Psychosis: everything about the disease. Acute psychosis: symptoms, causes, treatment

Psychosis is a pathological process accompanied by a disturbance of the state of mind and a characteristic disorder of mental activity. The patient has a distortion of the real world, his memory, perception and thinking are impaired.

Causes

Factors contributing to the development of this disease are divided into external and internal. The first group includes:

• stress;
• psychological trauma;
• infectious diseases;
• consumption of alcoholic beverages and narcotic drugs;
• poisoning with industrial poisons.

When the cause of the development of the disease is associated with an internal state, endogenous psychoses are formed. Its formation is facilitated by disruption nervous system.

Manifestations

Distinguish following signs psychosis:

• sudden change in activity at work;
• increased stress;
• attention disorder;
• feeling of fear;
• mood swings;
• depression;
• mistrust;
• stopping contact with people;
• shows interest in things like magic or religion.

As a rule, this disease has a paroxysmal course. Therefore, there are stages of psychosis that are characterized by seasonality and spontaneity. The latter arise in the case of the influence of psycho-episode trends that predominate at a young age. Such an attack is characterized by duration and gradual release.

Types of psychoses

The resulting mental state disorders, taking into account the etiology, are divided into the following types:

• endogenous;
• reactive psychosis;
• acute psychosis;
• situational;
• somatogenic.

In addition, when compiling the classification, both the clinical picture and the predominant symptoms were taken into account. In this case, the following are distinguished:

• paranoid psychosis;
• depressive;
• manic.

This type of illness very often makes itself felt after a woman gives birth to a child. Postpartum psychosis does not produce any specific symptoms, so it is very important to make a diagnosis and begin treatment for psychosis.

Postpartum psychosis can occur due to complications during childbirth. If a woman has suffered sufficient injuries during labor activity, those will be more difficult for her state of mind. More often postpartum psychosis occurs after the first birth, since this is where the woman is exposed to severe stress. Postpartum psychosis is often mistaken for postpartum depression. But it has clear symptoms:

• sense of anxiety;
• sleep disturbance;
• poor appetite;
• delusional ideas;
• hallucinations.

Postpartum psychosis must be treated in a hospital. Mother and baby are not allowed to be left alone. During lactation, postpartum psychosis must be treated very carefully with drug therapy and psychotherapy.

Mass psychosis

The development of such pathology occurs in a team, where the basis is suggestibility and susceptibility. Mass psychosis causes a disturbance in the state of mind, so people lose their adequate ability and become obsessed.

Cases of the presented disease have common mechanism formation. Mass psychosis is characterized by non-collective behavior called a crowd. In this case, mass self-immolation, religious worship, mass migrations, and hysteria may take place.

Mass psychosis is formed due to an illusion that arises in one of the individuals. It is this that is the core of crystallization, which fills the entire area of ​​the mind. Most often, mass psychosis affects people with a weak psyche, suffering from depression and mental disorders.

paranoid psychosis

This form of the disease is considered more severe. Paranoid psychosis is characterized by a disturbance of the state of mind, as a result of which ideas of persecution are present. As a rule, such pathology occurs in organic and somatogenic disorders. Paranoid psychosis in combination with schizophrenia causes mental automatisms and pseudohallucinosis. The following symptoms of psychosis exist:

• rancor;
• constant dissatisfaction;
• painful perception of all refusals and failures;
• the person becomes arrogant and jealous.

Most often, paranoid psychosis affects young people. To get rid of this condition, timely psychotherapy is necessary. Such treatment is aimed at improving general life skills, improving the quality of social contact and strengthening self-esteem.

Senile psychosis

In the world of medicine, such a pathological process is also called senial psychosis. Senile psychosis affects people over 60 years of age. Such disorders often resemble manic-depressive psychosis. Senile psychosis differs from senile dementia in that it does not have total dementia. Senial psychosis is characterized by an acute form of its course. The cause of the disease lies in somatic diseases. In addition, the formation of senile psychosis is influenced by:

• acute and chronic respiratory tract diseases;
• heart failure - common reason development of senial psychosis;
• physical inactivity;
• poor nutrition;
• hypovitaminosis.

Chronic senial psychoses are characterized by depression, which is most often diagnosed in women. With a mild course of senial psychoses, subdepressive states are formed. They are characterized by symptoms of psychosis such as lethargy, a feeling of emptiness, and aversion to life.

Alcoholic psychosis is a pathology of mental activity that occurs in the second and third stages of alcoholism. At the initial stage of alcohol dependence, there are no symptoms of psychosis. The following types of alcoholic psychosis are distinguished:

• alcoholic delirium;
• hallucinosis;
• delusional alcoholic psychoses;
• alcoholic pseudoparalysis;
• alcoholic encephalopathy;
• hemorrhagic polyencephalitis;
• alcoholic depression;
• dipsomania;
• Antabuse psychosis.

Alcoholic psychoses are a consequence of alcoholism. Those people who drink alcohol, but not so often, do not experience such mental disorders. Very often, alcoholic psychosis occurs due to the presence of additional hazards: acute infections, injuries, stress. They influence the formation of psychotic reactions relative to the unhealthy nervous system of alcohol, thereby causing alcoholic psychosis.

Among alcoholic psychoses, the following forms are distinguished:

• acute;
• subacute;
• chronic.

If alcoholic psychosis recurs, then its development follows the same cliche as the primary one, only there are complications during its course. Alcohol psychosis can cause severe violations reflections of reality and psychoorganic disorders. Alcoholic psychosis most affects people whose experience of drinking alcohol has exceeded 5–7 years.

If the pathology occurs against the background of chronic alcoholism, then it is called Korsakoff psychosis. The following symptoms are typical for this condition:

• lacks the ability to remember;
• Korsakov's psychosis causes retrograde amnesia;
• presence of orientation disorders in time and place;
• decreased intelligence.

Korsakoff psychosis develops gradually, and its duration can reach many years. It is not possible to fully recover; Korsakov psychosis leaves defects in memory and perception. If alcohol addiction proceeds in a mild form, the recovery process is successful, and Korsakov psychosis does not leave any defects.

Therapy in this case is aimed at eliminating the symptoms caused by Korsakoff psychosis. Initially, the patient is prescribed bed rest and warm baths.

Reactive psychoses are formed due to the influence of various factors that are of great significance. Reactive psychosis has one such feature, which is that after eliminating the cause of the disease, the disease itself disappears. Reactive psychosis has the following manifestations:

• excitement and lethargy;
• behavior is accompanied by either loud laughter or sobs.
• violation of correct orientation in time and place.

When prolonged reactive psychoses occur, they include reactive depression and paranoid. Depression occurs against the backdrop of the death of loved ones or difficult life situations. Such prolonged reactive psychoses manifest themselves in the form of depressed mood, tearfulness, poor appetite, and low mobility. People suffering from reactive psychoses walk hunched over, with their heads lowered to their chest.

Acute psychosis

This form of psychosis occurs in combination with the corresponding manifestations:

• delusional states;
• visual, auditory and tactile hallucinations;
• disorders in self-perception.

Acute psychosis is a disease during which the patient becomes alienated from the people around him. The presented illness is divided into two types: endogenous psychoses and exogenous. Endogenous psychosis is characterized by a mental disorder caused by internal conditions. The second type of acute psychosis is the result of exposure to external conditions. Very often, acute psychosis develops against the background of a traumatic brain injury or an oncological brain tumor. In other words, acute psychosis is formed due to the presence of somatic diseases.

This form of the disease is characterized by a variety of symptoms. These may include weight loss, poor appetite, loss of energy, and lack of interest in daily activities. Confirms the presence of a disease such as schizoaffective psychosis, a feeling of hopelessness, self-blame, and thoughts of suicide.

Schizoaffective psychosis can be distinguished from other forms by such a sign as a change in the state of mania, which is characterized by an increase in activity in all areas of life. The behavior of a person with schizoaffective psychosis is self-destructive and life-threatening.

Therapy

To treat psychosis of any form, patients must be hospitalized, otherwise their actions and actions can harm others.

Drug therapy includes taking the following drugs:

• psychotropic;
• neuroleptics;
• tranquilizers;
• antidepressants;
• restorative.

Effective remedies for agitated psychosis are:

• Seduxen;
• Triftazin or Aminazine;
• Stelazine;
• Etaperazine;
• Haloperidol;
• Reactive psychoses are treated with depressants Pyrazidol, Gerfonal, Amitriptyline.

Psychological rehabilitation also plays an important role. It increases the effectiveness of drug therapy. The main task of a psychiatrist is to establish a trusting relationship with the patient.

Recovery from psychosis includes doing educational activities. The following physiotherapeutic procedures are used here:

• electrosleep;
• acupuncture;
• physiotherapy;
• occupational therapy.

Physiotherapy helps eliminate fatigue, emotional stress, improve metabolic processes and increase performance.

Author of the article: Maria Barnikova (psychiatrist)

Psychosis: causes, types, signs and methods of treating the disorder

06.04.2017

Maria Barnikova

Psychosis is a pronounced severe disorder of the psychotic level. Causes, types, symptoms and methods of treatment of psychoses.

In modern psychiatry, the term is understood deep, severe, pronounced mental disorder. In psychosis, the reactions demonstrated by the patient clearly contradict the actual situation, which is manifested in a gross violation of the perception of the surrounding reality, severe disorganization of the patient’s behavior.

Psychoses are characterized by the occurrence of abnormal, incomprehensible, illogical phenomena, such as: hallucinations, delusional components, psychomotor dysfunction, affective defects. With psychosis, a person loses the ability to adequately perceive the real picture of the world, he cannot interpret the situation objectively, he is deprived of the ability to conduct a logical analysis. A patient with psychosis completely loses the ability to critically assess his condition and cannot comprehend the existence of the problem.

Disorders from the psychosis group are quite common diseases. According to the World Health Organization, about 2% of the entire human population suffers from some type of psychosis. Thus, according to the Russian Institutes of Psychiatry, the prevalence of schizophrenia alone is 2 cases per 1000 people. However, presenting accurate data on the incidence of psychosis is a difficult task due to the existence of different diagnostic approaches, the rather poor quality of work of Russian psychiatric services, the personality characteristics of patients and the existing misconception among many people about psychotic disorders.

