Somatic psychosis symptoms and treatment. Somatogenic neuropsychiatric disorders

It is customary to distinguish between two broad groups: symptomatic psychoses and non-psychotic 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 typical picture of acute symptomatic psychoses is 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, various autonomic disorders and pathological sensations. Ideas of guilt, refusal to eat, and suicidal tendencies are possible.

Dynamics somatogenic psychoses very diverse. Single-attack, recurrent and continuous attacks are possible, including progressive ones, which over time lead to the formation of irreversible psycho-organic disorders of varying severity.

Clear correlations between the severity of somatic and mental disorders are rarely identified. The development of somatogenic psychoses does not always mean an increase 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 physical condition and possible adverse outcome. Currently, due to the achievements modern medicine, amentia is rare and the prognosis is not so pessimistic.

Typical delirium is an indicator of a relatively 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 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 ulcer bleeding, he 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 was 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 agreed with embarrassment that he had probably suffered mental disorder. But now “everything has fallen into place.” D. had postoperative hypnagogic delirium interspersed with episodes of confusion.

Damage to internal organs can cause neuropsychiatric disorders. They are diagnosed based on the presence of symptoms of somatic illness, the time connection between somatic and mental disorders, and the parallelism in their course. The manifestations of these somatogenic disorders are different.

Asthenia characterized by mental and physical weakness, increased fatigue, emotional lability, irritability, hypersensitivity and sleep disorder. As a rule, other mental disorders occur against the background of asthenia.

Neurosis-like disorders consist of easily occurring exhaustion, daytime sleepiness, adynamia, affective instability, weakening of attention and memory. This may also cause headache, dizziness, tinnitus, tachycardia, increased sweating, fluctuations blood pressure, vegetative-vascular paroxysms, cardiophobia, cancerophobia, difficulty breathing, pain and discomfort in the abdomen.

Affective disorders on different stages physical illness varies from melancholy depression to dysphoria with grumpiness, dissatisfaction, pickiness, demandingness, moodiness, as well as anxiety. Prolonged asthenia is combined with depression, indifference, indifference and decreased activity.

Psychopathic-like disorders are more common in the form of egocentrism, suspicion, gloominess, embitterment, wariness, hostility, hysteriform reactions combined with aggravation of symptoms of the disease, demonstrative behavior with persistently attracting attention to oneself.

Delusional states are formed, as a rule, against the background of melancholy, asthenic and anxious depression. In their content, these are ideas of attitude, condemnation, damage, damage or poisoning. Usually the painful statements of patients are not persistent. With diseases that change the patient's appearance, ideas of attitude and physical disability may arise.

Disorders of consciousness. Stunning often develops against the background of asthenia, combined with loss of activity. Its depth varies from mild degrees to stupor, and even coma. Delirium, manifested by hallucinations and anxious arousal, may be combined with stunned or dreamlike experiences. An exhausted patient may experience asthenic confusion - with flickering consciousness, changing orientation and emotional lability.

Psychoorganic syndrome can form in the case of a long course of somatic illness. It is characterized by increasing mental weakness, severe exhaustion, tearfulness, asthenia, combined with dysthymia or obvious dysphoria, flattening of the personality and further impairment of cognitive processes.

Treatment of somatogenic neuropsychiatric disorders carried out in two directions - therapy of the underlying disease and therapy of prevailing mental disorders. Asthenic conditions are treated with sydnocarb (10-15 mg/day), acephen (400-800 mg/day), sibazone (5-15 mg/day), piracetam (1.2-2.0 g/day), chlozepid (30 -80 mg/day), sonapax (20-100 mg/day). For fear and anxiety, small doses of chlozepid, sibazon, and phenazepam are prescribed. For sleep disorders, tizercin (2-8 mg/day) is indicated. For affective disorders and psychomotor agitation - Sonapax (25-200 mg/day). For depression combined with agitation, amitriptyline (75-200 mg/day) is indicated. For disorders of consciousness and motor agitation, diazepam (20-40 mg IM), tizercin (25-75 mg IM), and aminazine (25-75 mg IM) are used. The increase in organic psychosyndrome requires the administration of piracetam (1.2-2.0 g/day), aminalon (1.5-3 g/day), pyriditol (0.3-0.4 g/day). For non-psychotic disorders, psychotherapy is useful. Treatment of somatogenic neuropsychiatric disorders is carried out in somatic hospitals, both by a therapist and a psychiatrist. An excited patient should be isolated in a separate room with an individual post for round-the-clock observation.

Clinical examination . Adolescents who have suffered somatogenic disorders require further observation depending on the completeness of the restoration of their mental health, that is, they belong to groups D-3 or D-2.

Expertise . Attribution to one or another health group depends not only on the mental, but also on the somatic state. Attitude towards military service is determined by the persistence, severity and residual effects after suffering somatogenic disorders.

