Somatogenic mental disorders: causes, symptoms. Somatogenic psychosis is

09.06.2015

— mental disorders for somatic diseases. Mental disorders arising in connection with pathology internal organs and systems, constitute a special section of psychiatry - somatopsychiatry.

Despite the diversity of psychopathological symptoms and clinical forms somatic pathology, they are united by commonality pathogenetic mechanisms and patterns of development. The diagnosis of “somatogenic psychosis” is made under certain conditions: the presence of somatic disease; temporary connection between somatic and mental disorders, interdependence and mutual influence in their course.

Symptoms and course of the disease

Symptoms and course depend on the nature and stage of development of the underlying disease, its severity, the effectiveness of the treatment, as well as individual characteristics patient, such as heredity, constitution, character, gender, age, condition protective forces organism and the presence of additional psychosocial hazards.

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

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

Some patients are full of painful doubts about the effectiveness of the treatment prescribed to them, successful outcome disease and its consequences. For others, anxiety and fear of the possibility of serious and long-term treatment, before surgery and complications, the likelihood of disability.

For a long time, chronic course illness, when there is no hope for improvement, an indifferent attitude towards oneself and the outcome of the disease may arise. The patients lie indifferently in bed, refusing food and treatment, “it’s all the same.” However, even in such apparently emotionally inhibited patients, even with minor outside influence, anxiety, tearfulness, self-pity and a desire to receive support from others may occur.

2 The second, much larger group consists of patients who have mental disorders are as if integral part clinical picture diseases. These are patients with psychosomatic pathology (see the article Psychosomatic diseases for more details), along with severe symptoms In internal diseases (hypertension, peptic ulcer, diabetes mellitus), neurotic and pathocharacterological reactions are observed.

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

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

asthenic
affective (mood disorders)
deviations in characterological reactions
delusional states
confusion syndromes
organic psychosyndrome

It is a core or end-to-end syndrome in many diseases. But it could be like a debut ( initial manifestation), and the end of the disease. Typical complaints include weakness, increased fatigue, difficulty concentrating, irritability, intolerance bright light, loud sounds. Sleep becomes shallow and restless. Patients have difficulty falling asleep, difficulty waking up, and getting up unrested.

Along with this, emotional instability, touchiness, and impressionability appear. Asthenic disorders are rarely observed in pure form, it is combined with anxiety, depression, fears, unpleasant sensations in the body and a hypochondriacal fixation on his illness.

At a certain stage, asthenic disorders can appear in any disease. Everyone knows that ordinary colds, the flu is accompanied by similar phenomena, and the asthenic “tail” often persists even after recovery.

Emotional disturbances

For somatic diseases, a decrease in mood with various shades is more typical: anxiety, melancholy, apathy. In occurrence depressive disorders The influence of psychotrauma (the disease itself is trauma), somatogenesis (the disease as such) and the personal characteristics of the patient are closely intertwined.

The clinical picture of depression varies depending on the nature and stage of the disease and the prevailing role of one or another factor. Thus, with a long course of the disease, a depressed mood can be combined with dissatisfaction, grumpiness, pickiness, and moodiness.

If on early stages the disease is more characterized by anxiety, fear, sometimes with suicidal thoughts, then with prolonged severe course disease may be dominated by indifference with a tendency to ignore the disease.

Increased mood in the form of complacency and euphoria is much less common. The appearance of euphoria, especially in severe somatic diseases (cancer, myocardial infarction) is not a sign of recovery, but a “harbinger” of an unfavorable outcome and usually occurs in connection with oxygen starvation brain

The appearance of euphoria is usually accompanied by anosognosia(denial of one’s own illness), which represents serious danger for the patient due to his underestimation of the severity of his condition and, as a consequence, incorrect behavior.

Deviations in characterological reactions

Characterological (psychopathic) disorders are observed more often with long-term illnesses with a chronic course and manifest themselves in the sharpening of personal characteristics and reactions. Diseases starting in childhood, contribute to the formation of pathocharacterological development of personality.

Diseases that result in appearance defects ( skin diseases, extensive burns, curvature of the spine, etc.) are the basis for the development of an inferiority complex, limiting social connections and emotional contacts of patients. Patients due to long illness become gloomy, selfish with a hostile and sometimes hostile attitude towards others.

Those living in conditions of overprotection and increased care become even more self-centered, requiring constant attention. In others, anxiety, suspiciousness, shyness, self-doubt, and indecision may increase, which forces patients to lead a solitary lifestyle.

Syndromes of confusion

These include: stupor, delirium, amentia, oneiroid, twilight stupefaction, etc.

