Psychoses are not characterized by severe mental disorders; they increase gradually as the disease progresses.

Treatment

Treatment of senile psychoses combines medicinal and psychotherapeutic methods. The choice depends on the severity of the condition, the type of disorder, and the presence of somatic diseases. Patients are prescribed the following groups of drugs:

The doctor selects a combination of drugs according to the type of psychosis.

It is also necessary to treat a somatic disease in parallel, if it appears cause of the disorder.

Psychotherapy

Psychotherapeutic sessions are an excellent means for correcting psychosis in the elderly. In combination with drug therapy they give positive results.

Doctors mainly use group classes. Old people, studying in groups, acquire a new circle of friends with common interests. A person can begin to talk openly about his problems and fears, thereby getting rid of them.

Most effective methods psychotherapy:

Senile psychoses - this is a problem not only for the patient himself, but also for his relatives. With timely and correct treatment, the prognosis for senile psychosis is favorable. Even with severe symptoms stable remission can be achieved. Chronic psychoses, especially those associated with depression, are less responsive to treatment.

The patient's relatives need to be patient, show care and attention. Mental disorder is a consequence of the aging of the body, so no person is immune from it.

Often mental disorders observed in older people. It's connected with natural process aging, in which the functional state brain.

Along with other mental illnesses, older people are often found to have presenile And senile psychoses. They are a consequence of the death of brain cells that can occur with age. Unfortunately, senile psychosis cannot be completely cured. But at the same time, it is not recommended to refuse treatment for senile psychosis altogether - it helps to weaken the symptoms of the disease and reduces the risk of patients causing harm to themselves and others. The likelihood of symptoms of psychosis depends on the person's age - as a rule, people aged 60 years and older are at risk.

At the age of 45-65, people mainly develop presenile psychosis, also called involutionary.

Senile psychosis usually occurs after 65 years of age and manifests itself in the forms of depression and paranoid disorders. Its symptoms depend on the form of manifestation.

The main cause of psychosis in the elderly is brain atrophy, but there are also specific factors that influence the development of the disease.

Causessenile psychosis

• hormonal changes (menopause);
• somatic diseases (acute, chronic diseases respiratory system, heart and blood vessels);
• psychosomatic disorders associated with sleep and eating disorders;
• strong feelings about one’s own aging, often – senile depression.

The manifestation of psychosis in older people may indicate the development of dementia, Pick's disease or Alzheimer's disease.

Symptoms of senile psychosis

• increased anxiety and depression;
• attacks of excessive suspiciousness (hypochondria);
• depressed mood, melancholy;
• appearance various forms delirium, as well as hallucinations;
• lethargy or, conversely, overexcitation (agitated depression);
• attacks of confusion;
• decreased intelligence;
• increased suggestibility, stereotypical thinking.

In this case, psychosis gradually progresses and leads to a complete breakdown of the mental functions of the brain, that is, dementia.

Treatment of senile psychosis

As we said earlier, senile psychosis cannot be treated complete cure. Treatment of senile psychosis in older people does not have a specific technique, but a correctly selected set of therapeutic measures and regular care can alleviate the patient's condition.

The consequences of progressive senile psychosis are such that an elderly person does not accept changes in his life at all, so you should not insist on placing such a person in a hospital. In this case, the most correct decision would be to call a psychiatrist to your home, especially if the patient behaves like crazy or suffers from hallucinations or delusions.

What can a psychiatrist called to your home do?

First of all, he can determine a treatment regimen and give relatives the necessary recommendations related to the specifics of care and ensuring the safety of the patient and others. Treatment for psychosis is comprehensive and includes prescribing medicines, as well as conducting

Senile (senile) psychoses are diseases that arise in late age due to brain atrophy. The development of diseases is mainly due to genetic factors, external influences play only a provoking or aggravating role in the process. Difference clinical forms associated with predominant atrophy of certain areas of the cortex and subcortical formations of the brain. Common to all diseases is a slow, gradual, but progressive course leading to deep decay mental activity, i.e. to total dementia.

