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Etiological factors of symptomatic psychoses. Symptomatic psychoses

Symptomatic psychoses are psychotic nonspecific disorders that can occur with various pathologies of internal organs, infectious diseases.

The manifestations of symptomatic psychoses are in many ways similar to the manifestations of some mental illnesses, only symptomatic psychosis is not a mental disorder, but a reaction of the human body, its nervous system to an existing somatic disease.

Causes

The main cause of these disorders is infectious and somatic diseases. At the same time, various metabolic disorders develop in the body, the reactivity of the body itself is weakened or distorted, toxic products released as a result of the existing disease poison the body (intoxication). In addition, with somatic diseases, the brain may not have enough oxygen for normal functioning (hypoxia).

Diseases that can be complicated by the development of somatogeny: infectious diseases (influenza, malaria, infectious hepatitis), malignant tumors, rheumatism, septic endocarditis. Common symptomatic psychoses are those that develop due to septic (purulent) inflammatory processes.

Some medications can also provoke the development of symptomatic psychoses. Among them are atropine, caffeine, cyclodol. Somatogeny can also occur due to poisoning with industrial poisons (gasoline, acetone, aniline, benzene, lead).

Classification

Symptomatic psychoses are divided by duration into:

Acute (transient) - last from several hours to several days. The main manifestations of acute psychosis are delirium, twilight stupefaction, stunning, amentia;
Subacute – lasts several weeks, manifests itself in depression, hallucinosis, delirium, manic-euphoric states;
Protracted – their duration is up to several months, and in rare cases up to a year. Prolonged somatogenies are manifested by delirium and persistent Korsakov symptom complex (syndrome).

Manifestations

Acute symptomatic psychoses

Delirium is most typical for this group of somatogenies. It manifests itself as abundant visual hallucinations, disorientation in time and place of stay, hallucinatory delusions, fear and speech motor agitation, reflecting the content of hallucinatory delusional experiences. With any somatic disease, delirium often develops in people suffering from alcoholism.

Twilight stupefaction occurs spontaneously and just as suddenly stops. Patients are completely disoriented in time, space and even in their own personality. As a rule, during twilight stupefaction, patients perform monotonous automatic actions, and after exiting this state they do not remember anything about this episode. Twilight states of consciousness can occur after epileptic seizures, malaria, and AIDS.

The main symptoms of amentia are complete disorientation (in time, place, self), speech agitation, combined with incoherence of speech and confusion, chaotic agitation, but the patient does not leave the bed or the place where he is. After recovering from the state of amentia, patients completely forget about all the events that happened. Most often, amentia develops due to brain infections.

Stunning (stupefaction) often occurs due to neurological diseases (especially against the background of cerebral edema) and intoxication. It manifests itself as severe speech-motor retardation, difficulty and slowdown in understanding the surroundings, and impaired memorization.

Subacute symptomatic psychoses

A common type of somatogenic mental disorder is depression (). A combination of depression with asthenia, anxiety, weakness, and various vegetative manifestations is typical. Sometimes such patients express ideas of guilt, refuse to eat, and exhibit suicidal tendencies. Somatogenic depression can develop with some brain tumors, with pancreatic cancer, as a side effect of the effects of certain drugs (clonidine, rauwolfia alkaloids).

Manic-euphoric states (manias) are manifested by increased mood, motor disinhibition, increased speech activity, sometimes there may be ideas of revaluation of one’s own personality, they are similar to manifestations of mania with. Various intoxications provoke the development of symptomatic mania.

Hallucinosis is manifested by an influx of auditory hallucinations without a clear delusional interpretation.

Subacute symptomatic psychoses can manifest themselves as hallucinatory-paranoid syndrome, with the appearance of auditory hallucinations, delusions of persecution and relationships.

Prolonged symptomatic psychoses

The main manifestation of Korsakov's syndrome is the inability to remember current events, as a result of which the patient is disoriented in time. Existing memory gaps are replaced by false memories - fictitious events or real events transferred in the near future.

Treatment

Treatment of symptomatic psychoses should be carried out comprehensively. First of all, it is necessary to devote all efforts to treating the underlying disease, eliminating intoxication and hypoxia, and normalizing metabolism in the body.

Treatment of psychosis itself is carried out depending on the existing manifestations. If the patient is predominant in delirium and agitation, then sibazon, aminazine, and tizercin are prescribed. In the presence of hallucinatory-delusional symptoms, haloperidol and tizercin are used.

Acute symptomatic psychoses often occur with transient stupefaction. Disorders of consciousness vary in depth, structure and duration. The most common syndromes are: stupor, delirium, amentia, twilight stupefaction, oneiroid. These disorders are possible in psychoses that develop both from somatic diseases and infections, and from poisoning.

Symptomatic psychosis is usually preceded by a short-term prodromal period with headache, lethargy or motor restlessness, emotional disorders (anxiety, fear, depression), sleep disturbances, hyperesthesia, i.e. signs of asthenic syndrome. According to some researchers, the particular severity of asthenic phenomena indicates a severe course of the disease. In some cases, mental disorders are limited to asthenic disorders, and psychosis does not develop.

If acute psychotic disorders, then they last from several hours to 2-3 days. Most often this is confusion with a picture of delirium or epileptiform agitation.

At the onset of many infectious diseases, delirium occurs only at night and often once. For children (especially young children), the most typical states of clouded consciousness are a combination of deafness with short-term episodes of delirious and pre-delirious disorders. In very severe underlying illnesses, delirium lasts for several days and in particularly unfavorable cases may give way to amentia.

In case of severe intoxication, the clinical picture is dominated by stunning, which, with increasing severity of the general condition, can turn into stupor and then into a coma.

A twilight state of consciousness with epileptiform agitation occurs suddenly and is accompanied by sudden excitement and fear. The patient rushes about, runs away from imaginary pursuers, screams; there is an expression of horror on his face. Such psychosis usually ends just as suddenly. It is replaced by deep sleep, often stupor. Sometimes psychosis can develop into a picture of amentia, which is prognostically unfavorable. The duration of the described psychotic state often ranges from 30 minutes to 2 hours. Epileptiform excitation can occur in the initial period of the disease, preceding the full picture of the infectious disease.

In somatic (infectious and non-infectious) diseases without pronounced toxicosis (malaria, rheumatism, etc.), oneiric conditions are more often observed, which are usually short-term, and when leaving oneiric, asthenia comes to the fore.

In some cases, it is possible to develop conditions that only superficially resemble oneiroid - oneiroid-like conditions with involuntary fantasizing, lethargy and detachment from the environment. At the same time, patients are correctly oriented in place, time and their own personality. This state can be interrupted by external influence (call, touch).

Many authors in acute symptomatic psychoses note the frequency oneiric (dream) states with a predominance in the clinical picture of dream experiences with ordinary, less often with fantastic themes, when patients become passive participants in events. The structure of dream states also includes visual hallucinations. At the same time, patients feel like spectators or victims of violence, experiencing anxiety, fear or horror. Excitement is accompanied by confusion and fussiness.

Amentia syndrome in the structure of symptomatic psychoses usually occurs when an acute somatic illness or intoxication develops against the background of preliminary weakening of the body (starvation, extreme physical and mental exhaustion, previous chronic disease). In this regard, some authors consider amentia as a variant of delirium (delirium on “altered soil”). IN Lately Amentia syndrome in its classical form practically does not occur. More often observed amentia-like states. It seems most successful to designate such states as asthenic confusion[Mnukhin S.S., 1963; Isaev D.N., 1964]. They are defined by a combination of confusion with pronounced exhaustion and inconsistency of thinking. The depth of stupefaction constantly and quickly changes, becoming greater or lesser under the influence of fatigue or rest, respectively, and sometimes spontaneously. During a conversation, it is usually possible to obtain correct answers only to the first questions, then the answers become confusing and confused; After rest, the ability to respond to the interlocutor is restored for a short time. In amentia-like states, orientation in the environment is incomplete. Fragmentary ideas of relationship, persecution, hypochondriacal statements, and isolated hallucinations are noted. Emotions are characterized by extreme lability: the affect of fear, anxiety, melancholy, and confusion quickly replace each other. These conditions are most characterized by severe asthenia and exhaustion of mental processes at the slightest stress. Asthenic confusion differs from amentia not only in the shallower depth of clouding of consciousness, but also in the extreme variability of the state - rapid fluctuations from deep clouding of consciousness to almost complete clarification.

Many foreign authors note that the syndromes of the exogenous type of reactions described by K. Bonhoeffer are now almost never found in their “pure” form, and peculiar “alloys” (W. Scheid), transitions from one syndrome to another, predominate. Quite often, especially in elderly patients, there are states of confusion with symptoms characteristic of exogenous types of reactions. English psychiatrists refer to such conditions as “confusal states”, American psychiatrists as “acute brain syndrome”, German psychiatrists as “acute states of confusion” (acute Verwirrtheitszustande).

Acute symptomatic psychoses can occur without clouding of consciousness, in the form of acute verbal hallucinosis. Such psychosis develops suddenly, with the appearance of verbal hallucinations of a commentary nature (usually in the form of dialogue), accompanied by confusion, anxiety and fear. In the future, hallucinations may acquire imperative content. In this state, patients, under the influence of hallucinatory experiences, commit dangerous actions towards others and themselves. Verbal hallucinosis worsens at night. A rapid influx of verbal hallucinations can lead to the development of so-called hallucinatory confusion.