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

Coma characterized by loss of all types of orientation and responses to external stimuli. When emerging from a coma, patients do not remember anything about what happened to them. Switching off consciousness is observed in renal, liver failure, diabetes and other diseases.

Delirium- a state of darkened consciousness with difficult orientation in place, time, environment, but maintaining orientation in one’s own personality.

Patients develop abundant illusions of perception (hallucinations), when they see objects and people that do not exist in reality, or hear voices. Being absolutely sure of their existence, they cannot distinguish real events from unrealistic ones, therefore their behavior is determined by a delusional interpretation of the environment.

Noted strong excitement maybe fear, horror, aggressive behavior depending on the hallucinations. Patients in this regard can pose a danger to themselves and others. Upon recovery from delirium, the memory of the experience is preserved, while the events that actually occurred may fall out of memory. A delirious state is characteristic of severe infections, poisoning.

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

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

Amentive state (amentia- a deep degree of confusion) is accompanied not only total loss orientation in the environment, but also in one’s own “I”. The surroundings are perceived fragmentarily, incoherently, and disconnectedly. Thinking is also impaired; the patient cannot comprehend what is happening.

There are deceptions of perception in the form of hallucinations, which are accompanied by motor restlessness (usually in bed due to severe general condition), incoherent speech. Excitement may be followed by periods of immobility and helplessness. The mood is unstable: from tearfulness to unmotivated gaiety.

The amental state can last for weeks and months with short clear intervals. The dynamics of mental disorders are closely related to the severity physical condition. Amentia is observed in chronic or rapidly progressing diseases (sepsis, cancer intoxication), and its presence, as a rule, indicates the severity of the patient’s condition.

Twilight stupefaction- a special type of clouding of consciousness, acutely beginning and suddenly ending. Accompanied by complete loss of memory for this period. The content of psychopathological products can only be judged by the results of the patient’s behavior.

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

A feature of stupefaction syndromes in somatic diseases is their erasure, short duration, rapid transition from one state to another and the presence of mixed states.

Prevention and treatment of somatogenic psychoses with our herbal remedies

Concerning of this disease, then we can offer very effective drugs and methods for the treatment and prevention of diseases that arise as a result of the psychosomatic reaction of a particular person’s body to stress.

It is customary to distinguish between two broad groups: symptomatic psychoses and non-psychotic ones. somatogenic disorders. According to various studies, the frequency of symptomatic psychoses varies from 0.5 to 1-1.2% of all somatic patients, i.e. very significant, given the high prevalence of internal diseases.

According to duration, somatogenic psychoses are divided into acute, or transient, subacute and protracted. Acute exogenous psychoses last from several hours to several days. These mainly include stupefaction syndromes: delirium, stupor, twilight stupefaction, amentia, oneiroid (rarely). Subacute symptomatic psychoses, lasting up to several weeks, include depression, manic-euphoric states, verbal hallucinosis, sensory delusions, hallucinatory-delusional, depressive-delusional states. Prolonged symptomatic psychoses, lasting up to several months, and in isolated cases - a year or more, can manifest themselves as chronic verbal hallucinosis, delusions with elements of systematization, catatonic-like disorders (rarely), persistent Korsakoff symptom complex. Of the acute symptomatic psychoses, the most typical is delirium in the form of abundant true visual hallucinations, illusions, false orientation, transient hallucinatory delusions, psychomotor agitation reflecting the content of hallucinatory-delusional experiences, and partial amnesia.

Another one typical picture acute symptomatic psychoses - asthenic confusion. It is related to amentia and is expressed in deep disorientation, an affect of bewilderment, inconsistency and incoherence of thinking, in monotonous, bed-bound, speech motor agitation, fragmented perception of the environment, fragmentary delirium, hallucinations and complete amnesia of what is happening. Accompanying severe exhaustion is manifested in a rapidly fading ability to maintain verbal contact. Soon the answers become increasingly monosyllabic and end in silence. Asthenic confusion is observed mainly with severe intoxication, deterioration somatic condition and worsening prognosis. In such cases, a thorough examination and identification of the causes of somatic decompensation are necessary.

Another common type of somatogenic mental disorder is depression. It comes in varying depths, but mostly at a non-psychotic level. More typical is the combination of depression with asthenia, weakness, anxiety, hypochondriasis, and various autonomic disorders and pathological sensations. Ideas of guilt, refusal to eat, and suicidal tendencies are possible.

The dynamics of somatogenic psychoses are very diverse. Possible single attacks, recurrent and continuous, including progressive, over time leading to the formation of irreversible psycho-organic disorders varying degrees expressiveness.

