A 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", but what does it mean? In fact, prostration is a specific detached state of a person, when all interest in everything and everyone is lost, including oneself. Such indifference can be short-term or long-term and occurs against the background of a feeling of complete exhaustion - both physical and moral. Next, we will consider whether prostration is a pathology and whether it requires treatment.

Epidemiology

The frequency of detection of prostrations in general medical practice is between 15 and 55%. However, information on the statistics of this condition is unclear and is not specifically kept. It is much more important for a practicing physician to determine the underlying cause of the pathology and prescribe appropriate treatment aimed at raising the overall tone of the body.

Prostrations are mostly experienced by educated, physically and mentally active, successful people. The most typical age range of patients is from 20 to 45 years. Among those suffering from prostrations, there are often teachers, doctors, office workers. People whose professional activities are associated with high responsibility (for example, drivers, pilots, dispatchers, etc.) and those who work with moving mechanisms, devices, machines are at particular risk. [ 1 ]

Causes prostration

When talking about prostration, most often they mean a state of physical and moral decline in the body, general exhaustion, confusion, depression and loss of interest in anything. The patient is able to be in this state from a few seconds to several months. Motor activity is sharply reduced, reactions and speech slow down, thinking ability is inhibited. When a person plunges into a state of prostration, he becomes indifferent to everything, he stops reacting emotionally, rejoicing, worrying, etc. As a rule, a person stares at one point with an “empty” gaze, being in a kind of numbness.

The pathological state of prostration develops in the following cases:

• In any moderate or severe pathology, including infectious diseases, prostration can be caused by increased fatigue of the body, its exhaustion, for example:
  • at the prodromal stage (against the background of weakness, fatigue, 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 overfatigue, the development of prostration is explained by objective factors. This may be due to stress, neuroses, the peculiarities of a person's mental perception of various situations, making excessive demands on oneself, overestimating one's capabilities. In many cases, a person creates conditions for himself in which he is "driven" into a state of chronic exhaustion.

The main causes of prostration are stressful situations, prolonged excitation of the nervous system, chronic lack of sleep, regular fatigue. Other factors include past pathologies, such as viral or bacterial infections, severe intoxications. An unfavorable environment also has a certain effect.

Risk factors

Risk factors for developing prostration include:

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

The 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, neglect, and other improper family relationships. In addition, the development of prostration is often associated with anxiety and depressive states, post-traumatic stress disorders. Repeated occurrences of prostration are often associated with acute stress or conflict situations.

Early life stress constantly affects the brain areas responsible for cognitive-emotional processes, regulation of the endocrine, immune and autonomic systems. Clinical and research information has proven that psychological traumas suffered in childhood provoke a long-term failure of the hypothalamus, pituitary gland and adrenal glands, and also cause an excessively vivid reaction to stressful situations. However, such childhood traumas are not always indicated in the anamnesis of patients with prostrations. It is quite possible that such a mechanism can manifest itself in a pathogenetic reaction only in a certain part of people.

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

Pathogenesis

The pathogenetic mechanism of prostration is associated with psychological, immune and systemic factors, as well as with the features of neurophysiology and neuroanatomy of the human brain. The degree of physical and mental activity also has an effect.

The neurotrophic factor BDNF plays an important role 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 the overload of the body. During the spectral analysis of the electroencephalogram during motor tests in patients with prostration, changes in signals from the central nervous system were detected that control the arbitrariness of muscle activity - and, in particular, such that causes a feeling of fatigue.

The etiological factors for the development of prostrations can be called:

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

Exhaustion of the body becomes an incentive to stop activity, any kind of activity, any efforts, etc. If we analyze this situation from a biological point of view, then prostration can be considered as the launch of a mechanism for preserving energy by stopping both physical and mental activity. Refusal of activity leads to a decrease in energy needs. Thus, prostration can be a kind of reaction to a condition in which critical depletion of energy resources is possible. The human body is a self-regulating system, so 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 considered as a universal protective or compensatory adaptation reaction: it is triggered both by objective disorders and by a supposed or imaginary threat (psychogenic prostration).

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

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

Symptoms prostration

The state of prostration can increase gradually, so it can be difficult to determine at first. And yet, the body gives specific signals in advance, which should be paid attention to. The entire clinical picture of prostration can be divided into several categories, in accordance with symptomatic groups, including physical and moral 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 may be:

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

Additional symptoms may include chest pain, rapid heartbeat, difficulty breathing, pain in the stomach, dizziness, pre-fainting, headache.

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

Often, periodic prostrations do not arouse any suspicion in people: they think that there is nothing serious going on and that treatment is not required. But in recent 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 disorder.

