In patients with somatic diseases, there can be a wide range of mental disorders of both neurotic and psychotic or subsischethic levels.
K. Schneider proposed to be considered the conditions for the emergence of somatically determined mental disorders the presence of the following signs: 1) the presence of a pronounced clinic of a somatic disease; 2) the presence of a noticeable connection in time between somatic and mental disorders; 3) a certain parallelism for mental and somatic disorders; 4) Possible, but not the mandatory appearance of organic symptoms
The probability of the occurrence of somatogenic disorders depends on the nature of the main disease, the degree of its severity, the flow stage, the level of efficiency of therapeutic effects, as well as from such properties, as heredity, the constitution, the premorbide warehouse of the personality, age, sometimes the floor, the body's reactivity, the presence of preceding the harm.

Thus, the etiopathogenesis of mental disorders in somatic diseases is determined by the interaction of three groups of factors:
1. Somatogenic factors
2. Psycho factors
3. Individual patient features
In addition, in the process of occurrence of somatogenic disorders, additional psychotrauming factors not related to the disease can participate.

Accordingly, the influence of a somatic disease on mental condition The patient can lead to the development of predominantly somatogenic or mainly psychogenic mental disorders. In the structure of the latter, there are most important and nosgery.
Determination of the role of somatogenic and psychogenic factors in the pathogenesis of mental disorders in each particular patient with somatic pathology is a prerequisite for choosing an adequate strategy and tactics of treatment. At the same time, the correct qualifications of the mental violation and its pathogenetic mechanisms are possible only when the somatic and mental status Sick, somatic and psychiatric history, peculiarities of treatment and its possible side effects, data on hereditary gulling and other factors of predisposition.
Mental disorders in a patient with a somatic disease makes it necessary for his joint management by an interchnish and psychiatrist (psychotherapist), which can be carried out within different models. The most widely used is the model of consulting-interaction, which involves the direct and mediated (through counseling and training of the Somatologists) participation of a psychiatrist in the therapeutic jurisdiction of somatic patients with mental violations: a psychiatrist acts as an expert consultant and, interacting with the patient and interchange physicians, Participates in the development and adjustment of tactics of treatment.
The priority for a psychiatrist consultant is the task of recognition and differential diagnosis Mental disorders associated and non-associated patient, as well as the appointment of adequate treatment, taking into account his mental and somatic status.
1. Somatogenic mental disorders
Somatogenic mental disorders are developing due to the immediate influence of the disease on the activities of the CNS and manifest mainly in the form of neurosis-like symptoms, however, in some cases, against the background of severe organic pathology, psychotic states are possible, as well as significant violations of higher mental functions up to dementia.
The following general criteria for somatogenic (including organic) disorders are indicated in the ICD-10:
1. Objective data (results of physical and neurological examinations and laboratory tests) and (or) anamnestic information on the lesions of the central nervous system or the disease, which can cause cerebral dysfunction, including hormonal disorders (not related to alcohol or other psychoactive substances) and the effects of unexoidal drugs.
2. Time? I am addicted between the development (exacerbation) of the disease and the beginning of the mental disorder.
3. Recovery or significant improvement in the mental state after eliminating or weakening the action of presumably somatogenic (organic) factors.
4. The absence of other probable explanations of the mental disorder (for example, high hereditary burden with clinically similar or related disorders).
In accordance with the clinical picture of the disease criteria 1, 2 and 4, a temporary diagnosis is justified, and, according to all criteria, the diagnosis of somatogenogenic (organic, symptomatic) mental disorder can be considered certain.
In ICB-10, somatogenic disorders are presented mainly in the F00-F09 section (organic, including symptomatic mental disorders) -
Dementia
F00 Dementia Disease Alzheimer
F01 Vascular dementia
F02 Dementia with other diseases (in peak disease, with epilepsy, with brain injuries, etc.)
F03 Dementia Uncomfortable
F04 Organic amnistic syndrome (pronounced memory disorders - Anterograd and retrograde amnesia - on the background of organic dysfunction)
F05 Deliya, not caused by alcohol or other psychoathered substances (permanent consciousness against the background of severe somatic disease or brain dysfunction)
Other mental disorders caused by damage or dysftsunction of the brain or somatic disease:
F06.0. Organic hallucins
F06.1. Organic catatonic state
F06.2 Organic delusional (schizophren-like) disorder.
F06.3 Organic Mood Disorders: Manic, Depressive, Bipolar Disorder of Psychotic Level, as well as hypolomanic, depressive, bipolar disorder of non-psychotic level
F06.4 Organic Anxiety Disorder
F06.5 Organic dissociative disorder
F06. Organic emotionally labile (asthenic) disorder
F06.7 Easy cognitive disorder due to brain dysfunction or somatic disease

1.1. Consciousness permarass.
Most often, with somatic pathology, delicious perishes are arising, characterized by disorientation in time and place, in the influx of bright true visual and auditory hallucinations, psychomotor excitation.
In case of somatic pathology, delirium can be worn as a wave-like and episodic character, manifested in the form of abortive deliries, often combined with a stunning or with onairic (rectangular) states.
For heavy somatic diseases, such options for delirium as a wealthy and professional with a frequent transition to whom
In the presence of an organic brain lesion of various genes, various options for twilight disorders are also possible.

1.2. Syndrome shutdown consciousness.
When the consciousness of varying degrees of depth is turned off, an increase in excitability threshold is noted, the slowdown in mental processes in general, psychomotor inhibition, a violation of perception and contact with the outside world (up to a complete loss at a coma).
Turning off consciousness occurs in terminal states, with severe inxications, brain injuries, brain tumors, etc.
The degree of shutdown of consciousness:
1. Somanlation,
2. Stunning,
3. Sportor,
4. Coma.

1.3 Psycho-Organic Syndrome and Dementia.
Psycho-Organic syndrome - syndrome of impaired intellectual activity and the emotional-volitional sphere under the lesions of the brain. It can develop on the background of vascular diseases, as the consequence of crank-brain injuries, neuroinfections, in chronic exchange disorders, epilepsy, atrophic senile processes, etc.
Intellectual activity disorders are manifested by a decrease in its overall productivity and violation of individual cognitive functions - memory, attention, thinking. Distinctly perform a decrease in the tempo, inertness and viscosity of cognitive processes, detection of speech, trend towards traces.
Disorders of the emotional-volitional sphere are manifested by emotional instability, viscosity and incontinence of affect, dispro, the difficulties of self-control behavior, the change in the structure and hierarchy of the motives, the depletion of the motivational value sphere of personality.
When progressing psychoorganic syndrome (for example, on the background of neurodegenerative diseases), dementia is possible.
A characteristic sign of dementia is a significant violation of cognitive activity and trained, loss of acquired skills and knowledge. In some cases, there is a violation of consciousness, disorders of perception (hallucinations), the phenomena of catatonia, Breda.
During the dementia there are also pronounced emotional-volitional disorders (depressed, euphorical states, alarm disorders) and distinct identity changes with the primary pointing of individual features and the subsequent leveling of personal features (up to a common personal decay).

1.4. Asthenic syndrome in somatic diseases.
Asthenic phenomena are observed in the majority of patients with somatic diseases, especially in decompensation, unfavorable the course of the disease, the presence of complications, polymorbidity.
Asthenic syndrome is manifested by the following symptomatics:
1. Increased physical / mental fatigue and pulpability of mental processes, irritability, hyperesthesia (increased sensitivity to sensory, proprio- and interoceptive stimuli)
2. Somato-vegetative symptoms;
3. Sleep disorders.
Three forms of asthenic syndrome are isolated:
1. Hypersthenic form;
2. irritable weakness;
3. Gypsy form.
Characteristic features The hyperstandic version of the asthenia is an increased irritability, hot temper, emotional lability, inability to bring to the end energetically started business due to instability of attention and rapid fatigue, impatience, tear, predominance of anxiety affect, etc.
For the hypostenial form of asthenia, persistent fatigue, a decrease in mental and physical performance, total weakness, lethargy, sometimes drowsiness, loss of initiative, etc.
Irisant weakness is a mixed form that combines signs and hyper- and hyposophical options for asthenia.
For somatogenic and cerebrogenic asthenic disorders are characteristic (Equiva M.M. et al., 2003):
1. Gradual development, often against the background of decay of the disease.
2. Clear, persistent, monotonous symptoms (as opposed to dynamic symptoms in psychogenic asthenia with typical connection of other neurotic symptoms).
3. Reducing disability, especially physical, independent of the emotional state (as opposed to a decrease in predominantly mental performance in psychogenic asthenia with a distinct dependence on emotionic factors).
4. The dependence of the dynamics of asthenic symptoms from the course of the underlying disease.

1.5. Somatogenic emotional violations.
The most typical emotional disorders due to somatogenic impacts are depression.
For organic depression (depression organic disorders Central nervous system) The combination of affective symptoms with the phenomena of intellectual decrease, the predominance in the clinical picture of the phenomena of negative affectivity (adamope, aspontanery, ancondonia, etc.), the severity of asthenic syndrome is characteristic. With vascular depressions, multiple sustainable somatic and hypochondriac complaints may also be marked. With cerebral dysfunctions, dysphoric depression are often developed with the predominance of woolly-evil mood, irritability, exposability.
Depressed against the background of somatic pathology is characterized by a significant severity of the asthenic component. Typical phenomena of high mental and physical evils, hyperesthesia, irritable weakness, weak, tearfulness. The vital component of depression in case of somatic disorders often prevails on actually affective. Somatic symptoms in the structure of depressive disorder can simulate the symptoms of the underlying disease and, accordingly, to significantly impede the diagnosis of mental violation.
It should be emphasized that the pathogenesis of depressive states in somatic disorders, as a rule, includes the interaction and interference of somatogenic and psychogenic factors. Depressive experiences often act in the structure of disadvantaged personal reactions to disease developing in patients against the background of the overall high mental fatigue and deficiency of personal resources to overcome the stress of the disease.

2. Nosegenous mental disorders
Nose-generated disorders are based on a dedupping response personality for the disease and its consequences.
In somatopsychology, the peculiarities of response personality to the disease are considered within the framework of the problem of the "inner picture of the disease", attitudes towards the disease, the "personal meaning of the disease", "experiences of the disease" "Somatonozognosia", etc.
In a psychiatric approach, those dezadapive personal reactions to the disease have the greatest importance, which in their manifestations correspond to the criteria of psychopathology and are qualified as nosed mental disorders.

