What is astheno-neurotic syndrome? This is a set of vegetative, neurological and psycho-emotional manifestations that occur against the background of a violation of the body’s adaptation, doctors call astheno-neurotic syndrome (asthenoneurosis). Such a deviation is possible with any pathology, the influence of mental or physical stress. The problem is identified at different periods of life. It does not allow adults to adequately respond to reality, nor does it allow children to develop according to their age. Emotional instability in children inhibits the processes of proper formation of intracerebral neural connections, therefore intellectual abilities slow down and the development of new skills worsens.
The syndrome is especially often diagnosed in children who have a delicate, very vulnerable mental organization. It is difficult for them to firmly respond to failures and control their mood. Treatment of asthenoneurosis usually consists of light psychocorrection, which helps to establish social relationships and quickly overcome one’s emotions.
Pathology or fiction?
Russians usually consider children's behavioral problems to be tiredness or poor upbringing. But according to the ICD, asthenoneurosis is recognized as a disease, having a personal code of F48.0. In the same category there are other neurotic disorders that require medical attention. Therefore, you need to be prudent, feel responsible for the child and treat him in a timely manner.
Causes of astheno-neurotic syndrome
The condition is provoked by many etiological factors. Infectious or somatic pathologies cause asthenia, which for children with unstable mental health is fraught with exhaustion. The prerequisites for asthenoneurosis include too much workload of the child both at school and outside its walls. The risk of developing the syndrome increases with poor social adaptation and an unhealthy family environment. The main provocateurs of the disease are:
- disorders of intrauterine brain development due to hypoxia, bad habits of a pregnant woman;
- head injuries;
- infectious diseases, chronic kidney or liver pathologies;
- vitamin B deficiency;
- overvoltage;
- hormonal disorders;
- stress due to fear, tragic events;
- features of upbringing and temperament.
PsyAndNeuro.ru
In addition to the new mental and behavioral disorders in ICD-11 described in the previous part, we are publishing changes made to each of the major disorder groups in the ICD-11 chapter on mental, behavioral and neurodevelopmental disorders. These changes were made based on a review of the available scientific evidence by working groups and expert consultants.
The February issue of World Psychiatry Journal, which described the main changes in ICD-11, was translated by the Council of Young Scientists of the Russian Society of Psychiatrists. This part describes changes in the following groups: neurodevelopmental disorders; schizophrenia and other primary psychotic disorders; mood disorders; disorders caused by anxiety and fear, obsessive-compulsive and related disorders, as well as disorders directly related to stress.
List of diagnostic categories of the chapter on mental, behavioral and neurodevelopmental disorders in ICD-11:
- Neurodevelopmental disorders
- Schizophrenia and other primary psychotic disorders
- Catatonia
- Mood disorders
- Disorders caused by anxiety and fear
- Obsessive-compulsive and related disorders
- Disorders directly related to stress
- Dissociative disorders
- Eating and feeding disorders
- Disorders associated with the excretory system
- Disorders related to bodily self-awareness and bodily discomfort
- Substance use and addictive behavior disorders
- Impulse control disorders
- Defiant and dissocial behavior disorders
- Personality disorders
- Desire disorders
- Factitious disorders
- Neurocognitive disorders
- Mental and behavioral disorders associated with pregnancy, childbirth and the postpartum period
- Psychological and behavioral factors influencing disorders or diseases classified elsewhere
- Secondary mental or behavioral syndromes associated with disorders or diseases from other headings
Neurodevelopmental disorders
Neurodevelopmental disorders are those that are associated with significant difficulties in the acquisition and use of certain intellectual, motor, language and social functions and begin during the developmental period. The ICD-11 group of neurodevelopmental disorders includes such ICD-10 groups as mental retardation, psychological development disorders, and attention deficit hyperactivity disorder (ADHD).
Major changes to ICD-11 include the renaming of mental retardation in ICD-10, which was an outdated and stigmatizing term that did not adequately cover the range of forms and etiologies associated with the condition, as intellectual developmental disorders. Intellectual developmental disorders continue to be defined based on significant limitations in intellectual functioning and behavioral adaptability, ideally defined using standardized, appropriately normed, and individually tailored metrics. Given that different regions of the world have traditionally used different standards of measurement or trained personnel, and because of the importance of determining the severity of the condition for treatment planning, the ICD-11 CDDG provides a comprehensive set of tables with behavioral indicators.
