HYSTERIA (hysteria; grech, hystera a uterus) — the kind of psychogenias arising in connection with the psychoinjuring situation at persons with a special warehouse of character (hysterical character) and at people healthy earlier in the severe psychoinjuring conditions. Appears at young age more often, it is preferential at women though also men get sick. It is expressed in numerous functional frustration with very polymorphic symptomatology resembling the most various diseases superficially what received the name «chameleon which incessantly changes the colours» (T. Sydenham) for, «great simulator» (. Sharko), «Illiad of all diseases» etc. Feature suffering And. — aspiration to draw with any way to themselves attention of people around also very big suggestibility and autosuggestibility.
A clinical picture
it is conditional (since transitions of one frustration to others or existence of the mixed forms are frequent) all extremely various symptomatology And. it is possible to subdivide into motive, touch, vegetative and mental disorders.
Motive frustration are expressed as hysterics, various paralyzes, paresis, muscular contractures, hyperkinesias, the phenomena astasias abasias (see), various disturbances of gait, stutter. The hysterics arises, as a rule, at someone's presence, is shown by falling, usually harmless, most often in the form of slow lowering, after the Crimea, according to E. Krechmer, «the whole fire of all, in general only imaginable expressive and reflex movements, one after another breaks out». Patients shiver, ride on a floor, beat with hands and legs, are bent by an arch, leaning against a floor a nape and heels («a hysterical arch»), growl, cry out, groan, cry out some phrases, quotes, sing, mutter something, bite to themselves hands, scratch a face and a body, tear clothes, pull out hair, break hands, accept so-called passionate poses with the corresponding characteristic mimicry and face reddening (it is very rare with a posineniye or blanching). The hysterics lasts of several minutes till several o'clock (at the sympathetic relation of people around), can be interrupted with external influence (a loud sound, sharp team, douche by a cold water and so forth), quite often turns into crying, a condition of weakness, fatigue, powerlessness, is more rare in a dream. About the period of a hysterics partial, sketchy memoirs remain. Hysterical paralyzes (as well as paresis) arise in the form of monoplegias (monopareses), paraplegiya (parapareses), tetraplegias (tetraparesis) etc. At the same time the zone of paralysis (paresis) can be limited to the size of a finger, a brush, foot, a hand or leg etc. Paralysis of phonatory bands is the cornerstone of a hysterical aphonia. There can be a hysterical glossolabialny hemispasm (Brisso's symptom — Mari). Hysterical contractures concern as separate groups of muscles (e.g., a hysterical nictitating spasm, a hysterical wryneck), and the whole complex in view of what suffering And. can «stiffen» for a long time in the most elaborate pose. Hysterical hyperkinesias (see) are most often shown in the form of tikopodobny and trembling movements as separate parts of a body (a chin, a century, hands, legs, the head), and all body.
Touch frustration can come to light decrease in sensitivity or full anesthesia on tactile, temperature or painful irritants, or hyperesthesias on the same reagents. Sites of anesthesia or a hyperesthesia at the same time can also not correspond to certain zones of an innervation at all: to be in the form of so-called jackets, semi-jackets, pants, semi-pants, stockings, socks, gloves etc. The phenomena of a hysterical blindness, deafness, loss of sense of smell, taste, lack of a gag reflex are frequent. Hysterical pains are various both on localization, and on duration and intensity: headaches, joint pains (arthralgia), in language (glossodynia), in a bladder (cystalgia), in nails (onychalgia), in a stomach (gastralgia) etc.
Vegetative and visceral frustration at And. are the most frequent and diverse. In connection with a spasm of smooth muscles there can be a feeling of compression of a throat (a hysterical lump), the feeling of shortage of air reminding bronchial asthma, feeling of impassability of a gullet (dysphagy), a delay of an urination, locks. Are possible hysterical anorexia (see), sometimes with disgust for a certain type of food, a hiccups, vomiting, disturbance of salivation, swelling of intestines, a diarrhea, nausea, vomiting both sporadic, and very frequent, almost constant, similar to pernicious vomiting of pregnant women. The paresis of intestines, frustration reminding intestinal impassability, clinic hron, appendicitis are possible. Various disturbances from cardiovascular system are frequent: lability of pulse, fluctuation of the ABP, the pain in heart sometimes simulating stenocardia or a myocardial infarction. Hysterical faints differ from true faints (see) the smaller depth of stupefaction, smaller weakening of breath and blood circulation, absence, as a rule, sharp blanching of the person. Disturbances of thermal control in the form of low, irregular rises in temperature are possible. From sexual frustration various disturbances of a menstrual cycle (an amenorrhea, a dysmenorrhea, menorrhagias) are most characteristic and vaginismus (see). False hysterical pregnancy is imitated by the sum of such symptoms as an amenorrhea, increase at the expense of a meteorism of the sizes of a stomach, increase in mammary glands, nausea, vomiting etc. Occasionally there are so-called vicarious bleedings when owing to local changes of permeability of vessels there is bleeding from the unimpaired sites of skin. Regarding cases similar changes of permeability of vessels cause also a so-called hysterical dermatosis when by auto-suggestion patients can cause local skin disturbances in the form of sites of reddening, hemorrhages, bubbles etc. (the various damages of skin which are artificially caused with the purpose to draw attention to themselves with possible subsequent amnesia of own actions also belong to a hysterical dermatosis).