Also, due to the existing diversity of psychoses, it is quite difficult to indicate the age range corresponding to the maximum number of cases of these disorders. It should be borne in mind that anyone can develop psychosis, regardless of their gender, age, level of education, financial situation, or social status. It was found that about 20% of patients who were diagnosed with a disease of the psychosis group had a fairly early onset of the disorder - from 15 to 25 years. However, there are also forms of psychosis that are more typical for elderly and senile people.

Psychosis: types and classification

There are several different approaches to classifying types of psychoses. The most accurate systematization of these disorders is based on the principle of dividing them into groups depending on the etiological causes and conditions of their occurrence, and the pathogenetic mechanisms of the development of the disease. So, psychoses that arise are classified into types:

• endogenous – conditions that developed due to lesions, defects, diseases of internal organs in the absence of brain damage;
• exogenous - ailments that manifested as a result negative impact external factors, for example: intoxications.

Endogenous types of psychoses include:

• manic-depressive, also called bipolar affective disorder or endogenous depression;
• senile – acute disturbance of mental activity in elderly people;
• schizophrenic – a deep personality disorder, characterized by a significant distortion of thinking and a disturbance of perception with the presence in the patient of a feeling of influence of extraneous forces;
• cycloid, characterized by constant sharp changes in mood, rapid changes motor activity;
• symptomatic – conditions caused by the progression of the underlying somatic illness.

There is also a syndromic classification of psychoses - a division of disorders in plain sight depending on the patient’s dominant symptoms. According to this division, the most common forms of psychoses are paranoid, hypochondriacal, depressive, manic, depressive-paranoid, depressive-hypochondriacal types of disorders.

It is also customary to divide psychoses into types:

• organic – disorders that started after traumatic brain injuries, neuroinfections and other painful conditions of structures cranium, including neoplasms;
• functional – states that arise under the influence of external psychotraumatic factors.

Based on the intensity of symptoms and the pace of their development, psychiatrists distinguish types of psychoses:

• reactive – reversible mental pathology, which started as a result of exposure to intense, long-term traumatic factors;
• acute – pathological mental defects that developed suddenly and rapidly.

It is not possible within the scope of this article to describe all existing and studied types of psychotic disorders that have specific symptoms and arise for established natural reasons. However, we point out that The most common types of psychoses are:

• metal alcohol, which are divided into delirium (delirium tremens), hallucinosis (acute, subacute, chronic), delusional states (delusions of persecution and paranoia), encephalopathies (Gaia-Wernicke, Korsakoff psychosis, pseudoparalysis) and pathological intoxication (epileptoid and paranoid forms);
• disorders that have developed as a result of drug use and substance abuse, such as hashish psychotic disorders having manic, hallucinatory-paranoid, depressive-hypochondriacal content; psychotic episodes when using LSD, phenamine; cocaine, amphetamine psychoses and others;
• traumatic - mental disorders that occur in the acute, remote and late period after injuries to cranial structures or damage to the central nervous system;
• senile – severe changes in the mental sphere that occur in older people;
• manic-depressive – an anomaly characterized by the presence of depressive inclusions and episodes of mania;
• epileptic – ictal, postictal and interictal types;
• postpartum mental disorders;
• vascular – psychopathological conditions associated with pathogenic vascular processes;
• schizophrenic – abnormal mental states, which are divided into affective, delusional, hallucinatory (usually pseudohallucinatory), hebephrenic, catatonic, oneroid clouding of consciousness;
• hysterical - disorders subdivided into the syndrome of delusional fantasies, pseudodementia (false dementia), mental regression syndrome (the phenomenon of “wildness”), puerilism (a manifestation of childishness in adult patients), psychogenic stupor, Ganser syndrome (the syndrome of “mimic speech”).

Psychosis: causes of the disorder

The rapid development of medicine has led to the fact that today many theories have been formulated and enough hypotheses have been considered about the causes of psychosis. However, at present, neither genetic, nor physiological, nor social, nor psychological research cannot indicate the exact true reason why psychotic disorders arise and develop in all people without exception.

That is why the world's leading psychiatrists recognize a multifactorial system of mechanisms that gives rise to psychotic disorders. This model implies that the same type of psychosis can start in different people according to various reasons. In this case, most often the disease develops due to the existence and layering of several predisposing and provoking factors (biological prerequisites and psychosocial reasons).

One of these systems is a model conventionally called “stress-vulnerability”. This theory is based on the following: there are certain genetic factors that predispose an individual to the formation of psychotic disorders. The presence of such a conditioned tendency to psychosis, coupled with a specific characterological portrait of the individual, serves as the basis for a person’s high susceptibility to the effects of stress factors, both positive and negative. At certain stages of life, for example: during puberty or pregnancy, the subject becomes especially vulnerable to the onset of traumatic events due to his tendency to excessive mental reactions and inability to withstand stress. This moment is the starting point for the formation of psychosis. However, factors that have a protective effect (for example: a person’s financial stability and happy marriage) can counteract traumatic circumstances. In some situations, when the intensity of stressors is too great, such “defenders” only postpone the moment of development of psychosis and soften the severity of the symptoms demonstrated.

If we consider each of the versions proposed by scientists separately, we should highlight the most proven theories describing the causes of the development of psychosis.

Reason 1. Biological (chemical)

One of the leading causes of any psychotic disorders is a failure in the production and exchange of neurotransmitters, one of the functions of which is to ensure the transfer of information between the structural units of the nervous system. A special role in the neurotransmitter system is assigned to the catecholamine dopamine, tryptamine serotonin, and 2-aminopentanedioic (glutamic) acid.

Thus, excessive dopamine activity in the mesolimbic tract provokes an increase in positive (productive) symptoms of psychosis, for example: the appearance of motor affective reactions, the occurrence of delusional judgments and hallucinations. On the contrary, a decline in dopamine activation in the mesocortical system gives rise to the development and aggravation of negative (deficient) symptoms of psychosis, provoking apathy, poor speech, attention deficit, and lack of working memory.

Reason 2. Genetic

A family predisposition to psychotic reactions is one of the leading causes of the development of psychosis. Individuals who have close relatives suffering from schizophrenia or bipolar affective disorder are at high risk of developing psychosis.

If both mother and father suffered from psychotic-level disorders, then the probability of developing psychosis in their offspring is 50%. If only one parent has symptoms of mental disorders, then the risk of developing psychotic reactions for the child reaches 25%.

Reason 3. Personal constitution

Character traits and certain personality traits can cause psychosis. For example, people suffering from schizophrenic psychoses are often introverts. They are distinguished by egocentrism. Thus, a person of the cycloid type is prone to manic-depressive psychosis. A person with a hysterical constitution is more likely to experience hysterical disorders than others.

Reason 4. Social factors

A person’s presence in a negative emotional climate is one of the leading causes of psychosis. Regular stress and frequent traumatic situations serve as the basis for the emergence of psychotic disorders. Certain people also lead to psychosis life circumstances: low economic status, poor social status, inability to repay loan obligations, lack of own housing, poor family relationships.

TO social reasons the development of psychosis also includes an unfavorable period of growing up - a situation where a child was raised in an incomplete or problematic family, excessive severity or complete inattention of parents. Psychiatrists indicate that the risk of developing psychosis in adulthood is very high in those people who experienced sexual, physical or moral violence. The chance of developing psychotic disorders is present in those people who were treated inappropriately and cruelly in childhood. A high degree of development of psychosis is present in children abandoned by their parents and who went through a “street upbringing.” Very often, people who were rejected or bullied by their peers in childhood become victims of psychosis.

Reason 5. Biological (intrauterine development abnormalities)

Factors predisposing to the onset of psychosis include problems in human intrauterine development. Infectious diseases of the mother, poor quality or insufficient nutrition during pregnancy, alcohol abuse, and drug use have a negative impact on the development and functioning of the central nervous system of the unborn baby. Prematurity, oxygen starvation, which arose during childbirth, are the cause of the formation of various psychotic disorders, including psychoses.

Reason 6. Anatomical

A common cause of psychotic conditions is abnormalities in the structures of the brain that arise as a result of trauma to the structures of the cranium, as a result of vascular pathologies, infectious diseases with a predominant localization of the focus of the disease in parts of the central nervous system.

Bruises and concussions, closed and open head injuries can trigger a cascade of psychotic reactions both a few hours later and several months after the injury. Moreover, the more severe the damage to the skull, the stronger the symptoms of psychosis will be.

Psychosis is often a companion or a consequence of:

• chronic autoimmune disease – multiple sclerosis;
• epilepsy;
• acute disorder of cerebral blood supply - stroke;
• senile dementia of the Alzheimer's type - Alzheimer's disease;
• shaking palsy - Parkinson's disease.

Psychotic reactions can occur in the presence of cysts, benign and malignant tumors in the structures of the cranium. Psychosis may be caused by bronchial asthma with severe debilitating attacks.

It can be argued that any somatic pathology accompanied by intense pain is a source of severe stress for a person, as a result of which the onset of psychosis is possible.

Reason 7. Intoxication

A common cause of psychosis is alcohol abuse, uncontrolled use of pharmacological drugs, and substance abuse. Quite often, a consequence of the use of cannabinoids in adolescence is the occurrence of psychotic disorders. The development of some symptoms of psychosis is provoked by taking:

• NMDA receptor antagonists, for example: ketamine, dextromethorphan and phencyclidine;
• anticholinergic drugs, for example: alkaloids atropine, scopolamine and hyoscyamine;
• glucocorticoids, for example: cortisol;
• adrenocorticotropic hormone;
• dopamine agonists, for example: tubazide;
• non-steroidal anti-inflammatory drugs, for example: dikloberla;
• sympathomimetics, for example: ephedrine;
• antidepressants, for example: Prozac;
• neuroleptics, for example: haloperidol.