2.1. Attitude towards disease
The concept of attitudes towards the disease is associated with a wide range of psychological phenomena considered in the study of the problem of the relationship of the identity of the disease.
Forming under the influence of objective and subjective factors, value system and primarily the value of health, the attitude towards the disease reflects the personal meaning of a particular disease, which determines the external manifestations of more or less successful adaptation of the patient to the disease.
Developing a patient with a disease relationship, structural-functional changes in the entire system of its relationship due to the fact of the disease naturally affect not only the course of the disease and a medical prognosis, but also for the entire course of personality development. In relation to the patient, the patient is expressed by the uniqueness of his personality, experience, relevant life situation (including the characteristics of the disease itself).
The concept of attitude towards the disease is substantially close to the concept of "inner painting of the disease" (WBB), introduced by R.A. Luria (1944), which contrasted its "external picture of the disease", accessible to an impartial study of the doctor. R.A. Luria determined VKB as the entire set of sensations and experiences of the patient in connection with the disease and treatment.
Currently, WCB is understood to be a "complex of secondary, psychological in nature, symptoms of the disease" (V.V. Nikolaev), reflecting the subjective meaning of the disease for the patient. In the structure of WCBs, the following levels are distinguished:
1. Sensual - sensations and conditions due to illness;
2. Emotional - experiences and emotional states due to illness and treatment, emotional response to illness and its consequences;
3. Intelligent - Presentations of the patient about the causes, entities, danger of the disease, about its influence on various spheres of vital activity, treatment and its effectiveness, etc.
4. Motivational - change in the motivational structure (hierarchy, leading motives) due to the disease; The nature of changes in behavior and lifestyle due to the disease.
It should be emphasized that the attitude towards the disease and WBBs are neglected to the ideas about the disease, an emotional response to a disease or behavioral strategy due to illness, although they include all these three components and manifest themselves in them.
Among the factors affecting the nature of the attitude towards the disease, the following are distinguished:
1. Clinical characteristics: The degree of the threat of the disease for life, the nature of symptoms, the features of the flow (chronic, acute, parlor) and the current phase of the course of the disease (exacerbation, remission), degree and nature of functional restrictions, specificity of treatment and its side effects, etc.
2. Premorbid features of the patient's personality: the characteristics, features of a system of meaningful relations and values, features of self-consciousness (self-perception, self-esteem, self-relation), etc.
3. Socio-psychological factors: Age at the time of the beginning of the disease, the social status of the patient and the nature of the influence of it diseases, adequacy / insufficiency of social support, the likelihood of stigmatization, the presentation of the disease, characteristic of the microcosocial environment of the patient, the presentation of the disease and the norm of the patient's behavior Characteristic of society as a whole, etc.
Conditionally allocate the following types of attitude towards a disease (personal A.E., Ivanov N.Ya., 1980; Wasserman L.I. et al., 2002):
1) Harmonious type - characterized by a sober assessment of his condition and the desire to promote the success of treatment.
2) ergopathic type - manifested by "care of work from illness", the desire to compensate for the sense of personal inferiority due to the disease of the achievements in professional, educational activities and in general high levels activity. Characteristically electoral attitude towards treatment, preference of social values \u200b\u200bof health value.
3) Anosognosic type - manifests itself partial or complete ignoring the fact of illness and medical recommendations, the desire to preserve the previous lifestyle and the previous image, despite the disease. Often, this attitude towards the disease has a protective compensatory nature and is a way to overcome anxiety due to the disease.
4) the alarming type - is characterized by a constant sense of concern somatic state, a medical outlook, real and imminent symptoms of disease and complications, degree of treatment efficiency, etc. Anxiety due to the disease causes the patient to experience new treatments, refer to a variety of specialists, not finding, but calm and opportunities to get rid of fears and fears.
5) obsessive-phobic type - manifests itself by obsessive thoughts on the unlikely adverse effects of illness and treatment, constant reflections on the possible influence of the disease on daily life, on the risk of disability, fatal outcome, etc.
6) The hypochondriac type is manifested in concentration on subjective painful, unpleasant sensations, the exaggeration of suffering due to the illness of the desire to report its ail to others. Typically, the combination of desire to be treated and disbelief in the success of treatment.
7) neurasthenic type - characterized by phenomena of irritable weakness, increased fatigue, intolerance pain sensations, outbreaks of irritation and impatience in connection with the disease with the subsequent repentance for their own incontinence.
8) Meancholic type - is determined by a reduced mood due to illness, depression, depression, unbelief in the success of treatment and the possibility of improving the somatic state, a sense of guilt due to illness / weakness, suicidal ideas.
9) Apache type - is characterized by indifference to its fate, the outcome of the disease, the results of treatment, passivity in the treatment, narrowing of the circle of interests and social contacts.
10) Sensitive type - manifested by increased sensitivity to the opinion of the surrounding diseases regarding the fact of the disease, fear of becoming a burden for loved ones, the desire to hide the fact of the disease, expecting an unlaimed response, offensive pity or suspicion of using the disease for mercenary purposes.
11) The egocentric type is characterized by the use of the disease in order to manipulate others and attract their attention, the requirement of exclusive care of themselves and subordination of their interests.
12) The paranoid type is associated with the confidence that the disease is the result of evil intent, suspicion of drugs and procedures, physician behavior and loved ones. Side effects And the emergence of complications is considered as a result of the unscrupulousness or maliciousness of the medical staff.
13) Dysforic type - manifests itself an evil-dreary mood due to illness, envy, hostility towards healthy people, irritability, outbreaks of anger, the requirement of subordination of the surrounding personal interests, including related to illness and treatment.

2.2. Actually noose mental disorders
In the presence of predisposing conditions (a special personal premorbide, mental disorders in history, hereditary hypocheticity of mental disorders, threats to life, social status, the external attractiveness of the patient), a dezadapive personal response to the disease can take the form of a clinically pronounced mental disorder - a nosed disorder.
Depending on the psychopathological level and the clinical picture of non-cooled disorders, the following types are distinguished:
1. Neurotic level reactions: alarming-phobic, hysterical, somatic.
2. Reactions of affective level: depressive, disturbing-depressive, depressive and hypochondriartic reactions, Euphoric pseudo-degeneration syndrome.
3. Reactions of the psychopathic level (with the formation of utasive ideas): health syndrome "Heproyondria of health", sutitive, sensitive reactions, pathological denial syndrome.
It is also fundamental to distinguishing ongoing disorders on the criterion of the degree of awareness and the patient's personal involvement in the situation of the disease. Based on this criterion allocate:
1. Anosognosia
2. Hyperino-hydrogen
Anosognosia is a clinical and psychological phenomenon characterized by a complete or partial (hyponosognosion) with an identity and distorted perception of patients with his painful state, mental and physical symptoms of the disease.
Accordingly, hyperinocognosios are characterized by the revaluation by the patient's severity and danger of the disease, which causes its inadequate personal involvement in the problems of illness and associated violations of psychosocial adaptation.
One of the risk factors for the development of hyperinocognosic reactions is incorrect (unethical) behavior of a doctor (medical personnel), leading to the wrong interpretation by the patient's symptoms and severity of the disease, as well as to the formation of deadaptive facilities against the disease. At the same time, in some cases, the development of (yatrogenic) neurotic symptoms with a pronounced anxiety and somato-vegetative component is possible.

The primary prevention of somatogenic disorders is closely related to the prevention and as many as possible detection and treatment of somatic diseases. Secondary prevention is associated with the timely and most adequate therapy of interrelated underlying disease and mental disorders.
Considering that psychogenic factors (response to the disease and all that it is connected with it, the response to a possible adverse situation) is of an important significance both in the formation of somatogenic mental disorders and with the possible weighing of the course of the main somatic disease, measures must be applied for prevention. This kind of impact. Here, the most active role is owned by medical deontology, one of the main aspects of which is to determine the specifics of deontological issues in relation to the peculiarities of each specialty.

3. Private aspects of mental disorders in somatic diseases (by N.P.vachakova et al., 1996)

3.1 Mental disorders in cancer
With oncological diseases, both somatogenic and psychogenic mental disorders can develop.
Somatogenic:
a) Tumor with primary localization in the brain or metastase in the brain: the clinic is determined by the lesion zone, represented by neurological symptoms, insufficiency or destruction of individual mental functions, as well as asthenia, psycho-organic syndromes, general-selling symptoms, convulsive syndrome and less often hallucinoses;
b) disorders caused by intoxication of decomposition of tissues and narcotic analgesics: asthenia, euphoria, consciousness syndromes (amenic, delicious, delirious-onaidoid), psychoorganic syndrome.
Psycho:
Represent the result of the personality reaction to the disease and its consequences. One of the most essential components is the reaction to the diagnosis of an oncological disease. In this regard, it is necessary to understand that the issue of the diagnosis message oncological patient remains ambiguous. In favor of the diagnosis message, as a rule, indicate:
1. The ability to create a more confidential atmosphere in relationships between patients, doctors, relatives and loved ones, reduce social insulation of the patient;
2. More active participation of the patient in the medical process;
3. The possibility of making sick responsibility for its further life.
The disagreement of the diagnosis is motivated, first of all, the high probability of severe depressive reactions to suicide attempts.
So go otherwise, regardless of the source of information about the presence of an oncological disease, a person passes through a crisis characterized by the following steps:
1. Shock and denial of the disease;
2. Anger and aggression (overwriteness of fate);
3. Depression;
4. Taking the disease.
The idea of \u200b\u200bwhat stage of the crisis is the patient is the basis of psychocorrection work aimed at optimizing the medical process and improving the quality of his life.

3.2. Mental disorders Pre- and postoperative periods
Preoperative period
The presenter of pathogenesis is the personality reaction to the disease and the need for operational intervention. The clinic is mainly represented by anxious and alarming-depressive disorders of varying severity. Significant in prevention is adequate preoperative psychological preparation, which includes an explanation of the nature and need for operation, the formation of an operation to carry out the operation and, if necessary, reducing the level of anxiety both psychotherapeutic and drug methods. The degree of psychological preparedness of the patient as a result of psychosomatic relationships largely determines both the course of the operation itself and the postoperative period.
Postoperative period
The emergence of mental disorders of the postoperative period is determined by the influence of all three major groups of factors. The clinic is represented by the main syndromes of mental disorders characteristic of somatic diseases (see above).