Mental disorders can be expressed by separate symptoms of any mental diseases of which patients have at least some idea. Psychogenic are more typical amnesia (see), total or partial, concerning most often the psychoinjuring event. The fixed fears and hysterical depressions are, as a rule, superficial and are followed by bright external design in the form of theatrical poses, groans, pathetic statements etc. Hysterical hallucinations (see) — bright, figurative, colourful, most often reflecting a psychogenic situation in the look desirable to patients, have short-term incidental character, occasionally stsenopodobny. Bredopodobny are possible imaginations (see). Hysterical twilight stupefactions (see) minutes, hours, days last. Consciousness at the same time is narrowed, the surrounding situation in complete manifold does not reach patients, they are entirely engaged with the painful experiences (testing at the same time bright, colourful hallucinations and finding bredopodobny imaginations) reflecting in direct or (more often) in light, favorable for them, the endured or endured psychoinjuring situation. Hysterical twilight states can be also expressed in a look noctambulation (see), hysterical fugues, trances, dromomanias (see. Impulsive inclinations ). In the period of, as a rule, not resolved psychogenic situation can find a syndrome in patients puerilism (see), pseudodementias (see. Pseudo-dementive syndrome ), Ganzer's syndrome (see. Ganzera syndrome ). Emergence of the stupor (usually with an expressive pose) which is combined with a mutism is possible (see. Catatonic syndrome ). The hysterical mutism can arise and separately, in the form of independent frustration.
Patofiziol, theory of a pathogeny And. it was created by I. P. Pavlov and his school and develops thanks to further researches in the field of physiology and a pathophysiology of century of N of I. P. Pavlov specified that the hysteric is a product of weak general type in connection with art, and allowed possibility And. at extraordinary blows of life and people with strong type have a century of N of. In general symptomatology And. from it «a conditional gratefulness or desirability» I. P. Pavlov explained with a characteristic prevalence of subcrustal activity over cortical and the first alarm system over the second: «... the hysterical subject lives to a greater or lesser extent not rational, but emotional life, is controlled not cortical activity, but subcrustal». Further studying of function of subcrustal educations in combination with studying of neurohumoral, neuroendocrinal and other relationship showed that at characteristic for And. decrease in level of functional lability of cortical neurons there is a change of a functional condition of trunk, mesodiencephalic and limbikoretikulyarny formations of a brain and numerous symptomatology And. finally is caused by disorder of limbiko-retikulo-visceral regulation.
Diagnosis put on the basis of characteristic a wedge, pictures. The differential diagnosis it is necessary to carry out hl. obr. with schizophrenia (see) and organic diseases of c. N of page, first of all traumatic genesis when emergence of hysteriform symptomatology is possible. Main difference And. — obligatory communication with the psychoinjuring situation, «a conditional gratefulness and a zhelayemost» of its symptomatology, an opportunity at least its short-term elimination by suggestion, discrepancy of defeats to zones of an innervation, to the general somatic or mental condition of patients, existence at them such lines as suggestibility and autosuggestibility. Hysterical differs from an epileptic seizure in smaller sharpness of falling, a possibility of its interruption, preservation of instinctive reflexes (in particular, pupillary), absence of full amnesia after its termination. Distinctions between And. and a hysterical psychopathy the same, as between psychogenias (see. Reactive psychoses ) and psychopathies (see) in general.
Therapy And. shall be complex and consist from: 1) fortifying treatment — balneoterapiya (see), correct day regimen, physiotherapy exercises (see), electrosleep (see), glucose with vitamins etc.; 2) purposes of various calming medicamentous drugs, hl. obr. tranquilizers (see) or small doses neuroleptics (see), and according to indications — hypnotic drugs; 3) active psychotherapy (see) — individual and collective; various options of suggestion and auto-suggestion, including an autogenic training, and also a narcopsychotherapy are shown, in particular. Hysterical ii an attack can be stopped by means of an injection of aminazine, in some cases the sudden irritant — a prick, washing by a cold water etc. helps.
Forecast in general favorable, especially at timely and correct treatment.
Prevention consists in timely holding first of all psychogienic actions, in prevention or whenever possible elimination (after detection of their character) the psychoinjuring influences.
Bibliography: Morozov G. V. Struporous states, M., 1968; Pavlov I. P. Complete works, t. 3, book 2, M. — L., 1951; With in I d about shch A. M. Neurosises and their treatment, M., 1971; With e 1 a n i D. An international approach to hysteria, Amer. J. Psychiat., v. 133, p. 1414, 1976: K a-minsky M. J. a. Slavney P. R. Methodology and personality in Briquet’s syndrome, ibid., p. 85; Lader M. The psychophysiology of hysterics, J. psy-chosom. Res., v. 17, p. 265, 1973; M a y o u R. The social setting of hysteria, Brit. J. Psychiat., v. 127, p. 466, 1975; S with h n e i-d e r P. An sujet de 1’hysterie, Rev. m^d. Suisse rom., t. 86, p. 232, 1966; S t e f a-nis G. Markidis M. Observation on the evolution of the hysterical symptomatology, Brit. J. Psychiat., v. 128, p. 269, 1976; V e r b e e k E. Hysteria, Psychiat. Clin. (Basel), v. 6, p. 104, 1973.
M of B. Korkina.