The content of the article

General and clinical characteristics

Somatogenic mental illnesses are a collective group of mental disorders that arise as a result of somatic non-infectious diseases. These include mental disorders in cardiovascular, gastrointestinal, renal, endocrine, metabolic and other diseases. Mental disorders of vascular origin (with hypertension, arterial hypotension and atherosclerosis) are traditionally classified as a separate group.

Classification of somatogenic mental disorders

1. Borderline non-psychotic disorders:
a) asthenic, neurosis-like conditions caused by somatic non-infectious diseases (code 300.94), metabolic, growth and nutritional disorders (300.95);
b) non-psychotic depressive disorders caused by somatic non-infectious diseases (311.4), metabolic, growth and nutritional disorders (311.5), other and unspecified organic diseases brain (311.89 and 311.9);
c) neurosis- and psychopath-like disorders due to somatogenic organic brain lesions (310.88 and 310.89).
2. Psychotic conditions that developed as a result of functional or organic damage brain:
a) acute psychoses (298.9 and 293.08) - asthenic confusion, delirious, amentive and other syndromes of stupefaction;
b) subacute prolonged psychoses (298.9 and 293.18) - paranoid, depressive-paranoid, anxiety-paranoid, hallucinatory-paranoid, catatonic and other syndromes;
c) chronic psychoses (294) - Korsakoff syndrome (294.08), hallucinatory-paranoid, senestopathic-hypochondriacal, verbal hallucinosis, etc. (294.8).
3. Defective organic conditions:
a) simple psychoorganic syndrome (310.08 and 310.18);
b) Korsakoff syndrome (294.08);
c) dementia (294.18).
Somatic diseases acquire independent significance in the occurrence of the disorder mental activity, in relation to which they are exogenous factor. Important have mechanisms of brain hypoxia, intoxication, metabolic disorders, neuroreflex, immune, autoimmune reactions. On the other hand, as noted by B. A. Tselibeev (1972), somatogenic psychoses cannot be understood only as the result of a somatic illness. Predisposition to a psychopathological type of reaction plays a role in their development, psychological characteristics personality, psychogenic influences.
The problem of somatogenic mental pathology is becoming increasingly important in connection with the growth of cardiovascular pathology. The pathomorphosis of mental illness is manifested by the so-called somatization, the predominance of non-psychotic disorders over psychotic ones, “bodily” symptoms over psychopathological ones. Patients with sluggish, “erased” forms of psychosis sometimes end up in general somatic hospitals, and severe forms somatic diseases are often unrecognized due to the fact that the subjective manifestations of the disease “overlap” the objective somatic symptoms.
Mental disorders are observed in acute short-term, protracted and chronic somatic diseases. They manifest themselves in the form of non-psychotic (asthenic, asthenodenpressive, asthenodysthymic, asthenohypochondriacal, anxious-phobic, hysteroform), psychotic (delirious, delirious-amentive, oneiric, twilight, catatonic, hallucinatory-aranoid), defective-organic (psycho-organic syndrome and dementia) states .
According to V. A. Romasenko and K. A. Skvortsov (1961), B. A. Tselibeev (1972), A. K. Dobrzhanskaya (1973), the exogenous nature of mental disorders of nonspecific mud is usually observed with acute course somatic illness. In cases of its chronic course with diffuse brain damage of a toxic-anoxic nature, more often than with infections, there is a tendency towards endoformity of psychopathological symptoms.