Questions for self-preparation

1. List the groups of factors contributing to the development of mental disorders in somatic patients
2. Tasks of psychiatric counseling of a somatic patient
3. List the general criteria for somatogenic mental disorder (on ICD 10)
4. Asthenic syndrome clinic
5. List emotional disorders that are most common in somatic diseases
6. Inner Painting Disease - Definition, Concept Concept (Components)
7. Variants of the inner painting of the disease
8. Give the definition of iatrogenation
9. List the most frequent mental disorders arising from oncological patients (connection with the etiological factor)
10. List the most frequent mental disorders in pre-and postoperative period.
Tasks:
1. Patient 78 years old is on treatment for discirculatory encephalopathy on the neurological separation of the somatic hospital. The second day. In the afternoon, she was placed in the department regime, visited relatives, communicated with the doctor, found a moderate intellectual - a meal decline in vascular type. At night, the condition has changed acutely, it became worried, anxious, fussy, did not hold on the spot, wandered around the chambers, I was convinced that he was "at home", I was looking for any things, to convince the nurse attempts to convince aggressively.
Give the characteristic of the changed consciousness of the patient, tactics of treatment, the features of therapy mode.

Somatogenic mental disorders are usually determined by the symptoms caused by not only somatic, but also endogenous, subjective factors. In this regard, the clinical picture reflects the personality reactions to the pathological process. In other words, the nature of the course of the pathological process is reflected in the identity of the patient, its emotional experiences.

The diagnosis of any serious somatic disadvantage is always accompanied by a patient's personal reaction reflecting the newly emerged situation. In clinical manifestations, psychogenic states in somatic patients are extremely diverse. More often, they are expressed by mood disorders, total depression, intensity. At the same time, a tendency to increased concerns regarding the impossibility of recovery. There is fear, anxiety in connection with the upcoming long-term treatment and stay in the hospital in the separation from the family, close. At times, the first place is the longing, the oppressive feeling, externally expressed in the closetness, in motor and intellectual inhibition, tearfulness. Caprisality and affective instability may appear.

The diagnosis of somatogenic psychosis is raised under certain conditions: the presence of a somatic disease; temporary communication between somatic and mental disorders, interdependence and mutual influence in their course. Symptoms and flow depend on the nature and phase of the development of the main disease, the degree of its severity, the effectiveness of the treatment, as well as on the individual characteristics of the patient, such as heredity, the Constitution, nature, the floor, age, the state of the body's protective forces and the presence of additional psychosocial hazards.

According to the emergence mechanism distinguish 3 groups of mental disorders.

Mental disorders as a reaction to the very fact of the disease, hospitalization and the associated separation from the family, the usual situation. The main manifestation of such a reaction is the varying degree of depression of mood with one or another tint. Some patients are full of painful doubts in the effectiveness of the treatment prescribed by him, in the prosperous outcome of the disease and its consequences. Others prevailing the alarm and fear of the possibility of serious and long-term treatment, before surgery and complications, the likelihood of obtaining disability. Patients are indifferently lying in bed, refusing food, from the treatment "Anyway one end." However, in such, externally emotionally inhibited patients, even with an insignificant influence of the outside, anxiety may occur, foulness, pity for themselves and the desire to gain support from others.

The second, significantly large group is patients who have mental disorders, as it were, a component of the clinical picture of the disease. These are patients with psychosomatic Nazyugia, along with severe symptoms of internal diseases (hypertension, ulcery disease, diabetes) Neurotic and pathocharacterological reactions are observed.

The third group will be patients with acute impaired mental activity (psychosis). Such states are developing either with severe acute diseases with high temperature (bruboral inflammation of light, abdominal title) or pronounced intoxication (masking renal failure) or with chronic diseases In terminal stages (cancer, tuberculosis, kidney disease).

Major psychopathological syndromes in case of somatic diseases.

1.Napsychotic level:

Asthenic syndrome

Affective disorders of an unexigated level

Obsessive-compulsive syndrome

Phobic syndrome

Estro-conversion syndrome.

2.Athotic levels:

Syndromes permanent and shutdown consciousness

Hallucinatorial-delusional disorders

Affective psychotic level disorders.

3. Dissenters-dementary disorders:

Psycho-Organic syndrome

Korsakovsky syndrome

Dementia

122. Problems solved by age clinical psychology.

The aging of the body is accompanied by a change in all its functions - both biological and mental. Age, which is usually considered the beginning of the emergence of mental changes associated with the involution, is over 50-60 years.

Emotional manifestations with age are modified. Emotional instability is developing, anxiety. There is a tendency to jam on unpleasant experiences, anxiously depressive coloration. Mental disorders in individuals and senile people are manifested both in the form of border mental disorders and psychosis.

Border disorders Include neurosis-like disorders, affective disorders and identity change. Non-obsishable disorders are manifested by a breakdown of sleep, various unpleasant sensations in the body, emotional-unstable mood, irritability, varying disturbance and concerns, well-being of loved ones, its health, etc. , "Deadly" disease. The occurring changes in the patient's personality are captured by both characterological and intellectual properties. In the characterological characteristics, there is a sharpness of the yutrement of individual, characteristic of the patient earlier personal traits. Thus, the incredulusity goes into suspicion, thrift - in stupidity, perseverance - in stubbornness, etc. Intelligent processes lose their brightness, associations become poor, the quality and level of synthesis of concepts are reduced. First of all, memory is violated on current events. With difficulty, for example, the events of the past day are remembered. There is also a decrease in criticism - the ability to correctly evaluate its mental state and changes occurring.

Involutionary melancholy.This is frequent psychosis in persons of the prediction. The leading psychopathological manifestations for this disease are depression with anxiety. The severity of depressive and disturbing manifestations is different: from light psychopathological manifestations to severe depressions with severe anxiety and award. Patients also have a state when the depression is concerned with the intensity. Such a motor inhibition can acquire the form of a stupor.

Involutionary paranoid. This psychosis is characterized by the development of systematized nonsense ideas. Drain ideas are usually combined with an alarming-depressed mood. They concern the threat of well-being, health of the illness of patients, as well as their loved ones. The content of delusional ideas is associated with the specific events of everyday life and is not something unusual, fantastic. Sometimes the statements of patients look plausible and misleading others.

Along with delusional experiences, patients often observed hallucinatory manifestations. Hallucinations are more often auditory. Patients hear the noise behind the wall, hopot, voices, threatening them, condemning their actions and actions.

Patients detected peculiar identity changes: the narrowing of the circle of interest, monotony of manifestations, increased anxiety and suspicion.

Mental disorders in atrophic processes in the brain

Heavy mental disorders are found in a number of patients in a prediction and old age, which have characteristic organic changes in the brain. This includes mental disorders in connection with brain atrophy and senile dementia.

Peak disease.This disease is characterized by the development of progressive amnesia, total dementia. In the earliest stages of its development, pronounced personality changes are noted, characterized by aspotation and pseudoparalytic shift. Aspontaneity is manifested in indifference, indifference, apathy. Patients forget the events of the past day, current events, do not recognize familiar persons, meeting them in an unusual setting. There is no critical attitude towards its state, but they are upset when they are convinced of their insolvency. Usually in patients with even, complacent mood. There are gross violations of thinking. They do not notice explicit contradictions in their judgments and estimates. So, patients are planning their affairs without taking into account their own inconsistency. For patients with peak disease, so-called standing symptoms are typical - multiple repetitions of the same speech revolutions.

Alzheimer's disease. For him, progressive amnesia and total dementia are also typical. In the disease Alzheimer, in the initial period, there is often tear-irritable depressions, in parallel with these disorders there is a rapidly growing deterioration in memory, close to progressive amnesia, and shortly after the appearance of the first signs of the disease develops disorientation in space. The feature of Alzheimer's disease is that patients retain a long time to maintain a general formal critical attitude to their state (in contrast to the peak disease). With the development of the disease progresses dementia. The behavior of such patients becomes completely ridiculous, they lose all household skills, their movements are often completely meaningless.

The forecast of these diseases is unfavorable.

Senile dementia.With senile dementia, as can be seen from the name, the leading value belongs to total dementia in combination with special meal and emotional disorders. Brightly perform memory violations, first of all on current events, then the meal disorders apply to earlier periods of the patient's life. Patients's formed memory gaps are filled with false memories - pseudomminiscoles and confabulation. However, they are distinguished by inconsistency and lack of a certain topic. Emotional manifestations of patients are sharply narrowed and changed, either grateful, or a sullen-irritable mood. In behavior there is passivity and inertness (patients cannot do anything) or fussiness (they collect things, try to leave somewhere). The criticism and ability of an adequate understanding of the surrounding, current events are missing, there is no understanding of the pain of its condition. Often the behavior of patients is determined by definition of instincts - increased appetite and sexuality. Sexual disbursement is manifested in the ideas of jealousy, in attempts to corrupt sexual action on juvenile.

Drain and hallucinatory states.Patients express the delusional ideas of persecution, guilt, impoverishment and hypochondria. In delusional statements, individual facts of real circumstances appear. Patients also discovered hallucinatory symptoms. The most frequent are visual and tactile hallucinations. By their content, they are associated with delusional ideas. Epizodically, the states of frustrated consciousness with abundant confibulations are subsequently may occur. The possibility of a wave-like flow of delusional psychosis in old age was noted. These states may repeat several times. Between them there are various durations of light gaps. Along with depressive-alarming symptomatics, patients are constantly marked by delusional ideas. The most typical delusted statements are the ideas of self-evidence and self-confidence. Often, delusional ideas of persecution join the delusional ideas of self-evidence. Patients say that they are pursued for the grave crimes they committed that they will have a lawsuit where they will be sentenced to death. Sometimes delusional ideas in patients have a hypochondriacity.

123. Psychological phenomena and psychopathological symptoms with various mental disorders.

Schizophrenia

Schizophrenia is a chronic disease with a progradient (deteriorating over time) the flow leading to a change in the identity of the patient.

Debut schizophrenia is determined very difficult. The beginning of schizophrenia is noted by the disorder of the emotional sphere: the uncommunicability, closure, emotional coldness, inability to concentrate - manifestations of schizoid accentuation. However, it cannot be considered depression, since there is no depressive triad.

At the debut, obsessions are manifested, including ridiculous ritualized.

In thinking there is a pathological wise, ridiculous questions, reflections around nothing. There is a common asthenia, energy loss. A volition component is disturbed. Ambivalence is manifested, including emotional. The same stimulus can cause simultaneously joy and evil rejection. Also arises an accief - the duality of desires and the impossibility of choice.

Mutism may appear. Emotional background: gloomy, closedness.

Negative is a negative attitude to those who are trying to join the Count, and the behavior can be opposite to adequate in this situation.

It is possible to counter the physiological needs, as well as the "hood syndrome".