The picture of symptomatic psychoses in acute poisoning (acute intoxication psychoses) is usually limited to a profound change in consciousness and convulsive seizures. If death does not occur, then these disorders completely disappear or are significantly smoothed out.

Upon recovery from acute symptomatic psychosis, phenomena of asthenia or states of emotional-hyperesthetic weakness (according to K. Bonhoeffer) of varying severity are observed. Patients are tired, incapable of prolonged stress, and quickly become exhausted during work, especially mental work. At the same time, they are irritable, capricious, touchy, self-centered, and require special attention. The mood is extremely unstable, with a tendency to depression; the phenomena of hyperesthesia are expressed. In children and adolescents, along with asthenia, psychopathic-like behavioral disorders, a tendency to fear, hypochondriacal and other neurotic disorders occur [Sukhareva G. E., 1974].

The following characteristic signs of the disease are distinguished:

presence of somatic disease;

a noticeable connection in time between somatic and mental disorders;

a certain parallelism in the course of mental and somatic disorders;

possible, but not obligatory, appearance of organic psychopathological manifestations diseases.

Signs of somatic psychosis during pregnancy

During pregnancy there may be depressive states with suicidal tendencies. Decompensation of psychopathy occurs due to the fact that pregnancy reveals a hidden inferiority of the endocrine-diencephalic system. Somatic psychoses more often occur in the postpartum period, as a rule, in the presence of unfavorable premorbidity; Often there is dissatisfaction with the relationship with the husband, poor living conditions, etc.

The clinical picture of somatic psychosis may consist of:

feelings of alienation and hostility towards your husband or child,

depression (usually morning), sometimes accompanied by suicidal tendencies,

fear for the child, which becomes obsessive.

Symptoms of somatic psychoses after childbirth

Postpartum somatic psychoses occur in the first 3 months after childbirth. Most often occur in first-time mothers and begin with a feeling of confusion, which can turn into paranoid, amentive or depressive syndrome s. Symptoms of the disease are sometimes schizophrenia-like in nature, which is an unfavorable prognostic sign. Treatment of symptomatic psychoses is aimed at relieving delusions or depression (depending on the dominant symptoms). Psychotherapeutic methods of treating somatic psychoses play a major role in these cases.

Symptoms of somatic mental disorders with influenza

The disease is more common with influenza caused by type A virus; Persons suffering from hypertension and atherosclerosis are most vulnerable due to frequent viral damage to the vascular system. Violations are observed at all stages of the disease. IN initial period asthenic signs dominate:

headache(mainly in the temples and back of the head),

increased sensitivity to light, smells, touch.

At the height of the development of influenza, acute manifestations of the disease with delirious stupefaction can be observed, which in complicated cases turn into amentia after 1-2 days.

In the post-febrile period of influenza, protracted neurosis-like (asthenic, hypochondriacal, depressive) somatic psychoses can also develop.

Symptoms of neoplasms complicated by somatic psychoses

Most characteristic syndrome psychosis of this type is asthenia. A peculiarity of these patients is their reluctance to see a doctor for fear of finding out the true diagnosis, i.e., a desire to “escape from the disease” is revealed. At the same time, characterological personality traits become more acute and tension increases.

From the moment the diagnosis becomes known to the patient, the symptoms of somatic psychosis give way to psychogenic symptoms. Sometimes patients with somatic psychosis develop distrust of the diagnosis and a hostile attitude towards doctors, hoping for a possible diagnostic error.

Often, information received about the presence of a tumor causes severe depressive reactions, accompanied by suicidal attempts. Subsequently, among the symptoms of somatic psychosis, a melancholy mood with a predominance of lethargy and indifference dominates. During the advanced phase of cancer, oneiroid states, illusions, and sometimes suspicion of medical personnel, reminiscent of delusional doubt. Chronic pain syndrome in the terminal stage of the disease aggravates fear, fear of the future, and depression.

Symptoms of postoperative somatic psychoses

Postoperative somatic psychoses occur mainly in middle-aged and elderly people in the first two weeks after surgery, lasting from several hours to 1 – 2 weeks. After gynecological operations associated with the removal of organs, depressive syndrome often develops. Symptoms of postoperative somatic psychosis are relatively common in older people after eye surgery (especially during cataract removal), when delirium may develop with an influx of visual hallucinations with a formally clear consciousness.

After severe heart surgery, it is possible to develop anxious depression, some stupor, followed by a slowdown and impoverishment of mental activity, and a decrease in the range of interests. After adenomectomy surgery in case of decompensation cerebral atherosclerosis a picture of symptoms of postoperative somatic psychoses may develop with severe fussiness and isolated hallucinations, a shift of the situation into the past (as in senile psychoses). It should be noted that postoperative stress itself in most cases causes a softening and weakening of the current symptoms in a patient with schizophrenia.

Signs of somatic psychoses in renal failure

Mental disorders in somatic diseases such as renal failure are also not uncommon. In states of compensation and subcompensation of chronic renal failure, the most typical symptom of somatic psychosis is asthenic syndrome, which develops as its earliest manifestation and often persists throughout the entire disease. Its features include a combination of irritable weakness and persistent sleep disturbances (drowsiness during the day and insomnia at night).

As intoxication increases, disturbances of consciousness of varying degrees of severity usually appear, for example oneiric syndrome. Asthenia gradually becomes more and more adynamic in nature. During this period, with somatic psychosis, fluctuations in the tone of consciousness may occur (the so-called flickering stupor); Convulsive seizures may occur with a long post-ictal period of disturbance of consciousness.

Further intensification of intoxication is usually accompanied by characteristic sleep disturbances with drowsiness during the day and persistent insomnia at night, nightmares followed by the addition of hypnagogic hallucinations. Acute somatic psychoses occur as delirious and amental, in late stage In uremia, the state of stunning becomes almost permanent. The appearance of symptoms of somatic psychosis in chronic renal failure indicates the severity of the condition and the need for hemodialysis.

Symptoms of psychosis due to diabetes mellitus

Diabetes is often accompanied by symptoms of somatic psychosis in the form of:

Symptomatic psychoses: causes, classification, manifestations, treatment

Symptomatic psychoses are psychotic nonspecific disorders that can occur with various pathologies of internal organs and infectious diseases.

Causes

Diseases that can be complicated by the development of somatogeny: infectious diseases (influenza, malaria, infectious hepatitis), malignant tumors, rheumatism, septic endocarditis. Common symptomatic psychoses are postpartum psychoses, which develop due to septic (purulent) inflammatory processes.

Classification

Symptomatic psychoses are divided by duration into:

Acute (transient) - last from several hours to several days. The main manifestations of acute psychosis are delirium, twilight stupefaction, stunning, amentia;
Subacute – lasts several weeks, manifests itself in depression, hallucinosis, delirium, manic-euphoric states;
Protracted – their duration is up to several months, and in rare cases up to a year. Prolonged somatogenies are manifested by delirium and persistent Korsakov symptom complex (syndrome).

Manifestations

Subacute symptomatic psychoses

A common type of somatogenic mental disorder is depression (the main symptoms of depression). A combination of depression with asthenia, anxiety, weakness, and various vegetative manifestations is typical. Sometimes such patients express ideas of guilt, refuse to eat, and exhibit suicidal tendencies. Somatogenic depression can develop with some brain tumors, with pancreatic cancer, as a side effect of the effects of certain drugs (clonidine, rauwolfia alkaloids).

Manic-euphoric states (mania) are manifested by increased mood, motor disinhibition, increased speech activity, sometimes there may be ideas of re-evaluation of one’s own personality, they are similar to manifestations of mania in manic-depressive psychosis. Various intoxications provoke the development of symptomatic mania.

Hallucinosis is manifested by an influx of auditory hallucinations without a clear delusional interpretation.

Subacute symptomatic psychoses can manifest as a hallucinatory-paranoid syndrome, with auditory hallucinations, persecutory delusions and relationships.

Prolonged symptomatic psychoses

Treatment

You may also want to look into treating schizophrenia.

What are symptomatic psychoses?

Psychosis is a mental disorder in which a person’s reactions are completely contrary to reality. Symptomatic psychoses belong to the group mental disorders for somatogenic diseases. Psychoses due to intoxication are usually classified as a separate category, but the identity of their development allows us to describe them in this article.

What it is?

Symptomatic psychoses are exogenous psychotic states that arise from somatic diseases, infectious or non-infectious in nature, and also, as we said, from various intoxications. Various diseases can give different clinical pictures; the body's reactions are distinguished by their non-specificity. In addition, there are frequent cases of psychosis provoked by a physical illness, but having an endogenous nature. Confusion often arises when a disease such as schizophrenia or bipolar affective disorder first appears. The difference between symptomatic psychoses is that when the underlying disease is cured, psychosis, as one of its symptoms, disappears. While endogenous disorders provoked by any disease remain even after the somatic cause is eliminated.

Classification

Symptomatic psychoses are divided into several types:

acute psychoses;
prolonged psychoses;
organic psychosyndromes.

The same bodily disease, depending on many factors, can lead to any of the three types listed in the classification.

Acute symptomatic psychoses manifest themselves as twilight disorder, amentia, epileptimorphic agitation, delirium, and stunning. This happens with intense but short-term exposure to exogenous harmfulness. Average duration symptoms range from 2 to 72 hours.

