Causes of psychosis in women. Symptoms of various types of psychosis

1. WHAT IS PSYCHOSIS

The purpose of this material is to convey in the most accessible form to all interested people (primarily to the relatives of patients) modern scientific information about the nature, origin, course and treatment of such serious diseases as psychosis.

Psychoses (psychotic disorders) are the most striking manifestations of mental illness, in which the mental activity of the patient does not correspond to the surrounding reality, the reflection of the real world in the mind is sharply distorted, which manifests itself in behavioral disorders, the appearance of abnormal pathological symptoms and syndromes.

Most often, psychoses develop within the framework of the so-called "endogenous diseases" (Gr. endo - inside, genesis- origin). The variant of the occurrence and course of a mental disorder due to the influence of hereditary (genetic) factors), which include: schizophrenia, schizoaffective psychosis, affective diseases (bipolar and recurrent depressive disorder). The psychoses that develop with them are the most severe and protracted forms of mental suffering.

The concepts of psychosis and schizophrenia are often equated, which is fundamentally wrong, since psychotic disorders can occur in a number of mental illnesses: Alzheimer's disease, senile dementia, chronic alcoholism, drug addiction, epilepsy, mental retardation, etc.

A person may experience a transient psychotic state caused by taking some medicines, drugs, or the so-called psychogenic or "reactive" psychosis that occurs as a result of exposure to severe mental trauma (stressful situation with danger to life, loss of a loved one, etc.). Often there are so-called infectious (developing as a result of a severe infectious disease), somatogenic (caused by severe somatic pathology, such as myocardial infarction) and intoxication psychoses. The most striking example of the latter is alcoholic delirium - "white tremens".

Psychotic disorders are a very common type of pathology. Statistical data in different regions differ from each other, which is associated with different approaches and possibilities for identifying and accounting for these conditions that are sometimes difficult to diagnose. On average, the frequency of endogenous psychoses is 3-5% of the population.

Accurate information about prevalence in the population exogenous psychoses(gr. exo- out, genesis- origin. There is no option for development due to the influence of external causes outside the body, and this is explained by the fact that most of these conditions occur in patients with drug addiction and alcoholism.

The manifestations of psychosis are truly limitless, which reflects the richness of the human psyche. The main manifestations of psychosis are:

• hallucinations(depending on the analyzer, auditory, visual, olfactory, gustatory, tactile are distinguished). Hallucinations can be simple (ringing, noise, hailing) or complex (speech, scenes). The most common are auditory hallucinations, the so-called "voices" that a person can hear coming from outside or sounding inside the head, and sometimes the body. In most cases, voices are perceived so vividly that the patient does not have the slightest doubt about their reality. Voices can be threatening, accusing, neutral, imperative (ordering). The latter are rightfully considered the most dangerous, since often patients obey the orders of voices and commit acts that are dangerous to themselves or others.

· crazy ideas- judgments, conclusions that do not correspond to reality, completely seizing the patient's consciousness, not amenable to correction by dissuasion and explanation. The content of delusional ideas can be very diverse, but the most common are: delusions of persecution (patients believe that they are being monitored, they want to be killed, intrigues are woven around them, conspiracies are organized), delusions of influence (by psychics, aliens, special services with the help of radiation, radiation, "black" energy, witchcraft, damage), delirium of damage (poison is added, they steal or spoil things, they want to survive from the apartment), hypochondriacal delirium (the patient is convinced that he suffers from some kind of disease, often terrible and incurable, stubbornly proves that he is amazed internal organs, requires surgical intervention). There are also delusions of jealousy, invention, greatness, reformism, of a different origin, amorous, litigious, etc.

· movement disorders, manifested in the form of inhibition (stupor) or excitation. With stupor, the patient freezes in one position, becomes inactive, stops answering questions, looks at one point, refuses to eat. Patients in a state of psychomotor agitation, on the contrary, are constantly on the move, speak incessantly, sometimes grimace, mimic, are foolish, aggressive and impulsive (perform unexpected, unmotivated actions).

· mood disorders manifested by depressive or manic states. Depression is characterized, first of all, by low mood, melancholy, depression, motor and intellectual retardation, the disappearance of desires and urges, a decrease in energy, a pessimistic assessment of the past, present and future, ideas of self-blame, thoughts of suicide. The manic state is manifested by an unreasonably elevated mood, an acceleration of thinking and motor activity, an overestimation of the capabilities of one's own personality with the construction of unrealistic, sometimes fantastic plans and projects, the disappearance of the need for sleep, disinhibition of drives (alcohol abuse, drugs, promiscuity).

All of the above manifestations of psychosis belong to the circle positive disorders, so named because the symptoms that appeared during psychosis are, as it were, added to the pre-morbid state of the patient's psyche.

Unfortunately, quite often (although not always) a person who has undergone psychosis, despite the complete disappearance of his symptoms, has so-called negative disorder, which in some cases lead to even more serious social consequences than the psychotic state itself. Negative disorders are called so because in patients there is a change in character, personality traits, loss of powerful layers from the psyche that were previously inherent in it. Patients become lethargic, uninitiative, passive. Often there is a decrease in energy tone, the disappearance of desires, motives, aspirations, an increase in emotional dullness, isolation from others, unwillingness to communicate and enter into any social contacts. Often they lose their previously inherent responsiveness, sincerity, a sense of tact, and irritability, rudeness, quarrelsomeness, and aggressiveness appear. In addition, patients develop disorders of thinking, which becomes unfocused, amorphous, rigid, empty. Often these patients lose their previous labor skills and abilities so much that they have to apply for disability.

