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 doctor's doctor needs special caution when clarifying the patient of the true state of his health and the results of paraklinic research, as well as when issuing medical documents into hand. Unfortunately, the well-conditioned states are observed not so rarely, and the doctor in the process of the psychotherapeutic conversation should calm the patient, relieve the alarm, doubts, instill faith in successful recovery.

CLINIC

Symptomatic psychosis may occur sharply (in most cases with a violation of consciousness) and take a long (protracted) current, not accompanied by the permanent of consciousness. In addition, the development of a somatic disease can be accompanied by the occurrence or exacerbation of latent endogenous psychosis (schizophrenia, manico-depressive psychosis, etc.).

With different somatic diseases, the depressive-paranoid state may occur, characterized by the absence of daily mood fluctuations (unlike endogenous depression), the presence of an advention, anxiety, tear. At night, delirious symptoms are possible. The emergence of nonsense against the background of depression indicates the deterioration of the somatic state of the patient. In severe cases, auditory hallucinations and multiple illusions with the development of the stubs are joined.

Corsakovsky syndrome is relatively rarely found with the presence of confable disorders and fixing amnesia. These violations are usually transient, and after them comes a complete memory recovery.

Mental disorders for various diseases internal organs Determined by the feature and severity of somatic disorder. With acutely developing cardiovascular failure (myocardial infarction, condition after the operation on the heart, etc.) often arise stunning, action and delicious states, accompanied by fear of anxiety, sometimes euphoria.

In the early period of myocardial infarction, illusory-hallucinatory disorders, affective violations (anxiety, depression, psychomotor dismissal), loss of critical assessment of their condition and surrounding events are possible. Sometimes a maniacal state arises with a sense of general well-being, increased mood, conviction in the absence of any somatic disorders, including infarction. As the disease develops, there are signs of dramatization and depersonalization, unstable delusional ideas of relationships, self-evidence.

Mental disorders occur more often in people who have suffered a cranial injury to the disease, abused alcohol and were in chronic or sharp psychotrambulating situations. With recovery, they have a desire for activity, an increased mood is normalized or, on the contrary, subdependility disorders and hypochondriadity develop.

Psychopathological symptoms often occurs in patients with chronic cardiovascular failure. With a wallpaper, regardless of its pathogenetic mechanisms, affective disorders, anxiety, fear of death, hypochondriage appear during attacks. After repeated seizures, the cardophobic syndrome is possible in the form of persistent neurotic patient reactions to the transferred attacks of angina.

The active phase of rheumatic disease may be accompanied by delirious disorders, rheumatic hyperkinosis, depressive-paranoid states with alarming and award.

Deliosis disorders are usually combined with onaireoid components. The patients against the background of a high temperature merry armed faces, enemies, crowds of people of various nationalities, parades, festive demonstrations, voices, sounds of music, songs in different languages \u200b\u200bof the world, noise, shots. These experiences are accompanied by fear, anxiety, alertness.

Rheumatic hyperkinesis are manifested by choreoform movements of varying degrees of severity - from single muscle twitching face, neck, shoulder belt, hands to continuous motor excitation. More often observed the hypercines of the muscles of the face and the distal departments of the upper limbs, less often - the muscles of the neck, the upper half of the body. In severe cases, the choreoid excitement appears externally reminiscent of Gebifrenic syndrome: grimaces, cubs appear, cordless movements that resemble a child's foolishness. However, they never pass into general psychomotor arousal, characteristic of hebeth.

Mental disorders in acute rheumatism usually last 2-3 months (sometimes more) and ends with recovery that occurs, as a rule, simultaneously with the end of the active phase of the disease, normalization of temperature, blood formula, SE.

With liver diseases, gastrointestinal tract We gradually arise irritability, insomnia, emotional instability, sometimes-perception, carcherophobia.
Liver diseases are accompanied by dysphoric mood disorders, hypnogogical hallucinations.

In cirrhosis of the liver with severe clinical manifestations (jaundice, ascites, gastrointestinal bleeding) from mental disorders to the fore, asthenic disorders are actuated with dysphoric inclusions in the form of evilness, irritability, pathological punctuality, depressions, comprehensive attention. In addition, severe vegetative disorders are observed with heartbeat bits, sweating, oscillations. arterial pressure, redness of the skin with emotional experiences. Characteristic also skin itch, insomnia, feeling of fines the limbs. If the state is weighted, the stunning is growing, which is subsequently moving into a copor, and sometimes in anyone.

With toxic liver dystrophy, a comatose state is developing. As is known, toxic dystrophy is hepato -cergic pathology, and during comatose state (for example, acute yellow liver atrophy when viral hepatitis A) first appear headaches, sweating, attacks of suffocation, vomiting, sleep is disturbed. In the future, against the background of general stunning, attacks of psychomotor excitation are developing, delirious and alternative disorders with incoherence of speech, fragmentary hallucinatory and delusional phenomena. Epileptiform seizures are possible. The weighting of a somatic state is accompanied by a stunning strengthening, then copor comes, and in the subsequent coma with a possible fatal outcome.

Patients with chronic pneumonia, heavy forms of pulmonary tuberculosis are characterized by protracted depressive states, hallucinatory-delusional phenomena, false recognition. Sometimes there are euphoric shades of mood, carelessness, superficial thinking, there is an increased motor activity. These mental disorders are combined into an asthenic symptom complex. In some cases, it fully defines a clinical picture, in the other on the background of mental asthenia, additional mental disorders occur in the form of manic or paranoid inclusions, occasionally - signs of violation of consciousness.

Mental asthenia with tuberculosis does not differ from the asthenic state with other somatic diseases and manifests increased mental fatigue, lethargy, inactive, depression, etc. However, with tuberculosis, more than with other diseases, expressed emotional and hyperbacked weakness: under the influence of minor or even completely insignificant. Irriters quickly arise the attacks of emotional explosives with crying, tears, childish helplessness. For some patients, anosognosia is characterized (not as sufficiently evaluated by its own state). In this case, patients are careless, complacent, carefree.

When weighing the process, the state of the asthenic confusion is developing, in which the inability is observed to the concentration of attention, the correct assessment of the environment, quickly depletion in the presentation of thoughts, frivolity of solutions.

In the event of a further weighting of tuberculosis, the state of the asthenic confusion can go into aimative state. At the same time, the confusion of the patient's consciousness reaches such an extent that it is no longer able to navigate the environment. Its speech becomes incoherent, the actions are inadequate. These disorders acquire that maniacal, then depressive coloring. With a serious flow of fibrous-cavernous tuberculosis, with outbreaks of the tuberculous process, the estimative states occur more often. In these cases, delicious states, catatonic disorders, verbal hallucins may also be observed. Violation of consciousness is usually not distinguished by a great depth and proceeds waves. Amenification, which persists within 1.5-2 months, indicates the progression of the process and the possibility of the development of tuberculous meningitis. Delia in patients with tuberculosis is more often developing in persons abusing alcohol. Its clinical picture includes verbal and visual hallucinations.

In patients with tuberculosis against the background of light asthenic confusion, paranoid states may develop. At the same time, they express the delusional ideas of persecution, poisoning, become suspicious, refuse food, believe that deaths are carried out on them. In addition, after episodically emerging short-term attacks of Euphoria, persistent signs of irritable weakness, lethargy, laidness appear. In the case of the effective use of antibiotics (streptomycin, etc.), antibacterial drugs (PASK, fivazide, etc.) and surgical methods of treatment, the depth of mental disorders gradually decreases for the attenuation of the painful process. Initially, the symptoms of upset consciousness and paranoid inclusions disappear, then affective disorders and asthenic symptoms are gradually leveled.

Postpartum psychoses are accompanied by aimative disorder of consciousness, depressive manifestations. The mental disorders arising from this may be the initial stages of any endogenous disease (schizophrenia, manic-depressive psychosis, etc.).

Postpartum psychoses are usually developing in the first 1.5 months after delivery, and sometimes in a later date due to the impact of exo- and endogenous factors, in particular as a result of endocrine-diancephal and emotional and instincting disreventulation, a dysfunctional micro-social environment (family situation), somatosexual infantilism.

Amenitative and alternative-onauiroid disorders are more often manifested as a result of various gynecological complications of infectious nature. Especially deep alternative states are observed in the septic process. Amentia in these cases is combined with hallucinatorial-delirious or onairoid experiences. Possible spooring states with mutism and immobility. The emergence of these disorders speaks of the generalization of the pathological process. True, in some cases there is a disproportion between the severity general status The organism, pronounced by the temperature reaction (more than 39 ° C), and relatively small inflammatory changes from the genital organs. This suggests that mental disorders in the postpartum period are associated directly not only with somatic, but also cerebral (diancephal) pathology.

Postpartum depression more often occurs after 1.5-2 weeks after childbirth. It usually begins at home a few days after discharge from the hospital. At the same time, oppressed mood, motor and intellectual inhibition, insomnia, self-vaccination ideas appear. Depressive states usually last from a few weeks to 2-3 months, and sometimes we take a sluggish protracted flow.

In cases of birth of children with deformities, the death of a child or the presence of other psychogenic situations, for example, with family troubles, reactive depression may occur. In such cases, against the background of pronounced, the patients complain about the difficulties of life, they have a thought about their own helplessness, the inability to have children, to ensure care for the child and others. Fear for the safety of the family, the exaggerated sense of own guilt in the subsequent will develop in alienation and hostility between loved ones . Often, such patients refuse to feed the child, say that they have lost interest in life, suicide trends show.

It should be noted that depressive states in the postpartum period in their depths never reach such an extent of endogenous depression, as in schizophrenia, manic-depressive psychosis. The appointment of antidepressive, tranquilizing agents almost always gives a positive effect. Insulinthomatous and electrosal therapy is especially effective.

Under malignant neoplasms, depressive-paranoid states prevail, sometimes in the form of Brad catare, Korsakov syndrome. Mental violations, as a rule, are developing after surgery and at the increasing of cachexia phenomena.

First of all, it should be noted that the fact of cancer's disease itself or even suspicion of it has a massive psychotrauming effect, since, on the one hand, the threat of life arises, on the other, they scare all sorts of complications associated with operational intervention, followed by disability. This creates the basis for the development of a reactive state, the severity of which depends not so much from somatic well-being, as from psychogenic effects.

The clinical picture of the reactive state in oncological patients is primarily characterized by the development of anxious-depressive syndrome. Possible hypochondrial reactions with hysterical components, psychopathoid disorders with paranoid plants, irritable, evil mood. In some cases, depressive disorders are observed, accompanied by fear, routine, dedication-depersonalization disorders, stubborn insomnia, suicidal tendencies.

In the case of a favorable outcome after the operational interventions and success of conservative therapy, these disorders undergo slow reverse development. This also contributes to the preservation of hopes for a prosperous outcome in patients even with pronounced depressive and other psychopathological disorders. In addition, many patients have a psychologically protective tendency to simplify the current situation and displacing dark thoughts from the consciousness regarding the disease.

When progressing the malignant neoplasm and weighting of somatic status, especially with cancer tumors of the gastrointestinal tract, against the background of an alarming-depressive state, nihilistic nonsense with auditory and tactile hallucinations (coat syndrome) can develop. Sometimes amnistic disorders with correlations and pseudo-resendments (Corsakov syndrome) are developing (Corsakov syndrome), as well as the delicious-aimative confusion of consciousness.

The clinical picture in brain tumors is very variable. Severence and character depends on the localization of the tumor, the tempo and nature of the tumor growth. Mental disorders are additional pathological changes in cerebral tumors.

Most often, with brain tumors, a stunned disorder of consciousness of various severity is noted. At the same time, the overall inhibition of mental processes, lethargy, intimidation, weakens active and passive attention, memory, orientation is disturbed. Some less often meet other types of refined consciousness with psychomotor (epileptiform) excitation, as well as an onauroid state. Sometimes the phenomena of the dramatization and depersonalization are noted. Acute paroxysmal disorders with the above symptoms are usually more often arising from elderly.

