State of prostration

Many terms that are actively used in psychology remain incomprehensible to ordinary people who are not related to medicine and psychotherapy. For example, most of us have heard of such a concept as "prostration", however - what does it mean? In fact, prostration is called a specific detached state of a person, when all interest in everything and in everyone, including himself, is lost. Such indifference can be short-term or long-term and arises against the background of a feeling of complete exhaustion - both physically and mentally. Next, we will consider whether prostration is a pathology and whether its treatment is required.

Epidemiology

The detection rate of prostration in general medical practice ranges from 15 to 55%. However, information about the statistics of this state is unclear and is not specially kept. For the practicing physician, it is much more important to determine the underlying cause of the pathology and prescribe appropriate treatment aimed at raising the general tone of the body.

People who are predominantly educated, physically and mentally active, and prosperous are prone to prostration. The most typical age range for patients is between 20 and 45 years. Among persons suffering from prostration, there are often teachers, doctors, office workers. A special risk group includes people whose professional activities are associated with high responsibility (for example, drivers, pilots, dispatchers, etc.), as well as those who work with moving machinery, apparatus, machine tools. [1]

Causes prostration

When it comes to prostration, most often they mean a state of physical and moral decline in the body, general exhaustion, loss, oppression and loss of interest in anything. The patient is able to stay in this state from several seconds to several months. Motor activity sharply decreases, reactions, speech slow down, thinking ability is inhibited. When a person plunges into a state of prostration, everything becomes indifferent to him, he ceases to emotionally react, rejoice, worry, etc. As a rule, a person looks with an “empty” gaze at one point, being in a kind of numbness. 

The pathological condition of prostration develops in such cases:

• With any moderate or severe pathology, including infectious diseases, prostration can be caused by increased body fatigue, its weakening, for example:
  • at the stage of the prodromal period (against the background of weakness, weakness, increased fatigue);
  • at the peak of the febrile period (the so-called "asthenic prostration");
  • at the stage of recovery (again, against the background of increased fatigue).
• In chronic physical, mental or combined fatigue, the development of prostration is explained by objective factors. This may be due to stresses, neuroses, peculiarities of a person's mental perception of various situations, making excessive demands on himself, overestimating his capabilities. In many cases, a person creates for himself such conditions under which he is "driven" into a state of chronic exhaustion.

The main reasons for the appearance of prostration are stressful situations, prolonged excitement of the nervous system, chronic lack of sleep, and regular overwork. Other factors include the transferred pathologies - for example, viral or bacterial infections, severe intoxication. The unfavorable environment also has a certain influence.

Risk factors

Risk factors for developing a state of prostration include:

• female;
• hereditary predisposition;
• individual personal characteristics and behavioral features;
• biological and socio-psychological stressors.

Anamnesis preceding the pathological one indicates the presence of a large number of stressful life situations, infectious and inflammatory pathologies and surgical operations. An important factor is moral childhood trauma, such as cruel treatment of a child, elements of violence, ignorance, and other wrong family relationships. In addition, the development of prostration is often associated with anxiety and depression, and post-traumatic stress disorder. The recurrence of prostration is often associated with acute stress or conflict situations.

Stress at an early stage in life constantly affects the brain regions responsible for cognitive-emotional processes, regulation of the endocrine, immune and autonomic systems. It has been proven clinical and research information that psychological traumas suffered in childhood provoke a prolonged failure of the function of the hypothalamus, pituitary and adrenal glands, and also cause an overly vivid reaction to stressful situations. However, such childhood trauma is not always indicated in the history of patients with prostration. It is quite possible that such a mechanism is capable of manifesting itself in a pathogenetic reaction only in a certain part of people.

Anxiety and depression accompanying prostration often aggravate the pathology. Therefore, it is very important to identify them and eliminate (treat) them.

Pathogenesis

The pathogenetic mechanism of the appearance of prostration is associated with psychological, immune and systemic factors, as well as with the peculiarities of neurophysiology and neuroanatomy of the human brain. Additionally, the degree of physical and mental activity affects.

The neurotrophic factor BDNF is of no small importance in pathogenesis: a decrease in its level in the hippocampus is often associated with the development of prostration. An increase in the expression of this factor may be observed, which is a reaction to an overload of the body. Spectral analysis of the electroencephalogram during motor tests in patients with prostration revealed changes in signals from the central nervous system that control the volition of muscle activity - and, in particular, such that causes a feeling of fatigue.

