The close relationship of neurogenic NCD with street neurosis with constitutional inferiority of the central systems of vascular regulation makes it possible to put rational psychotherapy in the first place in the treatment of NCD. The goal of psychotherapeutic influence is to create in the patient the correct idea of \u200b\u200bhis illness, which does not threaten his life, as reported by the Internet publication for girls and women from 14 to 35 years old Pannochka. net The patient should learn well that if the general hygienic regime is observed, the correct rhythm of life, adequate professional orientation, exclusion of provoking factors, minimizing psycho-traumatic situations, constant recreational activities, including systematic exercise therapy, the risk of decompensation can be reduced to zero.

In the presence of foci of chronic infection or somatic disease, all measures should be taken to cure them.. The frequency and duration of drug treatment courses are determined by the course and severity of NCD.

The basis of drug treatment are tranquilizers and antidepressants, which are prescribed taking into account their sedative or psychotonic effect, depending on neurotic manifestations [Avrutskiy G. , Neduva A. , 1981]. With pronounced emotional lability, anxiety and fear in patients with NCD decompensation, it is preferable to start treatment with tranquilizers that eliminate vegetative-vascular disorders and at the same time do not cause lethargy, drowsiness and discoordination.

These properties are possessed by mebikar, which is prescribed orally 0.3 g 2-3 times a day [if necessary, up to 2.7 g / day]. Another " A more pronounced tranquilizing effect is exerted by drugs that can cause lethargy and drowsiness, especially at the beginning of treatment..

These are chlordiazepoxide (elenium, librium, napoton) at 10-80 mg / day by mouth, nozepam (oxazepam, tazepam) at 10-50 mg / day by mouth, diazepam (sibazone, seduxen, relanium) at 5-30 mg / day and phenazepam. With moderately severe neurotic manifestations, you can limit yourself to bromides, preparations of valerian, hawthorn, motherwort, and with hyposthenic symptoms - preparations of Eleutherococcus, zamanihi, ginseng. In all cases, normalization of sleep should be sought..

For depressive neurotic disorders, amitriptyline (tryptizol) is prescribed orally at 50-150 mg / day, azafen (pipofezin) at 25-100 mg / day.

If NCD decompensation is due to an increase in the activity of the sympathetic nervous system, then antipsychotics are effective - thioridazine (sonapax, melleril) orally at 30-75 mg / day or frenolone at 15-30 mg / day.

With persistent systemic arterial hypertension, drugs are prescribed that inhibit central sympathetic activation: clonidine (clonidine, hemiton) orally at 0.0750.15 mg / day, methyldofu (dopegit) orally at 0.2-0.75 mg / day, reserpine at 0; ?-blockers with central adrenergic blocking properties and at the same time relieving fear and tachycardia: propranolol (obzidan, anaprilin) \u200b\u200bis prescribed orally at 20-80 mg / day, oxprenolol (trazikor) at 20-80 mg / day, nadolol (corgard).

Prescribe ACE inhibitors - captopril and others, moreover, prolonged-acting drugs (for example, perindopril, lisinopril), or blockers of AT P-receptors, for example losartan (kosaar) and others are preferable.

Of the means that inhibit the conduction of sympathetic impulses in the autonomic ganglia, gangleron is most often used internally at 0.04-0.12 g / day, or intramuscularly or subcutaneously, 2 ml of a 1.5% solution 1-2 times a day. To regulate vascular tone in case of arterial hypertension, no-shpa is prescribed inside at 0.12-024 g / day, papaverine at 0.06-0.12 g / day, Lesser periwinkle preparations - cavinton at 15-30 mg / day, vincapan.

Cc-blockers have a pronounced antispasmodic property - pyrroxan orally at 0.03-0.06 g / day, dihydroergotoxin (redergin, redergam) at 4.5-9 mg / day, nicergoline (sermion) at 30-60 mg / day,.

With arterial hypotension, ergotamine is prescribed at 13 mg / day or combined drugs containing it: gynergin, gynofort, ergomar, sekabrevin, belloid 1 tablet 2-3 times a day.

In the case of a predominance of venous hypotension, venotonic drugs are indicated: xanthine derivatives - caffeine orally 0.1 g 2-3 times a day, theophylline or aminophylline orally 0.1-0.2 g 2-3 times a day or in suppositories 0. In case of insufficient effectiveness, a course of treatment of 10-20 daily intravenous injections of 10 ml of a 2.4% solution of aminophylline or 10 ml [200 mg] of trental is prescribed.

