Schizophrenic dementia. Simple schizophrenia form deep dementia schizophrenia or dementia

Weathemia - irreversible progressive degradation of intelligence. When the intelligence disorder is noted, as if passing, depending on the state of the person. Proper adequate treatment allows you to improve the patient's condition.

Larithic in schizophrenia occurs periodically. At the same time, selflessly unstable, and schizophrenia patient, who considered weakly, unexpectedly manifests a good memory and thinking. For this reason, schizophrenic dementia is called transient (transient).

Symptoms

The exacerbation period begins against the background of anxiety or oppressed state, as a result of the formation of psychosis. You can highlight some typical behaviors.

Sorry schizophrenia begin to be afraid of something, they can start hiding or crawling on certain items. Emotions of fear are associated with the presence of hallucinations with bright images of a fantastic nature.
Usually arise problems of orientation in space, patients may forget how to use ordinary household appliances.
Adult people's behavior resembles a nursery. For example, to the question of the number of fingers, the person begins to recalculate them, it is embarrassed and comes off from the account. Manipulations with clothing can often be simply comical and at first glance seem to be tamed, until it becomes clear that a person does not pretend and not sharpening, but really confuses the purpose of the toilet items.
After performing the exercises of neurological diagnostics, the patient instead of the tip of the nose can reach the uh's lobe, and according to the instructions "Show your teeth," lips with her lips.
In behavior, you can obey the animals: nail, crawl on all fours, lacquer soup from a plate.
Echolalia phenomenon may appear: mirror responses are followed by questions. Patients may forget the names of objects. And instead, explain the value. Sometimes there is a long speech from competent suggestions, but absolutely meaningless.
In behavior there is a change of periods of excitation and inhibition. After bustle and activity, you can observe complete immobility and inhibition.

Orientation in space and time is gradually restored, anxiety disappears, patients become adequate and transferred to communication. The period of psychosis is forgotten.

In case of schizophrenia, memory is preserved, and a long time retains the ability to abstract thinking. However, there is a change in targetedness, that is, thinking is not effective and symbolic. The person is inclined to meaningless philosophizing. There is a thinking, but it becomes distant from real life. At the same time, knowledge luggage slowly decreases, and skills, including vital, are lost. There are also problems with concentration of attention.

Along with intellectual violations, the loss of the desire for communication occurs, and autism develops.

In a severe stage, patients do not lose the ability to move, but almost still, they cannot eat independently, cease to control physiological needs, do not answer questions.

Disorders of mental processes

Perception. When schizophrenia, first of all, symbolism is observed and. The perception of the outside world is deprived of reality, which negatively affects the intellect in general.
Thinking disorder. Schizophrenic dementia is characterized by subtraction, symbolism, manners, mosaic, formality. Thoughts like "travel around" in different directions. Speech disorder is observed, often in the form when the forms are correct, and the meaning of the said is completely lost.
Memory disorder. Memory in schizophrenic dementia remains preserved, but the patient cannot use its reserves, and is oriented only in his own personality, it is not capable of creating logical space-temporal links. At the same time, some preserved aspects and logical conclusions may be observed, which introduces the surrounding people who cannot understand the accumulation of a person.

Since it is an irreversible disease, then the prognosis of the treatment of dementia is dubious. But, given the transientity of the state, when the diagnosis of the disease itself, the forecast may be favorable.

According to O. V. Kerbikov's classification, it belongs to dementia, in which there are no deep organic changes. According to I. F. Slochevsky, it belongs to transient dementia. On this occasion, he wrote:

satzophrenia patients can be deeply delicate for many years, and then unexpectedly for others, including doctors, discover relatively well-preserved intellect, memory and sensual sphere.

There was a discussion, is it possible to consider dementia in schizophrenia actually dementia. So, Kurt Schneider believed that in these cases, strictly speaking, dementia is not observed, dementia, since "common judgments and memory, and so on, which can be found to intelligence, does not undergo direct changes," but only some impaired thinking are observed. A. K. Anufriev noted that the patient suffering from schizophrenia can simultaneously seem during a conversation with him and low-minded, and not weakly and that the term "schizophrenic dementia" is completely justified in quotes. According to G. V. Glut, the disorder of intellect during schizophrenia depends on the peculiarities of mental activity, directly on the intellect not affecting and who are volitional disorders by the type of Apato-Babulia and thinking disorders. Therefore, it is impossible to talk about the changes in the intellect in schizophrenia as a classical dementia. With schizophrenic dementia, it does not suffer from intelligence, but the ability to use it. As the same G. V. G. Torle:

machine Castle, but not entirely serviced.