Mental disorders in certain somatic diseases

Mental disorders in heart disease

One of the most frequently detected forms of heart damage is ischemic disease heart (CHD). In accordance with the WHO classification, coronary artery disease includes angina pectoris of exertion and rest, acute focal myocardial dystrophy, small and large focal myocardial infarction. Coronary-cerebral disorders are always combined. In case of heart diseases, cerebral hypoxia is observed, in case of lesions cerebral vessels detect hypoxic changes in the heart.
Mental disorders arising as a result of acute heart failure can be expressed as syndromes of impaired consciousness, most often in the form of stupor and delirium, characterized by the instability of hallucinatory experiences.
Mental disorders during myocardial infarction began to be systematically studied in recent decades (I. G. Ravkin, 1957, 1959; L. G. Ursova, 1967, 1969). Depressive states, syndromes of impaired consciousness with psychomotor agitation, and euphoria have been described. Very valuable formations are often formed. At small focal infarction myocardium develops a pronounced asthenic syndrome with tearfulness, general weakness, sometimes nausea, chills, tachycardia, low-grade body temperature. With a large-focal infarction with damage to the anterior wall of the left ventricle, anxiety and fear of death arise; during a heart attack back wall In the left ventricle, euphoria, verbosity, lack of criticism of one’s condition, with attempts to get out of bed and requests to be given some kind of work are observed. In the post-infarction state, lethargy, severe fatigue, and hypochondria are noted. A phobic syndrome often develops - anticipation of pain, fear of a second heart attack, getting out of bed at a time when doctors recommend an active regimen.
Mental disorders also occur with heart defects, as pointed out by V. M. Banshchikov, I. S. Romanova (1961), G. V. Morozov, M. S. Lebedinsky (1972). For rheumatic heart defects V.V. Kovalev (1974) identified the following types of mental disorders:
1) borderline (asthenic), neurosis-like (neurasthenic-like) with autonomic disorders, cerebrosteic with mild manifestations of organic cerebral insufficiency, euphoric or depressive-dysthymic mood, hysteroform, asthenoinochondriacal states; neurotic reactions of depressive, depressive-hypochondriacal and pseudoeuphoric types; pathological development personality (psychopathic);
2) psychotic (cardiogenic psychoses) - acute with delirious or amentive symptoms and subacute, prolonged (anxious-depressive, depressive-paranoid, hallucinatory-paranoid); 3) encephalopathic c (psychoorganic) - psychoorganic, epileptiform and Korsazhkovsky syndromes. Congenital defects heart disease is often accompanied by signs of psychophysical infantilism, asthenic, neurosis- and psychopath-like states, neurotic reactions, and delayed intellectual development.
Currently, heart surgery is widely performed. Surgeons and cardiologists-therapists note a disproportion between the objective physical capabilities of operated patients and the relatively low actual indicators of rehabilitation of people who have undergone heart surgery (E. I. Chazov, 1975; N. M. Amosov et al., 1980; S. Bernard, 1968 ). One of the most significant reasons for this disproportion is the psychological maladjustment of people who have undergone heart surgery. When examining patients for pathology of cardio-vascular system It has been established that they have pronounced forms of personal reactions (G.V. Morozov, M.S. Lebedinsky, 1972; A.M. Vein et al., 1974). N.K. Bogolepov (1938), L.O. Badalyan (1963), V.V. Mikheev (1979) point to high frequency of these disorders (70-100%). Changes in the nervous system with heart defects were described by L. O. Badalyan (1973, 1976). Circulatory failure, which occurs with heart defects, leads to chronic brain hypoxia, the occurrence of general cerebral and focal neurological symptoms, including in the form of convulsive seizures.
Patients operated on for rheumatic heart defects usually have complaints of headache, dizziness, insomnia, numbness and coldness of the extremities, pain in the heart and behind the sternum, suffocation, fatigue, shortness of breath, aggravated by physical exertion, weakness of convergence, decreased corneal reflexes, muscle hypotonia, decreased periosteal and tendon reflexes, disorders of consciousness, often in the form of fainting, indicating circulatory disorders in the system of vertebral and basilar arteries and in the internal carotid artery.
Mental disorders that occur after cardiac surgery are a consequence not only of cerebrovascular disorders, but also of a personal reaction. V. A. Skumin (1978, 1980) identified “cardioprosthetic psychopathological syndrome”, which often occurs during implantation mitral valve or multivalve replacement. Due to noise phenomena associated with the activity of the artificial valve, disruption of the receptive fields at the site of its implantation and disturbances in the rhythm of cardiac activity, the attention of patients is focused on the work of the heart. They have concerns and fears about a possible “valve separation” or its breakage. The depressed mood intensifies at night, when the noise from the operation of artificial valves is heard especially clearly. Only during the day, when the patient sees medical personnel nearby, can he fall asleep. A negative attitude towards vigorous activity is developed, and an anxious-depressive mood background arises with the possibility of suicidal actions.
In the immediate postoperative period, V. Kovalev (1974) noted asthenoadynamic states, sensitivity, and transient or persistent intellectual-mneetic deficiency in patients. After operations with somatic complications, acute psychoses with clouding of consciousness (delirious, delirious-amentive and delirious-opeiroid syndromes), subacute abortive and prolonged psychoses (anxious-depressive, depressive-hypochondriacal, depressive-paranoid syndromes) and epileptiform paroxysms often occur.