There are presenile dementias (Pick's disease and Alzheimer's disease) and senile dementia itself.

Pick's disease

Pick's disease is a limited presenile atrophy of the brain, mainly in the frontal and temporal lobes. The disease begins at 50-55 years of age, lasts 5-10 years, leading to total dementia. Both earlier and later onset are possible. Women get sick more often than men. The disease begins with personality changes. Lethargy and apathy appear, initiative disappears, and the liveliness of emotional reactions disappears. The productivity of thinking decreases, the ability to abstraction, generalization and comprehension is impaired, criticism of one’s condition, behavior and way of life disappears. Some patients experience euphoria with disinhibition of drives and loss of ethical and ethical attitudes. Speech becomes poor, with progressive decrease vocabulary, stereotypical repetitions of the same words and phrases. Gross violations of writing occur: handwriting, literacy, and semantic expression change. The patient gradually ceases to recognize objects, understand their purpose (he cannot, for example, name a pen, a knife and what they are needed for), and therefore cannot use them.

A profound decrease in intelligence leads to increased suggestibility and stereotypical imitation of others (their facial expressions, gestures, repetition of words after them). If the patient is not disturbed, then he is mostly silent, or repeats the same movements or phrases.

As the disease progresses, memory impairments, especially memorization, become increasingly noticeable. new information, leading to disruption of orientation in space. At the final stage, there is a total breakdown of thinking, recognition, speech, writing, and skills. Complete mental and physical helplessness (senility) sets in. The prognosis is unfavorable. Death comes from various reasons, usually as a result of infection.

Alzheimer's disease

Alzheimer's disease is one of the types of presenile dementia that occurs as a result of atrophy mainly in the temporal and parietal lobes brain. The disease begins on average at 55 years of age and is much more common than Pick's disease. Women get sick 3-5 times more often than men. The disease begins with increasing memory impairment. However, patients notice these disorders and the associated decrease in intellectual capabilities and try in every possible way to hide this from others. With the increase in memory impairment, a feeling of confusion, misunderstanding, and bewilderment appears, which in some cases forces them to consult a doctor.

Gradually, patients cease to navigate in place and time, accumulated knowledge, experience, and skills fall out of memory. The process of loss goes from the present to the past, that is, events that are immediate in time are forgotten first, and then more distant ones. At first, memory for abstract concepts suffers - names, dates, terms, titles. Next, memory impairments occur, and therefore patients begin to confuse the chronological sequence of events, both in general and in their personal lives. Patients cannot tell where they are or their home address (they can give the address of the house where they lived in their youth). Having left the house, they cannot find their way back. Recognition of shape, color, faces, and spatial location is impaired.

People from the immediate circle begin to be called by other people's names, for example, representatives of the younger generation - by the names of their brothers and sisters, then - by the names of long-dead relatives and acquaintances. Ultimately, patients cease to recognize their own appearance: looking at themselves in the mirror, they may ask, “Who is this old woman?” Poor orientation in space is reflected in the disorder and asymmetry of handwriting: letters accumulate in the center or in the corners of the page, usually written vertically. Speech disorders, poor vocabulary, and lack of understanding of what is heard, read, or written in one’s own hand are closely associated with this. Therefore, writing increasingly represents a collection of irregular circles, curves, and then straight lines. Speech becomes increasingly incomprehensible, consisting of separate parts of words and syllables.

Patients gradually lose all the skills and habitual actions acquired during their lives: they cannot get dressed, cook food, do some basic work, for example, sew on a button, and ultimately - perform even one purposeful action. The mood is unstable: apathy alternates with gaiety, excitement, continuous and incomprehensible speech. In the final stage of the disease, gait disturbances, convulsive seizures, reflex movements of the lips and tongue (sucking, smacking, chewing) may be observed. The outcome of the disease is unfavorable: a state of complete insanity. Death occurs either during a seizure or due to an associated infection.