Prostration should not be confused with ordinary severe fatigue: with prostration, the feeling of detachment and severe fatigue can remain with a person for a long time, sometimes up to several months. And most often, such a condition occurs without any apparent reason. For example, sometimes it becomes a prelude to some disease - for example, an infectious one.

First signs

At the initial stages of prostration, a person may feel a worsening of mood, a feeling of hopelessness and loss of initiative. All this may cause thoughts of detachment from the world, of hopelessness. Already in this situation, one should seek help from a specialist.

In addition, at first you may be bothered by increased irritability, the source of which is often problems at work or in your personal life, the understanding of your 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 stops being happy and radiating positive emotions, which others do not notice right away. At the same time, not only professional activity stops bringing joy, but also communication with loved ones or friends. A loss of motivation for life, trust in colleagues at work or relatives is possible: pessimistic moods and thoughts prevail.

Many patients become increasingly withdrawn: they have no desire to leave the house, communicate with anyone, or take part in events. They feel the need to close doors and limit the number of people in a room. Sometimes it causes irritation if someone tries to start a conversation, asks something, etc.

Complete prostration

The state of complete prostration is a prolonged feeling of complete detachment and indifference, loss of strength and energy. Many patients compare this state to a device whose power supply has been turned off: interest in the surroundings is completely lost, you just want to sit and look in one direction.

Such symptoms are not uncommon. If the disorder continues for a long time, it should not be underestimated or ignored. The problem may indicate some mental or neurological disorder.

Given the above, if anyone suffers from such alarming symptoms, they should not ignore them, but try to understand the problem.

What can lead to the development of complete prostration? This is:

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

The listed reasons are not uncommon, especially for residents of modern megacities. And if temporary prostrations usually disappear after the end of the provoking factor, then complete prostrations already require qualified medical care. After all, in some cases, complete immersion in a detached state can be a sign of certain psychoneurological disorders - for example, depression, Alzheimer's disease, schizophrenia.

Temporary prostration

An ordinary healthy person can fall into a state of prostration as a result of deep stress - for example, after some negative event, unfavorable and unforeseen circumstances. Seasonal prostration also occurs - for example, winter or autumn, caused by excessive loads, aggravated 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. Such temporary phenomena should not be feared, as well as attaching too much importance to them. Although sometimes we can really talk about a serious disorder or disease. The following tactics for eliminating prostrations are recommended: in rare such moments, actions are aimed at maintaining and strengthening the body. But: if regular prostrations do not go away for several weeks, then you need to go to the doctor for a consultation. At 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 the glucose content in the blood.

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 sleep deficiency. Often, short-term numbness is observed after passing exams or an important, complex task that took a lot of strength and energy, made you worry and worry.

Prostration in a child

Prostrations in childhood are practically no different in their clinical picture from those in adults. The main point in the treatment of such conditions in children is to ensure regular physical activity while maintaining a balance between such activity and rest. It is optimal to conduct systematic activities or games with other children in the fresh air.

Another condition for eliminating children's prostrations is to maintain 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, greens, fruits, fish, seafood. Such food will contribute to the production of high-quality energy in the child's body, preventing the development of exhaustion.

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

• childhood psychological trauma (child abuse, cruelty from adults or peers, neglect of the child, improper family relationships);
• excessive “workload” of the child (daily increased workload, when the child, in addition to school and lessons, attends several other clubs and sections);
• previous infectious diseases, surgical interventions that lead to a general weakening of the body.

Complications and consequences

Prostration itself is most often a consequence or a sign of some pathology. The initial 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 caused by:

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

In the most unfavorable development of the underlying disease associated with prostration, severe somatic pathologies may occur. People with suicidal tendencies may attempt suicide. However, milder complications are most often observed, such as memory loss and impaired concentration.

Prolonged or frequently recurring prostrations can cause quite serious cognitive impairments, which in some patients occur in the form of pseudo-dementia: if episodes of prostration disappear, then the person’s state of brain activity is completely restored.

It is 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 heart rhythm disturbances, digestive function failures, hypertension, headaches. From a psychological point of view, frequent deep prostrations can cause phobic disorders, increasing 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 conditions. Therefore, to diagnose them, it is necessary to use various methods and their combinations. The following methods must be used:

• observational control and external detailing of the state, in particular – the use of photography and video recording of moments of prostration;
• experimental testing, which is carried out both at home and in outpatient settings;
• conversation with the patient, listening to his point of view and information about self-monitoring of the pathology;
• study of drawings, written and other works, by which one can judge the condition of a patient who is in periodic prostrations.

