Manic-depressive psychosis (TIR)
The disease occurs in the form of depressive and manic phases (seizures), between which the patient is healthy. In other words, the patient leaves the attack without a change in personality, 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, with depressive occurring several times more often than manic. This is probably due to the fact that patients in a poorly expressed manic state (hypomania) do not go to a doctor and do not cause too much trouble to others. Depression is determined by depressed mood, inhibition of mental and motor processes. Patients complain of melancholy (oppressive sense of hopelessness, heartache, pinching feeling in the heart, in the epigastrium - under the spoon), indifference to loved ones, to everything that used to give pleasure. Patients are inhibited, sometimes immobilized, sitting in the same position or lying in bed. The expression is sad, sad. Questions are answered in monosyllables, with a delay, because "tight thoughts flow." The future seems hopeless, life has no meaning. The past is viewed only in terms of failures and mistakes.
Patients talk about their worthlessness, uselessness, inconsistency, humiliate themselves, underestimate. In this state, there may be thoughts of suicide, which are often implemented. In addition, patients lose their appetite, food seems tasteless (“like grass”), patients lose weight, sometimes significantly (1015 kg). In women for the period of depression, menstruation disappears (amenorrhea). With shallow depression, diurnal mood fluctuations characteristic of MDP are noted: health is worse in the morning (they wake up early with a feeling of melancholy and anxiety, they are inactive, they are indifferent), in the evening mood and activity are somewhat elevated. With age, anxiety takes an increasing place in the clinical picture of depression (unmotivated anxiety, a premonition that “something should happen”, “internal excitement”). The manic state is expressed in an elevated, high spirits, excessively vigorous activity. Patients are in excellent mood, feel an extraordinary vigor, a surge of strength. They are cheerful, talkative, joking, easily distracted, taken for unnecessary things, find activities unusual for them. Numerous ideas arising from them, do not bring to the end. Reassessing their capabilities, they offer their candidature for various positions that do not correspond to their level of knowledge and qualifications. Often, they open up extraordinary abilities, impersonating an actor, a poet, a writer. Sometimes they leave their jobs in order to engage in creative work or simply change their profession. Patients have a great appetite, however, they can lose weight, because spending too much energy. A short sleep (3-4 hours), but this is enough for them, otherwise "you will sleep through your whole life." Increased sexual desire, which can result in promiscuous sex. In those cases, if manic syndrome is not very pronounced, they speak of a hypomania state. In hypomania, patients are extremely productive, because there is still increased distractibility, disinhibition. The performance is good, the memory is beautiful, the mood is great, no problem - in this condition, the person is ready to move mountains. People of creative work - composers, artists, poets, scientists, being in a similar state, create masterpieces in art and outstanding works in science. But, unfortunately, the line between the hypomaniacal and manic state is very indistinct and it is easy to cross it, and beyond this, it is already a serious painful condition. If a patient has only hypomania and subdepression, then this disease is called cyclothymia. But if patients in hypomania do not go to the doctor, then the doctor’s help, even outpatient, is required in subdepression.
In a significant number of patients in their entire life, there is only one phase of the disease, after which recovery occurs. However, the likelihood of the second and third phases persists until the end of life. In more than half of the patients, the disease proceeds only in the form of depressive phases, approximately in 5% - only manic (monopolar course). If manic and depressive phases alternate - this is a bipolar type of flow. In some patients, bouts of depression are repeated annually, and at certain times of the year (in 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 is severely inhibited, antidepressants are prescribed with a stimulating effect (melipramine), if there is a pronounced feeling of anxiety, anxiety, then drugs with a sedative effect (amitriptyline, triptyzol). When insomnia add tranquilizers. The manic state is stopped using neuroleptics (aminazin, haloperidol, etc.). For the prevention of subsequent attacks using lithium salts, and recently finlepsin (tegretol) is widely used for these purposes as a mood stabilizer. During the period of illness (with the exception of hypomania), patients are disabled. After leaving the attack, the ability to work is restored. Disability of patients is transferred only in cases where the attacks are very frequent or the course of the disease becomes continuous, i.e. one phase replaces another.