Delirium is characterized by the presence of verbal hallucinations and illusions, accompanied by secondary delusions and emotional and affective disorders. Most often occurs during intoxication.

We talk in detail about what delirium that arises against the background of alcohol addiction is, its symptoms are described in this video

Epileptiform disorder is characterized by severe agitation and fear; the patient takes active actions, screams, and wants to escape from an imaginary danger. The attack most often ends in a sleepy sleep.

Verbal hallucinosis is manifested by the appearance of voices commenting on any actions. Typically, exacerbation occurs at night. As a result, the patient experiences fear and confusion, and may be dangerous to himself and others at such times.

Oneiric syndrome occurs with severe infectious diseases. Distinctive Features This condition consists of colorful hallucinatory pictures, in which the patient can either actively participate or observe from the side.

Amentia is a crisis of consciousness, characterized by disorientation in time and space, incoherence of thinking and speech, and confusion.

It is believed that in most cases, acute symptomatic psychoses, after eliminating the symptoms, do not leave any organic consequences.

Protracted psychoses are contrasted with the acute ones described above. They are provoked by less intense but longer lasting harmful effects. The duration of the disorder itself is also much longer. Protracted psychoses manifest themselves as depression, manic-delusional states, and transient Korsakoff syndrome. All this against the background of an asthenic state.

Depression in this case resembles the phase of bipolar affective disorder, demonstrating motor retardation, while there are no biorhythmic mood swings. Also, the picture is similar to involutional melancholia, patients are excited and anxious. The difference is tearfulness, asthenia, and fatigue. With prolonged psychosis, especially at night, symptoms of delirium appear. Depression with delusions occurs in case of progression of somatic disease. Visual and auditory hallucinations, nihilistic and paranoid delusions, and illusions are possible. Manic traits in this case are characterized by inaction. Pseudoparalytic euphoric states may develop.

Korsakoff's syndrome rarely manifests itself in symptomatic psychoses, but it also occurs. Represents the inability to remember a current event while retaining memory for the past. After recovery, memory is completely restored.

Psychoorganic syndrome manifests itself as irreparable personality disorders. It is characterized by a decrease in memory, intelligence and social adaptation, a weakening of will, and an increase in emotional reactions. Milder changes at the organic level can manifest as problems asthenic nature, decreased initiative, irritability.

The asthenic state is characterized by extreme exhaustion, weakness, fatigue, sleep disturbance and mood instability. Patients experience a dependence of asthenic symptoms on barometric pressure.

Organic psychosyndrome can manifest itself as an explosive variant. In this case, the patient’s behavior will be brutal, irritable, and extremely demanding of others.

The apathetic variant of the development of psychoorganic syndrome is expressed in a high degree of indifference in the current reality, including one’s own life.

With the euphoric type, there is a lack of self-criticism and high mood and complacency. This state can suddenly give way to aggression and anger, turning into tearfulness and moodiness.

The concept of symptomatic psychoses that have an organic periodic nature is often expanded when diagnosing recurrent schizophrenia.

Treatment and prevention

A feature of the treatment of symptomatic psychoses is the emphasis on eliminating the root cause. Of course, psychiatry can also help here; its main task is to relieve acute symptoms so that the patient does not cause harm to himself and others during an attack. Depending on the clinical picture, antipsychotics or antidepressants may be prescribed. But the main focus of therapy is the treatment of the somatic illness that provoked psychosis. It is best if it is possible to hospitalize the patient in psychiatric department in a somatic hospital, if an infectious disease is the cause of symptomatic psychosis, then only this option is implemented. The second option is to place the patient in a mental hospital, but with the obligatory supervision of a therapist. For certain somatic diseases, heart surgeries, transportation of the patient is contraindicated, and then therapy takes place in a general hospital.

Thus, treatment should be aimed at resolving the somatic problem that was the basis for the onset of the mental disorder. The same applies to psychosis due to intoxication. Therapy is aimed at cleansing the body of the harmful effects of a toxic substance.

As a preventive measure for symptomatic psychoses, we can only advise not to let any somatic disease progress, to diagnose it in time and begin therapy.

Features of symptomatic psychoses in children

Mental disorders can appear at any age. With severe infections, children may also experience symptomatic psychosis. They usually manifest themselves as stupor, stupor, and even coma. In milder forms, variants of pre-delirium symptoms are possible: anxiety, moodiness, illusions, fears, irritability, asthenia. In addition, productive motor symptoms: excitement, convulsive states, lethargy.

The main difference between symptomatic psychoses in childhood is the danger of their transition from the acute phase to the organic one. After all, it entails serious mental changes. That is, an adult who has suffered acute symptomatic psychosis, after getting rid of a somatic illness, can fully recover and never have any mental problems again. Unlike the growing body of a child, which previous illness, can have a serious impact, including developmental delays.

In conclusion, we can say that, as the name implies, these psychoses are a symptom of another disease, and the basis of therapy is to treat the cause, not the result. The main task is to ensure that acute psychosis does not become protracted, and that protracted psychosis does not provoke an organic psychosyndrome. It is especially important to diagnose the problem in time in childhood.

Symptomatic psychoses

Symptomatic psychoses are psychotic states that occur in certain somatic diseases. This group of diseases includes infectious and non-infectious diseases, intoxications, endocrinopathies, and vascular pathology. Acute symptomatic psychoses, as a rule, occur with symptoms of confusion; protracted forms usually have clinical manifestations of psychopathic, depressive-paranoid, hallucinatory-paranoid states, as well as persistent psychoorganic syndrome. The initial and final stages of symptomatic psychoses are characterized by asthenia.

Certain somatic diseases and intoxications are characterized by various nonspecific types of reactions. The structure of symptomatic psychosis also depends on the intensity and duration of exposure to harm. Age is of great importance: in infancy, the reaction to harmfulness is limited to convulsive syndrome, in childhood epileptiform excitation most often develops, in adulthood - almost all types of exogenous and endoform reactions, and pictures of delirium are inherent in old age. The characteristics of mental disorders depend to a certain extent on the somatic suffering that caused the psychosis.

Classification of symptomatic psychoses

There are various clinical types of symptomatic psychoses.

Acute symptomatic psychoses with confusion (stunning, delirium, amentia, epileptiform and oneiric states, acute verbal hallucinosis).

Protracted symptomatic psychoses are transitional syndromes, according to Wik (depressive, depressive-delusional, hallucinatory-paranoid states, apathetic stupor, mania, pseudoparalytic states, transient Korsakoff psychosis and confabulosis).

Organic psychosyndrome due to prolonged exposure to harmful substances on the brain.

In most cases, acute symptomatic psychoses disappear without leaving a trace. After somatic diseases with a picture of prolonged psychoses, asthenia or personality changes of an organic type may develop.

Prevalence. There are no exact data on the prevalence of symptomatic psychoses. This is due to the lack of a unified concept of their origin and clinical boundaries.

Clinical forms

Acute symptomatic psychoses

In the prodromal period and after recovery from symptomatic psychosis, emotional-hyperesthetic weakness is observed with lability of affect, intolerance of minor emotional stress, as well as loud sounds and bright light.

Acute psychotic states occur in the form of stupor of varying degrees of depth, amentia, twilight stupefaction, delirium, oneirism, oneirism, as well as acute verbal hallucinosis. The duration of such psychosis ranges from several hours to two to three days.

Twilight stupefactions begin suddenly, often accompanied by epileptiform excitement, fear, and a senseless desire to escape. Psychosis also ends suddenly, its duration ranges from 30 minutes to 2 hours. In some cases, after twilight stupefaction, stupor or an amental state occurs.

Delirium usually develops at night and is usually preceded by sleep disturbances. In severe cases, delirium may give way to amentive syndrome or amentiform state.

Amentiform states are clinically manifested by asthenic confusion with severe exhaustion and inconsistency of thinking. The depth of confusion varies, largely due to fatigue or rest. Confusion increases even during a short conversation. Patients are disoriented, there is an affect of fear, anxiety, and confusion.

Oneiric states in symptomatic psychoses are distinguished by such features as variability in the content of fantastic experiences (everyday themes are replaced by adventure and fairy-tale themes); marked inhibition, detachment from the environment, involuntary fantasies. Orientation is not lost.

Acute verbal hallucinosis. Against a background of anxious anticipation and vague fear, commentary verbal hallucinations suddenly appear, usually in the form of dialogue. Subsequently, hallucinatory disorders acquire an imperative character. Under the influence of voices, patients can commit aggressive actions. The duration of psychosis ranges from several days to a month or more.

Protracted symptomatic psychoses

These types of psychoses last longer than acute ones, in the form of depression, depression with delusions, hallucinatory-delusional states, manic syndromes, as well as pseudoparalytic states, confabulosis and transient Korsakoff syndrome. All of these syndromes leave behind long-term asthenic conditions. In some cases, diseases accompanied by prolonged symptomatic psychoses leave behind organic personality changes (psychopathic-like changes, sometimes psychoorganic syndrome).

Depression differs from the MDP phase in the absence of a circadian rhythm, severe asthenia, and tearfulness.

Depression may give way to depression with delirium, which indicates the progression of the somatic state. The structure of depressive-delusional states includes verbal hallucinations, delusions of condemnation, nihilistic delirium, and delirious episodes.

Hallucinatory-delusional states have the features of acute paranoid with delusions of persecution, verbal hallucinations, illusions, and false recognitions. They may disappear when the patient changes location.