Reason 8. Perceptual-cognitive and neuropsychological factors

It has been established that psychosis is very often recorded in people who have problems in neuropsychological development and have a low coefficient of intellectual potential. In such patients, the processing of visual and spatial information is quite often impaired, sensory-motor dysfunctions are determined, associative thinking is weakened, and the ability to recognize presented stimuli is impaired.

Psychosis: symptoms of the disorder

Due to the existing diversity of psychotic disorders, it is impossible to describe in one publication all the symptoms demonstrated in psychosis. It can be argued that the manifestations and signs of psychosis are limitless, just as the human psyche is multifaceted and unique. However, symptoms that may indicate the onset and development of a psychotic disorder have been studied and described.

You should know that the first symptoms of the disease can be detected in a person long before the onset of psychosis. Such conditioned signals include any changes occurring in a person’s mental activity that arise spontaneously and unexpectedly in the absence of adequate reasons. Precursors of psychosis include:

• excessive nervousness, causeless irritability of a person;
• sudden and sharp change in mood, its fluctuations from a state of deep sadness to euphoria;
• psychomotor agitation and motor restlessness;
• significant slowness of reactions, inhibition of the subject;
• the appearance of problems with sleep;
• sudden change in eating behavior;
• a significant decline in performance, inability to perform usual professional duties;
• the emergence of irrational fears and illogical anxiety;
• sudden change in habits;
• voluntary isolation of a person from society;
• groundless change of interests and hobbies.

All symptoms of psychosis are divided into two conventional categories: positive signs and negative signs.

Positive symptoms of psychosis

To the number Positive symptoms of a psychotic disorder include:

• Verbal, visual, olfactory, gustatory, vestibular, visceral, tactile hallucinations of simple and complex forms. Most often, the individual hears “voices” coming from outside. Bright and distinct sounds may come from the patient's head. The perceived message from the “voices” may have a neutral color, but most often the patient is threatened, humiliated or accused, or ordered to perform some action. When verbal hallucinations the subject can talk to himself. A person may suddenly become wary and begin to listen carefully to something. He may start crying a lot or laughing for no reason.
• Delusional inclusions are diverse ideas, reasoning, conclusions, conclusions that do not reflect the actual picture of reality and cannot be corrected with the help of beliefs and explanations. The most common type is delusion of persecution, when a person is sure that he is being watched, intrigues are being woven against him, there are conspiracies to injure or kill him. Delusions of influence are also widespread - a phenomenon when the patient is convinced that he is being influenced by some otherworldly forces or other structures, for example: intelligence services, using classified equipment.
• A common symptom of psychosis is damage delusions., characterized by a person’s conviction that they want to harm him. Symptoms of psychosis also include hypochondriacal delusion - a phenomenon when the subject is sure that he is sick with some kind of incurable disease. Another symptom of psychosis is no less common - delusions of jealousy, when an individual is sure that his other half is cheating on him. Other delusional ideas may also occur, for example: delusions of grandeur.
• Movement disorders of akinetic-rigid types and hyperkinetic forms, manifested in diametrically opposite phenomena - in the form of stupor (retardation) or motor excitation. In the first case, the individual looks inactive, his body takes on a static and unnatural position, he seems to freeze in one position. A person can remain motionless for hours, staring at one point. He does not respond to requests addressed to him and stops giving answers to questions. In the case of psychomotor agitation, the subject cannot remain without movement. His actions are chaotic and inconsistent, impulsive and unmotivated. His speech is verbose and illogical. There is a noticeable increase in gesticulation, the person vigorously waves his arms and grimaces.
• Mood disorders are mood instability in the form of depressive episodes and manic states. Symptoms of a depressive nature in psychosis are a melancholy mood, depression, a pessimistic outlook on life, the emergence of ideas of self-blame, and suicidal behavior. Symptoms of a manic state are excessively elevated mood, a tireless thirst for activity, overestimation of one’s own capabilities, disinhibition of drives and impulses.

Negative symptoms of psychosis

Negative signs of psychotic disorders include such phenomena that are characterized by a global change in the character and personal qualities of a person, the loss from the mental sphere of a huge part of the processes that were previously inherent in it. Negative symptoms psychosis are:

• decline in human energy potential;
• reduction and subsequent complete disappearance of desires;
• lack of motivation, motivation, aspirations;
• the emergence and increase in dullness of the emotional response;
• social isolation of a person, voluntary isolation from society, reluctance to communicate in the human community;
• the disappearance of moral and ethical standards, the appearance of rudeness, vulgarity, aggressiveness;
• impoverishment of speech and thinking;
• behavior that is dangerous for the patient and others;
• rigidity, emptiness of thinking, lack of focus;
• loss of work skills and ability to self-care.

It is worth pointing out that mentally ill people cannot eliminate the symptoms of psychosis through willpower or coercion. Therefore, the understanding and support of loved ones is extremely important for them; consultation with a doctor and subsequent treatment are vital.

Psychosis: phases of disorder

As a rule, psychoses have a periodic course with sudden or naturally occurring attacks. However, psychotic pathologies can also become chronic, acquiring a continuous course with constant demonstration of symptoms.

The phases of any type of psychosis include:

• prodromal stage – the period from the manifestation of one-time symptoms to their subsequent constant demonstration;
• stage of untreated psychosis – the interval from the onset of constant demonstration of symptoms of psychosis until the start of treatment for the disease;
• acute phase – the stage characterized by the peak of the disease and the maximum intensity of the symptoms of the disorder;
• residual phase - a stage of decreasing intensity of symptoms of psychosis, lasting several years.

Psychosis: treatment methods

All people who notice symptoms of psychotic disorders and people who suspect that their relatives have problems should visit a treatment facility as soon as possible. It should be remembered: these days, a visit to a psychiatrist is not fraught with publicity and does not have any unpleasant consequences. Visiting a doctor remains voluntary and anonymous. Therefore, timely consultation with a doctor is the only chance to choose the right program for treating psychosis and rid a person of the painful symptoms of the disorder.

Need to know: symptoms of psychosis are amenable successful treatment exclusively through pharmacological therapy. No miraculous herbs, visits to healers, or psychological beliefs can help overcome a serious mental illness.

How should you respond if a close relative exhibits symptoms of psychotic disorders? It is important to observe the following:

• Do not ask, do not clarify, do not be interested in details regarding the details of his hallucinations.
• Do not try to find out the essence of his delusional statements.
• Do not enter into debates with the patient.
• Do not prove that his beliefs are false and illogical.
• You need to try to calm him down and redirect his attention.
• If a person is inclined to talk, you need to listen to him carefully.
• The patient should be motivated to see a psychiatrist.
• If there are suspicions that a person has decided to do so, it is necessary to call medical team on an emergency basis.
• In cases of demonstration of aggressive socially dangerous behavior, it is necessary to immediately seek medical help, since acute symptoms of psychosis can only be relieved in a hospital setting.

Although psychoses are a very broad and difficult group of disorders to overcome, the principles of drug treatment for all diseases of this series are the same. However, when carrying out drug therapy, an unconventional, purely individual approach to choosing a treatment program for each individual patient is required. Before prescribing drug treatment, the doctor takes into account a number of different factors, such as: age, gender, general health of the patient, the presence of somatic ailments, features of the course of psychosis, existing risks and contraindications.

The basis of pharmacological therapy for the treatment of psychosis is drugs from the group of antipsychotics, otherwise called antipsychotics. The main property of antipsychotic drugs is their ability to have an effective effect on the productive symptoms of psychosis. In addition, some atypical antipsychotics are often used to treat the deficit symptoms of the disorder.

In modern psychiatry, two types of antipsychotics are used: atypical and typical antipsychotics. Atypical antipsychotics are highly active against productive disorders. Typical antipsychotics include:

• with a sedative effect that has a clear inhibitory effect;
• with a strong incisive (antipsychotic) effect, eliminating persistent changes personality, delusions, hallucinations, mania, increasing interest in the environment;
• disinhibiting properties, showing an activating effect.

The prescription of antipsychotics should be accompanied by a guarantee of the implementation of appropriate treatment and control measures in connection with high risk development of extremely life-threatening side effects.

The psychosis treatment program can also include benzodiazepine tranquilizers. Drugs of this class have a sedative effect, eliminate anxiety and help restore sleep.

Also used in the treatment of affective disorders mood stabilizers - mood stabilizers. These drugs exhibit tranquilizing properties, reduce anxiety, and improve the mental well-being and mood of patients with psychosis.

If there are depressive symptoms, they include in the treatment program antidepressants. However, the use of antidepressants for the relief of bipolar affective disorder is associated with a high risk of phase inversion - the development of a hypomanic or manic state.

For elimination side effects caused by taking antipsychotics can be treated with anticholinergics. These drugs eliminate extrapyramidal disorders, dyskinesias, and akinesias caused by treatment with neuroleptics.

To increase the effectiveness of drug therapy, it is advisable to carry out parallel rehabilitation of a psychological nature. The most commonly used methods are cognitive behavioral therapy, a short-term, intensive treatment aimed at changing painful patterns of thinking and behavior. A variety of training programs help patients with psychosis develop other adequate reactions to environmental phenomena.

To prevent relapses of psychotic disorders and to avoid the formation of any diseases, each person should lead an orderly lifestyle. It is necessary to set aside time for regular physical activity. Receive reasonable and high-quality rest in sufficient quantities. Stably follow the routine. Eat regularly and balanced. A complete abstinence from taking drugs and alcoholic beverages is necessary.

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Like many other medical terms, the word “psychosis” has Greek origin: “psyche” means “soul”, and “osis” means a painful condition, disorder. Psychosis is a symptom of some mental health problems, but not a diagnosis itself. That is, psychosis is not a separate disease and covers a number of related disorders: schizophrenia, bipolar disorder, schizoaffective disorder and others.

These disorders most often occur in late adolescence or young adulthood. Among children, there are 1.6–1.9 cases of psychosis per 100 thousand people, and after 14 years of age this figure increases sharply.

