Mild mental illness. How to recognize mental illness

All over the world suffer from one or another mental illness. According to other data, one in five people in the world has a mental or behavioral disorder.

In total, there are about 200 clinically diagnosed diseases, which can be roughly divided into five types: mood disorders, anxiety disorders, schizophrenia and psychotic disorders, eating disorders, dementia.

Depression is the most common mental illness. The World Health Organization estimates that by 2020, depression will be the second leading cause of disability worldwide, after cardiovascular disease. Slightly less common are general anxiety, bipolar disorder, schizophrenia and anorexia, and eating inedible objects.

How to recognize the first signs of the disease

This is fine. But, as soon as emotions begin to spoil life, they become a problem that indicates a possible mental disorder.

Signs of mental illness are fairly easy to spot. When we feel so anxious that we can’t go to the store, call the phone, talk without panic attacks. When we are so sad that our appetite disappears, there is no desire to get out of bed, it is impossible to concentrate on the simplest tasks.

Simon Wessely, President of the Royal College of Psychiatrists and Lecturer at King's College London

Too long looking at yourself in the mirror, an obsession with your appearance can also talk about health problems. An equally serious signal should be changes in appetite (both an increase and a decrease), sleep patterns, and indifference to an interesting pastime. All of these can indicate depression.

The voices in your head are signs of a much more serious problem. And, of course, not everyone who suffers from a mental illness hears them. Not everyone who is depressed will cry. Symptoms are always variable and may vary by age and gender. Some people may not notice changes in themselves. But, if the changes that speak of the disease are obvious to the people around, then you should contact a psychiatrist.

What causes mental illness

The causes of mental illness are both natural and social factors. However, some illnesses, such as schizophrenia and bipolar disorder, may appear due to a genetic predisposition.

Mental illness occurs twice as often after natural Disasters and disasters. It is also affected by changes in life and physical health person. However, the exact causes of the disorder are currently unknown.

How to make a diagnosis

Of course, you can do self-diagnosis and look for descriptions of problems on the Internet. This can be useful, but such results should be trusted with great caution. It is best to contact a specialist for qualified assistance.

Medical diagnosis can take a very long time, maybe years. Diagnosis is the beginning, not the end. Each case proceeds individually.

How to be treated

The concept of "mental illness" has changed over time. Today, electrotherapy is banned, like many other forms of treatment, so patients are trying to help with drugs and psychotherapy. However, therapy is not a panacea, and medicines are most often insufficiently studied due to low funding and the impossibility of conducting mass studies. It is impossible to treat such diseases according to the template.

Is a cure possible?

Yes. People can fully recover from acute illness and learn to overcome chronic conditions. The diagnosis can change, and life can get better. After all the main objective treatment is to enable a person to live the life he wants.

This chapter provides an overview of the psychiatric disorders common in women, including their epidemiology, diagnosis, and treatment approach (Table 28-1). Mental disorders are very common. The monthly incidence among American adults exceeds 15%. The lifetime incidence is 32%. Most common in women are major depression, seasonal affective disorder, manic-depressive psychosis, eating disorders, panic disorders, phobias, generalized anxiety disorders, somatic mental disorders, pain conditions, borderline and hysterical disorders, and suicidal attempts.

In addition to the fact that women are much more likely to have anxiety and depressive disorders, they are more resistant to drug therapy. However, most studies and clinical trials are conducted on men and then extrapolated to women, despite differences in metabolism, drug sensitivity, side effects. Such generalizations lead to the fact that 75% psychotropic drugs prescribed to women, and they are more likely to experience serious side effects.

All physicians should be aware of the symptoms mental disorders, first aid for them and available methods of maintaining mental health. Unfortunately, many cases of mental illness remain undiagnosed and untreated or undertreated. Only a small part of them reaches the psychiatrist. Most patients are seen by other specialists, so only 50% of mental disorders are recognized at the initial visit. Most patients present somatic complaints and do not focus on psycho-emotional symptoms, which again reduces the frequency of diagnosis of this pathology by non-psychiatrists. In particular, affective disorders are very common in patients with chronic diseases. The incidence of mental illness in GP patients is twice as high as in the general population, and even higher in severely ill hospitalized patients and those who seek medical attention frequently. Neurological disorders such as stroke, Parkinson's disease and Meniere's syndrome are associated with psychiatric disorders.

Untreated major depression can worsen the prognosis of physical illness and increase the amount of medical care required. Depression can intensify and increase the number of somatic complaints, lower the pain threshold, and increase functional disability. A study of patients who frequently use medical care found depression in 50% of them. Only those who had a decrease in the severity of their depressive symptoms during the year of observation showed an improvement in functional activity. Symptoms of depression (low mood, hopelessness, lack of satisfaction with life, fatigue, impaired concentration and memory) disrupt the motivation to seek medical help. Timely diagnosis and treatment of depression in chronic patients helps to improve the prognosis and increase the effectiveness of therapy.

The socioeconomic cost of mental illness is very high. Approximately 60% of suicidal cases are due to affective disorders alone, and 95% meet diagnostic criteria for mental illness. The costs associated with treatment, death, and disability due to clinically diagnosed depression are estimated at more than $43 billion per year in the United States. Because more than half of people with mood disorders are either left untreated or undertreated, this figure is far below the total cost that depression is costing society. Mortality and disability in this undertreated population, most of which are women, is particularly depressing, as 70 to 90% of depressed patients respond to antidepressant therapy.
Table 28-1
Major Mental Disorders in Women

1. Eating disorders

Anorexia nervosa

bulimia nervosa

Bouts of gluttony
2. Mood disorders

big depression

Adjustment disorder with depressed mood

postpartum affective disorder

seasonal affective disorder

Affective insanity

Dysthymia
3. Alcohol abuse and alcohol dependence

4. Sexual disorders

Libido disorders

sexual arousal disorders

Orgasmic disorders

Painful sexual disorders:

vaginismus

Dyspareunia
5. Anxiety disorders

Specific phobias

social phobia

Agoraphobia

Panic Disorders

Generalized Anxiety Disorders

Syndrome obsessive states

post-traumatic stress
6. Somatoform disorders and false disorders

False Disorders:

Simulation

Somatoform disorders:

Somatization

Conversion

Hypochondria

somatoform pain
7. Schizophrenic disorders

Schizophrenia

paraphrenia
8. Delirium
Mental illness during a woman's life

There are specific periods in a woman's life during which she is at increased risk of developing mental illness. While the major psychiatric disorders—mood disturbances and anxiety—can occur at any age, the various precipitating conditions are more common during specific age periods. During these critical periods, the clinician should include specific questions to identify psychiatric disorders by taking the history and examining the patient's mental status.

Girls have an increased risk of school phobias, anxiety disorders, attention deficit hyperactivity disorder and learning disorders. Adolescents are at increased risk for eating disorders. During menarche, 2% of girls develop premenstrual dysphoria. After puberty, the risk of developing depression rises sharply, and in women it is twice as high as in men of the same age. In childhood, by contrast, girls have less or the same incidence of mental illness as boys their age.

Women are prone to mental disorders during and after pregnancy. Women with a history of psychiatric disorders often refuse medical support when planning a pregnancy, which increases the risk of relapse. After giving birth, most women experience mood swings. Most have a short period of "baby blues" depression that does not require treatment. Others develop more severe, disabling, depressive symptoms in postpartum period, a small number of women develop psychotic disorders. The relative risk of taking drugs during pregnancy and lactation makes it difficult to choose a treatment, in each case the question of the ratio of benefits and risks of therapy depends on the severity of symptoms.

The middle age period is associated with a continued high risk of anxiety and mood disorders, as well as other psychiatric disorders such as schizophrenia. Women may have impaired sexual function, and if they take antidepressants for mood or anxiety disorders, they are at increased risk of side effects, including reduced sexual function. Although there is no clear evidence that menopause is associated with an increased risk of depression, most women experience major life changes during this period, especially in the family. For most women, their active role in relation to children is replaced by the role of carers for elderly parents. Elderly parents are almost always cared for by women. It is necessary to monitor the mental status of this group of women to identify possible violations of the quality of life.

