Psychosis and psychopathy symptoms
Psychoses can occur with various human diseases.
Mental disorders in atherosclerosis of cerebral vessels are of a progressive nature. In accordance with the course of the disease, they manifest themselves in the following periods:
1) a manifestation period with asthenic, neurosis-like and psychopathic syndromes that have arisen on the basis of functional and dynamic disorders due to atherosclerosis of the brain vessels;
2) a period of pronounced clinical manifestations with anxiety-depressive, anxious-hypochondriacal, anxiety-delusional syndromes and acute confusion, developed on the basis of atherosclerotic encephalopathy;
3) a period of dementia with dysmnestic disorders( dementia pseudosenile, post-paraplegic), developed on the basis of gross atherosclerotic organic lesions of the brain.
In the initial period, asthenia is most common. In patients, the working capacity decreases, there is a rapid fatigue, the difficulty of switching from one activity to another, difficulty in mastering a new case, malaise, heaviness and pressure in the head, headaches, dizziness, sometimes mild paresthesia. Asthenia develops very slowly, has a wavy course. Gradually, a decline in memory develops, it is difficult for a patient to recall dates, names, terms. For a number of years, patients are coping with their usual duties, but they spend more and more time performing them. There are violations of attention, difficulty in using memory stocks. In the future, memory disorders deepen. Patients hardly remember and learn new knowledge, but memory for the past long time remains safe. The mood of patients is usually low, the patients are aware of the changes that have come about and are critical of them. Wave flow gradually becomes less pronounced;mental disorders acquire a permanent character, revealing a tendency toward progressive development. Psychic activity is becoming more rigid, one-sided, the circle of interests sharply narrows and focuses on small things. The character of the patients changes: features of stinginess, grumbling, pickiness, unceremoniousness with the tendency of interference in other people's affairs appear.
In the second period against a background of increasing somatic and neurological disorders( see Internal Diseases, Nervous Diseases), patients develop an anxious-depressive state with a depressed mood, tearfulness, insecurity, anxiety for their health. The patients experience various senestropathies( "prickles the face", "bows the back of the head," "the legs grow numb," etc.).There is a hypochondriacal fixation on minor somatic painful sensations. With an anxious hypochondriacal condition, patients express alarming fears about having any disease( more often cancer), looking for signs of this disease. Some patients experience hallucinatory-paranoid disorders with the presence of delusions of damage, exposure, persecution( the patient claims that the neighbors have conspired against him to steal him, live at his expense, in their actions he is always looking for a secret meaning,at home, locked in many locks).
In the third period, the state of dementia( dementia) is noted. In patients, memory for current events is dramatically upset and relatively preserved on the past. There is marked dementia. The patients are helpless, can not service themselves. The consequence of the hemorrhages in the brain may be post-apoplectic dementia, which is expressed in deep memory disorders, violent laughter and crying, complete helplessness with the inability to serve yourself and amnestic disorientation in the environment. Late epilepsy may develop. With chronic ischemic disease of the brain, pseudosenile dementia develops with aphathic disturbances and violation of praxis in some patients, a sharp decrease in memory with a shift to the past, a disorder of orientation in the environment and in one's own personality.
Treatment of mental disorders in atherosclerosis depends on the clinical picture. The asthenic and neurotic state in the first period is reversible. After treatment of atherosclerosis, aminalone is used - 0.25 g 2-4 times a day, general restorative therapy, tranquilizers. The work ability of patients is usually restored. It is necessary to monitor the psychoneurological dispensary dynamically to prevent decompensation, which is usually associated with mental trauma, alcoholism and other exogenous factors. A correct regime is necessary, alternating the work and rest that is feasible for the sick. For the treatment of depression, pyrazidol, azaphene, amitriptyline, imizine( melipramine) are used. The dose of drugs is usually low( with an increase in the dose in patients may develop delirious phenomena).In paranoid syndromes, triflazine, aminazine are shown. The dosage is determined individually depending on the mental, somatic and neurological state of the patient( see Internal Diseases, Nervous Diseases).Treatment of late epilepsy is carried out with phenobarbital and other anticonvulsants( see Epilepsy).The work ability of patients in this period is usually lost. With atherosclerotic dementia, symptomatic therapy is performed;patients need care and supervision.
Mental disorders in hypertensive disease are difficult to distinguish from atherosclerotic. In the initial stage of hypertensive disease, asthenic syndrome also develops, memory weakness is noted: memory of the current, present is usually upset. There may be disturbances in consciousness that occur suddenly, last from several hours to several days, accompanied by a sharp rise in blood pressure, and with a decrease in hypertension pass. The confusion of consciousness can manifest itself in the form of delirium with bright visual hallucinations of sometimes awesome character;there are isolated auditory hallucinations.
Psevdotumorozny syndrome in hypertensive disease is reminiscent of the clinical picture in the development of brain tumors. Patients complain of intense headache, euphoric, irritable, often angry. Bradypsychism develops with slow motion. Psevdotumorozny syndrome develops acutely, and its basis is the hypertonic crisis. After hypertensive stroke, a pseudo-paralytic syndrome can develop. Patients are euphoric, benign, with pronounced impaired memory;the circle of interests is limited to domestic issues, work capacity is lost;sometimes there is a reassessment of one's self;Critical attitude to their condition in patients is not.