Mental disorders in patients with renal pathology

Mental disorders in renal pathology are observed in 20-25% of patients with LC (V. G. Vogralik, 1948), but not all of them come to the attention of psychiatrists (A. G. Naku, G. N. German, 1981). Severe mental disorders developing after kidney transplantation and hemodialysis are noted. A.G. Naku and G.N. German (1981) distinguished typical nephrogenic and atypical nephrogenic psychoses with the obligatory presence of an asthenic background. The authors include asthenia, psychotic and non-psychotic forms of disordered consciousness in the 1st group, and endoform and organic psychotic syndromes in the 2nd group (we consider the inclusion of asthenia syndromes and non-psychotic disturbances of consciousness in psychotic conditions to be erroneous).
Asthenia in renal pathology, as a rule, precedes the diagnosis of kidney damage. There are unpleasant sensations in the body, a “stale head”, especially in the morning, nightmares, difficulty concentrating, a feeling of exhaustion, depressed mood, somatoneurological manifestations (coated tongue, grayish-pale complexion, instability of blood pressure, chills and profuse sweating). at night, unpleasant feeling in the lower back).
The asthenic nephrogenic symptom complex is characterized by a constant complication and increase in symptoms, up to a state of asthenic confusion, in which patients do not perceive changes in the situation, do not notice the objects they need nearby. When increasing renal failure the asthenic state may give way to amentia. Characteristic feature nephrogenic asthenia is adynamia with the inability or difficulty to mobilize oneself to perform an action while understanding the need for such mobilization. Patients spend most of their time in bed, which is not always justified by the severity of the renal pathology. According to A.G. Naku and G.N. German (1981), the often observed change from asthenoadynamic states to asthenosubdepressive ones is an indicator of improvement in the patient’s somatic state, a sign of “affective activation,” although it goes through a pronounced stage of a depressive state with ideas of self-deprecation (uselessness, worthlessness, a burden to the family).
Syndromes of clouded consciousness in the form of delirium and amentia in nephropathies are severe, and patients often die. There are two variants of amentia syndrome (A. G. Maku, G. II. German, 1981), reflecting the severity of renal pathology and having prognostic significance: hyperkinetic, in which uremic intoxication is mildly expressed, and hypokinetic with increasing decompensation of renal activity, a sharp increase in arterial pressure.
Severe forms of uremia are sometimes accompanied by psychoses such as acute delirium and end in death after a period of stupefaction, severe motor restlessness, and fragmentary delusional ideas. As the condition worsens, productive forms of disordered consciousness are replaced by unproductive ones, adynamia and somnolence increase.
Psychotic disorders in the case of protracted and chronic kidney diseases are manifested by complex syndromes observed against the background of asthenia: anxiety-depressive, depressive and hallucinatory-paranoid and catatonic. The increase in uremic toxicosis is accompanied by episodes of psychotic stupefaction, signs of organic damage to the central nervous system, epileptiform paroxysms and intellectual-mnestic disorders.
According to B. A. Lebedev (1979), 33% of the examined patients, against the background of severe asthenia, had mental reactions of depressive and hysterical types, the rest had an adequate assessment of their condition with a decrease in mood, an understanding of the possible outcome. Asthenia can often prevent the development of neurotic reactions. Sometimes, in cases of slight severity of asthenic symptoms, hysterical reactions occur, which disappear as the severity of the disease increases.
Rheoencephalographic examination of patients with chronic kidney diseases makes it possible to identify a decrease in vascular tone with a slight decrease in their elasticity and signs of impaired venous flow, which are manifested by an increase in the venous wave (presystolic) at the end of the catacrotic phase and are observed in individuals long time suffering from arterial hypertension. Characterized by instability of vascular tone, mainly in the system of vertebral and basilar arteries. In mild forms of kidney disease in pulse blood supply pronounced deviations not observed from the norm (L. V. Pletneva, 1979).
In the later stages of chronic renal failure and with severe intoxication, organ replacement surgeries and hemodialysis are performed. After kidney transplantation and during dialysis stable suburemia, chronic nephrogenic toxicodyshomeostatic encephalopathy is observed (M. A. Tsivilko et al., 1979). Patients experience weakness, sleep disorders, depressed mood, sometimes a rapid increase in adynamia, stupor, and seizures. It is believed that clouded consciousness syndromes (delirium, amentia) arise as a result of vascular disorders and postoperative asthenia, and blackout syndromes arise as a result of uremic intoxication. During hemodialysis treatment, cases of intellectual-mnestic disorders, organic brain damage with a gradual increase in lethargy, and loss of interest in the environment are observed. At long-term use dialysis, a psychoorganic syndrome develops - “dialysis-uremic dementia”, which is characterized by deep asthenia.
During kidney transplantation, large doses of hormones are used, which can lead to disorders of autonomic regulation. During acute failure transplant, when azotemia reaches 32.1-33.6 mmol, and hyperkalemia reaches 7.0 mEq/l, hemorrhagic phenomena (profuse nosebleeds and hemorrhagic rash), paresis, and paralysis may occur. An electroencephalographic study reveals persistent desynchronization with an almost complete disappearance of alpha activity and a predominance of slow-wave activity. Rheoencephalographic examination reveals pronounced changes vascular tone: uneven waves in shape and size, additional venous waves. Asthenia sharply increases, subcomatose and comatose states develop.