As women age, their risk of developing dementia and psychiatric complications of somatic conditions, such as stroke, increases. Because women live longer than men and the risk of dementia increases with age, most women develop dementia. Elderly women with multiple medical conditions and high medication use are at high risk of delirium. Women are at increased risk of paraphrenia psychotic disorder, usually coming after 60 years. Due to the long life expectancy and greater involvement in interpersonal relationships, women experience the loss of loved ones more often and more strongly, which also increases the risk of developing mental illness.
Examination of a psychiatric patient

Psychiatry deals with the study of affective, cognitive and behavioral disorders that occur while maintaining consciousness. Psychiatric diagnosis and treatment selection follow the same logic of history taking, examination, differential diagnosis and treatment planning as in other clinical areas. A psychiatric diagnosis must answer four questions:

1) mental illness (what the patient has)

2) temperamental disorders (what the patient is)

3) behavioral disorders (what the patient is doing)

4) disorders that arose in certain life circumstances (what the patient encounters in life)
Mental illness

Examples of mental illnesses are schizophrenia and major depression. They are similar to other nosological forms - they have a discrete onset, course, clinical symptoms that can be clearly defined as present or absent in each individual patient. Like other nosologies, they are the result of genetic or neurogenic disorders of the organ, in this case- brain. With obvious abnormal symptoms - auditory hallucinations, mania, severe obsessive-compulsive disorders - the diagnosis of a mental disorder is easily made. In other cases, it can be difficult to distinguish pathological symptoms, such as low mood in major depression, from normal feelings of sadness or disappointment caused by life circumstances. We need to focus on identifying known stereotyped symptom complexes that are characteristic of mental illness, while keeping in mind the diseases that are most common in women.
Temperament disorders

Understanding the characteristics of the patient's personality increases the effectiveness of treatment. Personal traits such as perfectionism, indecision, impulsiveness are somehow quantified in people, as well as physiological ones - height and weight. Unlike mental disorders, they do not have clear characteristics - "symptoms" as opposed to "normal" values, and individual differences normal in the population. Psychopathology or functional personality disorders occur when traits take on the character of extremes. When the temperament leads to impaired professional or interpersonal functioning, this is enough to qualify it as a possible personality disorder; in this case you need health care and collaboration with a psychiatrist.
Conduct violations

Conduct disorders are self-reinforcing. They are characterized by purposeful, irresistible forms of behavior that subjugate all other activities of the patient. Eating disorders and abuse are examples of such disorders. The first goals of treatment are switching the patient's activity and attention, stopping problem behavior and neutralizing precipitating factors. Concomitant mental disorders, such as depression or anxiety disorders, illogical thoughts (the anorectic opinion that "if I eat more than 800 calories a day, I will become fat") can be provoking factors. Group therapy can be effective in treating behavioral disorders. The final step in treatment is relapse prevention, since relapse is a normal course of behavioral disorders.
Patient history

Stressors, life circumstances, social circumstances are factors that can modulate the severity of the disease, personality traits and behavior. Various life stages, including puberty, pregnancy, and menopause, may be associated with an increased risk of certain diseases. Social conditions and gender role differences may help explain the increased incidence of specific symptom complexes in women. For example, the focus of media attention on the ideal figure in Western society is a provoking factor in the development of eating disorders in women. Such contradictory female roles in today's western society, the "devoted wife", the "madly loving mother" and the "successful business woman" add stress. The purpose of collecting an anamnesis of life is a more accurate selection of methods of internally oriented psychotherapy, finding the "meaning of life". The healing process is facilitated when the patient comes to self-understanding, a clear separation of her past and recognition of the priority of the present for the future.

Thus, the formulation of a psychiatric case should include answers to four questions:

1. Whether the patient has a disease with a clear time of onset, a specific etiology, and a response to pharmacotherapy.

2. What personality traits of the patient influence her interaction with the environment and how.

3. Does the patient have goal-directed conduct disorders

4. What events in the life of a woman contributed to the formation of her personality, and what conclusions did she draw from them.
Eating Disorders

Of all the mental disorders, almost exclusively in women, only eating disorders occur: anorexia and bulimia. For every 10 women who suffer from them, there is only one man. The incidence and incidence of these disorders is increasing. Young white women and girls from the middle and upper classes of Western society have the highest risk of developing anorexia or bulimia - 4%. However, the prevalence of these disorders in other age, racial, and socioeconomic groups is also on the rise.

As in cases of abuse, eating disorders are formulated as behavioral disorders caused by dysregulation of hunger, satiety, and absorption of food. Behavioral disorders associated with anorexia nervosa include restriction of food intake, cleansing manipulations (vomiting, abuse of laxatives and diuretics), debilitating physical exertion, abuse of stimulants. These behavioral responses are compulsive in nature, supported by the psychological attitude towards food and weight. These thoughts and behaviors dominate every aspect of a woman's life, disrupting physical, psychological and social functions. As with abuse, treatment can only be effective if the patient is willing to change the situation.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), anorexia nervosa includes three criteria: voluntary fasting with a refusal to maintain more than 85% of the required weight; psychological attitude with fear of obesity and dissatisfaction with one's own weight and body shape; endocrine disorders leading to amenorrhea.

Bulimia nervosa is characterized by the same fear of obesity and dissatisfaction with one's own body as in anorexia nervosa, accompanied by bouts of binge eating, and then compensatory behavior aimed at maintaining a low body weight. In DSM-IV, anorexia and bulimia are distinguished primarily on the basis of underweight and amenorrhea, and not on the basis of the behavior by which weight is controlled. Compensatory behaviors include intermittent fasting, exhausting exercise, laxatives, diuretics, stimulants, and vomiting.

Binge eating disorder differs from bulimia nervosa in the absence of compensatory weight-maintenance behaviors, resulting in obesity in these patients. Some patients change from one eating disorder to another during their lifetime; most often, the change goes in the direction from the restrictive type of anorexia nervosa (when food restriction and excessive physical activity predominate in behavior) towards bulimia nervosa. There is no single cause of eating disorders, they are considered as multifactorial. Known risk factors can be divided into genetic, social predispositions and temperamental characteristics.

Studies have shown a higher concordance of identical twins compared to fraternal twins for anorexia. One family study found a tenfold increased risk of anorexia in female relatives. In contrast, for bulimia, neither familial nor twin studies have shown a hereditary predisposition.

Temperamental and personality traits that contribute to the development of eating disorders include introversion, perfectionism, and self-criticism. Patients with anorexia who restrict food intake but do not engage in cleansing procedures are likely to have predominant anxiety that keeps them from life-threatening behavior; those suffering from bulimia expressed such personality traits as impulsiveness, the search for novelty. Women with binge eating and subsequent cleansing procedures may have other impulsive behaviors such as abuse, sexual promiscuity, kleptomania, self-harm.

Social conditions conducive to the development of eating disorders are associated with the idealization of a slender androgynous figure with underweight, common in modern Western society. Most young women eat a restrictive diet, a behavior that increases the risk of developing eating disorders. Women compare their appearance with each other, as well as with the generally accepted ideal of beauty and strive to be like it. This pressure is especially pronounced in adolescents and young women, as the endocrine changes at puberty increase the amount of adipose tissue in a woman's body by 50%, and the psyche of adolescents simultaneously overcomes such problems as personality development, separation from parents and puberty. The incidence of eating disorders in young women has increased over the past few decades in parallel with increased media attention to slimness as a symbol of a woman's success.

Other risk factors for developing eating disorders are family conflict, loss of significant person such as a parent, physical illness, sexual conflict, and trauma. Triggers can also be marriage and pregnancy. Some professions require maintaining harmony - for ballerinas and models.

It is important to distinguish between the primary risk factors that trigger pathological process, from those that support an already existing conduct disorder. Eating disorders periodically cease to depend on the one who launched them etiological factor. Supporting factors include the development of abnormal eating habits and voluntary fasting. Patients with anorexia start by maintaining a diet. They are often encouraged by their initial weight loss, receiving compliments on their looks and self-discipline. Over time, thoughts and behaviors related to nutrition become the dominant and subjective goal, the only one that relieves anxiety. Patients resort more and more intensely to these thoughts and behaviors to maintain their mood, as alcoholics increase the dose of alcohol to relieve stress and translate other ways of discharge into drinking alcohol.