Treatment. Along with the general therapeutic measures( see Internal Diseases, Nervous Diseases) with hypertensive psychoses, psychopharmacological drugs can be used: reserpine, aminazine, propazine, thioridazine( melleril), haloperiol. The use of these drugs requires constant monitoring of fluctuations in blood pressure in order to avoid the development of severe collapse and constant monitoring of the neurological condition of patients in order to avoid complications of extrapyramidal nature from the nervous system.
Mental disorders can occur at different stages of the course of an infectious disease. As a rule, after the end of the infectious disease, the so-called asthenia of convalescents with increased exhaustion, irritability, headache is noted. Asthenia passes gradually within 1 -3 weeks. We recommend general restorative therapy. In the acute period of an infectious disease, in some patients, obscuration of consciousness in the form of delirium may develop, less often amenations. With the development of delirium, multiple visual hallucinations of a fantastic or intimidating nature appear, the patients are detached from the environment, they are not oriented in time and environment, but the orientation in their own personality is preserved. The sick feel fearful, restless. Amenia is accompanied by deep confusion, an affect of perplexity, incoherence of thinking and speech in the form of a meaningless set of words. There is a disorientation in the surrounding and self. Patients are excited, do not answer questions. The duration of the anomalous obscuration of consciousness is from several days to several weeks;on recovery the patients do not remember the acute period of the disease. It is necessary to carefully monitor the patient's condition.
Treatment. It is recommended that hypnotics be prescribed, since insomnia is an early symptom of mental disorders. To stop the excitation, which occurs when the mind is darkened, it is recommended to administer 25% magnesium sulfate solution - 10 ml IM, 2.5% solution of aminazine - 2 ml IM or 0.5 ml of 0.5% solution of haloperidol IM.Carry out detoxification therapy( glucose injections), massive vitamin therapy, hypodermic injections of isotonic sodium chloride solution, abundant drink, rational high-calorie nutrition. Patients with acute infectious psychoses are not recommended to be transferred to a psychiatric hospital. They must be left in the infectious department for the treatment of the underlying disease, isolated from other patients and assigned to an individual 24-hour sanitary post.
Despite the certain commonality in the development of mental disorders in acute infectious diseases, in some diseases it is possible to note the inherent characteristics of them.
Mental changes in the first period of the disease are characterized by depression of the psyche, lethargy, asthenia. At the height of the disease sometimes at night there is a brief delirium with an abundance of visual hallucinations and motor excitement. At the end of a somatic disease, when somatic exhaustion occurs in some patients, the anomalous confusion of consciousness with disorientation in the surrounding, confusion, bewilderment, incoherence of speech can develop;sometimes there is motor excitement within the bed. Patients need strict supervision, appointment of an individual medical post.
Treatment. In addition to etiological treatment, measures are recommended to improve the physical condition( infusion of glucose, vitamins, with the development of delirium - sedatives, haloperidol 2.5 mg / day IM, triftazine 5 mg / day IM( inside psychotropic drugsDo not give.)
Mental disorders occur at the height of croupous pneumonia. This is often observed delirium with multiple visual hallucinations of a frightening nature, a sharp excitement( the patients try to escape somewhere). The intensity of confusion of consciousness fluctuatesI. Psychosis occurs more often during a crisis and is associated not only with intoxication phenomena, but also with the phenomena of anoxemia
Treatment: oxygen inhalation, sedation( valerian, motherwort) and cardiac care.period of delirium
Mental changes are characterized by asthenia, against which depression can develop with suicidal thoughts. With severe virus flu, delirions with sharp motor excitement can occur, sometimes fromAgen cranial nerves, a high temperature. Psychoses last for several days. Usually they end in convalescence. Encephalitic influenza psychosis with a vascular lesion of a toxic and inflammatory nature sometimes ends lethal. Treatment is symptomatic and antitoxic. Patients need strict supervision of medical personnel.
Mental disturbances can occur at the height of the breath in the form of a delirious confusion of consciousness with copious scene-like hallucinations, with disorientation in the surrounding, a transition to an amenable state is possible. Duration - from several hours to several days
Treatment - see treatment of malaria with quinine or acrichine, restorative therapy, sedatives - etaperazine, chlorprotixen in small doses.
Mental disorders are characterized by a delirious confusion of consciousness at the height of the disease with the development of delusions of the "double"( the patient seems to have another person next to him), with delusional ideas of influence( the sick feel that their body is being ripped apart), with a sense of some disasterssick It seems that they are flying somewhere, fail);mood is anxious-depressed with excitement. Psychosis usually continues until the resolution of the disease, ends with a long sleep and severe asthenia. Patients need strict supervision, an individual post is needed at the time of delirium. Treatment is symptomatic, restorative, sedative( small doses of etaperazine).In the period of asthenia, aminalon is recommended.
With the increase in the number of diseases of infectious-allergic origin with a sluggish course, which include brucellosis, rheumatism, etc., other forms of mental disorders have been identified. With prolonged and severe course of the disease accompanied by severe asthenia, protracted psychoses can appear in the form of affective, paranoid and organic psychosyndromes. Protracted psychosis takes a long time - from 2-3 weeks to several months. Depressive states are characterized by frequent mood swings throughout the day - from melancholy with suicidal thoughts to depression with irritable weakness and rapid exhaustion, grumbling, discontent with the environment, treatment. Paranoid states are characterized by development against the background of pronounced asthenia of the so-called primitive delusions of the relationship with unstable delusional ideas, the content of some reflects the external situation( perceived wrongly by the patient) and constantly changes along with the change of this situation. Patients claim that they are treated worse than others, give less drugs, want to get rid of them. In some cases, with an unfavorable course of the underlying disease, protracted psychoses can transform into organic changes in the person with a decrease in memory and criticism, exhaustion, apathy.