2. COURSE AND PROGNOSIS OF PSYCHOSIS

Most often (especially in endogenous diseases) there is a periodic type of psychosis with occurring from time to time acute attacks diseases, both provoked by physical and psychological factors, and spontaneous. It should be noted that there is also a single-attack course, which is observed more often in adolescence. Patients, having suffered one, sometimes a protracted attack, gradually come out of the painful state, restore their ability to work and never again come to the attention of a psychiatrist. In some cases, psychoses can become chronic and become continuous without the disappearance of symptoms throughout life.

In uncomplicated and uncomplicated cases hospital treatment lasts, as a rule, one and a half to two months. It is this period that doctors need to fully cope with the symptoms of psychosis and select the optimal supportive therapy. In cases where the symptoms of the disease are resistant to drugs, a change in several courses of therapy is required, which can delay the stay in the hospital for up to six months or more. The main thing that the patient's relatives need to remember is that do not rush the doctors, do not insist on an urgent discharge “on receipt”! It takes a certain time to fully stabilize the condition, and by insisting on an early discharge, you run the risk of getting an undertreated patient, which is dangerous for both him and you.

One of the most important factors influencing the prognosis of psychotic disorders is the timeliness of initiation and intensity of active therapy in combination with social rehabilitation measures.

3. WHO ARE THEY INSANE?

Over the centuries, a collective image of the mentally ill has formed in society. Unfortunately, in the view of still many people, this is an untidy, unshaven person with a burning look and a clear or secret desire to pounce on others. The mentally ill are feared because, allegedly, "it is impossible to understand the logic of their actions." Mental illnesses are considered sent down from above, transmitted strictly by inheritance, incurable, contagious, leading to dementia. Many believe that the cause of mental illness is difficult living conditions, prolonged and severe stress, difficult intra-family relationships, lack of sexual contact. The mentally ill are considered either "weaklings" who simply cannot pull themselves together or, falling into the other extreme, sophisticated, dangerous and ruthless maniacs who commit serial and mass murders, sexual violence. It is believed that people suffering from mental disorders do not consider themselves sick and are not able to think about their treatment.

Unfortunately, the patient's relatives often adopt the views typical of society and begin to treat the unfortunate person in accordance with the misconceptions prevailing in society. Often, families in which a mentally ill person has appeared, at all costs strive to hide their misfortune from others and thereby further aggravate it, dooming themselves and the patient to isolation from society.

A mental disorder is a disease like any other. There is no reason to be ashamed that this disease has manifested itself in your family. The disease has a biological origin, i.e. occurs as a result of a violation of the metabolism of a number of substances in the brain. Suffering from a mental disorder is about the same as having diabetes, peptic ulcer or others chronic disease. Mental illness is not a sign of moral weakness. Mentally ill people cannot eliminate the symptoms of illness by an effort of will, just as it is impossible to improve vision or hearing by an effort of will. Mental illnesses are not contagious. The disease is not transmitted by airborne or other means of infection, so it is impossible to become ill with psychosis by closely communicating with the patient. According to statistics, cases of aggressive behavior among the mentally ill are less common than among healthy people. The hereditary factor in patients with mental illness manifests itself in the same way as in patients with cancer or diabetes. If two parents are sick, the child gets sick in about 50% of cases, if one, the risk is 25%. Most people with mental disorders understand that they are sick and seek treatment, although initial stages illness is difficult for a person to accept. A person's ability to make decisions about their own treatment is greatly enhanced if their family members take an interested position, approve and support their decisions. And, of course, we should not forget that many brilliant or famous artists, writers, architects, musicians, thinkers suffered from serious mental disorders. Despite a serious illness, they managed to enrich the treasury of human culture and knowledge, immortalize their name with the greatest achievements and discoveries.

4. SIGNS OF BEGINNING DISEASE OR EXCANCTION

For relatives whose loved ones suffer from a particular mental disorder, it may be useful information O initial manifestations psychosis or symptoms of an advanced stage of the disease. All the more useful may be recommendations on some rules of behavior and communication with a person who is in a painful condition. IN real life it is often difficult to immediately understand what is happening with your loved one, especially if he is scared, suspicious, distrustful and does not express any complaints directly. In such cases, only indirect manifestations of mental disorders can be noticed. Psychosis can have a complex structure and combine hallucinatory, delusional and emotional disorders (mood disorders) in various proportions. The following symptoms may appear with the disease all without exception, or separately.

Manifestations of auditory and visual hallucinations:

· Conversations with oneself, reminiscent of a conversation or remarks in response to someone's questions (excluding comments aloud like "Where did I put my glasses?").

Laughter for no apparent reason.

· Sudden silence, as if the person is listening to something.

· Anxious, preoccupied look; inability to focus on a topic of conversation or a specific task.

· The impression that your relative sees or hears something that you cannot perceive.