Irina, 22 years old:“The first time happened when I was 18: I looked at myself in the mirror and realized that in my life I had never seen a more uglier, disgusting person, whom everyone I met hated (and deservedly so). Nothing made me happy anymore. I spent more than an hour examining myself and studying meticulously. The gap between the teeth seemed huge, hare-like, the eyes were disproportionately different, the cheeks were huge, the scar on the forehead was bright white, as if crossing the entire face, and the nose - even the witch did not have such a nose in the most terrible fairy tales. I remember that I began to cry from the realization of the terrible ugliness both inside and outside, and then only the pain and sound of breaking glass. This was probably one of the episodes that convinced me to seek help.”

Psychotic episodes can seriously interfere with a teenager's social life or education. Adolescents with psychosis are often not only exposed to bullying and severe stigmatization, but also at risk of violations of their rights.

Psychosis in adolescents is difficult to treat compared to adults, since it disrupts the process of social and mental development.

Many people mistakenly believe that the word "psychotic" means "dangerous." The media often shows people with psychosis acting aggressively. But in fact, very few sufferers of this illness pose a threat to strangers - basically the main victim of this condition is the psychotic himself.

What is psychosis

Psychosis is a state of confusion that can happen to a person who has a diagnosis (schizophrenia, bipolar disorder, etc.) or to a person who has never known anything about the disorder.

This state does not arise on its own, just like that. Psychosis is almost always preceded by a period (of varying duration) during which the person experiences general signs mental problems. When a person loses touch with reality, it is called a psychotic episode. Those who have experienced this often call it a loss of control, insanity, or describe it as a feeling of everything exploding - this is perhaps the best description!

Vera, 18 years old:“It all started as a panic attack, I had a fight with a classmate and burst into tears during the training.
I began to choke, then anger began.
Tossed in the manic direction.
In fact, mixed.
Subjectively, it’s like jumping with a parachute and not being sure whether it will open.
Don't remember if you took it at all. I don't know how to convey it.
You are so insecure that it goes beyond the boundaries of good and evil.
You don't understand what is real and what is not.
Hospitalization only helped with the selection of primary medications.
No more.
The main thing is just to find a good doctor who won't give a damn.
And about antipsychotics. Sometimes you get so overwhelmed that you don’t even understand whether you’re sleeping or not and stuff like that. Everything is either marshmallow or plush.
But this effect does not last long. So far I can't find a suitable scheme.
Lots of side effects.
Most of the time I am in a depressive phase.
And to be honest, it’s hard for me to say which is worse.
I don’t want to live with this, but I don’t know who I am without it.”

Many of those who have experienced more than one episode of psychosis can generally live well - provided they receive appropriate support, the extent of which will always vary from person to person.

What are the causes of psychosis

Doctors don't know exactly what causes psychosis, but...

Symptoms of confusion due to mental illness are slightly more common among people who have relatives with mental illness - this is due to a genetic vulnerability. If a person has had at least one episode of psychosis, then this means that he is ill, and he can be diagnosed depending on the specific symptoms.

Stress can trigger the onset of psychosis. Our ability to cope with different types of stress depends on our personality type and previous experiences: not everyone easily copes with stress, problems in relationships or at work. Psychotic symptoms during times of stress can occur in personality disorders or post-traumatic stress disorder.

For many people, psychosis is a quite distressing experience. A person may feel misunderstood or abandoned if they do not feel supported by others. Often there may be a feeling that he is not trusted and everyone is trying to harm him. A psychotic state causes fear, panic, anxiety, horror.

The good news is that the experience of psychosis can prepare us to recognize early signs of such conditions in the future, plan ahead for crisis intervention, and seek help early.

If you notice symptoms of psychosis

If you or your loved ones notice symptoms of psychosis, then you should quickly seek help from a psychiatrist at your place of residence at the PND (neuropsychiatric dispensary) or in a private clinic where a psychiatrist sees you. It is important to do this as early as possible so that the painful condition does not have time to affect work, study and your relationships with others.

Frequent or long-term symptoms psychosis means that something serious is happening to a person's brain. In addition, problems in thinking and perceiving the world can have a major impact on a person's life, relationships, school or career. The longer the problems continue, the more serious the consequences will be, and the more they will affect that person's future.

Early intervention is the best way to prevent future problems. Effective treatment may have great value for a speedy recovery.

How others can help someone with psychosis:

• There are clinics for the first psychotic episode, for example, at the Psychiatric Clinical Hospital No. 1 named after N. A. Alekseev in Moscow. These types of agencies can be contacted without a referral. All you have to do is call and explain the situation.
• Call 112, dial the number 3 in tone mode, say that you need emergency psychiatric help and give the address. Stay with the patient until paramedics arrive.
• Encourage the sufferer to go to.

It is necessary to tell the doctors about what you observed, saw, heard and what alarmed you about the patient’s behavior. Be with the patient when the doctors arrive, support him and tell him that his life is not in danger.

Irina, 22 years old:“My first hospitalization saved me. The first time I got there was not entirely voluntary, after a suicide attempt caused precisely by psychosis. Two months spent in almost complete silence, tranquility, and, frankly speaking, under haloperidol, were generally the first impetus to the realization that there were problems and they needed to be solved. Our hospital is located on the shores of the White Sea, and I remember how my neighbor and I ran just to get some fresh air and feed the birds. Combined with daily therapy, pills and silence - quite a good treatment.

I have been taking antipsychotics for quite a long time, most often I change one to another, depending on the phase. I can’t explain it, but one helps better with mixed symptoms, the other with depression. For the first month of taking it, I was afraid that I would remain drowsy and not understanding anything. I was afraid that there would be nothing left of my personality, that I would become a vegetable. But no - I’m still the same, it’s just that now at the slightest suspicion I don’t get into a fight and don’t run into trouble. I'm still the same, but calmer and more reasonable. Overall, hospitalization helped me.”

There are other ways to help a suffering person:

• Psychosis is very frightening for the patient. It is important to create a calm, quiet environment if possible.
• Sit next to the person, not in front of them. Speak simply and clearly.
• Don't argue with a person about their thoughts or experiences. Instead, focus on how he feels and how scary it must be for him.
• Be vigilant. If a person becomes very agitated or aggressive, make sure you take steps to keep yourself and others safe. If the patient is aggressive, you can call the police and emergency psychiatric help. This will help protect others and the patient from self-harm.

If the patient does not want to be treated, read our “What to do if there is a mentally ill person in the family - and he denies treatment.”

Where is the best place to get treatment?

Along with public hospitals, there are private clinics, which also have an inpatient facility. There is an opinion that “free” means low quality, but this is not the case. In state medical institutions there are professionals in their field, doctors who are sincerely ready to help.

Yes, in private clinics the conditions are more free. For example, a patient is allowed to stay with a relative, and can freely use a tablet or phone in the hospital. A person feels cared for; the staff, as a rule, is friendly and attentive to each patient. IN paid clinics There is good doctors, but the financial side of the issue is a priority - not everyone can afford it, but this does not mean that there are no other options. Both private and public clinics can provide assistance.

During the hospitalization process, it is important to stay with the patient. If he cannot adequately answer the doctor's questions, you need to present the facts about his condition clearly and clearly.

Maria, 30 years old: “Of course, hospitalization helped. And yes, it was scary, because the methods used to calm mania can be cruel. Professionally burnt out people work there (IMPORTANT: not all!), and their attitude hits their pride very hard. All three times that I was lying there, I, of course, regretted that I had made the decision to come there and sign documents that I allowed them to treat me as the doctor saw fit.

They don’t say what they are treating with, they don’t say when they will be discharged, in general, no one really cares about anyone there, with exceptions that confirm the rule.

I was lying in bindings - it was really humiliating and painful. Perhaps, yes, I behaved violently, but when it finally dawned on me where I was, I simply began to look for open doors, for which I received a blow to the head and was tied up. It was more than scary. Therefore, with all my heart I wish those who suffer from mental disorders to get treatment and never end up there.”

Hospitalization can be quite traumatic for the patient if it occurs suddenly.

In such a situation, it is important to calm the person down and explain to him all your actions consistently. Of course, this does not always work out, so it is important to remain in contact with the patient, speak in a calm voice and, without criticism, explain to him the need to be examined by a doctor. As a last resort, you can pass off a doctor’s visit as a routine medical examination.

Olga, 23 years old:“I was amazed by the doctors’ attitude when I came with acute psychosis. First, my then doctor stated that my condition had gotten “a little worse.” Wow, a little! All areas of my activity were disrupted, I was kicked out of work, but for him this is “not much.” At the day hospital they tell me: “We only book a month in advance!” I explain to them that I have an exacerbation, I feel terrible. The doctor comes and says: “I don’t care that you have an exacerbation!” It’s said that a month in advance, that means a month in advance!” Another doctor told me: “It’s just autumn, well, you wait there,” - this is when I told him that I’ve been feeling terribly bad since April.”

How is psychosis treated?

Treatment of psychosis on a hospital basis is carried out by a multidisciplinary team: psychiatrist, psychotherapist, psychologist, Social worker. Specialists are working on the treatment and adaptation of the patient after suffering psychosis. A psychiatrist and psychologist conduct psychoeducational sessions where patients are informed about the symptoms, causes and secondary prevention of psychosis. Specialists of helping professions conduct classes in art therapy, occupational therapy, and bibliotherapy in order to adapt the patient as much as possible.

During treatment, your psychiatrist may prescribe antipsychotic medications (in the form of tablets, liquids, or shots) to reduce symptoms and recommend inpatient treatment.

When the condition stabilizes, cognitive behavioral therapy is used. It allows you to understand the experience of psychosis and consider strategies for overcoming the painful condition. Increasing your psychological awareness will help you recognize whether what you see and hear is real or imaginary. This type of therapy also emphasizes the importance of antipsychotic medications and adherence to treatment.

Art therapy can help express feelings that may be overwhelming the patient. It uses paint, clay, dance, music and other means to express emotions. This type of therapy may be helpful if a person has difficulty talking about their experiences.

Side effects from medications

Antipsychotics may have side effects, although not everyone will experience them and their severity will vary depending on individual characteristics person.

Side effects may include:

• drowsiness;
• trembling of limbs;
• weight gain;
• restlessness;
• muscle twitching and spasms;
• blurred vision;
• dizziness;
• constipation;
• loss of sexual desire (libido);
• dry mouth.

