Manic-depressive psychosis (MDP)
A disease that occurs in the form of depressive and manic phases (seizures), between which the patient is practically healthy. In other words, the patient leaves the attack without changing personal characteristics, with the complete disappearance of all psychopathological symptoms. The absence of a personality defect even after repeated attacks is evidence of a favorable prognosis of the disease as a whole. MDP is considered endogenous psychosis. The causes of this disease include hereditary and constitutional factors.
Symptoms and course:The disease manifests itself in the form of depressive and manic phases, and depressive ones are noted several times more often than manic. This happens, possibly because patients in a weakly expressed manic state (hypomania) do not go to the doctor and others do not cause any particular trouble. Depressive state is determined by depressed mood, inhibition of mental and motor processes. Patients complain of anguish (an oppressive feeling of hopelessness, mental pain, a nagging feeling in the region of the heart, in the epigastrium - under the spoon), indifference to loved ones, to everything that used to be a pleasure. Patients are inhibited, sometimes immobilized, sit in the same position or lie in bed. Facial expression is mournful, sad. The questions are answered in monosyllables, with a delay, because "thoughts flow tight." The future seems hopeless, life does not make sense. The past is considered only from the point of view of failures and errors.
Patients talk about their worthlessness, uselessness, insolvency, humiliate themselves, underestimate. In this state, thoughts of suicide can arise, which are often put into practice. In addition, the appetite disappears in patients, the food seems tasteless ("like grass"), patients lose weight, sometimes significantly (1015 kg). In women, menstruation (amenorrhea) disappears during the period of depression. With shallow depression, the daily mood swings characteristic for TIR are noted: one feels worse in the morning (wakes up early with a feeling of longing and anxiety, is inactive, indifferent), in the evening the mood and activity slightly increase. With age, anxiety takes an increasingly important place in the clinical picture of depression (unmotivated anxiety, a premonition that “something should happen”, “internal excitement”). The manic state is expressed in increased, high spirits, overly active activity. Patients are in excellent mood, they feel extraordinary vivacity, a surge of strength. They are cheerful, eloquent, joking, easily distracted, taken for unnecessary things, find unusual activities for them. Numerous ideas that arise from them do not bring to the end. Overestimating their capabilities, they offer their candidacy for various positions that do not correspond to their level of knowledge and qualifications. Often discover outstanding abilities, impersonate an actor, poet, writer. Sometimes they leave their work in order to do creative work or simply change their profession. Patients have a great appetite, however, they can lose weight, because spend too much energy. The dream is short (3-4 hours), but that’s enough for them, otherwise "sleep through your whole life." Sex drive increases, which can result in promiscuous sexual intercourse. In those cases if the manic syndrome is not very pronounced, they speak of a hypomanic state. In hypomania, patients are extremely productive, because there is no increased distractibility, disinhibition. Efficiency is good, memory is excellent, mood is excellent, no problems - in this state a person is ready to turn mountains. People of creative work - composers, artists, poets, scientists, being in such a state, create masterpieces in art and outstanding works in science. But, unfortunately, the line between the hypomanic and manic states is very fuzzy and easy to cross, and beyond this line there is already a serious painful state. If the patient has only hypomania and subdepression, then this disease is called cyclothymia. But if in hypomania patients do not go to the doctor, then the doctor’s help, at least outpatient, is required in subdepression.
A significant number of patients in their entire lives have only one phase of the disease, after which recovery occurs. However, the likelihood of the appearance of the second and third phases remains until the end of life. In more than half of patients, the disease proceeds only in the form of depressive phases, in about 5% - only manic (monopolar course). If the manic and depressive phases alternate, this is a bipolar type of course. In some patients, bouts of depression are repeated annually, and at a certain time of the year (autumn or early spring).
Treatment and prevention. Treatment depends on the nature of the phase, depressive or manic. Depression is treated with antidepressants. If depression with severe inhibition, antidepressants with a stimulating effect (melipramine) are prescribed, if with a pronounced feeling of anxiety, anxiety, then drugs with a calming effect (amitriptyline, tryptisol). With insomnia, tranquilizers are added. The manic state is stopped with the help of antipsychotics (chlorpromazine, haloperidol, etc.). For the prevention of subsequent attacks, lithium salts are used, and recently finlepsin (tegretol) is widely used for these purposes as a mood stabilizer. During the period of the disease (with the exception of hypomania), patients are disabled. After exiting the attack, disability is restored. Patients are transferred to disability only in those cases when seizures are very frequent or the course of the disease becomes continuous, i.e. one phase replaces another.