Treatment is the same as treatment of the underlying disease, as well as general restorative therapy, aminazine - 12-50 mg / day, trifazin - 5-10 mg / day, and with depression - pyrazidol.
Patients need supervision of medical personnel, individual post is recommended.
These are mental disorders caused by the effects of a variety of toxic factors - industrial poisons, insecticides, poisonous fungi, etc.
For acute intoxication, obscuration of consciousness is more common in the form of delirium, sometimes passing into sopor and coma. It is accompanied by a number of somatic and neurological disorders. With prolonged chronic intoxication, reversible, but protracted, depression-paranoid, catatonic syndromes, sometimes amnestic( Korsakov) syndrome develop. Then the intellect decreases, memory is broken, and organic dementia gradually builds up.
Treatment is symptomatic, detoxication, careful use of neuroleptic drugs only with protracted psychoses. Necessary hospitalization of patients, bed rest, careful observation.
is characterized by periodic affective attacks( depressions or mania) followed by a complete recovery of health( light interval).The etiology of the disease is not clear enough. The importance of hereditary complication is based on a constitutional anomaly. Predisposing moments include mental trauma and somatic diseases. The disease occurs usually in adulthood, women are more often ill.
Depressive phase. In the clinical picture the leading place is occupied by a mood disorder in the form of melancholy, as well as other changes in mental activity. The unfolded syndrome is characterized by affective, ideatoric and motor inhibition. Anguish is vital, accompanied by pain in the heart. The patients are bleak, do not have an interest in life, their future is hopeless, the surrounding perceive gloomily. Thinking is slow, differs monotonous depressive content;any mental strain seems heavy. Patients complain of memory loss. Many lie, the motivation for activity is reduced, movements are slow, the expression is sorrowful, speech is quiet, monosyllabic. Patients express nonsense self-blame, consider themselves criminals, superfluous people. Some patients develop suicidal thoughts and tendencies;decreased appetite, sleep disturbed, body weight decreased;there are tachycardia, increased blood pressure, wide pupils. There are daily fluctuations in the state: in the morning, depression is more pronounced than in the evening.
All patients, who have suicidal thoughts and tendencies, are placed in the supervisory psychiatric ward. They must be under strict 24-hour supervision, their staff should be informed of their condition. Their things need to be viewed every day. Medicines should be taken under the supervision of the staff.
Depressive phases may be less deep, their clinical picture in a number of cases is manifested by anxiety, motor anxiety( agitation).
Usually, patients with depression are placed in a psychiatric hospital or day hospital( if there are no suicidal thoughts).Perhaps outpatient treatment under constant medical supervision and supervision by relatives, who monitor the reception of patients with drugs, for possible sharp deterioration of the condition.
Manic phase - unmotivated increased cheerful mood, accompanied by acceleration of intellectual processes, speech and motor excitement. Patients experience a feeling of unusual vigor, a burst of energy. Patients expressed a desire for action, but they do not carry out one thing to the end;are restless, occasionally aroused, they are many-sided. The ideas of greatness that arise in the manic state are usually of a concrete nature and consist in exaggeration of one's own merits or occupied position. Disinhibition of instincts is observed: patients are gluttonous, sexual, they have no control over their behavior. Sleep is usually upset. Despite the gluttony, patients lose weight. Sympathico-tonic disorders( tachycardia, increased blood pressure, mydriasis) in the manic phase are less pronounced than in the depressive phase. Patients in a manic state are hospitalized in a psychiatric hospital due to misconduct.
The phases of manic-depressive psychosis result in complete restoration of health while maintaining individual personality characteristics. Sometimes light intervals can lead to light mood swings without a significant change in performance. Isolate the depressive type of flow, in which no manic phases occur, the manic type - without depressive phases and the circular type - with alternating manic and depressive phases. The mild forms of this disease are called cyclotomy.
Treatment of the depressive phase is carried out with antidepressants( imizin - melipramine, amitriptyline), if there is no agitation, anxiety, hypochondriacelo-senestopathic disorders. Prescribe melipramine to 150-200 mg in the first half of the day orally or 100-125 mg IM;at night with a sleep disturbance, it is recommended that levomepromazine( tizercin) be 0.025 g or nitrazepam( eunotin) 0.01 g( or 0.005 g) or phenazepam 0.0005 g. Amitriptyline is administered at a dose of 200-400 mg / day. When the therapeutic effect is achieved, the doses gradually decrease.
In agitated or hypochondriacal depression of antidepressants, pyrazidol may be administered at a dose of 0.1-0.15-0.3 g / day. With pronounced motor excitement, fear, senestopathy, it is recommended to use neuroleptics of a wide spectrum of action - aminazine up to 100 mg / day or levomepromazine up to 50-75 mg / day;gradually doses of antipsychotics are reduced, and doses of antidepressants are increased. It is necessary to control blood pressure, blood picture, prothrombin index, liver function and kidney function.
