Syndrome of the Vietnam War

At the end of hostilities in Vietnam for several years, many people have had such a mental disorder as the Vietnamese syndrome is a kind of post-traumatic stress disorder that is often diagnosed in those who were in war conditions. In fact, the same mental disorder is now called the Afghan, Chechen syndrome - depending on which military actions affected the appearance of the violation.

Epidemiology

According to some reports, at least 12% of former participants of local armed conflicts suffer from the Vietnamese syndrome to some extent (according to other sources, from 25 to 80%). A similar stress disorder is diagnosed in 1% of the world's population, while 15% have some of its individual signs.

Over the past decades, such a syndrome has been replenished with Afghan, Karabakh, Transnistrian, Abkhaz, Chechen, and now Donbas syndrome - and the types of such pathology are becoming increasingly difficult.

The Vietnamese syndrome can last several weeks, but can last for decades.

Unfortunately, there are no exact statistics of such cases. However, experts suggest that the incidence rate has only increased over the years.

[1], [2], [3], [4], [5],

Causes of the vietnamese syndrome

Type of posttraumatic stress disorder - Vietnamese syndrome - is considered a particularly complex psychopathic disorder characterized by bouts of irritability and aggression, with a craving for destruction and even killing.

The reasons for the development of such a syndrome may be different: these are experienced episodes of violence, contemplation of physical mutilation, own disability and the proximity of death. To qualify for the Vietnamese syndrome, it is not necessary to be a war veteran in Vietnam: in most cases, such a syndrome can be applied to people who have also participated in other hostilities in other countries.

[6], [7], [8], [9], [10],

Risk factors

• Participation in hostilities, contemplation of violence, death, grief.
• Personal experiences and fears, often caused by the death of a friend or a loved one.
• Forced to risk their own lives.
• Participation in accidents, disasters.
• Physical trauma, concussion, craniocerebral trauma.

[11], [12], [13], [14], [15]

Pathogenesis

As a rule, the Vietnamese syndrome develops as a result of severe psychological traumatic effects. As a rule, these are events related to the war, which are hard to accept and realize. In most cases, the appearance of the syndrome is provoked by cruelty, death of people, violence and pain. Visual images are associated with a sense of fear and horror, with a sense of inevitability and helplessness.

The war has a very negative impact on the person's mental state. Its negative contribution is made by a constant sense of fear and emotion, unceasing nervous tension, contemplation of murders and someone else's grief - this can not pass without a trace for the psyche.

At the same time, the Vietnamese syndrome can be found not only among immediate combatants, but also among their families, from volunteers, journalists, doctors, rescuers, and people living in the territory of a military conflict.

[16], [17], [18], [19]

Forms

Patients with Vietnamese syndrome can live several stages of symptom onset:

1. There is a loss of vital joys, insomnia, loss of appetite and sexual desire, a change in self-esteem.
2. There is a desire to revenge, thoughts of suicide arise, which is often explained by the loss of the meaning of life.
3. The patient's conclusions become persistent, he does not go into contact and does not give in to persuasion.
4. Develop crazy states, the patient blames himself for almost all the troubles.

At a serious stage, the patient's body is depleted, cardiac disorders occur, blood pressure changes.

In addition, several phases of a person's stress reaction are divided:

• the phase of the initial emotional reaction;
• the phase of "negations" (emotional limitations, suppression of thoughts about traumatic events);
• intermittent phase with the periodic appearance of "negations" and "intrusions" (in addition to the will, breakthrough thoughts, dreams);
• the phase of gradual elaboration of information, which usually ends with the assimilation or adaptation of a person.

The Vietnamese syndrome can have such types of a pathology pathology:

• Acute syndrome (the first signs of the disease appear within six months after the injury and take place for 5-6 months).
• Chronic syndrome (the symptomatology continues for more than six months).
• Delayed syndrome (symptoms appear after a certain latent period - after six months or more after a traumatic situation, and last more than six months).