The appearance of delirium can be recognized by the following signs:

· Changed behavior towards relatives and friends, the appearance of unreasonable hostility or secrecy.

Direct statements of implausible or dubious content (for example, about persecution, about one's own greatness, about one's inexcusable guilt.)

· Protective actions in the form of curtains on windows, locking doors, obvious manifestations of fear, anxiety, panic.

· Statement without obvious grounds of fear for one's life and well-being, for the life and health of loved ones.

Separate, incomprehensible to others, meaningful statements that give mystery and special significance to everyday topics.

Refusal to eat or carefully check the content of food.

· Active litigious activity (for example, letters to the police, various organizations with complaints about neighbors, colleagues, etc.).

How to respond to the behavior of a person suffering from delusions:

Do not ask questions that clarify the details of delusional statements and statements.

· Do not argue with the patient, do not try to prove to your relative that his beliefs are wrong. This not only does not work, but can also aggravate existing disorders.

If the patient is relatively calm, tuned in to communication and help, listen carefully to him, calm him down and try to persuade him to see a doctor.

Suicide Prevention

In almost all depressive states, thoughts about unwillingness to live can arise. But depressions accompanied by delusions (for example, guilt, impoverishment, an incurable somatic disease) are especially dangerous. These patients at the height of the severity of the condition almost always have thoughts of suicide and suicidal readiness.

The following signs warn of the possibility of suicide:

Statements of the patient about his uselessness, sinfulness, guilt.

· Hopelessness and pessimism about the future, unwillingness to make any plans.

The patient's belief that he has a fatal, incurable disease.

Sudden sedation of the patient after a long period of sadness and anxiety. Others may have the false impression that the patient's condition has improved. He puts his affairs in order, for example, writing a will or meeting up with old friends whom he has not seen for a long time.

Preventive action:

· Take any discussion of suicide seriously, even if it seems unlikely to you that the patient might attempt suicide.

· If there is an impression that the patient is already preparing for suicide, without hesitation, immediately seek professional help.

· Hide dangerous items (razors, knives, pills, ropes, weapons), carefully close windows, balcony doors.

5. YOUR RELATIVE IS ILL

All members of the family, where the mentally ill appeared, at first experience confusion, fear, do not believe in what happened. Then the search for help begins. Unfortunately, very often, first of all, they turn not to specialized institutions where they can get advice from a qualified psychiatrist, but, at best, to doctors of other specialties, at worst, to healers, psychics, and specialists in the field of alternative medicine. The reason for this is a number of prevailing stereotypes and misconceptions. Many people have a distrust of psychiatrists, which is associated with artificially inflated means mass media during the years of perestroika, the problem of the so-called "Soviet punitive psychiatry". Most people in our country still associate various serious consequences with the consultation of a psychiatrist: registration in a psychoneurological dispensary, loss of rights (limitation of the ability to drive vehicles, travel abroad, carry weapons), the threat of loss of prestige in the eyes of others, social and professional discredit. Fear of this peculiar stigma, or, as they say now, “stigma”, conviction in a purely somatic (for example, neurological) origin of one’s suffering, confidence in the incurability of mental disorders by methods modern medicine and, finally, simply a lack of understanding of the morbid nature of their condition makes sick people and their relatives categorically refuse any contact with psychiatrists and take psychotropic therapy - the only real possibility improve their condition. It should be emphasized that after the adoption in 1992 of the new Law of the Russian Federation "On psychiatric care and guarantees of the rights of citizens in its provision", most of the above fears are unfounded.

The infamous “registration” was canceled ten years ago, and at present a visit to a psychiatrist does not threaten with negative consequences. Nowadays, the concept of "accounting" has been replaced by the concepts of consultative and medical care and dispensary observation. The advisory contingent includes patients with mild and short-term mental disorders. Assistance is provided to them in the case of an independent and voluntary appeal to the dispensary, at their request and with their consent. Underage patients under the age of 15 years of age are provided with assistance at the request or with the consent of their parents or legal representatives of their rights. The dispensary observation group includes patients suffering from severe, persistent or often exacerbated mental disorders. Dispensary observation can be established by a decision of a commission of psychiatrists, regardless of the consent of a person suffering from a mental disorder, and is carried out through regular examinations by doctors of neuropsychiatric dispensaries (PND). Termination of dispensary observation is carried out under the condition of recovery or a significant and persistent improvement in the patient's condition. As a rule, observation is stopped in the absence of exacerbations within five years.

It should be noted that often at the first signs of a mental disorder, worried relatives assume the worst - schizophrenia. Meanwhile, as already mentioned, psychoses have other causes, so each patient requires a thorough examination. Sometimes delay in contacting a doctor is fraught with the most serious consequences (psychotic conditions that have developed as a result of a brain tumor, stroke, etc.). To identify the true cause of psychosis requires the advice of a qualified psychiatrist using the most sophisticated high-tech methods. That is also why turning to alternative medicine, which does not have the entire arsenal of modern science, can lead to irreparable consequences, in particular, to an unjustified delay in delivering the patient to the first consultation with a psychiatrist. As a result, the patient is often brought to the clinic by an ambulance in a state of acute psychosis, or the patient is admitted for examination in an advanced stage. mental illness when time has already been lost and there is a chronic course with the formation of negative disorders that are difficult to treat.

