Affective insanity

Manic-depressive psychosis (MDP) (circular psychosis, amphithymia) -zabolevanie manifested recurrent manic and depressive states (phases), generally separated by intermission; It does not lead to the formation of the mental defect.

Etiology, pathogenesis. Important role played by hereditary predisposition, and constitutional factors. Most often, the ill person and cycloid psychasthenic warehouse. A certain importance is also dysfunction podbugornoy field and pathology of the endocrine system. Women suffer more often than men. The first attacks may occur in puberty and in old age. In most cases the disease begins at 3-5 or fourth decade of life.

Symptoms within. Intensity of affective disorders (see. Affective syndromes) varies from mild disorders (cyclothymia), which is usually treated on an outpatient basis, to severe depression and mania, requiring immediate hospitalization. For TIR typically complete regression of painful disorders, return to the state that was before the illness. Less commonly, after repeated relapses, during remission, also marked residual psychopathological manifestations mainly in the form of deleted hypomanic and subdepressive disorders. The number of phases for the disease is very different. Phase Duration - from 1 week to 1-2 years or more, the average 6-12-month. Bright intervals in some cases may be absent (so-called continuum of the disease), but typically they are measured in months, years and even decades. Bipolar for - a change of depressive and manic phases - is observed in 1/3 cases. Most often the disease occurs in the form of periodic depressions.

TIR The diagnosis is based on the autochthonous origin and subsequent recurrence of affective phases on. typical endogenous affective disorders picture of mania and depression, and the presence of the relatives of people with cyclothymic manifestations or TIR patients. TIR The phases must be distinguished from the endogenous, psychogenic, constitutionally (phases in psychopaths) and somatogenically caused affective states. TIR Delimitation from periodic schizophrenia is based on the absence at the time of attack, hallucinations, delusions of reference, persecution and formal thought disorder. In difficult cases, deliver differentiation TIR diagnosis is possible only after prolonged observation, if not growing personality changes in the development of the disease.

Treatment for depression antidepressants (amitriptyline, imipramine, pirazidol, inkazan by 50-300 mg / day). In severe cases shown parenteral (w / m, in / in drip) administration of drugs. When resistant to psychotropic drugs carried zlektrosudorozhnuyu depression therapy. With hypomania effective tranquilizers [diazepam (seduksen), oxazepam (tazepam), chlordiazepoxide (elenium) on 5-40 mg / day, Phenazepamum 1-3 mg], neuroleptics in small doses, lithium salt (lithium carbonate at 900-1200 mg / day). Mania cropped antipsychotics (chlorpromazine at 100-400 mg / day of haloperidol at 6-20 mg / day, triftazin 20-50 mg leponeks 50-200 mg sonapaks, Chlorprothixenum 100-300 mg / day). With symptoms of manic excitement shown in / m introduction drugs (chlorpromazine, haloperidol, triftazin).

Forecast favorable in most cases. When depressive phases, it is complicated because of the risk of suicide attempts. The primary means of preventing subsequent affective phases is preventive therapy (over several years), and lithium salts finlepsipom. lithium salts provide controlled content of lithium in the blood (its optimal content providing preventive effect is 0.4-0.8 mmol / L).