Tables of intellectual functioning and adaptive behavior are separated. Functional areas are divided into three components: conceptual, social, practical; There are three age groups (early childhood, childhood/adolescence and adulthood) and four levels of severity (mild, moderate, severe, profound). Behavioral indicators describe those skills and abilities that are typically observed within each of these categories. Thus, it is expected that the level of confidence in severity profiles will increase and the quality of public health data regarding the burden of intellectual development disorders will improve.
Autism spectrum disorder in ICD-11 includes both childhood autism and Asperger's syndrome in ICD-10 under one category characterized by deficits in social communication and restricted, repetitive and inflexible patterns of behavior, interests or activities. Guidelines for autism spectrum disorder have been substantially updated to reflect current literature, including the life course manifestations of the disorder. The assessment criteria are designed to represent degrees of impairment in intellectual functioning and language skills and cover all aspects of autism spectrum disorder across a broad range of dimensions.
ADHD replaced hyperkinetic disorder in ICD-10 and was moved to the group of neurodevelopmental disorders due to its early onset, characteristic impairments in intellectual, motor and social functioning, and frequent co-occurrence with other neurodevelopmental disorders. This move was also intended to differentiate previously related ADHD from disruptive behavior and dissocial disorders, for the reason that in ADHD, disruptive behavior tends to be unintentional. ADHD in ICD-11 would be characterized as predominantly inattentive, predominantly hyperactive-impulsive, or mixed type and described across the lifespan.
Finally, chronic tic disorders, including Tourette's syndrome, are classified under ICD-11 as Disorders of the Nervous System and overlap with neurodevelopmental disorders due to their high comorbidity (eg, with ADHD) and typical early onset of development.
Schizophrenia and other primary psychotic disorders
In ICD-11, the group of schizophrenia and other primary psychotic disorders replaced the group of schizophrenia, schizotypal and delusional disorders from ICD-10. The term "primary" indicates that psychotic processes are the primary feature, as opposed to psychotic symptoms that may arise as an aspect of other forms of psychopathology (eg, mood disorders).
In ICD-11, the symptoms of schizophrenia remained virtually unchanged compared to ICD-10, although the importance of Schneider's first rank symptoms was reduced. The most significant change is the elimination of all subtypes of schizophrenia (paranoid, hebephrenic, catatonic, etc.) due to their lack of predictive validity or benefit in treatment selection. Instead of subtypes, dimensions were introduced. These include: positive symptoms (delusions, hallucinations, disorganized thinking and behavior, phenomena of mental automatism); negative symptoms (dull or flattened affect, alalia or impoverished speech, abulia, anhedonia); symptoms of depressive mood; symptoms of manic mood; psychomotor symptoms (psychomotor agitation, psychomotor retardation, catatonic symptoms); cognitive symptoms (particularly deficits in processing speed, attention/concentration, orientation, judgment, abstraction, verbal or visual learning, and working memory). These same symptom scales can be applied to other disorders in the group (schizoaffective disorder, acute and transient psychotic disorder, delusional disorder).
The ICD-11 diagnosis of schizoaffective disorder still requires that criteria for schizophrenia and a mood disorder episode be present simultaneously. This diagnosis is intended to qualify the current episode of a disease state and is not considered to be stable over time.
In ICD-11, acute and transient psychotic disorder is characterized by the sudden onset of positive psychotic symptoms that rapidly change in appearance and intensity over a short period of time and persist for no more than three months. This corresponds only to the ICD-10 "polymorphic" form of acute psychotic disorder, which is the most common form, and does not indicate schizophrenia. Non-polymorphic subtypes of acute psychotic disorder (ICD-10) have been excluded and will instead be classified in ICD-11 as “other primary psychotic disorders.” As in ICD-10, schizotypal disorder is classified in this group and is not considered a personality disorder.