Other authors compare intelligence when schizophrenia with a bookcase, full of interesting, smart and useful books to which the key is lost. According to M. I. Weisfeld (1936), schizophrenic dementia is due to the "distraction" (delirium and hallucinations), the "insufficient activity" of the person to the illness, the "influence of acute psychotic states" and "non-proceeding". According to the last reason, he cites the words of the Great Worker of the Renaissance Leonardo da Vinci, who claimed that the razor through non-consumption is covered with rust:

the same happens with the minds that, stopping the exercise, indulge in idleness. Such, like the above-mentioned razor, lose the cutting subtlety and rust of ignorance corrosive their appearance.

Criticizing the idea of \u200b\u200bthe outcome of mental illness in dementia, N. N. Pukhovsky notes that the phenomena attributable to "schizophrenic dementism" are closely related to toxic-allergic complications in the inadequate tactics of active therapy of psychosis (including neuroleptic, EST, insulin coatous therapy, Pyroterapy), with the remnants of the constraint system in psychiatric hospitals and phenomena of hospitalism, desocialization, coercion, separation and insulation, domestic discomfort. It also binds "schizophrenic dementia" with a protective mechanism of regression and displacement (parapraction).

Nevertheless, still the inconsistency of intellectual reactions with stimuli indicates the presence of dementia's schizophrenia patients, although in its peculiar version.

History

Special dementia in schizophrenia patients in 4 years after the creation of E. Blair the very concept of the disease described the Russian psychiatrist A. N. Bernstein in 1912 in "Clinical lectures on mental illnesses".

Classification

According to the classification of A. O. Edelstein, based on the degree of disintegration of the person allocate:

Syndrome "Apathetic" dementia ("Dementia of motivation");
"Organic" type of dementia - by type of organic illness, for example, as Alzheimer's disease;
"Ruinating" syndrome with the onset of marasma;
Syndrome "Personal Disintegration".

Pathogenesis

The pathogenesis of schizophrenic dementia, as well as the schizophrenia itself, is not fully known. However, some of its aspects are described. The Austrian Psychiatrist Joseph Burts in 1914 considered the schizophrenic dementia of the "hypotension of consciousness". It is noteworthy that in the future many other scientists were agreed with him: large researchers schizophrenia K. Schneider, A. S. Kronfeld and O. K. E. Bumka. Soviet physiologist I. P. Pavlovitakzh considered schizophrenia by chronic hypnotic state. However, to understand the pathogenesis of schizophrenic dementia, this is not enough. When schizophrenia, when the elements of intelligence are preserved, its structure is disturbed. In this regard, the main state clinic manifests itself. According to V. A. V. V. V., expressed in 1934, the basis of schizophrenic dementia is the splitting of intelligence and perceptions, paralohythic thinking and flattened affect.

Clinical picture

Disorders of perception

Deep disorders of perception in schizophrenia, first of all - symbolism, dramatization and depersonalization on intelligence affect negatively.

Thinking disorders

Thinking with schizophrenic dementiaratic, with elements of strollery, symbolism, formalities, manners, mosaic. At one time, E. Farther, exploring Dementia Praecox noted "traveling", "slipping", "disappointing" thoughts. The so-called attactic thinking occurs, externally manifested speech disorders, more often in the form of schizophasia, when the proposals are grammatically correct, but their contents are meaningless, there are slurping from the topic, neologisms arise, contamination, symbolic understanding, permerement, embolofrazia, paraluded, combination of incompatible and separation indivisible.

Memory disorders

Memory during schizophrenic dementia, as in schizophrenia as a whole, has been saved for a long time. Such patients are well oriented in their own personality, space and time. According to E. Bleiler, when schizophrenic patients, along with psychotic, have saved some aspects of intelligence, is figuratively called "double accounting".

Forecast

Since schizophrenia is a disease chronic and progrement, a forecast for recovery with such dementia, if it has already arisen, as a rule, doubtful. However, since this dementary is transient, if it was possible to stop the course of the disease itself, the forecast may be relatively favorable. In other cases, an extremely unfavorable outcome is possible. It comes either the extreme increase in negative symptoms in the form of complete apathy, Abulia and autism, which is manifested in absolute indifference, untidiness, the decay of social bonds and the absence of speech, or with the elements of the former clinical form of schizophrenia: defectgeeffeth, residual catatonia, rudiments of nonsense during paranoid form. However, for life, the prognosis is favorable, and for working capacity - relatively favorable with successful treatment.