Mental disorders in diseases of the digestive tract

Diseases of the digestive system rank second in general morbidity population, second only to cardiovascular pathology.
Mental dysfunction due to pathology digestive tract more often they are limited to sharpening of character traits, asthenic syndrome and neurosis-like conditions. Gastritis, peptic ulcer And nonspecific colitis are accompanied by exhaustion of mental functions, sensitivity, lability or torpidity of emotional reactions, anger, a tendency to hypochondriacal interpretation of the disease, and cancerophobia. With gastroesophageal reflux, neurotic disorders (neurasthenic syndrome and obsessiveness) are observed, preceding symptoms of the digestive tract. Statements by patients about the possibility of a malignant neoplasm are noted within the framework of overvalued hypochondriacal and paranoid formations. Complaints of memory impairment are associated with attention disorders caused by both fixation on sensations caused by the underlying disease and depressive mood.
A complication of gastric resection operations for peptic ulcer disease is dumping syndrome, which should be distinguished from hysterical disorders. Dumping syndrome is understood as vegetative crises that occur paroxysmally in a hypo- or hyperglycemic manner immediately after a meal or after 20-30 minutes, sometimes 1-2 hours.
Hyperglycemic crises appear after eating hot food containing easily digestible carbohydrates. Suddenly there is a headache with dizziness, tinnitus, less often - vomiting, drowsiness, tremor. “Black dots”, “spots” before the eyes, disturbances in the body diagram, instability, and unsteadiness of objects may appear. They end with excessive urination and drowsiness. At the height of the attack, sugar levels and blood pressure increase.
Hypoglycemic crises occur outside of meals: weakness, sweating, headache, dizziness appear. After eating, they quickly stop. During a crisis, blood sugar levels drop and blood pressure drops. Disorders of consciousness are possible at the height of the crisis. Sometimes crises develop in the morning after sleep (R. E. Galperina, 1969). In the absence of timely therapeutic correction, hysterical fixation of this condition cannot be ruled out.

Mental disorders in cancer

The clinical picture of brain tumors is determined by their localization. As the tumor grows, general cerebral symptoms become more prominent. Almost all types of psychopathological syndromes are observed, including asthenic, psychoorganic, paranoid, hallucinatory-paranoid (A. S. Shmaryan, 1949; I. Ya. Razdolsky, 1954; A. L. Abashev-Konstantinovsky, 1973). Sometimes a brain tumor is detected in sections of deceased persons treated for schizophrenia or epilepsy.
In case of malignant neoplasms of extracranial localization, V. A. Romasenko and K. A. Skvortsov (1961) noted the dependence of mental disorders on the stage of cancer. In the initial period, a sharpening of the characterological traits of patients, neurotic reactions, and asthenic phenomena are observed. In the advanced phase, asthenodepressive states and anosognosia are most often observed. In case of cancer of internal organs in the manifest and predominantly terminal stages, states of “quiet delirium” with adynamia, episodes of delirious and oneiric experiences are observed, followed by stunnedness or attacks of excitement with fragmentary delusional statements; delirious-amentive states; paranoid states with delusions of relation, poisoning, damage; depressive states with depersonalization phenomena, senestopathies; reactive hysterical psychoses. Characterized by instability, dynamism, frequent change psychotic syndromes. IN terminal stage Depression of consciousness gradually increases (stunning, stupor, coma).

