Symptomatic psychosis

Symptomatic psychoses include mental disorders that occur in diseases of internal organs, infectious diseases, endocrinopathies. Acute symptomatic psychoses usually occur with the phenomena of obscuration of consciousness; Protragirovannye forms are manifested in the form of psychopathic depressive-paranoid, hallucinatory-paranoid states, as well as persistent psycho-organic syndrome.

Pathogenesis. Acute symptomatic psychoses manifest when exposed to intense, but short-lived harmfulness; In the emergence of protracted psychoses, a certain role is also played by previously suffered brain damage (trauma, intoxication, etc.).

The specific features of mental disorders depend to a certain extent on the somatic suffering that caused psychosis. Acutely developing heart failure can be accompanied by phenomena of stunning, amenity; With chronic heart failure, lethargy, apathy, lack of initiative predominate, but as anxiety decay increases, anxiety and depression take the leading place; Hypnagogic hallucinations, delirium are possible. With myocardial infarction, most often there is anxiety with fear of death, but in some cases the mood is higher, euphoria. Deterioration of the state can occur with the phenomena of an upset consciousness (delirium, amenia). In the stage of improvement, sometimes protracted hypochondriacal states are formed with suspicion, egocentrism, persistent fixation on painful sensations.

Mental disorders of vascular genesis at the initial stage are most often determined by neurotic manifestations (headache, head noise, dizziness, sleep disturbance, fatigue, mood lability), as well as sharpening of the psychotic traits peculiar to the patient. More progredient flow is accompanied by a decrease in the level of personality with a decrease in mental activity, weakening of memory and ends with dementia. Acute vascular psychosis is often transient and proceeds with the phenomena of confusion of consciousness (most often there are confusional states that usually occur at night). Along with this, epileptiform paroxysms, phenomena of verbal hallucinosis are possible.

In cancerous tumors in the terminal stage, as well as in the postoperative period, acute psychotic outbreaks occur, which, as a rule, are short-lived and are accompanied by a confusion of consciousness of different depths (delirious, delirious-amenable states). Depressive and depressive-paranoid conditions are also observed. Chronic renal failure with uremic symptoms is complicated by a delirious, delirious-oniroid or delirious-amenial disorder of consciousness, which changes when the condition deteriorates into deep stunning. Along with this, epileptiform seizures may occur. With liver diseases (hepatitis), erased depression with apathy, a feeling of fatigue, irritability is observed. Yellow dystrophy of the liver is accompanied by a delirious and twilight confusion of consciousness. With vitamin deficiency (a lack of thiamine, nicotinic acid, etc.), asthenic, anxiety-depressive, apathic conditions, as well as delirious and amenious disorder of consciousness are more often observed; In far-reaching cases, Korsakov's syndrome and dementia may develop. Acute influenza psychosis usually occurs with delirious disorders and phenomena of epileptiform excitation; The clinical picture of protracted psychoses is determined by depression with a predominance of asthenia and tearfulness. Patients with tuberculosis often have an elevated mood, sometimes reaching a manic state; Asthenic conditions with irritability and tearfulness are also noted. In the acute stage of rheumatism, along with dream-delirious states, short-term attacks of psychosensory disorders with disruption of the body scheme, depersonalization and derealization phenomena are possible. With protracted rheumatic psychosis, manic, depressive and depressive-paranoid patterns are observed.

Endocrinopathies at the initial stages are characterized by the manifestations of the endocrine psychosyndrome, for which the most typical changes in cravings (increase or decrease in appetite), thirst, changes in sensitivity to heat and cold, increase or decrease in the need for sleep, etc. Along with this, changes in general mental activity The former latitude and differentiated (tm) interests) and moods (hypomanic, depressive, mixed states that occur with increased excitability, nervousness, anxiety, dysphoria).