Literature

O. V. Kerbikov, M. V. Korkina, R. A. Nadzharov, A. V. Snezhnevsky. Psychiatry. - 2nd, recycled. - Moscow: Medicine, 1968. - 448 p. - 75,000 copies;
O. K. Strєnko, І. Y. Vlokh, O. Z. Golubkov. Psychiatry \u003d Psychiatry / Ed. O. K. Strєєnko. - Kyiv: Healthy "I, 2001. - P. 325-326. - 584 p. - 5000 copies - ISBN 5-311-01239-0;
Yu. A. Anthropov, A. Yu. Anthropov, N. G. Zhozhanov. Intellect and its pathology // Basics of diagnosis of mental disorders. - 2nd, recycled. - Moscow: Gootar Media, 2010. - P. 257. - 448 p. - 1500 copies. - ISBN 978-5-9704-1292-3.;
N. N. Pukhovsky. Therapy of mental disorders, or other psychiatry: a tutorial for students of higher educational institutions. - Moscow: Academic Project, 2003. - 240 p. - (Gaudeamus). - ISBN 5-8291-0224-2.

Schizophrenic dementia is a transient reduction in cognitive mental functions at.

At the end of the 19th century, the German psychiatrist Emil Fucket introduced the term "Dementia Praecox" to designate cognitive violations beginning in adolescence leading to dementia. The scientist also noted changes in the emotionally personal sphere of adolescents. In the 20th century, scientists described were combined by the term "schizophrenia" (the splitting of the mind). These two concepts have become synonymous.

The dementia in schizophrenia is based on paralogical thinking (the lack of logic in speech, the loss of the ability to conclude from said), the cleavage of intelligence (violation of the structure when the intelligence itself is preserved, "to use it"), the violation of perception, the inclined affect ("emotional stupidity") .

Schizophrenic dementia is indigenously different from the organic, due to degenerative processes in the brain. Differential - diagnostic criteria are presented in Table 1.

Table 1. Differential and diagnostic criteria for schizophrenic and organic dementia

Causes of dementia in schizophrenia

The causes of schizophrenic dementia have not yet been studied. There are a number of predisposing factors:

hereditary predisposition (a high percentage of risk, if the patient's parents or twin have observed schizophrenic dementia);
hormonal perestroika (under the debut in publity);
the inxication of the brain by medicines (an overdose of neuroleptics that buy positive symptoms of schizophrenia - nonsense, hallucinations);
incorrectly carrying out the pyrogenic, insulinomatous, electrosculation therapy in the period of attacks to suppress the affect;
forced insulation of the patient with a long stay in hospital (hospitalism syndrome), during which the patient experiences discomfort, everyday constraint, is experiencing separation from loved ones;
mechanisms of psychological protection regression (return to earlier, safe for patient, forms of behavior), displacement (subconscious "forgetting" stressful events, displace them from consciousness).

Classification

Depending on the degree of personality decay, schizophrenic dementia happens:

Clinical picture

The first manifestations of schizophrenic dementia can debut against the background of a psychotic state. Sick:

The condition is restored after the treatment. With frequent attacks, the ineffectiveness of therapy is observed an increase in negative symptoms to a resistant schizophrenic defect, characterized by a decrease in will, motor activity, lack of motivation to action, emotional indifference, coldness, loss of empathy, lack of motivation to actions, sludge.

Disorders of perception

To reduce cognitive functions in schizophrenia, negative impacts have deep violations of perception - Derealization and depersonalization.

- The patient feels like a lifeless figurine, a third-party observer of life. The world around him perceives distorted, in too bright or dull paints. Reality is accepted for fiction, performance.

- Self-consciousness disorder. The patient presents that is in someone else's body, and not in his. I am convinced of the death, splitting or reincarnation of your "I".

In both syndromes, the patient complains of the loss of emotionality, feeling out of reality.

Thinking and Memory Disorders

The features of the impaired thinking in schizophhenical dementia are that there is no decay, but distortion of mental processes (generalizations, abstraction, analysis, synthesis, classification, construction of logical connections).

This is expressed in:

Memory during schizophrenic dementia is preserved quite long.

Speech disorders

Speech disorders are presented:

neologisms - the inclusion in the speech of new words invented by patients;
verbigerations - the patient infinitely repeats the same words and phrases, rhymes them;
echolalia - the patient repeats the latest syllables, words of converted speech;
(speech confusion) - it is meaningless;
manners - the patient talks to the nitestal "discreet" suggestions, as if he reads a scientific report.

Diagnostics

The diagnosis of schizophrenic dementia is based on the identification of schizophrenia criteria developed in the international classification of ICD diseases - 10.

Signs of dementia are diagnosed on the basis of special tests:

Supplement diagnostics observation of patients - behavior features, appearance, facial expressions, gestures, communication with the doctor and others.

Four and forecast

In the initial stage of schizophrenic dementia understanding of patients around the surrounding, it can perform elementary actions to care, cleaning the room, chambers, is available to contact. There are characteristic changes in speech and thinking.