Mood disorders
Unlike ICD-10, in ICD-11 episodes are not regarded as independent conditions, but as a basis for making a diagnosis that best matches the clinical picture. Mood disorders are divided into depressive disorders (which include single depressive disorders, recurrent depressive disorder, dysthymic disorder, and mixed depressive-anxiety disorder) and bipolar disorders (which include bipolar I disorder, bipolar II disorder, and cyclothymia). ICD-11 divides bipolar disorder into type I and type II disorders. A separate ICD-10 mood disorder subgroup group consisting of persistent mood disorders (dysthymia and cyclothymia) was removed.
The diagnostic guidelines for a depressive episode are one of the few places in ICD-11 where a minimum number of symptoms is required. This is due to many years of research and clinical tradition of conceptualizing depression in this way. A minimum of five of ten symptoms is required, rather than four of the nine possible symptoms listed in ICD-10, increasing consistency with DSM-5. To help clinicians conceptualize and recall the full spectrum of depressive symptomatology, the ICD-11 CDDG organizes depressive symptoms into three clusters—affective, cognitive, and neurovegetative. Fatigue is part of the neurovegetative cluster of symptoms, but is no longer considered an independent initial-level symptom; more precisely, for diagnosis, a daily low mood or decreased interest in activities must be observed for at least the last two weeks. Hopelessness was added as an additional cognitive symptom due to strong evidence of its predictive value in the diagnosis of depressive disorders. The ICD-11 CDDG provides clear guidance on differentiating culturally normative grief reactions and symptoms that require consideration when diagnosing a depressive episode in the context of bereavement.
To diagnose manic episodes, ICD-11 requires the presence of level 1 symptoms (increased activity, subjective feeling of energy) in addition to euphoria, irritability, or incontinence. This was done to prevent false positive diagnosis cases that correspond to normative mood swings. ICD-11 defines hypomanic episodes as a weakened form of a manic episode without significant loss of functionality. The description of mixed episodes in ICD-11 coincides with ICD-10, because there is evidence of the validity of this approach. The guide contains indications of typical bipolar symptoms when manic or depressive symptoms predominate. The presence of a mixed episode indicates a diagnosis of bipolar disorder, type I.
ICD-11 provides various tools to qualify a current episode of mood disorder or remission (partial or complete). Depressive, manic, and mixed episodes may occur with or without psychotic symptoms. Current depressive episodes in the context of depressive or bipolar disorders can be further characterized by severity (mild, moderate, or severe); melancholic symptoms correspond to somatic manifestations from ICD-10, and a persistent episode (protracted episode) must last more than two years. All mood episodes in the context of depressive or bipolar disorders may be complemented by the use of anxiety symptoms, the presence of panic attacks, and the presence of seasonality. It is also possible to qualify bipolar disorder with rapid cycling.
ICD-11 includes a category of mixed depressive and anxiety disorders due to their importance in primary care settings. Given evidence of shared symptomatology with mood disorders, this ICD-11 diagnosis was moved from the ICD-10 anxiety disorders category to depressive disorders.
Disorders caused by anxiety and fear
ICD-11 groups disorders with anxiety or fear as the main clinical feature in this new group. Consistent with the ICD-11 life course approach, this group includes separation anxiety disorder and selective mutism, both of which were classified as childhood disorders in ICD-10. In ICD-11, the distinction between phobic anxiety disorders and other anxiety disorders that existed in ICD-10 was eliminated in favor of a more clinically useful method of characterizing each anxiety and fear-related disorder according to its perceptual focus, that is, the description of the stimulus that evokes anxiety, excessive physiological reaction or maladaptive behavior.
Generalized anxiety disorder (GAD) is characterized by a general apprehension or worry that is not limited to any specific stimulus. In ICD-11, GAD has a more elaborate set of diagnostic criteria, reflecting advances in understanding its unique phenomenology. In particular, anxiety is added to the general perception as a basic symptom of the disorder. Unlike ICD-10, the ICD-11 CDDG indicates that GAD may co-occur with depressive disorders as long as symptoms are present regardless of mood episodes. Similarly, other hierarchical exclusion rules that were in ICD-10 (GAD cannot be diagnosed with anxiety-phobic disorder or obsessive-compulsive disorder) are also excluded due to better delineation of the phenomenology of the disorder in ICD-11 and evidence that these rules could interfere with the detection and treatment of conditions that require separate, specific clinical attention.