Etiological factors in the development of prostration include:

• psychological and social;
• immune-infectious;
• neurohormonal;
• exchange factors.

Exhaustion of the body becomes an incentive to stop activity, any kind of activity, any effort, etc. If we analyze this situation from a biological point of view, then prostration can be considered as a trigger for the mechanism of energy conservation by stopping both physical and mental activity. Withdrawal from activity leads to a decrease in energy requirements. Thus, prostration can be a kind of reaction to a state in which a critical depletion of energy resources is possible. The human body is a self-regulating system, therefore, even the initial development of a threatening condition can lead to a decrease in overall activity.

The mechanism of formation at the cerebral level is associated with the functionality of the limbic-reticular complex, which regulates adaptation processes in response to any type of stress. Prostration can be viewed as a universal protective or compensatory adaptation reaction: it works both in objective disorders and in case of a supposed or contrived threat (psychogenic prostration).

In addition to psychosocial factors, the influence of immune-infectious factors (post-infection syndrome, chronic fatigue syndrome, immune dysfunction, etc.) is allowed.

In childhood, a disorder often occurs in response to prolonged and difficult ARIs that can cause a failure in physical and neuropsychic development, lead to a decrease in the performance of the immune system and a disorder on the part of the compensatory-adaptive mechanism in the body. The duration of the period when the child is in prostration is inextricably linked with the negative emotional state (depression, fear, depression, etc.).

Symptoms prostration

The state of prostration can grow gradually, so at first it can be difficult to determine. And yet, the body gives in advance a kind of signals that should be paid attention to. The entire clinical picture of prostration can be conditionally divided into several categories, in accordance with symptomatic groups, which include physical and mental exhaustion, detachment, indifference, etc. Symptoms gradually worsen, so early detection of the problem allows you to solve the problem easier and faster.

The main signs of prostration can be:

• sudden fatigue, a sharp energy deficit, a moment of physical and moral decline, without feeling any fear and worries about the future, etc.;
• loss of hunger, complete lack of appetite;
• loss of the ability to concentrate attention, memory, etc.;
• minimal contact or complete loss of contact with others, "withdrawal".

Additional signs may be chest pain, rapid heartbeat, shortness of breath, pain in the stomach, dizziness, light-headedness, headache.

Physical decline often leads to a weakening of immune defenses, which leads to the appearance of colds, viral and other infections.

Often, periodic prostration does not cause any suspicion in people: they think that nothing serious is at stake, and treatment is not required. But over the past decades, the state of prostration has been recorded in patients more and more often, which already indicates the need to pay maximum attention to this violation.

Prostration should not be confused with ordinary severe fatigue: with prostration, the feeling of detachment and severe overwork can remain with a person for a long time, sometimes up to several months. And most often, such a state occurs for no apparent reason. For example, sometimes it becomes the threshold of a disease - for example, an infectious one.

First signs

In the initial stages of the development of prostration, a person may feel a deterioration in mood, the appearance of a feeling of hopelessness and a loss of initiative. All this can cause thoughts of detachment from the world, of hopelessness. Already in this situation, you should seek help from a specialist.

In addition, the first time may be disturbed by increased irritability, the source of which are often problems at work or in personal life, understanding of their own "uselessness", health problems. Irritability can lead to tension in communication, periodic outbursts of anger, conflicts, disputes - both in the family circle and in the work environment.

A person gradually ceases to be happy and emit positive emotions, which others do not notice immediately. At the same time, not only professional activity, but also communication with relatives or friends ceases to bring joy. Loss of vital motivation, trust in colleagues at work or relatives is possible: pessimistic moods and thoughts prevail.

In many patients, isolation is growing: there is a reluctance to leave the house, communicate with someone, and take part in events. There is a need to close doors, limit the number of people in the room. Sometimes it gets annoying if someone tries to start a conversation, asks something, etc.

Complete prostration

A state of complete prostration is a prolonged feeling of complete detachment and indifference, loss of strength and energy. Many patients compare this state with a device that has been turned off the power supply: they completely lose interest in the environment, they just want to sit and look in one direction.