Treatment of the manic phase is performed by a wide spectrum of neuroleptics - aminazine( 150-200 mg IM or up to 300 mg / day orally) or tizercin( 150 mg / day inwards or 75 mg / day IM).Correctors - cyclodol( up to 6-9 mg / day) are prescribed, insomnia - neuleptil( 10 mg at night!)
Clinic of mental disorders depends on the nature of the tumor, localization and prescription of the disease. In a malignant tumor( or metastasis) mental disorders occursuddenly, are manifested by absurd acts, incoherent and meaningless utterances, and then comes the stunning, gradually turning into a sopor. In benign tumors, mental disorders manifest themselves first in hyperesthesia, fatigue, fastingand the difficulty of intellectual activity, the slowed reaction to the environment, persistent headache, and sometimes convulsive seizures and paroxysmal impairments of consciousness occur, followed by local symptoms-psychosensory disorders, monotonous elementary auditory and visual hallucinations( dogs barking, squeaking, etc.).), aphathic and aprakticheskie violations, develop syndromes of obscuration of consciousness - stunning, sopor, coma.
Neurosurgical treatment. Patients need care and supervision.
Occur during the involution period;etiology is unclear, great importance is attached to age-related impairment of endocrine gland function. Predisposing moments are psychogeny and somatic diseases. Psychosis manifests itself in the form of involuntary melancholy and an involutional paranoid.
Involutional melancholy in most cases occurs after a short prodromal period with asthenia, mood reduction, headache. Further depression develops with the phenomena of hypochondria and numerous senestopathies, increased attention to one's health, obsessive fear of contracting a serious incurable disease or conviction of an incurable disease.
It is accompanied by vegetative symptoms - tachycardia, sweating, dyspeptic phenomena and multiple unusual sensations - sensopathies( sensation of burning in the body, crawling, shaking of blood vessels and nerves).The behavior of patients is incorrect. They prescribe a special regime, a diet. Constantly address to doctors of various specialties, demanding numerous inspections.
Acute period of the disease manifests itself in the form of agitated depression: patients are constantly on their feet, rushing, groaning, expecting the upcoming torment, execution, death of the family. Perception of the environment is illusory;in conversations of people hear threats to their address, accusations, convictions. In patients, somatic changes are observed - premature senescence, weight loss. The course of the disease is long, after severe clinical disorders, the clinical picture stabilizes. Then the affective disorders become less pronounced, the depressive delirium gradually disappears and recovery comes. Patients should be hospitalized. Strict supervision is necessary.
Treatment. In involutional melancholy, vigorous general restorative therapy is recommended - zursovoe treatment with cocarboxylase with vitamins B1, B2, C;drip infusion of 5% glucose solution - 500 ml or isotonic sodium chloride solution( especially when refusing to eat).It is expedient to prescribe tizercin - 75-100 mg / day IM in the presence of severe agitation. After the agitation, antidepressant therapy with amitriptyline is prescribed up to 300 mg / day, and then with imipen( melipramine) up to 75 mg / day. With prolonged course and increase of somatic exhaustion, it is recommended to conduct electroconvulsive therapy( in the absence of contraindications).With a refusal to eat - the introduction of insulin( 6-10 units) before meals, feeding from the hands and through the probe, amytal-caffeine disinhibition( see Care of the mentally ill).
Characterized by delusions of everyday relationships in conjunction with delirium damage. The mood of the patients is alarming, suspicious. They begin to "notice" that things are disappearing, food is spoiled, clothes are spoiled, accusing friends or neighbors of it. They complain to the police, take measures to protect their property from embezzlement: they hang many locks, plant dogs, etc. They protect their interests actively, stenically and energetically in order to punish the "guilty".In order to prove their rightness, they bring a lot of arguments of ordinary content, they try to refer to the testimony of other persons. The usual nature of delirium and apparent consistency in the presentation of complaints does not create an impression of the onset of mental illness in relatives and friends. The combination of delusions of everyday relationships with other types of delirium( delirium of jealousy, delusion of poisoning), although expressed rudimentary, the presence of mental disorders in the form of detail, monotonously-elevated mood and uncriticality make it possible to recognize mental illness. The flow is sluggish. Treatment: trisedil, haloperidol, trifazine.
This is psychosis in encephalitis, meningitis, arachnoiditis, toxoplasmosis, etc.
In the acute period of intracranial infection, mental disorders manifest themselves in the form of deep asthenia with pronounced exhaustion, irritable weakness, intolerance to strong external stimuli, severe headache, sleep disturbance, attention deficit, memory loss. The condition of patients worsens in the evening and at night. At the height of the disease there are obscurations of consciousness: delirium with a lot of bright visual hallucinations, which can be replaced by stunning and matching.
Patients need supervision and care.
The consequence of the transmitted intracranial infections( or in their chronic stage) is mental disorders in the form of psycho-organic( encephalopathic) syndrome: coarse psychopathic behavior with foolishness, importunity, irritability, narrowing of the range of interests and their instability( the patient quickly gets bored), absent-mindedness,memory loss. There are often violations of drives - hyperbole, dromomania, hypersexuality. In some cases, there is an aspontaneity, a sharp narrowing of the circle of interests, adynamy. In the chronic stage of intracranial infection, psychosensory disturbances can occur with a change in perception of the surrounding and own body: all objects are perceived in an enlarged or reduced volume, parts of their own body are either very large or very small. Seizures may develop.