Patients with psychotic disorders can receive specialized care in the PND at the place of residence, in psychiatric research institutions, in the offices of psychiatric and psychotherapeutic care at general clinics, in psychiatric offices of departmental polyclinics.

The functions of the psycho-neurological dispensary include:

· Outpatient reception of citizens referred by doctors of general polyclinics or who applied on their own (diagnosis, treatment, solution of social issues, examination);

Direction to psychiatric hospital;

· Urgent Care at home;

· Consultative and dispensary supervision of patients.

After examining the patient, the local psychiatrist decides under what conditions to carry out treatment: the patient's condition requires urgent hospitalization in a hospital or outpatient treatment is sufficient.

Article 29 of the Law of the Russian Federation "On psychiatric care and guarantees of the rights of citizens in its provision" clearly regulates the grounds for involuntary hospitalization in a psychiatric hospital, namely:

“A person suffering from a mental disorder may be hospitalized in a psychiatric hospital without his consent or without the consent of his legal representative before the decision of the judge, if his examination or treatment is possible only in hospital conditions, and the mental disorder is severe and causes:

a) his immediate danger to himself or others, or

b) his helplessness, that is, his inability to independently satisfy the basic needs of life, or

c) significant harm to his health due to deterioration mental state if the person is left without psychiatric care"

6. TREATMENT: BASIC METHODS AND APPROACHES.

Despite the fact that psychoses are a complex group, which includes conditions of various origins, the principles of treatment for them are the same. All over the world, drug therapy is considered the most effective and reliable method of treating psychosis. During its implementation, an unconventional, strictly individual approach is applied to each patient, taking into account age, gender, and the presence of burdened by other diseases. One of the main tasks of the specialist is to establish fruitful cooperation with the patient. It is necessary to instill in the patient faith in the possibility of recovery, to overcome his prejudice against the "harm" caused by psychotropic drugs, convey to him his conviction in the effectiveness of treatment, subject to the systematic observance of the prescribed prescriptions. Otherwise, there may be a violation medical advice regarding doses and regimen of medication. The relationship between the doctor and the patient should be based on mutual trust, which is guaranteed by the observance by the specialist of the principles of non-disclosure of information, medical secrecy, anonymity of treatment. The patient, in turn, should not hide from the doctor such important information as the fact of using psychoactive substances (drugs) or alcohol, taking medications used in general medicine, driving a car or driving complex mechanisms. A woman should notify her doctor if she is pregnant or breastfeeding. Often, relatives or the patients themselves, having carefully studied the annotations to the medicines recommended by them, are perplexed, and sometimes indignant, that the patient was prescribed the drug for, while he has a completely different diagnosis. The explanation is that almost all drugs used in psychiatry act non-specifically; help with the widest range of painful conditions (neurotic, affective, psychotic) - it's all about the prescribed dose and the doctor's art of choosing the optimal treatment regimens.

Undoubtedly, the intake of drugs should be combined with social rehabilitation programs and, if necessary, with family psychotherapeutic and psychopedagogical work.

Social rehabilitation is a set of programs for teaching patients with mental disorders the ways of rational behavior both in hospital conditions and at home. Rehabilitation focuses on teaching social skills to interact with other people, skills needed in daily life such as managing one's own finances, cleaning the house, shopping, using public transport, etc., vocational training, which includes the activities necessary to obtain and job retention and education for those patients who want to graduate from high school or college. Auxiliary psychotherapy is also often used to help the mentally ill. Psychotherapy helps the mentally ill feel better about themselves, especially those who experience feelings of inferiority due to their illness and those who tend to deny that they have an illness. Psychotherapy helps the patient learn ways to deal with everyday problems. An important element of social rehabilitation is participation in peer support groups with other people who understand what it means to be mentally ill. Such groups, led by patients who have been hospitalized, allow other patients to feel helped in understanding their problems, and also increase their opportunities for participation in recovery activities and community life.

All of these methods, when used judiciously, can increase the effectiveness of drug therapy, but are not capable of completely replacing drugs. Unfortunately, science still does not know how to cure mental illness once and for all, often psychoses have a tendency to recur, which requires long-term preventive medication.

8. NEUROLEPTICS IN THE TREATMENT OF PSYCHOTIC DISORDERS

The main drugs used to treat psychosis are the so-called antipsychotics or antipsychotics.