In addition, against the background of the changed consciousness in the brain tumors there may be signs of psycho-organic syndrome. In this case, the increase in memory disorder is characterized, the development of initial fixation amnesia with pseudo-resembitions and confabulation, and in the subsequent retro and anterograde amnesia. At the same time, an affective sphere can change - it acquires the type of irritability, incontinence, or, on the contrary, lethargy, indifference, apathy. Critical attitude to its state of such a patient reduced.

The mental disorders clinic to a certain extent depends on the localization of tumors.

In tumors of temporal brain fractions, rudimentary auditory and visual hallucinations are possible, occasionally - olfactory and taste disorders. Similar disorders may also be observed when localizing tumors in dark and occipital areas.

With the so-called frontal symptoms of brain tumors, the clinic of apatalabulic syndrome with memory violations is performed to the fore. The opposite affective changes in the form of euphoria, moroide, disbuilding are found somewhat less.

In case of damage to the depths of the brain against the background of emotional lability, expressed signs of Parkinsonism arise. Sometimes drowsiness, indifference to the surrounding, dreary mood is observed. Occasionally, the emotional background can be enhanced, the attraction is defined.

It should be noted that under the tumors of the brain of various localization, generalized and abortive (Jackson, diancephaly and other) epileptiform seizures may be observed. Convulsive seizures usually arise against the background of organic changes from the central nervous system.

The diagnosis of brain tumors is often considerable difficulties. They must be differentiated from vascular and atrophic brain diseases.

The brain tumor is removed by the operational way. In addition, dehydration, anticonvulsant therapy and radiotherapy are carried out. With acute psychotic disorders, psychomotor excitation are used tranquilizers and neuroleptic drugs in small doses.

Nephrogogenic psychosis is manifested by the following psychopathological signs: astehenic symptom complex, delicious and amenitative disorders.

In violation of the functioning of the endocrine glands, psycho-finnish syndrome develops. The clinical picture of it is nonspecific and relatively dependent on the type and nature of the functions endocrine Systems, in particular, with the involvement in the painful process of the hypothalamic structures of the brain.

In endocrine disorders, negros-like and affect psychopathological syndromes may develop.

The neurosis-like symptoms manifests itself mainly in the form of a senthenetics of hypochondria. The patients are felt by the severity, the feeling of burning in the whole body, cutting in the head, lumbar region, in the abdomen and other parts of the body. These sensations are enhanced during the exacerbation of hormonal pathology. Their patients describe colorfully, emotionally, saturated. Psycho-like disorders are characterized by the development of psycho-beans.

The clinical picture of affective syndromes in endocrine pathology is represented by depressive and hypomaniac states.

Depressive disorders are more often manifested against the background of an asthenic symptom complex.

TREATMENT

The presence of mental disorders in somatic diseases is a relative indication for hospitalization into the psychiatric department of a somatic hospital. Such a patient must be constantly under the supervision of both the therapist, an endocrinologist or infectiousnessist and a psychiatrist, that is, it must be provided with a round-the-clock supervision. With pronounced protracted disorders of mental activity, treatment can be carried out in a psychiatric hospital.

Therapy of symptomatic psychosis should be aimed at eliminating the main somatic or infectious disease. In addition, disintellation treatment is prescribed, as well as psychotropic drugs, depending on the syndromological characteristics of psychotic disorders. In the process of recovery, nootropic preparations (nootropyl, piracetam) can be used.

If psychotropic drugs in a number of cases are used as the main therapeutic agent, then in the treatment of symptomatic psychosis, the same means play an additional role. They are shown only at a certain stage of a somatic disease and, depending on its severity, sharpness, stages of development and clinical features, are prescribed once, within a few days and even weeks or months. However, in any case, psychotropic drugs, normalizing mental activities, contribute successful treatment Basic somatic disease.

The use of aminezine for the treatment of symptomatic psychosis is very limited, as it has a negative somatotropic effect in diseases of the liver, biliary tract, kidneys. In addition, it enhances the depressive background of mood, causes motor inhibition. Given these negative properties, the aminazine is prescribed in one-time doses (1-2 ml of 2.5% solution) in acute psychotic states accompanied by psychomotor excitation.

Tizercin is used more often. It is less toxic, does not have a depressive property. It is prescribed in small doses (25-75 mg per day) in the nerity-like and asthenoparanoid states flowing down with the predominance of anxiety, disharmony. The negative property of tiercin is its ability to cause muscle weakness, vegetative-vascular crises. For this reason, the appointment of tyercin astested patients is undesirable.

Tenerus is shown in the treatment of symptomatic mental disorders with asthenodepresses and neurosis-like symptoms. The easy sedative effect of the drug in combination with a thymoleptic effect has a favorable effect, eliminating disturbing concerns, gripping, as well as diancephal and vegetative disorders. Assign it in doses from 5 to 60 mg per day.

Melleril used in small dosages (5-40 mg per day) does not cause somatic complications and side effects. It is prescribed for asthenodepressive and neurosis-like states. It has a slight antidepresses and soothing effect. Easy stimulation of speech and motor activity is not accompanied by the depletion of the body's energy resources, the strengthening of the asthenic state.

Tryphthazine in doses up to 10-20 mg per day is used in the presence of saathogenic psychosis of paranoid and hallucinatory and paranoid phenomena in the symptoms. To prevent the possible development of extrapyramidal disorders, it is necessary to assign correctors (cyclodol, parkopan, etc.), maneuvering with dosages, take breaks in treatment, carrying disintellation and light dehydration therapy.

Haloperidol, as well as triftazine, contributes to the reverse development of hallucinatorium-delusional symptoms, mental automatic syndrome, verbal hallucinosis. It does not adversely affect the parenchymal organs. However, side neurological effects that occur in the treatment of haloperidol, limit its application. The drug is prescribed in small doses (1.5-15 mg per day), which is not always enough to achieve the necessary antipsychotic effect.

Frenolon is adjusted for asthenoocheondria and apatalabulic states, as well as in asthenic confusion. It has a positive effect on gastrointestinal secretion. It is assigned in small dosages (5-15 mg per day), which makes avoiding side effects.

The use of Majptila and Trisedila Even in minimal dosages in the process of combined treatment of somatogenic psychosis is not always appropriate, as they cause the rapid development of extrapyramidal disorders. They should be prescribed with persistent, long-term delusional-hallucinatory phenomena that are not affected by other neuroleptics. In these cases, a slow increase in dosages is needed simultaneously appointing proofreaders.

Melipramine (25-125 mg per day) is most effective in depressive states of rheumatic nature. Shown in intellectual and motor inhibition. In anxious-depressive states, it is prescribed in combination with Tisercin, because without it, Melipramine aggravates the alarm.
Amitriptyline (25-125 mg per day) is shown in the depresses of somatogenic nature, in the structure of which assessment, anxiety, impairment phenomena are noted.

Pyrazidol (25-125 mg per day) was widely used in somatogenic and reactive-somatogenic mental disorders. Moderate sedative, antidepressive and stimulating pyrazidol effect in combination with low toxicity it allows you to successfully apply this drug With depressed, asthenochondria and distortic disorders.

Chlorocycine (15-75 mg per day) has a positive effect on real somatic painfulness, reduces the sharpness of the onnestopathies.

From a group of monoaminoxidase inhibitors, an iprazid (25-75 mg per day) is often used. It is shown in angina, with a long-term treatment of ischemic heart disease, accompanied by asthendepressive state, and in cases of angina, resistant to other experienced funds.

In the practice of treating somatogenic mental disorders, tranquilizers are widely applied. The greatest positive effect is observed when prescribing preparations with a sedative bias of action (phenazepam, meproamate, eleganium, amizyl, eochnoitin, etc.) Tranquilizers are used to mitigate or relieve diancephal, vegetative-vascular and epileptiform disorders of somatogenic nature. However, the long-term purpose of tranquilizers in chronic asthenic or neurosis-like states may cause the development of psychological dependence on them.

The appointment of neuroleptics even in small doses must be combined with the introduction of Cordiamine. The relative incompatibility of a number of psychotropic drugs (neuroleptics and tranquilizers) with barbiturates and drugs (morphine, Promedol, etc.) should be noted. With simultaneous reception of neuroleptics and drugs, vegetative-vascular disorders appear, dysarthria, dizziness. Barbiturates in combination with neuroleptics cause stunning, hyperemia, cardiovascular disorders. The incompatibility of psychotropic drugs with Fenamine and Ephedrine is manifested in anomalies heart Rhythm, psychomotor excitation. In order to avoid these violations, a two-week break between the appointments of incompatible drugs is necessary.

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. When recognizing somatogenic mental diseases It is necessary to be guided not only by the simultaneous presence of mental illness and somatic disease, but also the peculiarities of 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 of 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 diffuse magnification 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.

In the overwhelming majority of cases, somatogenic mental disorders are expressed either in the "pure" asthenic symptom complex, or in its background there are depressive (depression, flexibility, a sense of hopelessness), apathetic (indifference, lethargy), hypochondriage (focus on their somatic state, disbelief in Recovery), hysterical (attracting a maximum of attention in connection with the disease), phobic (fear of a sharp deterioration of somatic state), euphoric (unmotivated fun) and other inclusions.

The asthenia underlying these disorders usually passes the Ir-ritative, apathetic and atonic stage. In the first one, characterized by irritability, anxiety, there may be violations of perception: hallucinations, illusions, unusual bodily sensations, delusional interpretation of the surrounding and its condition, and in the most difficult cases - an asthenic confusion or delirium. For an apathetic stage, characterized by lethargy, indifference to its disease and surroundings, poverty of mental processes, a fall in activity, more peculiarization, less bright and sensual hallucinations, delusional ideas and disorders of the consciousness of the onauiroid type or in the form of confusion. If an atonic stage occurs, an apathetic state is developing, reaching the degree of pronounced stunning.

For endocrine diseases, the so-called psychoendocrine syndrome is characteristic. When it gradually weakens memory and intelligence, instinctive activities and motivation are upset, the identity of the patient as a whole changes.

Hypothyroidism is more peculiar to amnetic disorders in combination with aspotation and indifference, hyperthyroidism - anxiety incentive, depression, childish expectation of misfortune, tetania - epileptiform disorders.

In the case of engaging in the pathological process of the diancephal region, severe psychotic disorders with delusted and affective syndromes are more common. The picture of these psychosis, such as, for example, the disease of Itsenko-Cushing, resembles schizophrenic (Celbeys B. A., 1966).

In diabetes mellitus, at the beginning of the disease, there is a phenomenon of massive cerebral syndrome, followed by a comatose state; With the improvement of the state of the cerebralism, the nerity-like and psychopathoid disorders is replaced, in the stabilization stage, vegetative violations and diancephaly paroxysms are put forward, the retreat of mental development is becoming more noticeable (V. A., 1973 parishes).

We bring a brief history of the disease, illustrating the difficulties of diagnosing somatogenic psychosis (observation of K. Popp).