Since it is difficult to separate the contribution of genetic factors from environmental impact, numerical estimates usually differ, but twin research speaks of high degree The hereditary conditionality of the disease. Evidence is obtained that prenatal (prenatal) infections increase risks, and this is another confirmation of the communication of the disease with impairment of intrauterine development.

Blair highlighted autism as an option schizophrenia. There is no desire to communicate, care for internal experiences.

Symptoms of schizophrenia are often divided into positive (productive) and negative (deficient).

TO positive Believe nonsense, auditory hallucinations and thinking disorders are all manifestations, usually testifying to the presence of psychosis.

In turn, about the loss or absence of normal character traits and human abilities speak negativesymptoms: Reducing the brightness of experienced emotions and emotional reactions (flat or bleached affect), poverty of speech (alogia), inability to enjoy (Angedonia), loss of motivation. Recent studies, however, suggest that despite the external affect loss, schizophrenia patients are often capable of emotional experiences on normal or even increased level, in particular, with stressful or negative events.

Often allocate the third group of symptoms, the so-called disorganization syndrome, which includes chaotic speech, chaotic thinking and behavior.

Violations of thinking processes in schizophrenia are made up of several processes.

Disturbance of targeted It is one of the defining features of the entire mental life of schizophrenia patients, traced both in the emotional-volitional sphere and in the field of thinking. The main symptom in which it is most brightly traced is resonance. Resonance, or fruitlessness - reasoning not having a final goal, in which the patient takes words alone to others without coming in the end. This trend is most clearly visible at the so-called. schiophasiaWhen the patient builds a grammatically correct phrase from absolutely unnecessied in the meaning of words.

Reduced volitional activityunderlying the violation of the focusing of thinking can behave in strengthening to the loss of indection, simplifying associative processes, up to the acquisition of a primitive, formal, specific nature, loss of ability to understand the abstract meaning of statements, for example, in the interpretation of proverbs and sayings.

The following phenomena is also associated with volitional regulation violations. The circumstance of thinking - severe detailing and systematic jams on adverse associations. Maze thinking- Return uneconomically to the main topic. Viscosity of thinking - constant involvement in the mental process of secondary insignificant details. Viscosity is the extreme degree of circumstance at which the detailing completely closes the main theme, there is no return to it.

Next trend is violation of the associative process. With schizophrenia, we are dealing with a tendency to form associations, links between concepts on the basis of the so-called. Latent (weak, not obvious, not basic) signs. As a result, thinking is becoming a strange, difficult character. Such thinking is called paralogical. Thus, the patient's reasoning becomes difficult to understand not only because he often does not know where it moves and whether it moves in general, but also the movement is carried out according to a malfunction path. One possible options at the same time is the preferential use in the thinking of the symbolic "portable" meaning of words and concepts. This thinking is called symbolic.

Trends K. education of new connectionsAssociations between concepts also find their expression in the merger of several concepts into one and the formation of new words to denote such concepts. This trend leads to the formation of the so-called. neologisms.

The extreme form of paralude thinking in which the violation of the associative process is pronounced, the total character is called atthantic thinking or schizophrenic incoherence.

The combination of negativism in the volitional sphere, disorders of focus and paralylaminicity finds its expression in the so-called. scrollsor answers not in terms of the question when the patient in response to the question begins to talk about something that has no relation to the question in general or having a weak attitude towards him.

Epilepsy

Epilepsy - chronic brain disease, paroxysmally arising (in the form of seizures) Disorder in the form of sharp convulsive and sensory seizures and their mental equivalents with progressive impaired psyche - a progradient disease (symptoms are weighted with time).

A few hours before the onset, the seizure of the patient begins to feel aura. Aura can be emotionally pleasant and meaningful for the patient - such people do not want to be treated, for they will lose aura.

Types of Aur:

1. Visual aura - optical disorders in the form of colored spots, the state of the incoming blindness. The whole world around becomes red / yellow. The world "bleeds" and burns.

2. Hearing aura - noise, crackling, ringing or auditory images (melodies, crying, imperative orders).

3. Psychosensory aura - the world or body becomes large or small.

4. Vestibulo-aura - dizziness, vomiting.

5. Obnapitive, taste aura - the appearance of the smell of rot, smoke, etc.

6. Visceral Aura - heartbeat, difficulty breathing, gastrointestinal disorders, urination disorders, feeling of hunger and thirst.

7. Motor Aura - tico-like twitching, cramps, automatons, rapid run forward.

For a change, Aure comes a big seizure. The patient knows that the seizure will happen, but does not know when. It is necessary to prepare to the seizure - to lie on sides on soft (but not on the pillows, since they can suffocate), take a wand in your mouth, a pencil or some item in order not to bite the language, call an ambulance.

The seizure begins crying. 20-25 seconds the convulsions continue, at the end of which - a deep permanent of consciousness. There is an involuntary urination, there are no reactions to sounds and action. Then follows deep dreamAfter which there is a sharp or a gradual return to the norm begins.

Small seizures last 2-7 seconds, there are no auras, they dismissed. Reflex postures during the seizure can be saved. The patient may not be suspected that he is sick, but they notice the surrounding. The most common abscanance - patient interrupts the action started and loses its initial goal.

The frequency of seizures is different - from one time in life up to 5-6 times a day.

In general, in the seal 4 phases are isolated: (0. Aura), 1. Turning off consciousness, cramps, cry, pupil does not respond to light. 2. Redness of face, deep breathing - 1.5-2 minutes. 3. Epileptoid Coma / Deep Sleep. 4. Age of consciousness, facial anemia, complexity of speech.

Mental equivalent - various kinds of suddenly emerging psyche disorders. Suddenness and episodic replace the convulsive fit itself. Signs:

1) Motor automates, somnambulism - with a changed state of consciousness, a person continues to perform the initiated actions, but not for sure.

2) The twilight state of consciousness is the mental equivalent of a convulsive epilepsy.

3) Special states of consciousness, not accompanied by amnesia: Derealization (alien to the surrounding world, causing confusion and anxiety), dysphorria (passionate impulses, mood disorders, absence of a stable radical), narcotepsy (bouts of falling asleep, falling muscle tone while maintaining consciousness, Perhaps under the influence of bright emotions of anger or joy, while there is no oppression in the intellectual sphere; such attacks of sleepiness occur to 30 times a day).

Migraine (vomiting, nausea, dizziness), EEG markers include disorders of the epileptic circle.

The complexity of the differential diagnosis represents the distinction of the hysterical and epileptic seas. The differences between the epileptic seizure of hysterical:

1) Epileptic seizure occurs without communication with psychogenic factors, in contrast to hysterical.

2) Aura is only with an epileptic seizure.

3) Epileptic seizure has a natural structure.

4) With epileptic seizure there pupil reaction, involuntary urination and biting language occurs; With the hysterical seizure of these manifestations.

5) Epileptic fit is accompanied by amnesia.

6) Long-term epileptic seizures lead to progressive dementia, hysterical - no.

Psychoic disorders.

The concept of "psychodies" unites a wide circle of disorders that are formed under the influence of mental injury.

Among the attempts to systematize the basic laws of psychogenic disorders, the "Tiad of Jaspers" was most common, which includes three traits:

1. Psychogenic diseases are caused by mental injury;

2. Mental injury is reflected in the content of the symptoms of these diseases;

3. The reactive states end under the termination of the cause caused their cause.

From a clinical point of view, the following forms of reactive jets are distinguished:

§ Acute reaction to stress (affective shock reaction)

§ hysterical psychosis

§ Psycho-depressed

§ Psychogenic mani

§ Psychodic paranoids.

Sharp shock reactions Described as "Horror's Psychosites", but such definitions as emotional shocks, acute affectogenic reactions, crisis reactions, reactions of extreme situations also appear in the literature. In all these cases, we are talking about transient disorders of considerable gravity with sharp endocrine and vasomotor shifts developing in individuals without mental pathology in extreme conditions. Sensitivity to stressful impacts increases in asthenized persons, elderly people and somatic diseases.

There are hyper- and hypokinetic forms of sharp reactions to stress.

With hyperkinetic form, to a certain extent corresponding to the "motor storm" reaction, the behavior of patients loses focusing; Against the background of a rapidly increasing anxiety, fear there is a chaotic psychomotor arousal with messy movements, aimless throwing, the desire to escape somewhere (fugiform reaction). Orientation in the surrounding is disturbed. The duration of motor excitation is small, it is usually stops after 15-25 minutes.

For a hypokinetic form corresponding to the reaction of "imaginary death", the state is characterized by a sharp motor inhibition, reaching up to complete immobility and mutism (affectogenic stupor). Patients usually remain on the place where the affect of fear arose; They are indifferent to what is happening around, the look is directed into space. The duration of the stupor from several hours to 2-3 days. Experiences related to the acute period of psychosis are usually amnesized. Upon exit of acute psychosis, there is a pronounced asthenia that lasts up to 2-3 weeks.

Hysterical (dissociative) psychosis Posted by inhomogeneous in a clinical picture with psychotic states - the hysterical twilight permanent of consciousness, pseudo-degeneration, puerylism, syndrome of instant fantasies, the syndrome of the regression, hysterical stupor. Depending on the severity and duration of the reaction, there is a combination of different hysterical disorders, or a sequential transformation of some hysterical manifestations to others. This type of psychogenic reactions in a peacetime is most often observed in forensic psychiatric practice ("prison hysteria"), but is also formed in connection with the situations of loss (the death of the next relatives, the gap of marital relations), as well as with some other pathogenic factors. In accordance with psychodunic concepts, hysterical psychosis is interpreted as a "reaction of displacement" of mental injury.

Acute depressive reactions Most often directly related to the inconsistent unfortunate, the sudden impact of individually significant mental injury. At the height of acute depression, fear is dominated, deep despair, thoughts of death. Such states are usually short-lived and fall into the field of view of the psychiatrist only in cases where they are associated with self-injunations or suicidal attempts. It is characterized by the concentration of the entire content of consciousness on the events of what happened misfortune. The topic of experience gaining sometimes the properties of the dominant representation does not disappear completely even when the depression becomes protracted and more erased. A sufficiently random reminder so that the depression is intensified again; Even remote associations can provoke outbreaks of despair.