Mental disorders of the postpartum period

There are four groups of psychoses that arise in connection with childbirth:
1) generic;
2) actually postpartum;
3) psychoses of the lactation period;
4) provoked by childbirth endogenous psychoses.
Mental pathology the postpartum period does not represent an independent nosological form. What is common to the entire group of psychoses is the situation in which they arise.
Labor psychosis is a psychogenic reaction that usually develops in primiparous women. They are caused by the fear of expecting pain, an unknown, frightening event. At the first signs of labor beginning, some women in labor may develop a neurotic or psychotic reaction, in which, against the background of a narrowed consciousness, hysterical crying, laughter, screaming, sometimes fugiform reactions, and less often - hysterical mutism appear. Mothers in labor refuse to follow the instructions offered medical personnel. The duration of reactions ranges from several minutes to 0.5 hours, sometimes longer.
Postpartum psychoses are conventionally divided into postpartum psychoses and psychoses of the lactation period.
Actually postpartum psychoses develop during the first 1-6 weeks after birth, often in the maternity hospital. The reasons for their occurrence are: toxicosis of the second half of pregnancy, difficult childbirth with massive tissue trauma, retained placenta, bleeding, endometritis, mastitis, etc. The decisive role in their occurrence is played by a birth infection; the predisposing factor is toxicosis of the second half of pregnancy. At the same time, psychoses are observed, the occurrence of which cannot be explained by postpartum infection. The main reasons for their development are trauma to the birth canal, intoxication, neuroreflex and psychotraumatic factors in their totality. Actually, postpartum psychoses are more often observed in primiparous women. The number of sick women who gave birth to boys is almost 2 times more than women who gave birth to girls.
Psychopathological symptoms are characterized by an acute onset, occurring 2-3 weeks, and sometimes 2-3 days after birth, against the background of elevated body temperature. Postpartum women are restless, gradually their actions become erratic, and speech contact is lost. Amentia develops, which in severe cases turns into a soporous state.
Amentia in postpartum psychosis is characterized by mild dynamics throughout the entire period of the disease. The exit from the amental state is critical, followed by lacunar amnesia. Protracted asthenic conditions are not observed, as is the case with lactation psychoses.
The catatonic (catatonic-oneiroid) form is observed less frequently. A feature of postpartum catatonia is the weak severity and instability of symptoms, its combination with oneiric disorders of consciousness. With postpartum catatonia, there is no pattern of increasing stiffness, as with endogenous catatonia, and active negativism is not observed. Characterized by the instability of catatonic symptoms, the episodic nature of oneiric experiences, their alternation with states of stupor. When catatonic phenomena weaken, patients begin to eat and answer questions. After recovery, they are critical of the experience.
Depressive-paranoid syndrome develops against the background of mildly expressed stupor. It is characterized by “matte” depression. If the stupefaction intensifies, the depression is smoothed out, the patients are indifferent and do not answer questions. Ideas of self-blame are associated with the failure of patients during this period. Phenomena of mental anesthesia are often detected.
Differential diagnosis of postpartum and endogenous depression is based on the presence of postpartum depression changes in its depth depending on the state of consciousness, the severity of depression at night. In such patients, in a delusional interpretation of their failure, the somatic component is more prominent, while with endogenous depression, low self-esteem concerns personal qualities.
Psychoses of lactation period occur 6-8 weeks after birth. They occur approximately twice as often as postpartum psychoses themselves. This can be explained by the trend towards younger marriages and the psychological immaturity of the mother, lack of experience in caring for children - younger brothers and sisters. Factors preceding the onset of lactation psychosis include shortening hours of rest due to child care and deprivation of night sleep (K.V. Mikhailova, 1978), emotional stress, lactation with irregular nutrition and rest, leading to rapid weight loss.
The disease begins with impaired attention, fixation amnesia. Young mothers do not have time to do everything necessary due to lack of composure. At first, they try to “make up time” by reducing rest hours, “clean things up” at night, don’t go to bed, and start washing children’s clothes. Patients forget where they put this or that thing, they search for it for a long time, disrupting the rhythm of work and the order that was difficult to establish. The difficulty of comprehending the situation quickly increases, and confusion appears. The purposefulness of behavior is gradually lost, fear, an affect of bewilderment, and fragmentary interpretative delirium develop.
In addition, changes in the condition are noted throughout the day: during the day, patients are more collected, which gives the impression that the condition returns to its pre-painful state. However, every day the periods of improvement are shortened, anxiety and lack of composure increase, and fear for the life and well-being of the child increases. Amentia syndrome or stunning develops, the depth of which is also variable. The recovery from the amentive state is protracted and is accompanied by frequent relapses. The amentive syndrome is sometimes replaced by a short-term period of a catatonic-oneiric state. There is a tendency to increase the depth of consciousness disorders when trying to maintain lactation, which is often requested by the patient’s relatives.
An asthenodepressive form of psychosis is often observed: general weakness, emaciation, deterioration of skin turgor; patients become depressed, express fears for the child’s life, and ideas of low value. The recovery from depression is protracted: patients remain for a long time with a feeling of instability of their condition, weakness, and anxiety that the disease may return.