Example 3 ______________________________________ Lena, 14 years

Early development is prosperous. From 12 years old began to lag behind in growth, the skin became more dry, angry appeared. He gradually developed farewellity and lethargy, was not interested in anything, could not quickly collect his belongings. I became a fearful, indecisive, with the arrival of guests hidden in the corner. In the 8th grade went to a new school. He studied with difficulty, shy his low growth, lowestore. The face has become an endless and earthy. Hands were cold and cyanotic. There was fatigue, a dream and appetite worsened. It seemed that relatives were unhappy with her, and the neighbors laugh: "Lazy", "dry", "low". Almost did not go outside. When she was taken to doctors, I thought that relatives want to get rid of it. I heard my father said: "I will kill her!", And brother: "I'll poison." I did not sleep for 2-3 nights. It seemed that the surrounding knew her thoughts, repeat them out loud, look at her, comment on her actions. It was hospitalized. Elementary oriented. Responded quietly, monosyllant, not immediately. I did not remember the name of the doctor, the date and the first days of stay in the hospital. He said: "Everything is gray", "the sounds reach deaf". Complained about the "stupidity in the head", poor memory. It was slow down, depressive, plaxive. He considered himself a short, dry, unable to work and learn. Being sluggish, drowsy, most of the time lay in bed. In the classroom could not engage. It was not capable of folding double-digit numbers. When checking the intelligence made an impression mentally retarded. Hypothyroidism was suspected, treatment begins by thyroidine. The patient immediately became cheerful, the mood improved, got out of bed. He stated that "she began to think better." Embedded to classes in the classroom. However, at that time, "voices" of relatives and doctors, speaking that she "kills" appeared periodically. Heavyness disappeared, dry skin, constipation. Improved learned school material, first the 7th, and then the 8th grades. I remembered the studied school curriculum. Under the influence of treatment, the pastosity of the face and legs, dry skin and cyanosis disappeared, normalized menstrual cycle, pulse instead of 55 became 80 beats per minute. Arterial pressure rose from 90/50 to 130/75 mm Hg. Art. The mass of the body increased from 40.5 kg to 44.5 kg, growth - from 136 cm to 143. After a year: regularly takes a thyroidine, there is no hypothyroidism phenomena, successfully studies in a sewing school. Critically evaluates experiences during the disease.

In the patient, along with the growth stop and the appearance of somatic signs of hypothyroidism, lethargy, fatigue, light stupidity, difficulty of intellectual activity and apathetic depression were observed. The psychotic state, which developed in this background, should be regarded as an anxious-hallucinatory syndrome with episodic hearingly hallucinations, with delirious interpretations of a particular nature, consonant personality and situations, with the sound of thoughts and a sense of openness. The flow of psychotic somatic symptoms and the outcome of the disease made it possible to diagnose a somatogenic psychosis, which is confirmed by the presence of hypothyroidism and success from treatment with thyroidin.

On neuropsychiatric disorders arising from violation menstrual cycle In a publity, a little is known. B. E. Mikirtumov (1988) In 352 adolescent girls, 11-16 years old found several syndromes typical of this pathology of the central regulatory functions of the hypothalamus: asthenovegetative, alarming, anxious-ipochondria, obsessive-phobic, anxious-obsessive, depressive-ipochondria ASTENOPRESSIBY, SENNETOPATO-IPOKHONDRIC, DISTRICT DISTITIMIC, DISORTORIFOFOBIC, DISORTORIFOMANICAL, CAPES OF FUT SYNDROM.

Here we give an extract from the history of the disease (observation B. E. Mikirtumova).

Example 4 _____________________________________ Katya, 15.5 years

In the family, grandfather, grandmother and two unidie in the mother suffered chronic alcoholism. Father is a drunkard and a scandalist, during one of the drunken debaches broke the sick hand, despite the divorce with his mother, continues to live in the same apartment. The patient in the early preschool age suffered in severely cortex. Menarh at 13 years old, from 14 years during menstruation of dizziness, fainting, hyperhydrosis, elevated appetite, heat and chills, frequent urges on urination. Active, sociable, emotionally labil. After the home quarrel considered herself too much, suicide thoughts appeared, left the house, spent the night on the stairs, refused food. After the emerging house of the fire at night threw, there was an attack of cough, fainting, uterine bleedinglasting for a month. During the whole period, weakness and irritability remained, it was difficult to engage. It constantly felt anxious, it seemed that everything was bad about her, as if she did something bad. It was such a feeling as if they were looking at her like a depraved. " After waking an alarm, it often reached such a force that he captured her all, shoved, the girl at that moment was standing by the bed, could not move. Against this background there were repeated vaginsular crises.

Anxious state with the ideas of the relationship in this patient is due to the same reason that juvenile bleeding. The presence of vaginswasular attacks, as well as the nature of mental disorders, indicates a hypothey-laminum lesion. Apparently, hereditary burdensome and chronic psychotrauming situation contributed to him. Fear in connection with the fire played the role of provocating juvenile bleeding, and with him and mental disorder.

Mental literature is devoted to mental disorders for kidneys. One of their features is a flickering flareness, against the background of which more complex psychopathological paintings develop. Amenia and anti-delicious disorders or monotonna, stereotypes, without fear, anxiety, a duration of no more than 2-3 weeks, or less commonly, with severe catatonic excitation. The replacing their asthenia lasts for several months and is combined with apathy or depression, but can also appear in the form of asthenovegetative syndrome. On its background, a painful personal reaction is developing with a sense of inferiority, depressive and hypochondriatic experiences, there may be onuric experiences - from bright dreaming hypnogogic hallucinations to delicious episodes (Herman T. N., 1971). Also, delicious disorders are also described, under which there are non-hard static visual deceptions of feelings and non-discovered motor excitement with stereotypical movements, and sometimes convulsive manifestations. In some cases, endoform symptoms in the form of catatonic excitation, alternating with convulsions, apathetic stupor or paranoid phenomena on the background of asthenia, is found.

With the complication of the renal disease, hypertension may occur a pseudo-dued version of exogenous organic psychosis. In chronic renal failure in the terminal stage, majority of patients have asthenodepressive phenomena with depersonalization, delicious-onaireoid experiences, delirium, convulsions (Lopatkin N. A., Korkina M. V., Tsivilko M. A., 1971). Drug therapy in these patients - often too much additional load on the body and when appointing ACTH, cortisone, antibiotics, or during dialysis, some of them have or aggravated by the former mental disorders (Naku A. G., German G. N., 1971 ). About mental disorders in these diseases in children are less known (Smith A., 1980; Franconi S., 1954). The patients observed were discovered hallucinatory and delicid-like episodes on the background of severe asthenia, motor disbuits with euphoria, anxious and hypochondriatic experiences with obsessive phenomena.

It seems to be an extract from the history of the child's illness, observed O. V. Solerettov.

Example 5 ___________________________________ Vitya, 11.5 years

Development without features. I had a rubella and twice pneumonia. Studies satisfactorily. Since 7 years, the kidney disease suffers. Currently diagnosed chronic glomerulonephritis, nephrotic form, period of exacerbation. The mental state is characterized by nonsense: can't calmly stay in place, even for a short time, turns his head, clicks his fingers, interferes in the affairs of others. Euphoric, he himself notes in his heightened mood: "I want to run, jump." Despite the understanding of the harmfulness of the loads, it cannot be resistant from excessive activity. About illness says: "I do not remember her." The attention is unstable, the mental performance fluctuates, the patient is easily depleted, tiring. The level of reactive and personal anxiety is low.

In this case, it is not easy to explain the cause of the occurrence of a mental disorder and precisely in the form of euphorically painted asthenia. It can only be assumed that the basis is a severe breach of the kidney function that is not compatible with the normal operation of the central nervous system. Prevention of mental disorders is difficult, as it would require long-term use of psychopharmacological means without a guarantee in their harmability for kidneys.

Among the blood diseases leukemia occupy a special place. The severity of the physical condition of patients with them always encourages the doctor to focus on neuropsychic manifestations that seriously complicating the position of the child, which, due to the increase in the duration of the patient's life, is observed quite often (Alekseev N. A., Vorontsov I. M., 1979) . Thus, asthenic and asthenovegetative syndromes occur in 60%, the meningoencephalitic syndrome due to neurolekosis - in 59.5% of patients. Early recognition and therapy of these painful phenomena can significantly mitigate the complications mentioned (Jolobova S. V., 1982).

I. K. Chaz (1989) described neuropsychiatric disorders found in all children suffering from acute leukemia. He found in these patients with distortic, disturbing, depressive, asthenic and psycho-organic disorders of non-psychotic levels and psychosis with anxious-agted, anxious-asthenic, depressive melancholic or depressive-adamic symptomatics, as well as in the form of asthenic confusion. The flow of these neuropsychiatric disorders is complicated by the severity of a somatic disease, the presence of concomitant psychotrauming factors, the formation of a negative inner picture of the disease (Isaev D. N., Chaz I. K., 1985). In connection with what was said, for the treatment of unexicotic disorders it is recommended to combine psychotropic drugs with psychotherapy.

Mental deviations in children are found in specialized children's clinics. An example is mental disorders in the burn disease, the pathogenetic factors of which (severe intoxication, strong pain syndrome, extensive purulent processes, damage to internal organs - kidney, cardiovascular and endocrine systems, violation of water-salt equilibrium) lead in many cases to these disorders . To a large extent, they are determined by the periods of burn disease, depth and area of \u200b\u200blesion, somatic disorders, premature features of the individual, gender and age of patients (Gelfand V. B., Nikolaev G. V., 1980). At all stages of the disease, persistent asthenia, neurological symptoms and increasing intellectual disorders are noted. During the first, erectile, phase, along with psychomotor excitation, neurological signs of the lesion of the brain trunk are observed (eye-minded disorders, nystagm, weakness and asymmetry of mimic muscles), muscle hypertension, total hyperreflexia, vegetual sympathetic-tonic disorders: an increase in blood pressure, tachycardia, tachipne, Pallor and dry skin. The second, trapid, phase is characterized by general-selling disorders with inhibition and stunning, decrease in sensitivity and reflexes, psychotic disorders. An adverse appearance of convulsion (Voloshin P. V., 1979). Among the psychosis describe theseritic, delicious episodes, confusion and stupidity states, hallucinatory-paranoid, astheno-hypochondriac, astheno-hypomanical syndromes (Bogochenko V. P., 1965).

N. E. Butorina et al. (1990) neuropsychiatric disorders in children and adolescents in the burn disease are described depending on its stages. During a burn shock at the first stage, acute affective shock reactions are noted, more often in the form of a motor storm, at the next stage there are disorders of consciousness - stupidity, aging-delicious and convulsive states. At the stage of toxemia, such disorders of consciousness are dominated as an asthenic confusion, delicious-onoeroid episodes, anxious-depressive, depressive-phobic and depersonal states. In the period of septicotoxemia, encephalopathy with anxiety, irritability, fear, protest reactions and refusals is found. In the period of reconvaluescence of encephalopathy, it is complicated by psycho-emotional factors, as a result, asthenodepres-sevene, asthenoid and obsessive-phobic manifestations arise. Similar observations are also given by other authors (Anfin-Genova N. G., 1990). In the post-discussional stage (after 6-12 months) the most frequent phenomenon - cerebrals with vegetative instability, dissensia, emotional and behavioral disorders. In most patients, the symptoms of the dismorticophobic complex (Shadrina I. V., 1991) arise from the majority of patients.

I. A. Zilberman (1988), having studied children enrolled in the hospital with a burn disease, found their mental disorders, whose severity depended on the area of \u200b\u200bburns and the depth of the defeat. Directly following the injury in children there are emotional arousal, motor anxiety and varying degrees of severity of the disorder of consciousness. For a period of toxmia, characterized by a high fever, accounts for most of the observed psychosis: delicious or delicious-onairoid disorders, whose feature is the lack of psychomotor excitation and the wave-like flow. In the period of septicopiamia, emotional and motor disorders are performing: emotional lability, deprimation, plasticity, fears, motor concerns, excitability, deploying against the background of explicit asthenia. During recovery and improving the somatic state, violations of behavior with light excitability and sometimes aggressiveness are detected.

To understand the clinical picture of neuropsychiatric disorders in children with a burn disease, it is necessary to know the features of their premature personality, the micro-social environment and other risk factors for the occurrence of burns. In 75% of cases, these children from families with an inadequate attitude towards them and improper education. 50% of them in the past - psychological injuries. Often they have neuropathy syndrome (Frolov B. G., Kagansky A. V., 1985).

