Astheno-depressive syndrome as one of the most common mental disorders. Astheno-depressive syndrome, anxiety, anxious-depressive syndrome

The reason for the emergence of the term was the complexity differential diagnosis between depression and asthenia. The prefix "astheno" (from the Greek asthenēs) - in translation means weak, exhausted. This syndrome- this is a kind of symbiosis of asthenia and depression. This disorder should not be confused with asthenovegetative or astheno-neurotic syndromes, which are diseases of a completely different kind.

Thus, astheno-depressive syndrome is a shallow depression, in which the symptoms of asthenia are most pronounced (syndrome chronic fatigue). Often found in somatic diseases, neuroses and cyclothymia ( mild form ).

Causes and manifestations of astheno-depressive syndrome

The main reasons that cause astheno-depressive syndrome, experts call long-term psychotraumatic circumstances of a person's life that occur against the background of mental overstrain. Other sources of frustration can be:

• Traumatic brain injury.
• Avitaminosis.
• Sedentary lifestyle.
• Decreased immunity.
• Impaired thyroid function.
• Diseases of the cardiovascular system.
• Slagging of the body.
• Poor digestibility or insufficient intake of minerals from food.

As in the case of depression, astheno-depressive syndrome has primary and secondary symptoms. Pathological changes mood, disturbances in the rhythm of sleep and wakefulness, weakening of psychomotor functions come to the fore in this case. Other symptoms of the disorder that may well indicate its presence:

• Increased vulnerability.
• Rapid exhaustion.
• Weakness.
• Lethargy.
• Distracted attention.
• Various sleep disorders (insomnia, prolonged sleep).
• Distractibility.
• Hypersensitivity.
• Emotional lability (mood instability).
• Decreased libido.
• Slowing down the pace of thinking.

Risk group

1. People suffering from chronic inflammatory diseases: gastritis, duodenitis, cholecystitis, nephritis.
2. Representatives of the mass intelligentsia and creative professions: doctors, teachers, journalists, designers, designers, directors.
3. People in high leadership positions working activity associated with high nervous loads and great responsibility.

Astheno-depressive syndrome is a considerable danger to the mental health of a person. And not so much because in most cases it becomes a source of reduced efficiency and social activity, but because ignoring it can lead to the development of more complex and deep ones. The syndrome requires a specific treatment.

Self Steps to Healing

Defeat the disease without resorting to outside help, is quite real. To do this, follow the following best practices.

• Adjust your diet, eat less fatty and fried foods. Be sure to take vitamins, soft sedatives.
• Before going to bed, be sure to ventilate the room and try to relax.
• Take your time physical activity, their frequency should be at least twice a week. If there is no time for full-fledged workouts, do at least morning exercises.
• Distribute loads correctly. After work, try to have a good rest.
• For relaxation, use massage, aromatherapy and herbal medicine.

If, despite the measures taken, you do not observe significant improvements in your condition (the symptoms accompanying astheno-depressive syndrome are still strong), contact a neurologist, psychotherapist or psychiatrist who will select the appropriate treatment for you.

Help from experts

Treatment of the disorder begins with diagnosis. The specialist will conduct a conversation with you aimed at collecting an anamnesis, and will also try to identify and analyze the causes that provoked the onset of the disease. Then he will offer you some tests, questionnaires, with which he can get an idea of ​​​​the current state of your psycho. emotional sphere and course of the disorder.

At the next stage, the specialist determines the treatment regimen. The treatment of the syndrome directly depends on which symptomatology prevails in the patient: depressive or asthenic. In some cases, a course of psychotherapy may be effective: interpersonal and cognitive-behavioral psychotherapy. In other cases, the patient needs combination therapy, which will help eliminate the causes that caused his astheno-depressive syndrome. To achieve these goals, specialists use both psychotherapeutic effects on the patient and sedatives, as well as drugs from the group of antidepressants.

Remember that this syndrome cannot be ignored. This is fraught with grave consequences. Do not delay going to the doctor if you think that you cannot cope with your condition on your own and you need the help of specialists.

Depressive syndrome is a painful condition caused by a number of physical and mental disorders and characterized by a variety clinical manifestations. Depression is not always, as is commonly believed by many, expressed only in depression, apathy, melancholy and melancholy. This disease is often accompanied autonomic disorders, gastrointestinal lesions, endocrine pathologies. In some cases, these manifestations are so pronounced that they can overshadow the affective disorders of the syndrome itself. The depressive syndrome is serious illness requiring timely professional treatment.