You should tell your doctor if side effects become particularly bothersome. The doctor will prescribe an alternative antipsychotic medication that causes fewer side effects, or suggest correctors to reduce uncomfortable symptoms.

Olga, 23 years old: « For a long time I took risperidone. At first it seemed to help, but then, during his monotherapy session, I felt terribly ill and derealization intensified. Then I began to sound the alarm, but, as you might guess, the doctors didn’t care.

I took it for a year and a half. This resulted in hormonal disruption and the production of prolactin in huge doses, and now I am undergoing treatment.

My current doctor, a very good and competent specialist, stopped the drug and prescribed Quentiapine. I felt good, but the voices and hallucinations returned, delusions and an unrealistic craving for self-harm appeared.

She immediately changed it to Zilaxera. Now I take it, in principle there are no side effects. The psychosis remains the same. But I'm used to it, and it's not particularly noticeable. The mood leveled off, interphase began. But nonsense and other things don’t interfere with life. Like hallucinations: they are rare and very short. The voices have also disappeared, and if they exist, they speak some kind of nonsense that I cannot make out. All the “you have to die because blablabla, no.”

Never stop taking medications prescribed to you unless directed by the qualified healthcare professional responsible for your care. Suddenly stopping prescription medications may cause symptoms to return. It is important to discontinue medications gradually and strictly under the supervision of a doctor.

After an episode of psychosis, most people who get better on medications need to continue taking them for at least a year. About 50% of people must take long-term medication to prevent symptoms from recurring.

Antipsychotics certainly affect the patient’s personality. A person may become apathetic and lacking initiative. As a rule, the reaction speed and accuracy of actions slow down.

Many describe the experience of using antipsychotics as quite negative.

Maria, 30 years old:“Antipsychotics saved my life. This is the guarantee of my peace of mind. As soon as something happens that seems strange to me in my behavior, I increase the dosage and live in peace. Perhaps I was lucky with my treatment regimen.

At one time it seemed to me that they made me stupid, made me... how to say... slow, not the same as I was before. Cheerful and sociable. But over time, I came to the conclusion that no, they did not affect my character in any fundamental way. I am entirely in favor of drug treatment, but with a caveat: the regimen must be chosen correctly, otherwise it will be very painful.”

Unfortunately, it is impossible to cope with psychosis through a healthy lifestyle and climate change, since it is caused by a disruption in the functioning of neurotransmitters in the brain - this can only be treated with medication.

For each patient, the end of treatment is determined individually. Some people experience psychosis once in a lifetime, while others take medications for life. It is worth noting that antipsychotics do not always eliminate symptoms completely. Even while taking the medication, a person may continue to have delusions and hallucinations - but of lesser intensity.

How to recover from a psychotic episode

Self help groups

If you have experienced episodes of psychosis, you may find it helpful to be around others who have had similar experiences and participate in psychoeducational sessions together. This helps you get over what happened and feel like you are not alone. Groups allow people to connect and support each other during a difficult recovery period.

To recover from a psychotic episode, it is important to know your triggers that can lead to a psychotic break. It can be helpful to keep a journal, noting important events, mood swings, diet, and sleep quality.

It is important to learn to recognize early warning signs of psychosis.

Family and friends can help you determine when you are sick. Pay attention to what your loved ones say about your well-being (“you’ve lost weight...”, “it’s time for you to take medications or increase the dosage...”, “please call the doctor...”). These are signals that you need to seek help from a doctor.

Manage your stress, learn to relax. Try some relaxation techniques. Relaxation can help you take care of your well-being when you feel stressed, worried, or anxious.

Draw, displaying your state on paper, this will help in experiencing emotions.

Monitor your sleep. Try to get enough sleep. Sleep can give you the energy to cope with difficult feelings and experiences.

Think about nutrition. Eating regularly and keeping your blood sugar levels stable can have a positive impact on your mood and energy levels.

Do your business and your favorite hobbies. They help you feel more significant and connected to the world around you.

Exercise and fresh air can be beneficial for mental well-being.

Quitting drugs and alcohol can prevent relapse of psychosis.

A calm environment combined with medication can be the key to recovery.

Create a crisis plan in case things get bad. It must include specific actions. For example, call a relative or close friend whom you trust and who is aware of your problem - tell him about how you are feeling. The next step may be to call an ambulance, receive antipsychotic drugs. Here it is important to rely on your experience in the past and use what has already helped you once.

Advice for relatives of people with psychosis

Very often, relatives develop behavioral tactics that worsen relationships with a person during illness. Rely on the following recommendations.

Treat your sick relative with care. People tend to feel less well if family and friends are very critical.

Make an anti-crisis plan. When your loved one is feeling well, discuss how you can help if they are feeling worse. This may include assistance with hospital visits. Be clear about what you can and cannot do during a crisis.

Offer to help. Ask him/her if he/she needs any practical help right now.

Get support for yourself. Supporting others can be mentally and physically exhausting. Think about what affects your own well-being. Take time for yourself. Take care of yours mental health. Think about something you enjoy doing: drawing, playing sports, playing a musical instrument, or going to the movies - doing something that makes you feel good is good for your well-being.

Don't blame yourself. Sometimes relatives may feel guilty that they cannot help the patient get better or that they need time for themselves. It’s not your fault: any help you can get is good, and taking care of yourself helps you be more resistant to the stress associated with dealing with someone suffering from psychosis.

Keep in touch with friends and family. Connections with others help you cope with adversity, increase confidence, and create a support network.

Take care of yours physical health. Eat food on time, follow a work-rest schedule, get plenty of rest, and sleep 6-8 hours.

Don't deny your feelings. Simply acknowledging your feelings and saying them out loud can help.

Focus on “small wins.” Don't chase big achievements. Do the little things and use them as a springboard - as something you can be proud of.

Diagnosis and stigma

Experiencing a psychotic episode can be quite traumatic for a person.

Unfortunately, the image of a mentally ill person is stigmatized and is often ridiculed by other people, which often leads to self-stigmatization. Self-stigmatization is another risk factor for the development of psychosis: a person becomes withdrawn, isolated from others, feels loneliness and mistrust, and it becomes difficult for him to share his experiences with loved ones. But the patient needs support and care.

We must not allow the diagnosis to stop us noticing the person himself as he is, in all his integrity.

Remain humane and sympathetic to people with mental disorders.

Acute psychosis is a severe mental illness, accompanied by a violation of the objective perception of the surrounding reality, critical assessment of events and information, hallucinations and delusional states. At the same time, the person does not consider himself sick and cannot adequately assess what exactly in his perception the people around him consider abnormal.

As a rule, acute psychosis has a relapsing course, that is, after a period of absence symptomatic manifestations a sharp deterioration of the condition may occur. If there is a history of this disease, a person requires constant monitoring from others, since during an attack the patient may forget himself and his identity, place of residence and other important information.

Reasons for development

Acute psychosis, like many other mental illnesses, is currently not yet fully studied by psychiatric medicine. The difficulty in understanding the reasons for the development of such conditions lies in the fact that the human brain is an extremely complex and incompletely studied structure, which can be negatively influenced by both external and internal factors. Most often sharp forms psychosis is observed in adolescents at puberty, as well as in women over 50 years of age, which is a consequence of serious hormonal changes. Depending on the reasons that led to the development of this mental illness, there are 3 main types of psychosis, including:

• endogenous;
• exogenous;
• organic.

The endogenous type of psychosis develops due to the influence of various internal factors. Such internal factors often include severe chronic diseases of the endocrine system and neurological disorders; in addition, genetic predisposition and schizophrenia can contribute to the development of this type of psychosis. The group of endogenous types of psychoses also includes the fairly common senile psychosis, which is a consequence of age-related changes, atherosclerosis and hypertension.

Exogenous types of psychosis develop due to the influence of various external factors. Such external factors include:

• severe stress;
• severe alcohol or drug intoxication;
• infectious diseases.

It is worth noting that exogenous types of psychoses are currently considered the most common. Delirium tremens also belongs to these forms of acute psychosis. Organic psychosis develops, as a rule, as a result of various brain damage, including against the background of severe traumatic brain injury and tumor growths.

There are many different forms of the disease, each of which has its own developmental characteristics and prognosis. The most common variants of this mental illness include:

• manic-depressive;
• manic;
• reactive;
• polymorphic.

Conditions such as acute manic-depressive syndrome, which is also known as bipolar disorder, are accompanied by alternating periods of severe depression and phases of excessive arousal. The manic version of psychosis is accompanied by persistent excessive arousal and a desire to constantly do something.

The reactive form of the disease develops as a result of severe stress, which can appear in a person with a weak psyche in situations that threaten his life or health. This type of mental disorder usually goes away without treatment once the person is safe. Acute psychosis of a polymorphic form usually manifests itself in children aged 10 to 15 years. Such a mental disorder may indicate developing schizophrenia.

This is not a complete list of the forms of psychosis. In reality, there are many variants of such a mental disorder, but only a qualified psychiatrist can make a correct diagnosis in a particular case.

Symptoms

Acute psychosis is characterized by the appearance of a mass of various symptomatic manifestations. The development of this pathological condition can be noticed long before the acute phase, characterized by complete loss of orientation in space and hallucinations. People around a person suffering from this mental illness should be aware of the following symptoms:

• personality change;
• nervousness;
• fast fatiguability;
• inability to concentrate for a long time;
• distortion of the perception of sound and light;
• sleep disorders;
• depression;
• unreasonable fears;
• sudden mood swings.

All these signs of a developing attack often go completely unnoticed by both the patients themselves and their relatives. If the incipient attack was not stopped with medication at this stage, signs of the acute phase of the disease appear, including:

• hallucinations;
• pseudohallucinations;
• loss of sense of self;
• derealization;
• incoherent speech;
• distorted logic;
• misunderstanding the meaning of what is being said.

All symptoms of the disease can remain with a person for several hours and sometimes months. At this time the patient requires special attention from relatives and medical staff of a psychiatric hospital.