Mental disorders in somatic diseases

The progress of treating somatic diseases and somatogenic psychosis led to a decrease in the occurrence of pronounced acute psychotic forms and an increase in protracted Vigolopro-cruthent forms. The noted changes in the clinical features of diseases (pathomorphosis) were also shown in the fact that the number of cases of mental disorders in somatic diseases decreased by 2.5 times, and in forensic psychiatric practice, the cases of the examination of the mental state in the somatic diseases occur often. At the same time, a change in the quantitative relationship of the forms of the flow of these diseases occurred. The proportion of individual somatogenic psychosis (for example, amnelic states) and mental disorders that do not reach the degree of psychosis decreased.

The stereotype of the development of psychopathological symptoms in somatogenic psychosis is characterized by the beginning of asthenic disorders, and then the replacement of symptoms with psychotic manifestations and endoform "transitional" syndromes. The outcome of psychosis is the recovery or development of psychoorganic syndrome.

Somatic diseases in which mental disorders are most often observed include diseases of the heart, liver, kidneys, lung inflammation, ulcerative disease, less often - pernicious anemia, alimentary dystrophy, avitaminosis, as well as postoperative and postpartum psychoses.

In chronic somatic diseases, signs of personality pathology are found, in the acute and subacute period, mental changes are limited to the manifestations of the personality reaction with the features inherent in it.

One of the main psychopathological symptom complex observed in various somatic diseases is asthenic syndrome. This syndrome is characterized by severe weakness, rapid fatigue, irritability and the presence of pronounced vegetative disorders. In some cases, phobic, hypochondriac, apathetic, hysterical and other disorders are joined to asthenic syndrome. Sometimes pho-oic syndrome appears on the fore. Fear inherent to the diseased person

240 Section III. Separate forms of mental diseases

The leading syndrome in somatogenic psychosis is the perishes of consciousness (more often than the delicious, amenitative and less often twilight type). These psychosis develop suddenly, sharply, without precursors against the background of preceding asthenic, non-fragmentation, affective disorders. Acute psychosis usually lasts 2-3 days, are replaced by an asthenic state. With an unfavorable course of a somatic disease, they can take protracted flows with a clinical picture of depressive, hallucinatorium-paranoid syndromes, an apathetic stupor.

Depressive, depressive-paranoid syndromes, sometimes in combination with hallucinatory (more often tactile hallucinations), are observed in severe diseases of the lungs, cancer and other diseases of internal organs that have chronic flow and lead to exhaustion.

After suffered somatogenic psychosis, psychoorganic syndrome can be formed. However, the manifestations of this syrtotel complex are smoothed over time. The clinical picture of the psychoorganic syndrome is expressed different in the intensity of intelligence disorders, a decrease in the critical attitude to its state, affective lability. With a pronounced degree of this state, aspotation is observed, indifference to self and surrounding, significant multi-intellectual disorders.

Among patients with heart pathology, the most often mental disorders are found in patients with myocardial infarction.

Mental disorders are generally one of the most common manifestations in patients with myocardial infarction, weighting the course of the disease (I. P. Lapin, N. A. Aka-Lov, 1997; A. L. Syrkin, 1998; S. Sjtisbury, 1996, etc. .), Increasing death and disability rates (U. Herlitz et al., 1988;

Mental disorders are developing in 33-85% of patients with myocardial infarction (L. G. Ursova, 1993; V. P. Zaitsev, 1975; A. B. Smlevich, 1999; Z. A. Doezfler et al., 1994; M. J . Razada, 1996). The heterogeneity of the statistical data given by various authors is explained wide spectrum Mental disorders, from psychotic to nerity-like and Pavoharac-terrological disorders.

There are various opinions about the preference of the reasons that contribute to the emergence of mental disorders with myocardial infarction. Reflects the value of certain conditions, in particular features clinical flow and the severity of the myocardial infarction (M. A. Tsivilko et al., 1991; N. N. Cassem, T. R. R. R. R. R. R. R. R. R. R., 1978, etc.), Constitutional-biological and socio-environmental factors (V. S. Volkov, N. A. Belyakova, 1990; F. Vaduidi et al., S. ROOSE, E. Spatz, 1998), Comorrhtic pathology (I. Shvets, 1996; R. M. Sarme et al., 1997), features of the patient's personality , adverse mental and social impacts (V.P. Zaitsev, 1975; A. Arrels, 1997).

Miocardials are usually pronounced affective disorders, anxiety, fear of death, motor arousal, vegetative and cerebrovascular violations. Among other precursors of psychosis describes the state of euphoria, sleep disorders, hypnogogical hallucinations. Violation of behavior and regime of these patients dramatically impairs their somatic state and may even lead to a fatal outcome. Most often, psychosis arise during the first week after myocardial infarction.

In the acute stage of psychosis, with a myocardial infarction, it is most common with a picture of an upset consciousness, more often on delicious type: patients experience fears, anxiety, disoriented in place and time, are experiencing hallucinations (visual and auditory). In patients noted motor anxiety, they seek somewhere, non-critical. The duration of this psychosis does not exceed several days.

Depressive conditions are also observed: the patients are oppressed, they do not believe in the success of the treatment and the possibility of recovery, intellectual and motor inhibition, hypochondriadity, anxiety, fears, especially at night, early awakening and anxiety.

242 Section III. Separate forms of mental diseases

In the diagnosis of somatogenic psychosis, it is necessary to degrade it from schizophrenia and other endoform psychosis (manico-depressive and involutionary). The main diagnostic criteria are: a clear relationship between a somatic disease, a characteristic stereotype of the development of the disease with a change of syndromes from asthenic to the states of disturbed consciousness, a pronounced asthenic background and a person-friendly exit of psychosis in the improvement of somatogenic pathology.

Treatment, prevention of mental disorders in case of somatic diseases. Treatment of mental disorders in somatic diseases should be directed to the main disease, be complex and individual. Therapy provides for the impact on pathological center and disintellation, normalization of immunobiological processes. It is necessary to provide strict round-the-clock medical supervision for the patients, especially with sharp psychosis. Treatment of patients with mental disorders is based on common syndromological principles - on the use of psychotropic drugs based on the clinical picture. In asthenic and psycho-organic syndromes, massive conjunctioning therapy is prescribed - vitamins and nootrops (piracetam, nootropyl).

The prevention of somatogenic mental disorders is the timely and active treatment of the underlying disease, disinfective measures and the use of tranquilizers when anxiety increasing and sleep disorders.

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Somatic disorders and violations of physiological functions as a manifestation of mental pathology

The analysis of the somatic state in patients with mental illness allows us to clearly demonstrate the close relationship of mental and somatic. The brain as the main regulator determines not only the effectiveness of all physiological processes, but also the degree of psychological well-being (well-being) and satisfaction. The violation of the brain can lead as a true disorder of the regulation of physiological processes (disorders of appetite, dyspepsia, tachycardia, sweating, impotence) and to a false sense of discomfort, dissatisfaction, discontent with their physical health (with the actual absence of somatic pathology). Examples of somatic disorders arising from mental pathology are described in the previous chapter panic attacks.

The disorders listed in this chapter usually occur again, i.e. They are only symptoms of any other disorders (syndromes, diseases). However, they deliver such significant concern to patients that require special attention of the doctor, discussion, psychotherapeutic correction and in many cases of the appointment of special symptomatic means. In the ICD-10, individual headings are proposed to designate such disorders.

Food disorders

Food disorders (in foreign literature in these cases, they are talking about "violations of food behavior".) There may be a manifestation of various diseases. A sharp decline in appetite is characteristic of depressive syndrome, although in some cases it is possible to overeat. The decrease in appetite takes place and many neurosis. With a katatonic syndrome, there is often a refusal of food (although there is a pronounced need for food with such patients when disgraced by such patients). But in some cases, breaching of food becomes the most important manifestation of the disease. In this regard, emit, for example, the nervous anorexia syndrome and bulimia attacks (they can be combined with the same patient).

The nervous anorexia syndrome (Anorexia Nervosa) develops more often in the girls in a pubertal and youthful age and is expressed in a conscious refusal to eat for the purpose of weight loss. For patients, dissatisfaction with its appearance is characterized by its appearance (dysmorfoomania - dysmorphophobia), about a third of them before the occurrence of the disease had a slight weight excess. Dissatisfaction with imaginary obesity patients carefully hide, do not discuss him with any of the outsiders. The decrease in body weight is achieved by limiting the amount of food, the exception of the diet of high-calorie and fatty products, a complex of heavy exercise, the reception of large doses of laxative and diuretic products. Periods of a sharp restriction in food are interspersed with bulimia attacks, when a strong feeling of hunger does not pass even after receiving a large number of food. In this case, patients artificially cause vomiting.

A sharp decline in body weight, violations in electrolyte exchange and lack of vitamins lead to serious somatic complications - amenorrhea, pallor and dryness of skin, zyabacity, nail fragility, hair loss, teeth destruction, intestinal atony, bradycardia, reduction of blood pressure, etc.. The presence of all The listed symptoms indicates the formation of the cachexic stage of the process, accompanied by adamasses, disability loss. If this syndrome occurs in the pubertal period there may be a delay in puberty.

Bulimia is uncontrolled and rapid absorption of large amounts of food. It can be combined with both nervous anorexia and obesity. Women suffer more often. Each bulimic episode is accompanied by a feeling of guilt, hate to yourself. The patient seeks to free the stomach, causing vomiting, accepts laxatives and diuretics.

Nervous anorexia and bulimia in some cases are an initial manifestation of a progressional mental illness (schizophrenia). In this case, autism are on the fore, the violation of contacts with close relatives, fastened (sometimes delusional) interpretation of starvation goals. Other frequent cause Nervous anorexia are psychopathic character traits. So patients are characterized by rabbits, stubbornness and perseverance. They persistently seek to achieve the ideal in everything (usually learned diligently).

Treatment of patients with food intake disorders should be carried out taking into account the main diagnosis, however, several general recommendations should be taken into account that are useful for any of the options for duel.

Inpatient treatment in such cases is often more efficient than an outpatient basis, since at home cannot be able to control food well enough. It should be borne in mind that the replenishment of the defects of the diet, the normalization of body weight by organizing a fractional nutrition and the establishment of the activities of the gastrointestinal tract, the general investment therapy is a prerequisite for the success of further therapy. Neuroleptics apply neuroleptics to suppress the superssente relationship. Psychotropic means are also used to regulate appetite. Many neuroleptics (phrenolone, etperazine, aminazine) and other means blocking histamine receptors (pipolfen, ciprogeptadine), as well as tricyclic antidepressants (amitriptyline) increase appetite and cause weight gain. To reduce the appetite, psychostimulants (FEPRANON) and antidepressants are used from the group inhibitors of serotonin reverse seizure (fluoofsetin, sertraline). Of great importance for recovery has properly organized psychotherapy.

Sleeping is one of the most frequent complaints with various mental and somatic diseases. In many cases, the subjective sensations of patients are not accompanied by any changes in physiological indicators. In this regard, some basic sleep characteristics should be given.

Normal sleep has a different duration and consists of a series of cyclic vibrations of wakefulness. The greatest decline in the activity of the CNS is observed in the phase of slow sleep. Awakening in this period is associated with amnesia, sitting, enuresis, nightmares. The fast sleep phase occurs for the first time after 90 minutes after falling asleep and is accompanied by rapid movements of the eyes, a sharp drop in the muscular tone, an increase in blood pressure, the erection of the penis. EEG in this period differs little from the status of wakefulness, during awaken, people tell about the presence of dreams. The newborn fast sleep is about 50% of the total duration of sleep, in adults slow and fast sleep occupy 25% of the entire sleep period.

Incotion is one of the most frequent complaints among somatic and mentally illness. Insomnia is not connected so much with a decrease in sleep duration, as much as its quality deterioration, a sense of dissatisfaction.