The first chemical compounds with the ability to stop psychosis were discovered in the middle of the last century. Then for the first time in the hands of psychiatrists was a powerful and effective remedy psychosis treatment. Such drugs as chlorpromazine, haloperidol, stelazin and a number of others have proven themselves especially well. They stopped psychomotor agitation quite well, eliminated hallucinations and delirium. With their help, a huge number of patients were able to return to life, to escape from the darkness of psychosis. However, over time, evidence has accumulated that these drugs, later called classic antipsychotics, affect only positive symptoms, often without affecting negative ones. In many cases, the patient was discharged from the psychiatric hospital without delusions or hallucinations, but became passive and inactive, unable to return to work. In addition, almost all classical antipsychotics cause so-called extrapyramidal side effects (drug parkinsonism). These effects are manifested by muscle stiffness, tremors and convulsive twitching of the limbs, sometimes there is a hard tolerable feeling of restlessness, because of which the patients are in constant motion, unable to stop for a minute. To reduce these unpleasant phenomena, doctors are forced to prescribe a number of additional drugs, which are also called correctors (cyclodol, parkopan, akineton, etc.). Side effects of classical antipsychotics are not limited to extrapyramidal disorders, in some cases salivation or dry mouth, urination disorders, nausea, constipation, palpitations, a tendency to decrease blood pressure and fainting, weight gain, decreased libido, erectile dysfunction and ejaculation, women often have galactorrhea (discharge from the nipples) and amenorrhea (disappearance of menstruation). It should be noted side effects from the side of the central nervous system: drowsiness, memory impairment and concentration of attention, increased fatigue, the possibility of developing the so-called. neuroleptic depression.

Finally, it should be emphasized that, unfortunately, traditional antipsychotics do not help everyone. There has always been a part of patients (about 30%), whose psychoses responded poorly to treatment, despite adequate therapeutic tactics with a timely change of drugs of various groups.

All these reasons explain the fact that patients often arbitrarily stop taking medications, which in most cases leads to an exacerbation of the disease and re-hospitalization.

A real revolution in the treatment of psychotic disorders was the discovery and introduction into clinical practice in the early 90s of a fundamentally new generation of neuroleptics - atypical antipsychotics. The latter differ from classical antipsychotics in the selectivity of their neurochemical action. By acting only on certain nerve receptors, these drugs, on the one hand, turned out to be more effective, and on the other, much better tolerated. It was found that they practically do not cause extrapyramidal side effects. Currently, there are already several such drugs on the domestic market - rispolept (risperidone), ziprexa (olanzapine), seroquel (quetiapine) and Azaleptin (leponex), which was introduced into clinical practice earlier. The most widely used are Leponex and Rispolept, which are included in the List of Vital and Essential Medicines. Both of these drugs are highly effective in various psychotic conditions. However, while rispolept is more often prescribed by practitioners in the first place, Leponex is reasonably used only in the absence of the effect of the previous treatment, which is associated with a number of pharmacological features of this drug, the nature of side effects and specific complications, which, in particular, require regular monitoring general analysis blood.

What are the advantages of atypical antipsychotics in the treatment of the acute phase of psychosis?

1. Opportunity to achieve more therapeutic effect, including in cases of resistance of symptoms or intolerance to patients with typical antipsychotics.

2. Significantly greater than that of classical antipsychotics, the effectiveness of the treatment of negative disorders.

3. Security, i.e. insignificant severity of both extrapyramidal and other side effects characteristic of classical antipsychotics.

4. No need to take correctors in most cases with the possibility of monotherapy, i.e. single drug treatment.

5. Admissibility of use in debilitated, elderly and somatically aggravated patients due to low interaction with somatotropic drugs and low toxicity.

8. MAINTENANCE AND PREVENTIVE THERAPY

Among psychotic disorders of various origins, psychoses that develop as part of endogenous diseases make up the lion's share. The course of endogenous diseases differs in duration and tendency to recurrence. That is why international recommendations regarding the duration of outpatient (supportive, preventive) treatment clearly stipulate its terms. Thus, patients who have experienced the first episode of psychosis as preventive therapy it is necessary to take small doses of drugs for one to two years. In the event of a repeated exacerbation, this period increases to 3-5 years. If the disease shows signs of a transition to a continuous course, the period of maintenance therapy is extended indefinitely. That is why there is a reasonable opinion among practical psychiatrists that for the treatment of newly ill patients (during their first hospitalization, less often outpatient therapy), maximum efforts should be made, a long and complete course of treatment and social rehabilitation should be carried out as long as possible. All this will pay off handsomely if it is possible to save the patient from repeated exacerbations and hospitalizations, because after each psychosis, negative disorders grow, which are especially difficult to treat.

Prevention of relapse of psychosis

Reducing the recurrence of mental illness is facilitated by an orderly daily lifestyle that has the maximum therapeutic effect and includes regular physical exercise, reasonable rest, a stable daily routine, a balanced diet, avoidance of drugs and alcohol, and regular intake of drugs prescribed by a doctor as a maintenance therapy.

Signs of an impending relapse may include:

Any significant changes in behavior, daily routine or activity of the patient (unstable sleep, loss of appetite, irritability, anxiety, change of social circle, etc.).

Features of behavior that were observed on the eve of the last exacerbation of the disease.

The appearance of strange or unusual judgments, thoughts, perceptions.

Difficulties in performing ordinary, uncomplicated tasks.

· Unauthorized withdrawal of maintenance therapy, refusal to visit a psychiatrist.

If you notice warning signs, take the following steps:

· Inform the attending physician and ask him to decide whether it is necessary to adjust the therapy.

Eliminate all possible external stressful effects on the patient.

Minimize (within reasonable limits) all changes in the usual daily life.

• Provide the patient with as calm, safe, and predictable an environment as possible.

To avoid exacerbation, the patient should avoid:

Premature withdrawal of maintenance therapy.

Violations of the drug regimen in the form of an unauthorized reduction in dosage or irregular intake.

