with favorable results, a good social and labor reinsertion after him.

One of the main objectives of the use of psychotherapy in complex treatment of patients with organic diseases of the central nervous system is the elimination of the neurotic component due to the reaction of the individual to the disease, often due to iatrogenic, as well as a more complex related psychogenic.In some patients, the occurrence of neurotic disorders is caused by abnormal reaction to the defeat of the nervous system, and the experience of the disease assumes the character of psychogenic because of their personal features (alarming suspiciousness, hypochondriacal).The genesis of these secondary neurotic symptoms in the clinic of organic brain lesions, especially when encephalitis with lesions of the midbrain, which is closely associated primarily with generalized systemic disorders sensory spheres.These patients are characterized by senestopatii, frequent violations of the body and especially visceral body schema, bright psychosensory disorder.These sensations patients experiencing particularly acute and hard, and they have a belief in the reality of life catastrophes, which may occur at any time, despite the assurances of the doctor.Often, patients are fully delve into the experiences associated with the frightening bodily sensations, concentrate on them all our attention and are excluded from the usual circle of family and social problems (Leshchenko).The reaction to these disorders tend to be neurotic fears "go crazy", bleeding in the brain, the emergence of tumors.Noted by many authors hypochondriac mood of patients with these diseases is accompanied by persistent fixation on the sensations, excessive concern about their health and often iatrogenic supported by diagnostic errors.When treating patients with neurotic fixation of organic disorders is essential indirect psychotherapy, in particular in the form of psychotherapy and mediation potentiation of various types of biological therapy.About expediency chrezpredmetnogo (indirect) psychotherapeutic effect has long been known (Bekhterev, Platonov, and others.).

important role psychotherapy gains in the complex treatment of patients with prolonged, prolonged for an organic disease of the nervous system becomes a factor contributing to the emergence of more complex psychogenic, revealed only when a deep study of the history of the patient's development and formation of his relationship to reality.As noted Myasischev, with destructive lesions of pathological changes of cerebral substratum characterized by a decrease of resistance and endurance, so the situation is insignificant for a healthy nervous system, is dekompensiruyuschey in these conditions.Such patients, being mostly "organics", prone to relapse of the disease and decompensation by psychogenic way and well restored in resolving the situation with the help of psychotherapy.At the same time there are cases when one or another adverse factor in the life of the patient becomes pathogenic significance only after suffering an organic disease of the nervous system.When organic diseases with severe neurotic disorders psychotherapy preferably carried out in the hospital, where it has favorable conditions (prolonged and constant contact with the sick doctor, the need for a systematic individual psychotherapy, to conduct group therapy and various types of so-called sociotherapy).Psychotherapeutic importance is the fact of receipt of the patient with an organic disease of the nervous system in the hospital for a thorough examination, and medical office or clinic environment.After discharge should be carried out supportive psychotherapy, which in severe cases lasting for several months, and sometimes years.In the absence of sufficient capacity for this purpose a method of psychotherapy correspondence by correspondence can be used.

in general medical practice often encountered patients who from the very beginning put the correct diagnosis of organic disease of the nervous system, but often even a long, long-term treatment in these cases is not sufficiently effective.When clinical and psychological study of the patient revealed a neurotic and hypochondriac reactions and basic fixing of painful symptoms.Only a careful elucidation of the history of life of the patient, the characteristics of his personality allows us to understand the content of this fix and identify the psychogenic factors that cause it.One of the main and the most appropriate methods of rehabilitation treatment in these cases is psychotherapy in its various forms, primarily in the form of person-centered psychotherapy.

A number of studies indicated the effectiveness of different types of psychotherapy - the rational, in the form of suggestion, narkopsihoterapii etc. -. In the complex treatment of neurological patients to eliminate secondary neurotic and neurosis-like disorders in the background of infectious, vascular, traumatic disorders of the nervous system.Psychotherapy is useful in traumatic injuries of the spine and spinal cord, with secondary neurotic and neurosis-like disorders, and neurological disorders, characteristic of this group of patients (violations of bowel function, bladder, movement and sensitivity disorders).The effectiveness of hypnotherapy and other forms of psychotherapy in patients with lesions of the nervous system at the spinal and peripheral levels is due to their participation in the mechanisms of compensation of cerebral structures, particularly the nonspecific structures of the limbic-reticular complex;matter and descending corrective influence of the limbic system in the functional state of spinal and peripheral structures, including their motor, sensory, vegetative-trophic manifestations.Yatskova prolonged outpatient psychotherapy (80-100 sessions) was used in patients with remote consequences of cerebral organic pathology and the presence of neurotic and neurosis-like disorders.The author points to the effectiveness of psychotherapy different depending on syndromal structure of neuro-psychiatric disorders.Less effective was therapy in patients with hypochondriacal and senesto-cephalgic syndromes.

The system of treatment of neurological patients with widespread autogenous training.A review of research on the use of this technique in the clinic of nervous diseases is given in the monograph Panov et al. The paper emphasizes that the autogenous training more than adequate with rehabilitation therapy residual effects of organic diseases of the central nervous system, primarily to address a wide range of functional disorders of the neurotic and neurosis-like character.Deserves special attention data on the use of autogenous training with the aim of relaxing individual muscle groups in these treatment-resistant forms of diseases such as spasmodic torticollis, facial paraspazm and others. An increasing number of examples of the treatment of nervous and mental disorders using the principle of biofeedback.This method gives a good therapeutic results in the treatment of cerebral arachnoiditis with mainly convulsive disorders, in patients with consequences of spinal injuries and spinal cord, with the active rehabilitation therapy of patients with post-stroke movement disorders.A large literature devoted to the use of this method in the treatment of migraine.

Fig.8 shows a patient with facial images paraspazmom before and after the course of autogenic training.

patient facial paraspazmom.


and - bilateral symmetric tonic spasm of the facial muscles.Intensive twitching orbicularis oculi muscle deprives the patient of the possibility of anything to see, muscle spasm mouth impedes speech and food;b - during a very short (a few seconds) intervals between attacks still persists tonic spasm of the muscle tension that is arbitrary, by reducing antagonists, overcome with great effort and quickly tired of the patient;in - after treatment autogenous training is only a voltage orbicularis oculi muscle, which does not disturb vision.(By Lobzin).

accumulating experience of group therapy in various diseases of the nervous system, in particular persons suffering from cardiovascular diseases.In the first lessons the features of the disease (for forecast);further discuss issues of concern such patients usually - the need and ways to improve their emotional and volitional and social activity, correction facilities and relationships to a variety of social conditions, adequate attitude to the symptoms of the disease, the emergence of resistance to them.The problems associated with the return of patients to the family (here is important and family therapy), preparation for retirement and, therefore, a new way of life.When indicated group therapy can be combined with other types of hypnotherapy and psychotherapy in the same group.During the therapy in patients with vascular diseases of the nervous system must take into account their increased vulnerability and the lability of the psyche;reckless behavior therapist can lead to iatrogenic and didaktogenii.

Demidenko, Balunov applied the methods of psychotherapy in the system of complex rehabilitation therapy post-stroke patients.The object of therapeutic effects were reactive layers of personality (low self-esteem, loss of confidence in the recovery), especially pronounced in patients with severe defects of motor, sensory, and other functions.Treatment was carried out in small groups and included various forms of rational psychotherapy - group sessions using techniques "psychotherapeutic mirror", "correction scale experiences," "therapeutic prospects", music therapy, contributing to the development of adaptive systems and the mobilization of the patient's own activity.A significant place was given to elements psihogimnastiki, movement therapy, the most appropriate to meet the challenges of emotional and motor activation patients.