Gradually, cognitive disorders are becoming deeper, the patient is removed from real life, intellectual and practical skills are lost. The patient leaves himself, ceases to communicate. In far running stages, the insanity - the patient cannot control the physiological needs, it does not serve itself, the contact is not available, almost not moving.

With timely diagnosis and treatment, dementia can be suspended in the early stages, temporarily restore the disturbed cognitive functions. But with the next attack of schizophrenia, refund to the initial state is possible.

Treatment

Treatment Complex. Schizophrenia therapy is carried out, observing the correct doses of neuroleptics, paying attention to the testimony, time and number of procedures of biological treatment methods.

Symptoms of dementia are reduced by nootrops, vitamos and mineral complexes that improve the work of the brain. With increased anxiety, the stress factors in etiology is carried out by the general sedation of the body with tranquilizers and sedatives on a vegetable basis.

Psycho and sociotherapy attached great importance. In schizophrenic dementia, art therapy is shown (treatment with music, drawing, modeling, dancing), sand therapy, animal communication therapy (horses, dolphins).

Positive effect gives work therapy - the work of patients in workshops, hospital garden, park.

What to do relatives

Relatives of a sick schizophrenic dementia need:

To pass sessions of family psychotherapy, on which they explain the essence of the disease, they will give recommendations, how to communicate with such patients correctly;
Carefully comply with all prescriptions of the attending physician.
Be sure to give the patient with melting mental and exercise - to solve uncomplicated household tasks (something to count, remember where a certain thing is stored), make cleaning at home, endure the garbage, wash the dishes, water the flowers.
Follow the execution of the day mode - to be in the fresh air daily, get enough sleep, make a cash charge, limit the use of electronic devices that have an exciting effect on the psyche.
Monitor the correct nutrition of the patient.
Helping the patient to serve himself, without scolding him, with understanding to relate to his state.
The most important thing is to become a sick support in the literal and figurative sense, so that he felt defense, support, love.

Live together with such patients is very difficult. Therefore, relatives are recommended to go through psychotherapy to take a look at the problem with other eyes, take it and learn to live with her.

Weathered - total change and emptying of the individual, coarse disorders of thinking, apathetic or disorganized behavior in the absence of criticism for their state.

Specificity of schizophrenic dementia.

Loss or sharp decline in spontaneity and initiative;

A deep violation of intellectual activity (a sharp decline in the ability to suggest, judgments, generalization, understanding the situation is the complete loss of all intellectual baggage, the entire stock of knowledge, the destruction of any interests.

All this creates a "ruining syndrome" (described by Edelstein AO in the 30s).

Ruinization syndrome is observed in 15% - 22% of schizophrenia. Its formation is difficult to associate with any form of schizophrenia, but more often during catatonic and hebethnetic forms.

Clinic: Completeness and indifference, frozen smile, misunderstanding of elementary questions, answers by type of schizofasia, inspiration when meeting with relatives, the lack of the slightest care about family, voraciousness, slope (when taking food often do not use a spoon).

Defect - Unlike dementia, it is relatively light forms of partial weakening of mental activity. Patients in the stage of the resistant is typical of the recovery in one degree or another critical attitude towards the manifestations of the defect.

The defect is primary negative symptoms, i.e. Reflective persistent deficient identity changes. They need to be distinguished from secondary-negative - related to the current exacerbation of psychosis, depression, neurolepsy.

Determine the depth and type of negative / deficient disorder at the active stage of the process flow - it is impossible. During the exacerbation or in the step of incomplete remission in the clinic, both primary and secondary negative disorders are present.

Primary negative disorders (the consequences of the disease itself) is extremely difficult to degrade from the side effect of drugs, hospitalism, loss of social status, reducing the level of expectations from relatives and doctors, gaining a "chronic patient", loss of motivation, hope.

Typology of defect in schizophrenia.

In assessing the nature and severity of the defect, the forecast of the state should be remembered by the two positions of D.E. Melejova (1963).

1) signs of increasing the severity of the defect or the emergence of new symptoms in its structure - indicate the continuing activity of the process;

2) Even pronounced manifestations of the defect are accessible to compensation if the process stopped in its development, it goes into the steady of remission, the post-acessual (residual) state and takes a long slurgeous course without frequent exacerbations.

Typology of defect.

1) Asthenic - or nonspecific "clean" defect (Huber), "Reduced energy potential" (Conrad K.), "Dynamic devastation" (Janzarik W), "Primary Adamiya" (Weitbrecht) is a decrease in energy potential and spraying activity, as well as level of targeted thinking and emotional responsiveness (Huber).

"Reducing the energy potential" according to Conrad K. (1958) is characterized by a decrease in the strength of mental tension, will, the intensity of desires, interests, the level of motivation, dynamic activity in achieving the goal;

"Dynamic devastation" according to Janzarik W (1954, 1974) - includes a decrease in emotional tension, concentration, intentional impulsivity, preparedness for action, which is manifested by emotional coldness, insufficientity, lack of interests, initiative failure.