Eating disorders are often underdiagnosed. Patients hide symptoms associated with a sense of shame, internal conflict, fear of condemnation. Physiological signs eating disorders can be seen on examination. In addition to reduced body weight, fasting can lead to bradycardia, hypotension, chronic constipation, delayed gastric emptying, osteoporosis, menstrual cycle. Cleansing procedures lead to electrolyte imbalance, dental problems, hypertrophy of the parotid salivary glands and dyspeptic disorders. Hyponatremia can lead to the development of a heart attack. In the presence of such complaints, the clinician should conduct a standard survey, including clarification of the minimum and maximum weight patients during adulthood brief history eating habits, such as counting calories and grams of fat in the diet. A further survey may reveal the presence of binge eating, the frequency of resorting to compensatory measures to restore weight. It is also necessary to find out whether the patient herself, her friends and family members believe that she has an eating disorder - and whether this bothers her.

Patients with anorexia who resort to cleansing procedures are at high risk serious complications. Anorexia has the highest mortality among all mental illnesses - more than 20% of anorexics die after 33 years. Death usually occurs due to physiological complications of starvation or due to suicide. In bulimia nervosa, death is often the result of hypokalemia-induced arrhythmias or suicide.

Psychological signs of eating disorders are regarded as secondary to or concomitant with the underlying psychiatric diagnosis. Symptoms of depression and obsessive-compulsive disorder can be associated with fasting: low mood, constant thoughts about food, decreased concentration, ritualistic behavior, decreased libido, social isolation. In bulimia nervosa, shame and the desire to hide binge eating and cleansing routines lead to increased social isolation, self-critical thoughts, and demoralization.

Most patients with eating disorders are at increased risk for other psychiatric disorders, with major depression, anxiety disorders, abuse, and personality disorders being the most common. Concomitant major depression or dysthymia was noted in 50-75% of patients with anorexia and in 24-88% of patients with bulimia. Obsessive neuroses during life met in 26% of anorectics.

Patients with eating disorders are characterized by social isolation, communication difficulties, problems in intimate life and professional activities.

Treatment of eating disorders occurs in several stages, beginning with an assessment of the severity of the pathology, identifying comorbid mental diagnoses, and establishing motivation for change. It is necessary to consult a nutritionist and a psychotherapist specializing in the treatment of patients with eating disorders. It must be understood that, first of all, it is necessary to stop pathological behavior, and only after it is brought under control, it will be possible to prescribe treatment aimed at internal processes. A parallel can be drawn with the primacy of withdrawal in the treatment of abuse, when therapy given concomitantly with continued alcohol intake fails.

Treatment by a general psychiatrist is less desirable in terms of maintaining treatment motivation, treatment in special inpatient institutions such as sanatoriums is more effective - the mortality rate for patients in such institutions is lower. Group therapy and rigorous monitoring of food intake and toilet use by medical staff in these facilities minimizes the chance of relapse.

Several classes of psychopharmacological agents are used in patients with eating disorders. Double-blind, placebo-controlled studies have proven the effectiveness of a wide range of antidepressants in reducing the frequency of binge eating and subsequent cleansing procedures in bulimia nervosa. Imipramine, desipramine, trazodone and fluoxetine reduce the frequency of such attacks, regardless of the presence or absence of comorbid depression. When using fluoxetine, a more effective dose is more effective than is usually used in the treatment of depression - 60 mg. Monoamine oxidase inhibitors (MAOIs) and buproprion are relatively contraindicated because dietary restrictions are required when using MAOIs, and buproprion increases the risk of a heart attack in bulimia. In general, treatment for bulimia should include an attempt to use tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs) along with psychotherapy.

In anorexia nervosa, no weight gain medication has been shown to be effective in controlled trials. Unless the patient is severely depressed or has obvious signs of obsessive-compulsive disorder, most clinicians recommend monitoring the mental status of patients during remission rather than prescribing drugs while weight is still underweight. Most of the symptoms of depression, ritualistic behavior, obsessions disappear when the weight approaches normal. When a decision is made to prescribe antidepressants, low doses of SSRIs are the safest choice given the high potential risk cardiac arrhythmia and hypotension while taking tricyclic antidepressants, as well as a generally higher risk of side effects of drugs in people who are underweight. A recent double-blind, placebo-controlled trial of fluoxetine in anorexia nervosa found that the drug may be useful in preventing post-weight loss.

Few studies have been conducted on the levels of neurotransmitters and neuropeptides in patients and recovered patients with eating disorders, but their results show dysfunction of the serotonin, noradrenergic and opiate systems of the CNS. Studies of eating behavior in animal models give the same results.

The efficacy of serotonergic and noradrenergic antidepressants in bulimia also supports the physiology of this disorder.

Evidence from human studies is inconsistent, and it remains unclear whether neurotransmitter level disturbances in patients with eating disorders are associated with this condition, whether they appear in response to fasting and bouts of binge eating and purging, or precede psychiatric disturbance and are personality traits susceptible to this condition. patient's disorder.

Studies of the effectiveness of the treatment of anorexia nervosa show that among hospitalized patients, after 4 years of follow-up, 44% had a good result with the restoration of normal body weight and menstrual cycle; in 28% the result was temporary, in 24% it was not and 4% died. Unfavorable prognostic factors are the variant of the course of anorexia with bouts of binge eating and purging, low minimum weight and the ineffectiveness of therapy in the past. More than 40% of anorexics develop bulimic behavior over time.

The long-term prognosis for bulimia is unknown. Episodic relapses are most likely. A decrease in the severity of bulimic symptoms is observed in 70% of patients with a short follow-up period after treatment with drugs in combination with psychotherapy. As with anorexia, the severity of symptoms in bulimia affects prognosis. Among patients with severe bulimia, 33% failed after three years.

Eating disorders are a complex psychiatric disorder most commonly seen in women. Their frequency of occurrence in Western society is growing, they are combined with high morbidity. The use of psychotherapeutic, educational and pharmacological techniques in treatment can improve the prognosis. Although no specific help may be needed initially, treatment failure requires early referral to a psychiatrist. Further research is needed to elucidate the reasons for the predominance of women among patients, to assess the real risk factors and to develop an effective treatment.
affective disorders

affective disorders are mental illness, the main symptom of which are mood changes. Everyone experiences mood swings in life, but their extreme expressions - affective disorders - are few. Depression and mania are the two main mood disorders seen in mood disorders. These diseases include major depression, manic-depressive psychosis, dysthymia, adjustment disorder with depressive mood. Features of the hormonal status can serve as risk factors for the development of affective disorders during a woman's life, exacerbations are associated with menstruation and pregnancy.
Depression

Depression is one of the most common mental disorders and is more common in women. Most studies estimate the incidence of depression in women to be twice as high as in men. This pattern may be partly explained by the fact that women have a better memory of past bouts of depression. Diagnosis of this condition is complicated by the wide range of symptoms and the lack of specific signs or laboratory tests.

When diagnosing, it is quite difficult to distinguish between short-term periods of sad mood associated with life circumstances and depression as a mental disorder. The key to differential diagnosis is recognizing the typical symptoms and monitoring their progress. A person without mental disorders usually there are no disturbances in self-esteem, suicidal thoughts, feelings of hopelessness, neurovegetative symptoms such as sleep disturbances, appetite, lack of vital energy within weeks and months.

The diagnosis of major depression is based on history taking and mental status examination. The main symptoms include low mood and anhedonia, the loss of desire and ability to enjoy the normal activities of life. In addition to depression and anhedonia lasting for at least two weeks, episodes of major depression are characterized by the presence of at least four of the following neurovegetative symptoms: significant weight loss or gain, insomnia, or increased drowsiness, psychomotor retardation or revival, fatigue and loss of strength, reduced ability to concentrate and make decisions. In addition, many people suffer from increased self-criticism with feelings of hopelessness, excessive guilt, suicidal thoughts, feeling like a burden to their loved ones and friends.

The duration of symptoms for more than two weeks helps to distinguish an episode of major depression from a short-term adjustment disorder with lowered mood. Adjustment disorder is a reactive depression in which depressive symptoms are a reaction to an overt stressor, are limited in number, and are amenable to minimal therapy. This does not mean that an episode of major depression cannot be triggered by a stressful event or cannot be treated. An episode of major depression differs from an adjustment disorder in the severity and duration of symptoms.

In some groups, in particular the elderly, the classic symptoms of depression, such as lowered mood, are often not observed, which leads to an underestimation of the frequency of depression in such groups. There is also evidence that in some ethnic groups, depression is more pronounced with somatic signs than with classic symptoms. In older women, complaints of feelings of social worthlessness and a set of characteristic somatic complaints should be taken seriously as they may require medical antidepressant help. Although some laboratory tests, such as the dexamethasone test, have been suggested for diagnosis, they are not specific. The diagnosis of major depression remains clinical and is made after a thorough history and assessment of mental status.