Senile dementia

Senile dementia (senile dementia) is a disease of old age caused by brain atrophy, manifested by the gradual disintegration of mental activity with loss individual characteristics personality and outcome in total dementia. Senile dementia is a central problem in late-life psychiatry. Patients with senile dementia make up 3-5% of the population of people over 60 years of age, 20% among 80-year-olds and from 15 to 25% of all elderly mentally ill people.

The cause of senile dementia, like other atrophic processes, is still unknown. There is no doubt about the role of heredity, which is confirmed by cases of “familial dementia”. The disease begins at 65-75 years of age, average duration disease - 5 years, but there are cases with a slow progression over 10-20 years.

The disease develops imperceptibly, with gradual personality changes in the form of sharpening or exaggeration of previous character traits. For example, frugality turns into stinginess, persistence into stubbornness, distrust into suspicion, etc. At first, this resembles the usual characterological shifts in old age: conservatism in judgments and actions; rejection of the new, praise of the past; tendency to moralize, edify, intractability; narrowing of interests, selfishness and egocentrism. Along with this, the pace of mental activity decreases, attention and the ability to switch and concentrate deteriorate.

Thinking processes are disrupted: analysis, generalization, abstraction, logical inference and judgment. With the coarsening of a personality, its individual properties are leveled out and the so-called senile traits become more and more prominent: narrowing of horizons and interests, stereotyped views and statements, loss of previous connections and attachments, callousness and stinginess, pickiness, grumpiness, malice. In some patients, complacency and carelessness, a tendency to talkativeness and jokes, complacency and impatience of criticism, tactlessness and loss predominate. moral standards behavior. In such patients, modesty and basic moral principles disappear. In the presence of sexual impotence, there is often an increase in sexual desire with a tendency towards sexual perversion (public exposure of the genitals, seduction of minors).

Along with the “deterioration” of character, which loved ones often regard as a normal age-related phenomenon, memory disorders gradually increase. Memorization is impaired and the ability to acquire new experiences is lost. The reproduction of information in memory also suffers.

First, the most recently acquired experience falls out of memory, then memory for distant events also disappears. Forgetting the present and recent past, patients remember the events of childhood and adolescence quite well. There appears to be a shift of life into the past, up to “life in the past,” when an 80-year-old woman considers herself an 18-year-old girl and behaves according to this age. Roommates and medical staff names the names of persons who were in her circle at that time (long dead). In answering questions, patients report facts from long ago or talk about fictitious events. At times, patients become fussy, businesslike, collecting and tying things into bundles - “getting ready for the journey,” and then, sitting with the bundle on their laps, waiting for the trip. This occurs due to gross violations of orientation in time, the environment, and one’s own personality.

However, it should be noted that with senile dementia there is always a discrepancy between pronounced dementia and the preservation of certain external forms of behavior. The manner of behavior with features of facial expressions, gestures, and the use of familiar expressions is preserved for a long time. This is especially evident in streets with a certain professional style of behavior developed over many years: teachers, doctors. Thanks to the preservation of external forms of behavior, lively facial expressions, several common speech patterns and some reserves of memory, especially for past events, such patients at first glance can create the impression of being completely healthy. And only by chance asked question can reveal that a person who is having a lively conversation with you and demonstrating an “excellent memory” for past events does not know how old he is, cannot determine the date, month, year, season, has no idea where he is or who he is talking to etc. Physical decrepitude develops relatively slowly, compared with the increase in mental decay of the personality. However, over time there appear neurological symptoms: constriction of the pupils, weakening of their reaction to light, decreased muscle strength, trembling of the hands (senile tremor), gait with small, mincing steps (senile gait).

Patients lose weight, the skin becomes dry and wrinkled, and function is impaired. internal organs, insanity sets in. During the course of the disease, there may be psychotic disorders with hallucinations and delusions. Patients hear “voices” containing threats, accusations, and talk about torture and reprisals against loved ones. There may also be visual illusions of perception (they see a person who came into their apartment), tactile ones (“bugs” crawling on the skin).