Types of manic-depressive syndrome

By specific features depressive syndrome is divided into manic-depressive, asthenic-depressive and anxious-depressive. Manic-depressive syndrome is characterized by an unstable psycho-emotional background with periods of excessive depression, followed by extremely excited states, while the phases of depression are much longer than the manic phases. There are two types of manic-depressive syndrome. With the first type bright signs depressions can be combined with at least one full-fledged manifestation of the excited state phase, the second type - with a very rare observation of full episodes of this phase. Mild forms may also appear this disease with low manifestations of both phases, called cyclothymia.

Signs, treatment of manic-depressive syndrome

The manic phase is characterized by the following symptoms of a depressive syndrome:

• Inability to adequately control their actions;
• Excessive energy;
• disturbed concentration;
• Active gestures;
• Overeating, excessive alcohol consumption;
• Extreme excitability and irritability.

During this period, a patient with a depressive syndrome cannot objectively assess his capabilities, sometimes he creates the illusion of his own genius, unrecognized by others.

Signs of a depressive phase are:

• Apathy;
• Fast fatiguability;
• Depressed and dreary mood;
• Low self-esteem;
• Insomnia;
• Slowness and stiffness of movements;
• problems with memory and concentration;
• Feelings of hopelessness and thoughts of death.

At severe forms manifestations of the disease and suicidal tendencies, the treatment of depressive syndrome takes place in a hospital with the use of antidepressants, mood stabilizing agents, benzodiazepines, antipsychotic drugs.

Astheno-depressive syndrome

The causes of astheno-depressive syndrome may be external and internal factors, the latter include unstable psycho-emotional states provoked by various stressful situations. External causes include diseases that worsen the quality of life - oncological lesions, operations, injuries, chronic ailments etc. The symptoms of this type of depressive syndrome are:

• Irritability;
• Excessive sensitivity;
• Fast fatiguability;
• Inhibition of the thought process and speech;
• Feeling of exhaustion and general weakness.

With a long-term illness, gloomy, untrue assessments of one's condition and forecasts for the future appear. Against the background of depression, there may be disorders of the gastrointestinal tract, increased blood pressure, sleep disorders, menstrual disorders, lack of sexual desire, weight loss, etc. hallmark pathology is the improvement of the patient's well-being and the disappearance of many signs of the syndrome after a good rest or elimination of symptoms of somatic diseases.

Adolescents and young people, in addition to the above signs of astheno-depressive syndrome, may experience a guilt complex, problems with the perception of the surrounding reality, anger, rudeness, tantrums and unreasonable protests. The treatment of depression in this case depends on clinical picture diseases, courses of psychotherapy are usually prescribed, and if necessary, antidepressants and sedatives.

Anxiety-depressive syndrome

Manifestations of anxiety-depressive syndrome, as its name implies, are anxiety, excessive tension and all kinds of phobias. This type depression most often occurs in adolescence, with inferiority complexes, emotional instability, vulnerability and self-doubt characteristic of this period. The depressive syndrome at the onset of the disease can be expressed by various painful anxieties and fears, which, as the pathology develops, without proper treatment, can transform into panic fears. Teenagers fear the most own life and the well-being of loved ones, they are afraid of punishment (often completely without reason) for various faults, for their imaginary ugliness, lack of talent, abilities, etc., they are afraid to endure humiliation in front of other people. These manifestations are often accompanied by palpitations, dizziness, dry mouth, increased sweating. In a severe course of the disease associated with the loss of an objective assessment of the world around and the place of one's personality in it, a persecution mania may also arise. Treatment of anxiety-depressive syndrome includes the use of blockers, antidepressants and tranquilizers.

Take care of your health and the health of your loved ones, at the first signs of a depressive syndrome, contact a specialist. With timely and effective therapy, patients with this disease have the opportunity to conduct a full-fledged normal image life, work and have a family.

Asthenic depression is called mental illness, another name for which is mental exhaustion". This type of depression is one of the easiest. In addition to asthenic depression, psychasthenic depression is distinguished (accompanied by self-doubt), tearful (accompanied by impotence and melancholy), anxious (accompanied by causeless fear) and dystrophic (accompanied by displeasure, longing, disgust for life) depression.