This symptom is different, depending on the cause of insomnia. Thus, sleep disorders in patients with neurosis are primarily associated with a severe psychotrauming situation. Patients can, lying in bed, to think about the facts concerned for a long time, look for exit from the conflict. The main problem in this case is the process of falling asleep. Often the psychotrauming situation is played again in nightmarish dreams. With asthenic syndrome, characteristic of neurasthenia and vascular diseases of the brain (atherosclerosis), when irritability and hyperesthesia take place, patients are particularly sensitive to any outsiders: the ticking of the alarm clock, the sounds of dripping water, the noise of transport - everything does not allow them to fall asleep. At night, they sleep sensitively, often wake up, and in the morning they feel completely broken and inseparable. For suffering depressions, not only fallback difficulties are characterized, but also early awakening, as well as the lack of a sense of sleep. In the morning clock such patients lie with open eyes. The approach of a new day gives rise to them the most painful feelings and thoughts about suicide. Patients with maniacal syndrome never complain of sleep disorders, although its total duration can be 2-3 hours. Insomnia is one of the early symptoms of any acute psychosis (acute attack of schizophrenia, alcohol delicacy, etc.). Usually, the lack of sleep in psychotic patients is combined with an extremely pronounced anxiety, a sense of confusion, non-systematized delusted ideas, individual deceptions of perception (illusions, hypnogogical hallucinations, nightmarish dreams). A frequent cause of insomnia is the state of abstinence due to the abuse of psychotropic or alcohol. The state of abstinence is accompanied by somateegetative disorders (tachycardia, hesitation of blood pressure, hyperhydrosis, tremor) and a pronounced desire for repeated reception of alcohol and medicines. The causes of insomnia are also snoring and attacks of apnea attacks.

A variety of causes of insomnia requires a thorough differential diagnosis. In many cases, the appointment of individually selected sleeping pills (see Section 15.1.8), but it should be borne in mind that it is often more efficient and safe method Treatment in this case is psychotherapy. For example, behavioral psychotherapy implies compliance with the strict regime (awakening always at the same time, the ritual of preparation to sleep, regular use of nonspecific funds - a warm bath, a glass of warm milk, a spoon of honey, etc.). Quite painfully for many older people associated with age. Natural reduction in the need in a dream. They need to explain that the reception of sleeping equipment in this case is meaningless. It should advise patients not to go to bed before drowsiness arise, do not lie for a long time in bed, trying to fall asleep effort. It is better to stand up, take yourself a calm reading or complete small economic affairs and lie later when the need appears.

Hyperstia can accompany insomnia. So, for insufficiently sleeping at night, sickness is characteristic of daytime. In the occurrence of hyperscia, it is necessary to carry out differential diagnosis with organic diseases of the brain (meningitis, tumors, endocrine pathology), narcolepsy and Klein-Levin syndrome.

Narcolepsy is a relatively rare pathology, having a hereditary nature, is not related to either epilepsy, nor with psychodias. It is characteristic of the frequent and rapid emergence of the fast sleep phase (already 10 minutes after falling asleep), which is clinically manifested by the attacks of a sharp drop in the muscle tone (cataplexia), bright hypnogogo hallucinations, episodes of turning off consciousness with automatic behavior or states of the "waking paralysis" in the morning after waking up. There is a disease under 30 years old and further progresses little. In some patients, the cure was achieved forced sleep during the daytime, always in the same hour, in other cases stimulants and antidepressants apply.

Klein-Left syndrome is an extremely rare disorder, in which hypersmen is accompanied by the appearance of episodes of the narrowing of consciousness. Patients are prevented, looking for a quiet place for dorms. The dream is very long, but the patient can be wake up, although it is often associated with the occurrence of irritation, depression, disorientation, incoherent speech and amnesia. Disorder arises in youthful age, and after 40 years, spontaneous remission is often observed.

The unpleasant sensations in the body serve as a frequent manifestation of mental disorders, but they do not always take the nature of pain actually. From pain should be distinguished by extremely unpleasant unpleasant subjectively painted sensations - sensenestopathy (see section. 4.1). Psycho-conditioned pains can occur in the head, heart, joints, back. The point of view is expressed that in psychosis it is most worried about the part of the body, which, in the opinion of the patient, is the most important, vital, exercise personality.

Cardiac pain is a frequent symptom of depression. Often they are expressed by a heavy sense of constraint in the chest, "stone stone". Such pains are very rack, enhanced in the morning hours, accompanied by a sense of hopelessness. The unpleasant sensations in the field of the heart often accompany the alarming episodes (panic attacks) from neurosis suffering. These acute pain arising are always combined with expressed anxiety, fear of death. In contrast to an acute heart attack, they are well bought by sedatives and validol, but do not decrease from nitroglycerin intake.

Headache may indicate the presence of organic brain disease, but often emerges psychogenically.

Psychogenic headache is sometimes due to the voltage of the muscles of the aponeurotic helmet and neck (with a pronounced anxiety), the overall state of the depression (at subsecurity) or self-pressure (during hysteria). Anxiously distinguished, pedantical personalities are often complaining about the irradiants in shoulders bilateral pulling and graceful pains in the back of the head and the patterns, increasing in the evening, especially after the psychotrauming situation. The skin of the head often becomes painful ("painfully comb hair"). In this case, agents that reduce muscle tone (benzodiazepine tranquilizers, massages, warming procedures) help. Calm serene rest (watching telecasts) or pleasant exercise distract patients and reduce suffering. Headaches are often observed with a soft depression and, as a rule, disappear when the state is weighted. Such pain is growing up to the morning in parallel with the total gain of the longing. With hysteria, pain can take the most unexpected forms: "drilling and compressing", "Head tightens the hoop", "Skull splits in half," "pierces whiskey."

The organic causes of headaches are vascular diseases of the brain, an increase in intracranial pressure, facial neuralgia, cervical osteochondrosis. With vascular diseases, the sorrowful sensations, as a rule, have a pulsating nature, depend on the increase or decrease in blood pressure, are facilitated when shredding sleepy arteries, increase when administered vasodilatory funds (Histamine, Nitroglycerin). The attacks of vascular origin can be the result of a hypertensive crisis, alcoholic abstinence syndrome, an increase in body temperature. Headache - an important symptom for the diagnosis of volumetric processes in the brain. It is associated with an increase in intracranial pressure, increases by the morning, increases with the movements of the head, is accompanied by vomiting without prior nausea. An increase in intracranial pressure is accompanied by such symptoms as bradycardia, a decrease in the level of consciousness (stunning, zero) and a characteristic picture on the eye day (stagnant discs of optic nerves). Neuralgic pains are more often localized in the area of \u200b\u200bthe person, which is almost never found in psychosis.

Migraine attacks have a very characteristic clinical picture. These are periodically emerging episodes of an extremely strong headache, which is ongoing several hours, usually exciting half of the head. The attack may precede Aura in the form of distinct mental disorders (lethargy or excitement, reduction of hearing or auditory hallucinations, cattle or visual hallucinations, aphasia, dizziness or feeling unpleasant odor). Shortly before the resolution of the attack, vomiting is often observed.

In case of schizophrenia, true headaches arise quite rarely. It is much more often observed with extremely frosted senthenetics: "the brain melts", "ameal", "the bones of the skull breathe".

Disorders of sexual functions

The concept of sexual dysfunction is not quite definitely, since, as studies show, the manifestations of normal sexuality differ significantly. The most important diagnosis criteria is the subjective sense of dissatisfaction, depression, anxiety, guilt, arising from an individual due to sexual contacts. Sometimes such a feeling occurs with quite physiological sexual relationships.

The following disorder variants are distinguished: reduction and emergency increase in sexual attraction, insufficient sexual arousal (impotence in men, frigidity - in women), disorders of orgasm (anorgasmia, premature or delayed ejaculation), pain during sexual intercourse (dispensing, vaginism, postcoital head Pain) and some others.

As experience shows, quite often the cause of sexual dysfunction are psychological factors - personal predisposition to the alarm and anxiety, forced long breaks in sexual relations, the absence of a permanent partner, the feeling of its own unquatalness, unconscious dislike, a significant difference in the expected stereotypes of sexual behavior in a pair, education, condemning Sexual relationships, etc. Often the disorder are associated with fear of sexual life or, on the contrary, after 40 years - with an approaching involution and fear of losing sexual attractiveness.

Significantly less often the cause of sexual dysfunction is a severe mental disorder (depression, endocrine and vascular diseases, Parkinsonism, epilepsy). Even less often, sexual disorders are due to the general somatic diseases and local pathology of the genital sphere. It is possible a disorder of sexual function when prescribing some drugs (tricyclic antidepressants, irreversible inhibitors of Mao, neuroleptics, lithium, hypotensive agents - clofelin, etc., diuretic - spironolactone, hypothiazide, anti-phaquinsonic agents, heart glycosides, anaprilin, indomethacin, clofibrate, etc.) . Quite frequent cause of sexual dysfunction is the abuse of psychoactive substances (alcohol, barbiturates, opiates, hashish, cocaine, fenamine, etc.).

Proper diagnosis of the cause of the violation allows you to develop the most effective therapeutic tactics. The psychogenic nature of disorders determines the high efficiency of psychotherapeutic treatment. The ideal option is to work simultaneously with both partners of 2 cooperating groups of specialists, however, individual psychotherapy gives a positive result. Medicinal products and biological methods are used in most cases only as additional factors, such as tranquilizers and antidepressants - to reduce anxiety and fear, cooling the sacrum with chloroethyl and the use of weak neuroleptics - for a delay in prematurely occurring ejaculation, nonspecific therapy - in case of pronounced asthenia (vitamins, Nootropics, reflexology, electrosone, ginseng type biostimulants).

Hypochondria is called unreasonable concern about their own health, constant thoughts on the imaginary somatic disorder, possibly a serious incurable disease. Hypochondria is not a nosologically specific symptom and can be taken depending on the severity of the disease the form of obsessive thoughts, utmost ideas or nonsense.

The obsessive (obsessive) hypochondria is expressed by constant doubts, anxious concerns, persistent analysis of processes occurring in the body. Patients with obsessive hypochondria are well accepting explanations and soothing words of experts, sometimes they themselves are crushing about their conciseness, but they cannot get rid of painful thoughts without help. The obsessive hypochondria is a manifestation of obsessive-phobic neurosis, decompensation from anxious and disruption (psychasterics). Sometimes the emergence of such thoughts contributes to the careless statement of the doctor (Yat-Roggen) or incorrectly interpreted medical information (advertising, "second-year disease" among medical students).

Ultra-supersonal hypochondria is manifested in inadequate attention to minor discomfort or a light physical defect. Patients are attached incredible efforts to achieve the desired state, produce their own diets and unique training systems. They defend their rightness, strive to punish doctors who are obedy, from their point of view, in the ailment. Such behavior is a manifestation of paranoid psychopathy or indicates a debut of mental illness (schizophrenia).

Drainic hypochondria is expressed by unshakable confidence in the presence of a severe, incurable disease. Any statement of the doctor in this case is interpreted as an attempt to deceive, hide the true danger, and the rejection of the operation convinces the patient that the disease reached the terminal stage. Hypochondrial thoughts can act as a primary nonsense without deceptions of perception (paranoral hypochondria) or accompanied by sensenestopathies, olfactory hallucinations, feeling of foreign impact, automatisms (paranoid hypochondria).

Quite often, hypochondrial thoughts accompany the typical depressive syndrome. In this case, hopelessness and suicidal trends are especially expressed.

In case of schizophrenia, hypochondriad thoughts are almost constantly accompanied by a senthenetopathic sensation - senthenetopathic-ipochondric syndrome. Emotional-willed cruise in these patients often makes them in connection with the alleged illness to abandon work, stop going out into the street, avoid communication.

Masked depression

Due to the wide use of antidepressant drugs, it became apparent that among patients applying to therapists, a substantial share is patients with endogenous depression, in which hypothymia (longing) is masked by the dominant in the clinical picture of somatic and vegetative disorders. Sometimes other psychopathological phenomena are not a depressive register - obsessiveness, alcoholization, act as a manifestation of depression. Unlike classic, such depression is designated as masked (Larved, somatic, latent).