Treatment methods

In the vast majority of cases, treatment of acute psychosis is aimed at stabilizing the patient’s condition and eliminating the manifestations of the disease. First of all, it is assigned drug therapy which includes:

• neuroleptics;
• antidepressants;
• tranquilizers;
• detoxification agents.

The regimen and dosage of medications is selected by the attending psychiatrist.

After the symptoms of psychosis have subsided, long-term psychotherapeutic treatment is often required.

Correctly carried out psychocorrection allows you to create an atmosphere of trust between the doctor and the patient, and in addition, teach a person suffering from psychosis to adequately assess himself and the actions of others, as well as understand reality. This allows a person suffering from attacks of psychotic delirium to get rid of obsessive fears.

Among other things, electroconvulsive therapy is currently used for some types of acute psychosis. In addition, reflexology, physical therapy, acupuncture and Spa treatment. Complex treatment, as a rule, has a positive effect, and the person returns to normal life.

Russian Academy of Medical Sciences
RESEARCH CENTER FOR MENTAL HEALTH

MOSCOW
2004

Oleychik I.V. - Candidate of Medical Sciences, Head of the Scientific Information Department of the National Center for Mental Health of the Russian Academy of Medical Sciences, Senior Researcher of the Department for the Study of Endogenous Mental Disorders and Affective States

2004, Oleychik I.V.
2004, Scientific Center for Public Health of the Russian Academy of Medical Sciences

WHAT ARE PSYCHOSES

The purpose of this brochure is to convey in the most accessible form to all interested people (primarily relatives of patients) modern scientific information about the nature, origin, course and treatment of such serious diseases as psychosis.

Psychoses (psychotic disorders) are understood as the most striking manifestations mental illness, in which the patient’s mental activity does not correspond to the surrounding reality, the reflection of the real world in consciousness is sharply distorted, which manifests itself in behavioral disorders, the appearance of unusual pathological symptoms and syndromes.

Most often, psychoses develop within the framework of the so-called “ endogenous diseases"(Greek endo- inside,genesis- origin). A variant of the occurrence and course of a mental disorder due to the influence of hereditary (genetic) factors, which include: schizophrenia, schizoaffective psychosis, affective diseases (bipolar and recurrent depressive disorder). The psychoses that develop with them are the most severe and protracted forms of mental suffering.

The concepts of psychosis and schizophrenia are often equated, which is fundamentally wrong, since psychotic disorders can occur in a number of mental illnesses: Alzheimer's disease, senile dementia, chronic alcoholism, drug addiction, epilepsy, mental retardation, etc.

A person can suffer a transient psychotic state caused by taking certain medications, drugs, or the so-called psychogenic or “reactive” psychosis that occurs as a result of exposure to severe mental trauma (life-threatening stressful situation, loss loved one etc.). Often there are so-called infectious diseases (developing as a result of severe infectious disease), somatogenic (caused by severe somatic pathology, such as myocardial infarction) and intoxication psychoses. The most striking example of the latter is delirium tremens - “delirium tremens”.

Psychotic disorders are a very common type of pathology. Statistical data in different regions differ from each other, which is associated with different approaches and capabilities for identifying and accounting for these sometimes difficult to diagnose conditions. On average, the frequency of endogenous psychoses is 3-5% of the population.

Accurate information about the prevalence of exogenous psychoses among the population (Greek. exo- outside, genesis- origin. There is no option for the development of a mental disorder due to the influence of external causes located outside the body, and this is explained by the fact that most of these conditions occur in patients with drug addiction and alcoholism.

The manifestations of psychosis are truly limitless, which reflects the richness of the human psyche. The main manifestations of psychosis are:

• hallucinations(depending on the analyzer, auditory, visual, olfactory, gustatory, and tactile are distinguished). Hallucinations can be simple (bells, noise, calls) or complex (speech, scenes). Most common auditory hallucinations, the so-called “voices” that a person can hear coming from outside or sounding inside the head, and sometimes the body. In most cases, voices are perceived so clearly that the patient does not have the slightest doubt about their reality. Voices can be threatening, accusing, neutral, imperative (commanding). The latter are rightfully considered the most dangerous, since patients often obey the orders of voices and commit acts that are dangerous to themselves or others.

crazy ideas- judgments, conclusions that do not correspond to reality, completely take over the patient’s consciousness, and cannot be corrected by dissuading and explaining. Content crazy ideas can be very diverse, but the most common are: delusions of persecution (patients believe that they are being spied on, they want to kill them, intrigues are woven around them, conspiracies are being organized), delusions of influence (by psychics, aliens, special services with the help of radiation, radiation , “black” energy, witchcraft, damage), delusions of damage (they add poison, steal or spoil things, want to survive from the apartment), hypochondriacal delusions (the patient is convinced that he is suffering from some kind of disease, often terrible and incurable, stubbornly proves that he is affected internal organs, requires surgical intervention). There are also delusions of jealousy, invention, greatness, reformism, other origins, love, litigious, etc.

movement disorders, manifested in the form of inhibition (stupor) or agitation. When stupor occurs, the patient freezes in one position, becomes inactive, stops answering questions, looks at one point, and refuses to eat. Patients in a state of psychomotor agitation, on the contrary, are constantly on the move, talk incessantly, sometimes grimace, mimic, are foolish, aggressive and impulsive (they commit unexpected, unmotivated actions).

mood disorders manifested by depressive or manic states. Depression is characterized, first of all, by low mood, melancholy, depression, motor and intellectual retardation, disappearance of desires and motivations, decreased energy, a pessimistic assessment of the past, present and future, ideas of self-blame, and thoughts of suicide. A manic state is manifested by unreasonably elevated mood, acceleration of thinking and motor activity, overestimation of one’s own capabilities with the construction of unrealistic, sometimes fantastic plans and projections, disappearance of the need for sleep, disinhibition of drives (abuse of alcohol, drugs, promiscuity).

All of the above manifestations of psychosis belong to the circle positive disorders, so named because the symptoms that appear during psychosis seem to be added to the pre-morbid state of the patient’s psyche.

Unfortunately, quite often (though not always) a person who has suffered psychosis, despite the complete disappearance of his symptoms, develops so-called negative disorders, which in some cases lead to even more serious social consequences than the psychotic state itself. Negative disorders are so called because patients experience a change in character, personal properties, and a loss of powerful layers from the psyche that were previously inherent in it. Patients become lethargic, lack initiative, and passive. Often there is a decrease in energy tone, the disappearance of desires, motivations, aspirations, an increase in emotional dullness, isolation from others, a reluctance to communicate and enter into any social contacts. Often their previously inherent responsiveness, sincerity, and sense of tact disappear, and irritability, rudeness, quarrelsomeness, and aggressiveness appear. In addition, patients develop thinking disorders that become unfocused, amorphous, rigid, and meaningless. Often these patients lose their previous work skills and abilities so much that they have to register for disability.

1. COURSE AND PROGNOSIS OF PSYCHOSES

The most common type (especially with endogenous diseases) is the periodic type of psychosis with occasional episodes of psychosis. acute attacks illnesses, both provoked by physical and psychological factors, and spontaneous. It should be noted that there is also a single-attack course, observed more often in adolescence. Patients, having suffered one, sometimes protracted attack, gradually recover from the painful state, restore their ability to work and never come to the attention of a psychiatrist. In some cases, psychoses can become chronic and develop into a continuous course without disappearance of symptoms throughout life.

In uncomplicated and unadvanced cases, inpatient treatment usually lasts one and a half to two months. This is exactly the period doctors need to fully cope with the symptoms of psychosis and select the optimal supportive therapy. In cases where the symptoms of the disease turn out to be resistant to drugs, several courses of therapy are required, which can delay the hospital stay for up to six months or more. The main thing that the patient’s relatives need to remember is not to rush the doctors, do not insist on an urgent discharge “on receipt”! It takes a certain time to completely stabilize the condition, and by insisting on early discharge, you risk getting an undertreated patient, which is dangerous for both him and you.

One of the most important factors influencing the prognosis of psychotic disorders is the timeliness of the start and intensity of active therapy in combination with socio-rehabilitation measures.

1. WHO ARE THEY - THE MINDALLY ILL?

Over the centuries, a collective image of a mentally ill person has formed in society. Unfortunately, in the minds of many people, he is still an unkempt, unshaven man with a burning gaze and an obvious or secret desire to attack others. They fear the mentally ill because, supposedly, “it is impossible to understand the logic of their actions.” Mental illnesses are considered to be sent down from above, strictly inherited, incurable, contagious, leading to dementia. Many believe that the cause of mental illness is difficult living conditions, prolonged and severe stress, complex family relationships, and lack of sexual contact. Mentally ill people are considered either “weaklings” who simply cannot pull themselves together or, going to the other extreme, sophisticated, dangerous and ruthless maniacs who commit serial and mass murders and sexual violence. It is believed that people suffering from mental disorders do not consider themselves sick and are unable to think about their treatment.

Unfortunately, the relatives of the patient often internalize the views typical in society and begin to treat the unfortunate person in accordance with the prevailing misconceptions in society. Often, families into which a mentally ill person appears try at all costs to hide their misfortune from others and thereby aggravate it even more, dooming themselves and the patient to isolation from society.

Mental disorder is a disease like any other. There is no reason to be ashamed that this disease runs in your family. The disease is of biological origin, i.e. occurs as a result of metabolic disorders of a number of substances in the brain. Suffering from a mental disorder is about the same as having diabetes, peptic ulcers, or other chronic disease. Mental illness is not a sign of moral weakness. Mentally ill people cannot eliminate the symptoms of their illness through willpower, just as it is impossible to improve their vision or hearing through willpower. Mental illnesses are not contagious. The disease is not transmitted by airborne droplets or other means of infection, so it is impossible to get psychosis by closely communicating with the patient. According to statistics, cases of aggressive behavior among mentally ill people are less common than among healthy people. The heredity factor in patients with mental illness manifests itself in the same way as in patients with cancer or diabetes mellitus. If two parents are sick, the child gets sick in about 50% of cases; if one parent is sick, the risk is 25%. Most people with mental disorders understand that they are ill and seek treatment, although initial stages illness is difficult for a person to accept. A person's ability to make decisions about his or her own treatment is greatly enhanced if family members are involved and approve and support their decisions. And, of course, we should not forget that many brilliant or famous artists, writers, architects, musicians, and thinkers suffered from serious mental disorders. Despite the serious illness, they managed to enrich the treasury of human culture and knowledge, immortalizing their name with the greatest achievements and discoveries.