The structure of an asthenic defect is intellectual and emotional depletion, non-timber expressed frustration of thinking, narrowing the circle of interest. The behavior of patients externally ordered. Domestic and simple professional skills are preserved, selective attachment to one of the close or medical equipment, the sense of its own change is preserved.

2) Fershroben (stated deficient or expansive schizoidide on Smolevich A.B., 1988).

The structure is autism in the form of cordiality, absurd of actions with a separation from reality and life experience. Reducing sensitivity and varying, disappearance of a tendency to internal conflict, extinction of child feelings. The feeling of tact, humor, distances disappears. In general, the decrease in criticality and emotional flaws. Lose (decline) former creative abilities. Cognitive activity is reduced to the use of insignificant, latent properties and relations of items, consideration of them in unusual aspects and connections, the use of rare words, neologisms, a tendency to crucial expressions. "Pathological autistic activity" - comes down to crucial, cut off from the reality and past life experience actions. There are no clear plans and intentions for the future. The lack of criticism is manifested by the disorder of the assessment of its "I", in the form of awareness of its own individuality by means of comparison with others. In the life of the oddity - the litterness of the dwelling, neglence, hygiene disregard, contrast with the pretentiousness of the hairstyles and parts of the toilet. Mimica is unnatural, ianger, dyslastic motor skill, movements angular. Emotional degradation is manifested - reduction of sensitivity and vulnerability, disappearance of a tendency to an internal conflict, the extinction of child feelings. Roughly disturbing the feeling of distance and tact. Often - euphoricity, jokes are not to the place, complacency, empty patience, regressive synthony.

3) psychopath-like (pseudopsychopathy) is typologically comparable to the constitutional anomalies of the individual (psychopathy).

This type of defect predispose - a) the deritment of the active (manifestic periods of the diseases to age crises, b) is a low-strength flow, c) the presence in the initial period of schizophrenia affinity to violations of the psychopathic circle.

Pseudopsychopathy in the clinic of parietal-progressional schizophrenia is described in the idea of \u200b\u200b2 options for postprocerant development of the individual (Spelevich A. B., 1999).

1. "Alien to the world of idealists" by E.recchmera (1930) - with a new approach to reality, hermits, unlike eccentrics, indifferent to the fate of relatives, with the worldview subordinate to the ideas of spiritual self-improvement, detached from foreign affairs, with autistic wiping. This also includes and personality changes in the type of "second life" (VIE J., 1939) with a radical gap with the entire system of premature social, professional and related ties. Changing the kind of activity, the formation of a new family.

2. Residual states by the type of dependent personalities (Psychiatric remissions in V.M. Morozov, R.A. Nadzharov). Doubts about any occasion, the fall of the initiative, the need for permanent motivation, passive subordination, the position of "neighborhood children" in the family. In production conditions, they are lost with minor deviations from the usual activities, in non-basal situations occupy a passive position with avoiding behavior and reactions of refusal.

4) syndrome of monotonous activity and rigidity of affect (D.E. Melejov, 1963).

Patients are distinguished by good performance, enthusiasm, tirelessness, invention, innovation, professional erudition in the stereotyping of the working day and planning. The circle of interest is preserved, but with the possibility of one deduction. Along with this, the lack of emotional resonance, a decrease in sympathy and empathy, dryness and restraint of emotional manifestations, external sociability and latitude of contacts in the absence of truly close people, the inflexibility and elimination of family problems. There is a resistance to frustrations, the absence of reactive lability, overestimated self-esteem, not always adequate optimism, insufficiency of the critical attitude and rationalization in explaining the causes of the undergoing attack.

5) Pseudoorganic - formed when developing schizophrenia on organically modified soil.

It is characterized by a drop in mental activity and productivity, intellectual decrease, the rigidity of mental functions, a leveling of personal characteristics, a narrowing of contacts and a circle of interest (defect in the type of simple deficit (EY H., 1985), Authethonous Asthenium (Glatzel J., 1978)). It is formed more often on the background of family predisposition to schizoid psychopathy.

5) Syndrome of infantilism and juvenile - more often formed in atypical attacks transferred in puretate and youthful age with expressive, pseudo-erectic, atypical depressive, dysmertophobic disorders or ultra-subject formations of metaphysical intoxication. Juvenilism affects the manner to dress, behave in the team, in choosing hobbies, friends, profession and worldview.

Necrognitive deficit during schizophrenia.

In recent years - in psychiatry intensive development received the paradigm of the biological basis of mental disorders, in its framework - the concept of neurocognitive deficit during schizophrenia.