The diagnosis of such states is difficult, since the patients themselves may not notice or even deny the presence of longing. Among the complaints are dominated by pain (cardiac, head, abdominal, pseudo-evadicular and articular), sleep disorders, a sense of constraint in the chest, hesitation of blood pressure, disorders of appetite (both reduction and raising), constipation, reduction or increase in body weight. Although the direct question about the presence of longing and psychological experiences is usually the patients respond negatively, however, with careful abrasion, you can identify the inability to experience joy, the desire to get away from communication, a sense of hopelessness, the proliferation of the fact that ordinary home care and beloved work began to patient. Pretty characteristic aggravation of symptoms in the morning clock. Often there are characteristic somatic "stigmas" - dry mouth, expansion of pupils. An important feature of the masked depression is a gap between the abundance of painful sensations and the poverty of objective data.

It is important to take into account the characteristic dynamics of endogenous depressive attacks, a tendency to a protracted flow and an unexpected unfortunate resolution. Interestingly, the addition of infection with a high body temperature (flu, tonsillitis) can be accompanied by mitigating the feelings of longing or even break the attack of depression. In the history of such patients, periods of unreasonable "Handra" are often discovered, accompanied by non-harmony smoking, alcoholization and without treatment.

In differential diagnosis, the objective examination should not be neglected, since the simultaneous existence and somatic and mental disorder (in particular, the depression is an early manifestation of malignant tumors).

Hysterical conversion disorders

Conversion is considered as one of their psychological protection mechanisms (see Section 1.1.4 and Table 1.4). It is assumed that in conversion, internal solrencies associated with emotional stress are converted into somatic and neurological symptoms developing on the self-alignment mechanism. Conversion is one of the most important manifestations of a wide range of hysterical disorders (hysterical neurosis, hysterical psychopathy, hysterical reactions).

The amazing variety of conversion symptoms, their similarities with the most different organic diseases allowed J. M. Sharko (1825-1893) to call the hysteria of the "great simulant". At the same time, hysterical disorders from the actual simulation should be clearly distinguished, which is always targeted, completely subordinated to the control by the will, can be extended or discontinued at the request of the individual. Hysterical symptoms do not have a specific goal, cause the true inner suffering of the patient and cannot be discontinued at its request.

On the hysterical mechanism, violations of the functions of a variety of organism systems are formed, in the last century, neurological symptoms were most often met: paresis and paralysis, fainting and seizures, sensitivity disturbances, astolya-abasy, dying, blindness and deafness. In our century, symptoms correspond to diseases that have been distributed in recent years. These are heartfall, head and "radicular" pain, a sense of light shortness, swallowing disorders, weakness in hand and legs, stuttering, aphony, a feeling of chills, an indefinite feeling of tingling and crawling goosebumps.

With all the variety of conversion symptoms, a number of common properties are characteristic of any of them can be distinguished. First, it is a psychogenic character of symptoms. Not only the emergence of disorder is associated with a psychotraum, but its further flow depends on the relevance of psychological experiences, the presence of additional traumatic factors. Secondly, a strange, not corresponding typical picture of a somatic disease set of symptoms should be taken into account. The manifestations of hysterical disorders are as a patient, so the presence of a patient some experience in communication with somatic patients makes its symptoms of more similar to organic. Thirdly, it should be borne in mind that the conversion symptoms are intended to attract attention to others, so they never occur during the patient's stay alone with themselves. Patients are often trying to emphasize the uniqueness of their symptoms. The more attention, the doctor pays to the disorder, the more pronounced it becomes. For example, the doctor's request to speak a little pogroms can cause a complete voice loss. On the contrary, the distraction of the patient leads to the disappearance of symptoms. Finally, it should be borne in mind that not all the functions of the body can be controlled by self-imposition. A number of unconditional reflexes and objective indicators of the body can be used for reliable diagnostics.

Occasionally, conversion symptoms is the cause of re-circulation of patients to surgeons asking for serious operational interventions and traumatic diagnostic procedures. Such disorder is known for the name of Münhhausen's syndrome. The aimlessness of such a fiction, the soreness of numerous undergoing procedures, the explicit deadaptive nature of the behavior is distinguished by this disorder from the simulation.

Asthenic syndrome

One of the most common disorders is not only in psychiatric, but also in general-general practice is asthenic syndrome. Asthenia manifestations are extremely diverse, but such basic components of the syndrome, as pronounced depletion (fatigue), increased irritability (hyperesthesia) and somategometative disorders can always be found. It is important to take into account not only the subjective complaints of patients, but also the objective manifestations of the listed disorders. So, the deaptability is well noticeable with a long conversation: with increasing fatigue, the patient becomes more difficult to understand every next question, his answers are becoming more and more inaccurate, he finally refuses to further conversation, because it does not have more strength to support a conversation. Increased irritability is manifested by a bright vegetative reaction on the face, a tendency to tears, susceptibility, sometimes unexpected sharpness in responses, sometimes accompanied by subsequent apologies.

Somategetable disorders in asthenic syndrome are nonspecific. It may be complaints of pain (head, in the field of heart, in joints or abdomen). Often there are increased sweating, the feeling of "tides", dizziness, nausea, sharp muscular weakness. Usually observed blood pressure fluctuations (lifts, drop, fainting), tachycardia.

Almost constant manifestation of asthenia is a sleep disturbance. In the daytime, patients tend to experience drowsiness, seek to retire and relax. However, at night, they often can't fall asleep because they interfere with any extraneous sounds, bright light of the moon, folds in bed, bed springs, etc. In the middle of the night, they, completely exhausted, finally fall asleep, but sleep very sensitively, they are tormented by "nightmares". Therefore, in the morning hours, patients feel that they didn't rest at all, they want to sleep.

Asthenic syndrome is the simplest disorder in a number of psychopathological syndromes (see section 3.5 and Table. 3.1), so signs of asthenia can enter any more complex syndrome (depressive, psychoorganic). You should always make an attempt to determine if there is some more coarse disorder in order not to make a mistake in the diagnosis. In particular, the depressed is well noticeable by vital signs of longing (lose weight, shedding in the chest, daily mood fluctuations, a sharp suppression of impulse, dry skin, no tears, self-evaluation ideas), in psycho-organic syndrome, intelligent-enemy decrease and personality change is noticeable (circumstance, Weak, dysphoria, hypomensions, etc.). In contrast to hysterical somatoform disorders, patients with asthenia do not need society and sympathy, they seek to retire, annoy and cry when they are once again worried.

Asthenic syndrome is the least specific of all mental disorders. It can meet in almost any mental illness, often appears in somatic patients. However, the most brightly given syndrome is traced in patients with neurasthenia (see section 21.3.1) and various exogenous diseases - infectious, traumatic, intoxication or vascular lesions of the brain (see section 16.1). In case of endogenous diseases (schizophrenia, TIR), distinct attributes of asthenia are rarely determined. The passivity of schizophrenia patients is usually due to the lack of forces, but the absence of will. Depression in patients with TIR is usually considered as a strong (rack) emotion, this corresponds to the ultra-sustain and delusional ideas of self-evidence and self-confidence.

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Somatic mental disorders

Total and clinical characteristics

Classification of somatogenic mental disorders

a) asthenic, neric-like states due to somatic non-infectious diseases (cipher 300.94), metabolic disorders, growth and nutrition (300.95);

b) non-psychotic depressive disorders due to somatic non-infectious diseases (311.4), metabolic disorders, growth and nutrition (311.5), other and unspecified organic brain diseases (311.89 and 311.9);

c) neurosis and psychopathoid disorders due to somatogenic organic lesions of the brain (310.88 and 310.89).

2. Psychotic states that have developed as a result of functional or organic lesion Brain:

a) sharp psychosis (298.9 and 293.08) - asthenic confusion, delicious, amenata and other syndromes of the permanent of consciousness;

b) subacutely protracted psychosis (298.9 and 293.18) - paranoid, depressive-paranoid, anxious-paranoid, hallucinatory-paranoid, catatonic and other syndromes;

c) Chronic psychosis (294) -Korsakovsky syndrome (294.08), hallucinatory-paranoid, sentestopato-ipochondria, verbal hallucinosis, etc. (294.8).

3. Defective-organic conditions:

a) a simple psychoorganic syndrome (310.08 and 310.18);

b) Korsakovsky syndrome (294.08);

c) Dementia (294.18).

Somatic diseases acquire independent importance in the occurrence of mental disorder, with respect to which they are an exogenous factor. The mechanisms of brain hypoxia, intoxication, metabolic disorders, neuroreflex, immune, autoimmune reactions are essential. On the other hand, according to B. A. Decibyev (1972), somatogenic psychosis cannot be understood only as a result of a somatic disease. In their development they play the role of a predisposition to the psychopathological type of response, psychological features of the individual, psychogenic effects.

The problem of somatogenic mental pathology is becoming increasingly important due to the growth of cardiovascular pathology. Patomorphosis of mental diseases is manifested by the so-called somatization, the predominance of non-psychotic disorders over psychotic, "bodily" symptoms over psychopathological. Patients with sluggish, "erased" forms of psychosis sometimes fall into general formative hospitals, and severe forms of somatic diseases are often unrecognized in view of the fact that the subjective manifestations of the disease "overlap" objective somatic symptoms.

Mental disorders are observed in acute short-term, protracted and chronic somatic diseases. They are manifested in the form of unexicotic (asthenodenodensess, asthenodistmic, asthenoid, anxious-phobic, extero-formal), psychotic (delicious, delicious-alimentary, onyric, twilight, catatonic, hallucinatory-jiaranoids), defective-organic (Nsisorganic syndrome and dementia) .

According to V. A. Romasenko and K. A. Skvortsova (1961), B. A. Celbeeva (1972), A. K. Bestjan (1973), the exogenous nature of mental disorders of nonspecific TIN is usually observed in the acute course of somatic disease. In cases of the chronic flow with a diffuse lesion of a toxico-anoxic-anoxic brain, more often than in infections, there is a tendency to endo-formity of psychopathological symptoms.

Mentalic disorders in individual somatic diseases

Mental disorders for heart disease

Mental disorders arising due to acute heart failure can be expressed by the syndromes of disturbed consciousness, most often in the form of stupidity and delirium characterized by the inconsistency of hallucinatory experiences.

Mental disorders with myocardial infarction systematically began to study in recent decades (IG Ravkin, 1957, 1959; L. G. Ursova, 1967, 1969). Depressive states, disturbed syndromes with psychomotor excitation, euphoria are described. Often formal education. In case of small-scale myocardial infarction, a pronounced asthenic syndrome with tears, general weakness, sometimes nausea, chills, tachycardia, a subfebrile body temperature, develops. With a large-scale infarction with the lesion of the front wall of the left ventricle, anxiety arises, the fear of death; With a heart attack of the back wall of the left ventricle, euphoria are observed, multi-mindedness, lack of criticism for their state with attempts to get up from bed, requests to give any work. In the post-infarction state, lethargy, sharp fatigue, and hypochondriage are noted. It is often developing phobic syndrome - waiting for pain, the fear of re-infarction, rise from bed at that time when doctors recommend active mode.

Mental disorders also arise at heart defects, which indicated V. M. Bashchikov, I. S. Romanova (1961), G. V. Morozov, M. S. Lebedinsky (1972). With rheumatic defects of the heart V. V. Kovalev (1974) allocated the following variants of mental disorders:

1) border (asthenic), neurosis-like (neurotic-like) with vegetative disorders, cerebrasteic with light manifestations of organic cerebral insufficiency, euphoric or depressive-distivial mood, exterformal, asthenoinochondria states; neurotic reactions of depressive, depressive and hypochondriac and pseudoiaphoric types; pathological development of personality (psychopathoid);

2) psychotic (cardiogenic psychosis) - sharp with delicious or altenitative symptoms and subacute, protracted (alarming-depressive, depressive-paranoid, hallucinatory-paranoid); 3) Encephalopathic C (psychoorganic) - psychoorganic, epileptiform and corsage Kovsky syndromes. Congenital heart defects are often accompanied by signs of psychophysical infantilism, asthenic, neurosis and psychopath-like states, neurotic reactions, delay in intellectual development.