Asthenic depression was described as early as 1899 by Ya.A. Anfimov, who described this disease as "periodic laziness and fatigue among students." However, later it was noticed that "periodic laziness and fatigue" can affect people of all ages and professions.

Causes of asthenic depression

This disease can occur at any age.

Asthenic depression (or otherwise asthenic syndrome), which developed as a result nervous tension or stress is called neurasthenia.

The cause of the development of asthenic depression can be any event that provokes nervous or physical exhaustion. Such events, in addition to stress, include chronic, infectious, nervous diseases and intoxication.

Symptoms

Symptoms of asthenic depression include:

In a severe form of asthenic depression, physical symptoms are observed:

• loss of appetite;
• weight loss;
• constant feeling of thirst;
• increased tearfulness;
• lack of concentration, poor ability to concentrate;
• decreased libido;
• sleep disturbance.

At mild form patients with asthenic depression remain fully active, but even simple steps such as washing and dressing are difficult and take much longer than usual. In severe form, the feeling of depression intensifies, the person feels a complete loss of strength.

Diagnosis can be made by physical symptoms. The initial period of the disease may be accompanied by vegetative-vascular disorders.

Drug treatment of asthenic depression

Without medical assistance asthenic depression can last a very long time. The treatment of this disease consists in creating for the patient favorable conditions. Everything needs to be removed annoying factors, and if necessary apply medical preparations: tranquilizers, sedatives and antidepressants. Mandatory in the treatment of depression is a course of psychotherapy.

Antidepressants are psychotropic medicinal substances used to treat depression. They reduce and relieve melancholy, apathy, lethargy and anxiety, improve mood, normalize sleep duration, and restore appetite.

Stimulant antidepressants (Prozac, Anafranil, Paxil, Cipramil) are used in the treatment of patients with apathy, melancholy and lethargy. Prozac (or fluoxetine) is a member of the serotonin reuptake inhibitor group. This medicinal product improves mood, reduces anxiety, dulls the feeling of fear, does not have a sedative effect, is not cardiotoxic. Anafranil is used for depressive states various symptoms, it has an antiserotonin effect and a sedative effect. Paxil refers to selective inhibitors reuptake of serotonin, is not amphetamine-like and does not affect the cardiovascular system. Another serotonin reuptake inhibitor is cipramil. It is used for depression various etiologies and structure, compatible with alcohol, antihistamines, beta-blockers, antipsychotics.

Sedative antidepressants (ludiomil, azafen, amitriptyline) relieve unconscious anxiety and irritability. Ludiomil belongs to tetracyclic antidepressants: the drug improves mood, eliminates anxiety. Azafen is effective in mild depression and depression medium degree gravity, strong sedative effect. Amitriptyline belongs to tricyclic antidepressants, has a pronounced sedative and hypnotic effect.

For mild depression, sedatives based on natural ingredients, such as St. John's wort, are used. St. John's wort extract can improve the condition in patients with mild to moderate depression. Unlike antidepressants, St. John's wort does not often have negative side effects(nausea, vomiting, allergic reaction). Unless it increases the excretion of drugs through the liver (due to which, it may be necessary to increase the doses of other drugs taken by the patient).

With timely adequate treatment asthenic depression has a favorable prognosis. The disease can quickly recede, but no one is immune from the recurrence of this disease.

Non-drug treatment

At non-drug treatment focus on diet, exercise, correct regimen day and walks fresh air. Insomnia in depression greatly exacerbates an already unstable state of mind. Therefore a good long good sleep promotes recovery in depression. For more sound sleep you should ventilate the bedroom before going to bed and, if possible, leave the window open. It would be best if during sleep the head is not much higher than the body (for this, the pillow should not be much higher than the level of the sheet), otherwise the blood supply to the brain will worsen, which will provoke a headache in the morning.

Exercising for depression can also help good impact on general state. Especially useful outdoor sports: jogging, cycling, swimming.

To get rid of depression, you need to have fun. You need to leave the house, visit friends, attend social events, concerts, exhibitions, nightclubs. Those who do not like noisy entertainment can play chess or read books, garden or plant a flower garden, take a bath with foam and fragrant oils. The main thing is that a person should have some kind of outlet - a favorite thing, the pursuit of which would help, at least for a while, to forget about bad mood. In a state of depression, many people spend day after day in front of the TV. This does nothing to improve the well-being of a person with depression: entertainment programs will seem uninteresting, and melodramas will cause unnecessary tears.