Endocrine diseases

Disruption of the hormonal function of one of the glands usually causes changes in the condition of the others endocrine organs. Functional relationship between nervous and endocrine systems underlies mental disorders. Currently, there is a special branch of clinical psychiatry - psychoendocrinology.
Endocrine disorders in adults, as a rule, are accompanied by the development of non-psychotic syndromes (asthenic, neurosis- and psychopathic) with paroxysmal autonomic disorders, and with increasing pathological process- psychotic states: syndromes of clouded consciousness, affective and paranoid psychoses. In congenital forms of endocrinopathy or their occurrence in early childhood, the formation of psychoorganic neuroendocrine syndrome. If an endocrine disease appears in adult women or during adolescence, they often experience personal reactions associated with changes in their somatic condition and appearance.
In the early stages of all endocrine diseases and with their relatively benign course, there is a gradual development of psychoendocrine syndrome (endocrine psychosyndrome, according to M. Bleuler, 1948), its transition with the progression of the disease into a psychoorganic (amnestic-organic) syndrome and the occurrence of acute or prolonged psychoses against the background these syndromes (D. D. Orlovskaya, 1983).
The most common occurrence is asthenic syndrome, which is observed in all forms of endocrine pathology and is part of the structure of the psychoendocrine syndrome. It is one of the earliest and most persistent manifestations of endocrine dysfunction. In cases of acquired endocrine pathology, asthenic phenomena may long precede the detection of gland dysfunction.
"Endocrine" asthenia is characterized by a feeling of pronounced physical weakness and weakness, accompanied by a myasthenic component. At the same time, the impulses to activity that persist in other forms of asthenic conditions are leveled out. Asthenic syndrome very soon acquires the features of an apatoabulic state with impaired motivation. This transformation of the syndrome usually serves as the first sign of the formation of psychoorganic neuroendocrine syndrome, an indicator of the progression of the pathological process.
Neurosis-like changes are usually accompanied by manifestations of asthenia. Neurosthenic-like, hysteroform, anxious-phobic, asthenodepressive, depressive-hypochondriacal, astheno-abulic states are observed. They have a persistent character. In patients, mental activity decreases, desires change, and mood lability is noted.
Neuroendocrine syndrome in typical cases manifests itself as a “triad” of changes - in the sphere of thinking, emotions and will. As a result of the destruction of higher regulatory mechanisms, disinhibition of drives appears: sexual promiscuity, a tendency to vagrancy, theft, and aggression are observed. The decline in intelligence can reach a degree organic dementia. Epileptiform paroxysms often occur, mainly in the form of convulsive seizures.
Acute psychoses with impaired consciousness: asthenic confusion, delirious, delirious-amentive, oneiric, twilight, acute paranoid states - occur during an acute course endocrine disease, for example, with thyrotoxicosis, as well as as a result of acute exposure to additional external harmful factors (intoxication, infection, mental trauma) and in the postoperative period (after thyroidectomy, etc.).
Among psychoses with a protracted and recurrent course, the most frequently identified are depressive-paranoid, hallucinatory-paranoid, senestopathic-hypochondriacal states and verbal hallucinosis syndrome. They are observed when infectious lesion hypothalamus-pituitary gland system after removal of the ovaries. In the clinical picture of psychosis, elements of the Kandinsky-Clerambault syndrome are often found: phenomena of ideational, sensory or motor automatism, verbal pseudohallucinations, delusional ideas of influence. Features of mental disorders depend on damage to a certain part of the neuroendocrine system.
Itsenko-Cushion disease occurs as a result of damage to the hypothalamus-pituitary-adrenal cortex system and is manifested by obesity, hypoplasia of the gonads, hirsutism, severe asthenia, depressive, senestopathic-hypochondriacal or hallucinatory-paranoid states, epileptiform seizures, decreased intellectual-mnestic functions, Korsakovsky syndrome. After radiation therapy and adrenalectomy, acute psychosis with confusion may develop.
Patients with acromegaly, resulting from damage to the anterior lobe of the pituitary gland - eosinophilic adenoma or proliferation of eosinophilic cells, experience increased excitability, anger, anger, a tendency to solitude, a narrowing of interests, depressive reactions, dysphoria, sometimes psychosis with impaired consciousness, usually arising after additional external influences. Adiposogenital dystrophy develops as a result of hypoplasia of the posterior lobe of the pituitary gland. Characteristic somatic signs include obesity and the appearance of circular ridges around the neck (“necklace”).
If the disease begins at an early age, underdevelopment of the genital organs and secondary sexual characteristics is observed. A.K. Dobzhanskaya (1973) noted that with primary lesions of the hypothalamic-pituitary system, obesity and mental changes long precede disorders of sexual function. Psychopathological manifestations depend on the etiology (tumor, traumatic injury, inflammatory process) and the severity of the pathological process. In the initial period and with mild dynamics, the symptoms manifest themselves as asthenic syndrome for a long time. Subsequently, epileptiform seizures, personality changes of the epileptoid type (pedanticity, stinginess, sweetness), acute and prolonged psychoses, including the endoform type, apatoabulic syndrome, and organic dementia are often observed.
Cerebral-pituitary insufficiency (Symonds' disease and Sheehan's syndrome) is manifested by sudden weight loss, underdevelopment of the genital organs, asthenoadynamic, depressive, hallucinatory-paranoid syndromes, intellectual and mnestic disorders.
For diseases thyroid gland either its hyperfunction (Graves' disease, thyrotoxicosis) or hypofunction (myxedema) is noted. The cause of the disease can be tumors, infections, intoxications. Graves' disease characterized by a triad of somatic signs such as goiter, bulging eyes and tachycardia. At the onset of the disease, neurosis-like disorders are noted:
irritability, fearfulness, anxiety or high spirits. At severe course diseases may develop delirious states, acute paranoid, agitated depression, depressive-hypochondriacal syndrome. At differential diagnosis the presence of somatoneurological signs of thyrotoxicosis should be taken into account, including exophthalmos, Mobius's sign (weakness of convergence), Graefe's symptom (lag of the upper eyelid from the iris when looking down - a white stripe of the sclera remains). Myxedema is characterized by bradypsychia, decreased intelligence. The congenital form of myxedema is cretinism, which previously was often endemic in areas where drinking water not enough iodine.
With Addison's disease (failure of function of the adrenal cortex), phenomena of irritable weakness, intolerance to external stimuli, increased exhaustion with increasing adynamia and monotonous depression are observed, and sometimes delirious states occur. Diabetes often accompanied by non-psychotic and psychotic mental disorders, including delirium, which are characterized by the presence of vivid visual hallucinations.