Clear correlations between the severity of somatic and mental disorders are rarely identified. The development of somatogenic psychoses does not always mean an increase in somatic pathology. Paradoxical inverse relationships between the depth of visceral and mental disorders are possible: the worsening of symptomatic psychoses is sometimes accompanied by an improvement in the somatic condition, and vice versa.

Pathogenetic mechanisms somatogenic psychoses are complex and largely insufficiently understood. The most universal pathogenetic mechanisms of symptomatic psychoses:

metabolic disorders;

weakened or distorted reactivity;

intoxication, including medicinal and infectious;

hypoxic factor due to cardiovascular or pulmonary diseases.

In case of circulatory failure, intracranial infection, hypoxia, traumatic brain injury, patients acutely or gradually develop psychoorganic disorders of varying severity:

cerebrovascular disease;

encephalopathy;

Korsakov's syndrome;

epileptiform syndrome;

dementia, in the form of frequent headaches, dizziness, meteoropathy, mnestic-intellectual deficiency, excitability, conflict and other psychopathic disorders.

Forecast somatogenic psychoses are different. Amentia has the most unfavorable prognosis. In the past, amentia was thought to indicate a fatal deterioration in physical condition and a possible poor outcome. Currently, due to the achievements modern medicine, amentia is rare and the prognosis is not so pessimistic.

Typical delirium is a relative indicator favorable prognosis, especially its abortive (pareidolic and hypnagogic) variants. Delirium and occupational delirium, on the contrary, have a prognosis almost as unfavorable as an amental state.

Increasing stupor, with transition to stupor and coma, indicates a violation cerebral circulation and, by at least, for a temporary increase intracranial pressure and the need for urgent medical emergencies.

Manic-euphoric states are prognostically favorable. The occurrence of this syndrome often indicates the onset of convalescence.

The syndromic picture of symptomatic psychoses has a certain diagnostic value. Delirium is more likely to indicate infectious nature diseases, and amentia - to a debilitating and progressive internal disease.

D., 27 years old. Due to ulcerative bleeding underwent gastric resection. On the 3rd day he became restless and had difficulty staying in bed. He was afraid of something, kicked someone out of the room, demanded that they leave. He was looking closely at something, listening. He looked confused, was afraid, and constantly looked from one place to another. He protested when the lights were turned off. On a short time calmed down, fell asleep, but quickly woke up. After 2 days, during treatment with tableted haloperidol and injectable Relanium, behavior became orderly. Correctly oriented. Answered questions coherently. He told the doctor that he saw himself in a large unfamiliar room with the lights off, filled with some people. I saw them poorly in the dark, like “vague shadows.” For some reason I realized that these were “guest workers”. They made noise, played cards, disturbed sleep, and did not answer his calls and questions. I heard guest workers say to each other: “He’s bothering us. Maybe kill him? He admitted with embarrassment that he must have suffered a mental disorder. But now “everything has fallen into place.” D. had postoperative hypnagogic delirium interspersed with episodes of confusion.

Description:

Somatogenic psychoses(mental disorders in somatic diseases). Mental disorders arising in connection with the pathology of internal organs and systems constitute a special branch of psychiatry - somatopsychiatry. Despite the diversity of psychopathological symptoms and clinical forms of somatic pathology, they are united by a common pathogenetic mechanisms and patterns of development.

Symptoms:

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

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

Mental disorders as a reaction to the very fact of illness, hospitalization and the associated separation from family and familiar surroundings. The main manifestation of such a reaction is varying degrees of depressed mood with one shade or another. Some patients are full of painful doubts about the effectiveness of the treatment prescribed to them, about the successful outcome of the disease and its consequences. Others are dominated by fear of the possibility of serious and long-term treatment, of surgery and complications, and the possibility of disability. Some patients are burdened by the very fact of being in the hospital and yearn for home and loved ones. Their thoughts are occupied not so much with the illness as with household chores, memories and dreams of being discharged. Outwardly, such patients look sad and somewhat inhibited. With a long, chronic course of the disease, when there is no hope for improvement, an indifferent attitude towards oneself and the outcome of the disease may arise. The patients lay indifferently in bed, refusing food and treatment, “it’s all the same.” However, even in such apparently emotionally inhibited patients, even with minor outside influence, anxiety, tearfulness, self-pity and a desire to receive support from others may occur.

The second, much larger group consists of patients in whom mental disorders are, as it were, an integral part of the clinical picture of the disease. These are patients with psychosomatic pathology (see. Psychosomatic illnesses), along with severe symptoms of internal diseases (hypertension, peptic ulcer, ) neurotic and pathocharacterological reactions are observed.