Symptoms like these are not uncommon. If the violation lasts long enough, then it can not be underestimated or ignored. The problem may be indicative of a mental or neurological disorder.

Considering the above, if someone suffers from such warning symptoms, one should not ignore, but try to understand the problem.

What can lead to the development of complete prostration? It:

• severe stress (loss of a friend, dismissal, accident, etc.);
• emotional overload (chronic stressful environment, pressure from the outside, regular states of increased responsibility);
• somatic diseases (pathologies that indirectly affect the activity of the brain);
• endocrine diseases (diabetes mellitus, thyroid disorders), etc.

These reasons are not uncommon, especially for residents of modern megacities. And, if temporary prostration usually disappears after the end of the influence of the provoking factor, then complete prostration already requires qualified medical care. Indeed, in some cases, complete immersion in a detached state can be a sign of certain neuropsychiatric disorders - for example, depression, Alzheimer's disease, schizophrenia.

Temporary prostration

An ordinary healthy person is able to plunge into a state of prostration as a result of deep stress - for example, after some negative event, adverse and unforeseen circumstances. Seasonal prostration also occurs - for example, winter or autumn, due to excessive loads, burdened by a lack of vitamins and sunlight. In such a situation, prostrations are a kind of protective reactions, signals from the body that it needs rest. You should not be afraid of such temporary phenomena, as well as give them too much importance. Although sometimes we can really talk about a serious violation or disease. The following tactics for eliminating prostrations are recommended: with rare such moments, actions are aimed at maintaining and strengthening the body. But: if regular prostration does not leave for several weeks, then you need to go to the doctor for advice. In the initial stages, both a psychotherapist and an ordinary family doctor and endocrinologist can help, who will check the functioning of the thyroid gland, the general hormonal background and blood glucose.

People experience a similar temporary state of prostration after a serious illness or prolonged psycho-emotional or physical stress, especially if it is combined with a lack of sleep. Often, short-term numbness is observed at the end of exams or a responsible difficult task, which took a lot of strength and energy, made you worry and worry.

Prostration in a child

Prostrations in childhood in their clinical picture practically do not differ from those in adults. The main point in the treatment of such conditions in children is to ensure regular physical activity with a balance between such activity and rest. It is optimal to carry out systematic activities or games with other children in the fresh air.

Another condition for eliminating child prostration is maintaining a healthy and nutritious diet. The child's diet should be enriched with vitamins, microelements, proteins, and the main components of the dishes should be vegetables, herbs, fruits, fish, seafood. Such food will contribute to the production of high-quality energy in the child's body and prevent the development of exhaustion.

Risk factors for the appearance of prostration in a child are:

• child mental trauma (child abuse, abuse by adults or peers, neglect of the child, improper family relationships);
• excessive "workload" of the child (daily increased loads, when the child, in addition to school and lessons, attends a few more circles and sections);
• transferred infectious diseases, surgical interventions, entailing a general weakening of the body.

Complications and consequences

Prostration itself is most often a consequence or sign of any pathology. The root cause may be:

• depressive state;
• schizophrenia;
• diseases of the central nervous system;
• senile dementia;
• brain tumor processes;
• alcoholism, drug addiction;
• disorders of the endocrine system.

In addition, prostration can be provoked by:

• certain medications (hypnotics, antidepressants, sedatives, hormones, etc.);
• stressful situations and deep emotional experiences;
• lack of adequate rest, chronic overwork.

With the most unfavorable development of the underlying disease associated with prostration, severe somatic pathologies may appear. Suicidal individuals may attempt suicide. However, more often there are milder complications - for example, memory and concentration impairment.

Prolonged or often repeated prostration can cause quite serious cognitive impairments, which in some patients proceed in the form of pseudodementia: if episodes of prostration disappear, then the state of human brain activity is fully restored.

It's no secret that a person's emotional status has a direct impact on the overall health of the body. Therefore, various nervous disorders and prostrations do not pass without a trace in everyone: serious disorders can provoke cardiac arrhythmias, malfunctions of digestive functions, hypertension, and headaches. From the point of view of psychology, frequent deep prostration can cause phobic disorders, an increase in psychological stress. Some patients develop alcohol or drug addiction: a person is looking for an opportunity to relax, rest, relieve accumulated fatigue, “forget” about an unpleasant life situation.