In childhood, the incidence of depression in boys and girls is the same. Differences become noticeable at puberty. Angola and Worthman consider the cause of these differences to be hormonal and conclude that hormonal changes may be the trigger mechanism for the depressive episode. Starting with menarche, women are at increased risk of developing premenstrual dysphoria. This mood disorder is characterized by symptoms of major depression, including anxiety and mood lability, occurring in the last week of the menstrual cycle and ending in the early days of the folliculin phase. Although premenstrual emotional lability occurs in 20-30% of women, its severe forms are quite rare - in 3-5% of the female population. A recent multicenter, randomized, placebo-controlled trial of sertraline 5–150 mg showed significant improvement in symptoms with treatment. 62% of women in the main group and 34% in the placebo group responded to treatment. Fluoxetine at a dose of 20-60 mg per day also reduces the severity of premenstrual disorders in more than 50% of women - according to a multicenter placebo-controlled study. In women with major depression, as with manic-depressive psychosis, psychiatric disturbances worsen during the premenstrual period - it is not clear whether this is an exacerbation of one condition or a superposition of two (the underlying psychiatric disorder and premenstrual dysphoria).

Pregnant women experience a full range of affective symptoms both during pregnancy and after childbirth. The incidence of major depression (about 10%) is the same as in non-pregnant women. In addition, pregnant women may experience less severe symptoms of depression, mania, periods of psychosis with hallucinations. The use of medications during pregnancy is used both during an exacerbation of a mental state and for the prevention of relapses. Interruption of medication during pregnancy in women with pre-existing mental disorders leads to a sharp increase in the risk of exacerbations. To make a decision on drug treatment, it is necessary to compare the risk potential harm drugs for the fetus with a risk for both the fetus and the mother of recurrence of the disease.

In a recent review, Altshuler et al described existing therapeutic guidelines for the treatment of various psychiatric disorders during pregnancy. In general, medications should be avoided during the first trimester if possible due to the risk of teratogenic effects. However, if symptoms are severe, treatment with antidepressants or mood stabilizers may be necessary. Initial studies with fluoxetine have shown that SSRIs are relatively safe, but there are no reliable data on the prenatal effects of these new drugs. The use of tricyclic antidepressants does not lead to a high risk of congenital anomalies. Electroconvulsive therapy is another relatively safe method treatment of severe depression during pregnancy. Lithium supplementation during the first trimester increases the risk congenital pathologies of cardio-vascular system. Antiepileptic drugs and benzodiazepines are also associated with an increased risk of congenital anomalies and should be avoided if possible. In each case, it is necessary to evaluate all indications and risks individually, depending on the severity of the symptoms. To compare the risk of untreated mental illness and the risk of pharmacological complications for the mother and fetus, a psychiatric consultation is necessary.

Many women experience mood disturbances after childbirth. The severity of symptoms ranges from "baby blues" to severe major depression or psychotic episodes. For most women, these mood changes occur in the first six months after childbirth, at the end of this period, all signs of dysphoria disappear on their own. However, in some women, depressive symptoms persist for many months or years. In a study of 119 women after their first childbirth, half of the women who received medical treatment after childbirth had a relapse within the next three years. Early definition symptoms and adequate treatment necessary for both the mother and the child, since depression can affect the mother's ability to adequately care for the child. However, antidepressant treatment in breastfeeding mothers requires caution and comparative risk assessment.

Mood changes during menopause have been known for a long time. Recent studies, however, have not confirmed a clear link between menopause and affective disorders. In a review on this issue, Schmidt and Rubinow found very few published studies to support this relationship.

Mood changes associated with menopausal hormonal changes may resolve with HRT. For most women, HRT is the first step in treatment before psychotherapy and antidepressants. If symptoms are severe, initial treatment with antidepressants is indicated.

Due to the long life expectancy of women compared to men, most women outlive their spouses, which is a stress factor in older age. At this age, monitoring is needed to identify symptoms of severe depression. History taking and examination of mental status in older women should include screening for somatic symptoms and identifying feelings of worthlessness, a burden on loved ones, because depression in the elderly is not characterized by a decrease in mood as a primary complaint. Treatment of depression in the elderly is often complicated by low tolerance to antidepressants, so they must be prescribed at a minimum dose, which can then be gradually increased. SSRIs are undesirable at this age due to their anticholinergic side effects, sedation and orthostasis. When a patient takes several drugs, drug monitoring in the blood is necessary due to the mutual influence on metabolism.

There is no single cause of depression. The main demographic risk factor is belonging to female gender. Analysis of population data shows that the risk of developing major depression is increased in divorced, single and unemployed people. The role of psychological causes is being actively studied, but so far no consensus has been reached on this issue. Family studies have demonstrated an increased incidence of affective disorders in the closest relatives of the proband. Twin studies also support the idea of ​​a genetic predisposition in some patients. Especially strongly hereditary predisposition plays a role in the genesis of manic-depressive psychosis and major depression. Probable cause is a violation of the functioning of serotonergic and noradrenergic systems.

The usual therapeutic approach to treatment is a combination of pharmacological agents - antidepressants - and psychotherapy. The advent of a new generation of antidepressants with minimal side effects has increased the therapeutic options for patients with depression. 4 main types of antidepressants are used: tricyclic antidepressants, SSRIs, MAO inhibitors and others - see table. 28-2.

A key principle in the use of antidepressants is adequate time to take them - a minimum of 6-8 weeks for each drug at a therapeutic dose. Unfortunately, many patients stop taking antidepressants before the effect develops, because they do not see improvement in the first week. When taking tricyclic antidepressants, drug monitoring can help confirm that adequate therapeutic blood levels have been achieved. For SSRIs, this method is less useful, their therapeutic level varies greatly. If a patient has not taken a full course of antidepressant and continues to experience symptoms of major depression, a new course of treatment with a different class of drug should be initiated.

All patients treated with antidepressants should be monitored for the development of manic symptoms. Although it's enough rare complication taking antidepressants, it does happen, especially if there is a family or personal history of manic-depressive psychosis. Symptoms of mania include reduced need for sleep, a feeling of increased energy, and agitation. Prior to the appointment of therapy in patients, it is necessary to carefully collect an anamnesis in order to identify symptoms of mania or hypomania, and if they are present or with a family history of manic-depressive psychosis, a psychiatric consultation will help select therapy with mood stabilizers - drugs of lithium, valproic acid, possibly in combination with antidepressants.
Seasonal affective disorders

For some people, the course of depression is seasonal, worsening in the winter. The severity of clinical symptoms varies widely. For moderate symptoms, exposure to full spectrum non-ultraviolet light (fluorescent lamps - 10,000 lux) for 15-30 minutes every morning during the winter months is sufficient. If symptoms meet the criteria for major depression, antidepressant treatment should be added to light therapy.
Bipolar disorders (manic-depressive psychosis)

The main difference between this disease and major depression is the presence of both episodes of depression and mania. Criteria for depressive episodes are the same as for major depression. Episodes of mania are characterized by bouts of high, irritable, or aggressive mood lasting at least a week. These mood changes are accompanied by the following symptoms: increased self-esteem, decreased need for sleep, loud and fast speech, racing thoughts, agitation, flashes of ideas. Such an increase in vital energy is usually accompanied by excessive behavior aimed at obtaining pleasure: spending large sums of money, drug addiction, promiscuity and hypersexuality, risky business projects.

There are several types of manic-depressive disorder: the first type is the classic form, type 2 includes a change in episodes of depression and hypomania. Episodes of hypomania are milder than classical mania, with the same symptoms but without disrupting the patient's social life. Other forms of bipolar disorder include rapid mood swings and mixed states, where the patient has both manic and depressive symptoms at the same time.