The venotonic effect is also exerted by preparations of the lesser periwinkle, horse chestnut [escusan, 10-20 drops 3 times a day] and a-agonists - ergotamine, mezaton [inside 10-25 mg 2-3 times a day, subcutaneously or intramuscularly, 0.5. To improve microcirculation and rheological properties of blood, aminophylline, trental, dipyridamole (curantil) are prescribed orally 25 mg 3 times a day.

In the case of a predominance of parasympathicotonic clinical manifestations, anticholinergics are prescribed - amizil, metamizil, cyclodol, and in mixed forms - combined drugs: bellataminal, belloid, bellaspon. Means that improve metabolic processes in the central nervous system are useful: aminalon, encephabol (pyriditol), piracetam (nootropil), vitamin therapy (Bp B6, C, PP).

In the treatment of paroxysms, they use the same means as in interictal treatment, but they are administered parenterally: for sympathoadrenal crises - sympatholytics and adrenergic blockers, for vagoinsular - anticholinergics. If the crisis unfolds in a mixed type, then the drugs are chosen with a focus on interictal manifestations, taking into account the effectiveness of certain drugs in the interictal period [WeinL. and etc. , 1981]. In the treatment of crises, psychotherapeutic effects play a well-known role..

Of other methods of treatment, acupuncture, as well as physical methods, are widely used, among which are effective electrosleep, medicinal electrophoresis, darsonvalization, coniferous, hydrogen sulfide, oxygen and radon baths, circular shower, Charcot's shower (with hyposthenic forms, as well as UFO),. Physical methods are more effective in a hospital, sanatorium or dispensary [Sosin I. , Sergieni E. , 1977].

Here are two observations in which the analysis of semiological features made it possible to choose the right drug for monotherapy..

Patient L. , 56 years old, pensioner. She worked as a chemical engineer, but there was no direct contact with harmful substances at work. " In his student years, fears first appeared, which at first were limited to the exam situation.

“I experienced fear with my whole body,” but there were no external manifestations of such states. When fear appeared, it rippled and darkened in the eyes, there was a strong aching headache. The onset of pain lasted for about 2-3 hours, after which relief came.. Fear was replaced by vague anxiety " After graduation, attacks of fear and headaches occurred mainly at work, when the patient felt that she was "

After the birth of the first child, fear and headache attacks were provoked by various everyday circumstances, more often by anxiety (usually unreasonable) for the health and well-being of family members. Despite the fact that frequent bouts of fear and headache constituted, as it were, a second life, the patient did not go to the doctors, as she was "

After retirement, these states became more frequent, and after the experiences associated with the unsuccessful marriage of their son, they became almost permanent.. A particularly " Outpatient examination revealed no pathology of internal organs.

The assumption that the attacks are due to pheochromocytoma or a vagus kidney was not confirmed during the examination.. BP remained stable even during seizures - 120/70130/80 mm Hg. st. , only sometimes during an attack there was a heartbeat.

On the advice of a doctor, she consistently took antipsychotics (sonapax), tranquilizers (seduxen), antidepressants (amitriptyline), B-blockers (obzidan), antispasmodics (papaverine, dibazol, no-shpa), but they did not stop the seizures. However, she noticed that obzidan acted better than other means, when taken "

Based on the anamnesis and complaints of the patient, taking into account the data of the neurological status, it was suggested that these paroxysmal states are realized by adrenergic mechanisms.. Treatment with redergin is proposed: 1 ml of the drug intramuscularly in the morning and 1 tablet by mouth in the afternoon and evening. Already in the first week of treatment, the attacks became less frequent, and from the second week they stopped, the intake of redergin inside continued for 3 months, the attacks did not resume. Relapse occurred after 5 months. after the end of the course in the "

The repeated course of treatment with redergin quickly interrupted the relapse, and subsequently, with decompensation, she resorted to redergin, each time with a positive effect..

Thus, in a patient with phobic neurosis, paroxysmal states consisted of two components: psychoemotional (fear) and vascular (angiospastic headache) without significant changes in systemic hemodynamics.. The drug of choice was an a-blocker, redergin, which was successfully used for monotherapy, while psychotropic drugs were ineffective..

Patient M. , 32 years old, housewife. Heredity is not burdened. In childhood, she was " During school years, especially in elementary school, she " Was released by doctors from physical education, but " Graduated from high school and college, got married. She gave birth to her first child at 27, pregnancy and childbirth are normal. During the second pregnancy, edema, bouts of lightheadedness, sometimes diffuse headache, childbirth proceeded normally.

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