Delusional ideas mainly spread to people in the immediate environment (relatives, neighbors), their content is ideas of damage, robbery, poisoning, and less often persecution.

Recognizing atrophic processes in the brain is difficult in the initial stages of the disease, when it is necessary to exclude vascular pathology, brain tumors and other diseases. With a pronounced clinical picture of the disease, making a diagnosis is not particularly difficult. Used to confirm the diagnosis modern methods research ( CT scan brain).

Treatment

There are currently no effective methods for treating atrophic processes. However, proper care and the prescription of symptomatic remedies (for individual symptoms of the disease) have great importance for the fate of such patients. At the onset of the disease, it is advisable to keep them at home without sudden changes in their lifestyle. Hospitalization may cause the condition to worsen.

The patient needs to create conditions for a fairly active lifestyle so that he moves more, lies less during the daytime, and is more occupied with his usual household chores. In case of severe dementia and in the absence of the possibility of constant care and monitoring of the patient at home, inpatient treatment or stay in a special boarding school is indicated. Psychotropic drugs are prescribed only for sleep disorders, fussiness, delusional and hallucinatory disorders. Preference is given to drugs that do not cause weakness, lethargy, or other side effects and complications. Tranquilizers are recommended only at night (radedorm, eupoctin). Antidepressants used include pyrazidol and azafen; neuroleptics - sonapax, teralen, etaparazine, haloperidol drops. All drugs are prescribed in minimal doses in order to avoid unwanted complications. Treatment with nootropics and other metabolic agents is advisable only for early stages disease, when it contributes to some extent to stabilizing the process.

There is no prevention for senile dementia. Good care, timely treatment of internal diseases and maintaining mental health can significantly prolong the patient's life.

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- this is one of those mental illnesses that manifests itself exclusively after 60 years, is expressed by various kinds of disorders, according to external signs very similar to endogenous mental illnesses, but it is worth noting the absence of senile dementia with this diagnosis.

In order for the disease to proceed without complications and the symptoms to be less pronounced, it is necessary to consult a specialist in a timely manner.

Causes

IN Lately This disease is often detected, but in the vast majority of cases, a doctor is consulted already acute stage. The manifestation is most often caused by somatic disorders, therefore they are defined as somatogenic psychoses of old age.

This can be influenced by the most various factors, for example, diseases of the respiratory tract, genitourinary or cardiovascular systems, and surgical interventions. In some cases, the cause may be poor nutrition, impaired vision or hearing. Diagnosing such a disease is not so easy, which is why treatment is not provided in a timely manner.

Symptoms depending on classification

In medicine, senile psychoses are divided into two forms: acute, which is characterized by clouding of consciousness, and chronic, which is fundamentally distinguished by hallucinations and a depressive state.

Acute form

The most common causes are: insufficient vitamins in the diet, hearing impairment, decreased vision, physical inactivity, as well as lack of sleep or upper respiratory tract disease. Most often, acute psychosis in older people is diagnosed when the situation is extremely advanced.

Such an exacerbation can be avoided in 9 out of 10 cases if you seek help in time. qualified assistance. Like any other disease, acute psychosis develops gradually and allows time for its detection.

In old age, somatic problems cannot be ignored, as in the future this can lead to a deterioration in their mental state and health. Acute psychosis always manifests itself unexpectedly and sharply, but, as a rule, it is preceded by a prodromal stage, which lasts for 1 to 3 days.

This period is determined by the following criteria:

• weakness;
• problems in self-care;
• violation of orientation in space;
• loss of appetite;
• sleep disturbance;

The end of such a period means only one thing - the onset of the stage acute psychosis, which is expressed in increased motor activity, anxiety, concern, the need to do something or go somewhere, confusion of thinking, and unclear formulation of demands and requests.

The pathology is accompanied by the emergence of delusional thoughts, unreasonable aggression, and the belief that everyone around them wants to cause harm in one way or another.