Manic states are unproductive euphoric manias without psychomotor agitation and desire for activity. They are accompanied by severe asthenic disorders. At their heights, pseudoparalytic states often develop with euphoria, but without delusions of grandeur.

Confabulosis is expressed in patients' stories about events that did not actually occur (feats, heroic and selfless deeds). The condition suddenly arises and ends just as suddenly.

Organic psychosyndrome is a condition characterized by irreversible personality changes with memory loss, weakening of will, affective lability and decreased ability to work and ability to adapt.

Recurrent symptomatic psychoses. In the long-term period of traumatic, infectious and intoxication diseases that caused organic psychosyndrome, periodic organic psychoses may develop. They occur with twilight stupefaction, accompanied by stereotypical arousal, often with elements of propulsion, or epileptiform arousal. In some cases, incomplete amnesia of the psychotic state is noted. Psychosis is accompanied by a variety of diencephalic disorders (hyperthermia, fluctuations blood pressure, increased appetite, excessive thirst).

Symptomatic psychoses in certain somatic diseases

Myocardial infarction. In the acute stage, fear, anxiety are noted, and amental or delirious states are not uncommon. In the subacute stage - mild stupor, an abundance of senestopathies, double orientation is often observed (the patient claims that he is both at home and in the hospital). The behavior of patients may be different. They may be outwardly indifferent, motionless, while lying down without changing their position. Other patients, on the contrary, are excited, fussy, and confused. Asthenic symptoms are very characteristic of myocardial infarction. In the acute period, somatogenic asthenia predominates, then symptoms of a psychogenic nature increase. In the long term, pathological development of personality can be observed.

Heart failure. With acutely developed cardiac decompensation, a picture of stunning, as well as amental states, is observed. Patients with chronic heart failure exhibit lethargy, apathy, and dysmnestic disorders. Symptoms “flicker” depending on the somatic condition of the patient.

Rheumatism. The active phase of rheumatism is accompanied by asthenia with symptoms of irritable weakness. Hysteriform manifestations, stupor, psychosensory disorders, anxious and melancholy states, and delirium may occur.

Malignant tumors. Acute symptomatic psychoses are manifested, as a rule, by a picture of delirium with sharp agitation, a few hallucinations, illusions, and the development of oneiric states at the height of delirium. In severe, often preterminal, conditions, pictures of persistent delirium or amentia develop. Protracted symptomatic psychoses in the form of depression or delusional states occur less frequently.

Pellagra. With mild pellagra, decreased mood, increased fatigue, hyperesthesia, and irritable weakness are noted. Before the development of cachexia, delirium, amentia, and a twilight state occur; with cachexia, depression with delirium, agitation, Cotard's delirium, hallucinatory-paranoid states, and apathetic stupor occur.

Kidney failure. With compensation and subcompensation of chronic renal failure, asthenic disorders are observed. Adynamic variants of asthenic syndrome are characteristic of decompensation of a somatic condition. Acute symptomatic psychoses in the form of stunning, delirium, amentia indicate a sharp deterioration in somatic status. Stunning accompanies severe forms of uremic toxicosis, delirium develops at the onset of uremia. Endoform psychoses with pictures of unstable interpretative delirium, apathetic stupor or catatonic agitation develop, as a rule, with an increase in uremia.

Symptomatic psychoses in certain infectious diseases

Brucellosis. IN initial stages The disease exhibits persistent asthenia with hypersthesia and affective lability. In some cases, acute psychoses occur, delirious, amental or twilight disorders consciousness, as well as epileptiform excitation. Protracted psychoses are represented by depression and mania.

Viral pneumonia. In the acute period of the disease, delirious and oneiric states develop. If pneumonia drags on, then delayed symptomatic psychoses may develop in the form of depression with agitation or hallucinatory-paranoid psychoses with delusions of ordinary content.

Infectious hepatitis. Accompanied by severe asthenia, irritability, dysphoria, and adynamic depression. With severe serum hepatitis, the development of organic psychosyndrome is possible.

Tuberculosis. Patients are characterized by an elevated background mood with a euphoric tint. Asthenic disorders are manifested by severe irritable weakness and tearfulness. Psychoses are rare, among them manic states are more common, and hallucinatory-paranoid states are less common.

Mental disorders in case of poisoning with industrial poisons

Aniline. In mild cases, symptoms of denubilation, headaches, nausea, vomiting, and isolated convulsive twitches develop. In severe cases - delirious states, the development of excruciating delirium is possible.

Acetone. Along with asthenia, accompanied by dizziness, unsteady gait, nausea and vomiting, protracted delirious states occur with a sharp deterioration in the evening hours. It is possible to develop depression with anxiety, sadness, and ideas of self-blame. Less typical are hallucinoses of commentary or imperative content. With chronic acetone poisoning, the development of organic personality changes of varying depth is possible.

Petrol. In acute poisoning, euphoria or asthenia with headaches, nausea, vomiting is observed, then delirium and oneiroid, followed by stupor and coma. Possible convulsions, paralysis; severe cases can be fatal.

Benzene, nitrobenzene. Mental disorders are close to the disorders described during aniline intoxication. Severe leukocytosis is characteristic. In case of nitrobenzene poisoning, the exhaled air has the smell of bitter almonds.

Manganese. In case of chronic intoxication, asthenic phenomena, algia, psychosensory disorders, anxiety, fears, affective disorders in the form of depression, often with suicidal thoughts, transient ideas of relationship.

Arsenic. In acute poisoning - stunning, turning into stupor and coma. The first symptoms of poisoning are vomiting with blood, dyspeptic disorders, and a sharp enlargement of the liver and spleen. With chronic arsenic poisoning, organic psychosyndrome develops.

Carbon monoxide. In the acute period of intoxication, a picture of stunning is observed, and delirium may occur. A few days or a week after poisoning, against the background of apparent health, psychopathic-like disorders, Korsakoff syndrome, phenomena of aphasia and agnosia, and parkinsonism develop.

Mercury. With chronic intoxication, organic psychopathic-like disorders appear with pronounced affective lability, weakness, sometimes euphoria and decreased criticism, in the most severe cases - with aspontaneity and lethargy. Dysarthria, ataxic gait, and tremor are noted.

Lead. The initial manifestations of intoxication are headaches, dizziness, asthenic disorders in the form of increased physical and mental fatigue and severe irritable weakness. In severe acute intoxication, delirium and epileptiform agitation are observed. Chronic intoxication causes a full-blown organic psychosyndrome with epileptiform seizures and severe memory disorders.

Tetraethyl lead. Bradycardia, decreased blood pressure, hypothermia, as well as headaches, nausea, vomiting, diarrhea, sharp pains in the stomach, sweating. Hyperkinesis is noted of varying severity and intention tremor, twitching of individual muscle groups, choreiform movements, muscle weakness, hypotonia, ataxic gait, “foreign body in the mouth” symptom. There is often a sensation of hair, rags and other objects in the mouth, and patients constantly try to free themselves from them. The development of epileptic seizures, as well as stupefaction syndromes (stunning, delirium), is possible.

Phosphorus and organophosphorus compounds. Characterized by asthenic disorders, emotional instability, photophobia, anxiety, convulsive phenomena with bradycardia, hyperhidrosis, nausea, dysarthria, nystagmus; Stunning, stupor, and coma may develop. Uncontrollable vomiting occurs, the vomit smells like garlic and glows in the dark.

Etiology and pathogenesis

Etiology is associated with three main groups of interacting factors: somatic diseases, infections and intoxications. The action of exogenous factors is realized, according to And. V. Davydovsky and A. b. Snezhnevsky, the predisposition existing in the body to the formation of certain mental disorders.

K. Schneider believed that the development of somatogenic psychoses is determined by a combination of a number of characteristic symptoms. He included the presence of a verified somatic disease, the existence of a noticeable connection in time between somatic disorders and mental pathology, the observed parallelism in the course and increase of mental and somatic disorders, as well as possible appearance organic symptoms.

The pathogenesis remains poorly understood, the same harmful effects can cause both acute and prolonged psychoses, and in severe cases lead to organic brain damage. Intense but short-lived exogeny often causes acute psychosis. Long-term exposure to weaker harmfulness leads to the formation of protracted symptomatic psychoses, the structure of which may approach endogenous psychoses.

Age plays an important role, as psychopathological disorders become more complex.

Diagnostics

Diagnosis of symptomatic psychoses is based on recognition of somatic illness and the picture of acute or protracted exogenous psychosis. Symptomatic psychoses should be distinguished from endogenous diseases (attacks of schizophrenia or phases of MDP) provoked exogenously. The greatest diagnostic difficulties arise in the onset, which may be similar to the picture of acute exogenous psychosis. However, in the future, endogenous features become more and more obvious.

In some cases, differential diagnosis with febrile schizophrenia is necessary. Febrile schizophrenia is characterized by a debut with catatonic agitation or stupor, as well as oneiric clouding of consciousness, which is not characteristic of the debut of symptomatic psychoses. If catatonic disorders are observed in symptomatic psychoses, then at long-term stages. The reverse development of symptomatic psychoses is accompanied by asthenic disorders.

Treatment

Patients with symptomatic psychoses are subject to hospitalization in the psychiatric department of a somatic hospital or in a psychiatric hospital. In the latter case, patients should be under constant supervision not only of a psychiatrist, but also of a therapist, and, if necessary, an infectious disease specialist.