Mood stabilizers such as lithium and valproate are first-line drugs for the treatment of all forms of bipolar disorder. Lithium starting at 300 mg once or twice daily, then adjusted to maintain blood levels of 0.8-1.0 mEq/L for bipolar disorder the first type. The level of valproate in the blood, effective for the treatment of these diseases, has not been precisely established; one can focus on the level recommended for the treatment of epilepsy: 50-150 mcg / ml. Some patients require a combination of mood stabilizers with antidepressants to treat symptoms of depression. A combination of mood stabilizers with low doses of neuroleptics is used to control the symptoms of acute mania.
Dysthymia

Dysthymia is a chronic depressive condition lasting at least two years, with symptoms less severe than those of major depression. The severity and number of symptoms are not sufficient to meet the criteria for major depression, but they interfere with social functioning. Typically, symptoms include appetite disturbances, decreased energy, impaired concentration, sleep disturbances, and feelings of hopelessness. Studies conducted in different countries claim a high prevalence of dysthymia in women. Although there are few reports of therapy for this disorder, there is evidence that SSRIs such as fluoxetine and sertraline may be used. Some patients with dysthymia may experience episodes of major depression.
Coexisting affective and neurological disorders

There is much evidence of associations between neurological disorders and affective disorders, more often with depression than with bipolar disorders. Episodes of major depression are common in Huntington's chorea, Parkinson's disease, and Alzheimer's disease. 40% of patients with parkinsonism have episodes of depression - half have major depression, half have dysthymia. In a study including 221 patients with multiple sclerosis, 35% were diagnosed with major depression. Some studies have shown an association between stroke in the left frontal lobe and major depression. AIDS patients develop both depression and mania.

Neurological patients with features that meet the criteria for affective disorders should be treated with drugs, since drug treatment of psychiatric disorders improves the prognosis of the underlying neurological diagnosis. If a clinical picture does not meet the criteria for an affective disorder, psychotherapy is sufficient to help the patient cope. The combination of several diseases increases the number of prescribed drugs and sensitivity to them, and hence the risk of delirium. In patients receiving a large number of drugs, antidepressants should be started at a low dose and increased gradually, monitoring for possible symptoms of delirium.
Alcohol abuse

Alcohol is the most commonly abused substance in the US, with 6% of the adult female population having serious problems with alcohol. Although the rate of alcohol abuse in women is lower than in men, alcohol dependence and alcohol-related morbidity and mortality are significantly higher in women. Studies of alcoholism are focused on the male population, the validity of extrapolating their data to the female population is questionable. For diagnosis, questionnaires are usually used to identify problems with the law and employment, which are much less common in women. Women are more likely to drink alone and are less likely to have tantrums when intoxicated. One of the main risk factors for the development of alcoholism in a woman is an alcoholic partner who inclines her to drinking companionship and does not allow her to seek help. In women, the signs of alcoholism are more pronounced than in men, but doctors determine it in women less often. All this makes it possible to consider the official frequency of occurrence of alcoholism in women underestimated.

Complications associated with alcoholism (fatty liver, cirrhosis, hypertension, gastrointestinal bleeding, anemia and digestive disorders) develop faster in women and at lower doses of alcohol than men, because women have a lower level than men gastric alcohol dehydrogenase. Dependence on alcohol, as well as on other substances - opiates, cocaine - women develop after a shorter time of admission than men.

There is evidence that the incidence of alcoholism and related medical problems is on the rise in women born after 1950. During the phases of the menstrual cycle, changes in the metabolism of alcohol in the body are not observed, however, women who drink are more likely to experience irregular menstrual cycles and infertility. During pregnancy, a complication such as alcohol syndrome fetus. The incidence of cirrhosis increases dramatically after menopause, and alcoholism increases the risk of alcoholism in older women.

Women with alcoholism have an increased risk of comorbid psychiatric diagnoses, especially drug addictions, mood disorders, bulimia nervosa, anxiety, and psychosexual disorders. Depression occurs in 19% of alcoholic women and 7% of women who do not abuse alcohol. Although alcohol brings temporary relaxation, it exacerbates the course of mental disorders in susceptible people. It takes several weeks of withdrawal to achieve remission. Women with a paternal family history of alcoholism, anxiety disorder, and premenstrual syndrome drink more during the second phase of their cycle, possibly in an attempt to reduce symptoms of anxiety and depression. Alcoholic women are at high risk of suicide attempts.

Women usually seek relief from alcoholism in a roundabout way, turning to psychoanalysts or general practitioners with complaints of family problems, physical or emotional complaints. They rarely go to alcoholism treatment centers. Alcoholic patients need a special approach due to their frequent inadequacy and reduced sense of shame.

Although it is almost impossible to directly ask such patients about the amount of alcohol taken, screening for alcohol abuse should not be limited to indirect signs such as anemia, elevated liver enzymes and triglycerides. The question “Have you ever had a problem with alcohol” and the CAGE questionnaire (Table 28-3) provide a rapid screening with a sensitivity of more than 80% for more than two positive responses. Support, explanation, and discussion with the doctor, psychologist, and members of Alcoholics Anonymous help the patient adhere to treatment. During the withdrawal period, it is possible to prescribe diazepam at a starting dose of 10-20 mg with a gradual increase by 5 mg every 3 days. Control visits should be at least twice a week, they assess the severity of signs of withdrawal syndrome (sweating, tachycardia, hypertension, tremor) and adjust the dose of the drug.

Although alcohol misuse is less common in women than in men, its harm to women, taking into account the associated morbidity and mortality, is much higher. New studies are needed to elucidate the pathophysiology and psychopathology of the sexual characteristics of the course of the disease.
Table 28-3
CAGE Questionnaire

1. Have you ever felt like you need to drink less?

2. Have people ever bothered you with their criticism of your drinking?

3. Have you ever felt guilty about drinking alcohol?

4. Has it ever happened that alcohol was the only remedy that helps to become cheerful in the morning (open your eyes)
Sexual disorders

Sexual dysfunctions have three successive stages: disturbances of desire, arousal and orgasm. The DSM-IV considers painful sexual disorders as a fourth category of sexual dysfunction. Desire disorders are further subdivided into reduced sexual desire and perversions. Painful sexual disorders include vaginismus and dyspareunia. Clinically, women often have a combination of several sexual dysfunctions.

The role of sex hormones and menstrual disorders in the regulation of sexual desire remains unclear. Most researchers suggest that endogenous fluctuations in estrogen and progesterone do not significantly affect sexual desire in women of reproductive age. However, there is clear evidence of a decrease in desire in women with surgical menopause, which can be restored by the administration of estradiol or testosterone. Studies of the relationship between arousal and orgasm with cyclic fluctuations in hormones do not give unambiguous conclusions. There is a clear correlation between the plasma level of oxytocin and the psychophysiological magnitude of orgasm.

In postmenopausal women, the number of sexual problems increases: a decrease in vaginal lubrication, atrophic vaginitis, a decrease in blood supply, which are effectively solved with estrogen replacement therapy. The addition of testosterone helps to increase sexual desire, although there is no clear evidence of the supportive effect of androgens on blood flow.

Psychological factors, communication problems play a much more important role in the development of sexual disorders in women than organic dysfunction.

Special attention deserves the influence of medications taken by psychiatric patients on all phases of sexual function. Antidepressants and antipsychotic drugs There are two major classes of drugs associated with these side effects. Anorgasmia has been observed with the use of SSRIs. Despite clinical reports of the effectiveness of adding cyproheptadine or interrupting the main drug for the weekend, a more acceptable solution so far is to change the antidepressant class to another one with less side effects in this area, most often to buproprion and nefazodone. In addition to the side effects of psychopharmacological agents, a chronic mental disorder in itself can lead to a decrease in sexual interest, as well as physical diseases accompanied by chronic pain, low self-esteem, changes in appearance, and fatigue. A history of depression may be the cause of reduced sexual desire. In such cases, sexual dysfunction occurs during the manifestation of an affective disorder, but does not disappear after the end of its episode.
Anxiety disorders

Anxiety is a normal adaptive emotion that develops in response to a threat. It works as a signal to activate behavior and minimize physical and psychological vulnerability. Anxiety reduction is achieved either by overcoming or avoiding a provoking situation. Pathological anxiety states differ from normal anxiety in the severity and chronicity of the disorder, provocative stimuli, or adaptive behavioral response.

Anxiety disorders are widespread, with a monthly incidence of 10% among women. The median age at which anxiety disorders develop is adolescence and adolescence. Many patients never seek help for this or go to non-psychiatrists complaining of somatic symptoms associated with anxiety. Overdosing or withdrawal of medications, use of caffeine, weight loss drugs, pseudoephedrine can exacerbate anxiety disorder. medical examination should include a thorough history taking, routine laboratory tests, ECG, and urinalysis. Some types of neurological pathology are accompanied by anxiety disorders: movement disorders, brain tumors, circulatory disorders of the brain, migraine, epilepsy. Somatic diseases accompanied by anxiety disorders: cardiovascular, thyrotoxicosis, systemic lupus erythematosus.

