Types of symptomatic psychoses. Symptomatic psychoses: causes, classification, manifestations, treatment Symptomatic psychoses in general somatic practice

6.1. Symptomaticpsychoses

Meaning temporary psychotic disorders for general infections, intoxications and non-infectious somatic diseases. Vestigial symptomatic psychotic psychoses in children they occur much more often than in adults, while developed and especially prolonged symptomatic psychoses in childhood are relatively rare (Kovalev V.V., 1979). Abortive symptomatic psychoses occur in children mainly during febrile states, especially during general infections or toxic infections (febrile psychoses, according to E. Kraepelin, 1927).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Symptomatic psychoses.

LECTURE 14.

Symptomatic psychoses are psychoses that develop with common non-infectious diseases, infections and intoxications as one of the manifestations of the underlying disease.

In the genesis of psychoses associated with somatic ill-being, the main role is played by extracerebral biological factors, which cause disturbances in various functional systems of the body (cardiovascular, respiratory, excretory, endocrine, etc.). Deviations in their work, in turn, lead to brain disorders and mental disorders. Thus, the brain suffers not directly, but indirectly, in connection with general diseases, and is affected along with other organs. Mental disorders in this case are mainly associated with toxic, hypoxic, metabolic and other influences.

Symptomatic psychoses with various diseases have a similar clinical picture, due to the presence of a certain type of brain response to external (exogenous) harm. The spectrum of this response was described by Bongoffer under the name "exogenous type of reaction". He included stupor, delirium, amentia, twilight disorder of consciousness and acute hallucinosis, which are characterized by an acute course.

Later, the doctrine of exogenous reactions was supplemented by the so-called. transitional or intermediate psychoses, since in their course they occupy an intermediate place between exogenous type reactions and endogenous psychoses, which is why they are also called endoform. They are more protracted, some of them resemble endogenous psychoses and include affective, delusional and amnestic disorders.

In case of severe brain damage, the consequences of experienced symptomatic psychoses can be irreversible and be expressed in a psychoorganic syndrome varying degrees severity up to dementia.

Thus, all symptomatic psychoses can be divided into 2 groups: 1) spicy and 2) protracted.

Acute psychoses

Most often they occur with confusion of consciousness. They are preceded by a short prodromal period in the form of asthenia. It is characterized by headache, lethargy or restlessness, emotional disorders(anxiety, fear, depression), hyperesthesia, sleep disorders.

The more severe the asthenia, the more severe the subsequent psychosis. In some cases mental disorders may be limited to asthenic syndrome.

Acute psychoses last from several hours to 2-3 days. The most common are delirium And twilight disorder of consciousness with epileptiform agitation .

1. Delirium has a typical picture, occurring most often once, at night. In severe somatic diseases, it can last for several days and develop into amentia.

2. Twilight disorder of consciousness with epileptiform agitation develops suddenly, is accompanied by a sharp psychomotor agitation with the experience of fear, delusions of persecution, and just as suddenly ends with release through sleep or stupor. The duration of psychosis is from half an hour to several hours. Sometimes it occurs even before a detailed picture of the infectious disease appears. The transition of twilight disorder to amentia is considered a prognostically unfavorable sign.

3. Amentia usually develops against a background of weakened body (starvation, extreme physical or mental exhaustion, chronic diseases), which precedes an acute somatic or infectious disease. Classic amentia is rare; an amentia-like state in the form of asthenic confusion . It is characterized by confusion, severe exhaustion, and inconsistency of thinking. There is partial disorientation, fragmentary delusional ideas of relationship and persecution, and isolated hallucinations. Characterized by pronounced emotional lability with a predominance of anxiety and fear. Disturbances deepen with fatigue and decrease with rest.

4. Oneiroid rare, more common oneiric states , which can be likened to sleeping with your eyes open. There are dream-like experiences with everyday content, visual hallucinations, in relation to which the patient takes a passive contemplative position. Orientation saved. Patients are detached, inhibited, sometimes confused and fussy.