Diagnostics prostration

Prostrations are complex and multifaceted states. Therefore, for their diagnosis, it is necessary to apply various techniques and their combinations. The following methods must be used:

• supervisory control and external detailing of the state, in particular - the use of photographing and video filming of moments of prostration;
• experimental testing, which is performed both at home and in an outpatient setting;
• conversation with the patient, listening to his point of view and information about independent observation of pathology;
• the study of drawings, written and other works, by which one can judge the condition of a patient who is in periodic prostration.

In the course of diagnosis, it is imperative to check the presence or absence of somatic diseases in a person that can provoke the development of prostration. For this, the patient is prescribed general instrumental diagnostic procedures:

• Ultrasound of the chest and abdominal organs, thyroid gland, kidneys;
• chest x-ray;
• resting electrocardiogram;
• anthropometry with an estimate of BMI (body mass index).

An examination is carried out with the involvement of doctors of other specializations:

• therapist;
• a surgeon;
• neurologist (neuropathologist);
• ophthalmologist.

Laboratory tests may include:

• clinical blood test (with an assessment of the level of hemoglobin in erythrocytes, the level of leukocytes and ESR);
• general urine examination;
• general therapeutic biochemical blood test (determination of total protein, albumin, fibrinogen, uric acid, creatinine, total bilirubin, ALT, AST, total cholesterol, glucose, potassium and sodium).

If an elevated blood glucose level is detected, then the patient is referred for further examination for diabetes.

Differential diagnosis

Differential diagnosis of prostration is often carried out with chronic fatigue syndrome, apathy and asthenia.

Asthenia is a psychopathological disorder in which there is persistent increased physical and / or mental fatigue with a decrease in the degree of activity (lack of vigor, energy, motivation). Asthenia, asthenic depression are serious pathological conditions that require compulsory medical intervention.

Apathy is a symptom of many mental pathologies, manifested by an indifference to everything, no matter what happens around. Apathy is prone to aggravation, it is a serious deviation from the norm of the behavioral, cognitive and emotional sphere. The disorder is often noted in patients with schizophrenia, depression, in patients with organic brain lesions, and can also be a consequence of traumatic brain injury.

Prostration in old age should be differentiated from dementia and depressive pseudodementia. Dementia is a polyetiological syndrome caused by organic pathology of the brain, in which mnestic and cognitive disorders occur. Speech, orientation, thought process, etc. Suffer.

Dementia is characterized by the following symptoms:

• intellectual disabilities occur before signs of depression appear;
• there is a somatic illness;
• complaints about a dull mood are voiced, but not about a bad memory;
• the patient incorrectly answers relatively simple questions, tries to hide or minimize complaints;
• appetite is not impaired or even increased;
• normal sleep, less often - restless;
• decamethasone test is negative (cortisol level decreases).

With depressive pseudodementia:

• depression begins to bother long before the onset of intellectual disorders;
• the patient complains of memory impairment, scrupulously describes the disease in detail, but often tries not to answer the simple questions asked;
• the patient is inclined to exaggerate complaints, worries about memory impairment;
• self-esteem decreases, appetite is poor, sleep is short;
• decamethasone test is positive (cortisol level does not decrease).

Prostration and frustration

There are many different terms in psychology, and some of them are similar. Thus, concepts such as prostration and frustration are often confused. Frustration is understood as a kind of state of annoying disappointment, which can also lead to a feeling of transient spiritual emptiness and become a reason for unwillingness to do something or do something. For example, a person tried to achieve something for a long time, believed - and as a result he could not get what was expected due to one reason or another. At this moment, a state of frustration arises, which is accompanied by the feeling that everything and everyone is bored, and nothing else is needed.

Indeed, all this is somewhat reminiscent of prostration. However, there are also significant differences. Prostration is akin to a state of severe fatigue, including physical, which can be caused by a serious illness or prolonged stress overstrain. Often a person who behaves aloof and indifferent is said to be in prostration. This is due to the fact that outwardly the situation becomes similar to "hovering in the clouds."

Treatment prostration

To get rid of prostration, the main forces must be directed to improving health in general. It is imperative that you undergo preventive diagnostics to exclude other pathologies in the body, and in particular, those that could provoke the appearance of prostration.