During the diagnostics, it is necessary 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 BMI (body mass index) assessment.

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

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

Laboratory tests may include:

• clinical blood test (with assessment of the level of hemoglobin in erythrocytes, the level of leukocytes and ESR);
• general urine test;
• 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 elevated blood glucose levels are detected, the patient is referred for further testing for diabetes.

Differential diagnosis

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

Asthenia is a psychopathological disorder characterized by persistent increased physical and/or mental fatigue with decreased activity (lack of vigor, energy, motivation). Asthenia and asthenic depression are serious pathological conditions that require mandatory medical intervention.

Apathy is a symptom of many mental pathologies, manifested by an indifferent attitude to everything that happens around. Apathy tends to worsen, is a serious deviation from the norm of the behavioral, cognitive and emotional spheres. The disorder is often noted in patients with schizophrenia, depression, in patients with organic brain damage, and can also be a consequence of craniocerebral trauma.

Prostrations in old age should be differentiated from dementia and depressive pseudo-dementia. Dementia is a polyetiological syndrome caused by organic pathology of the brain, in which mnemonic and cognitive disorders occur. Speech, orientation, thought process, etc. suffer.

Dementia is characterized by the following signs:

• intellectual impairment is observed before the onset of signs of depression;
• there is a somatic disease;
• complaints are voiced about a despondent mood, but not about a bad memory;
• the patient incorrectly answers relatively simple questions, tries to hide or downplay complaints;
• appetite is not disturbed or even increased;
• sleep is normal, less often restless;
• Decamethasone test is negative (cortisol level decreases).

In depressive pseudodementia:

• depression begins to bother long before the appearance of intellectual disorders;
• the patient complains of memory loss, describes the illness in meticulous detail, but often tries not to answer simple questions at all;
• the patient tends to exaggerate complaints and worries about memory loss;
• 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. For example, such concepts as prostration and frustration are often confused. Frustration is understood as a specific state of annoying disappointment, which can also lead to a feeling of temporary spiritual emptiness and become the reason for the unwillingness to undertake or do anything. For example, a person has been striving for something for a long time, believed - and as a result, could not get what he expected due to one reason or another. At this moment, a state of frustration arises, which is accompanied by a feeling that everything and everyone is boring, and nothing more is needed.

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

Treatment prostration

To get rid of prostration, the main efforts should be directed to strengthening health in general. It is necessary to undergo preventive diagnostics - to exclude other pathologies in the body, and in particular, those that could provoke the appearance of prostration.

An important and mandatory step is vitamin therapy. It is necessary to ensure the intake of vitamins and microelements into the body, both with food and with additional intake of special complex preparations. You should also pay attention to the amount of liquid you drink, since dehydration negatively affects the metabolic and endocrine processes in the body, the function of the nervous system. Gymnastics in the fresh air, or just walking (walking, cycling, etc.) have a good effect. In addition to vitamins, you can also pay attention to general tonics - for example, tincture of eleutherococcus or ginseng.

However, the main point of treatment for prostrations should be normalization of the daily routine. It is necessary to carefully distribute time, devoting a considerable share to sleep and rest. Meditation is considered effective: regular exercises help 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 program or film, talk to an interesting interlocutor, read an entertaining book or leaf through a magazine. It is great if you have a favorite hobby: if not, you can find one, discovering a lot of new things. In complex or advanced cases, only a specialist can help - for example, a psychologist or psychotherapist.

Drug therapy is an addition to other methods used: it is prescribed by a doctor only in case of extreme necessity. Self-medication can only achieve a negative result, the opposite of what is desired.

The main categories of medications that are taken for regular prostrations are the following:

• Symptomatic agents that also have a calming effect - for example, Corvalol, Tenoten, Glycesed. The listed drugs have a mild anti-stress effect, quickly calm, and improve sleep. The doctor determines the dosage and duration of administration on an individual basis. It is important to remember that even the safest, at first glance, medications cannot be taken uncontrollably and constantly.
• Herbal sedatives - in particular, containing extracts of motherwort, valerian, peony, etc. Such medications include the well-known Persen, Antistress, Novo-Passit. The effect of such drugs is fast. The downside is a certain 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 products really help the body 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 necessary.
• Tranquilizers and antidepressants are potent drugs that are dispensed strictly as prescribed by a doctor, have a considerable list of restrictions and contraindications for use, and are characterized by fairly strong side effects. Treatment with such drugs is advisable if the stressful situation is approaching its maximum and urgent medical support is required.

How to get out of prostration?

Prostration can be deep and superficial. Only a doctor with the appropriate qualifications, who has experience in treating such pathologies, should be engaged in bringing a person out of a deep state of prostration, in which appetite, sleep, etc., disappear.

