Asthenic Disorder (Asthenia)

What is Asthenic Disorder (Asthenia)?

Organic asthenic disorder is a persistent psychopathological formation, due to a combination of cerebrastenic and neurosis-like syndromes, which is a kind of “visiting card” of vascular pathology of the brain. Appearing at the very beginning of the disease, manifestations of cerebral asthenia persist until its final stage – vascular dementia.

Asthenia is a psychopathological condition characterized by weakness, fatigue, emotional lability, hyperesthesia, and sleep disorders.

Asthenic syndrome is one of the most frequent in the practice of the doctor of any specialty. Asthenia is the least specific manifestation of disorders, in many cases being the initial (starting) links of the etiopathogenesis of mental disorders of the neurotic structure and determining the basis for the development of phenomenologically more complex psychopathological processes.

Non-specificity of asthenic disorders causes their widespread occurrence. They are observed in various diseases in general somatic, neurological and psychiatric practice. At the same time, due to an increase in psychogenic loads in the life of a modern person, an increase in the frequency of asthenic disorders is noted.

Asthenic syndrome in the framework of neurasthenia (irritable weakness) began to allocate in the XIX century. The ICD-10 classification, unlike the previous one, “getting rid” of all other neuroses as “vague and indefinite concepts”, preserved neurasthenia as an independent nosological unit, thereby emphasizing, on the one hand, the clinical reality of this condition, and on the other – independence of therapeutic approaches.

Fatigue is the most common complaint with which patients go to doctors, especially to general practitioners, and which is the main symptom of asthenic disorders. Along with increased fatigue and exhaustion, they include such manifestations as irritable weakness, hyperesthesia, autonomic dysfunction, sleep disorders (difficulty falling asleep, shallow sleep). The clinical typology of asthenic disorders is determined by its two options: hypersthenic asthenia, characterized by hypersensitivity of sensory perception with increased susceptibility of normal neutral external stimuli (intolerance of sounds, light, etc.), excitability, increased irritability, sleep disorders, etc., and hyposthenic asthenia, The main elements of which are the reduction of the threshold of excitability and susceptibility to external stimuli with lethargy, increased weakness, daytime sleepiness.

Although patients describe asthenia as fatigue, the scientific definition of an asthenic condition requires distinguishing it from simple fatigue. Unlike fatigue (sometimes referred to as prenosological asthenia, a physiological condition that follows intensive and prolonged mobilization of the body, usually arises quickly and disappears after rest, does not require medical assistance), asthenic condition is a pathology, appears gradually and is not related with the need to mobilize the body, lasts months and years, does not recover after a rest and requires medical intervention. Donosological asthenia often occurs after excessive physical, mental or mental stress, with improper alternation of work and rest, systematic lack of sleep, adaptation to new climatic conditions, etc. and is referred to in the literature as informational neurosis, manager syndrome, white-collar syndrome, guiding syndrome personnel, asthenia in foreigners, asthenia when changing time zones, asthenia in athletes, iatrogenic asthenia. In contrast, the occurrence of asthenic disorders is due to more diverse and often associated with other existing pathologies.

The symptom complex of an asthenic condition as a pathological exhaustion after normal activity, energy reduction in solving problems that require effort and attention, or a generalized reduction in the ability to act, consists of three components:
– manifestations of asthenia itself;
– disorders caused by the underlying pathological condition of asthenia;
– Violations caused by the response of the individual to the disease.

The second component of asthenic disorder, namely, the underlying pathological conditions, is the main feature, which takes into account the current classification of asthenic conditions. Organic asthenia, the share of which in all asthenic conditions is estimated at 45%, develops against the background of chronic, often progressive organic (neurological), mental and somatic diseases. These include infectious, endocrine, hematological, neoplastic, hepatological, neurological, mental (primarily schizophrenia, substance abuse) and other diseases. In contrast to organic, functional (reactive) asthenia, which constitutes 55% in the general structure of asthenia, is characterized primarily by principal reversibility, since it occurs after or as a component of time-limited or curable pathological conditions. These include acute asthenia, which occurs as a reaction to acute stress or significant work overload; chronic asthenia, appearing after childbirth (postpartum asthenia), past infections (post-infectious asthenia) or in the structure of withdrawal syndrome, cachexia, etc.