In a clinical picture psychogenic mania From the very beginning, the phenomena of exhaustion, irritability, fussiness with a minor severity of vital disorders - affects of joy, contentment, dismantling disorders, prevail. Characterized by the combination of polar affects - grief and inspiration, contrasting experiences of life collapse and optimistic rates. Often, sleep disorders are commemorated: the difficulty of falling asleep associated with the influx of memories of tragic events, a small duration of night sleep with early awakening and lack of drowsiness during the day. Activity is raised. Patients discover the previously unusual energy, mobility, the desire for activities that are adequate to the current circumstances, are making efforts to prevent the decay of the family, the search for rare drugs, the "shining" medicine for a dying relative, the organization of funerals, aless.

Clinical picture of acute psychogeneic paranoid It is characteristic of simplicity, elementality, imagery, emotional saturation of nonsense and a sharply pronounced affect of fear and anxiety. Most often there is a nonsense and relationship. The content of nonsense reflects in the direct or opposite (non-vernacy and pardon delimitation) by the traumatic situation. In some cases, this is a threat to physical existence, the strife, in others - the moral and ethical damage caused by the patient himself and his relatives. Also as visual and auditory hallucinations are also possible.

Post-traumatic stress disorder (PTSD) - a protracted disease. More often in people who have received minimal physical damage or not received them in general as a result of a catastrophe. PTSD is stated to the bottom of half a year after the event. It is characterized by sleep disorders with flashbacks. The complex of guilt is formed (for example, in front of the relatives of the dead people), or the accusation complex (everyone who has a relationship to the event).

Neurosis.

Neuroses, along with personality disorders, belong to border mental disorders.

Border mental disorders are characterized by the following parameters:

1. The critical attitude of the person to its state is preserved.

2. Painful changes primarily in the emotional sphere and are accompanied by violations of all functions.

3. Violation is caused by mental, and not organic reasons.

4. Lack of psychogenic symptoms, progressive dementia and personality changes.

The cause of border disorders is the mismatch between aspirations and capabilities.

For border disorders, affective violations arise: fears, depressed, longing, stress.

Stress- This is a non-specific body reaction. Selre described the pathogenesis of stress, expanding these concepts of adaptation syndrome.

Somatic diseases in defeat internal organs (including endocrine) or entire systems, often cause various mental disorders, most often called "somatically determined psychosis" (K. Schneider).

The condition for the emergence of somatically determined psychoses K. Schneider proposed to consider the presence of the following signs: (1) the presence of a pronounced clinic of a somatic disease; (2) the presence of a noticeable connection in time between somatic and mental disorders; (3) a certain parallelism for mental and somatic disorders; (4) Possible, but not the mandatory appearance of organic symptoms.

There is no single look at the accuracy of this "quadria." The clinical picture of somatogenic disorders depends on the nature of the main disease, the degree of its severity, the flow stage, the level of effectiveness of therapeutic effects, as well as from such individual properties, as heredity, the constitution, the premorbide warehouse of the personality, age, sometimes gender, the body's reactivity, the presence of preceding the harm ( The ability to reaction "changed soil" - S.G. Zhislin).

The so-called somatopsychiatry section includes a number of closely interrelated, but at the same time different groups of painful manifestations in the clinical picture. First of all, it is actually a daity, that is, mental disorders caused by a somatic factor that belong to the large section of exogenous-organic mental disorders. No less in the clinic of mental disorders in the somatic diseases occupy psychogenic disorders (the response to the disease not only with the limitation of human activity, but also possible by very dangerous consequences).

It should be noted that in the ICD-10 mental disorders in the somatic diseases are described mainly in the F4 sections ("neurotic, associated with stress, and somatoform disorders") - F45 ("Somatoform disorders"), F5 ("behavioral syndromes associated With physiological disorders and physical factors ") and F06 (other mental disorders due to damage and brain dysfunction or somatic disease).

Clinical manifestations. Different stages Diseases may be accompanied various syndromes. At the same time, there is a certain circle of pathological conditions, especially characteristic at present for somatogenic mental disorders. These are the following disorders: (1) asthenic; (2) negros-like; (3) affective; (4) psychopath-like; (5) delusional states; (6) the state of permanent consciousness; (7) Organic Psychosinder.

Asthenium is the most typical phenomenon in the somatoids. Often there is a so-called rod or through syndrome. It is the asthenia that currently due to the pathorphosis of somatogenic mental disorders may be the only manifestation of mental changes. In the event of a psychotic state of asthenia, as a rule, it may be his debut, as well as the completion.

Asthenic states are expressed in various versions, but typical are always increased fatigue, sometimes from the very morning, the difficulty of concentrating attention, slowing perception. Emotional lability is also characteristic, increased vision and syradiability, fast distractions. The patients do not tolerate even minor emotional stress, quickly get tired, are upset due to any trifle. It is characterized by hyperesthesia, expressing in the intolerance of sharp stimuli in the form of loud sounds, bright light, smells, touches. Sometimes hyperesthesia is so pronounced that the patients are annoyed even by gentle voices, ordinary light, touch of linen to the body. Frections a variety of sleep disorders.

In addition to asthenia in its pure form, it is quite often its combination with depression, anxiety, obsessive fears, and hypochondriamic manifestations. The depth of asthenic disorders is usually associated with the severity of the underlying disease.

Non-relation-like violations. These disorders are associated with somatic status and arise when weighing the latter, usually with the almost complete absence or a small role of psychogenic effects. A feature of neurosis-like disorders, in contrast to neurotic disorders, their rudimentaryness, monotony, is characterized by a combination with vegetative disorders, most often a paroxysmal nature. However, vegetative disorders may be persistent, existing ones.

Affective disorders. Distimic disorders are very characteristic of somatogenic mental disorders, primarily depression in its various versions. In the context of the complex weakening of somatogenic, psychogenic and personal factors in the origin of depressive symptoms, the share of each of them varies significantly depending on the nature and phase of the somatic disease. In general, the role of psychogenic and personal factors in the formation of depressive symptoms (in the progression of the underlying disease) is initially increasing, and then, with a further gravity of the somatic state and, respectively, the deepening of asthenia is significantly reduced.

You can note some features depressive disorders Depending on what kind of somatic pathology, they are observed. In cardiovascular diseases in the clinical picture, the ability to prevail, fast fatigue, weakness, lethargy, apathy with disbelief in the possibility of recovery, thoughts about allegedly inevitably coming in any cardiac disease "Physical insolvency." Patients of Tsoscili are immersed in their experiences, detect a tendency to constant self-analysis, spend a lot of time in bed, reluctantly come into contact with their neighbors on the ward and personnel. In conversation, they say predominantly about their "severe" disease, that they do not see the exit of the situation. Typical complaints about a sharp decline of forces, on the loss of all sorts of desires and aspirations, to the inability to focus on something (hard to read, watch TV, even speak hard). Patients often build all kinds of assumptions regarding their poor physical condition, the possibility of an unfavorable forecast, express uncertainty in the correctness of the treatment.

In cases where the presentations of violations in the gastrointestinal tract prevail in the inner picture of the disease, the patient's condition is determined by a persistent daisy affect, disturbing doubts about its future, subordinate to the attention of an extremely single object - the activities of the stomach and intestines with fixation on various outgoing unpleasant sensations. There are complaints about the "degrading" feeling, localized in the field of epigastria and at the bottom of the abdomen, on almost not passing gravity, squeezing, sawing and other unpleasant sensations in the intestine. Patients in these cases often associate such disorders with "nervous tension", the state of depression, depression, treating them as secondary.

Under the progression of a somatic disease, a long-term course of the disease, the gradual formation of chronic encephalopalopathy, a thousandth depression gradually acquires the nature of the depression of dysforic, with gridness, discontent with those surrounding, cavity, demanding, capriciousness. Unlike an earlier stage, the alarm is not constant, but usually occurs during periods of exacerbation of the disease, especially with a real threat to development hazardous consequences. On remote tapaches of severe somatic disease in severe phenomena of encephalopathy often, against the background of dystrophic phenomena, asthenic syndrome includes an oppression with the predominance of adamisia and apathy, indifference to the surrounding.

During the period of significant deterioration of the somatic state, an attacks of anxious and dreary excitation occur, at the height of which suicidal actions may be committed.

Psychopathoid disorders. Most often, they are expressed in an increase in selfishness, egocentrism, suspicion, dislike, disliked, wary or even hostile attitude towards others, hydiform reactions with a possible propensity to aggraphering their condition, the desire to constantly be the focus, elements of the installation behavior. It is possible to develop a psychopath-like state with an increase in anxiety, constancy, difficulties in making any decision.

Dead states. In patients with chronic somatic diseases, delusional states usually arise against the background of a depressive, asthenodepressive, anxiously depressive state. Most often it is a nonsense relationship, condemnation, material damage, less often nihilistic, damage or poisoning. Drain ideas at the same time obstacious, episodic, often have a character of a malfunctionless doubt with a noticeable extrusion of patients, are accompanied by verbal illusions. If the somatic disease led to a rapid change in appearance, it may be formed by the syndrome of dysmorfoomania (the ultra-subject idea of \u200b\u200bthe physical disadvantage, the idea of \u200b\u200bthe relationship, depressive state) arising from the mechanisms of the reactive state.

The condition of the praised consciousness. Most often noted episodes of stunning arising on an asthenic-adamus background. The degree of stunning washes to wear a hesitate. The easiest degree of stunning in the form of reassembly of consciousness during the weightlifting of the general state can be traveled by a copor and even to whom. Deliosis disorders It is often an episodic character, sometimes manifested in the form of so-called abortive deliries, often combined with a stunning or with onairic (dream) states.

For serious somatic diseases, such options for delirium, as a wealthy and professional with a frequent transition in whom, as well as the group of so-called quiet delicacy are characteristic. Quiet delirium and the states like it are observed by the pi chronic diseases of the liver, kidneys, hearts, gastrointestinal tract And they can proceed almost imperceptibly to others. Patients are usually sedimed, located in a monotonous position, indifferent to the surrounding, often produce the impression of dormants, sometimes something murmurs. They seem to be present when viewing onairic paintings. Periods these onairoid-like states can alternate with the state of excitement, most often in the form of a random fussiness. Illusory-hallucinatory experiences with this condition are characterized by colorfulness, brightness, scenedom. Deconsonizational experiences, sensory synthesis disorders are possible.

Amenpetic perisage of consciousness in pure form is infrequent, mainly in the development of a somatic disease on the so-called modified soil, in the form of a preceding weakening of the body. It is much more often aimative state from a rapidly changing depth of the permanent of consciousness, often approaching the disorders of the type of quiet delirium, with clarifications of consciousness, emotional lability. The twilight state of consciousness in its pure form in the somatic diseases is rare, usually in the development of organic psychosindrome (encephalopathy). Oneiroid in its classic form is also not very typical, it is much more commonly delicious-onairoid or onairic (dream) states, usually without moving excitement and expressed emotional disorders.