Anxiety disorders are divided into 5 main groups: phobias, panic disorders, generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress syndrome. With the exception of obsessive compulsive disorder, which is equally common in men and women, anxiety disorders are more common in women. Women are three times more likely to have specific phobias and agoraphobia, 1.5 times more likely to have panic with agoraphobia, 2 times more likely to have generalized anxiety disorder, and 2 times more likely to have post-traumatic stress syndrome. Reasons for predominance anxiety disorders it is in the female population that are unknown, hormonal and sociological theories have been proposed.

Sociological theory focuses on traditional sex-role stereotypes that prescribe helplessness, dependence, and avoidance of active behavior to a woman. New mothers often worry about whether they will be able to keep their children safe, not wanting to become pregnant, infertility - all of these conditions can exacerbate anxiety disorders. A large number of Expectations and conflicting roles of mother, wife, housewife and successful worker also increase the frequency of anxiety disorders in women.

Hormonal fluctuations exacerbate anxiety in the premenstrual period, during pregnancy and after childbirth. Progesterone metabolites function as partial GABA agonists and possible modulators of the serotonergic system. Alpha-2 receptor binding also changes throughout the menstrual cycle.

Anxiety disorders are highly associated with other psychiatric diagnoses, most commonly affective disorders, drug dependence, other anxiety disorders, and personality disorders. At panic disorder ah, for example, the combination with depression occurs more often than in 50%, and with alcohol dependence - in 20-40%. Social phobia is combined with panic disorder in more than 50%.

The general principle of the treatment of anxiety disorders is the combination of pharmacotherapy with psychotherapy - the effectiveness of this combination is higher than the use of these methods in isolation from each other. Drug treatment affects three major neurotransmitter systems: noradrenergic, serotonergic, and GABAergic. The following classes of drugs are effective: antidepressants, benzodiazepines, beta-blockers.

All drugs should be started at low doses and then gradually increased by a factor of two every 2 to 3 days or less frequently to minimize side effects. Patients with anxiety disorders are very sensitive to side effects, so gradually increasing the dose increases compliance with therapy. Patients need to be explained that most antidepressants take 8-12 weeks to work, tell them about the main side effects, help them continue the drug for the required amount of time, and explain that some of the side effects go away with time. The choice of antidepressant depends on the patient's set of complaints and on their side effects. For example, patients with insomnia may be better off starting with more sedating antidepressants such as imipramine. If effective, treatment should be continued for 6 months to a year.

At the beginning of treatment, before the effect of antidepressants develops, the addition of benzodiazepines is useful, which can dramatically reduce symptoms. Long-term use of benzodiazepines should be avoided due to the risk of dependence, tolerance and withdrawal. When prescribing benzodiazepines, the patient should be warned about their side effects, the risks associated with their long-term use, and the need to consider them only as a temporary measure. Clonazepam 0.5 mg twice daily or lorazepam 0.5 mg four times daily for a limited period of 4–6 weeks may improve initial antidepressant compliance. When taking benzodiazepines for more than 6 weeks, discontinuation should be gradual to reduce anxiety associated with a possible withdrawal syndrome.

In pregnant women, anxiolytics should be used with caution, most safe drugs in this case, tricyclic antidepressants. Benzodiazepines can lead to the development of hypotension, respiratory distress syndrome and a low Apgar score in newborns. Clonazepam has a minimal potential teratogenic effect and may be used with caution in pregnant women with severe anxiety disorders. The first step should be to try non-pharmacological treatment - cognitive (training) and psychotherapy.
Phobic disorders

There are three types of phobic disorders: specific phobias, social phobia, and agoraphobia. In all cases, in a provoking situation, anxiety occurs and a panic attack may develop.

Specific phobias are irrational fears of specific situations or objects that cause them to be avoided. Examples are fear of heights, fear of flying, fear of spiders. They usually occur at the age of under 25, women are the first to develop a fear of animals. Such women rarely seek treatment because many phobias do not interfere with normal life and their stimuli (such as snakes) are fairly easy to avoid. However, in some cases, such as fear of flying, phobias can interfere with a career, in which case treatment is indicated. Simple phobias are fairly easy to deal with with psychotherapeutic techniques and systemic desensitization. Additionally, a single dose of 0.5 or 1 mg of lorazepam before flying helps to reduce this specific fear.

Social phobia (fear of society) is the fear of a situation in which a person is available for close attention of other people. Avoidance of provoking situations with this phobia severely limits the working conditions and social function. Although social phobia is more common in women, it is easier for them to avoid a provoking situation and do housework, so men with social phobia are more common in the clinical practice of psychiatrists and psychotherapists. Social phobia can be associated with movement disorders and epilepsy. In a study of patients with Parkinson's disease, the presence of social phobia was revealed in 17%. Pharmacological treatment of social phobia is based on the use of beta-blockers: propranolol at a dose of 20-40 mg an hour before the disturbing presentation or atenolol at a dose of 50-100 mg per day. These drugs block the activation of the autonomic nervous system in connection with anxiety. Antidepressants, including tricyclics, SSRIs, MAO blockers, can also be used - in the same doses as in the treatment of depression. A combination of pharmacotherapy with psychotherapy is preferred: short-term use of benzodiazepines or low doses of clonazepam or lorazepam in combination with cognitive therapy and systemic desensitization.

Agoraphobia is the fear and avoidance of crowded places. Often combined with panic attacks. It is very difficult to avoid provoking situations in this case. As with social phobia, agoraphobia is more common in women, but men seek help more often because its symptoms interfere with their personal and social lives. Treatment for agoraphobia is systemic desensitization and cognitive psychotherapy. Because of their high association with panic disorder and major depression, antidepressants are also effective.
Panic Disorders

A panic attack is a sudden attack of intense fear and discomfort lasting several minutes, resolving gradually and including at least 4 symptoms: chest discomfort, sweating, trembling, hot flashes, shortness of breath, paresthesias, weakness, dizziness, palpitations, nausea, frustration stool, fear of death, loss of self-control. Panic attacks can occur with any anxiety disorder. They are unexpected and accompanied by a constant fear of expecting new attacks, which changes behavior, directs it to minimize the risk of new attacks. Panic attacks also occur in many conditions of intoxication and some diseases such as emphysema. In the absence of therapy, the course of panic disorders becomes chronic, but treatment is effective, and the combination of pharmacotherapy with cognitive-behavioral psychotherapy causes a dramatic improvement in most patients. Antidepressants, especially tricyclics, SSRIs, and MAO inhibitors, at doses comparable to those used in the treatment of depression, are the drug of choice (Table 28-2). Imipramine or nortriptyline is started at a low dose of 10–25 mg daily and increased by 25 mg every three days to minimize side effects and improve compliance. Blood levels of nortriptyline should be maintained between 50 and 150 ng/mL. Fluoxetine, fluvoxamine, tranylcypromine, or phenelzine may also be used.
generalized anxiety disorder

DSM-IV defines generalized anxiety disorder as persistent, severe, poorly controlled anxiety associated with daily activities such as work, school, that interferes with life and is not limited to the symptoms of other anxiety disorders. At least three of the following symptoms are present: fatigue, poor concentration, irritability, sleep disturbances, restlessness, muscle tension.

Treatment includes medication and psychotherapy. First line drug in the treatment of generalized anxiety disorder is buspirone. The initial dose is 5 mg twice a day, gradually increasing it over several weeks to 10-15 mg twice a day. An alternative is imipramine or an SSRI (sertraline) (see Table 28-2). Short-term use of long-acting benzodiazepines, such as clonazepam, may help manage symptoms in the first 4 to 8 weeks, before mainstream treatment takes effect.

Psychotherapeutic techniques used in the treatment of generalized anxiety disorder include cognitive behavioral therapy, supportive therapy, and an introspective approach that aims to increase the patient's tolerance for anxiety.
I took it here: http://www.mariamm.ru/doc_585.htm

Our psyche is quite subtle and complex system. Experts classify it as a form of active reflection by a person of objective reality, which arises when an individual interacts with the outside world and regulates his behavior and activities. Quite often, doctors have to deal with pathological deviations from normal state which they call mental disorders. There are many mental disorders, but some are more common. Let's talk about what constitutes a violation of the human psyche in a little more detail, discuss the symptoms, treatment, types and causes of such health problems.