The neurobiological model of schizophrenia implies a violation of the formation of the CNS, in the form of a decrease in the volume of gray substance, reducing the level of metabolism, membrane synthesis and regional blood flow of prefortional bark, reducing Delta sleep on EEG. But evidence of the defeat of any particular section of the brain was not received. Violations occur on a synaptic level, although there are data on structural violations in the literature.

Necrognitive deficit is a form of violation of information processing, insufficient of cognitive function: memory, attention, training, executive function. It is observed in 97% of schizophrenia patients and only 7% in a healthy population. Cognitive decline is observed in relatives of schizophrenia patients. The main intellectual decline occurs in the first 2 years of the disease.

The neurocognitive deficit is considered as the "third key group of symptoms" in schizophrenia, along with negative and productive disorders.

Intelligent functioning in schizophrenia patients relatively does not suffer (IQ is only 10% lower than in healthy). But at the same time it is detected - "deficit" of memory, attention, information processing speeds, executive functions. This affects the social, professional consistency and quality of life of schizophrenia patients.

Memory disorders - relate to verbal and auditory modality, lack of working memory (working memory - the ability to record information for use in follow-up). The lack of working memory is manifested in violation to maintain information for a short period during which its processing and coordination with other long-term mental operations is occurring, which ultimately leads to the development of the response. The ability to concentrate attention is an indicator of consistency in solving problems and acquiring skills.

Violation of attention is an audual and visual modality, the difficulty of preserving attention for a long time, sensitivity to distracting factors.

Insufficiency in the schizophrenia of the executive function (preparation and execution of plans, the solution of new problems requiring new knowledge. The state of the executive function - determines the ability to live in society) - a weak ability to plan, regulate behavior and setting a goal.

"Cognitive profile" of schizophrenia patients (according to the results of averaged neurocognitive tests).

Normal or closer to normal reading test;

Lower limit of tests of evaluating simple sensory, speech and motor functions;

decline of 10 points IQ on the test of the ventira;

A decrease of 1.5 - 3 standard deviations of test indicators for memory assessment and more complex motor, spatial, and linguistic tasks;

Extremely low test results on attention (especially stability) and test tests of problem-decisive behavior.

Affective mood disorders.

Affective disorders - a group of mental disorders with different flow options, the main clinical manifestation of which is a pathological decline or improving the mood, accompanied by a violation of various spheres of mental activity (motivation of activity, desection, arbitrary behavior, cognitive function) and somatic changes (vegetative, endocrine regulation, Tronof, etc.) ..

Antique period -Hippocrates "Melancholy", "Black bile"

1686 Theophile Bonet: "Manico-Melancolicus"

1854 J. Falret and Baillarger: "Circular insanity"

1904 Emil Kraepelin "Manico-depressive psychosis."

Symptomatology - Polar, phase affective oscillations

Depressive phase.

Emotions - longing, depression, sadness, hopelessness, worthlessness, feeling of twin, meaningless existence; anxiety, fears, anxiety; pessimism; loss of interest in family, friends, work, sex; Impossibility to get pleasure, have fun - Angedonia

Thinking is the slowdiness of thinking, difficulties in concentration, decision-making; Thoughts about failures, reduced self-esteem, the inability to switch from thoughts of negative content; The loss of the feeling of reality may be the appearance of hallucinations and delusional ideas of depressive content; Suicidal thoughts (about 15% of non-treated patients with affective diseases make suicide).

Physical condition - change of appetite and weight (70% lose weight, others are gaining); Sometimes an excessive desire for sweets is developing; Sleep disorders: Although the insomnia is a frequent complaint, about 15-30% feel the increased need for a dream, and they do not feel rested even after 12-14 hours of sleep; loss of energy, weakness, drowsiness; Various pain (head, muscular pains; Gorky taste in the mouth, blurredness, digestive disorders, constipation; assessment and anxiety.

Behavior - slow motion, movement, general "inhibition"; Excessive reflection or, on the contrary, the lack of tears even if you wish to cry; Alcohol and / or drug abuse.

Typology of depressive syndromes: melancholic depression; Depression with anxiety; Anesthetic depression; Adamic depression; Depression with apatine; Dysphoric depression; Smiling (or ironic) depression; Tearful depression; Masked depression ("depression without depression", somatization of depression) Somatization is a manifestation of mental disorder in the form of a physical suffering.

Maniacal phase.

The main symptom of Mania is an increased high spirits. As a rule, this mood increases in a certain dynamic sequence, which includes a sequential change of the following phases:

Lifting mood within the normal range: happiness, joy, fun (hyperthy);

Moderate lifting: increased self-esteem, increased disability, activity, reduction in the need in a dream (hypologia);

Actually, mania: manic symptoms grow and begin to violate the normal social activity of the patient;

- "delusional" or psychotic mania: excessive supercharativeness, irritability, hostility, possible aggression, delusional ideas of magnitude and hallucinations

Emotions - increased mood, lifting, euphoria, ecstasy.

