Neurotic disorders (neuroses) belong to the category of mental and behavioral disorders, but patients visit primarily neurologists and general practitioners, since neurological and somatic disorders predominate in complaints and clinical symptoms.
The term “neurosis” was introduced in 1776 by the Scottish physician W. Cullen to refer to “disorders of sensations and movements that are not associated with fever, and do not depend on a local damage to any organ”. Thus, historically, neuroses often included not only functional but also degenerative diseases, metabolic diseases, etc. Later, the concept of “neuroses” was limited to disorders caused or provoked by a traumatic situation. In the International Classification of Diseases of the 10th revision, the term “neurosis” is replaced by the term “neurotic disorders”. However, the concept of “neurosis” has not lost its meaning, which is widely used both in scientific literature and in practice. Currently, neurotic disorders are widely recognized as one of the most common, so their study is relevant not only in medical, but also in social terms. Neurosis and neurotic disorders are addressed in the works of many domestic and foreign psychiatrists and neurologists (Y.A. Aleksandrovsky, L.V. Blumenau, A.M. Vein, V.A. Gilyarovsky, S.N. Davidenkov, G.M. Dukova, B.D. Karvasarsky, V.V. Kovalev, N.D. Lacosina, V.N. Myasishchev, A.M. Svyadosch, V.N. Ushakov, Z. Ganser, P. Janet, E. Kraepelin, E. Kretschmer, S. Freud, J.M. Charcot, K. Jaspers, etc.).
Neuroses are thought to be a consequence of acute or chronic stress, leading to impairment of the functions of structures that provide integration between the emotional, autonomic, visceral and endocrine system (limbic-reticular complex, hypothalamus, upper brainstem), which determines the clinical polymorphism of diseases. Psychogeny is a trigger factor in the development of neurotic disorders. Special attention should be paid to pediatric psychogenies that lead to children’s forms of neurotic response (logoneurosis, enuresis, hyperkinesis) and prepare the groundwork for the development of neurotic disorders in adults with repeated psychotrauma. The psychotraumatic factor should have a special individual significance. There is a concept of “actual psychogenies” (intimate-personal, occupational, creative, loss of loved ones, threat to health and life, natural disasters). Personality traits play an important role in the formation and manifestations of neurotic disorders. The most vulnerable are individuals with anxious suspiciousness, emotional lability, demonstrativeness, subdepressiveness, rigidity. The peculiarities of the physical and mental state are also important. Neurotic disorders are more often observed during periods of endocrine development (puberty, menopause), with fatigue.
The main pathogenetic link of neuroses is a psychological conflict that causes difficulties in forming correct behavior due to the lack of psychological defense mechanisms. Such forms of protection as suppression, repression, regression, rationalization, sublimation, sleep, prevent the penetration of unwanted information into consciousness and mitigate psychological stress.
Biological aspects of the pathogenesis of neurotic disorders
Neuroses are considered functional reversible diseases without organic brain damage; however, they often take a prolonged course. The disease is based on an impairment of the integrative activity of the brain with the disruption of the internal connection of various systems with an increase in maladaptation, restrictive behavior. Neurotic disorders are associated with neurotransmitter dysfunction. Thus, it has been shown that impairment of the noradrenergic systems of the brain may play a role in the mechanisms of anxiety. An anomaly in united GABAergic and benzodiazepine receptor complex or the insufficiency of their endogenous ligands is thought to cause pathological anxiety of the individual and the ease of provoking it. This concept is confirmed by the effectiveness of benzodiazepines in the treatment of anxiety. The effectiveness of antidepressants that specifically affect serotonin metabolism in the brain indicates the pathogenetic role of serotonergic system dysfunction in neuroses. Hereditary predisposition can be realized in the features of the personality. At the same time, the neurosis has a more severe course.