Patients with myocardial infarction, as well as after heart surgery and with subacute septic endocarditis are not transportable. If they develop psychosis, transfer to a psychiatric clinic is strictly contraindicated. Such patients are treated in a general hospital, where round-the-clock supervision should be provided, especially for agitation and depression, to prevent suicide.

Patients with pronounced organic personality changes are recommended to be treated in a psychiatric hospital.

Treatment of symptomatic psychoses is aimed at eliminating their cause. For somatic infectious diseases, the underlying disease should be treated, as well as detoxification therapy. Acute symptomatic psychoses with confusion, as well as hallucinosis, are treated with antipsychotics. For prolonged symptomatic psychoses, drugs are used depending on the clinical picture. For hallucinatory-paranoid and manic states, as well as confabulosis, antipsychotics with a pronounced sedative effect (propazine, clopixol, seroquel) are indicated. Depression should be treated with antidepressants, taking into account clinical characteristics (depression with lethargy, depression with agitation, etc.).

Therapeutic measures for intoxication psychoses are aimed at eliminating intoxication. Detoxifying drugs: unithiol - up to 1 g/day orally or 5-10 ml of a 50% solution intramuscularly daily for several days for poisoning with compounds of mercury, arsenic (but not lead!) and other metals; sodium thiosulfate (10 ml of 30% solution intravenously). Subcutaneous administration of an isotonic sodium chloride solution, blood transfusion, plasma, and blood substitutes are indicated.

In case of acute poisoning with sleeping pills, along with general measures (cardiac drugs, lobeline, oxygen), gastric lavage is performed, strychnine is administered intravenously (0.001-0.003 g every 3-4 hours), corazol is administered subcutaneously.

Forecast

The prognosis for symptomatic psychoses depends on the underlying disease or intoxication. At favorable outcome the underlying disease, acute symptomatic psychoses disappear without a trace. If a somatic illness becomes subacute or chronic and is accompanied by prolonged symptomatic psychosis, then features of an organic psychosyndrome may develop.

Depressive psychosis is a severe mental disorder, expressed in a distorted perception of the surrounding reality. This disorder is caused by pathological organic changes in.

Manic psychosis: treatment

Under manic psychosis a disorder of mental activity is determined, in which a disturbance of mood (affect) occurs.

Psychosis in a child

Psychosis is difficult mental illness, which is characterized by a violation of the ability to distinguish between fantasy and reality. Psychosis does not allow you to respond adequately.

What is included in the concept of “acute psychosis”?

Experts use the term “psychosis” or “acute psychosis” when talking about certain types of mental disorders, common feature of which the disorder is.

Chronic psychosis

The concept of chronic psychosis currently includes a whole group of diseases. This group includes such complex mental illnesses as:

Hypomanic psychosis

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Psychosis after childbirth

Postpartum psychosis is a condition that occurs quite often in women after the birth of a child. The disease is caused by complications arising during childbirth. IN.

Reactive psychosis

Reactive psychoses (also called psychogenic psychoses) are mental disorders of the psychotic level that arise as a result of exposure to extreme shocks.

Schizoaffective psychosis

Schizoaffective psychosis is an endogenous non-progressive mental illness with a relatively favorable prognosis, which is characterized by periodic attacks with the presence of depression.

Symptomatic psychosis

Symptomatic psychosis is a disease that occurs as a result of a number of somatic and infectious conditions. Clinical manifestations of this disease are depression, psychomotor agitation, clouding of consciousness. All symptoms are extremely similar to functional psychoses. An important point is the correct diagnosis of the disease.

Among symptomatic psychoses in chronic form distinguish psychoses that are similar to schizophrenia and manic-depressive psychosis.

Symptomatic psychosis is usually classified as follows:

Acute – at this state a darkening of the state occurs, which is accompanied by hallucinations and deafness. Develops in such severe conditions as myocardial infarction, vascular disorders of the brain. As a rule, it goes away on its own.
Targeted – accompanied by depression, delirium, apathetic stupor, mania, hallucinations. It lasts longer and leaves behind an asthenic state. Depression often gives way to delusions, illusions and false recognitions. A paranoid state accompanied by hallucinations indicates a deterioration in the patient's condition.
Organic – develops with organic pathology of the brain.

Groups of symptomatic psychoses differ in the depth of manifestations of anxiety syndromes and can lead to dementia and decay of memory and intelligence.

Symptomatic prolonged psychosis

Symptomatic prolonged psychosis - with this condition, there is a transition from the stage of clouding of consciousness to transition states: hallucinatory-delusional, manic, pseudoparalytic. Disorders of consciousness may not develop immediately.

Symptomatic prolonged psychosis develops as a result of the unfavorable course of the underlying somatic disease: renal failure, endocrine diseases, systemic lupus erythematosus. There is a frequent change in the patient's mood: from depression with feelings of hatred and anger to elevated mood, which is accompanied by complete inactivity.

Periodically, an excessive need for food, drink and sleep appears, which is replaced by insomnia and decreased sexual activity. The patient shows selfishness, irritability, touchiness, tearfulness, seeks privacy and demonstrates indifference to everything that happens.

Causes

Causes of symptomatic psychosis may be related to:

Poisoning with industrial poisons (acetone, gasoline, lead, mercury);
Somatic infectious diseases: tuberculosis, malaria, infectious hepatitis, viral pneumonia, influenza. There is a decrease in attention, the patient is unable to concentrate. If the disease drags on, depression, increased anxiety, delusions and hallucinations may develop.
Somatic non-communicable diseases: myocardial infarction, rheumatism, endocarditis, malignant neoplasms, in rehabilitation period after surgical interventions on the heart. Stunning, visual hallucinations, and motor agitation are observed.
Chronic intoxication with phosphorus and organophosphorus compounds: development of asthenic disorders, photophobia, restlessness, anxiety, convulsions, nausea, vomiting is observed. The vomit glows in the dark and has a garlicky odor.

The causes of symptomatic psychosis may be associated with intoxication with atropine, cortisone, barbiturates, caffeine, and cyclodol. This condition develops when the recommended therapeutic dose is exceeded several times.

Diagnostics

Diagnosis of symptomatic psychosis is aimed at identifying the underlying cause.

The prognosis depends on the degree of complexity of the concomitant disease or intoxication. As a rule, with proper treatment of the underlying cause, acute symptomatic psychosis resolves on its own. If psychosis becomes chronic and symptoms of organic psychosyndrome are observed, drug therapy is prescribed.

Treatment

In most cases, treatment of symptomatic psychosis is carried out in an inpatient setting. In case of pronounced organic personality changes, the patient is placed in a psychiatric hospital.

Treatment of symptomatic psychosis is aimed primarily at eliminating the underlying cause. In intoxication psychosis, therapy is aimed at eliminating the cause of intoxication. Additionally, the following may be assigned:

Nootropic drugs.
Neuroleptics with a pronounced sedative effect.
Antidepressants taking into account the general clinical picture of the disease.
Psychostimulants for lethargy.
Neuroleptics - if there is lethargy, irritability and a decrease in the ability to do physical work. Taking medications is recommended in the first half of the day.
Use of detox drugs: sodium thiosulfate, unithiol.

During therapy, the patient must be under systematic medical supervision. As the patient's well-being improves, suspiciousness and self-centeredness may occur. These conditions go away on their own.

Somatogenic psychoses

Somatogenic psychoses (mental disorders due to somatic diseases). Mental disorders arising in connection with the pathology of internal organs and systems constitute a special branch of psychiatry - somatopsychiatry. Despite the diversity of psychopathological symptoms and clinical forms of somatic pathology, they are united by a common pathogenetic mechanisms and patterns of development. The diagnosis of “somatogenic psychosis” is made under certain conditions: the presence of a somatic disease, a temporary connection between somatic and mental disorders, interdependence and mutual influence in their course.

Depends on the nature and stage of development of the underlying disease, the degree of its severity, the effectiveness of the treatment, as well as individual characteristics the patient, such as heredity, constitution, character, gender, age, the state of the body’s defenses and the presence of additional psychosocial hazards.

Based on the mechanism of occurrence, there are 3 groups of mental disorders:

1. Mental disorders as a reaction to the very fact of the disease, hospitalization and the associated separation from the family and familiar environment. The main manifestation of such a reaction is varying degrees of depressed mood with one shade or another.

Some patients are full of painful doubts about the effectiveness of the treatment prescribed to them, about the successful outcome of the disease and its consequences. For others, anxiety and fear of the possibility of serious and long-term treatment, before surgery and complications, the likelihood of disability. Some patients are burdened by the very fact of being in the hospital and yearn for home and loved ones.

Their thoughts are occupied not so much with the illness as with problems at home, memories and dreams of being discharged. Outwardly, such patients look sad and somewhat inhibited. With a long, chronic course of the disease, when there is no hope for improvement, an indifferent attitude towards oneself and the outcome of the disease may arise. The patients lie indifferently in bed, refusing food and treatment - “it’s all the same.”

However, in such apparently emotionally inhibited patients, even with minor outside influence, anxiety, tearfulness, self-pity and a desire to receive support from others may occur.

2. Second, significantly large group consist of patients whose mental disorders are, as it were, integral part clinical picture of the disease. These are patients with psychosomatic pathology, where, along with pronounced symptoms of internal diseases (hypertension, peptic ulcer, diabetes mellitus), neurotic and pathocharacterological reactions are observed.