A severe consequence of the transmitted intracranial infection is an organic demented memory disorder. When the disease with intracranial infection in early childhood, there is a delay in mental development.
Treatment of psychoorganic syndrome is symptomatic: correctors of behavior - thioridazine( melleril, sonapaks), neuleptil;tranquilizers - trioxazine, rudotel. To improve intellectual activity, aminalone is 0.25 g 1-3 times a day.
These are temporary, reversible mental disorders that occur under the influence of a mental trauma. Reactive states appear more easily in psychopathic personalities, as well as on the basis of transferred infectious diseases, head trauma, vascular diseases, overwork, prolonged insomnia. Age can also matter. For example, persons in the pubertal and menopausal periods are more vulnerable to external influences. For the occurrence of a psychogenic reaction, the nature of the trauma is important. Acute shock causes other reactions than prolonged serious injuries. Affective shock reactions are more often observed in mass disasters( earthquake, fire, shipwreck);they manifest themselves in a hyperkinetic and hypokinetic form. Hyperkinetic form is characterized by disorientation in the surrounding, flight, meaningless actions. When the hypokinetic form of the patient under the influence of fear becomes immovable, silent. Sometimes there is a so-called emotional paralysis: a person does not experience any emotional reactions of fear, although he understands everything that is happening around, and is aware of the danger. Affective-shock reactions are short-term and reversible, accompanied by vegetative symptoms, a violation of cardiovascular activity. The use of tranquilizers is indicated.
Reactive depression - depressed mood with a touch of irritability, sometimes malignancy, slight motor braking. Sleep and appetite in patients are disturbed. Thinking is focused on the traumatic events that caused depression. There are no self-blaming ideals. Patients exhibit lability of affect, are tearful, capricious, closely monitor the attitude of others around them.
Acute reactive paranoid. The clinical picture consists of delusional ideas of attitude and persecution arising against a background of sharply expressed fear. Patients notice that people have pockets in their pockets, with which they will be killed. There are hallucinations( both visual and auditory).A paranoid can arise in prison, then its contents reflect a traumatic situation, an anxiety for one's own destiny. Sometimes paranoids arise on the train, during aviation flights. Patients are restless, sometimes aggressive, can make unexpected acts under the influence of fear and hallucinations( for example, to rush into the window of the car).
The reactive hallucinosis is extremely rare. The first place in the clinical picture is true auditory hallucinations. Develops with sensory deprivation and a traumatic situation. Reactive paranoids and hallucinosis arise sharply and have a short-term character.
Acute hysterical psychosis occurs more often. They are manifested by a small number of syndromes that can cross into each other.
The Hanser syndrome is a hysterical twilight consciousness disorder, during which patients behave incorrectly, give ridiculous answers to the simplest questions, reveal the inability to produce the simplest actions, do not understand the purpose of everyday objects. The condition is acute and ends within a few days.
The pseudodegmentation of differs from the Ganser syndrome by a lesser degree of impairment of consciousness and more orderly behavior. Patients also give incorrect answers to simple questions, make mistakes with simple actions, but can unexpectedly cope with a difficult task. The facial expression is stupid, the patients goggle their eyes, sometimes they laugh, but the affect is depressing.
Pseudodementia can be acute and end in a few days, sometimes lasting for months.
Puerilism is characterized by pronounced traits of childlike behavior, facial expressions and speech of the patient, the nature of judgments and emotional reactions. In comparison with pseudodegmentation, puerilism tends to be more prolonged.
Psychogenic stupor - complete immobility of patients and mutism( temporary absence of speech).On the face - usually an expression of fear, the sick refuse food, are untidy. There is tachycardia, increased sweating. This form of reactive psychosis develops gradually, tends to a prolonged course.
Treatment of reactive psychoses includes a set of measures: urgent hospitalization of patients in a psychiatric hospital: supervision, care, feeding, use of psychotropic drugs. To stop the reactive paranoid or hallucinosis, use aminazine, haloperidol in combination with correctors in usual therapeutic doses. Treatment of reactive depressive psychosis is performed by antidepressants sometimes in combination with tranquilizers or antipsychotics. In the treatment of acute hysterical psychosis, it is expedient to prescribe etaperazine, frenolone, behavior correctors - thioridazine or neuleptil.
Psychopathies - pathological characters and temperaments, which arose on the basis of congenital inferiority of higher nervous activity and disharmony of its development. The formation of pathological character, as well as normal, occurs under the influence of the external environment and upbringing.
Asthenic psychopathy is characterized by a combination of increased impressionability, sensitivity with significant mental exhaustion. Such people are distinguished by a timid, indecisive character, easily fall into despair, are lost. They are shy, eager to evade everything that requires stress, as they are not immune to severe mental and physical stress. Often complain of a bad dream, unpleasant sensations in the body, are prone to constant concerns about their health and hypochondriacal fears.
Excitable psychopathy is manifested by a discrepancy between the intensity of emotional reactions to the strength and the quality of the stimulus. Excitable psychopaths are not able to restrain themselves, react negatively to a violent outburst of anger accompanied by curses and cries;in a state of irritation can be aggressive.