Causes of mental disorders

Mental disorders can be explained by a variety of factors, which can generally be divided into exogenous and endogenous. The first are factors of external influence, for example, the intake of dangerous toxic substances, viral diseases and traumatic lesions. BUT internal causes presented chromosomal mutations, hereditary and gene ailments, as well as disorders mental development.

An individual's resistance to mental disorders is also determined by specific physical characteristics, and common development psyche. After all, different subjects react differently to mental anguish and various kinds of problems.

Typical causes of mental disorders include neurosis, neurasthenia, depressive states, aggressive exposure to chemical or toxic elements, as well as traumatic head injuries and a hereditary factor.

Mental disorder - symptoms

There are a number of different symptoms that can be observed in mental disorders. They are most often manifested by psychological discomfort and impaired activity in various areas. Patients with these problems present with a variety of physical and emotional symptoms, and cognitive and perceptual disturbances may also occur. For example, a person may feel unhappy or super happy, regardless of the severity of the events that have occurred, and he may also experience failures in building logical relationships.

Excessive fatigue, rapid and unexpected mood swings, insufficiently adequate response to events, spatiotemporal disorientation are considered classic manifestations of mental disorders. Also, specialists are faced with a violation of perception in their patients, they may not have an adequate attitude to their own condition, there are abnormal reactions (or lack of adequate reactions), fear, confusion (sometimes hallucinations). Enough common symptom anxiety, problems with sleep, falling asleep and waking up become mental disorders.

Sometimes mental health problems are accompanied by the appearance of obsessions, persecution delusions and various phobias. Such disorders often lead to the development depressive states, which can be interrupted by violent emotional outbursts, directed at the fulfillment of some incredible plans.

Many mental disorders are accompanied by disorders of self-awareness, which make themselves felt by confusion, depersonalization and derealization. In people with such problems, memory often weakens (and sometimes completely absent), paramnesia and impaired thought process.

A frequent companion of mental disorders is considered delirium, which can be both primary and sensual, and affective.

Sometimes mental disorders are manifested by problems with eating - overeating, which can cause obesity, or, conversely, by refusing food. Alcohol abuse is common. Many patients with such problems suffer from sexual dysfunction. They also often look sloppy and may even refuse to hygiene procedures.

Types of mental disorders

There are quite a few classifications of mental disorders. We will consider only one of them. It includes conditions provoked by various organic diseases of the brain - injuries, strokes and systemic diseases.

Doctors also separately consider persistent or drugs.

In addition, disorders can be distinguished psychological development(debut in early childhood) and impaired activity, concentration and hyperkinetic disorders (usually recorded in children or adolescents).

Mental disorder - treatment

Therapy of problems of this kind is carried out under the supervision of a psychotherapist and other narrow specialists, while the doctor takes into account not only the diagnosis, but also the patient's condition, and other existing health disorders.

So quite often experts use sedatives that have a pronounced calming effect. Tranquilizers can also be used, they effectively reduce anxiety and relieve emotional tension. Still such funds lower the tone of the muscles and have a mild hypnotic effect. The most common tranquilizers are Chlordiazepoxide, and.

Mental disorders are also treated with the use of antipsychotics. These drugs are considered the most popular in such diseases, they reduce the excitement of the psyche, reduce psychomotor activity, reduce aggressiveness and suppress emotional tension. Popular drugs in this group are Propazine, Pimozide, and Flupentixol.

Antidepressants are used to treat patients with complete depression of thoughts and feelings, with severe depression of mood. Such drugs are able to increase the pain threshold, improve mood, relieve apathy and lethargy, they normalize sleep and appetite well, and also increase mental activity. Qualified psychotherapists often use Pyritinol and as antidepressants.

Another treatment of mental disorders can be carried out with the help of normotimics, which are designed to regulate inadequate manifestations of emotions, and have anticonvulsant efficacy. These drugs are often used for bipolar affective disorder. These include, etc.

Nootropics are considered the safest drugs for the treatment of mental disorders, which have a positive effect on cognitive processes, enhance memory and increase the resistance of the nervous system to various stresses. The drugs of choice usually become, and Aminalon.

In addition, patients with mental disorders are shown corrective psychotherapy. They will benefit from hypnotechniques, suggestion, sometimes NLP methods. An important role is played by the mastery of the method of autogenic training, in addition, one cannot do without the support of relatives.

Mental disorder - alternative treatment

Specialists traditional medicine argue that some herbal and improvised medicines may well contribute to the elimination of mental disorders. But you can use them only after consultation with the doctor.

So traditional medicine can be an excellent alternative to some sedative medicines. For example, to eliminate nervous excitement, irritability and insomnia, healers advise mixing three parts of crushed valerian root, the same amount of peppermint leaves and four parts of clover. Brew a tablespoon of such raw materials with a glass of only boiled water. Infuse the medicine for twenty minutes, then strain, and squeeze the plant material. Take a ready-made infusion in half a glass twice a day and just before bedtime.

Also, with irritability of the nervous system, insomnia and nervous excitement, you can mix two parts of valerian roots with three parts of chamomile flowers and three parts of cumin seeds. Brew and take such a remedy in the same way as in the previous recipe.

You can cope with insomnia with a simple infusion based on hops. Pour a couple of tablespoons of crushed cones of this plant with half a liter of cool, pre-boiled water. Insist for five to seven hours, then strain and drink a tablespoon three to four times a day.

Another great sedative is oregano. Brew a couple of tablespoons of this herb with half a liter of boiling water. Infuse for half an hour, then strain and take half a glass three or four times a day immediately before a meal. This medicine is great for relieving sleep problems.

Some traditional medicine can be used to treat depression. So a good effect is given by taking a medicine based on chicory root. Twenty grams of such crushed raw materials, brew a glass of boiling water. Boil the product on a fire of minimum power for ten minutes, then strain. Take a ready-made broth in a tablespoon five to six times a day.

If depression is accompanied by a severe breakdown, prepare a medicine based on rosemary. Twenty grams of crushed leaves of such a plant, brew one glass of boiling water and boil on a fire of minimum power for fifteen to twenty minutes. Cool the finished medicine, then strain. Take half a teaspoon of it half an hour before a meal.

A remarkable effect in depression is also obtained by taking an infusion based on ordinary knotweed. Brew a couple of tablespoons of this herb with half a liter of boiling water. Insist for half an hour, then strain. Take during the day in small portions.

Mental disorders are quite serious conditions that require close attention and adequate correction under the supervision of specialists. Appropriateness of application folk remedies also worth discussing with your doctor.

Typical signs of a mental disorder are behavioral changes and thought disorders that go beyond existing norms and traditions. Basically, these signs are associated with the complete or partial insanity of a person and make a person incapable of performing social functions.

Similar disorders can occur in men and women at any age, regardless of nationality.

The pathogenesis of many mental disorders is not completely clear, but scientists have come to the conclusion that a combination of social, psychological and biological factors influences their formation.

The person who feels early symptoms diseases, worries, how to understand that you have a mental disorder? In this case, you should take a multi-item test and get the opinion of a professional psychotherapist. Questions must be answered as honestly and frankly as possible.

During the progression of the disease, symptoms appear that are noticeable, if not to the patient himself, then to his relatives. The main signs of a mental disorder are:

• emotional symptoms ();
• physical symptoms(pain, insomnia);
• behavioral symptoms (drug abuse, aggression);
• perceptual symptoms (hallucinations);
• cognitive symptoms (memory loss, inability to formulate a thought).

If the first symptoms of the disease are persistent and interfere with exercise normal activities, it is recommended to undergo diagnostics. There are borderline mental states of the individual, which are present in many mental and somatic diseases or ordinary fatigue.

Asthenia

Asthenic syndrome is manifested by nervous exhaustion, fatigue, low performance. The female psyche is more vulnerable and therefore such disorders are more characteristic of the weaker sex. They have increased emotionality, tearfulness and mood lability.

The male psyche reacts to asthenic syndrome with outbursts of irritation, loss of self-control over trifles. With asthenia, severe headaches, lethargy and disturbed night sleep are also possible.

Obsessions

This is a condition in which an adult persistently has various fears or doubts. He cannot get rid of these thoughts, despite the awareness of the problem. A patient with mental pathology can check and recount something for hours, and if he was distracted at the time of the ritual, start counting again. This category also includes claustrophobia, agoraphobia, fear of heights, and others.

Depression

This painful condition for any person is characterized by a persistent decrease in mood, depression, and depression. The disease can be detected in early stage, in this case the state can be quickly normalized.