SIGNS OF BEGINNING DISEASE OR EXCERNSATION

For relatives whose loved ones suffer from one or another mental disorder, information about the initial manifestations of psychosis or symptoms of the advanced stage of the disease may be useful. All the more useful may be recommendations on some rules of behavior and communication with a person in a painful condition. In real life, it is often difficult to immediately understand what is happening to your loved one, especially if he is scared, suspicious, distrustful and does not directly express any complaints. In such cases, only indirect manifestations of mental disorders can be noticed. Psychosis can have a complex structure and combine hallucinatory, delusional and emotional disorders (mood disorders) in various proportions. The following symptoms may appear during the disease, all without exception, or individually.

Manifestations of auditory and visual hallucinations:

Conversations with oneself that resemble a conversation or remarks in response to someone else's questions (excluding comments out loud like “Where did I put my glasses?”).

Laughter for no apparent reason.

Sudden silence, as if a person is listening to something.

Alarmed, preoccupied look; inability to concentrate on the topic of conversation or a specific task.

The impression that your relative sees or hears something that you cannot perceive.

The appearance of delirium can be recognized by the following signs:

Changed behavior towards relatives and friends, the appearance of unreasonable hostility or secrecy.

Direct statements of implausible or dubious content (for example, about persecution, about one’s own greatness, about one’s irredeemable guilt.)

Protective actions in the form of curtaining windows, locking doors, obvious manifestations of fear, anxiety, panic.

Expressing, without obvious grounds, fears for one’s life and well-being, or for the life and health of loved ones.

Separate, meaningful statements that are incomprehensible to others, adding mystery and special significance to everyday topics.

Refusal to eat or careful checking of food contents.

Active litigious activity (for example, letters to the police, various organizations with complaints about neighbors, co-workers, etc.).

How to respond to the behavior of a person suffering from delusions:

Do not ask questions that clarify the details of delusional statements and statements.

Do not argue with the patient, do not try to prove to your relative that his beliefs are wrong. Not only does this not work, but it can also worsen existing disorders.

If the patient is relatively calm, inclined to communicate and help, listen carefully, reassure him and try to persuade him to see a doctor.

Suicide Prevention

Almost everyone depressive states thoughts may arise about not wanting to live. But depression accompanied by delusions (for example, guilt, impoverishment, incurable somatic illness) is especially dangerous. At the height of the severity of the condition, these patients almost always have thoughts of suicide and suicidal readiness.

The following signs warn of the possibility of suicide:

The patient’s statements about his uselessness, sinfulness, and guilt.

Hopelessness and pessimism about the future, reluctance to make any plans.

The patient's conviction that he has a fatal, incurable disease.

Sudden calmness of the patient after long period sadness and anxiety. Others may have the false impression that the patient's condition has improved. He puts his affairs in order, for example, writes a will or meets with old friends whom he has not seen for a long time.

Preventive action:

Take any conversation about suicide seriously, even if it seems unlikely to you that the patient might try to commit suicide.

If you get the impression that the patient is already preparing for suicide, do not hesitate to immediately seek professional help.

Hide dangerous objects (razors, knives, pills, ropes, weapons), carefully close windows and balcony doors.

YOUR RELATIVE IS ILL

All members of the family where a mentally ill person appears initially experience confusion, fear, and do not believe what happened. Then the search for help begins. Unfortunately, very often people first turn not to specialized institutions where they can get advice from a qualified psychiatrist, but, at best, to doctors of other specialties, at worst - to healers, psychics, and specialists in the field of alternative medicine. The reason for this is a number of existing stereotypes and misconceptions. Many people have a mistrust of psychiatrists, which is due to the artificially inflated means mass media during the years of perestroika, the problem of the so-called “Soviet punitive psychiatry”. Most people in our country still associate a consultation with a psychiatrist with various serious consequences: registration at a psychoneurological dispensary, loss of rights (limitation of the ability to drive vehicles, travel abroad, carry weapons), the threat of loss of prestige in the eyes of others, social and professional discredit. Fear of this peculiar stigma, or, as they now say, “stigma”, conviction in the purely somatic (for example, neurological) origin of one’s suffering, confidence in the incurability of mental disorders by methods modern medicine and, finally, simply a lack of understanding of the painful nature of their condition forces sick people and their relatives to categorically refuse any contact with psychiatrists and taking psychotropic therapy - the only real possibility improve their condition. It should be emphasized that after the adoption in 1992 of the new Law of the Russian Federation “On psychiatric care and guarantees of the rights of citizens in its provision,” most of the above fears are unfounded.

The infamous “registration” was abolished ten years ago, and currently a visit to a psychiatrist does not threaten negative consequences. Nowadays, the concept of “accounting” has been replaced by the concepts of advisory and medical care and dispensary observation. The advisory population includes patients with mild and short-term mental disorders. Help is provided to them if they independently and voluntarily go to the dispensary, at their request and with their consent. Minor patients under the age of 15 are provided with assistance at the request or with the consent of their parents or legal representatives of their rights. The dispensary observation group includes patients suffering from severe, persistent or frequently exacerbating mental disorders. Dispensary observation can be established by a decision of a commission of psychiatrists, regardless of the consent of the person suffering from a mental disorder, and is carried out through regular examinations by doctors of psychoneurological dispensaries (PND). Dispensary observation is terminated upon condition of recovery or significant and persistent improvement in the patient’s condition. As a rule, observation is stopped if there are no exacerbations for five years.

It should be noted that often when the first signs of mental disorder appear, concerned relatives assume the worst - schizophrenia. Meanwhile, as already mentioned, psychoses have other causes, so each patient requires a thorough examination. Sometimes delay in seeing a doctor is fraught with the most severe consequences (psychotic conditions that develop as a result of a brain tumor, stroke, etc.). To identify the true cause of psychosis, consultation with a qualified psychiatrist using the most complex high-tech methods is necessary. This is also why appealing to alternative medicine, which does not have the full arsenal of modern science, can lead to irreparable consequences, in particular, to an unjustified delay in delivering the patient to the first consultation with a psychiatrist. As a result, the patient is often brought to the clinic by an ambulance in a state of acute psychosis, or the patient is taken for examination in an advanced stage of mental illness, when time has already been lost and chronic course with the formation of difficult-to-treat negative disorders.

Patients with psychotic disorders may receive specialized assistance in PND at the place of residence, in psychiatric research institutions, in psychiatric and psychotherapeutic care rooms at general clinics, in psychiatric rooms departmental clinics.

The functions of the psychoneurological dispensary include:

Outpatient appointments for citizens referred by doctors of general clinics or who applied independently (diagnosis, treatment, decision social issues, examination);

Referral to a psychiatric hospital;

Emergency care at home;

Consultative and clinical observation of patients.

After examining the patient, the local psychiatrist decides in what conditions to carry out treatment: the patient’s condition requires urgent hospitalization in a hospital or outpatient treatment is sufficient.

Article 29 of the Law of the Russian Federation “On psychiatric care and guarantees of the rights of citizens during its provision” clearly regulates the grounds for involuntary hospitalization in a psychiatric hospital, namely:

“A person suffering from a mental disorder may be hospitalized in a psychiatric hospital without his consent or without the consent of his legal representative until a judge’s decision, if his examination or treatment is possible only in an inpatient setting, and the mental disorder is severe and causes:

a) his immediate danger to himself or others, or

b) his helplessness, that is, his inability to independently satisfy the basic needs of life, or

c) significant harm to his health due to a deterioration in his mental state if the person is left without psychiatric help.”

TREATMENT: BASIC METHODS AND APPROACHES.

Despite the fact that psychoses are a complex group that includes conditions of various origins, the principles of treatment are the same for them. Throughout the world, drug therapy is considered the most effective and reliable method of treating psychosis. When it is carried out, an unconventional, strictly individual approach is used to each patient, taking into account age, gender, and the presence of other diseases. One of the main tasks of a specialist is to establish fruitful cooperation with the patient. It is necessary to instill in the patient faith in the possibility of recovery, to overcome his prejudice against the “harm” caused by psychotropic drugs, to convey to him his conviction in the effectiveness of treatment, subject to systematic adherence to the prescribed prescriptions. Otherwise, there may be a violation of medical recommendations regarding doses and medication regimen. The relationship between doctor and patient should be built on mutual trust, which is guaranteed by the specialist’s compliance with the principles of non-disclosure of information, medical confidentiality, anonymity of treatment. The patient, in turn, should not hide such important information from the doctor as the fact of using psychoactive substances(drugs) or alcohol, taking medications used in general medicine, driving a car or operating complex machinery. A woman should notify her doctor if she is pregnant or breastfeeding. Often relatives or patients themselves, having carefully studied the annotations for the medications recommended to them, are perplexed, and sometimes even indignant, that the patient was prescribed a drug to treat schizophrenia, while he has a completely different diagnosis. The explanation is that almost all drugs used in psychiatry act nonspecifically, i.e. They help with a wide range of painful conditions (neurotic, affective, psychotic) - it’s all about the prescribed dose and the doctor’s skill in selecting optimal treatment regimens.

Undoubtedly, taking medications should be combined with social rehabilitation programs and, if necessary, with family psychotherapeutic and psychopedagogical work.