Affective psychopathies is a group of psychopaths characterized by a constantly elevated or decreased emotional background. For hypertension is characterized by a constantly elevated background of mood. These people are optimistic, carefree, inclined to various hobbies. They are sociable, respond to all events. They are energetic, active, enterprising. Sometimes the increased mood is combined with increased irritability, a tendency to outbursts of anger. Hypotymics are characterized mainly by a decreased background of mood. These people are pessimistic, often dissatisfied with themselves. But at the same time they are responsive, sociable, work well and are highly productive. Often they are prone to hypochondriacal fears.
The ananastic psychopathies of ( psychasthenia) are characterized by anxious suspicion, self-doubt, a tendency to form obsessions that arise under the influence of psychogeny, are of a more persistent nature than with obsessive-compulsive neuroses.
Hysterical psychopathies are characterized by increased emotionality, which is manifested by violent affective reactions on an insignificant occasion. At the same time, external manifestations of the reaction do not correspond to the cause that caused it, as well as the depth of emotional experience;gives the impression of deliberate exaggeration of emotional manifestations. Emotions do not differ in depth, they quickly turn opposite. Thinking, actions largely depend on the emotional state( "affective logic").Patients always strive to be in the center of attention, to play some role in the eyes of others.
When recognizing psychopathies, one must take into account that the characteristics of a character are manifested not so much in the patient's statements as in his reactions, actions and behavior as a whole. Therefore, when establishing the diagnosis of psychopathy, one must also rely on objective information about the patient. The most important diagnostic feature in establishing a diagnosis of psychopathy is the lack of progredness. This is important for distinguishing psychopathies from psychopathic conditions that may occur in the initial period of progredient mental illnesses( such as schizophrenia) or as a result of light organic changes in the psyche: under the influence of trauma, infections and intoxications, vascular and endocrine pathology.
To compensate for psychopathy, proper education, the elimination of psychogenic trauma, and adequate job placement are necessary. Recently, along with social rehabilitation, the role of psychotropic medications has increased as symptomatic therapy in the case of psychopathy decompensation. With hysteria or psychopathy of an excitable type, drugs of an antipsychotic series can be used: aminazine, propazine, tryptazine, etaperazine in small and medium therapeutic doses. When the condition is improved, the doses can be reduced and then canceled. Of great importance is psychotherapy.
This is a group of psychoses that develop due to somatic diseases. They have general flow principles and a similar clinical picture. The clinical picture is in a certain connection with the severity, duration and nature of the somatic disease.
Highlights acute symptomatic psychosis with confusion( delirium, amenia, twilight state), protracted psychoses without consciousness disorder( depressive, paranoid), organic psychosyndrome with a decrease in the level of personality.
Mental disorders are characterized by a depressed mood, anxiety, slowing of thinking;Occasionally there is a confusion of consciousness with abundant visual and auditory hallucinations.
The clinical picture of psychosis manifests itself in the form of a depressive state with anxious arousal, nihilistic delusions( "inside the body is emptiness, there are no viscera and the brain"), restlessness within the bed. Patients badly eat, do not sleep, are exhausted, look older than their years. The hallucinatory-paranoid form is characterized by an influx of hallucinations( mainly visual), a primitive relationship delusion, the content of which depends on the surrounding situation. In both forms, there are episodes of obscuration of consciousness( delirium and amenia).In severe cases, an organic psychosyndrome can develop with a gross memory impairment.
Mental disorders are initially characterized by symptoms of asthenia, depression with concern for their health, feelings of hopelessness, sometimes with suicidal thoughts. Against the backdrop of cachexia, psychosis develops with a depressively paranoid clinical picture, nihilistic delusions, a changing delirious fainting of consciousness. Cancer psychosis in some cases occur after surgery.
Mental disorders develop in acute and chronic heart failure. Against this background, there are episodes of obscuration of consciousness( delirium) and a prolonged state of lethargy, apathy with memory impairment. In the period of depressive conditions, patients often develop suicidal thoughts and tendencies. With myocardial infarction, sometimes there is marked motor excitement with a sense of anguish and a fear of death.
Mental changes occur in the presence of acute or chronic renal failure and are due to the toxic effect on the brain of unpaired decay products. Acute nephrogenic psychosis occurs suddenly and is characterized by a confusion of consciousness with a sharp motor excitement, sometimes with convulsive seizures. Then a coma can develop. Protracted nephrogenic psychosis develops against persistent azotemia. Characterized by lethargy, depression, then apathy, increased drowsiness, stunning and increasing dementia. The prognosis for this form is unfavorable.
The treatment of mental disorders in somatic diseases is the same as the treatment of somatic diseases on the basis of which they developed. Symptomatic therapy includes arresting excitement, eliminating hallucinatory-paranoid and depressive disorders, detoxification activities, massive vitamin therapy.
Patients with somatogenic psychoses are transferred to psychosomatic departments of hospitals, their treatment should be conducted with the participation of a physician-therapist. A 24-hour observation post is required.