5 . Acute verbal hallucinosis begins suddenly, intensifies at night, occurs in the form of commentary auditory hallucinations of a true nature, accompanied by anxiety and fear. There may be a transition to imperative hallucinations with social dangerous actions in relation to yourself and others.

6.Stun occurs when severe intoxications, may progress to stupor and coma.

Upon recovery from acute symptomatic psychoses, it is observed asthenic syndrome.

Prolonged symptomatic psychoses

Occurs in unfavorable course of somatic disease. They may occur after acute psychosis with impaired consciousness or independently. Their duration is from 2 weeks to 2-3 months. After their completion, prolonged asthenia or, less commonly, psychoorganic syndrome may occur.

Symptomatic psychoses are psychotic nonspecific disorders that occur when various diseases internal organs, intoxications, infectious diseases. They develop in response to an emerging pathological condition.

But not everyone psychotic episode, which occurs during the above types of diseases, is symptomatic.

SPs are classified as follows:

organic psychosyndrome;
intermediate symptomatic psychoses, usually such states last several weeks;
acute (transient) symptomatic psychoses, duration ranges from several hours to a day or more.

An epileptiform state is a disorder of consciousness with intense fear and agitation that begins and ends suddenly. The man cannot find a place, tries to run (sometimes runs away) from his fictitious pursuers, and screams. Then comes deep dream. Lasts 0.5 – 3 hours.
Oneiroid is an extremely interesting phenomenon. Characterized by colorful, moving, mass hallucinations. A person, for example, can stroke beautiful unicorns in a fairy-tale forest, feel their breath, soft fur, while being at the dinner table with his family.

Intermediate joint ventures

They last longer, and after recovery they leave long-term asthenic states - lethargy, weakness. But it happens that personality changes occur on an organic level.

Depression. Modern psychiatry represents the most pressing disease of our time. Manifested by anxiety, asthenia, tearfulness. The patient does not want to do anything, is depressed, and his mood drops. Depression may be complicated by delusions. This means that the original disease is progressing.
Depression with delusions can be accompanied by verbal hallucinations, delusions when patients feel that everyone around them is judging them for everything they do, and episodes of delirious attacks.
Hallucinatory-paranoid syndrome is a condition when delusions of persecution and influence, as well as phenomena of mental automatism, can be combined with pseudohallucinations. It has been established that delusions of influence are very diverse in their content: from hypnosis and witchcraft to the most modern technical devices or methods - atomic Energy, radiation, laser beams and more.
A manic state is the opposite of depression - intellectual excitement, a desire for activity. But not everything is as good as it seems. The price to pay is a partial loss of concentration. A person takes on all things at once, without finishing a single one.
Confabulation is one of the memory disorders. The patient forgets some events of his life and replaces them with fantasies. After the symptoms disappear, patients are critical of their ridiculous stories.

Organic psychosyndrome

Occurs as a result of organic changes. It is characterized by irreversible personality changes, psychological helplessness, memory loss, and weakening of will appear. Sometimes patients are incapable of self-care. According to Schneider, the following variants of the course of the joint venture are distinguished.

The apathetic variant is accompanied by complete indifference to the outside world.
The asthenic variant is characterized by a predominance of increased psychological and physical exhaustion, symptoms of weakness, hypersensitivity, mood instability.
The euphoric version is reflected in high spirits, complacency, confusion, increased desires, and decreased criticism of oneself.
The explosive option is extreme irritability and decreased adaptation.

Diagnostics

Recognizing the underlying somatic illness makes it easier to see the picture of external psychosis. The greatest difficulties arise when trying to distinguish independent mental illnesses from those provoked by somatic ones.

Symptomatic psychoses must be distinguished from internal mental illnesses (for example, schizophrenia). A psychiatrist will help here, since the main direction devoted to the study of this problem is psychiatry.

Treatment

Patients experiencing symptomatic psychosis are hospitalized in a psychiatric department. They are under the constant supervision of specialists, whose qualifications depend on the cause of the disease. Supervision of such patients is very important, as they are prone to suicidal attempts and aggressive actions.