Separately, due to the extreme importance of the problem, psychiatric asthenia is highlighted, during which an asthenic symptom complex is detected in the structure of functional borderline mental disorders (anxiety, depression, insomnia, etc.).

Causes of Asthenic Disorder (Asthenia)

In many works of domestic and foreign researchers it is noted that many social factors contribute to the increase in the number of patients with asthenia. Negative life circumstances, difficulties associated with social career, frequent stress, current and chronic diseases, lead to the fact that asthenic disorders acquire a “social connotation”.

An important role in the etiopathogenesis of asthenic disorders is also assigned to somatogens. It is emphasized that asthenia is the starting etiotropic factor of various diseases. Asthenic syndrome begins and ends with infectious, cardiovascular, endocrine and other diseases. Pronounced manifestations of asthenia are observed in organic brain damage: traumatic brain injuries, in the initial stages of vascular processes, after disorders of cerebral circulation, in infectious-organic, demyelinating diseases and degenerative processes in the brain. In the clinical manifestations of asthenia, along with the emotional component, pronounced somatovegetative disorders, cognitive and conative (behavioral) changes are detected.

Symptoms of Asthenic Disorder (Asthenia)

Fatigue with asthenia is always combined with a decrease in productivity at work, especially noticeable with intellectual stress. Patients complain of poor intelligence, forgetfulness, unstable attention. It is difficult for them to focus on any one thing. They try to force themselves to think about a certain subject by an effort of will, but soon they notice that in their head, quite involuntarily, completely different thoughts appear that have nothing to do with what they do. The number of representations decreases. Their verbal expression is difficult: you cannot find the right words. The views themselves lose their clarity. The formulated thought seems to the patient to be inaccurate, poorly reflecting the meaning of what he wanted to express. Patients annoy their failure.

Some take breaks at work, but a short rest does not improve their well-being. Others strive to overcome the difficulties encountered by an effort of will, they try to sort things out not as a whole, but in parts, but the result is either greater fatigue or dispersion in classes. Work begins to seem overwhelming and overwhelming. There is a feeling of tension, anxiety, conviction in their intellectual insolvency.

Along with increased fatigue and unproductive intellectual activity during asthenia, mental balance is always lost. Easily lost composure is accompanied by irritability, irascibility, grumbling, captiousness, arrogance. Mood hesitates easily.

A minor reason is enough to cause depression, alarming fears, and pessimistic assessments, which can also be easily, if only for a short time, replaced by unfounded optimism. And unpleasant and joyful events often lead to the appearance of tears. Constantly there is one or another degree of hyperesthesia, primarily to loud sounds and bright light. Fatigue and mental instability, manifested constantly irritability, combined with asthenia in various ratios.

Asthenia almost always accompanied by autonomic disorders. Often they may occupy a dominant position in the clinical picture. The most common disorders of the cardiovascular system: fluctuations in blood pressure, tachycardia and pulse lability, a variety of unpleasant or just pain in the heart, ease of redness or blanching of the skin, feeling hot at normal body temperature or, on the contrary, increased chilliness , increased sweating – then local (palms, feet, armpits), then relatively generalized. Dyspeptic disorders are common – loss of appetite, pain along the intestines, spastic constipation. Men often have a decrease in potency. In many patients it is possible to identify a variety of manifestations and localization of headaches. Often complain of a feeling of heaviness in the head.

Sleep disorders in the initial period of fatigue are manifested by the difficulty of falling asleep, superficial sleep with an abundance of anxious dreams, awakening in the middle of the night, the difficulty of the subsequent falling asleep, early awakening. After sleep, do not feel rested. There may be a lack of a sense of sleep at night, although in reality the patients are sleeping at night. With the deepening of asthenia, and especially with physical or mental stress, there is a feeling of drowsiness during the daytime, without, however, simultaneously improving nighttime sleep.