The main feature of the syndromes of permanent consciousness in the somatic diseases are their spun, a quick transition from one syndrome to another, the presence of mixed states, the emergence, as a rule, on an asthenic background.

Typical psychoorganic syndrome. In case of somatic diseases, it occurs infrequently, it usually occurs, as a rule, with long diseases with severe course, such in particular, as chronic renal failure or a long-term cirrhosis of the liver with phenomena of the hypertension. In case of somatic diseases, an asthenic version of psychoorgic syndrome with increasing mental weakness, increased depletion, fusibility, an asthenodisforic mood-tone (see also article " Psycho-Organic syndrome "In the" Psychiatry "section of the medical portal site).

Somatogenic mental disorders are usually determined by the symptoms caused by not only somatic, but also endogenous, subjective factors. In this regard, the clinical picture reflects the personality reactions to the pathological process. In other words, the nature of the course of the pathological process is reflected in the identity of the patient, its emotional experiences.

The diagnosis of any serious somatic disadvantage is always accompanied by a patient's personal reaction reflecting the newly emerged situation. In clinical manifestations, psychogenic states in somatic patients are extremely diverse. More often, they are expressed by mood disorders, total depression, intensity. At the same time, a tendency to increased concerns regarding the impossibility of recovery. There is fear, anxiety in connection with the upcoming long-term treatment and stay in the hospital in the separation from the family, close. At times, the first place is the longing, the oppressive feeling, externally expressed in the closetness, in motor and intellectual inhibition, tearfulness. Caprisality and affective instability may appear.

The diagnosis of somatogenic psychosis is raised under certain conditions: the presence of a somatic disease; temporary communication between somatic and mental disorders, interdependence and mutual influence in their course. Symptoms and flow depend on the nature and phase of the development of the main disease, the degree of its severity, the effectiveness of the treatment, as well as on the individual characteristics of the patient, such as heredity, the Constitution, nature, the floor, age, the state of the body's protective forces and the presence of additional psychosocial hazards.

According to the emergence mechanism distinguish 3 groups of mental disorders.

Mental disorders as a reaction to the very fact of the disease, hospitalization and the associated separation from the family, the usual situation. The main manifestation of such a reaction is the varying degree of depression of mood with one or another tint. Some patients are full of painful doubts in the effectiveness of the treatment prescribed by him, in the prosperous outcome of the disease and its consequences. Others prevailing the alarm and fear of the possibility of serious and long-term treatment, before surgery and complications, the likelihood of obtaining disability. Patients are indifferently lying in bed, refusing food, from the treatment "Anyway one end." However, in such, externally emotionally inhibited patients, even with an insignificant influence of the outside, anxiety may occur, foulness, pity for themselves and the desire to gain support from others.

The second, significantly large group is patients who have mental disorders, as it were, a component of the clinical picture of the disease. These are patients with psychosomatic Nazoigia, along with pronounced symptoms of internal diseases (hypertension, yasel disease, diabetes mellitus), neurotic and pathocharacterological reactions are observed.

The third group will be patients with acute impaired mental activity (psychosis). Such states are developed either with severe acute diseases with high temperature (brunt inflammation of lungs, abdominal title) or pronounced intoxication (masking renal failure), or in chronic diseases in terminal stages (cancer, tuberculosis, kidney disease).

Major psychopathological syndromes in case of somatic diseases.

1.Napsychotic level:

Asthenic syndrome

Affective disorders of an unexigated level

Obsessive-compulsive syndrome

Phobic syndrome

Estro-conversion syndrome.

2.Athotic levels:

Syndromes permanent and shutdown consciousness

Hallucinatorial-delusional disorders

Affective psychotic level disorders.

3. Dissenters-dementary disorders:

Psycho-Organic syndrome

Korsakovsky syndrome

Dementia

122. Problems solved by age clinical psychology.

The aging of the body is accompanied by a change in all its functions - both biological and mental. Age, which is usually considered the beginning of the emergence of mental changes associated with the involution, is over 50-60 years.

Emotional manifestations with age are modified. Emotional instability is developing, anxiety. There is a tendency to jam on unpleasant experiences, anxiously depressive coloration. Mental disorders in individuals and senile people are manifested both in the form of border mental disorders and psychosis.

Border disorders Include neurosis-like disorders, affective disorders and identity change. Non-obsishable disorders are manifested by a breakdown of sleep, various unpleasant sensations in the body, emotional-unstable mood, irritability, varying disturbance and concerns, well-being of loved ones, its health, etc. , "Deadly" disease. The occurring changes in the patient's personality are captured by both characterological and intellectual properties. In the characterological characteristics, there is a sharpness of the yutrement of individual, characteristic of the patient earlier personal traits. Thus, the incredulusity goes into suspicion, thrift - in stupidity, perseverance - in stubbornness, etc. Intelligent processes lose their brightness, associations become poor, the quality and level of synthesis of concepts are reduced. First of all, memory is violated on current events. With difficulty, for example, the events of the past day are remembered. There is also a decrease in criticism - the ability to correctly evaluate its mental state and changes occurring.

Involutionary melancholy.This is frequent psychosis in persons of the prediction. The leading psychopathological manifestations for this disease are depression with anxiety. The severity of depressive and disturbing manifestations is different: from light psychopathological manifestations to severe depressions with severe anxiety and award. Patients also have a state when the depression is concerned with the intensity. Such a motor inhibition can acquire the form of a stupor.

Involutionary paranoid. This psychosis is characterized by the development of systematized nonsense ideas. Drain ideas are usually combined with an alarming-depressed mood. They concern the threat of well-being, health of the illness of patients, as well as their loved ones. The content of delusional ideas is associated with the specific events of everyday life and is not something unusual, fantastic. Sometimes the statements of patients look plausible and misleading others.

Along with delusional experiences, patients often observed hallucinatory manifestations. Hallucinations are more often auditory. Patients hear the noise behind the wall, hopot, voices, threatening them, condemning their actions and actions.

Patients detected peculiar identity changes: the narrowing of the circle of interest, monotony of manifestations, increased anxiety and suspicion.

Mental disorders in atrophic processes in the brain

Heavy mental disorders are found in a number of patients in a prediction and old age, which have characteristic organic changes in the brain. This includes mental disorders in connection with brain atrophy and senile dementia.

Peak disease.This disease is characterized by the development of progressive amnesia, total dementia. In the earliest stages of its development, pronounced personality changes are noted, characterized by aspotation and pseudoparalytic shift. Aspontaneity is manifested in indifference, indifference, apathy. Patients forget the events of the past day, current events, do not recognize familiar persons, meeting them in an unusual setting. There is no critical attitude towards its state, but they are upset when they are convinced of their insolvency. Usually in patients with even, complacent mood. There are gross violations of thinking. They do not notice explicit contradictions in their judgments and estimates. So, patients are planning their affairs without taking into account their own inconsistency. For patients with peak disease, so-called standing symptoms are typical - multiple repetitions of the same speech revolutions.

Alzheimer's disease. For him, progressive amnesia and total dementia are also typical. In the disease Alzheimer, in the initial period, there is often tear-irritable depressions, in parallel with these disorders there is a rapidly growing deterioration in memory, close to progressive amnesia, and shortly after the appearance of the first signs of the disease develops disorientation in space. The feature of Alzheimer's disease is that patients retain a long time to maintain a general formal critical attitude to their state (in contrast to the peak disease). With the development of the disease progresses dementia. The behavior of such patients becomes completely ridiculous, they lose all household skills, their movements are often completely meaningless.

The forecast of these diseases is unfavorable.

Senile dementia.With senile dementia, as can be seen from the name, the leading value belongs to total dementia in combination with special meal and emotional disorders. Brightly perform memory violations, first of all on current events, then the meal disorders apply to earlier periods of the patient's life. Patients's formed memory gaps are filled with false memories - pseudomminiscoles and confabulation. However, they are distinguished by inconsistency and lack of a certain topic. Emotional manifestations of patients are sharply narrowed and changed, either grateful, or a sullen-irritable mood. In behavior there is passivity and inertness (patients cannot do anything) or fussiness (they collect things, try to leave somewhere). The criticism and ability of an adequate understanding of the surrounding, current events are missing, there is no understanding of the pain of its condition. Often the behavior of patients is determined by definition of instincts - increased appetite and sexuality. Sexual disbursement is manifested in the ideas of jealousy, in attempts to corrupt sexual action on juvenile.

Drain and hallucinatory states.Patients express the delusional ideas of persecution, guilt, impoverishment and hypochondria. In delusional statements, individual facts of real circumstances appear. Patients also discovered hallucinatory symptoms. The most frequent are visual and tactile hallucinations. By their content, they are associated with delusional ideas. Epizodically, the states of frustrated consciousness with abundant confibulations are subsequently may occur. The possibility of a wave-like flow of delusional psychosis in old age was noted. These states may repeat several times. Between them there are various durations of light gaps. Along with depressive-alarming symptomatics, patients are constantly marked by delusional ideas. The most typical delusted statements are the ideas of self-evidence and self-confidence. Often, delusional ideas of persecution join the delusional ideas of self-evidence. Patients say that they are pursued for the grave crimes they committed that they will have a lawsuit where they will be sentenced to death. Sometimes delusional ideas in patients have a hypochondriacity.