People who have gone through the war are also distinguished by such stages of the Vietnamese syndrome:

• stage of primary impact;
• stage of negation (suppression) of events;
• stage of decompensation;
• stage of recovery.

According to the common opinion of many specialists, recovery may not occur in all patients, and much more slowly than it should.

[20], [21], [22], [23]

Complications and consequences

Certainly, increased mental activity can not pass unnoticed for human health, manifesting in the future serious consequences. Very often unwanted memories and terrible visions visit the patient in a dream, which ultimately leads to insomnia. Often a person is banally afraid to go to bed, and if he falls asleep, then intermittent and uneven sleep, often waking up in a cold sweat. Since such a dream can not be called a complete rest, the patient's psyche experiences additional colossal overloads, which only aggravates the situation.

Pathology makes itself felt not only at night. In the daytime, hallucinations can occur - a person sees tragic pictures, and in real time, identifying them with reality. This can play a negative role and lead to isolation from society.

Another complication is the growing sense of guilt that is inherent in people if they survived under certain circumstances, and their friends or relatives died. These people have a cardinal revaluation of values: they lose the ability to enjoy life and even just live in the modern world.

The most severe consequence of the Vietnamese syndrome is the thought of suicide, which many manage to implement.

Among former military men who took part in hostilities in Vietnam, during the 20 years after the end of the war, suicide committed more soldiers than they died in the years of military conflict. Among those who survived, about 90% of families disintegrated - mostly because of persistent depressions, the development of alcohol and drug dependence, etc.

[24], [25], [26], [27], [28], [29], [30],

Diagnostics of the vietnamese syndrome

Such diagnosis, as "Vietnamese syndrome", is put when there are appropriate criteria for this disease:

1. The fact of presence in the zone of combat operations, the fact of threat to life or health, stressful situations associated with war (anxiety, emotional concern for the lives of others, moral trauma from contemplating others' sufferings).
2. Obsessive "scrolling" of the experiences, nightmares during sleep, vegetative reactions when referring to the war (tachycardia, sweating, quickening of breathing, etc.).
3. The desire to "forget" about the period of the war, which is analyzed at the subconscious level.
4. The presence of signs of stressful lesion of the central nervous system (insomnia, attacks of irritability and temper, weakness of attention, distorted reactions to external stimuli).
5. Prolonged presence of signs of the syndrome (more than a month).
6. Change in attitudes towards society (loss of interest in pre-existing hobbies, in professional activities, isolation, alienation).

Over time, the patient may have various kinds of dependencies (including alcohol or drugs), which must also be taken into account when making a diagnosis.

Instrumental and laboratory diagnostics do not give results for confirming the Vietnamese syndrome.

[31]

Differential diagnosis

When conducting diagnostics of the Vietnamese syndrome, you need to be careful, since the disease can easily be confused with other pathologies that develop in response to a psychological trauma. It is very important to be able to identify diseases of a somatic or neurological nature that are well treatable if it is started in a timely manner.

For example, the use of certain medicines, withdrawal symptoms and head trauma can also lead to the development of "delayed" symptoms, which are detected only after a few weeks. In order to detect and recognize somatic and neurological disorders, it is necessary to collect as much detailed anamnesis, as well as to examine the patient not only physically, but also with the use of neuropsychological methods.

During the Vietnamese syndrome there are no abnormalities from the patient's consciousness and orientation. If such signs are revealed, then additional diagnostics should be carried out to exclude organic brain pathology.

The clinical picture of the Vietnamese syndrome often coincides with that in panic disorders or in the generalized anxiety disorder. In this case, anxiety and vegetative hyperreaction may become common symptoms.

For the correct diagnosis it is important to establish a temporary connection between the appearance of the first signs and directly the time when there were psycho-traumatic events. In addition, with the Vietnamese syndrome, the patient constantly "scrolls" in the head traumatic episodes, and at the same time seeks to protect themselves from any reminders of them - this behavior is not considered typical for panic and generalized anxiety disorders.