Currently, the operations are widely performed. Surgeons and cardiac therapists note the imbalance between the objective physical capabilities of the operated patients and relatively low actual indicators of the rehabilitation of persons who have undergone operations on the heart (E. I. Chazov, 1975; N. M. Amosov et al., 1980; S. Bernard, 1968 ). One of the most significant causes of this imbalance is the psychological deadaption of persons who have undergone the operation on the heart. When examining patients about the pathology of the cardiovascular system, they have established the presence of pronounced forms of personal reactions (G. V. Morozov, M. S. Lebedinsky, 1972; A.M. Vain and Sov., 1974). N. K. Bogolepov (1938), L. O. Badalyan (1963), V. V. Mikheev (1979) indicate a high frequency of these disorders (70-100%). Changes in the nervous system at heart defects described L. O. Badalyan (1973, 1976). The insufficiency of blood circulation arising in heart defects leads to chronic brain hypoxia, the emergence of common-selling and focal neurological symptoms, including in the form of convulsions.

In patients who are operated on for rheumatic heart defects, complaints are usually observed on headache, dizziness, insomnia, numbness and cooling of the limbs, pain in the heart and sternum, suffocation, fast fatigue, shortness of breath, increasing in physical stress, convergence weakness Corneal reflexes, muscle hypotension, reduction of periostal and tendon reflexes, disorders of consciousness, more often in the form of fainting, indicating a violation of blood circulation in the system of vertebrate and basilar arteries and in the inner carotid artery pool.

Mental disorders arising after cardiac surgery are a consequence of not only cerebral-vascular disorders, but also a personal reaction. V. A. Skumin (1978, 1980) allocated a "cardiorothetic psychopathological syndrome", often occurs when the mitral valve implantation or multiclap prosthetics. Due to the noise phenomena associated with the activities of the artificial valve, disruption of recipe fields at the site of its impairment and disorders of the rhythm of heart activity The attention of patients is riveted to the work of the heart. They have concerns and fears about the possible "valve separation", his breakdown. The oppressed mood is enhanced by the night when the noise from the operation of artificial valves is particularly clear. Only during the day when the sick promin is near the medical personnel, he can fall asleep. A negative attitude towards active activity is produced, an alarming-depressive background of moods with the possibility of suicidal actions occurs.

In V. Kovalev (1974) to Neo-Anorean postoperative period It was noted in patients with asthenoadynamic conditions, sensitivity, transient or sustainable intellectual-changing deficiency. After operations with somatic complications, sharp psychoses often occur with the permanent of consciousness (delicious, delicious and alternative and delicious opiiroid syndromes), subacute, abortion and protracted psychosis (anxious-depressive, depressive-hypochondriac, depressive-paranoid syndromes) and epileptiform paroxysms.

Mental disorders in patients with renal pathology

Astations for renal pathology, as a rule, precedes the diagnosis of kidney damage. There are unpleasant feelings in the body, the "stupid head", especially in the morning, nightmarish dreams, difficulties in focusing, a sense of breakdown, depressed mood, somatoneryological manifestations (cased language, grayish-pale color, instability of blood pressure, octvitations and profuse Nights, unpleasant feeling in the lower back).

Asthenic nephrogogenic ehimptom complex is characterized by constant complication and increase of symptoms, up to the state of the asthenic confusion, in which patients do not catch changes in the situation, do not notice the necessary items. With increasing renal failure, the asthenic state can change the formation. A characteristic feature of nephrogenous asthenia is Adamina with the inability or difficulty mobilizing himself to perform an action when an understanding of the need for such mobilization. Patients most of the time are carried out in bed, which is not always justified by the severity of renal pathology. According to A. G. Naku and G. N. Herman (1981), often the observed change of asthenoadynamic states of asthenospadepressive - an indicator of improving the somatic state of the patient, a sign of "affective activation", although it passes through the pronounced stage of the depressive state with the ideas of self-esteem (unnecessaryness, Nicely, family burden).

The syndromes of the praised consciousness in the form of delirium and amenia in nephropathies are difficult, often sick die. Two options for action syndrome (A. G. Maku, G. II. Herman, 1981), reflecting the severity of renal pathology and having prognostic importance: hyperkinetic, in which uremic intoxication is expressed, and hyokinetic with increasing decompensation of kidney activities, sharp increase in arterial Pressure.

Heavy forms of Uremia are sometimes accompanied by psychosis on the type of acute nonsense and ends with a fatal outcome after a period of stunning about a sharp motor anxiety, fragmentary crazy ideas. With a deterioration in the state, the productive forms of frustrated consciousness are replaced by unproductive, adamasses are growing, a doubt.

Psychotic disorders in the case of protracted and chronic kidney diseases are manifested by complex syndromes observed against the background of asthenia: anxious-depressive, depressive and hallucinatory-paranoid and catatonic. The increase in uremic toxicosis is accompanied by episodes of psychotic permanent of consciousness, signs of organic lesion of the central nervous system, epileptiform paroxysms and intellectual-moon disorders.

According to B. A. Lebedev (1979), in 33% of the surveyed patients against the background of severe asthenia, mental reactions of depressive and hysterical types are noted, the remaining is an adequate assessment of its condition with a decrease in mood, understanding the possible outcome. Asthenium often can impede the development of neurotic reactions. Sometimes in cases of insignificant severity of asthenic symptoms, hysterical reactions occur, which disappear by increasing the severity of the disease.

The reoencephalographic examination of patients with chronic kidney disease makes it possible to reveal a decrease in the tone of the vessels with a minor decrease in their elasticity and signs of impaired venous current, which are manifested by an increase in the venous wave (presesting) at the end of the catacrotic phase and are observed in persons for a long time suffering arterial hypertension. Characteristic instability vascular tone, mainly in the system of vertebrate and basilar arteries. With the light forms of the disease of the kidneys in the pulse blenification of pronounced deviations from the norm not noted (L. V. Pletneva, 1979).

In the later stages of chronic renal failure and with severe intoxication, organic-substituting operations and hemodialysis are carried out. After the congestion of the kidney and during dialysis stable submaymia, chronic nephrogogenic toxicodiagomeostatic enencephalopathy is observed (M. A. Civilo et al., 1979). Patients have weakness, sleep disorders, depression of mood, sometimes rapid increase in adami, stunning, convulsive seizures appear. It is believed that the syndromes of the praised consciousness (delirium, amemention) arise due to vascular disorders and postoperative asthenia, and the shutdown syndromes of consciousness are as a result of uremic intoxication. In the process of treatment with hemodialysis, there are cases of intellectual-meal disorders, organic brain damage with gradually increasing lethargy, loss of interest in the surrounding. With prolonged use of dialysis, psychoorganic syndrome is developing - "dialysis-uremic dementia" for which deep asthenia is characterized.

When kidney transplantation, large doses of hormones are used, which can entail the frustration of vegetative regulation. During the period of acute transplant insufficiency, when azotemia reaches 32.1-33.6 mmol, and hymorrhagic phenomena (abundant nose bleeding and hemorrhagic rash), paresis, paralysis may occur to 7.0 MKV / L. In the electroencephalographic study, resistant desynchronization with the almost complete disappearance of alpha activity and the predominance of slow-wave activity are detected. With a reochepalographic study, pronounced changes of the vascular tone are revealed: non-uniformity of waves in form and magnitude, additional venous waves. Asthenium is sharply enhanced, subcomatomic and comatose state develop.

Mental disorders for diseases of the digestive tract

Violations of the mental functions of the NRT pathology of the digestive tract are more often limited by the pointing of character characteristics, asthenic syndrome and neurosis-like states. Gastritis, ulcerative disease and nonspecific colitis are accompanied by the depletion of mental functions, sensitivity, lability or injecting emotional reactions, angerness, a tendency to a hypochondriatic interpretation of the disease, carcercofobia. With stitch-esophageal reflux, neurotic disorders are observed (neurasthenic syndrome and obsessionism) preceding the symptoms of the digestive tract. Approval of patients about the possibility of malignant neoplasms are noted within ultra-specific hypochondriac and paranolas. Complaints on the deterioration of memory are associated with disorder of attention due to both fixation on sensations caused by the main disease and depressive mood.

The complication of the stomach resection operations during ulcerative disease is a dumping syndrome, which should be accommodated from hysterical disorders. Under the dumping syndrome, the vegetative crises are understood by the type of hypos or hyperglycemic immediately after eating or after 20-30 minutes, sometimes 1-2 hours.

Hyperglycemic crises appear after receiving hot food containing easily driving carbohydrates. Suddenly there is a headache with dizziness, noise in the ears, less often - vomiting, drowsiness, tremor. "Black dots", "flies" before the eyes, body circuit disorders, instability, affection of objects can appear. They end with abundant urination, drowsiness. At the height of the attack rises the level of sugar and blood pressure.

Hypoglycemic crises occur outside meal: weakness, sweating, headache, dizziness appear. After meals, they quickly stop. During the crisis, the blood sugar level decreases, the drop in blood pressure is observed. Possible disorders of consciousness at the height of the crisis. Sometimes crises are developing in the morning after sleep (R. E. Galperin, 1969). In the absence of timely therapeutic correction, the hysterical fixation of this state is not excluded.

Mental disorders

With malignant neoplasms of extra formalization of the Localization V. A. Romasenko and K. A. Skvortsov (1961), the dependence of mental disorders from the stage of cancer was noted. In the initial period, a sharpening of the characteristic traits of patients, neurotic reactions, asthenic phenomena are observed. In the deployed phase, asthenodepressive states, anosognosia are most often noted. In the cancer of the internal organs in the manifest and mainly terminal stages, the states of the "quiet delicacy" with the adamasses, episodes of delicious and onuric experiences, alternating overlapping or excitement attacks with fragmentary cravesties; Deliosal and estimative states; Paranoid states with delirium relations, poisoning, damage; depressive states with depersonalizational phenomena, senthenetics; Jet hysterical psychosis. Characteristic unstoppost, dynamism, frequent change of psychotic syndromes. In the terminal stage, the oppression of consciousness (stupor, sopor, coma) is gradually growing.

Mental disorders of the postpartum period

2) Actually postpartum;

3) psychosis of the lactation period;

4) endogenous psychosis provoked by childbirth.

The mental pathology of the postpartum period does not represent an independent nosological form. Common for the whole group of psychosis is the situation in which they arise.

Generic psychosis is psychogenic reactions, developing, as a rule, from primible women. They are due to the fear of waiting for pain, an unknown, frightening event. At the first signs of beginningring clans, some of the birthrooms may develop a neurotic or psychotic reaction, in which the background of a narrowed consciousness appears hysterical crying, laughter, cry, sometimes fugiform reactions, less often - hysterical umutism. The manufacturers refuse to fulfill the instructions offered by medical personnel. Duration of reactions - from a few minutes to 0.5 h, sometimes longer.

Postpartum psychoses are conventionally divided by postpartum and psychosis of the lactation period.

Actually postpartum psychosis They develop throughout the first 1-6 weeks after childbirth, often in the maternity hospital. The reasons for their occurrence: toxicosis of the second half of pregnancy, severe childbirth with massive trauma of tissues, delayed branch of the placenta, bleeding, endometritis, mastitis, etc. The decisive role in their appearance belongs to the generic infection, the predisposing point is toxicosis of the second half of pregnancy. At the same time, psychosis is observed, the emergence of which cannot be explained by postpartum infection. The main reasons for their development are traumatization of generic pathways, intoxication, neuroreflex and psychotrauming factors in their aggregate. Actually postpartum psychosis is more often observed from primordin women. The number of female women who gave birth to boys, almost 2 times more than women who gave birth to girls.

Psychopathological symptoms are characterized by sharp start, occurs after 2-3 weeks, and sometimes 2-3 days after delivery against the background of elevated body temperature. Rowards are restless, gradually their actions become disorderly, loses speech contact. Amection develops, which in severe cases goes into a comporant state.