Emotional upheavals (conflicts in the family and at work).

· Physical overload, including both excessive exercise and overwork at home.

· Colds(ARI, flu, tonsillitis, exacerbations chronic bronchitis etc.).

Overheating (solar insolation, prolonged stay in the sauna or steam room).

· Intoxications (food, alcoholic, medicinal and other poisonings).

Changes in climatic conditions during the holidays.

Benefits of atypical antipsychotics in prophylactic treatment.

When conducting maintenance treatment, the advantages of atypical antipsychotics over classical antipsychotics are also revealed. First of all, this is the absence of “behavioral toxicity”, that is, lethargy, drowsiness, inability to do any business for a long time, blurred speech, unsteady gait. Secondly, a simple and convenient dosing regimen, because. almost all drugs of the new generation can be taken once a day, for example at night. Classical neuroleptics, as a rule, require a three-time intake, which is caused by the peculiarities of their pharmacodynamics. In addition, atypical neuroleptics can be taken with or without food, which allows the patient to follow their usual daily routine.

Of course, it should be noted that atypical antipsychotics are not a panacea, as some advertising publications try to present. Drugs that completely cure serious diseases such as schizophrenia or bipolar affective disorder have yet to be discovered. Perhaps the main disadvantage of atypical antipsychotics is their cost. All new drugs are imported from abroad, produced in the USA, Belgium, Great Britain and, of course, have a high price. Thus, the approximate cost of treatment when using the drug in average dosages for a month is: Zyprexa - $ 300, Seroquel - $ 250, Rispolept - $ 150. True, more and more pharmacoeconomic studies have recently appeared, convincingly proving that the total costs of patient families for the purchase of 3-5, and sometimes even more classic drugs, namely such complex schemes used for the treatment and prevention of psychotic disorders, approach the cost of one atypical antipsychotic (here, as a rule, monotherapy is performed, or simple combinations with 1-2 more drugs are used). In addition, such a drug as rispolept is already included in the list of medicines dispensed free of charge in dispensaries, which makes it possible, if not to fully meet the needs of patients, then at least partially alleviate their financial burden.

It cannot be argued that atypical antipsychotics do not have side effects at all, because even Hippocrates said that "an absolutely harmless medicine is absolutely useless." When they are taken, there may be an increase in body weight, a decrease in potency, disorders monthly cycle in women, increased levels of hormones and blood sugar. However, it should be noted that almost all of these adverse events depend on the dosage of the drug, occur when the dose is increased above the recommended one, and are not observed when using average therapeutic doses.

Extreme caution should be exercised when considering dosage reduction or withdrawal of an atypical antipsychotic. This question can be solved only by the attending physician. Untimely or abrupt withdrawal of the drug can lead to a sharp deterioration in the patient's condition, and, as a result, to urgent hospitalization in a psychiatric hospital.

Thus, from all of the above, it follows that psychotic disorders, although they are among the most serious and rapidly disabling diseases, do not always lead to severe outcomes with fatal inevitability. In most cases, subject to the correct and timely diagnosis of psychosis, the appointment of early and adequate treatment, the use of modern sparing methods of psychopharmacotherapy, combined with the methods of social rehabilitation and psychocorrection, it is possible not only to quickly stop acute symptoms, but also to achieve full recovery social adaptation of the patient.

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Acute psychosis is a severe mental disorder from which no person in the world is immune. Literally each of us can go crazy and lose our adequacy when exposed to certain negative factors, so it is important to know what psychosis is, how to recognize its manifestations and how this condition can be cured.

The term "acute psychosis" refers to the section "acute and transient psychotic disorders", ICD-10 ( international classification diseases of the 10th revision, developed by WHO for the classification and coding of medical diagnoses), designated by the code F23. "Acute" means that the development of a psychotic reaction manifests itself suddenly, vividly, intensely.

Inadequate behavior of a person is beyond doubt, in such a state he can harm both others and himself.

The opposite of acute psychosis is remission, when the chronic course of the disease is not manifested by pronounced symptoms.

If a person develops acute psychosis, he shows certain symptoms of mental confusion. Signs of psychopathy in a patient may appear partially or in combination:

• extremely unstable emotional background, indicating pathological condition a person (for example, the patient may aggressively lose his temper or fall into euphoria, etc.);
• clouding of consciousness - the patient does not adequately perceive the reality surrounding him;
• development of delusions and hallucinations;
• memory loss - from partial to complete;
• incoordination of movements of varying degrees, up to complete disorientation in space;
• loss of the ability to think coherently.

Remember that the consequences of destructive processes for consciousness do not go away on their own. Acute psychosis always requires urgent medical attention.

The main types of disease

Unhealthy mental reactions of a person can lead to both internal and external factors. Depending on this, they are divided into two groups - exogenous and endogenous (from the Greek "exo" - "outside, outside" and "endo" - "inside").

The reason for the development of psychogeny of an exogenous nature can be:

• intoxication of the body with large doses of alcohol or drugs;
• craniocerebral or mental trauma;
• infections.

Endogenous factors include:

• somatic and mental illnesses;
• hereditary pathologies of the psyche;
• age-related changes in the functioning of the body.