Due to atrophy of cells in the cerebral cortex. The disease occurs mainly after 60 years. Clinical manifestations are characterized by a gradual disintegration of memory, disorientation in the surrounding. The sick stop absorbing the new, do not remember the current events, they do not recognize the family. There is a so-called "shift to the past": the patients claim that they are 15-18 years old, that they are still studying, they have no children, etc. Confabulations are often observed - fantastic fictions with which the patients fill the memory gaps. Usually they are fussy, the mood is gloomy-depressed or complacently-careless. At night, patients do not sleep, wander around the room, collect unnecessary things, bind their bed. With a long-gone disease, patients lose their habitual skills, can not dress themselves and use a spoon while eating, become sloppy, untidy. Patients with senile dementia need constant care and supervision. Recommended hospitalization in a psychiatric hospital.
Treatment is symptomatic. With pronounced fussiness and nighttime anxiety, aminazine is recommended - 0.025 g / day, hypnotics, bromide preparations.
Mental disorders occurring in the acute, distant and late period after a head injury. With concussion and concussion in an acute period, a coma develops. The way out of the coma can be gradual, through stunning - to a clear consciousness with a pronounced asthenia. In some cases, the coma passes into the twilight state or delirium( see Nervous Diseases).The long-term consequences of light brain injuries are characterized by traumatic cerebral events with asthenic disorders( fatigue, poor tolerance of loud sounds, bright light), vegetative lability, sleep disturbance, headache, dizziness. There is a bad tolerance of heat, cold, moving in transport. The long-term consequences of a more serious trauma are encephalopathy with explosiveness, aggressiveness, memory impairment, stiffness of thinking, and encephalopathy with apathy, bradypsychism, inhibition, lethargy. In the clinic of various variants of traumatic encephalopathy, dysphoria is often observed, for which a low mood is typical with discontent all surrounding, tension, irritability, reaching up to explosions of anger. Dysphoria lasts for several days. Under the influence of psychogeny, alcohol abuse or somatic diseases, decompensation of traumatic encephalopathy begins - the described symptomatology is strengthened, expressed hysterical reactions develop with the phenomena of puerilism, pseudodementia, hysterical disorders of consciousness( see Psychotic reactive).In the late period of brain injuries against traumatic encephalopathy in some patients, periodic traumatic psychoses( due to liquorodynamic disturbances) can develop, the clinic of which is determined by disorders of consciousness, outpatient automatisms and epileptophorine excitation. In the twilight confusion of consciousness, patients are detached from the environment, experiencing visual hallucinations of a frightening nature, delirium of persecution, fear. They are nervous, they can be aggressive. In some patients epileptiform seizures occur in the distant and late period of head trauma.
Treatment. In case of traumatic encephalopathy, it is necessary to organize the correct mode of work and rest, apply general restorative therapy, tonic drugs for apathy, and when excited, sedatives.
Do not drink alcohol, stay in the sun for a long time. It is not recommended to work in hot, noisy shops, work at night.
Mental disorders are characterized by asthenia with lethargy, aspontaneity, mood disorders - depression, sometimes changing euphoria. The course is prolonged with subsequent intellectual and mnestic disturbances. Against the backdrop of these changes in the clinical picture of the Addisonian crisis, psychoses with obscuration of consciousness, excitement, epileptiform spasms and acute hallucinosis( visual and tactile hallucinations) can occur.
Mental disorders are characterized by constant dysphoria with irritability, discontent, hostility to people, egocentrism.
Thyrotoxicosis is accompanied by asthenia with hyperesthesia, exhaustion, mood lability with increased irritability. The pace of mental processes is accelerated.
After thromectomy, delirium sometimes develops.
Diabetes mellitus is accompanied by asthenia and affective lability. During a diabetic coma, a deep clouding of consciousness occurs.
In the initial period of the disease - lethargy, asthenia, adynamic, decreased mood. Often there are epileptiform seizures. With prolonged course of the disease, hypertension joins. Mental changes at this stage are characterized by a combination of depressive-hypochondriacal symptoms( melancholy, suicidal thoughts, unpleasant, unusual sensations - senestopathic) with symptoms peculiar to hypertensive disease. Acute exogenous psychoses occur against the background of a hypertensive crisis. Gradually, as the course of the Itenko-Cushing disease progresses, the intellectual-mnestic functions are violated in patients, the criticism to the state is reduced.
Myxedema is characterized by a slowing of mental processes, apathy. There are dizziness, chilliness, a feeling of crawling on the skin. With the early appearance of the disease, there is a delay in mental and physical development.
Treatment is carried out by psychotropic drugs in combination with endocrine system therapy.
Care of such patients is of great importance in the treatment;usually apply the same measures as for patients with somatic diseases. Patients with excitement, the presence of suicidal thoughts, as well as stupor and untidy patients in a psychiatric hospital are assigned bed rest in special observation chambers with a constant, twenty-four-hour observation post. Observation of patients in a psychiatric hospital has a number of purposes: to protect the patient from wrong actions both in relation to himself and against other persons;prevent possible suicidal attempts in patients. Of great importance is monitoring the course of the disease, as in mental illness the state of the patient during the day or night is completely different. Observation is provided by a doctor and nurses.
In addition to bed rest and supervision, much attention is paid to the daily routine. In a psychiatric hospital, the daily routine should strictly correspond to the treatment being administered. Morning toilet for weak, stuporous and excited patients is conducted by personnel. Nutrition of patients should be diverse, taking into account that excited patients spend a lot of energy, as well as taking into account the disorders of vitamin metabolism in the treatment with neuroleptic drugs.