Agoraphobia is defined in ICD-11 as severe and excessive fear or anxiety that occurs in anticipation of, or in the immediate experience of, a situation where help is difficult or unavailable. The difference from ICD-10 is that it was previously described more narrowly as a fear of open spaces and associated situations, such as crowds of people, and may have difficulty leaving the area quickly; now the basis is fear for negative consequences that could lead to negative consequences or be cast in an unsightly light.
Panic disorder is defined in ICD-11 as recurrent, unexpected panic attacks that are not limited to specific stimuli or situations. The ICD-11 CDDG indicates that panic attacks that occur only in response to a specific stimulus or in anticipation of a feared stimulus (eg, public speaking in social anxiety disorder) do not require an additional diagnosis of panic disorder.
Rather, in such cases, the classification “with panic attacks” may be added to the diagnosis of anxiety disorder. The categorization “with panic attacks” may also be applied to other disorders where anxiety may be a prominent but not a defining symptom, such as in some patients with a depressive episode.
Social anxiety disorder in ICD-11 is based on the fear of negative evaluation from others and replaces the ICD-10 diagnosis of “social phobia.” The ICD-11 CDDG specifically describes separation anxiety disorder in adults, which most often occurs in association with a romantic partner or child.
Obsessive-compulsive and related disorders (OCRD)
The introduction of OCRD into ICD-11 represents a significant change from ICD-10. The rationale for creating the OCRD group, as distinct from the anxiety-phobic disorder group, despite phenomenological overlap, was the clinical benefit of grouping the symptoms of recurrent unwanted thoughts and associated repetitive behaviors as a core clinical feature. The diagnostic consistency of this grouping is based on emerging evidence of common validators among the included disorders from neuroimaging, genetic, and neurochemical studies.
ICD-11 OCRD includes obsessive-compulsive disorder, dysmorphia, olfactory disorder, hypochondria (obsessive fear of illness) and pathological hoarding. Equivalent disorders in ICD-10 were located in different groups. OCRD also includes a subgroup of body-focused repetitive behavior disorders that include trichotillomania (hair pulling disorder) and excoriation disorder (skin picking/picking disorder), both of which share the common feature of repetitive behavior patterns without the cognitive aspect of other OCRDs. Tourette's syndrome, in ICD-11, is a disease of the nervous system, but is also included in the OCRD group due to its frequent combination with obsessive-compulsive disorder.
ICD-11 retains the core features of obsessive-compulsive disorder from ICD-10 (persistent obsessions and/or actions), but with some important changes. ICD-11 expands the concept of obsessions beyond obsessive thoughts to include unwanted images and urges/impulses. Moreover, the concept of coercion expands to include, but is not limited to, covert (e.g., counting) as well as overt, repetitive behavior.
Although anxiety is the most common affective experience associated with obsessions, ICD-11 explicitly mentions other phenomena reported by patients, such as disgust, shame, a feeling of “incompleteness,” or anxiety when things don’t look or feel “right.” . OCD subtypes that existed in ICD-10 were removed because most patients reported both obsessions and compulsions and because they had no impact on treatment prognosis. The impossibility of simultaneous diagnosis of OCD and depressive disorder, which existed in ICD-10, was abolished in ICD-11, because this reflects the high incidence of co-occurrence of both disorders, which require different treatments.
Hypochondriasis (obsessive fear of illness), due to its common phenomenology and patterns of common origin, is located in OCRD rather than among the group of anxiety and fear-related disorders, even though health concerns are often associated with anxiety and fear. However, hypochondriasis (obsessive fear of illness) is also listed under the group of anxiety and fear-related disorders, suggesting some phenomenological overlap. Dysmorphic disorder, olfactory disorder and hoarding are new categories that have been included in the ICD-11 group OCRD.