Hallucinogenic phenomena may occur that are not sustainable. During this period, an exacerbation of those somatic disorders that had a key influence on the deterioration of the patient’s health is considered normal.

Acute psychosis manifests itself over 2-3 weeks, during which time a person’s behavior can be stable, without any significant changes, or it can be accompanied by regular exacerbations and outbursts, during the intervals between which the patient is in a deeply depressed and apathetic state.

Chronic form

This form of the disease can also be divided into several types, which differ in symptoms and types of manifestation.

The following symptoms are recognized as the main ones:

1. Depressive state. Older women are most susceptible to this disorder; it can begin with a mild form - apathy, lethargy, awareness of the futility of everything that is happening, a feeling of hopelessness. A more complex form of this disorder may result in increased anxiety, aggression, deepest depression, self-flagellation and not even long-term memory loss. According to statistics, depression lasts from 12 to 17 years.
2. Paranoid state- this is aggravated mental condition a person, accompanied by chronic delusions aimed at his own environment, in addition to this, the patient can be completely sure that everyone wants to cause him irreparable harm, get rid of him and even kill him, also anxiety and the desire to protect him from influence extends to things and property. This condition can last throughout life.
3. Hallucinosis is a type of psychotypical disorder in which mental clarity is maintained, but hallucinogenic phenomena, illusions, visions and sensations caused by various receptors occur. Such a manifestation can take the following forms.
   • verbal hallucinosis is that during an attack the patient hears non-existent voices, which in most cases carry a semantic load, they threaten or insult the patient. During such an attack, an elderly person becomes anxious, his physical activity, aggressiveness. The rest of the time, such vocal manifestations are perceived less critically;
   • visual hallucinosis is manifested by the appearance of planar hallucinations in the form of pictures, As the patient’s condition progresses, the pictures become more voluminous and colorful, closer to reality, and their number also increases.

     Most often, the patient adequately assesses the situation, understanding its unreality, but despite this, he can enter into dialogue with the characters of the hallucinations, and even perform some actions under the influence of the latter. The age of such patients is often close to 80 years;

     Changes in the psyche under the influence of anthropogenic factors are inevitable, but such critical deviations and disorders can cause inconvenience not only to others, but also to the patient himself, who can cause damage to his physical health.

     That is why, when identifying initial signs any form of disorder, it is necessary to immediately consult a doctor, even if it is forced on the patient.

     Treatment

     To diagnose an illness, it is necessary to observe the complete picture, consisting of a set of symptoms to differentiate the existing form of psychosis and disorder from other diagnoses with similar symptoms.

     After assessing the clinical picture and making a correct diagnosis, the doctor has the right to recommend hospitalization, which can only be carried out with the consent of the patient’s relatives.
     Treatment is carried out in this case, taking into account all the factors influencing the condition:

     • degree of neglect of the disease;
     • form;
     • cause;
     • a set of somatic disorders that have affected psychological condition person.

     During treatment depressive disorder psychotropic drugs are prescribed, either individually or in combination. In other cases, they resort to medications such as haloperidol, Sonapax, triftazin and others.

     In addition, corrective medications may be prescribed.

     For each patient, the type of treatment is selected individually, taking into account the characteristics of the psychosomatic condition. Such courses should only be carried out under the supervision of a physician.

     Oddly enough, the acute form of the disease in question is considered more favorable for cure, since with a long course of the disease, drugs most often only relieve attacks and alleviate the patient’s suffering, but do not completely eliminate them.

     In this case, it is necessary to warn the patient’s relatives that attacks and exacerbations will recur regularly and teach them to live with this, to be tolerant of the current situation, because the elderly person is unable to influence his behavior.

     Forecast

     Experts give the most favorable prognosis for the acute form of the disease, since otherwise the development of a stable psychoorganic syndrome is observed. In the case of chronic forms of the disease, the most adaptive form of the paranoid state is considered, despite the manifestations of delirium. In other cases, the chance of recovery is minimal.