When you're depressed, try to balance your diet. Try not to overeat, but don't starve either. Diet will not cure depression, but it can greatly improve the condition. When depressed, it is better to exclude red from the diet. dry wine and fatty cheeses, as well as limit the consumption of meat and chicken.

While in a state of depression, it is better not to make such serious decisions as a change of job, place of residence, or divorce from a spouse. If such decisions still need to be made, discuss this first with relatives or close people, as a depressed person should not rely on his conclusions.

One of the types of psycho-emotional disorder is astheno-depressive syndrome. The pathological condition is accompanied by a loss of all interest in life. A person with this disorder constantly faces difficulties in making even the simplest decisions. This syndrome precedes depression, into which it can develop if the patient refuses the help of a specialist.

Astheno-depressive syndrome is a pathological condition of physical and emotional fatigue

The disease does not have its own ICD-10 code, since given state not classified as a separate diagnosis. At the same time, it is referred to different categories, which include the international classification of diseases.

Pathology is most often referred to as other neurotic disorders, which are indicated in international classification diseases code F48.

Pathology can significantly worsen a person's life. With absence adequate therapy it can develop into more serious problems with a mentality that is difficult to treat.

During the course of astheno-depressive syndrome of the system and internal organs human function to the limit own capabilities. Therefore, periodically they fail, due to which the patient manifests characteristic symptoms ailments.

Who is at risk?

Astheno-depressive syndrome, for which it is selected special treatment, most often found in people with a predisposition to it. It's about about people at risk. These include:

1. Representatives of creative professions.
2. Persons in leadership positions.
3. Adults and children who are prone to developing mental illness.
4. Patients with inflammatory diseases that are characterized by a chronic course.

People who are at risk should be more responsible for their physical and mental health. Otherwise, it will be difficult for them to avoid astheno-depressive syndrome.

Reasons for violation

Mental stress can cause pathology

Finding out the cause of the development of astheno-depressive syndrome is not so simple. This task can only be done experienced specialist. There are many factors that can lead to the development of pathology.

In most cases, the disease manifests itself due to the influence of the following negative factors on the human body:

• Prolonged experience of a traumatic situation.
• hereditary predisposition to the disorder.
• Traumatic brain injury.
• Mental stress or overload.
• Cardiovascular diseases.
• Weakened immunity.
• Disruption of the thyroid gland.
• Prolonged course of avitaminosis.
• Different types of intoxication of the body, including alcohol and nicotine.
• Doing little active image life.

Many of these reasons can lead a person into a state of panic. If you don't fight panic attacks they begin to intensify. As a result, the patient has new problems, among which this syndrome stands out.

Any shock can lead to the development mild depression. Gradually, this condition will only worsen if a person fails to find relaxation.

If a man or woman often exposes himself to depressive conditions, then you should seek help from a specialist, as in the future a person risks facing astheno-depressive syndrome.

Symptoms in children and adults

The symptoms characteristic of it help to determine the astheno-depressive syndrome in an adult. They are the reason for the diagnosis, based on the results of which treatment is prescribed.

A patient with a mental disorder may be tormented by only a few symptoms. As a rule, many people do not pay attention to them. special attention, as they are attributed to ordinary fatigue.

You can recognize a painful condition by the following symptoms:

• Unreasonable loss of interest in the events that occur in a person's life.
• Constant irritability and aggressiveness, which manifests itself for any reason.
• Inability to complete the work begun.
• Sudden mood swings several times a day.
• Inability to concentrate normally on a particular topic during a conversation or class.
• The development of phobias that did not disturb a person before.
• Frequent panic attacks.
• Excessive appetite or its complete absence.

The patient may also experience deterioration in sleep. He begins to be disturbed by insomnia, with which he is not able to cope.

The main symptoms of astheno-depressive syndrome are supplemented physiological signs ailments. People with this disorder may experience tachycardia, shortness of breath, excessive sweating, persistent headaches, and nausea. Along with this, diseases that disrupt the functioning of internal systems appear.

Often, people with the syndrome complain of non-existent pain in the body.