Treatment, prevention and social and labor rehabilitation of patients with somatogenic disorders

Treatment of patients with somatogenic mental disorders is carried out, as a rule, in specialized somatic medical institutions. In most cases, it is not advisable to hospitalize such patients in psychiatric hospitals, with the exception of patients with acute and prolonged psychoses. In such cases, the psychiatrist often acts as a consultant rather than as an attending physician. Therapy is complex. Psychotropic drugs are used according to indications.
Correction of non-psychotic disorders is carried out against the background of basic somatic therapy using sleeping pills, tranquilizers, antidepressants; psychostimulants of plant and animal origin are prescribed: tinctures of ginseng, lemongrass, aralia, eleutherococcus extract, pantocrine. It must be taken into account that many antispasmodic vasodilators and antihypertensive drugs- clonidine (hemiton), daukarin, dibazol, carbocromene (intencordin), cinnarizine (stugeron), raunatin, reserpine - have a mild sedative effect, and tranquilizers amizil, oxylidine, sibazon (diazepam, relanium), nozepam (oxazepam), chlozepid (chlordiazepoxide ), phenazepam - antispasmodic and hypotensive. Therefore, when using them together, it is necessary to be careful with the dosage and monitor the state of the cardiovascular system.
Acute psychoses usually indicate a high degree of intoxication, impaired cerebral circulation, and clouding of consciousness indicates a severe course of the process. Psychomotor agitation leads to further depletion of the nervous system and can cause a sharp deterioration in general condition. V.V. Kovalev (1974), A.G. Naku, G.N. German (1981), D.D. Orlovskaya (1983) recommend prescribing aminazine, thioridazine (sonapax), alimemazine (teralen) and other antipsychotic drugs to patients , which do not have a pronounced extrapyramidal effect, in small or medium doses orally, intramuscularly and intravenously under blood pressure control. In some cases, it is possible to stop acute psychosis with intramuscular or intravenous administration tranquilizers (seduxen, relanium). For prolonged forms of somatogenic psychoses, tranquilizers, antidepressants, psychostimulants, neuroleptics and anticonvulsants are used. There is poor tolerability of some drugs, especially from the group of antipsychotic drugs, so it is necessary to individually select doses, gradually increase them, replace one drug with another if complications arise or there is no positive effect.
For defective organic symptoms, it is recommended to prescribe vitamins, sedatives or psychostimulants, amipalon, piracetam.

Description:

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

Symptoms:

Symptoms and course depend on the nature and stage of development of the underlying disease, the degree of its severity, the effectiveness of the treatment, as well as on the individual characteristics of the 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.

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, successful outcome disease and its consequences. For others, fear of the possibility of serious and long-term treatment, before surgery and complications, the likelihood of disability. Some patients are burdened by the very fact of being in the hospital and yearn for home and loved ones. Their thoughts are occupied not so much with the illness as with household chores, memories and dreams of being discharged. Outwardly, such patients look sad and somewhat inhibited. 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 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 whose mental disorders are, as it were, integral part clinical picture diseases. These are patients with psychosomatic pathology (see Psychosomatic diseases), along with severe symptoms In 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 diseases with high fever (lobar pneumonia) or severe intoxication (osiraya), or in 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 internal organs is not the cause of mental disorders, but only provoked the onset of 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 illnesses, only symptomatic psychosis is not a mental disorder, but a reaction of the human body, its nervous system to an existing somatic disease.

Causes

The main cause of these disorders is infectious and somatic diseases. At the same time, 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 somatogeny: infectious diseases (influenza, malaria, infectious hepatitis), malignant tumors, rheumatism, septic endocarditis. Common symptomatic psychoses are those that develop due to septic (purulent) inflammatory processes.

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

Classification

Symptomatic psychoses are divided by duration into:

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

Manifestations

Acute symptomatic psychoses

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

Twilight stupefaction occurs spontaneously and just as suddenly stops. Patients are completely disoriented in time, space and even in their own personality. As a rule, during twilight stupefaction, patients perform monotonous automatic actions, and after exiting this state They 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 severe speech-motor retardation, difficulty and slowdown in understanding the surroundings, and impaired memorization.

Subacute symptomatic psychoses

A common type of somatogenic mental disorder is depression (). A characteristic combination of depression with asthenia, anxiety, weakness, various vegetative manifestations. 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 as a hallucinatory-paranoid syndrome, with auditory hallucinations, persecutory delusions 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.