The main treatment is aimed at eliminating the root cause that caused symptomatic psychoses. If necessary, detoxification, restorative drugs, and symptomatic treatment are carried out. In case of acute psychomotor agitation, neuroleptics, tranquilizers, and sleeping pills are prescribed. For depressive conditions, antidepressants are used. The clinical picture determines the entire direction of treatment. Psychiatry is moving towards the development of new therapies.

Forecast

The prognosis depends entirely on the course of the underlying disease. With mild or moderate course without uncontrolled psychomotor agitation, the prognosis is favorable.

Prevention

Prevention is early diagnosis underlying disease and its immediate treatment. Symptomatic psychoses generally respond well to treatment. Preventive conversations with a psychologist and psychiatrist are recommended for severe somatic illnesses. It is these specialists who are able to interrupt the development of psychosis in the early stages.

Symptomatic psychoses: causes, classification, manifestations, treatment

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

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

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

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

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

Subacute symptomatic psychoses

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

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

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

Subacute symptomatic psychoses can manifest 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.

You may also want to look into treating schizophrenia.

What are symptomatic psychoses?

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

What it is?

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

Classification

Symptomatic psychoses are divided into several types:

acute psychoses;
prolonged psychoses;
organic psychosyndromes.

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

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

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

Learn more about what delirium is due to alcohol addiction, its symptoms are described in this video

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Treatment and prevention

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

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

As a preventive measure for symptomatic psychoses, we can only advise not to start any somatic illness, diagnose in a timely manner and begin therapy.

Features of symptomatic psychoses in children

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

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

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

Symptomatic psychoses

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

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

Classification of symptomatic psychoses

There are various clinical types of symptomatic psychoses.

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

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

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

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

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

Clinical forms

Acute symptomatic psychoses

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

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

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

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

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

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

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

Protracted symptomatic psychoses

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

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

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

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

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

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

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

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

Symptomatic psychoses in certain somatic diseases

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

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

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

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

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

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

Symptomatic psychoses in certain infectious diseases

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

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

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

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

Mental disorders in case of poisoning with industrial poisons

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

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

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

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

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

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

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

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

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

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

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

Etiology and pathogenesis

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

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

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

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

Diagnostics

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

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

Treatment

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

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

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

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

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

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

Forecast

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

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

Manic psychosis: treatment

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

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

Experts use the term “psychosis” or “acute psychosis” when talking about certain types of mental disorders that have a disorder as a common feature.

Chronic psychosis

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

Hypomanic psychosis

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Reactive psychosis

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

Schizoaffective psychosis

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

Symptomatic psychosis

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

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

Symptomatic psychosis is usually classified as follows:

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

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

Symptomatic prolonged psychosis

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

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

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

Causes

Causes of symptomatic psychosis may be related to:

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

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

Diagnostics

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

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

Treatment

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

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

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

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

Somatogenic psychoses

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

They 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, 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, 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. Some patients are burdened by the very fact of being in the hospital and yearn for home and loved ones.

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

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

2. 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, where, along with pronounced symptoms of internal diseases (hypertension, peptic ulcer, diabetes mellitus) neurotic and pathocharacterological reactions are observed.

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

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

affective (mood disorders);

deviations in characterological reactions;

confusion syndromes;

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

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

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

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

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

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

Asthenic disorders are rarely observed in 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.

Emotional disorders - somatic diseases are more characterized by a decrease in mood with various shades: anxiety, melancholy, apathy. In the occurrence of 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.

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

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

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

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

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

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

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

Twilight stupefaction

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

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

Symptomatic psychoses refer to peculiar disorders that appear with various pathologies of internal organs, as well as with infections and intoxication of the body. Most often, psychosis is a consequence of a long-term illness. In medicine they distinguish different types psychoses that a person should know about. An unpleasant condition often causes serious depression, which is why it is so important to prevent it in a timely manner. How dangerous is symptomatic psychosis? How to get rid of an unpleasant condition?