Medical specialists often have to distinguish Vietnamese syndrome from a major depressive state, from borderline personality disorder, from dissociative disorder, and from intentional imitation of psychoneurological pathology.

[32], [33], [34], [35]

Treatment of the vietnamese syndrome

Medical treatment of Vietnamese syndrome is prescribed in such cases:

• if the patient is in a state of constant nervous hypervoltage;
• if a person has hypertrophied responses;
• with frequent seizures obsessive thoughts, accompanied by autonomic disorders;
• with periodically recurring illusions and hallucinations.

Treatment with medications is prescribed in conjunction with methods such as psychotherapy and psychocorrection - and without fail.

If the clinical picture in the Vietnamese syndrome in the patient is expressed slightly, then you can use sedatives based on valerian root, motherwort, peony, cones of hops.

If the symptomatology is expressed strongly enough, the use of only sedatives will not bring a therapeutic effect. In complicated cases, antidepressants should be taken from a number of selective serotonin reuptake inhibitors - for example, Prozac (Fluoxetine), Fevarin (Fluvoxamine), Zoloft (Sertraline).

These drugs improve the quality of life mood, eliminate anxiety, normalize the state of the vegetative system, relieve obsessive thoughts, weaken aggressiveness and irritability, reduce cravings for various kinds of addictions.

When taking antidepressants at the initial stage of treatment, there may be an aggravation of symptoms of anxiety. To smooth out this effect, the treatment starts with a minimal amount of the drug, gradually increasing the dosage. If the patient complains of a constant nervous tension, Seduxen or Phenazepam is prescribed as an adjuvant during the first 20 days of therapy.

Among the main drugs that are often used in the Vietnamese syndrome, there are also beta-blockers that help to adjust the autonomic nervous system. These are such tools as Anaprilin, Atenolol, etc.

If the patient suffers from drug dependence on the background of attacks of aggression, drugs based on lithium salts, as well as carbamazepine, will be needed.

If the patient has illusory-hallucinogenic seizures in combination with uninterrupted anxiety, then a good effect can be achieved by taking neuroidoxic drugs Thioridazine, Chlorprotixen, Levomenromazin in small amounts.

In complicated cases, with night hallucinations and insomnia, often resort to the appointment of drugs benzodiazepine, as well as Haltsion or Dormikum.

The general stimulating effect on the nervous system is provided by drugs-nootropics (Piracetam) - they are used to treat the asthenic syndrome. Such funds are taken in the first half of the day.

An obligatory component of complex therapy for Vietnamese syndrome should be psychotherapy. In most cases, practice psychotherapeutic sessions on behavioral psychocorrection, such sessions can be either individual or group sessions.

As additional methods, you can successfully apply:

• hypnosis;
• auto-training;
• relaxing techniques;
• art treatment (the transfer of emotions and fears in the image).

Prevention

The appearance of Vietnamese syndrome can not be prevented - just as it is impossible to prevent cruelty and death of people during military operations and conflicts.

Nevertheless, timely psychological support often helps early self-management of the disorder. That is why it is very important to provide such assistance to all, without exception, people involved in the psychotrauma situation - in this case, the military actions.

[36], [37], [38]

Forecast

Vietnamese syndrome can not be cured at one time: treatment is usually lengthy, and its outcome depends on many circumstances, for example:

• from the timeliness of applying for help to specialists;
• from the support of family and close people;
• from the mood of the patient to a successful outcome;
• from the absence of further psychological trauma.

For example, if the patient addresses to experts at a stage of preliminary exacerbation of a syndrome the duration of treatment and restoration of an organism can make from half a year to a year. The chronic variant of the syndrome is treated for one or two years. A more protracted course has a delayed syndrome - his treatment continues for at least two years.

If the Vietnamese syndrome is complicated by any pathological disorders, then often there is a need for lifelong rehabilitation and psychotherapeutic treatment.