3. The third group includes patients with acute mental disorders (psychosis). Such conditions develop either in severe acute diseases with high fever (lobar pneumonia, typhoid fever) or severe intoxication (acute renal failure), or in chronic diseases in the terminal stage (cancer, tuberculosis, kidney disease).

In the clinic of internal medicine, despite the wide variety psychological reactions and more severe mental disorders, the most common are the following:

affective (mood disorders);

deviations in characterological reactions;

confusion syndromes;

It should be aimed, first of all, at the underlying somatic disease, because it depends on its severity mental condition. Treatment can be carried out in the hospital where the patient is, but two conditions must be met. Firstly, such a patient must be examined by a psychiatrist and give his recommendations.

Secondly, if the patient is in acute psychosis, he is placed in a separate room with round-the-clock observation and care. In the absence of these conditions, the patient is transferred to the psychosomatic department.

If the disease of the internal organs is not the cause of mental disorders, but only provoked the onset mental illness(for example, schizophrenia), then such a patient is also transferred to the psychosomatics department (in case of a severe somatic condition) or to a regular psychiatric hospital. Psychotropic medications are prescribed by a psychiatrist on an individual basis, taking into account all indications, contraindications, possible side effects and complications.

Prevention of somatogenic disorders should be aimed at preventing early detection and timely treatment of somatic diseases.

Asthenia is a core or end-to-end syndrome in many diseases. It can be either a debut (initial manifestation) or the end of the disease.

Typical complaints include weakness, increased fatigue, difficulty concentrating, irritability, intolerance to bright light and loud sounds. Sleep becomes shallow and restless. Patients have difficulty falling asleep, difficulty waking up, and getting up unrested. Along with this, emotional instability, touchiness, and impressionability appear.

Asthenic disorders are rarely observed in pure form, they are combined with anxiety, depression, fears, unpleasant sensations in the body and hypochondriacal fixation on one’s illness. At a certain stage, asthenic disorders can appear in any disease. Everyone knows that ordinary colds, the flu is accompanied by similar phenomena, and the asthenic “tail” often persists even after recovery.

Emotional disorders - somatic diseases are more characterized by a decrease in mood with various shades: anxiety, melancholy, apathy. In occurrence depressive disorders The influence of psychotrauma (the disease itself is trauma), somatogenesis (the disease as such) and personal characteristics sick.

Stunning is a symptom of switching off consciousness, accompanied by a weakening of the perception of external stimuli. Patients do not immediately respond to questions surrounding the situation. They are lethargic, indifferent to everything happening around them, inhibited. As the severity of the disease increases, stupor can progress to stupor and coma.

Delirium is a state of darkened consciousness with false orientation in place, time, environment, but maintaining orientation in one’s own personality. Patients develop abundant illusions of perception (hallucinations), when they see objects and people that do not exist in reality, or hear voices.

Being absolutely confident in their existence, they cannot distinguish real events from unreal ones, therefore their behavior is determined by a delusional interpretation of the environment. There is strong excitement, there may be fear, horror, aggressive behavior, depending on the hallucinations. Patients in this regard can pose a danger to themselves and others. Upon recovery from delirium, the memory of the experience is preserved, while the events that actually occurred may fall out of memory. A delirious state is typical for severe infections and poisoning.

The oneiric state (waking dream) is characterized by an influx of vivid scene-like hallucinations, often with unusual, fantastic content. Patients contemplate these pictures, feel their presence in the unfolding events (as in a dream), but behave passively, like observers, in contrast to delirium, where patients actively act.

Orientation in the environment and one’s own personality is impaired. Pathological visions are retained in memory, but not completely. Similar conditions can be observed with cardiovascular decompensation (heart defects), infectious diseases, etc.

An amental state (amentia is a deep degree of confusion of consciousness) is accompanied not only by a complete loss of orientation in the environment, but also in one’s own “I”. The environment is perceived fragmentarily, incoherently, and disconnectedly. Thinking is also impaired; the patient cannot comprehend what is happening. There are deceptions of perception in the form of hallucinations, which are accompanied by motor restlessness (usually in bed due to a severe general condition), incoherent speech.

Excitement may be followed by periods of immobility and helplessness. The mood is unstable: from tearfulness to unmotivated gaiety. The amental state can last for weeks and months with short light intervals. The dynamics of mental disorders are closely related to the severity of the physical condition. Amentia is observed in chronic or rapidly progressing diseases (sepsis, cancer intoxication), and its presence, as a rule, indicates the severity of the patient’s condition.

Twilight stupefaction

Twilight stupefaction is a special type of stupefaction that begins acutely and suddenly ends. Accompanied by complete loss of memory for this period. The content of psychopathological products can only be judged by the results of the patient’s behavior.

Due to deep violation orientation, possible frightening hallucinations and delusions, such a patient poses a social danger. Fortunately, in somatic diseases this condition is quite rare and is not accompanied by complete detachment from the environment, unlike epilepsy.

SYMPTOMATIC PSYCHOSES include mental disorders arising from diseases of internal organs, infectious diseases, endocrinopathies. Acute symptomatic psychoses usually occur with symptoms of confusion; protracted forms manifest themselves in the form of psychopathic-like depressive-paranoid, hallucinatory-paranoid states, as well as persistent psychoorganic syndrome.

Pathogenesis. Acute symptomatic psychoses manifest themselves when exposed to intense but short-term harm; Previous brain damage (trauma, intoxication, etc.) also plays a certain role in the occurrence of prolonged psychoses.

The characteristics of mental disorders depend to a certain extent on the somatic suffering that caused the psychosis. Acutely developing heart failure may be accompanied by symptoms of stunning and amentia; in chronic heart failure, lethargy, apathy, and lack of initiative predominate, but as decompensation increases, anxiety and depression take the leading place; possible hypnagogic hallucinations, delirium. With myocardial infarction, anxiety with fear of death is most often observed, but in some cases, elevated mood and euphoria predominate. Deterioration of the condition may occur with symptoms of upset consciousness (delirium, amentia). In the improvement stage, protracted hypochondriacal states sometimes develop with suspiciousness, egocentrism, and persistent fixation on painful sensations.

Mental disorders of vascular origin at the initial stage are most often determined by neurotic manifestations (headache, noise in the head, dizziness, sleep disturbance, increased fatigue, mood lability), as well as an exacerbation of previously psychopathic traits characteristic of the patient. A more progressive course is accompanied by a decrease in the level of personality with a drop in mental activity, weakening of memory and ends with dementia. Acute vascular psychoses are often transient and occur with symptoms of confusion (states of confusion are most often observed, usually occurring at night). Along with this, epileptiform paroxysms and phenomena of verbal hallucinosis are possible.

At cancerous tumors in the terminal stage, as well as in postoperative period Acute psychotic outbursts occur, which, as a rule, are short-lived and are accompanied by clouding of consciousness of varying depths (delirious, delirious-amentive states). Depressive and depressive-paranoid states are also observed. Chronic renal failure with symptoms of uremia is complicated by delirious, delirious-oneiroid

or delirious-amentive disorder of consciousness, which, when the condition worsens, turns into deep stupor. Along with this, epileptiform seizures may occur. With liver diseases (hepatitis), erased depression with apathy, a feeling of fatigue, and irritability are observed. Yellow liver dystrophy is accompanied by delirious and twilight stupefaction. With vitamin deficiency (lack of thiamine, nicotinic acid etc.) asthenic, anxiety-depressive, apathetic states, as well as delirious and amental disorders of consciousness are more often observed; in advanced cases, Korsakoff syndrome and dementia may develop. Acute influenza psychoses usually occur with delirious disorders and phenomena of epileptiform excitation;

The clinical picture of advanced psychoses is determined by depression with a predominance of asthenia and tearfulness. Patients with tuberculosis often experience elevated mood, sometimes reaching the level of mania; asthenic states with irritability and tearfulness are also noted. In the acute stage of rheumatism, along with dream-delirious states, short-term attacks of psychosensory disorders with a violation of the body diagram, phenomena of depersonalization and derealization are possible. With prolonged rheumatic psychoses, manic, depressive and depressive-paranoid patterns are observed.

Endocrinopathies in the initial stages are characterized by manifestations of endocrine psychosyndrome, for which the most typical changes in drives (increased or decreased appetite), thirst, changes in sensitivity to heat and cold, increased or decreased need for sleep, etc. Along with this, changes in general mental activity (loss of the same breadth and differentiated(tm) interests) and mood (hypomanic, depressive, mixed states, occurring with increased excitability, nervousness, anxiety, dysphoria).

The clinical picture of endocrine psychosyndrome varies depending on the nature of hormonal disorders. With hypopituitarism, inhibition of vital drives, physical weakness and adynamia are especially often observed; with acromegaly - apathy and spontaneity, sometimes combined with a complacent-euphoric mood; with hypothyroidism - slowness of all mental processes, apathetic-depressive states, decreased sexual desire; with hyperthyroidism - increased excitability, insomnia, mood lability. When the underlying disease becomes more severe, delirious, amentive, twilight states, as well as epileptiform seizures, may occur. Along with this, prolonged psychoses with a predominance of affective and schizophrenia-like symptoms are observed. Psychoses of the postpartum period most often occur with a predominance of amental, catatonic or affective disorders.