But it is possible: irritability, evilness, excessive response to ordinary things, lability, fast mood change: a feeling of happiness and a minute of anger without any visible cause of hostility.

Thinking is an increased self-esteem, the ideas of magnitude, their own power; incorrect interpretation of events, bringing its own sense in the comments of the usual content; distractions, no concentration; the jump of ideas, flight of thoughts, jumping from one topic to another; deficiency of criticism for their state; Loss of the feeling of reality, may appear hallucinations and delusional ideas.

Physical condition - increased energy, shortening sleep - sometimes only 2 hours of sleep is enough, exacerbation of the perception of all senses - especially colors and light.

Behavior - involvement in adventures and ambitious plans. Unprovable uncontrolled desire Communication: can call friends by phone many times at any time of the night to discuss their plans, excessive waste of money, often just distribution of money, meaningless numerous purchases, jumping from one activity to another, laughter, jokes, singing, dancing. Possible: malice and demanding. Sugagatitude, the speech is fast and loud. The emergence of a new interest in collecting something, increased sexual activity.

In the classification of the ICD-10 - are united under the heading F3 "Affective mood disorders"

According to modern ideas, painful episodes of mood disorders are a combination of symptoms (manic or depressive) components of a dominant affective state.

Etiology: predominantly hereditary, the flow of autochon.

The first episodes of the disease are often preceded by mental injuries (mental and physical overvoltage), physiological changes (pregnancy, childbirth), exogenous factors (CHMT, intoxication, somatic diseases) are subsequently weakening.

Types of episodes

1. Depressive

2. Maniacal

3. Mixed

Types of affective disorders (according to the classification of MKB-10, DSM-1V).

1. Addressive disorders

Depressive episode

Recurrent depression (big depression)

Distimia

Other depressive disorder

2. Bibolar disorders:

the first type

second type

Cyclotimia

Other bipolar disorders

3. Forward affective disorders:

Recurrent depression (Big depression on DSM-1V)

Epidemiology: Prevalence: Men 2-4%, women 5-9% (Men: Women \u003d 1: 2), Middle Age of Begin: ~ 30 years

Etiopathogenesis.

Genetic: 65-75% - monosic twins, 14-19% Diaily twins

Biochemical: neurotransmitter dysfunction on a synaptic level (lowering the activity of serotoninira, norepinephrine, dopamine)

Psychodynamic (imported self-esteem is important)

Cognitive (has a negative thinking).

Risk factors - Gender: Female, Age: Begin in the age range of 25-50 years; The presence in a family history (heredity) - depression, alcohol abuse, personal disorders.

History (especially early) - the loss of one of the parents in Porvarsh up to 11 years; Negative conditions of upbringing (violence, insufficient attention).

Personality type: suspicious, dependent, with obsessions.

Psychodia is recent stress / psychotrauming situations (illness, court, financial difficulties), postpartum injuries, lack of close warm relations (social insulation).

Distimia is an option of depressive disorders with moderate-pronounced symptoms and chronic flow (more than 2 years).

Features of the Reduced Mood at Distimia:

increased sensitivity to the surrounding, irritability, syradiability, amphibious reactions prevail. The inconsistency of actions and thoughts. Emotional and sensory hyperesthesia. Unstable (more often overwhelmed in hidden form) self-esteem. Lethargy, relaxation. Jamming at the resentment and failures, an idea of \u200b\u200bthe misfortune of others. The preservation of impulses with the difficulty of their implementation. More often an increase in appetite

If a syndrome-complete depression is developing against the background of Distimia, "double depression" is diagnosed.

Bipolar disorder (BR).

Systematics:

Bipolar type 1 type - is characterized by the presence of 1 or more manic or mixed episodes and at least 1 episode of the syndrome-complete depression.

Bipolar-type bipolar disorder - 1 or more syndrome-completed depressive episodes and, at a minimum, 1 - hypolomanical.

Etiology.

1) Genetic Prerendance - Concordance of monosigital twins 65-85%, Dizigoto - 20%, 60-65% of patients with bipolar disorder have affective disorders in a family history

2) The media factors contributing to the manifestations of the BR - stress, antidepressant therapy, a dust-wake rhythm disturbance, substances abuse.

Prevalence - Lifetime Prevalence: 1.3% (3.3 Million People In U.S.) The age of beginning: adolescence and in the area of \u200b\u200b20 years

The flow rate is periodic, in the form of dual phases and continual.

80-90% of patients with bipolar disorder have multiple relapses. The average number of episodes of the disease during life - 9

The duration of remissions (periods without manifestations of the symptoms of the disease) decreases with age and the number of previous episodes.

