Clinical Observations of Autonomic Nervous Dysfunctions from the Viewpoint of the Primary Care Physician(Pathophysiology and Treatment of Autonomic Nervous Dysfunctions)

Abstract

Though the pathogenesis of autonomic nervous dysfunctions (AND) is not completely understood, it is also true that many patients with various kinds of psychosomatic complaints are diagnosed as having an AND and are treated psychosomatically. To ascertain whether this is the practice, a questionnaire was sent to 15 primary physicians and it was found that 93% of these physicians diagnose psychosomatic patients as having an AND and that 80% Of these physician consider this diagnosis useful. The criteria they apply is that they can find no organic changes which could explain the patient's complaints or that the patient vaguely complaints about various autonomic nervous dysfunctions. When faced with such patients, rarely do these physicians perform psychometric and/or autonomic nervous function tests. The many AND outpatients seeking treatment at the author's hospital has led him to examine these cases in depth. Thus, a retrospective study was made of all new patients treated during 1987. The number totaled 301 (103 males and 198 females) and, in most instances, no more than two diagnoses were made per patient. Out of these 301 patients, 125 (54 males and 71 females) or 41.3% were diagnosed as suffering from depression or being in a depressive state. Additionally, 84 patients (37 males and 47 females) were diagnosed as having an AND. Statistically, the AND cases represented 27.7% of the total number of patients and their average age was 35. 2 years. The most common AND complication was depression, followed by conversion hysteria, psychogenic reactions, and anxiety neuroses in that order. Of this total of 84 AND patients, however, only five had no other complications nor a second diagnosis. As for previous treatment, 13 were first time patients, while 28 (34%) had visited more than two other clinics previously indicating a tendency to shop around for a cure. Treatment for AND cases most commonly consisted of pharmacotherapy with brief sessions of psychotherapy and 61 patients (71%) were handled in this way. Six other patients received autogenic training and music therapy, conducive to relaxation and the prevention of AND. Eight other patients, manifesting complicated and severe AND conditions, were given fasting therapy. In conclusion, though AND may be a transient diagnosis, it nevertheless is useful for primary care physicians, and it is essential to treat AND patients by employing a psychosomatic approach.