An important and obligatory step is vitamin therapy. It is necessary to ensure the supply of vitamins and minerals to the body, both with food and with the additional intake of special complex preparations. You should also pay attention to the amount of fluid you drink, since dehydration negatively affects metabolic and endocrine processes in the body, on the function of the nervous system. Gymnastic exercises in the fresh air, or just walks (walking, cycling, etc.) work well. In addition to vitamins, you can also pay attention to fortifying drugs - for example, tincture of Eleutherococcus or ginseng.

However, the main point of treatment for prostration should be the normalization of the daily routine. It is necessary to carefully allocate time, devoting a considerable share of sleep and rest. Meditation is considered effective: regular exercise helps to gain clarity of mind and fill the body with energy. It is important to receive positive emotions from a variety of sources. You can watch a good show or movie, chat with an interesting interlocutor, read an entertaining book or leaf through a magazine. It's great if you have a favorite hobby: if not, then you can find it by discovering a lot of new things. In difficult or advanced cases, only a specialist can help - for example, a psychologist or psychotherapist.

Drug therapy is an adjunct to the other methods used: it is prescribed by a doctor only if absolutely necessary. Self-medication can only achieve a negative result, the opposite of the desired one.

The main categories of medicines that are taken with regular prostration are as follows:

• Symptomatic agents that simultaneously have a sedative property - for example, Corvalol, Tenoten, Glycesed. The listed drugs have a mild anti-stress effect, quickly soothe, improve sleep. The doctor determines the dosage and duration of admission on an individual basis. It is important to remember that even the seemingly safest medicines cannot be taken uncontrollably and constantly.
• Herbal sedatives - in particular, containing extracts of motherwort, valerian, peony, etc. These medicines include the well-known Persen, Antistress, Novo-Passit. The action of such funds is fast. The downside is some inhibitory effect, decreased concentration, drowsiness. Given this, you should not take them if you have to drive a car, or do other things that require increased attention.
• Multivitamin and mineral complex preparations - for example, Supradin, Vitrum, Magnesium B ₆  Antistress, etc. Such funds really help the body to cope with numerous stresses, but in case of serious problems with the nervous system, vitamins alone are not enough: the help of a psychotherapist and other specialized specialists is needed.
• Tranquilizers and antidepressants belong to the category of potent drugs that are dispensed strictly according to the doctor's prescription, have a hefty list of restrictions and contraindications for use, and have rather strong side effects. Treatment with such drugs is advisable if the stressful situation is approaching the maximum, and urgent medical support is required.

How to get out of prostration?

Prostration can be deep and superficial. The conclusion from a deep state of prostration, in which appetite, sleep, etc. Disappear, should only be dealt with by a doctor of appropriate qualifications, who has experience in the treatment of such pathologies.

Superficial prostration, accompanied by a breakdown, complete indifference and general lethargy, you can try to eliminate on your own, or with the help of loved ones. A person who is plunged into such a depressed state needs vivid emotions that would be stronger than the negative that previously provoked oppression. For example, extreme surprise or even intense anger, coupled with the need to prove something or convince someone, can become optimal emotions. However, anger should not be accompanied by aggression: it is important to adhere to the "golden mean" in communication with the patient, so as not to aggravate the situation and worsen the condition completely.

The body of a person suffering from prostration needs rest, or respite. Sleep is often the most optimal remedy for physical exhaustion and fatigue. Sleeping off means sleeping and staying in bed not for several hours, but even for 1-2 days - for example, it is convenient to use weekends from work for this. The main condition is that during the whole rest you should not think about work, about unfinished business, about obligations. It will still not be possible to do something qualitatively in moments of extreme fatigue: therefore, it is better to have a good rest, gain energy, and only then - after a few days - start duties.

The need to take care of someone - for example, a pet - helps to escape the state of prostration. This option is great for responsible, sympathetic people who would rather help not themselves, but others. Psychologists say that useful and pleasant actions, the ability to help another person or animal are often the best way to change your own pattern, recharge with positive emotions, and switch attention.

With mild prostrations, any changes help: you can change your hairstyle, update your wardrobe, or act radically - change the situation in the apartment, move to another city. But these changes usually require the help of friends or family. You can start with little things: rearrange furniture, add bright colors to the interior, change linen, change the look of your workplace, try to prepare a new dish or drink.