Senile psychosis (or senile psychosis) is a group of mental illnesses of different etiologies that occur after 60 years of age. It manifests itself as clouding of consciousness and the emergence of various endoform disorders (resembling schizophrenia and manic-depressive psychosis). In various sources you can find information that senile psychosis is identical to senile dementia, that they are one and the same thing. But this is not entirely true. Yes, senile psychosis can be accompanied by dementia, but in this case it is not total. AND key features senile psychosis, still have the character of a psychotic disorder (sometimes the intellect remains intact).

There are acute and chronic forms of senile psychosis. Acute forms are manifested by clouding of consciousness, and chronic forms are manifested by the occurrence of paranoid, depressive, hallucinatory and paraphrenic states. Regardless of age, medical treatment for such conditions is mandatory.

Acute forms of senile psychosis

Their occurrence is associated with the presence of somatic diseases, which is why they are called somatogenic. The cause may be a lack of vitamins, heart failure, illness genitourinary system, upper respiratory tract diseases, lack of sleep, physical inactivity, decreased hearing and vision.

Such somatic diseases in older people are not always diagnosed in a timely manner, and treatment is often delayed. On this basis, an acute form of senile psychosis arises as a consequence. All this once again emphasizes how important role has timely treatment of any somatic diseases in older people - their mental health may depend on this.

Typically, the acute form of senile psychosis occurs suddenly. But, in some cases, the onset of acute psychosis is preceded by a so-called prodromal period (1-3 days).

During this period, the patient experiences weakness and problems in self-care, spatial orientation becomes difficult, appetite and sleep are disturbed. Then, in fact, the attack of acute psychosis itself occurs.

It is expressed in motor restlessness, fussiness, confusion of thinking. Various crazy ideas and thoughts (the patient usually believes that they want to harm him, take away his property, etc.). Hallucinations and illusions may appear, but they are few and have a stable appearance. As a rule, when acute senile psychosis develops, the symptoms of somatic disorders that led to its development also worsen. Psychosis lasts from several days to 2-3 weeks. The disease itself can occur continuously, or it can occur in the form of periodic exacerbations. During the period between exacerbations, the patient feels weakness and apathy. Treatment of the acute form of senile psychosis is preferably carried out in a hospital.

Chronic forms of senile psychosis

There are several chronic forms, and they are determined by the key signs (symptoms) that accompany the course of the disease.

Depressive states

Depressive states (more common in women). In mild cases, there is lethargy, apathy, a feeling of the meaninglessness of the present and the futility of the future. In severe cases, pronounced anxiety occurs, deep depression, delirium of self-blame, agitation up to Cotard's syndrome. The duration of the disease is usually 12-17 years, and nevertheless, the patient’s memory disorders are usually not profound.

Paranoid states

They are characterized by chronic delusions, which are usually directed at the immediate environment (relatives, neighbors). The patient constantly says that he is offended and oppressed in his own home, and they want to get rid of him. It seems to him that his personal belongings are being stolen or damaged. In severe cases, delusional ideas arise that they are trying to destroy him - kill him, poison him, etc. The patient can lock himself in his room and restrict access to other persons. However, with this form of the disease, the person is able to take care of himself, and in general socialization is preserved. The disease develops and lasts for many years.

Usually expressed as a combination of hallucinations various kinds with paranoid ideas and thoughts. This disease appears at the age of about 60 years and lasts for many years, sometimes up to 10-15 years. The clinical picture quickly becomes similar to the signs of schizophrenia (for example, the patient suspects that they want to kill or rob him, and this is accompanied by various visual hallucinations, the patient “hears voices,” etc.). Memory impairments develop slowly, are not noticeable in the first stages of the disease, and clearly manifest themselves after many years of the disease.