Symptomatic psychoses must be differentiated from endogenous diseases provoked by somatic suffering. Clarification of the diagnosis is facilitated by data on the occurrence during the development of the disease of at least short-term episodes of upset consciousness, severe asthenic disorders, as well as the combination of mental disorders with neurological and somatic symptoms. Acute symptomatic psychoses should be distinguished from exogenous psychoses of other etiologies (intoxication, organic diseases CNS).

Treatment. Relief of mental disorders caused by somatic pathology is closely related to the course of the underlying disease. When conducting drug therapy, it is necessary to take into account the possibility of adverse effects of psychotropic drugs on the course of somatic illness. It is necessary to keep in mind the hypotensive effect of psychopharmacological drugs and other side effects, as well as the potentiation of the effects of barbiturates, morphine and alcohol. Caution should not lead to refusal to prescribe psychotropic drugs, especially in cases of psychomotor agitation, which in itself poses a danger to the patient’s life.

When determining treatment tactics for acute symptomatic psychoses (delirious states, hallucinosis, etc.), it is necessary to take into account their short duration and reversibility. In this regard, the entire volume medical care and patient care can be provided in a somatic hospital (psychosomatic department). Transfer to a psychiatric hospital is associated with the risk of deterioration of the somatic condition and is not necessary in all cases. When the initial symptoms of delirium and, above all, persistent insomnia appear, along with detoxification therapy, the administration (parenteral if necessary) of tranquilizers (diazepam, chlordiazepoxide, elenium, oxazepam, nitrazepam, eunoctin), as well as neuroleptic drugs (chlorprothixene, teralen), which have a hypnotic effect, is indicated.

A patient in a delirious state requires 24-hour monitoring. Treatment of this condition should begin as early as possible. If confusion is accompanied by anxiety, fear, or symptoms of psychomotor agitation, along with detoxification therapy (hemodesis, polydesis, polyglucin), the use of psychotropic drugs is indicated. For this purpose, aminazine and levomepromazine (tizercin), as well as leponex (azaleptin), are most often used. Taking into account the somatic state of patients (pulse and blood pressure control), treatment should begin with minimal doses (25-50 mg). Neuroleptics are prescribed in tablets or by injection in combination with cardiac drugs. IV drip administration of tranquilizers is also effective (seduxen, relanium, elenium) In cases of severe cerebral insufficiency, parenteral administration of piracetam (nootropil) is indicated.

For prolonged symptomatic psychoses, the choice of drugs is determined by the characteristics of the clinical picture. In cases of depression, thymoleptics are prescribed (pirazidol, amitriptyline, melipramine, petilil, gerfonal); For the treatment of hypomanic and manic states, tranquilizers and antipsychotics are used. Therapy for hallucinatory and delusional states is carried out with neuroleptic drugs (etaperazine, frenolone, sonapax, triftazin, haloperidol, etc.).

Treatment of somatogenically caused neurotic conditions in many ways similar to the therapy of neuroses. For asthenic conditions, small doses of tranquilizers are used (especially if the clinical picture is dominated by irritable weakness and emotional incontinence) in combination with drugs that activate mental activity [from 1.5 to 3-3.5 gaminalon, 1.2-2.4 g piracetam (nootropil) in the first half of the day]. In cases of severe lethargy, inhibition (tm), decreased performance, psychostimulants are prescribed: 5-20 mg of sidnocarb in the first half of the day, centedrine, acephen.

Comments

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Currently, the program is successfully used in the following health care facilities:
- GP No. 135, Moscow
- GB N13, Nizhny Novgorod
- City Clinical Hospital No. 4, Perm
- LLC “First Emergency Room”, Perm
- JSC MC "Talisman", Perm
- "Philosophy of beauty and health" (Moscow, Perm branch)
- MUZ "ChRB No. 2", Chekhov, Moscow region.
- GUZ KOKB, Kaliningrad
- Cher. Central district hospital, Cherepovets
- MUZ "Sysolskaya Central District Hospital", Komi Republic
- Rehabilitation Center LLC, Obninsk, Kaluga region,
- City Clinical Hospital No. 29, Kemerovo region, Novokuznetsk
- Polyclinic KOAO "Azot", Kemerovo
- MUZ Central Regional Hospital of the Saratov region
- Polyclinic No. 2 of the Kolomenskaya Central District Hospital
There is information about the implementation yet
in approximately 30 organizations, incl.
in Moscow and St. Petersburg. Lena September 1, 2011 Cool! I had just read the article when...the doorbell rang and my grandfather was offered a filter! Anya September 7, 2011 I, too, at one time encountered acne, no matter what I did, no matter where I turned... I thought that nothing would help me, it seemed to be getting better, but after a while my whole face was scary again, I no longer trusted anyone. Somehow I came across the magazine “Own Line” and there was an article about acne and how you can get rid of them. I don’t know what pushed me, but I again turned to the doctor who commented on the answers in that magazine. A couple of cleansings, several peelings and three laser treatments, with homemade cosmetics I’m fine as it is, and you should see me. Now I can’t believe that I had such a problem. It seems that everything is real, the main thing is to get into the right hands. Kirill September 8, 2011 Wonderful doctor! A professional in his field! There are few such people! Everything is done very efficiently and painlessly! This is the most best doctor whom I met! Andrey September 28, 2011 Very good specialist, I recommend him. A beauty too... Artyom October 1, 2011 Well, I don’t know...My aunt also installed a filter from them. She says she's happy. I tried the water. It tastes much better than from the tap. And in the store I saw five-stage filters for 9 thousand. So, it seems they are not scammers. Everything works, the water flows decently and thank you for that.. Sergey Ivanovich October 8, 2011 There is no point in slandering them, the system is excellent, and everything is in order with their documents, my wife checked, she is a lawyer by training, and I want to say thank you to these guys, so that you go shopping and look for this filter, and here They brought it to you, installed it, and they also fix any problems, I have had this system for more than 7 months. the filters were changed, everything was fine, you should have seen the condition of the filters, they were all brown in mucus, terrible in one word, and those who don’t install them simply don’t go to think about themselves and their children, but now I can safely pour water for my child from the tap, without fear! Svetlana October 19, 2011 The most disgusting hospital I have ever known!!! Such a boorish and consumerist attitude towards women - you’re simply amazed how this can still happen in our time! I arrived in an ambulance with bleeding and went to bed to continue my pregnancy. They convinced me that it was impossible to continue the pregnancy, that there was already a miscarriage, now we will clean you up and everything will be fine! Imagine! She asked for an ultrasound, and the ultrasound showed that the child was alive, the heart was beating, and the child could be saved. I couldn’t get it cleaned, they had to put me in storage. She was treated with Vikasol and papaverine. ALL!!! No vitamins, no IVs, NOTHING! Well, okay, thank God, I escaped from there after 3 days and was treated at home. The treatment was prescribed by my gynecologist, IVs were also given at home... It is still unknown how it would have ended if I had stayed there for another week... But now everything is fine, in August I gave birth to a girl, healthy, strong... Now he is calling me my sister. She's at the cons. Yesterday they said that she is pregnant, 3 weeks due. Today I started bleeding with clots, etc. I did an ultrasound and was told to run to the hospital for cleaning. The duty officer AS ALWAYS Avtozavodskaya... But they didn’t accept her!!! Bleeding! The hospital is on duty!!! Just bitches! And they also talk so rudely... I will find justice for you, I will immediately call where necessary. And I leave this comment for others - so that they bypass this lair... Elenna October 25, 2011 spent my childhood there. liked.
Although I really didn’t like injections, nor did I like massages. Elena October 25, 2011 Yes, a lot of people have a grudge against this hospital! Good luck Svetlana in your affairs. I have the same opinion about this hospital. Elena October 25, 2011 who works and how. or rather promotes the product. I had aquaphor (a jug), so the water from it is also great better than water from the tap!
The point is to impose your product, as I understand it. Now they run from Zepter like fire. just because of excessive intrusiveness. Mila October 25, 2011 I really like it there, qualified specialists, and they try not to smuggle anything in, but to pick it up! I will note one of the minuses. queues. Quite a popular center. And thank you very much for lenses and solutions without a crazy markup! Misha October 25, 2011 in my work I came across distributors different manufacturers electronic cigarettes. And there are fig ones - like pons, and there are good ones - like rich. Unfortunately, in Izhevsk they sell the cheapest, that is, the most crappy ones. But! There is no smell from electronic cigarettes! And their advantage is that there are no resins, which are carcinogens! Quit smoking. It's hard with their help. and not disturb others and significantly reduce the harm from cigarettes - it will work out! Danya October 25, 2011 here you go, crooks! plundered!!! Elena January 28, 2012 In December we were there, they held a meeting, I was offended by the quality of our water, I’m from Kazan, but then they didn’t supply it, my son said it wasn’t necessary! But recently I went to a store with a geyser, they also have 5 stages, the same price here 9700, now you don’t even know, you should have installed it because that’s how they cost, they sell it right at home and without store markups! You need to make sure that all the documents are in order before you buy. no name January 28, 2012 here you decide for yourself whether you want it or not! It’s not like they’re forcing it to be installed. There’s still an agreement, first they’ll install it and then they’re dissatisfied with something, you have to think first when you’re giving the money. nonsense Catherine January 29, 2012 Now also in Cheboksary, Chuvash Republic....People, be careful! Nika January 26, 2012 I work in a rural area. Ours are paid compensation of approximately 100 - 300 rubles. What is this for? But you won’t expect anything from our head of the district health department. And in general - how long can you tolerate such boors and ignoramuses (bosses) because of which the personnel in literally "flow"?! Aksinya November 28, 2011 I was there once: after finding out whether it was possible to do an ECG, they told me to come the next day at 16:00, in the end I came, but they told me no, there is no one to do it, or wait another hour until the doctor comes. In the end, I waited an hour, they did it, asked without a description, as it turned out the price with and without a description was the same, although the day before they said that without a description it was cheaper.
Conclusion: I didn’t like the girls at the reception, they had sour facial expressions. It feels like they are doing me a favor. Vadyai November 28, 2011 I recently had an appointment with you, the impressions were very good, the staff was friendly, the doctor explained everything correctly at the appointment, they immediately did an ultrasound and passed tests
I had an appointment at Pushkinskaya, tests and ultrasound at Sovetskaya... thank you all so much!!!
Special greetings to Alexey Mikhalych!!!