Here's what psychotherapists recommend about this:

• Take a notebook and pencil and answer the question ten times - why should I get out of prostration?
• Think about how you would like to spend the next weekend, several months or several years.
• Analyze what can negatively affect your energy resource: perhaps you use your time irrationally, work a lot, communicate with “toxic” people?
• Remember how often you go outdoors, especially on sunny days? How long have you been checked by a doctor, were tested for hemoglobin, thyroid hormones? All this can negatively affect your energy potential.

If prostration lasts several days or even more than a week, then you should definitely try to get up and go to a specialist. It is great if there are relatives or friends nearby who can help with this. In no case should you prescribe yourself treatment and take antidepressants or other drugs.

A short solitary prostration is recommended to be perceived as a kind of "bell" that you need to devote more time to yourself and rest for your body.

Prevention

People who are often stressed or overworked should think about their health in advance and try to prevent the occurrence of prostration. Even in the absence of moral strength and a desire to do something, it is important to try to overcome your apathy, to make efforts so that life again “kicked in” and acquired new bright colors.

• Physical education and breathing exercises relieve mental stress. If you moderately load and relax the muscles, it helps to speed up metabolic processes, eliminate the effects of stress. It is important to choose an activity that would be enjoyable: for some people yoga or pilates are suitable, while for others martial arts, cycling or equestrian sports are suitable. As for breathing exercises and yoga, these methods help to gain control over oneself in critical situations, to calm down in stressful conditions.
• Relaxing procedures, physiotherapy have a general positive effect on the human body and its psycho-emotional state. Manual therapy, acupuncture, stone therapy, aromatherapy are great ways to relax and relieve stress. In addition, you can practice water treatments (phyto baths, jacuzzi, chocolate or mud wraps). It is important to consolidate the result by going to rest for another 1.5-2 hours after a relaxing session.
• Correction of diet and lifestyle is an important and necessary rule for those who want to prevent nervous breakdowns and the development of prostration. How can a lifestyle contribute to the emergence of problems with the nervous system? Watching TV or flipping through social media pages late into the night, the habit of having a hearty dinner before bed and taking unfinished work home - such factors easily and quickly aggravate stress, worsen the psychological and physiological state, which over time can lead to the development of both prostration and breakdown and even depression. What to do? It is necessary to stabilize the rhythm of life: to establish a mode of night rest, try to eat right, find time for yourself to “catch your breath,” for example, do not run to work, not noticing anything around, but go out early and take a leisurely walk, breathe fresh air. Only these simple steps will significantly improve mood, reduce fatigue, and remove irritability.
• Preventive psychotherapy is appropriate at the first bells from the body. This is especially true if a person himself cannot understand the reasons for his condition and, accordingly, is not able to influence them. A good psychologist or psychotherapist will surely find the "root of the problem" and help to establish well-being neatly and comfortably for the patient.

Forecast

Prostrations are not always dangerous. Only deep and long-term such states can lead to unpleasant consequences for both the patient and his loved ones - of course, if the problem is ignored and you do not seek help from a specialist. If possible, it is better not to allow the development of prostration at all, listen to your body, try to get enough rest - both physically and mentally. And when the prerequisites for disturbances appear (constant fatigue, frequent irritability, sleep disturbances, loss of appetite, etc.), it is necessary to start treatment, which is prescribed by the doctor. Medicines should not only smooth out nervous tension, but also have a general supportive and strengthening effect. As an independent help, you can try non-drug methods: various methods of spiritual relaxation, change of scenery. You can sign up for a massage, visit SPA procedures, etc. If the state of health does not return to normal, then only a specialist can help in such a situation.

Unfortunately, it is very difficult and sometimes impossible to get around the stresses in the modern life stream. All sorts of irritating factors affect a person everywhere: at work, during school, and even at home. Therefore, prostration can occur in absolutely everyone, and in most cases they do not carry anything dangerous or terrible. The prognosis can be considered favorable, except in cases where prostration becomes a sign of serious pathologies of neuropsychic activity. Other factors of an unfavorable prognosis are old age, long duration and frequency of prostration, ongoing regular fatigue, and the presence of comorbid mental pathologies.