The cognitive component in OCRDs (beliefs) may be expressed with such intensity or persistence that they appear delusional. When these fixed beliefs are fully consistent with the phenomenology of OCRD and there are no other psychotic symptoms, the classification “with weak or absent insight” should be used and a diagnosis of delusional disorder should not be made. This approach is designed to help prevent people with OCRD from being treated for psychosis when they do not need it.
Disorders directly related to stress
The group of disorders specifically related to stress in ICD-11 replaces the ICD-10 group "Reactions to severe stress and adjustment disorders" to emphasize that stress is a necessary but not sufficient component in the etiology of these disorders, and also to distinguish between those included in this group. a group of disorders from various other mental disorders that occur in response to stressors (eg, depressive disorders). In accordance with the ICD-11 approach to considering disorders over the life span, ICD-10 diagnoses such as reactive attachment disorder and disinhibited attachment disorder of childhood are included in this group because these disorder disorders are directly related to attachment stress. ICD-11 includes several important conceptual updates to ICD-10—the introduction of complex PTSD and protracted grief disorder, which have no counterparts in ICD-10.
PTSD is defined by three features that must be present in all cases and must cause significant impairment. These include: re-experiencing the traumatic event in the present (flashbacks), deliberate avoidance of reminders that may trigger the re-experiencing, and a persistent sense of heightened threat in the present. Including a requirement to re-experience cognitive, affective, or physiological aspects of the trauma, rather than simply remembering the event, is expected to address the low diagnostic threshold for PTSD that existed in ICD-10.
Adjustment disorder in ICD-11 is diagnosed if there is an underlying “preoccupation” with a negative life event or its consequences, while in ICD-10 the disorder was diagnosed if symptoms arising in response to a life stressor did not meet certain requirements of another disorders.
Finally, in ICD-11, acute stress reaction is no longer considered a mental disorder, but is understood as a normal reaction to an extreme stressor. And now it is classified in the chapter “Factors influencing or related to health” and is not duplicated in the group of disorders directly related to stress. This is done to facilitate differential diagnosis.
Translation into Russian was organized by the Council of Young Scientists of the Russian Society of Psychiatrists with the support of the World Psychiatric Association.
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Translation: Pikirenya V.I. (Minsk)
Editor: Ph.D. Reznikov M.K. (Voronezh)
Source: Reed GM, First MB, Kogan CS, et al. Innovations and changes in the ICD-11 classification of mental, behavioral and neurodevelopmental disorders. World Psychiatry
. 2019;18(1):3–19. doi:10.1002/wps.20611
Symptoms of ANS
Characteristic manifestations of asthenoneurosis are rapid fatigue and chronic fatigue. Children have difficulty shifting their attention, their thinking is inhibited, and their memory is weak. Schoolchildren are unable to concentrate in class, they are fussy, and motor reflexes are noticeable. Teachers usually recognize the initial phases of the syndrome as bad manners, so they complain to parents, but they are in no hurry to visit the clinic.
The next typical category of symptoms is psycho-emotional disorders. The child is subject to sudden mood swings for no apparent reason; he experiences nervousness and increased irritability. Usually there is a pathologically bad mood, which gradually develops into depression. Teenagers react too emotionally to even quite minor events. Typical symptoms of the disease are:
- moodiness;
- enuresis;
- frequent headaches;
- mood swings;
- weak immunity, prone to colds;
- irritability, manifestations of anger, aggression;
- increased sweating;
- loss of appetite;
- low academic performance;
- nausea in transport;
- poor social adaptation.
Asthenoneurosis is manifested by touchiness, the presence of phobias, aggression, and the search for physical ailments. Children feel broken and sick, although in reality there is nothing like that.
Types according to ICD10
The international classification defines two main options for the development of pathology:
- Hyperdynamic. With this nature of the disease, increased excitability, absent-mindedness, disinhibition, and loss of attention are manifested. Also obvious signs are emotional instability and insomnia.
- Hypodynamic. Provokes reduced activity, bad mood, excessive calmness. The child exists inside his own world; he reacts weakly to the changing reality. There may be problems with speech development, inadequate perception of smells and extraneous sounds.