123. Psychological phenomena and psychopathological symptoms with various mental disorders.

A description of mental disorders in somatic diseases can be found in antique medicine. In the Middle Ages, mixtures of various alcoholoids in the treatment of mental changes associated with internal illness were widely used in the Arab and European Medicine. Somatic diseases consisting in the defeat of the internal organs (including endocrine) or entire systems, often cause various mental disorders, most often called "somatically determined psychosis, as well as" somatogenic psychosis. " The conditions for the emergence of somatically determined psychoses K. Schneider proposed to consider the presence of the following signs: 1) the presence of a pronounced clinic of a somatic disease; 2) the presence of a noticeable connection in time between somatic and mental disorders; 3) a certain parallelism for mental and somatic disorders; 4) Possible, but not the mandatory appearance of organic symptoms. There is no single look at the accuracy of this classification. The clinical picture of somatogenic disorders depends on the nature of the main disease, the degree of its severity, the flow stage, the level of effectiveness of therapeutic effects, as well as from such individual properties, as heredity, the constitution, the premorbide warehouse of the personality, age, sometimes the floor, the body's reactivity, the presence of preceding the harm. Different stages of the disease may be accompanied by various syndromes. At the same time, there is a certain circle of pathological conditions, especially characteristic at present for somatogenic mental disorders. These are the following disorders:

1.Asthenic; ; 2. Nameless; 3.Affective; 4.Akopato-like; 5. Distributed states;

6. Consciousness permanent;

7. Organic psychosindrome.

Asthenia - The most typical phenomenon in the somatoids. It is asthenia at present, due to the pathorphosis of self-photographic mental disorders, it may be the only manifestation of mental changes. In the event of a psychotic state of asthenia, as a rule, it may be his debut, as well as the completion. Asthenic conditions are expressed in various versions, but typical are always increased fatigue, sometimes from the morning, the difficulty of concentrating attention, slowing perception. Emotional lability is also characteristic, increased vision and syradiability, fast distractions. The patients do not tolerate even minor emotional stress, quickly get tired, are upset due to any trifle. It is characterized by hyperesthesia, expressing in the intolerance of sharp stimuli in the form of loud sounds, bright light, smells, touches. Sometimes hyperesthesia is so pronounced that the patients are annoyed even by gently voices, ordinary light, touching the linen to the body. Frections a variety of sleep disorders. The depth of asthenic disorders is usually associated with the severity of the underlying disease. In addition to asthenia in its pure form, it is quite often its combination with depression, anxiety, obsessive fears, and hypochondriam (as described above). Non-relation-like violations. These disorders are associated with somatic status and arise when weighing the latter, usually with the almost complete absence or a small role of psychogenic effects. A feature of neurosis-like disorders, in contrast to neurotic, is their rudimentaryness, monotony, characterized by a combination with vegetative disorders, most often a paroxysmal nature. However, vegetative disorders can be resistant, existing existing. Affective disorders. Distimic disorders are very characteristic of somatogenic mental disorders, primarily depression in its various versions. In the context of complex weave of somatogenic, psychogenic and personal factors, the origin of depressive symptoms The proportion of each of them varies significantly depending on the nature and phase of the somatic disease. In general, the role of psychogenic personal factors in the formation of depressive symptoms (under the progression of the underlying disease) is initially increasing, and then, with the further weighing of the somatic state and, accordingly, the deepening of asthenia is significantly reduced. Under the progression of a somatic disease, a long-term course of the disease, the gradual formation of chronic encephalopalopathy, a thousandth depression gradually acquires the nature of the depression of dysforic, with gridness, discontent with those surrounding, cavity, demanding, capriciousness. Unlike an earlier stage, the alarm is not constant, but usually occurs during periods of exacerbation of diseases, especially with a real threat to the development of hazardous consequences. In remote stages of severe somatic disease with severe phenomena of encephalopathy, often on the background of dysphoric phenomena, asthenic syndrome includes an oppression with the predominance of adamisia and apathy, indifference to the surrounding. During the period of significant deterioration of the somatic state, anxious and dreary excitation attacks occur, at the height of which suicidal attempts may be performed.

In case of somatic diseases with a chronic course, accompanied by a long impaired exchange, intoxication occurs heavier and long-term changes in the type psychopath-likewhich are characterized by:

the presence of persistent mood disorder, namely a dysphoria with a predominance

fatigue, fatigue, hostility to the whole surrounding;

feeling discontent, deaf anxiety;

reduced productivity of thinking;

the surface of judgments;

reduction of energy and activity;

the development of egocentricism and narrowing of the circle of interest;

monotony of behavior, annoyance and demand;

the state of confusion at the slightest life difficulties.

It is possible to develop a psychopath-like state with an increase in anxiety, constancy, difficulties in making any decision.

Dead states. In patients with chronic somatic diseases, delusional states usually arise against the background of depressive, astheno-depressive, anxiously depressive state. Most often it is a nonsense relationship, condemnation, material damage, less often nihilistic, damage or poisoning. Drain ideas at the same time obstacious, episodic, often have a character of a malfunctionless doubt with a noticeable extrusion of patients, are accompanied by verbal illusions. If the somatic disease led to some kind of incitement of appearance, it can be formed by a dismortion syndrome, arising from the mechanisms of the reactive state. The condition of the praised consciousness. Most often noted episodes of stunning arising on an asthenic-adamus background. The degree of stunning can be fluent in nature. The easiest degree of stunning in the form of revenue of consciousness when the general state can go to the opposite and even to whom. Deliosis disorders often wear an episodic character, sometimes manifest as in the form of so-called abortive deliries, often combined with stunning or onadeuric states. For heavy somatic diseases, such options are characterized by delirium options as a wealthy and professional transition to whom, as well as a group of so-called quiet delicacy. Quiet delirium and the states like it are observed in chronic diseases of the liver, kidneys, heart, gastrointestinal tract and can proceed almost imperceptibly for others. Patients are usually sedimed, located in a monotonous position, indifferent to the surrounding, often produce the impression of dormants, sometimes something murmurs. They seem to be present when viewing onairic paintings. Periods these onairoid-like states can alternate with the state of excitement, most often in the form of a random fussiness. Illusory-hallucinatory experiences with such exacerbation are characterized by colorfulness, brightness, scene. Deconsonizational experiences, sensory synthesis disorders are possible. Amenpetic perisage of consciousness in pure form is infrequent, mainly in the development of a somatic disease on the so-called modified soil, in the form of a preceding weakening of the body. It is much more often aimative state from a rapidly changing depth of the permanent of consciousness, often approaching the disorders of the type of quiet delirium, with clarifications of consciousness, emotional forehead.

The twilight state of consciousness in its pure form in case of somatic diseases is rare, usually in the development of organic psychosindrome (encephalopathy).

Oneiroid in its classic form is also not very typical, it is much more often delicious-onairoid or onairic (dream) states, usually without moving excitation and expressed emotional disorders. The main feature of the syndromes of permanent consciousness in the somatic diseases are their spun, a quick transition from one syndrome to another, the presence of mixed states, the emergence, as a rule, on an asthenic background. Psycho-organic syndrome. In case of somatic diseases, it occurs infrequently, it usually occurs, as a rule, with long diseases with severe course, such as chronic renal failure or a long-term cirrhosis of the liver with portal hypertension phenomena.

The degree of mental disorders, their development, the course and exodus largely depends on the characteristics and severity of the somatic disease. However, the correlation is not absolute. Disorders of the psyche may disappear or significantly deteriorates in spite of the prolonged development of a somatic disease. The opposite is also observed: the change in the psyche can exist for some time or remain persistent with the coming improvement, or the full disappearance of a somatic disease. In recognition of somatogenic mental illness, it is necessary to be guided not only by the simultaneous presence of mental illness and somatic disease, but also the peculiarities of the clinical manifestations of psychosis.

Mental disorders in cardiovascular diseases. Myocardial infarction. In the acute period, an unreadable fear of death, achieving special severity in increasing pains, may occur. Characteristic anxiety, longing, anxiety, a sense of hopelessness, also manifestations of hyperesthesia. Sharply depressed mood, scoreless fear, anxiety, the feeling of an increasing catastrophe may occur in the acute period of myocardial infarction and in the absence of pain syndrome, and sometimes be a harbinger of it. With a heart attack flowing without painful syndrome, often the state of suddenly coming anxiety, longing, depressive state can resemble the vital depression, which is especially characteristic of the elderly. Anxious depression is hazardous by the possibility of suicidal actions, with a worsening of the state, the worsening symptoms may change the euphoria, which is also very dangerous due to the inadequate behavior of the patient. In general, the behavior is different: from immobility to strong motor excitement. The states of the praised consciousness in the acute period in the form of a stunning of varying degrees of severity are possible. There may be delicious changes, as well as twilight disorders of consciousness (characteristic of elderly). It is also characterized by asthenic symptoms, but over time, symptoms associated with the influence of a psychogenic factor begin to prevail: the personality reaction to such a serious psychotrauming situation with the threat of life. In this case, neurotic psychogenic reactions are closely intertwined with the effects of a self-somatic disease. Therefore, neurotic reactions with myocardial infarction largely depend on the premorbid features and are divided into cardophobic, anxious-depressive, depressive-hypochondriac and, less often, hysterical. With cardophobic reactions in patients prevail the fear of re-infarction and possible death from it. They are overly careful, resist any attempts to expand the physical activity mode, try to reduce to a minimum of any physical actions. At the height of the fear of such patients there are sweating, heartbeat, a sense of lack of air, trembling in the whole body. Anxious-depressive reaction is expressed in a sense of hopelessness, pessimism, anxiety, often in engine worry. Depressive and hypochondriartic reactions are characterized by constant fixation at their own condition, a significant revaluation of its severity, the abundance of numerous somatic complaints, which are based on expressed sensencenetics. Relatively infrequently occurring theosognosic reactions are very dangerous to the disregard of the patient to their state, violation of the regime, ignoring medical recommendations. In a remote period of myocardial infarction, the pathological development of the personality, mainly phobic and hypochondriac type is possible.

Angina.The behavior of patients may be different depending on the shape of angina. During the attack there are fear, motor anxiety. In the outsecration period, symptoms are characterized in the form of a reduced mood background with instability of affects, increased irritability, sleep disorders, asthenic reactions, unmotivated emerging states of fearlessness and anxiety. Exterminal peculiarities of behavior with increasing egocentrism are possible, the desire to attract the attention of others, to cause their sympathy and participation, a tendency to demonstrativity, also frequent phobic conditions in the form of cardiophobia with the permanent expectation of the next attack and fear of him. Heart failure.With acutely developing heart failure, there is a slight stunning, asthenic disorders with severe mental and physical fatigue, irritable weakness, hyperesthesia. In chronic heart failure, lethargy, apathy, notionlessness, dismissal disorders or states of euphoria are observed.

Mental disorders for kidney diseases.These mental disorders arise as a result of accumulation in the body of pathological products of metabolism acting on the brain.