Main types

Acute psychosis

This is a rather unpleasant condition in which consciousness is upset, strong fear, excitement. A person cannot find a place for himself, he is constantly running somewhere, it seems to him that he is being pursued, he can scream loudly. Then the person falls into deep sleep, which lasts several hours.

An acute form of psychosis refers to a rather unpleasant condition in which colorful hallucinations appear. For example, a person may think that he is stroking a beautiful animal in the forest, hearing its breathing, but in fact the patient is simply having dinner with his family.

Intermediate psychosis

An unpleasant and long-term asthenic condition in which a person becomes weak and lethargic. Sometimes a personality completely begins to degrade.

Often the intermediate type ends with the development of serious depression, in which asthenia, anxiety, and tearfulness increase. The patient refuses to work, is constantly depressed, and his mood drops sharply. Depression is accompanied by a delusional state. This indicates that the disease is beginning to progress.

Sometimes delusional depression is accompanied by verbal hallucinations. In this case, the patient begins to constantly feel that he is being judged, and delirious attacks appear.

No less dangerous is paranoid, hallucinatory syndrome, in which delusions are accompanied by persecution mania and pseudohallucinations. Often a person can be influenced by witchcraft and hypnosis.

Some people develop mania, the opposite of depression. With it, the patient constantly strives for activity and is intellectually excited. In the future, the person completely loses concentration, can take on several things at once, but does not complete them.

One of frequent disorders memory is confabulation. With it, a person begins to forget what is happening to him in life. After unpleasant symptoms disappear, the patient begins to be critical of various ridiculous stories.

How does the organic form of psychosis occur?

Due to various organic changes, serious problems with health. In this case, memory sharply decreases and will weakens. Sometimes the patient cannot care for himself.

In the apathetic form, a person is indifferent to the world around him. With the asthenic variant of the development of the disease, physical and psychological exhaustion increases, severe weakness occurs, sensitivity increases, and mood is unstable.

Psychosis can occur in a euphoric version. In this case, the person is in high spirits, some experience increased desire, a state of complacency, and their self-criticism decreases. But with the explosive version, the level of adaptation may decrease, and an extremely irritable state is worrying.

Main reasons

There are a number of factors that lead to the development of psychosis:

Poisoning with various poisons - lead, mercury, gasoline, acetone.
Somatic infectious disease: malaria, tuberculosis, influenza, viral pneumonia, hepatitis.
Attention decreases, the patient cannot concentrate.

When the disease begins to drag on, depression develops, feelings of anxiety increase, and symptoms appear. With chronic intoxication with phosphorus, asthenic disorders develop, the person is very afraid of light, constantly worries, then convulsions, nausea, and vomiting appear.

Sometimes symptomatic psychosis is a consequence of intoxication with Cortisone, Atropine, Caffeine, Barbiturates, Cyclodol. The condition occurs when a person takes the drug in a higher dosage. Do not exceed the dosage!

Diagnostic methods

It is very important that a specialist promptly distinguish symptomatic psychosis from serious mental illness. Often the symptoms resemble schizophrenia. Here you cannot do without the help of a psychiatrist.

A course of treatment

A patient with psychosis may usually be admitted to a psychiatric ward. He is constantly monitored by a specialist. It is very important to monitor the patient’s condition, otherwise everything may end in suicide.

During treatment, it is important to first eliminate the cause that led to symptomatic psychosis. If necessary, detoxification is carried out, and it is also necessary to take restoratives. medicines, symptomatic therapy.

In case of development of acute psychomotor agitation, tranquilizers, antipsychotics, and sleeping pills are prescribed. At depressed state are used .

Forecasts

Please note that everything depends on how the disease progresses. If it is mild, the prognosis is favorable. IN for preventive purposes It is very important to diagnose the pathology in advance.

Symptomatic psychosis is easily treated. Additionally, a preventive conversation is carried out with a psychiatrist or psychologist. It is doctors who can prevent the development of pathology at an early stage.

Thus, psychosis is an unpleasant condition that can be a consequence various diseases. Therefore, it is important to prevent in a timely manner serious pathology. Be healthy!