6.1. Symptomaticpsychoses

This refers to transient psychotic disorders due to general infections, intoxications and non-infectious somatic diseases. Rudimentary symptomatic psychotic psychoses in children are much more common than in adults, while developed and especially prolonged symptomatic psychoses in childhood are relatively rare (Kovalev V.V., 1979). Abortive symptomatic psychoses occur in children mainly during febrile states, especially during general infections or toxic infections (febrile psychoses, according to E. Kraepelin, 1927).

Psychosis is usually preceded by a short prodromal period (up to 2–3 days). In cases of less pronounced toxicosis and moderate hyperthermia, children of preschool and younger school age may report feeling unwell (they “feel bad”), headache, unpleasant sensations in other areas of the body. They lose their characteristic cheerfulness, inexhaustible activity, become capricious, whiny, refuse to eat, and lose interest in the game. Older children and adolescents often exhibit depressed mood, anxiety, sensory hyperesthesia, and may have concerns about their health associated with somatovegetative dysfunction. With a more severe course of the disease, lethargy, lethargy, silence, and severe mental exhaustion are more often detected, and the prodromal period is reduced.

The psychotic state lasts from several hours to 2–3 days. The most typical are states of stunned consciousness (from oblivion to somnolence, less often stupor), which are interrupted by short-term episodes of delirium or pre-delirium. Stupefaction of consciousness is characterized by blurred perception, impoverished content of consciousness, slow course of mental processes, emotional indifference, fluctuations in clarity of consciousness, and drowsiness.

Delirious episodes are characterized by anxiety, fear, and optical illusions, especially pareidolia. Visual hypnagogic hallucinations often occur, often of ordinary content (people, animals, scenes from school life are seen). Much less frequently and, as a rule, in children 9–10 years of age and adolescents, extensive visual hallucinations occur at night with content typical of delirium, often of a frightening nature (animals, birds, etc.). Elementary auditory deceptions (noise, whistling, etc.), calls by name, and unclear voices of “familiar guys” may occur.

In intoxication psychoses (poisoning with henbane, atropine, atropine-containing drugs, cyclodol), more abundant and vivid visual hallucinations (numerous small animals, insects) are observed. During delirium, patients are excited, talkative, and their behavior reflects the content of visual illusions. Episodes of delirium are usually short-lived (no more than 2–3 hours) and may recur, usually in the evening and at night. Dyssomnia is detected (disturbance of the sleep-wake cycle, alternation of drowsiness and insomnia), and symptoms of autometamorphopsia often occur (“swollen fingers”, etc.).

Recovery from a psychotic state with a predominance of delirious disorders is usually critical, sometimes asthenic phenomena persist for some time (increased fatigue, tearfulness, mood swings, etc.). Congrade amnesia is detected, especially during periods of stunned consciousness. In this case, amnesia extends primarily to real impressions, while memories of deceptions of perception can be quite complete.

In childhood, in contrast to older adolescents, productive psychopathological symptoms are usually rudimentary and are represented by fragmentary illusions and deceptions of perception; emotional disturbances - fear, anxiety, and restlessness - come to the fore. The younger the child is, the greater the proportion of deafness in psychosis. The predominance of stunning in older children indicates the severity of psychosis, especially if states of stupor occur.

With the progression of the disease and the development of cerebral edema, patients fall into a comatose state of varying depths up to depression of vital functions and fatal outcome. The presence of stupor and coma in children under 5 years of age is associated with greater sensitivity of the brain to toxic-infectious agents and has a more favorable prognosis than in older children, and even more so in adults. However, upon recovery from psychosis in young children long time the asthenic state persists, and sometimes symptoms of regression (temporary loss of certain skills and abilities) are revealed.

In cases of protracted infectious and infectious-allergic diseases with less toxicosis (malaria, rheumatism, viral pneumonia), as well as in the immediate post-infectious period after influenza, scarlet fever, the picture of symptomatic psychoses is significantly transformed, approaching the manifestations of exogenous-organic psychoses and “late symptomatic psychoses” "(Snezhnevsky A.V., 1940). In this case, along with stunned consciousness and delirium, oneiric and amentive states may occur.

Oneiric states are usually short-lived (up to several hours) and are manifested by exciting dreams of fantastic content: scenes reminiscent of the plots of science fiction books or films are perceived, at which time the patient seems to transform into their characters, losing consciousness of his own identity. In the assumed virtual role, he can be active, perform some actions, but outwardly most often he becomes sedentary and even freezes in certain poses, his gaze is fascinated and is not fixed on real objects. He also perceives the surrounding people and the situation as some kind of enchanting phenomena, while he makes or does not make contact well, loses the ability to orient himself in reality and in time, or, more often, orientation can be double. For example, a doctor is perceived both as a doctor and at the same time as a character in the patient’s dreams, for example, an inhabitant other world(“oriented oneiroid”).

The content of dreams corresponds to the patient's mood. If the mood is depressed, then the dreams acquire a gloomy, sometimes otherworldly content; if it is elevated, delightful scenes are perceived, and an enthusiastic, ecstatic state develops. The depth of stupefaction constantly fluctuates, the patient either disappears from reality or returns back. The oneiric state usually alternates with phenomena of stunning consciousness, and sometimes delirious episodes occur, which, like stunning, indicates a worsening of the condition.

The presence of catatonic symptoms (stupor, mutism) or, on the contrary, psychomotor agitation with stereotypies, impulsive actions, presumably indicates the transition of symptomatic psychosis to exogenous-organic.

Upon recovery from psychosis, patients can talk about oneiric experiences in sufficient detail and, as a rule, cannot report anything about real impressions.

Much less often and mainly with long-term debilitating toxic infections in older children and adolescents, amental states may occur. Severe states of amentia are rare. They are characterized by chaotic mental processes, incoherence of thinking, speech and emotional manifestations, uncoordinated motor arousal (yactation - agitation within the bed). Sometimes fragmentary deceptions of perception and catatonic symptoms may be detected. Patients are not available for contact, and only in isolated cases and for a short time do they come into contact. In cases of mild amentia, patients answer questions correctly for some time, but as neuropsychic exhaustion increases, their speech becomes increasingly incoherent - asthenic confusion(Mnukhin S.S., 1963). The duration of amental darkness can reach several weeks. Upon recovery from psychosis, severe asthenia is noted with rapid exhaustion, lethargy, irritability, impressionability, sensory hyperesthesia, gloomy mood - emotionally-hyperesthetic weakness, according to K. Bonhoeffer (1910).

With prolonged symptomatic psychoses (post-infectious psychoses) in children and adolescents, endomorphic psychopathological syndromes: depressed, anxious-depressive, depressed - hypochondriacal, hypo- and manic, rudimentary depressive-paranoid (Kovalev V.V., 1979). In particular, they are described in malarial and malarial-acryquin psychoses. In post-infectious influenza psychoses, a transient amnestic syndrome has also been described (Sukhareva G.E., 1974). Depressive states are more common, in some cases including episodic visual and auditory illusions of perception, fragmentary crazy ideas relationships, stalking. As a rule, this reveals pronounced asthenic symptoms. The duration of such psychoses sometimes reaches 2–3 months. Unlike schizophrenia, in addition to asthenia, such psychoses usually occur following episodes of confusion and are accompanied by various somatic disorders, increased body temperature, inflammatory changes in the blood, and often increased cerebrospinal fluid pressure.

Does the child have symptomatic psychosis? We will help you!

Causes

Classification

Manifestations

Acute symptomatic psychoses

Subacute symptomatic psychoses

Prolonged symptomatic psychoses

Treatment

Symptomatic psychoses: causes, classification, manifestations, treatment

Causes

Classification

Manifestations

Subacute symptomatic psychoses

Prolonged symptomatic psychoses

Treatment

What are symptomatic psychoses?

What it is?

Classification

Treatment and prevention

Features of symptomatic psychoses in children

Symptomatic psychoses

Classification of symptomatic psychoses

Clinical forms

Acute symptomatic psychoses

Protracted symptomatic psychoses

Symptomatic psychoses in certain somatic diseases

Symptomatic psychoses in certain infectious diseases

Mental disorders in case of poisoning with industrial poisons

Etiology and pathogenesis

Diagnostics

Treatment

Forecast

Manic psychosis: treatment

Psychosis in a child

What is included in the concept of “acute psychosis”?

Chronic psychosis

Hypomanic psychosis

Psychosis after childbirth

Reactive psychosis

Schizoaffective psychosis

Symptomatic psychosis

Symptomatic prolonged psychosis

Causes

Diagnostics

Treatment

Somatogenic psychoses

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