Asthenic syndrome is an early manifestation of the disease and is often preserved throughout the disease. The feature of asthenia consists most often in combination of pronounced hyperesthesia, irritable weakness with persistent sleep disorders. Character for the dysphoria and periodically emerging violations of the body scheme, possibly the twilight permanent of consciousness, which indicate the growth of organic psychosindrome (encephalopathy). Increased intoxication is usually accompanied by characteristic sleep disorders, with sleepiness day and insomnia at night, nightmarish, often of the same scene of dreams with the subsequent addition of hypnogogical hallucinations. Acute psychoses in the form of atypical delicious, delirious-onaireoid, delicious and alternative states occur with relatively shallow decompensation. In the late period, the state of stunning is almost constant. Chronic renal failure leads to the development of a diffuse encephalopathic process, which most accurately can be determined as nephrogenic chronic toxic-dysseomettic encephalopathy. Mental disorders for liver diseases.The most pronounced mental disorders occur during liver cirrhosis various etiology. The most characteristic of asthenic symptoms, which has a number of features depending on the stage and severity of the disease: physical weakness, lethargy, scattered attention, and hypochondriacification at its own condition, sleep disorders are more pronounced. Emotional changes are observed. Vegetative disorders are amplified by weighting of the general condition. The growing phenomena of psychoorganic syndrome are accompanied by periodically advantageous states of the permanent of consciousness, and when weighing the underlying disease, it is characterized by growing stunning up to coma. Psychopathoid disorders manifest themselves in such reactions as excessive pending, suspicion, griffness.

Cirrhosis of the liver.Symptoms of asthenia can sometimes be the first manifestations of the disease. Sleeping is characteristic of sleeping in day and insomnia at night, and the attacks of drowsiness, resembling attacks of narcolepsy, are often the first symptoms of developing in the future psycho-organic syndrome (encephalopathy). The nature of the severity of asthenic symptoms depends on the stage and severity of the disease. Typical pronounced physical weakness, lethargy and a breaking from the morning. With the weighting of the general condition, vegetative disorders in the form of tachycardia attacks, sweating, hyperemia of the skin are enhanced. The growing phenomena of psychoorganic syndrome are accompanied by the characteristic shifts and periodically the advantage of the permanent of consciousness. When weighing the main disease, it is characterized by growing stunning up to coma. Mental disorders in patients with cirrhosis almost never achieve a psychotic level. Special psychotrauming factor in these patients are fears, sometimes very pronounced before the real threat of gastrointestinal bleeding. Hepatocerebral dystrophy(Wilson-Konovalov disease, hepatoleticular degeneration, leeticular progressive degeneration). The initial manifestations are usually emotional and hyperstatetic weakness with severe depletion and narrowing of the circle of interest. Soon, psychopath-like symptoms with excitability, aggressiveness, deposit disorders in the form of a tendency to vagrancy and theft. Fallenness appears, sometimes foolishness. Severe depressive states may be detected, depressive-paranoid and hallucinatory-paranoid disorders are possible. Among the delusional psychosis dominate the ideas of persecution. It is characteristic of the increasing of dementia with increasingly pronounced intellectual-moon and decrease in criticism, epileptiform seizures. In the terminal period, asthenia, reaching the degree of apathetic stupor, is becoming more pronounced, various options for the permanent of consciousness occur. Characterized so-called quiet delirium, delirious-amenitative state. Often, a fatal delicate delirium is directly preceded by a fatal outcome, which goes into the protected to whom. Pronounced psychoses are rarely found. Among them, depressive-paranoid states, paranoid syndromes are usually expressed, are usually expressed in neurko, accompanied by anxious excitation and rapidly fattyness. Corsakovsky syndrome may develop.

Mental disorders in blood diseases."Pure" cases of psychosis in blood diseases are relatively rare and in some cases mental disorders are combined with rude neurological disorders and are masked by them. Pernicious anemia (Addison-Burmer's disease, malignant anemia). In cases of light flow, the main mental disorder is asthenia, which is expressed in fast mental and physical fatigue, explicit attention, hypochondriatic fixation in its state, plasticity or irritable weakness. Psychopath-like disorders are also possible in the form of a dysphoria, increased excitability and demands. In acute flow, the development of delicious, less frequently amenitis syndrome is characterized. With long flow develops depressive syndrome. Heavy conditions They lead to the development of the sopor and coma. Anemia as a result of blood loss. Characterized by increasing asthenic disorders, possibly illusory perception of the surrounding. The growing asthenia reaches the degree of asthenic stupor, when the state is weighted, the upcoming stun goes into a copor and then to whom.

Mental disorders at Pellagra.Pellagra is a disease caused by deficiency of nicotinic acid, tryptophan and riboflavin, characterized by lesion of the skin, digestive tract and impaired psyche. The disease begins with the state of emotional and hyperstatetic weakness with a decrease in performance and hypothymia. In the development of cachexia, depressive-paranoid, hallucinatory-paranoid states occur, sometimes accompanied by anxious excitation, nihilistic nonsense. Often develops an asthenic stupor. Mental disorders in tumors of born location.Features of neuropsychiatric disorders in tumors depends on the personality constitutional characteristics of the patient, from the stage of the disease, the effectiveness of its therapy. The symptom presenter is asthenia, there is a "escape from the disease", the characteristic features of the person are exacerbated. When making a diagnosis of mistrust to him, the accusation of the incompetence of the doctor. During the period of the expanded phase of cancerous illness, it often occurs on designal states, illusory perception, suspicion in relation to doctors, reminiscent of malfunctional doubts; Abulia or hypolasses, various options for perishes consciousness. Often directly death is preceded by the authorizing delirium.

Mental disorders in endocrine diseases. Incenko Cushing's disease(Basophilism pituitary, Cushing's disease). For this disease, psychic and physical asthenia are typical, especially expressed in the morning. Patients are sluggish, larger, indifferent to the surrounding events, it is difficult for them to focus on something. Very typical decline or even complete absence of sexual attraction. Sleep disorders are also characteristic, sometimes with a violation of his rhythm: sleepiness in the afternoon and nonconimal at night. Sleep is usually superficial, alarming, more resembles a radiant state, accompanied by hypnogogical and hypopasic hallucinations. Possible mood disorders, affective oscillations. Depressive states have a pronounced diet color with possible outbreaks of rage, amphibiousness or fear. Pretty typical combinations of depressisis by senthenetics and hypochondriatic experiences, as well as depressive-paranoid disorders. Manico similar states are characterized by the presence of complacent mood. We often have epileptic disorders, various diancephaly manifestations, disorders of sensory synthesis. This disease due to disfiguring the appearance of the change can lead to the emergence of ultra-subject dismortion. These patients are prone to suicidal attempts. Possible psychotic delicious phenomena. With unfavorable flow, the disease can lead to the development of organic psychosinder. Syndrome is chichene.It occurs as a result of partial necrosis of adenogi disease cells with noncompensated massive blood loss during childbirth, postpartum sepsis. Anoressia, Agalactia, a decrease in the main exchange, arterial bodings and body temperature are combined with emotional disorders. SHYHIHEN SYSTEM SISSION SYSTEM SPRESS MANAGEMENTS ASPORTSAR CAKHECTION WITH The same increase in asthenapathico-abuliac symptoms, progressing memory disorders and a decrease in intelligence. Acromegaly(Marie Syndrome, Marie Leri Syndrome). Acromegaly develops due to a significant increase in the products of the somatotropic hormone of the front lobe of the pituitary. The increase in asthenic symptoms is accompanied by headaches and sleep disorders. Against the background of asthenia and increasing spontaneity, patients have outbreaks of irritability, discontent and ill-advantage in relation to others, and sometimes pronounced hatred for them. Psychotic disorders for acromegaly are rare. The aspotation is noted, the lack of interest in the surrounding, the increase in autism, egocentricity may externally resemble organic dementia. Goiter diffuse toxic (Basedova disease). The disease is characterized by a diffuse increase in the thyroid gland and increasing its function. There are violations of metabolic disorders, weight loss, tachycardia. Affective disorders are very characteristic, primarily in the form of so-called emotional lability. Patients are tear, prone to unmotivated mood fluctuations, they easily have irritation reactions. The fussiness is characteristic, the inability to a long concentration of attention. Patients are offended, scattered, frequent phenomena of hyperesthesia. In many cases, a reduced mood appears on the forefront, sometimes the state of expressed depression, less often there is a state of lethargy, apathy, indifference. Depression is usually accompanied by anxiety, hypochondriac complaints, sometimes acquire a dysphoric shade. In addition to various asthenic symptoms and affective disorders, psychotic disorders may also occur in the form of sharp and protracted psychoses, delusional states, hallucinosis, mostly visual. Occasionally there are schizophren-like psychosis and the state of the praised consciousness in the form of delicious, delicious and alternative disorders, depressive-paranoid states. Sometimes there is a phobia and ideas of jealousy, katathon-like symptoms. Very typical disorders in the form of difficulty falling asleep, frequent awakens, disturbing dreams. Upon the protracted form of the Based Disease, intellectual-e-disorders may be marked.

Hypothyroidism(Galla's disease, hypothyroidism). A sharply pronounced form of the hypothyroidism is called the name of the mixema. Hypothyroidism arises due to the insufficiency of the thyroid gland. The most characteristic somatic signs are swelling of the face, limbs, torso, bradycardia. With congenital hypothyroidism, called cretinism, and in the development of hypothyroidism in the early childhood Oligophrenia may occur. The delay in mental development can be expressed in varying degrees, but often reaches deep dementia. Intelligence does not develop, the vocabulary is very limited. Interests are associated with digestion and other instincts. Patients are sluggish, most of the time spend in bed, sleep a lot. The memorization is sharply violated. Often are apathetic and complacent, deafness is often developing. In some cases, with less pronounced crystinum, patients acquire elementary skills. External signs: dwarf growth, skull of irregular shape, short neck, very long tongue. The hypothyroidism is very characteristic of lethargy, drowsiness, hypodynamia, fast fatigue, slowing for associative processes. A neric-like symptomatology, expressed in irritability, depressed mood, vulnerability, emotional lability. When increasing the severity of the disease, there is a progressive reduction in memory, which achieves the severity of Korsakovsky syndrome, impaired intellectual functions, complete indifference to others. Psychotic conditions are often developing in the form of syndromes of the praised consciousness (a dreamless or delicious), severe depressive, depressive-paranoid disorders. Sometimes there are schizoform psychosis with hallucinatory-paranoid and katathon-like symptomatics, epileptiform seizures are possible. Comatous states (myxedhematous coma) are of great danger, often leading, especially in elderly people, to death. Hypoparatyosis. This disease occurs with the insufficiency of the function of the nearby rock. Characteristic nerity-like symptoms, mainly in the form of an exterformal or neurastin-like option. Patients are often tired, complain about weakening. Attention, scattered, sluggish, with an unstable mood, increased disapplication. Sleep disorders are characterized, there is often a sense of unmotivated fear, depression, a tendency to hypochondriac. Epileptoid disorders are possible, as well as the development of hypoparathyroid encephalopathy with pronounced memory disorders and a decrease in intellect.