Amenification in postpartum psychosis is characterized by a low-heated dynamics throughout the entire period of the disease. Exit from the amenitative state of critical, followed by lacunar amnesia. There is no prolonged asthenic states, as happens with lactation psychosis.

Catonic (katathono-onaireoid) form is less common. A peculiarity of the postpartum catatonia is the weak severity of the obstacity of symptoms, the combination of its onin disorders of consciousness. With postpartum catatonia, there is no regularity of stiffness of stiffness, as with endogenous catatonia, there is no active negativism. The inconsistency of the catatonic symptoms, the episodic of onaireoid experiences, their alternation with states of stunning is characteristic. With the weakening of the catatonic phenomena, patients begin to eat food, answer questions. After recovery, they critically belong to the experienced.

Depressive-paranoid syndrome develops against the background of a non-terrible stunning. It is characterized by "matte" depression. If the stupidity increases, depression smoothes, patients are indifferent, do not answer questions. The ideas of self-evidence are associated with the inconsistency of patients during this period. Often reveal the phenomena of mental anesthesia.

Differential diagnosis of postpartum and endogenous depression is based on the presence of a change in its depth, depending on the state of consciousness, weighing depression by night. In such patients, a somatic component sounds more in the instant interpretation of their insolvency, while under the endogenous depression, the affected self-assessment concerns personal qualities.

Psychoses of lactation period They occur after 6-8 weeks after childbirth. There are about two times more often than postpartum psychosis. This can be explained by the tendency to rejuvenate the marriages and the psychological immaturity of the mother, the lack of experience in childcare - younger brothers and sisters. The factors preceding the beginning of the lactation psychosis include shortening hours of recreation due to child care and night sleep deprivation (K. V. Mikhailov, 1978), emotional overvoltage, lactation with irregular nutrition and leisure, leading to rapid evil.

The disease begins violation of attention, fixing amnesia. Young mothers do not have time to fulfill everything necessary due to the lack of collaboration. Initially, they try to "catch time" due to the reduction in hours of rest, "clean up" at night, do not go to bed, start washing baby linen. Patients forget where one or another thing was laid, it is looking for her for a long time, breaking the rhythm of work and with difficulty induced order. Quickly grow difficulty comprehending the situation, a confusion appears. Gradually loses the purposefulness of behavior, fear develops, affect bewilderment, fragmentary interpretative nonsense.

In addition, changes in the state during the day are noted: the patients are more collected during the day, and therefore it seems that the condition returns to the downturn. However, every day the improvement periods are reduced, anxiety and disadvantage increases, the fear of the life and well-being of the child increases. Developing amenic syndrome or stunning, the depth of which is also non-permanent. Exit from the amenitative state of protracted, accompanied by frequent relapses. Amenistent syndrome is sometimes replaced by a short-term period of catathon-onairoid. There is a tendency to increase the depth of the disorders of consciousness when trying to preserve lactation, the relatives of the patient are often asked about.

Often there is an asthenodepressive form of psychosis: general weakness, eating, deterioration of the leather turgora; Patients become depressed, express fears for the life of the child, ideas of low value. Exit from depression protracted: patients have a long time a sense of instability of their condition remains, weakness, anxiety is noted that the disease can be returned.

Endocrine diseases

Endocrine Adults in adults, as a rule, are accompanied by the development of non-psychotic syndromes (asthenic, neurosis and psychopathoid) with paroxysmal vegetative disorders, and at the increasing of the pathological process - psychotic states: syndromes of the praised consciousness, affective and paranoid psychoses. With congenital forms of endocrinopathy or their occurrence in early childhood, the formation of psychoorganic neuroendocrine syndrome is clearly acting. If the endocrine disease appears in adult women either in adolescence, then they often have personal reactions associated with a change in somatic state and appearance.

On the early stages All endocrine diseases and with relatively benign flows are noted the gradual development of psycho-endocrine syndrome (endocrine psychosindrome, according to M. Bleuler, 1948), transitioning it to the progression of the disease in psychoorganic (amntestic-organic) syndrome and the emergence of sharp or protracted psychosis against the background of these syndromes ( D. D. Oryolskaya, 1983).

The most often an asthenic syndrome appears, which is observed with all the forms of endocrine pathology and is included in the structure of psycho-endocrine syndrome. It refers to the earliest and permanent manifestations of endocrine dysfunction. In cases of acquired endocrine pathology, asthenic phenomena may be long preceded by the detection of the dysfunction of the gland.

The "endocrine" asthenia is characterized by a sense of severe physical weakness and a breakdown, accompanied by a myasthenic component. At the same time, prompting to activities that persist in other forms of asthenic states are leveled. Asthenic syndrome very soon acquires the features of the apataabulic state with impaired motivation. Such a syndrome transformation usually serves as the first signs of the formation of psycho-organic neuroendocrine syndrome, an indicator of the progression of the pathological process.

Netrosy-like changes are usually accompanied by manifestations of asthenia. Neurastin-like, extractive, disturbing-phobic, asthenodepressive, depressive-hypochondriac, astheno-abulic states are observed. They are persistent. Patients decrease mental activity, attractions change, the mood lability is noted.

Neuroendocrine syndrome in typical cases is manifested by the "triad" changes - in the field of thinking, emotions and will. As a result of the destruction of the highest regulatory mechanisms, disinterested permission appears: sexual licenses are observed, a tendency to vagrancy, theft, aggression. Reducing the intelligence can reach the degree of organic dementia. Epileptiform paroxysms often occur, mainly in the form of convulsive seizures.

Acute psychoses with disturbances: Asthenic confusion, delicious, delirious-amenitative, onairoid, twilight, sharp paranoid states - arise in the acute course of endocrine disease, for example, with thyrotoxicosis, as well as as a result of acute effects of additional external harmful factors (intoxication, infection, mental Injuries) and in the postoperative period (after thyroidectomy, etc.).

Among the psychoses with a protracted and recurrent flow, depressive-paranoid, hallucinatory and paranoid, senthenetopathic and pelvicinosis syndrome are most often revealed. They are observed in infectious damage to the hypothalamus - pituitary system, after removal of the ovaries. In the clinical picture of psychosis, the elements of the Kandinsky-Clerambo syndrome are often discovered: the phenomena of ideator, sensory or motor automatism, verbal pseudogalucinations, delusional ideas of exposure. Features of mental disorders depend on the defeat of a certain neuroendocrine system.

Itsenko-Kushning's disease occurs as a result of the lesion of the hypothalamus - pituitary system - the cortical substance of the adrenal glands and is manifested by obesity, genital hypoplasia, gypsutism, expressed astenia, depressive, senthenetopathose-ipochondriac or hallucinatorial and paranoid states, epileptiform seizures, decrease in intellectual-meal functions, Korsakovsky syndrome. After radiation therapy and adrenalectomy, sharp psychosis can develop with the permanent of consciousness.

In patients with acromegaly, resulting in the lesion of the front lobe of the pituitary - eosinophilic adenoma or the growth of eosinophilic cells, increased excitability, evilness, alentability, a tendency to solitude, the narrowing of the circle of interests, depressive reactions, dysphoria, sometimes psychosis with a violation of consciousness, usually arising after additional External influences. Theadiposogenital dystrophy is developing due to the hypoplasia of the rear lobe of the pituitary. The characteristic somatic features include obesity, the appearance of circular rollers around the neck ("necklace").

If the disease begins at an early age, the underdevelopment of genital organs and secondary sexual signs is observed. A. K. Blyuanskaya (1973) noted that with primary lesions of the hypothalmium-pissed system, obesity and mental changes are preceded by sexual interferences. Psychopathological manifestations depend on the etiology (tumor, traumatic defeat, inflammatory process) and the severity of the pathological process. In the initial period and at the non-timbling dynamics of symptoms, aesthenic syndrome is manifested for a long time. In the future, epileptiform seizures are often observed, the personality changes in epileptoid type (pedantry, stamina, suggestion), sharp and protracted psychoses, including endoform type, apatalabulic syndrome, organic dementia.

Cerebral-pituitary insufficiency (sympathy disease and Schiena syndrome) is manifested by a sharp weight, underdevelopment of genital organs, asthenoadynamic, depressive, hallucinatory-paranoid syndromes, intellectual-insicurative disorders.

In the diseases of the thyroid gland, either its hyperfunction (Basedova disease, thyrotoxicosis), or hypofunction (mixedma), is noted. The cause of the disease can be tumors, infection, intoxication. Basedova disease is characterized by three somatic signs such as goiter, Pucheglasie and Tachycardia. At the beginning of the disease, negros-like disorders are noted:

irritability, bugs, anxiety or elevation of mood. In severe course of the disease, delicid states, acute paranoid, aged depression, depressive and hypochondriac syndrome may develop. In differential diagnosis, the presence of somatonevological signs of thyrotoxicosis, including Exophthalma, Mebius symptom (convergence weakness), the symptom of Gref (lag upper century From the iris when looking down - the white strip remains a sclera). Myxedema is characterized by bradypsie, decrease in intelligence. The innate form of myxedema is cretinism, which earlier often had endemic character in localities, where in drinking water is not enough iodine.

With Addison Disease (deficiency of the function of the adrenal cortical substance), there are phenomena of irritable weakness, intolerance to external stimuli, increased exhaustion with increasing adamisia and monotonous depression, sometimes delirious states occur. Sugar diabetes is often accompanied by non-psychotic and psychotic mental disorders, including delicious, for whom the presence of bright visual hallucinations is characterized.

Treatment, prevention and socio-labor rehabilitation of patients with somatogenic disorders

The correction of non-psychotic disorders is carried out against the background of the main somatic therapy with the help of sleeping drugs, tranquilizers, antidepressants; Psychostimulants of plant and animal origin are prescribed: tincture of ginseng, lemongrass, Aralia, Eleutherococcus extract, Pantokrin. It should be borne in mind that many antispasmodic vessels and hypotensive means - clofelin (hemiton), daukarin, dibazole, carboxine (intensor), cinnarizine (stamp), Raunatin, reserpine - have a slight sedative effect, and amizil tranquilizers, oxylidine, sybazon (diazepam, relaignation ), Nozheps (Oxazepam), Chlozain (chloridiazepoxide), on-szmismolytic and hypotensive phenazepam. Therefore, when they are combined, it is necessary to be careful about the dosage, monitor the state of the cardiovascular system.

Acute psychosis usually indicate high degree Inxication, violation of the cerebral circulation, and the perishes of consciousness - about the serious flow of the process. Psychomotor excitation leads to the further depletion of the nervous system, can cause a sharp deteriorate of a general condition. V. V. Kovalev (1974), A. G. Naku, G. N. Herman (1981), D. D. Orlovskaya (1983) Recommended to prescribe patients with aminezine, thiuridazine (Sonapaks), Alimemazin (Teralen) and other neuroleptic not possess a pronounced extrapyramidal effect, in small or medium doses inward, intramuscularly and intravenously under the control of blood pressure. In some cases, it is possible to stop acute psychosis with the help of intramuscular or intravenous administration of tranquilizers (Seduksena, Relanium). With protracted forms of somatogenic psychosis, tranquilizers, antidepressants, psychostimulators, neuroleptic and anticonvulsants are used. There is a bad tolerability of some drugs, especially from a group of neuroleptic tools, so it is necessary to individually select doses, gradually increase them, replace one medicine to others if complications appear or there is no positive effect.

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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 various degree The depression of mood with one or another shade. 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 developing either with severe acute diseases with high temperature (bruboral inflammation of lung, abdominal title) or pronounced intoxication (masking renal failure), or in chronic diseases in terminal stage (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, their health, etc. Cases of physical ailment, somatic disadvantages often suggest that , "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 suggests a high degree of hereditary conditionality. 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 it.

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 the deep sleep follows, after 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 an epileptic seizure there is no 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 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.