Treatment of astheno-neurotic syndrome
The need to visit a neurologist arises in situations where the child is too irritable and capricious, his school grades have deteriorated, or nervous breakdowns occur in which he raises his voice at adults. All such signs can indicate not character problems, but nervous disorders. Attempts to independently pacify a teenager by shouting (or punishing) only aggravate the problem.
The first step is to visit a pediatric neurologist. An experienced specialist will quickly find out what is really happening: is it asthenoneurosis or is the child simply manipulating his parents due to hormonal changes in his body. Most often, a child’s nervous system can be easily corrected with corrective and developmental exercises, after which everything is restored, returning to normal. Good treatment results are provided by:
- consultations with a psychologist, changing the style of everyday life;
- sand therapy;
- sensory integration.
When astheno-neurotic syndrome is provoked by organic damage to the central nervous system and brain, correction must be supplemented with rehabilitation measures.
In such a situation, doctors prescribe the following procedures:
- TANK;
- Audiotherapy according to the A. Tomatis method;
- TCM;
- Biofeedback trainings.
Symptoms of asthenoneurosis do not seriously threaten children's health, but prolonged asthenia significantly worsens the quality of life and delays intellectual and physical development. Treating the problem is a complex task; it requires the involvement of a professional team, a combination of various healing methods.
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Cranialgia is an impulsive, sudden acute headache, which in the form of alternating attacks manifests itself suddenly, without the influence of a provoking event. Such headaches are not an independent independent disease, but act as symptomatic pathologies. These pains are born when there is a violation or possibly organic damage to the structure of part of the peripheral nerves, caused either by injuries or by inflammatory processes developing to varying degrees of activity. With the sudden appearance of such systematic, sometimes even shooting pains in the head area, it is important to quickly identify the basis (the reason for their appearance) in order to prevent possible complete destruction of the nerve endings as soon as possible and immediately exclude the development of complications. What is a disease like cranialgia? This term is commonly used to describe headaches; the true cause of these pains is the pathology of the vertebrae of the spine (cervical spine). Here we are talking not only about a disease such as osteochondrosis, but also sometimes the cause of such vertebrogenic cranialgia is either a spinal column injury, a tumor or a possible autoimmune lesion.
But the pathology in the human spine is precisely the root cause that causes cranialgia syndrome, and this is how such a headache manifests itself. We have to emphatically state that there is no comprehensive answer. Cranialgia can also be a consequence of metabolic and blood flow disorders in the human vertebral artery, and the cause of this syndrome can be a pathological increase in intracranial pressure and possibly even compression (squeezing, pinching) of the human spinal nerves. And the treatment of such conditions requires an explicit differentiated approach. Headaches from cranialgia are localized just in the lower part of the back of the skull (it is “cranio” from Latin that can be translated as “skull”), they are often accompanied by varying degrees of compression of the nerve roots. The word "Cervico" is a prefix indicating the neck, and the word "vertebro" is anything that can be associated with the spine. Thus, the phrase vertebrogenic cervicocraniaglia is a headache that was caused by pain or other unpleasant sensations in the cervical region of the spinal column, but they were caused by diseases and possibly even pathologies of the spine.
Vague headaches in the cranium occur due to disturbances in the movement of nerve impulses along the fiber, and there may also be insufficient blood supply to different parts of the brain, and this is a possible cause of increased intracranial pressure as well as active pain syndrome. Therapy for headaches of this etiology cannot take place without a unique approach; popular analgesics usually do not provide patients with any relief.
In some cases, cranialgia covers not only the occipital part of the skull or the temples, parietal region or frontal region, but sometimes it manifests itself only unilaterally. The nature of headaches is also different: it can be bursting, enveloping, pressing, chronic, intensified, sharp, paroxysmal, spasmodic, even burning pain. Dizziness, vomiting, disorientation, limited mobility of the cervical vertebrae, changes in negative hearing functions and possibly vision, muscle weakness or numbness of the extremities often occur. Increased pain and accompanying symptoms occur with increased physical activity, extremely sudden movement of the limbs, hypothermia, as well as prolonged exposure to a forced position.