As a rule, the symptoms of asthenia are less pronounced or even (in mild cases) are completely absent in the morning and, on the contrary, are worse or appear in the afternoon, especially towards evening. One of the reliable signs of asthenia is a condition in which a relatively satisfactory state of health is observed in the morning, deterioration occurs at work and reaches its maximum in the evening.

In this regard, the patient must have a rest before doing any homework.

Symptomatology of asthenia is very diverse, which is due to several reasons. Manifestations of asthenia depend on which of the major disorders within its structure is predominant. If a hot temper, explosiveness, impatience, feeling of internal tension, inability to restrain, i.e. symptoms of irritation, they say about fatigue with hypersthenia. This is the mildest form of asthenia.

If the clinical picture is equally determined by the symptoms of irritation and fatigue, they speak of asthenia with irritable weakness syndrome. In cases where fatigue and a feeling of powerlessness dominate in the picture, asthenia is defined as hyposthenic, the most severe asthenia. An increase in the depth of asthenic disorders leads to a successive change in more severe hypersthenic asthenia with more severe stages. With the improvement of the mental state, hypostenic asthenia is replaced by lighter forms of asthenia.

The clinical picture of fatigue is determined not only by the depth of the existing disorders, but also by two important factors, such as the constitutional characteristics of the patient and the etiological factor. Very often both of these factors are closely intertwined. You can see the opposite effect: the developed asthenia constantly strengthens many characterologic features characteristic of the patient. This is especially characteristic of those patients in whose nature, in an explicit or latent form, there is a tendency to asthenic response – the “asthenic sting”.

Diagnosis of Asthenic Disorder (Asthenia)

A doctor of any specialty should be able to recognize the disorders described. To assess their level, it is necessary to objectively assess the patient’s condition, analyze his complaints (compliance / discrepancy between subjective and objective symptoms of the disease), identify the features of his night sleep, adherence to the prescribed therapy, his behavior during the examination, the history of the patient’s understanding of various life situations, including in cases of somatic illness.

Treatment of Asthenic Disorder (Asthenia)

In the treatment of asthenic conditions today used a variety of approaches. Schematically, the recommendations of experts are as follows. Since asthenia is associated with the consumption of mental or vital forces, and therefore biogenic amines, a person is recommended to rest, switch to another form of activity, change the situation in order to enable the brain to accumulate new stocks of these substances. For obvious reasons, these recommendations are not always feasible.

This is followed by drug therapy, which includes the appointment of certain groups of drugs. Among those that have been traditionally used for a long time are various nootropic or so-called neurometabolic agents. This therapeutic approach has its own characteristics. On the one hand, this therapy is accessible and safe from the point of view of side effects, on the other hand, its clinical efficacy essentially remains unproved due to the absence of large placebo-controlled studies that would show the effectiveness of therapy with nootropics of asthenic conditions. Therefore, this class of drugs in all countries of the world is used with different intensity. For example, nootropics are rarely used in the United States of America, in Western Europe, more generally in Eastern Europe, in the CIS countries, including Ukraine.

Antidepressants, serotonin reuptake inhibitors, are used in the structure of depression to treat asthenic symptom complex. In vital and asthenic conditions of endogenous-procedural genesis, stimulating neuroleptics, for example, modern atypical antipsychotics. In psychiatric practice, psychostimulants are used. In the USA, psychostimulants from the amphetamine group, which are regarded as drugs in Ukraine according to the regulatory framework, are widespread. Antidepressants, dopamine reuptake inhibitors, which, along with thymo-aleptic, have a distinct psychostimulating effect, have a certain practical value. In the presence of cognitive impairment, due to cerebral atherosclerosis and other pathological processes that lead to disruption of human cognitive functions, drugs belonging to the group of NMDA receptors are tested.

These drugs for their use require special knowledge in the field of clinical psychiatry. Their use in general medical practice is limited.

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