Diagnostics. Patients attend an average of 3.3 doctors before the correct diagnosis is set.

The average period before the setting of the correct diagnosis - 8 years after the first visit to the doctor (60% of patients do not receive treatment for a 6-month period at the initial episode; 35% of patients do not even pay for help for 10 years after the appearance of the first symptoms of the disease; 34% Patients first receive a diagnosis other than the diagnosis of bipolar disorder).

Suit frequency. 11-19% of patients with bipolar disorder commit suicide. At least 25% attempts to suicide.25-50% of patients have suicidal thoughts in a state of mixed mania.

The differentiation between BR and unipolar depression is important.

Family history - Persons with BRs often have a family history of affective disorders, as well as abuse of pats.

BP - has a more pronounced hereditary predisposition.

The age of the beginning - BP is more often manifest in adolescence, and UD - after 25 years.

The BP flow flows more outlined phases (with a sharp start and breakdown) and has a more pronounced seasonality in manifestations.

The response to therapy - with BP antidepressants detect smaller efficiency and often contribute to the transition to mania.

Cyclotimia is an easy version of bipolar affective disorder. Often seasonal flow. Severe winter-spring and autumn depression.

It belongs to transient dementia. On this occasion, he wrote:

There was a discussion, is it possible to consider dementia in schizophrenia actually dementia. So, Kurt Schneider believed that in these cases, strictly speaking, dementia is not observed, dementia, since "common judgments and memory, and so on, which can be found to intelligence, does not undergo direct changes," but only some impaired thinking are observed. A. K. Anufriev noted that the patient suffering from schizophrenia can simultaneously seem during a conversation with him and low-minded, and not weakly and that the term "schizophrenic dementia" is completely justified in quotes. According to G. V. Torah (it.)russianThe disorder of intelligence during schizophrenia depends on the peculiarities of mental activity, directly on the intellect not affecting and who are volitional disorders by the type of Apato-Abulia and thinking disorders. Therefore, it is impossible to talk about the changes in the intellect in schizophrenia as a classical dementia. With schizophrenic dementia, it does not suffer from intelligence, but the ability to use it. As the same G. V. G. Torle:

Other authors compare intelligence when schizophrenia with a bookcase, full of interesting, smart and useful books to which the key is lost. According to M. I. Weisfeld (), schizophrenic dementia is due to "distraction" (nonsense and hallucinations), the "insufficient activity" of the person to the illness, the "influence of acute psychotic states" and "non-proceeding". According to the last reason, he cites the words of the Great Worker of the Renaissance Leonardo da Vinci, who claimed that the razor through non-consumption is covered with rust:

Criticizing the idea of \u200b\u200bthe outcome of mental illness in dementia, N. N. Pukhovsky notes that the phenomena attributable to "schizophrenic dementia" are closely related to toxico-allergic complications in the inadequate tactics of active therapy of psychosis (including neuroleptic, EST, insulin coatous therapy, Pyroterapy), with the remnants of the constraint system in psychiatric hospitals and phenomena of hospitalism, desocialization, coercion, separation and insulation, domestic discomfort. It also binds "schizophrenic dementia" with a protective mechanism of regression and displacement (parapraction).

Nevertheless, still the inconsistency of intellectual reactions with stimuli indicates the presence of dementia's schizophrenia patients, although in its peculiar version.

History

Special dementia in patients with schizophrenia 4 years after the creation of E. Blailer, the very concept of the disease described the Russian psychiatrist A. N. Bernstein in "clinical lectures on mental illnesses". Prior to that, in the work of V. H. Kandinsky "On pseudogalucinations" (1890), the author indicated the possibility of an opportunity in the dementia of the disease of the idea (the modern analogue of which - schizophrenia).

Classification

By classification A. O. Edelsteinbased on the degree of personality decay allocate:

Pathogenesis

The pathogenesis of schizophrenic dementia, as well as the schizophrenia itself, is not fully known. However, some of its aspects are described. The Austrian psychiatrist Joseph Berester considered the schizophrenic dementia of the "hypotension of consciousness". It is noteworthy that in the future many other scientists were agreed with him: large researchers schizophrenia K. Schneider, A. S. Kronfeld and O. K. E. Bumka. Soviet physiologist I. P. Pavlov also considered Schizophrenia by chronic hypnotic state. However, to understand the pathogenesis of schizophrenic dementia, this is not enough. When schizophrenia, when the elements of intelligence are preserved, its structure is disturbed. In this regard, the main state clinic manifests itself. According to V. A. V. V. V., expressed by another B, the basis of schizophrenic dementia - the splitting of intellect and perceptions, paraludred thinking and flattening affect.