The third group includes patients with acute mental disorders (psychosis). Such conditions develop either in severe acute illnesses with high fever ( lobar inflammation lungs,) or severe intoxication (wasting), or with chronic diseases in the terminal stage (cancer, kidney disease)

In the clinic of internal diseases, despite the wide variety of psychological reactions and more pronounced mental disorders, the most common are the following: 1) asthenic; 2) affective (mood disorders); 3) deviations in characterological reactions; 4) delusional states; 5) syndromes of stupefaction; 6) organic psychosyndrome.

Causes:

This type occurs against the background of a somatic disease. There is a temporary connection between somatic and mental disorders, interdependence and mutual influence in their course.

Treatment:

For treatment the following is prescribed:

It should be aimed, first of all, at the underlying somatic disease, because it depends on its severity mental condition. Treatment can be carried out in the hospital where the patient is, but two conditions must be met. Firstly, such a patient must be examined by a psychiatrist and give his recommendations. Secondly, if the patient is in acute psychosis, he is placed in a separate room with round-the-clock observation and care. In the absence of these conditions, the patient is transferred to the psychosomatic department. If the disease of the internal organs is not the cause of mental disorders, but only provoked the onset mental illness(For example,

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

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

Causes

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

Diseases that may be complicated by the development of somatogenesis: infectious diseases(flu, malaria, infectious hepatitis), malignant tumors, rheumatism, septic endocarditis.

Common symptomatic psychoses are those that develop due to septic (purulent) inflammatory processes. Some medications

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

Classification

Symptomatic psychoses are divided by duration into: Acute (transient) – last from several hours to several days. Main manifestations acute psychoses
Subacute – lasts several weeks, manifests itself in depression, hallucinosis, delirium, manic-euphoric states;
Protracted – their duration is up to several months, and in in rare cases and up to a year. Prolonged somatogenies are manifested by delirium and persistent Korsakov symptom complex (syndrome).

Manifestations

Acute symptomatic psychoses

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

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

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

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

Subacute symptomatic psychoses

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

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

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

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

Prolonged symptomatic psychoses

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

Treatment

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

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

Mental disorders arising in connection with the pathology of internal organs and systems constitute a special branch of psychiatry - somatopsychiatry. Despite the diversity of psychopathological symptoms and clinical forms of somatic pathology, they are united by a common pathogenetic mechanisms and patterns of development.

The diagnosis of “somatogenic psychosis” is made under certain conditions: the presence of a somatic disease is necessary; temporary connection between somatic and mental disorders, interdependence and mutual influence in their course. Symptoms and course depend on the nature and stage of development of the underlying disease, its severity, the effectiveness of the treatment, as well as on the individual characteristics of the patient, such as heredity, constitution, character, gender, age, the state of the body’s defenses and the presence of additional psychosocial harms.

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

1. Mental disorders as a reaction to the very fact of the disease, hospitalization and the associated separation from the family and familiar environment. The main manifestation of such a reaction is varying degrees of depressed mood with one shade or another. Some patients are full of painful doubts about the effectiveness of the treatment prescribed to them, about the successful outcome of the disease and its consequences. Others are dominated by anxiety and fear of the possibility of serious and long-term treatment, of surgery and complications, and the possibility of disability.

Some patients are burdened by the very fact of being in the hospital and yearn for home and loved ones. Their thoughts are occupied not so much with the illness as with household chores, memories and dreams of being discharged. Outwardly, such patients look sad and somewhat inhibited. With a long, chronic course of the disease, when there is no hope for improvement, an indifferent attitude towards oneself and the outcome of the disease may arise. The patients lie indifferently in bed, refusing food and treatment, “it’s all the same.” However, even in such apparently emotionally inhibited patients, even with minor outside influence, anxiety, tearfulness, self-pity and a desire to receive support from others may occur.

The second, much larger group consists of patients in whom mental disorders are, as it were, an integral part of the clinical picture of the disease. These are patients with psychosomatic nataugia, along with severe symptoms of internal diseases (hypertension, peptic ulcer disease, diabetes) neurotic and pathocharacterological reactions are observed.

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

Asthenia is a core or end-to-end syndrome in many diseases. But it can be either a debut (initial manifestation) or the end of the disease. Typical complaints include weakness, increased fatigue, difficulty concentrating, irritability, intolerance to bright light and loud sounds. Sleep becomes shallow and restless. Patients have difficulty falling asleep, difficulty waking up, and getting up unrested. Along with this, emotional instability, touchiness, and impressionability appear. Asthenic disorders are rarely observed in their pure form; they are combined with anxiety, depression, fears, unpleasant sensations in the body and hypochondriacal fixation on one’s illness. At a certain stage, asthenic disorders can appear in any disease. Everyone knows that common colds and flu are accompanied by similar phenomena, and the asthenic “tail” often persists even after recovery.