Severe cases of depression are often accompanied by suicidal thoughts and require inpatient treatment.

Characteristic are:

• feeling of guilt, sinfulness;
• feeling of hopelessness;
• sleep disorders.

The condition may be accompanied by a heart rhythm disorder, excessive sweating, pressure surges, loss of appetite, weight loss, dyspeptic disorders. Mild forms of the disease respond well to treatment, and if severe depression occurs, the patient needs to go to the doctor.

Mania

This neuropsychiatric disorder is characterized by sleep disturbances: usually, adults with this disorder can sleep for 4-6 hours and feel alert. AT initial stage(hypomania) a person notes an increase in vitality, increased efficiency, creative upsurge. The patient sleeps little, but at the same time works a lot and is very optimistic.

If hypomania progresses and turns into mania, then a change in personality, the inability to concentrate, joins the indicated signs. Patients are fussy, talk a lot, while constantly changing their position and gesticulating vigorously.

Typical symptoms of mania in adults are increased appetite, increased libido, and defiant behavior. Good mood may change abruptly into irritation. As a rule, with mania sanity is lost, and patients do not understand that their condition is pathological.

hallucinations

This is an acute mental disorder in which the patient feels, sees or hears things that do not really exist. Hallucinations may occur due to alcohol consumption or the progression of mental illness.

Hallucinations are:

• auditory (voices);
• tactile (itching, pain, burning);
• visual (visions);
• taste;
• olfactory (smells), etc.

However, a situation is also possible when a sick person feels several of them at the same time. Imperative hallucinations are dangerous, when the "voices" in the patient's head order certain actions to be performed (sometimes to kill oneself or someone else). Such conditions are an indication for pharmacotherapy and constant monitoring.

delusional disorders

These disturbances are a sign of psychosis. Delusional beliefs do not correspond to reality, but it is not possible to convince the patient of this. Erroneous ideas are extremely important for the patient and affect all his actions.

Brad has a variety of content:

• fear of persecution, damage, poisoning, material damage, etc.;
• belief in one's own greatness, divine origin, all sorts of inventions;
• ideas of self-accusation and self-negation;
• ideas of a love or erotic nature.

Often the appearance crazy ideas preceded by depersonalization and derealization.

Catatonic syndromes

These are conditions in which motor disorders come to the fore: complete or partial inhibition, or vice versa, excitation. With a catatonic stupor, the patient is completely immobilized, silent, the muscles are in good shape. The patient freezes in an unusual, often ridiculous and uncomfortable position.

For catatonic excitation, the repetition of any movements with exclamations is typical. Catatonic syndromes are observed both with clouded and clear consciousness. In the first case, this indicates a possible favorable outcome of the disease, and in the second, the severity of the patient's condition.

clouding of consciousness

In an unconscious state, the perception of reality is distorted, interaction with society is disrupted.

There are several types of this condition. They are united by common symptoms:

• Disorientation in space and time, depersonalization.
• Detachment from the environment.
• Loss of the ability to logically comprehend the situation. Sometimes incoherent thoughts.
• Decreased memory.

Each of these signs sometimes occurs in an adult, but their combination may indicate a clouding of consciousness. Usually they pass when the clarity of consciousness is restored.

dementia

With this disorder, the ability to learn and apply knowledge is reduced or lost, and adaptation to the outside world is disrupted. Distinguish congenital (oligophrenia) and acquired form of intellectual decline, which occurs in people aged or patients with progressive forms of mental disorders.

Psychosis is a serious mental disorder, such a deep violation of the mental, emotional and affective components is considered quite dangerous for patients.

The disease manifests itself in a sharp change in the patient's behavior, the loss of an adequate attitude to life and others, in the absence of a desire to perceive the existing reality. At the same time, they interfere with the awareness of the presence of these very problems, a person cannot eliminate them on his own.

Due to the emotional component, hormonal explosions and susceptibility, women and other mental disorders are twice as common as (7 vs. 3%, respectively).

What are the reasons and who is most at risk?

The main causes of the development of psychosis in females are as follows:

One of the main reasons is increased emotional excitability or the presence of a similar disease in the woman's family, mother, sister, that is, the genetic component.

Who is at risk

The root cause of the appearance of psychosis is often alcohol abuse and subsequent intoxication of the body. In most cases, men are most susceptible to alcoholism, so the female suffers from much less often and endure it faster and easier.

But there is also a reason that is characteristic only for women, which increases the risk of the disease. This is pregnancy and childbirth. The physical factors of the appearance of psychosis in this case include toxicosis, vitamin deficiency, a decrease in the tone of all body systems, various diseases or complications due to difficult pregnancy and childbirth.

Psychological ones include fear, worries, increased emotional sensitivity, unwillingness to become a mother. At the same time, postpartum mental disorder is more common than during pregnancy.

Behavioral features

For a woman with mental disorders, such changes in behavior and life activity are characteristic (with the symptoms noticeable only from the outside, the sickest and unaware that she is sick):

• lack of resistance to, which often leads to or scandals;
• the desire to isolate oneself from communication with colleagues, friends and even relatives;
• there is a craving for something unreal, supernatural, interest in magical practices, shamanism, religion and similar areas;
• the emergence of various fears, phobias;
• decreased concentration, mental retardation;
• loss of strength, apathy, unwillingness to show any activity;
• sudden mood swings for no apparent reason;
• sleep disturbances, which can manifest itself both in excessive drowsiness and insomnia;
• downgrading either complete absence desire to eat.

If a woman herself was able to detect any signs of psychosis, or if her relatives noticed them, then it is urgent to seek qualified help.

Varieties of deviations in the mental state

Psychosis can be conditionally divided into two large groups:

1. organic. In such cases, it is a consequence of a physical illness, a secondary disorder after disturbances in the functioning of the central nervous and cardiovascular systems.
2. Functional. Such disorders are initially due to the psychosocial factor and the presence of a predisposition to their occurrence. These include violations of the process of thinking and perception. Among others, the most common:, schizophrenia,.

Separately, it can be distinguished, it appears in 1 - 3% of women in the first months after the birth of a child, unlike the more common postpartum depression, a psychotic deviation does not go away on its own and requires treatment under the qualified supervision of specialists.

Symptoms:

• decreased appetite and rapid weight loss;
• constant anxiety, sudden mood swings;
• desire for isolation, refusal to communicate;
• violation of the level of self-esteem;
• thoughts about committing suicide.

Symptoms appear individually, some may be within a day after giving birth, others a month later.

The causes of this type of psychotic disorder may be different, but they are not fully understood by scientists. It is reliably known that patients who have a genetic predisposition are susceptible to it.

The failure of the psyche can be accompanied by various conditions that provoke disturbances in the work of the whole body of a woman.

Violation of diet, activity and rest, emotional tension, taking medications. These factors "hit" the nervous, cardiovascular, respiratory, digestive and endocrine systems. The manifestation of concomitant diseases individually.

Who to turn to for help?

Self-medication in this case is contraindicated. You should also not contact familiar doctors of various specialties, psychologists, traditional healers. Treatment should be carried out only by a public or private doctor - a highly qualified psychotherapist!

Unfortunately, a woman suffering from psychosis cannot seek help herself, because she does not notice the signs of her illness. Therefore, the responsibility lies with the relatives and friends of the mother. Seek help from a doctor as soon as possible.

The specialist will examine the patient, refer him for additional tests and, based on their results, prescribe treatment and the necessary drugs.

Treatment can take place in a hospital with the participation of medical staff, or at home. When treating at home, a mandatory safety measure will be taking care of the baby with the least intervention of the mother (in case of postpartum mental failure). The nanny or relatives should take care of these concerns until the disappearance of all symptoms of the disease in the patient.

Treatment usually consists of a complex, which includes:

• medicines, usually this,;
• psychotherapy - regular sessions with a psychotherapist and a family psychologist;
• social adaptation.

The patient can not immediately realize, accept her condition to the end. Relatives and friends must be patient to help the woman return to normal life.

The consequences of the lack of therapy are extremely unfavorable. The patient loses touch with reality, her behavior becomes inadequate and dangerous not only for her own life and health, but also for those around her.

A person is suicidal, may become a victim or cause of violence.

How to prevent mental breakdown?

Preventive measures include:

Prevention should be a priority, especially in those women who are prone to emotional disruption or have a hereditary predisposition to psychotic disorders.