Exogenous types of psychogeny

Acute exogenous origin includes several main types: hysterical psychogeny, affective-shock reaction and psychogenic psychopathy.

Hysterical psychosis is the response of the human psyche to the infringement of his dignity, discrimination, humiliation by circumstances or other people. The duration of the tantrum usually directly depends on the time of exposure to the stress factor.

Among the most common forms of hysterical psychogeny are the following:

1. Ganser's syndrome, in which a person seems disoriented, he perceives reality selectively, not entirely, his consciousness is impaired.
2. Pseudo-dementia, when "false" dementia appears, while the patient demonstrates a very significant decrease in intelligence.
3. Feral Syndrome, when a person suddenly begins to behave like an animal. He moves on all fours, trying to eat from the floor. Unavailable for conscious contact, barks, meows or growls aggressively when addressed, as if you are talking to a cat or dog.
4. Delusional fantasies, in the presence of which the patient may fall into extreme self-abasement, get hung up on the hyper-significance of any ideas.
5. Puerilism is distinguished by the temporary "falling into childhood" of a sick person, when he begins to demonstrate the behavior and thinking of a small child.

Affective-shock psychotic reactions usually occur in threatening or extremely stressful moments of life. Pain, despair, horror can rapidly deform the human psyche. There are two types of painful reactions that are opposite in external manifestations: stupor or extreme excitability.

• hypokinetic reaction (from "hypokinesia" - restriction of movement) plunges a person into a stupor, he stops moving, talking, falls into a stupor;
• hyperkinetic behavior under stress, on the contrary, is manifested by the strongest motor excitation of an unhealthy nature: human movements and speech are usually incoherent and aimless, abrupt, even chaotic. However, he may demonstrate complete or fragmentary memory loss.

Psychogenic psychopathy (or psychogenic depression) occurs as a response of the mind to a painful loss, for example, the death of a relative, significant financial losses, the sudden loss of the entire way of the former way of life. A sick person develops depression and delusions.

Psychogenic psychopathic depression begins to develop from the next stressful situation days and, if left untreated, can be delayed for a long period.

Endogenous types of psychogeny

With the endogenous development of the disease, the cause that triggers the rapid development of the most acute emotional outburst matures inside the person. Often this is a somatic disease or an advanced mental disorder that has not been properly treated. Common types of endogenous obscurations of reason:

1. (disorders of consciousness in the elderly). Its symptoms are dementia, amnesia, the cause of which lies in the age-related decline of brain functions. The surge may be preceded by increasing isolation, inertia, depressive moods, incomprehensible aggression towards the family, which develop in an elderly person.
2. . It is clearly manifested in a sharp change in the excited manic stage of the oppressed depressive one. The cause of the development of this pathology is often heredity, as well as stress and serious illnesses.
3. . It is one of the acute reactions of a person to a number of somatic diseases (for example, hypertension, epilepsy, myocardial infarction, malignant tumors). The patient feels emotional exhaustion and apathy, he appears panic attacks, signs of clouding of consciousness. Peak psychotic reaction turns around manic phase, hallucinations, mental disorder.
4. . Clinical picture an attack includes a state of affect in a patient, inappropriate behavior and thinking, sometimes visual and auditory hallucinations, delirium.

Manifestations of psychosis in children

You need to know that acute psychosis can develop not only in an adult, but also in a child. The little man is also subject to stress. Situations that provoke child psychogeny can be medications used to treat any diseases, meningitis and other brain infections, and hormonal failure. Symptoms of psychosis in children usually include visual and auditory hallucinations, delusions, and inappropriate emotional reactions.

Psychosis in children is not always easy to diagnose, sometimes they disguise themselves as temperamental and behavioral features. However, an experienced specialist can quite accurately determine the mental disorder in a child and prescribe the correct therapy.

Features of the diagnosis of psychosis in children on the example of bipolar affective disorder manifested by alternating manic and depressive episodes

What is the danger of acute psychosis

Be very careful if you notice symptoms of psychogeny in a loved one (husband, wife, child, other family member), especially in a sharp form. In such conditions, the patient can be dangerous both for himself and for others. There are cases when a person with a mental disorder, without receiving help in time, hanged himself or shot himself when a spouse or child suffered from his actions.

In order to get out of a dangerous situation without damage, you need to know in advance what to do in case of trouble. If the family has already had cases of mental disorders, and there is a possibility that they can be inherited, it is recommended to study the topic of mental illness in more detail in advance, using the large number of available scientific medical articles, as well as video and audio materials. Knowledge and timely medical care will help minimize possible negative consequences.

Treatment of acute psychosis

Any form of mental confusion requires immediate treatment, and for treatment, the patient is usually hospitalized in a psychiatric hospital. The treatment of psychosis at home is absolutely excluded, since the patient (at least for the first time) needs to be removed from the traumatic situation and professional round-the-clock medical supervision.

The attending physician prescribes the main treatment, which is carried out with psychocorrective drugs. The drug course removes the sharp phase and prevents further disorder of consciousness. Often, for the complete correction of the patient's condition with acute psychosis, he is prescribed sessions of psychotherapy up to the complete elimination of mental dysfunctions.