The clinical picture of the endocrine psychosyndrome varies depending on the nature of the hormonal disorders. When hypopituitarism is particularly often observed inhibition of vital drives, physical weakness and adynamia; With acromegalia, apathy and aspontaneity, sometimes combined with a complacent-euphoric mood; Hypothyroidism - the slowness of all mental processes, apathic-depressive states, decreased sexual desire; Hyperthyroidism - increased excitability, insomnia, mood lability. With weighting of the underlying disease, delirious, amenable, twilight states, as well as epileptiform seizures may occur. Along with this, protracted psychoses with a predominance of affective and schizophreniform symptoms are observed. Psychoses of the postpartum period most often occur with the predominance of amenitive, catatonic or affective disorders.

Symptomatic psychoses must be differentiated from endogenous diseases, provoked by somatic suffering. Clarification of the diagnosis is facilitated by data on the occurrence in the course of the development of the disease, even brief episodes of an upset consciousness, pronounced asthenic disorders, as well as a combination of mental disorders with neurological and somatic symptoms. Acute symptomatic psychoses should be delimited from exogenous psychoses of a different etiology (intoxication, organic diseases of the central nervous system).

Treatment. The relief of mental disorders due to somatic pathology is closely related to the course of the underlying disease. When conducting drug therapy, one must take into account the possibility of adverse effects of psychotropic drugs on the course of a physical illness. It is necessary to bear in mind the hypotensive effect of psychopharmacological drugs and other side effects, as well as the potentiation of barbiturates, morphine and alcohol. Caution should not lead to the rejection of the appointment of psychotropic drugs, especially in cases of psychomotor agitation, which in itself is a danger to the life of the patient.

Defining the tactics of treating acute symptomatic psychoses (delirious conditions, hallucinosis, etc.), it is necessary to take into account their short duration and reversibility. In this regard, the entire volume of medical care and care for the patient can be provided in a somatic hospital (psychosomatic department). Transfer to a psychiatric hospital is associated with the danger of worsening of the somatic state and is not necessary in all cases. With the emergence of initial symptoms of delirium and especially persistent insomnia, along with detoxification therapy, the introduction of (if necessary parenteral) tranquilizers (diazepam, chlordiazepoxide, elenium, oxazepam, nitrazepam, eunotin) and neuroleptic drugs (chlorprotixen, terabolene) with a hypnotic effect is indicated.

A patient in a delirious state needs round-the-clock observation. You must start this state as early as possible. If the confusion of consciousness is accompanied by anxiety, fear, phenomena of psychomotor agitation, along with detoxification therapy (hemodez, polidez, polyglucin), the use of psychotropic drugs is shown. For this purpose, aminazine and levomepromazine (tizercin) are most often used, as well as leponex (azaleptin). Taking into account the somatic state of the B-cells (pulse control and blood pressure control), the treatment should begin with minimal doses (25-50 mg) .Neyoleleptiki appointed in tablets or in the form of injections in combination with cardiac funds .It is effective also in / in the drip of tranquilizers (Seduxen, Relanium, Elenium) .In cases of pronounced manifestations of cerebral insufficiency parenteral administration of pyracetam (nootropil) is indicated.

With protracted symptomatic psychoses, the choice of drugs is determined by the characteristics of the clinical picture. In cases of depression, appoint timoleptiki (pyrazidol, amitriptyline, melipramine, petilil, gerfonal); For the treatment of hypomanic and manic states use tranquilizers and neuroleptics. Therapy of hallucinatory and delusional conditions is performed by neuroleptic means (etaperazine, frenolone, sonapax, tryptazine, haloperidol, etc.).

Treatment of somatogenically conditioned neurotic conditions is similar in many respects to the therapy of neuroses. When asthenic conditions are used, small doses of tranquilizers (especially if the clinical picture is dominated by the phenomena of irritable weakness and incontinence) in combination with drugs that activate mental activity [from 1.5 to 3-3.5 ghamalona, ​​1.2-2.4 g Piracetam (nootropil) in the first half of the day]. In cases of severe lethargy, inhibited (tm), decreased performance are prescribed psychostimulants: 5-20 mg sidnokarba in the first half of the day, centedrine, acefen.