Superficial prostration, accompanied by a loss of strength, complete indifference and general inhibition, can be eliminated independently or with the help of loved ones. A person who has plunged into such a depressed state needs bright emotions that would be stronger than the negativity that previously provoked oppression. For example, the optimal emotions can be strong surprise or even strong anger, associated with the need to prove something or convince someone. 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 not worsen the condition completely.

The body of a person suffering from prostration needs rest, or a break. Sleep often becomes the most optimal "cure" for physical exhaustion and fatigue. To sleep off means to sleep and stay in bed not for several hours, but even for 1-2 days - for example, it is convenient to use days off from work for this. The main condition is that during the entire rest you cannot think about work, about unfinished business, about obligations. It will not be possible to do any task well in moments of extreme fatigue anyway: therefore, it is better to have a good rest, gain energy, and only then - after a few days - start your duties.

The need to take care of someone, for example, a pet, helps to leave the state of prostration. This option is great for responsible, compassionate people who would rather help someone else than themselves. Psychologists say that useful and pleasant actions, the opportunity to help another person or animal often become the best way to change your own pattern, recharge yourself with positive emotions, and switch your attention.

With mild prostrations, any changes help: you can change your hairstyle, update your wardrobe, or act radically - change the furnishings in your apartment, move to another city. But for such changes, as a rule, you need the help of friends or relatives. You can start with small things: rearrange the furniture, add bright colors to the interior, change the linen, change the look of your workplace, try to cook a new dish or drink.

Here's what psychotherapists recommend about this:

• Take a notepad and a pencil and answer the question ten times: why do I need to come out of my stupor?
• Think about how you would like to spend the next weekend, the next few months, or the next few years.
• Analyze what can negatively affect your energy resource: perhaps you are using your time irrationally, working too much, communicating with “toxic” people?
• Remember how often you walk in the fresh air, especially on sunny days? How long ago was it that you were examined by a doctor, had your hemoglobin and thyroid hormones tested? All of this can negatively affect your energy potential.

If prostration lasts for 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. You should never prescribe treatment for yourself or take antidepressants or other drugs.

It is recommended to perceive a short-term solitary prostration as a kind of “wake-up call” about the need to devote more time to yourself and rest for your body.

Prevention

People who are often stressed or overtired should think about their health in advance and try to prevent prostrations. Even if you lack moral strength and desire to do anything, it is important to try to overcome your apathy, make an effort to make life “flow with energy” again and acquire new bright colors.

• Physical exercise and breathing exercises relieve mental stress. Moderately loading and relaxing the muscles helps speed up metabolic processes and eliminate the effects of stress. It is important to choose an activity that brings pleasure: yoga or pilates will suit some people, while for others - martial arts, cycling or equestrian sports. As for breathing exercises and yoga, these methods help to gain control over oneself in critical situations and calm down in stressful conditions.
• Relaxation procedures, physiotherapy procedures have a general positive effect on the human body and its psycho-emotional state. Manual therapy, acupuncture, stone therapy, aromatherapy are excellent ways to relax and relieve stress. In addition, you can practice water procedures (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 the relaxing session.
• Correction of nutrition and lifestyle is an important and necessary rule for those who want to prevent nervous breakdowns and the development of prostration. How can lifestyle contribute to the emergence of problems with the nervous system? Watching TV or scrolling through social network pages until late at night, the habit of having a heavy 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? You need to stabilize the rhythm of life: establish a nighttime rest regime, 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 your mood, reduce fatigue, and eliminate irritability.
• Preventive psychotherapy is appropriate at the first signs of trouble from the body. This is especially relevant if a person cannot understand the reasons for his condition and, accordingly, is not able to influence them. A good psychologist or psychotherapist will definitely find the "root of the problem" and help improve the patient's well-being carefully and comfortably.

Forecast

Prostrations are not always dangerous. Only deep and prolonged such conditions can lead to unpleasant consequences for both the patient and his loved ones - of course, if the problem is ignored and no help from a specialist is sought. If possible, it is better not to allow prostrations to develop at all, listen to your body, try to rest enough - both physically and mentally. And if prerequisites for disorders appear (constant fatigue, frequent irritability, sleep disorders, loss of appetite, etc.), it is necessary to begin treatment prescribed by a doctor. Medicines should not only smooth out nervous tension, but also have a general supporting and strengthening effect. As an independent help, you can try non-drug methods: different methods of spiritual relaxation, a change of scenery. You can sign up for a massage, visit SPA procedures, etc. If your health does not normalize, then only a specialist can help in such a situation.

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