Senile paraphrenia (confabulosis)

Typical signs of the disease are multiple confabulations related to the past (the patient attributes to himself acquaintances and connections with famous and influential people, there is an overestimation of oneself, up to delusions of grandeur). Such confabulations take on the appearance of “clichés,” that is, they practically do not change either in form or content. Such disorders occur at the age of 70 years or more; memory impairments are not pronounced at the initial stage and develop gradually.

Of course, the gradual age-related breakdown of the psyche is partly a natural process. However, the symptoms of such illnesses can be painful both for the patient himself and for his loved ones. In extremely severe conditions, the patient may cause unintentional harm to himself or others. Therefore, treatment of such conditions is certainly necessary. While a person is alive, one must do everything possible to ensure that the last years of his life are filled with joy and tranquility.

Treatment methods for senile psychosis

The decision on the need for hospitalization is made by the doctor, with the consent of the patient’s relatives. Treatment is carried out taking into account general condition patient: the form and severity of the disease, as well as the presence and severity of somatic diseases are taken into account.

At depressive states psychotropic drugs such as azafen, pyrazidol, amitriptyline, and melipramine are prescribed. Sometimes a combination of two drugs is used at a certain dosage. Other forms of senile psychosis are treated with the following drugs: triftazine, propazine, haloperidol, sonapax. Treatment of any form of senile psychosis also involves the appointment of correctors (for example, cyclodol).

In each individual case, drugs are selected individually, and treatment should also include the correction of concomitant somatic diseases.

Doctors give the most favorable prognosis for acute forms of senile psychosis. For long periods, chronic forms ah disease, the prognosis is usually unfavorable, most often drugs only relieve symptoms, but the disease remains and accompanies the person for the rest of his life. Therefore, the patient’s family and friends need to be patient, show calm and loyalty - after all, age-related mental breakdown is an objective phenomenon, it does not depend on the will of the old person.

Senile psychoses

e. acute forms of senile psychoses are symptomatic psychoses.

Causes of senile psychoses:

In some cases, the cause of senile psychosis may be physical inactivity, sleep disturbances, malnutrition, sensory isolation (decreased vision, hearing). Since detection of somatic disease in older people is often difficult, its treatment in many cases is delayed. Therefore, mortality in this group of patients is high and reaches 50%. For the most part, psychosis occurs acutely; in some cases, its development is preceded by a prodromal period lasting one or several days, in the form of episodes of unclear orientation in the environment, the appearance of helplessness in self-care, increased fatigue, as well as sleep disturbances and lack of appetite.

Clearly delineated clinical pictures are much less common, most often delirium or stupor.

The disease can occur either continuously or in the form of repeated exacerbations. During the recovery period, patients constantly experience adynamic asthenia and passing or persistent manifestations of psychoorganic syndrome.

Forms and symptoms of senile psychoses:

Chronic forms of senile psychosis, occurring in the form of depressive states, are observed more often in women. In the mildest cases, subdepressive states occur, characterized by lethargy and adynamia; patients usually complain of a feeling of emptiness; the present seems insignificant, the future is devoid of any prospects. In some cases, a feeling of disgust for life arises. There are constantly hypochondriacal statements, usually associated with certain existing somatic diseases. Often these are “silent” depressions with a small number of complaints about one’s state of mind.

Paranoid states (psychoses):

Paranoid states, or psychoses, are manifested by chronic paranoid interpretive delusions, spreading to people in the immediate environment (relatives, neighbors) - the so-called delusions of small scope. Patients usually talk about being harassed, wanting to get rid of them, intentionally damaging their food, personal belongings, or simply being stolen. More often they believe that by “bullying” others want to hasten their death or “survive” from the apartment. Statements that people are trying to destroy them, for example, by poisoning them, are much less common. At the onset of the disease, delusional behavior is often observed, which is usually expressed in the use of various devices that make it difficult to enter the patient’s room, less often in complaints sent to various government agencies, and in a change of place of residence. The disease continues for for long years with gradual reduction delusional disorders. Social adaptation Such patients usually suffer little. Lonely patients take full care of themselves and maintain family and friendly ties with former acquaintances.