If first aid is provided on time, and the entire course of prescribed therapy is completed, mental disorders may have a favorable prognosis for recovery. Some of these diseases are completely curable. High-quality recovery of the psyche and the absence of relapses allow a person who has undergone psychosis to remove the diagnosis over time and live, feeling the joy and fullness of his existence.

Psychosis is a mental illness due to which a person is unable to adequately respond to the surrounding reality. Psychosis manifests itself in many ways and accompanies many illnesses, from delirium tremens and schizophrenia to senile dementia. And also this disease can be an independent pathology. This disease is quite common. Statistical studies confirm that about 15% of mental hospital patients have this diagnosis.

This is the degree of manifestation of a mental illness, in which distorted perception of the real world in the mind of a person, and his activity does not correspond to the surrounding reality, which is manifested by a violation of behavior, as well as the appearance of symptoms that are unusual for the norms.

In this case, a person cannot be objective, because he is afraid for his life, he hears voices in his head calling for some action. Such a patient may have visions that are available only to him. From here, the reaction becomes inadequate: tears for no reason, violent laughter, panic, anxiety or euphoria. It seems to some that they have superpowers, the second believe that someone is pursuing them, others themselves are pursuing the object of sympathy, unreasonably believing that they have the right to do so. Such a person definitely needs treatment. With psychosis, the symptoms and treatment are individual.

Symptoms, signs and causes

Patients with psychosis have different symptoms and signs. It is impossible to list everything. But allocate group of main features that occur in patients:

With psychomotor agitation, the patient is constantly on the move and can talk non-stop. Often imitates the voices of animals, grimaces, mimics human speech.

Psychosis is a complex condition, it is very difficult to identify the cause that provoked this disease.

The reasons can be external and internal. External causes are stress (loss of a loved one, property), mental trauma, infectious diseases(tuberculosis, syphilis). It also includes drug poisoning and alcohol abuse.

Internal causes are disorders of the nervous system and endocrine balance. In this case, endogenous psychosis occurs. Often this is associated with age-related changes organism. Endogenous psychosis is long-term, there is a possibility of relapse.

One of the causes of psychosis may be a genetic predisposition. People with poor heredity in most cases develop psychosis.

There is the concept of acute psychosis. In acute psychosis, the symptoms appear brightly and suddenly, and the course of the disease progresses rapidly. Before acute psychosis go into severe form, the following symptoms are possible: loss of appetite, irritability, fear, indifference, apathy, sleep disturbance.

Signs of acute psychosis are completely different. These are psychotic disorders with symptoms of schizophrenia, schizophreniform disorders, paranoid acute psychosis.

Risk category

Psychosis is possible in both adults and children. Moreover, in children, the disease is more difficult and requires long-term treatment.

At different periods of life they appear different types illness. For example, in adolescence, a hormonal explosion occurs, it is likely psychosis with manifestations of schizophrenia.

Manic-depressive manifestation of the disease most often occurs in young people during the period of vigorous activity. At this age, there are many fateful decisions that put pressure on the psyche (university, work, creating a family).

In old age, there are changes in nervous system. Improper circulation destroys nerve tissue, and this, in turn, leads to senile psychosis.

Certain forms of the disease affect mainly women. For example, manic-depressive psychosis is four times more common in women than in men. This usually occurs during menstruation, during menopause, after childbirth. This is due to hormonal fluctuations in the body of a woman.

As well as the causes of psychosis in women can become a social factor: an unsuccessful marriage or its complete absence, unfulfillment of oneself as a mother, failures in a career field. And many other social reasons.

In addition, women are susceptible postpartum psychosis. This usually manifests itself in the first month after childbirth. The reason for this may be pain shock and postpartum complications. Symptoms and signs of subsequent psychosis may include delusions, loss of appetite, insomnia, anxiety, hallucinations. A woman in this condition is prescribed psychotherapy and inpatient treatment. In some cases, drug therapy may be prescribed, but under the mandatory supervision of a doctor. It is categorically impossible to leave a woman in this state alone with a baby.

A disease such as psychosis and its symptoms need to be treated in hospital. After all, patients in most cases cannot control themselves, thereby harming themselves and others.

After an accurate diagnosis is established, therapeutic treatment is prescribed. Taking into account the severity of the disease, the patient is prescribed medication, including psychotropic drugs, antidepressants, tranquilizers, as well as drugs for general strengthening of the body.

After medical treatment, the patient prescribe psychotherapy. This greatly increases the effectiveness of the treatment of psychosis. Thanks to psychological methods of treatment, the patient begins to perceive reality correctly, his self-esteem increases, and the possibility of an exacerbation of the disease decreases.

Sessions of psychological treatment can be individual and group. Generally, group therapy is more effective. In addition, the group is led by a person who has successfully overcome this disease. This fact instills confidence in patients and sets them up for recovery.

Positive results in treatment help to achieve such psychological methods:

• art therapy
• psychoanalysis
• occupational therapy
• family therapy.

Prevention

There is a possibility that people who survived this disease may experience aggravation. Therefore, it is important for some time after hospitalization to take the necessary drugs prescribed by the doctor. And also attend classes in psychotherapy.

In addition, it is necessary to lead a measured pace of life, observe the daily routine, refuse bad habits eat a balanced diet and exercise moderately.