Social rehabilitation is a complex of programs for teaching patients with mental disorders ways of rational behavior both in a hospital setting and in everyday life. Rehabilitation is aimed at teaching social skills for interacting with other people, skills necessary in everyday life, such as taking into account one’s own T financial finances, cleaning the house, shopping, using society n transport, etc., vocational training, which includes activities T skills necessary to obtain and maintain employment, and training for those patients who want to graduate from high school or college. Auxiliary Psych O Therapy is also often used to help mentally ill people. Psychotherapy helps mentally ill people feel better O treat yourself, especially those who experience a feeling of inadequacy n anxiety due to their illness and to those who seek to deny the presence of the illness. Psychotherapy n O Helps the patient learn ways to solve everyday problems. An important element social rehabilitation is participation in the work of groups of mutual m noy on d hanging out with other people who understand what it means to be crazy And mentally ill. Such groups, led by patients who have undergone hospitalization, allow other patients to experience help in their lives. And mania of their problems, and also expand the possibilities of their participation in recovery b events and society n new life.

All of these methods, when used wisely, can improve efficiency. drug therapy, but are not able to completely replace drugs. Unfortunately, science still does not know how to cure mental illnesses once and for all; psychoses often have a tendency to recur, which requires long-term preventive medication.

NEUROLEPTICS IN THE TREATMENT SYSTEM OF PSYCHOTIC DISEASESESKIH RAWITHBUILDINGS

The main drugs used to treat psychosis are the so-called neuroleptics or antipsychotics.

The first chemical compounds that have the property of stopping psychosis were discovered in the middle of the last century. Then, for the first time, psychiatrists had powerful and effective remedy treatment of psychosis. Such drugs as aminazine, haloperidol, stelazine and a number of others have proven themselves especially well. They stopped psychomotor agitation well, eliminated hallucinations and delusions. With their help, a huge number of patients were able to return to life and escape from the darkness of psychosis. However, over time, evidence has accumulated that these drugs, later called classical neuroleptics, affect only positive symptoms, often without affecting negative ones. In many cases, the patient was discharged from a psychiatric hospital without delusions or hallucinations, but became passive and inactive, and was unable to return to work. In addition, almost all classical antipsychotics cause so-called extrapyramidal side effects (drug-induced parkinsonism). These effects are manifested by muscle stiffness, tremors and convulsive twitching of the limbs, sometimes a difficult feeling of restlessness appears, which is why patients are in constant movement, being unable to stop for a minute. To reduce these unpleasant phenomena, doctors are forced to prescribe a number of additional drugs, which are also called correctors (cyclodol, parkopan, akineton, etc.). The side effects of classical antipsychotics are not limited to extrapyramidal disorders; in some cases, drooling or dry mouth, urination problems, nausea, constipation, palpitations, a tendency to lower blood pressure and fainting, weight gain, decreased libido, erectile dysfunction and ejaculation may be observed. In women, galactorrhea (discharge from the nipples) and amenorrhea (disappearance of menstruation) are common. It should be noted side effects from the central nervous system: drowsiness, deterioration of memory and concentration, increased fatigue, the possibility of developing the so-called. neuroleptic depression.

Finally, it should be emphasized that, unfortunately, traditional antipsychotics do not help everyone. There has always been a portion of patients (about 30%) whose psychoses were difficult to treat, despite adequate therapeutic tactics with timely change of drugs of various groups.

All these reasons explain the fact that patients often voluntarily stop taking medications, which in most cases leads to an exacerbation of the disease and re-hospitalization.

A real revolution in the treatment of psychotic disorders was the discovery and implementation of clinical practice in the early 90s, a fundamentally new generation of neuroleptics - atypical antipsychotics. The latter differ from classical neuroleptics in their selectivity of neurochemical action. By acting only on certain nerve receptors, these drugs, on the one hand, turned out to be more effective, and on the other, much better tolerated. They were found to cause virtually no extrapyramidal side effects. Currently, several such drugs are already available on the domestic market - rispolept (risperidone), Zyprexa (olanzapine), Seroquel (quetiapine) and azaleptin (leponex), which was previously introduced into clinical practice. The most widely used are Leponex and Rispolept, which are included in the “List of Vital and Essential Medicines”. Both of these drugs are highly effective in various psychotic conditions. However, while Rispolept is more often prescribed by practitioners in the first place, Leponex is justifiably used only in the absence of an effect from previous treatment, which is associated with a number of pharmacological features of this drug, the nature of side effects and specific complications, which, in particular, require regular monitoring general blood test.

What are the advantages of atypical antipsychotics for lein the acute phase of psychosis?

The ability to achieve a greater therapeutic effect, including in cases of symptom resistance or patient intolerance to typical antipsychotics.

The effectiveness of treating negative disorders is significantly greater than that of classical neuroleptics.

Security, i.e. insignificant severity of both extrapyramidal and other side effects characteristic of classical antipsychotics.

There is no need to take correctors in most cases with the possibility of monotherapy, i.e. treatment with one drug.

Acceptability of use in weakened, elderly and somatically burdened patients due to low interaction with somatotropic drugs and low toxicity.

SUPPORTIVE AND PREVENTIVE TERAFDI

Among psychotic disorders of various origins, psychoses developing as part of endogenous diseases comprise the lion's share. The course of endogenous diseases differs in duration and tendency to relapse. That is why international recommendations regarding the duration of outpatient (maintenance, preventive) treatment clearly stipulate its terms. Thus, patients who have suffered a first attack of psychosis need to take small doses of drugs for one to two years as preventive therapy. If a repeated exacerbation occurs, this period increases to 3-5 years. If the disease shows signs of transition to a continuous course, the period of maintenance therapy is increased indefinitely. That is why among practical psychiatrists there is a justified opinion that in order to treat patients who become ill for the first time (during their first hospitalization, less often outpatient therapy), maximum efforts should be made, and the longest and most complete course of treatment and social rehabilitation should be carried out. All this will pay off handsomely if it is possible to protect the patient from repeated exacerbations and hospitalizations, because after each psychosis negative disorders increase, which are especially difficult to treat.

Preventing RecAnddivas of psychosis

Reducing the relapse of mental illness is facilitated by an orderly daily lifestyle that has the maximum therapeutic effect and includes regular physical exercise, reasonable rest, a stable daily routine, balanced diet, giving up drugs and alcohol and regularly taking medications prescribed by your doctor as maintenance therapy.

Signs of an approaching relapse may include:

Any significant changes in the patient’s behavior, daily routine or activity (unstable sleep, loss of appetite, appearance of irritability, anxiety, change in social circle, etc.).

Features of behavior that were observed on the eve of the previous exacerbation of the disease.

The appearance of strange or unusual judgments, thoughts, perceptions.

Difficulty doing ordinary, simple tasks.

Unauthorized termination of maintenance therapy, refusal to visit a psychiatrist.

If you notice warning signs, take the following measures:

Notify your doctor and ask him to decide if your therapy needs to be adjusted.

Eliminate all possible external stressors on the patient.

Minimize (within reasonable limits) all changes in your daily routine.

Provide the patient with as calm, safe and predictable an environment as possible.

To avoid exacerbation, the patient should avoid:

Premature withdrawal of maintenance therapy.

Violations of the medication regimen in the form of an unauthorized dosage reduction or irregular intake.

Emotional turmoil (conflicts in the family and at work).

Physical overload, including both excessive exercise and overwhelming housework.

Colds (acute respiratory infections, flu, sore throats, exacerbations of chronic bronchitis, etc.).

Overheating (solar insolation, prolonged stay in a sauna or steam room).

Intoxication (food, alcohol, medicinal and other poisoning).

Changes in climatic conditions during the holidays.

Advantages of atypical antipsychotics during professionalAndlactic treatment.

When carrying out maintenance treatment, the advantages of atypical antipsychotics over classical antipsychotics are also revealed. First of all, this is the absence of “behavioral toxicity,” that is, lethargy, drowsiness, inability to engage in any activity for a long time, slurred speech, and unsteady gait. Secondly, a simple and convenient dosing regimen, because Almost all new generation drugs can be taken once a day, say at night. Classical antipsychotics, as a rule, require three doses a day, due to the peculiarities of their pharmacodynamics. In addition, atypical antipsychotics can be taken without regard to meals, which allows the patient to maintain their usual daily routine.

Of course, it should be noted that atypical antipsychotics are not a panacea, as some advertising publications try to present. Medicines that completely cure such serious illnesses, like schizophrenia or bipolar disorder, has yet to be discovered. Perhaps the main disadvantage of atypical antipsychotics is their cost. All new drugs are imported from abroad, produced in the USA, Belgium, Great Britain and, naturally, have a high price. Thus, the approximate costs of treatment when using the drug in average dosages for a month are: Zyprexa - $200, Seroquel - $150, Rispolept - $100. True, recently more and more pharmacoeconomic studies have appeared, convincingly proving that the total costs of patient families for the purchase of 3-5, and sometimes even more classical drugs, namely, such complex regimens are used for the treatment and prevention of psychotic disorders, approaching the cost of one atypical antipsychotic (here, as a rule, monotherapy is carried out, or simple combinations with 1-2 more drugs are used). In addition, a drug such as rispolept is already included in the list of drugs provided free of charge in dispensaries, which makes it possible, if not to fully meet the needs of patients, then at least partially to alleviate their financial burden.

It cannot be said that atypical antipsychotics have no side effects at all, because Hippocrates said that “an absolutely harmless medicine is absolutely useless.” When taking them, there may be an increase in body weight, a decrease in potency, disturbances in the menstrual cycle in women, and an increase in the level of hormones and blood sugar. However, it should be noted that almost all of these adverse events depend on the dosage of the drug, occur when the dose is increased above the recommended one and are not observed when using average therapeutic doses.

Extreme caution must be exercised when deciding whether to reduce dosages or discontinue an atypical antipsychotic. This question can only be decided by the attending physician. Untimely or abrupt withdrawal of the drug can lead to a sharp deterioration in the patient’s condition, and, as a result, to urgent hospitalization in a psychiatric hospital.

Thus, from all of the above it follows that psychotic disorders, although they are among the most serious and quickly disabling diseases, do not always fatally lead to severe outcomes. In most cases, provided the correct and timely diagnosis psychosis, the appointment of early and adequate treatment, the use of modern gentle methods of psychopharmacotherapy, combined with methods of social rehabilitation and psychocorrection, it is possible not only to quickly stop acute symptoms, but also to achieve full recovery social adaptation sick.