Hallucinatory states:

Hallucinatory states, or hallucinoses, manifest mainly in old age. There are verbal and visual hallucinoses (Bonnet hallucinosis), in which other psychopathological disorders are absent or occur in a rudimentary or transient form. The disease is combined with severe or complete blindness or deafness. With senile psychoses, other hallucinoses are also possible, for example tactile hallucinosis.

Tactile hallucinosis:

Hallucinatory-paranoid state:

Hallucinatory-paranoid states more often appear after 60 years in the form of psychopathic-like disorders that last for many years, in some cases up to 10-15. The clinical picture becomes more complicated due to paranoid delusions of damage and robbery (delusions of small scope), which may be joined by unsystematized ideas of poisoning and persecution, which also extend to people in the immediate environment. The clinical picture changes mainly at the age of 70-80 years, as a result of the development of polyvocal verbal hallucinosis, similar in manifestations to Bonnet verbal hallucinosis. Hallucinosis can be combined with individual ideational automatisms - mental voices, a feeling of openness, echo thoughts.

Senile paraphrenia (senile confabulosis):

Another type of paraphrenic state is senile paraphrenia (senile confabulosis). Among such patients, people aged 70 years and older predominate. The clinical picture is characterized by multiple confabulations, the content of which relates to the past. Patients talk about their participation in unusual or significant events social life, about meeting high-ranking people, and relationships that are usually erotic in nature.

Signs of senile psychosis:

Most chronic senile psychoses are characterized by the following: general signs: limitation clinical manifestations one set of disorders, preferably one syndrome (for example, depressive or paranoid); severity psychopathological disorders, which allows one to clearly qualify the psychosis that has arisen; long-term existence of productive disorders (delusions, hallucinations, etc.) and only their gradual reduction; combination within long period productive disorders with sufficient preservation of intelligence, in particular memory; Memory disorders are more often limited to dysmnestic disorders (for example, such patients retain affective memory for a long time - memories associated with emotional influences).

Diagnosis of senile psychosis:

The diagnosis of senile psychosis is established on the basis of the clinical picture. Depressive states in senile psychoses are differentiated from depressions in manic-depressive psychosis that arose at a late age. Paranoid psychoses are distinguished from late-onset schizophrenia and paranoid states in the onset of senile dementia. Bonnet's verbal hallucinosis should be differentiated from similar conditions that occasionally occur in vascular and atrophic diseases of the brain, as well as in schizophrenia; Bonnet visual hallucinosis - with a delirious state noted with acute forms senile psychosis. Senile paraphrenia should be distinguished from presbyophrenia, which is characterized by signs of progressive amnesia.

Treatment of senile psychoses:

Treatment is carried out taking into account physical condition sick. Of the psychotropic drugs (it must be remembered that aging causes a change in the reaction of patients to their action), amitriptyline, azaphene, pyrazidol, and melipramine are used for depressive states. In some cases, two drugs are used simultaneously, for example melipramine and amitriptyline. For other senile psychoses, propazine, stelazine (triftazine), haloperidol, sonapax, teralen are indicated. When treating all forms of senile psychosis with psychotropic drugs, correctors (cyclodol, etc.) are recommended. Side effects are more often manifested by tremor and oral hyperkinesia, which are easily taken chronic course and are difficult to treat. In all cases, strict monitoring of the somatic condition of patients is necessary.

The prognosis for acute forms of senile psychoses is favorable in the case of timely treatment and the short duration of the state of stupefaction. Long-term existing obscuration consciousness entails the development of a persistent and, in some cases, progressive psychoorganic syndrome. The prognosis for chronic forms of senile psychosis with regard to recovery is usually unfavorable. Therapeutic remission is possible for depressive states, Bonnet visual hallucinosis, and for other forms - a weakening of productive disorders. Patients with a paranoid state usually refuse treatment; They have the best adaptive capabilities despite the presence of delirium.