More theory-driven and less diagnosis-based behavior therapy.

Individualized treatment based on a functional analysis of problem behavior used to be considered a hallmark of behavior therapy. Yet the relative success of recently developed treatment manuals for DSM-defined disorders has cast doubts as to whether treatment individualization is really necessary. This article evaluates some of the relative merits of assessments and manualized treatments based on DSM categories and discusses data that indicate when a protocol treatment approach is sufficient and when it is not. Finally, a theory-driven approach to conducting behavior therapy is proposed as a way to complement individualized and manualized treatments. This approach is illustrated by presenting a model-based assessment and treatment approach to overcome excessive heart-focused anxiety (cardiophobia).

The rise and fall of the chronic fatigue syndrome as defined by Holmes et al.

This paper is a sequel to my monograph on neurocirculatory asthenia and chronic fatigue syndrome. It pays special attention to the nature of chronic fatigue syndrome, to the forms of neurocirculatory asthenia, and above all to the 6th form in which profound fatigue is the dominant symptom. All forms including the 6th are characterized by the presence of concomitant symptoms due to dysfunction of the autonomic nervous system. Chronic fatigue syndrome as defined by Holmes et al is devoid of these symptoms. Up till the present day no case histories of it have been published. It is argued that chronic fatigue syndrome sensu Holmes et al does not exist, the 6th form of neurocirculatory asthenia having to take up its place.

Neurocirculatory asthenia: a reassessment using modern psychosomatic criteria.

The purpose of this study was to assess the prevalence of mental illness and to evaluate the quality of life of patients with neurocirculatory asthenia. A consecutive series of 80 patients who satisfied the diagnostic criteria developed by Kannel et al. for neurocirculatory asthenia was included in this study. Patients underwent a psychiatric diagnostic research interview and extensive psychometric evaluation, with both observer and self-rated scales for depression, anxiety, phobic symptoms, quality of life and abnormal illness behavior. In 47 patients (59%), a psychiatric diagnosis (mainly an anxiety disorder) antedated the onset of neurocirculatory asthenia, which was thus defined as secondary, also because cardiorespiratory symptoms were part of the mental symptoms. In the remaining 33 patients (41%) neurocirculatory asthenia was the primary disorder. Patients with secondary neurocirculatory asthenia reported significantly higher levels of anxiety, depression, social phobia, abnormal illness behavior and an impaired quality of life compared with patients with primary neurocirculatory asthenia. This latter did not significantly differ in these variables (except for depression) from healthy control subjects matched for sociodemographic variables. At a 1-year follow-up, patients with primary neurocirculatory asthenia had a much better prognosis than those with secondary neurocirculatory asthenia. The results indicate the feasibility of the primary/secondary distinction based on the time of onset of mental and cardiorespiratory symptoms in neurocirculatory asthenia. Since only about one quarter of the patients were found to suffer from decreased energy and fatigue according to specified criteria, the terms neurocirculatory asthenia and effort syndrome should probably be discarded.

[Characteristics of neurotic state and transmembrane transport of sodium in erythrocytes in hypertensive and cardiac variants of neurocirculatory dystonia]. / Osobennosti nevroticheskogo sostoianiia i transmembrannyi transport natriia v éritrositakh pri gipertonicheskom i kardial'nom variantakh neirotsirkuliatornoi distonii.

The paper provides findings from an examination of 26 patients with neurocirculatory dystonia (NCD) with the hypertensive syndrome, 18 with NCD of the cardiac type (neurocirculatory asthenia), and 10 healthy subjects. Application of original psychological questionnaires made it possible to detect anxiety neurosis in a cardiac variant of NCD and neurosis with marked conversion in a hypertensive variant of NCD. In the latter, there was an increase in Na+/H+ and Li+/Na+ countertransport rates in the erythrocyte membrane, which was typical of essential hypertension. In the former variant, the Na+/H+ countertransport rate was lower in the erythrocyte membrane than that in the controls, whereas no differences were found in Li+/Na+ countertransport rates between the cardiac NCD patients and the controls.

[Autonomic dystonia syndrome]. / Sindrom vegetativnoi distonii.

The problems of the terminology of vegetative disorders are discussed, the syndromal nature of vegetative dystonia is stressed. The main patterns of the pathology underlying the development of vegetative dystonia are described, providing an opportunity of identifying the etiological factors. Within the framework of the vegetative dystonia syndrome, a symptom complex is distinguished, which is determined by dysfunction of the suprasegmental parts of the vegetative nervous system, namely the psychovegetative syndrome and manifestations of segmental vegetative pathology in the form of a syndrome of progressive vegetative insufficiency and vegetotrophovascular syndrome.

[Clinical features of neurocirculatory asthenia within the neurological structure of neuroses]. / Klinicheskoe techenie vegetososudistoi distonii v nozologi- cheskoi strukture nevrozov.

As many as 177 patients were subjected to a clinical analysis of the course of vegetovascular dystonia within the scope of the nosologic structure of neuroses with different semiologic manifestations. Use was made of the polymodal clinical classification of vegetovascular dystonia with regard to the vegetative background, from, course, character and rate of crises. It has been established that vegetative function in neuroses is determined by different conditions of the vegetative tone, reactivity and vegetative supply of the activity which requires a differentiated approach to the treatment with an adequate selection of the sympathetic and parasympathetic remedies.

Rehabilitation of patients with NCA (neurocirculatory asthenia) through a short term training program.

Twenty-two patients, 18 years old, with the predominant somatic type of NCA, and a control group of 22 healthy subjects participated in a short term training course lasting three weeks. Following the training the NCA subjects showed a significant change in the systolic and diastolic blood pressure after 5 minutes of recumbency as well as in the systolic blood pressure after 5 minutes of standing, diastolic pressures during 50 W load and submaximal effort (100-150 W) - all the values being significantly lower following the training, except the diastolic pressure during 50 W load which was higher following the course. The prominent training effect was on the heart rate during light work loads (50 W) in which a decrease from a mean of 151.2 +/- 13.9 to 118.3 +/- 16.3 beats/min was recorded. This decrease indicates the better adaptation of the NCA patients to physical effort. Similarly, a significant increase in the mean VO2max from 31.5 +/- 6.1 to 37.7 +/- 5.9 ml O2/kg B.W./min was observed. No changes were recorded in the ECG after the short training course. Following the training all the symptoms typical of the NCA syndrome vanished. A short physical training of 3 weeks can start the procedure of rehabilitation of a well selected group of NCA patients with predominant somatic complaints. The rehabilitation must be continued throughout life by continued physical training.