The manifestation of the disease can be observed not only in adults. Children also complain of signs of astheno-depressive syndrome. Parents should start sounding the alarm if they notice the following symptoms in their child:

• Unreasonable weight loss.
• Abrupt change of activities every 30 minutes.
• Intolerance and self-isolation.
• Insomnia.

If the child suffers from constant mental stress and leads sedentary image life, then he can become a hostage of astheno-depressive syndrome.

Diagnostics

The psychotherapist will prescribe treatment and help identify the cause of the disease

Adults and children with severe symptoms astheno-depressive syndrome, it is imperative to undergo a diagnosis. You need to consult a doctor, even if the signs of the disorder are still slightly pronounced.

Patients with suspected this disease should be examined in the office of highly specialized specialists. We are talking about an endocrinologist, a neurologist, a gastroenterologist and a urologist.

In depression, it is recommended to contact a psychotherapist. He will determine the root cause of the disorder and tell you how to treat it. Consultation of highly specialized doctors is required in order to identify the presence chronic pathologies, which could have an impact on the development of astheno-depressive syndrome.

If a person does not have organic causes of the disease, then a psychotherapist will conduct further diagnostics. He must talk to the patient. During the collection of anamnesis, he will be able to find an explanation for the symptoms of the syndrome that have manifested.

Comprehensive treatment will help get rid of astheno-depressive syndrome

A mental disorder can be cured by methods that will be offered by the attending physician. It is strictly forbidden to try to cure a person with astheno-depressive syndrome on your own, as such actions can aggravate his condition and lead to slow death. Without adequate therapy for people with prolonged depression awaits death.

Treatment of the disorder involves A complex approach. It includes taking medications, attending psychotherapeutic trainings and changing the habitual way of life.

What drugs will the doctor prescribe?

It is extremely rare for patients with astheno-depressive syndrome to manage without medication. Therapy with drugs can only be prescribed by a doctor. They are prescribed by a psychotherapist. The psychologist does not have the right to recommend certain medicines to the patient.

Patients with a mental disorder should be observed by a psychotherapist. The cost of consulting a specialist on average costs 600 rubles.

In the treatment of astheno-depressive syndrome, drugs of different groups are used.

It is strictly forbidden to take drugs that have not been approved by your doctor. Such therapy can lead to a deterioration in general health and aggravate the course of the syndrome.

Lifestyle

As a self-help, the patient should change his habitual image life. This will strengthen the methods of therapy proposed by the doctor to combat astheno-depressive syndrome.

A good result is the maintenance of an active lifestyle. A patient with a mental disorder should include physical education in his daily routine. It is highly undesirable to play sports strenuously. It is necessary to periodically increase the degree of load.

Patients with astheno-depressive syndrome are useful hiking outdoors. It is best to do this in the evening, before going to bed. It is enough to walk for 30-60 minutes to improve your general condition and mood. From time to time, you can replace walking with running.

If desired, the patient can sign up for dancing and swimming classes. Rhythmic movements and water are among the most powerful antidepressants.

Any sport that a person decides to engage in should bring him exclusively positive emotions. Otherwise, such treatment will only be harmful, since the patient will have to force himself to attend classes that do not bring pleasure.

Diet

Cope with astheno-depressive syndrome will help special diet. It is also included in the therapy that is offered to patients with this disorder.

With the help of diet, it is possible to cope with the disease on early stage development. Thanks to her, patients can do without long-term drug therapy.

Patients with a mental disorder are strongly advised to stop using a large number fatty foods. Instead, it is best to include dried fruits, cereals, legumes and nuts in the diet.

Without fail, the diet should contain foodstuffs enriched with proteins, vitamins and minerals. It is worth paying attention to dairy products, lean varieties meat and eggs.

It is necessary to limit yourself in the use of sweets, as they are enriched with fats, which contribute to the aggravation of the course of the disease.

Other Therapies

Traditional physiotherapy procedures can be used as ancillary treatments. Patients with astheno-depressive syndrome are recommended:

1. Phytotherapy.
2. Aromatherapy.
3. Autotrainings.

Also, we must not forget about the correct distribution of work and rest. A person should have enough time for his body to fully recover after physical or mental activity.