Medicines are also given to patients at certain hours. The nurse must strictly monitor that the patients take them. It is necessary to check the bedside tables and pockets of patients, as they can accumulate unnecessary things and medicines. Lingerie patients must be changed in a timely manner. Weekly hygienic bath. Weak patients are rubbed with fragrant vinegar at least once a week. It is necessary to carefully monitor the skin condition of weak patients, especially in places of greatest pressure: on the shoulder blades, sacrum, elbows. Weak patients are turned over several times a day to avoid the development of congestive pneumonia. The bed of weak patients should be even, linen without folds. If necessary, use an underlay. In the department, along with the supervisory chambers, there should be wards for convalescent patients, rest rooms and rooms for labor therapy.
The daily routine should include hours of labor therapy. In addition to work indoors or outdoors( the type of work is appointed by the doctor), patients with improved conditions are allowed to read newspapers, magazines and fiction that should be picked up in the hospital library. Patients can attend film shows or watch TV.
Care for the mentally ill includes also symptomatic therapy. When insomnia prescribed sleeping pills. It is necessary to conduct general restorative therapy. On the appointment of doctors can be used coniferous baths, simple warm baths, gymnastics, massage and other types of physiotherapy treatment.
Along with the generally accepted measures for the care of patients, special attention should be paid to the treatment of patients, the tactics of the doctor and the staff. Despite the state of excitement and wrong actions, the mentally ill should use an attentive, caring attitude from the doctor and the staff. It is inadmissible to address a mentally ill person to "you", a brutal cry. At the same time, when agitation or aggression is initiated, staff should be able to keep the patient carefully until the stimulation is stopped by medication. Personnel in psychiatric hospitals under the guidance of physicians should learn how to properly care for the sick, attentive to them attitude and observation, which helps to prevent states of marked agitation, aggression, suicidal attempts.
When transporting the mentally ill to a psychiatric hospital, difficulties may arise due to the excitation of patients, suicidal attempts and delusions, under the influence of which the patient refuses to be hospitalized. On the prescription of the doctor, the patient is administered( usually intramuscularly) psychotropic drugs shown for his disease. The medical personnel accompanying the patient on the way should receive exhaustive instructions from the doctor or paramedic about the patient's condition, the necessary supervision and care for him.
Psychotherapy is a method of influencing a doctor and medical personnel by a word on the psyche of a patient with a curative purpose. There are several methods of psychotherapy known:
In our country, the first four methods have been most widely used.
Psychotherapy can be used both in combination with other methods of treatment, and independently. In the latter case, it is used to treat neuroses. In patients with psychosis, the main methods of treatment are biological( psychopharmacology, insulin therapy, etc.).However, psychopharmacology expanded the scope of psychotherapy in the treatment of psychoses: the rapid arrest of psychomotor agitation, the elimination of hallucinatory-delusional syndromes and the normalization of mood make it possible to apply psychotherapeutic methods at earlier stages of psychosis treatment.
The role of psychotherapy especially increases during the patient's return to family duties and work, i.e. during the period of reconvalescence and social readaptation. Psychotherapy is carried out in a psychiatric hospital, a day hospital and an outpatient clinic. Its task is to achieve disactualization of painful experiences in the patient, change of his incorrect judgments, stereotype of response and attitudes, and also to facilitate adaptation to external conditions. Psychotherapy is conducted by a psychiatrist, but in the psychotherapeutic work, a large role belongs to medical personnel, whose activities are aimed at organizing a therapeutic regimen for patients. From medical personnel requires a certain activity in establishing contact with mentally ill patients, and the conversation should not be limited only to questions of the state of his health;it is necessary to draw the patient's attention to his home affairs, his interests, his work, etc.
The purpose of rehabilitation( restorative) medicine is the restoration of mental and physical strength in a person who has transferred a mental illness to a control level, ie, the ability to work. Social and rehabilitation activities constitute an important part of the treatment of mental illnesses and are conducted both in outpatient settings and in a psychiatric hospital.
In the acute period of a mental illness, when even a normal emotional and workload can cause an increase in pathological changes, the patient needs mental and physical rest, i.e., a medical-protective regime, which is performed most often in a hospital. With the improvement of the patient's condition under the influence of active therapy, the curative-protective regime is replaced by a therapeutic-activating regime. When activating the regime, along with active therapy, social and psychological effects are recommended: encouraging self-service, stimulating an active attitude towards the life of the department by participating in collective arrangements for labor therapy and cultural entertainment. In the future, it is recommended that the workload for the patient be gradually increased and that it be involved in self-management.
Rehabilitation measures are designed to restore the patient's positive attitude to the family, society, life and prevent the formation of a mental defect with the patient's propensity for self-isolation. Continuing active treatment of the patient leads to compensation of the mental state, which allows the patient to keep under control of his efforts the residual manifestations of his illness. At this stage, all-round stimulation of the patient's social activity is necessary;the goal of rehabilitation measures is to restore the sick in social relationships, disturbed by the disease. These activities are conducted in the hospital, as well as after discharge of patients under the supervision of a district psychiatrist.
In the implementation of social rehabilitation, a large role belongs to medical personnel who supervise the systematic implementation of rehabilitation measures to patients with increasing labor load, taking into account individual patient inclinations and interests. Social rehabilitation on an outpatient basis allows the patient to return to his former job or creates conditions for rational employment, and also promotes the formation of useful interests in patients, the appropriate use of free time.