Forecast

Depressive syndrome is a painful condition of a person, which is characterized by various mental and physical disorders. And although many people under depression mean, as a rule, boredom, melancholy and apathy, to understand this pathology only as a manifestation of these symptoms is incorrect. In fact, depression is a rather serious disease that affects physical health human, and sometimes can lead to irreversible consequences. Therefore, depressive syndrome requires careful diagnosis and often long-term treatment.

Manic depressive syndrome

Depression different people may develop into certain types pathologies that have common features, as well as specific. The latter are inherent only in a particular variety of this disease state and help to identify it in determining the diagnosis. So, the manic-depressive syndrome is distinguished by the alternation of two main phases - manic and depressive, in the intervals of which periodic enlightenments can appear.

The following symptoms of a depressive syndrome are characteristic of the first phase:

• elevated mood;
• Energy;
• Psychomotor agitation;
• Active gestures;
• Acceleration of thought processes.

The patient in this phase usually talks and laughs a lot, often he overestimates his abilities and takes on work that he cannot actually do. Often he has confidence in his own genius, so patients with manic-depressive syndrome can pretend to be artists, poets, actors, etc.

The second, depressive phase is the exact opposite of the first. In this phase, the patient has the following symptoms:

• Oppression;
• sad mood;
• Stiffness of movements;
• Inhibition of thought processes.

Depressive phases, as a rule, last longer than manias, and the frequency of these conditions varies from person to person: from several days to months. It should be noted that patients with manic-depressive syndrome are usually aware and even critical of their condition, but they are unable to fight it.

In mild cases, the treatment of this type of depressive syndrome can be carried out on an outpatient basis, while in severe cases, it can be done inpatiently, using strong antidepressants.

Astheno-depressive syndrome

Astheno-depressive syndrome in medicine is called a mental disorder, which is characterized by such signs as:

• General weakness of the body;
• Fast fatiguability;
• Anxiety;
• Frequent headaches;
• Hypersensitivity;
• Inhibition of movements, speech and thought process.

The causes of this type of depression can be divided into internal and external. The first includes various stressful situations And pathological conditions emotional sphere. The external causes of astheno-depressive syndrome are all kinds of diseases, for example: oncological diseases, heavy operations, injuries, infections, diseases of cardio-vascular system etc.

In adolescents and young people, the symptoms of this type of depressive syndrome can acquire a bright negative connotation. In this case, signs such as:

• Regular tantrums;
• Coarseness;
• Anger and irritability;
• Unfounded protests.

A protracted illness is often fraught with the emergence of a guilt complex, which is joined by a gloomy assessment of both the surrounding world and one's own condition. In addition, astheno-depressive syndrome affects the physical health of a person. Against the background of this pathology, disturbances occur in digestive system, pressure rises, appetite and sleep are upset, often disturbed menstrual cycle in women, disappears sex drive etc.

It is important to note that characteristic feature this type of depression is the improvement of the psycho-emotional state of a sick person after elimination somatic symptoms sickness or good rest.

Treatment of a depressive syndrome in this case directly depends on the severity of the disease. In some cases, a short session of psychotherapy can help the patient, while in more neglected cases, not only a long course conducted by a psychotherapist, but also the use of antidepressants and sedatives for a long time.

Anxiety-depressive syndrome

The name of this type of pathology speaks for itself: the main symptoms of this type of depressive syndrome are anxiety and panic fears. It is important to note that these features are more characteristic of adolescence, in connection with which this type of depression in most cases is observed in transition period. This is due to increased emotionality, vulnerability and even an inferiority complex that arise at this stage.

Anxiety-depressive syndrome is manifested by painful fears different nature which gradually turn into phobias. Very often, adolescents who develop the syndrome are terribly afraid of punishment - for committed and imperfect actions, for not being beautiful enough, smart, talented, etc. An important symptom depressive syndrome in this case is almost total loss ability to objectively evaluate the world, various situations in him and his own personality. All this is presented to the patient in the most gloomy light, since it is perceived extremely hostilely.

Against this background, persecution mania can also develop. It often seems to patients that everyone is deceiving them, adjusting life situations in such a way as to lure them into a trap. People around can be perceived as enemy agents who are watching their every move. Suspiciousness, suspicion, excessive sensitivity become permanent signs anxiety-depressive syndrome, taking away from the patient all the energy and strength to fight against dangers that do not exist in reality.

Treatment of a depressive syndrome in this case involves the immediate help of a professional psychotherapist, possibly with the use of sedative drugs.

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