behavior in psychosis. What is psychosis, its symptoms and how to treat it

If the cause of psychosis lies within a person, then endogenous psychosis develops. In most cases, the root of such psychosis may be disorders of the nervous system and endocrine balance. Endogenous psychoses are associated with age-related changes in the body (cyanotic or senile psychosis), they can be the result of hypertension, atherosclerosis of cerebral vessels, and schizophrenia. The course of endogenous psychosis differs in duration and tendency to relapse. Psychosis is a complex condition and sometimes it is impossible to determine what exactly caused it, internal or external causes. The first push may be an external influence, later joined by an internal problem.

Senile psychoses are distinguished into a special group. They usually occur after the age of 60 and are manifested by various endomorphic disorders and states of clouding of consciousness. With senile psychosis, total dementia does not develop.

According to the characteristics of the course and occurrence, reactive and acute psychoses are distinguished. Reactive psychosis refers to temporary reversible mental disorders that occur under the influence of any mental trauma. Acute psychosis occurs suddenly and develops very quickly, for example, with unexpected news of the loss of a loved one, loss of property, and so on.

II. Prevalence of psychosis

Experts have concluded that the impact of psychosis on women is greater than on men, regardless of ethnicity, race, or economic status.

III. Clinical manifestations psychosis (symptoms of psychosis)

A person who suffers from psychosis undergoes a series of significant changes in behavior, thinking, and emotions. The basis of these metamorphoses is the loss of normal perception of the real world. A person ceases to be aware of what is happening and cannot assess the severity of changes in his psyche. Because of the depressed state of their consciousness, patients, as a rule, stubbornly resist hospitalization. Also, psychoses in most cases are accompanied by hallucinations and delusional statements.

IV. Diagnosis of psychosis

The diagnosis of psychosis is based on features clinical picture and characteristic dynamics of mental disorder. Many symptoms of psychosis may appear in a mild form long before the illness itself and thus serve as very important precursors. The very first signs of psychosis are extremely difficult to recognize.

Among early symptoms characteristic of psychosis are:
Changes in character: irritability, restlessness, nervousness, anger, hypersensitivity, sleep disturbances, lack of appetite, sudden lack of interest, lack of initiative, strange and unusual appearance.
Changes in working capacity: a sharp decline in activity, reduced stress resistance, impaired attention, a sudden decline in activity.
Change of sensations: various fears, depression, mood swings.
Change in public life: isolation, withdrawal into oneself, distrust, problems in communicating with people, termination of contacts.
Change of interests: sudden manifestation of interest in very unusual things (deepening into religion, interest in magic, and so on).
Experiences and changes in perception: color or sound may be perceived by the patient intensified or distorted), there may be a feeling that everything around has changed, as well as a feeling of being watched.

v. Treatment 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 diseases (developing as a result of 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 the prevalence among the population of exogenous psychoses (Greek. 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, reflecting wealth 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 followed, they want to be killed, intrigues are woven around them, conspiracies are organized), delusions of influence (from 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, disappearance of desires and urges, decreased energy, 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 acute attacks of the disease that occur from time to time, 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, inpatient 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 heredity 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 it is difficult for a person to accept it in the initial stages of the disease. 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 one or another mental disorder, information about the initial manifestations of psychosis or about the symptoms of an advanced stage of the disease may be useful. 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 connected with the problem of the so-called "Soviet punitive psychiatry" artificially inflated by the media during the perestroika years. 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, a simple lack of understanding of the morbid nature of their condition makes sick people and their relatives categorically refuse any contact with psychiatrists and taking psychotropic therapy - the only real opportunity to 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 the appeal to alternative medicine, which does not have the entire arsenal modern science, may lead to irreparable consequences, in particular, to an unjustified delay in the delivery of 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 enters the examination in the advanced stage of mental illness, when time has already been lost and there is chronic course with the formation of difficult-to-treat negative disorders.

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);

· Referral to a psychiatric hospital;

· Urgent care at home;

· Advisory and dispensary observation 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 a judge's order, if his examination or treatment is possible only in stationary 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 the deterioration of his 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. Worldwide, the most effective and reliable treatment for psychosis is considered drug therapy. 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, to 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 of medical recommendations regarding doses and medication regimen. 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 a fact of using psychoactive substances (drugs) or alcohol, taking medicines used in general medicine, driving a car or operating 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 wisely, can improve efficiency. drug therapy, but are not able to completely replace the 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 implementation in 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 had a first episode of psychosis as a preventive therapy need 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

The recurrence of mental illness is reduced by a disciplined daily lifestyle that has the maximum therapeutic effect and includes regular exercise, reasonable rest, a stable daily routine, a balanced diet, avoidance of drugs and alcohol, and regular use of drugs prescribed by a doctor as 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 of 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 more classic drugs, namely, complex schemes are 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 another 1-2 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, provided the correct and timely diagnosis 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 sick.

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Many types of psychoses change the patient's perception of reality, which can be frightening for loved ones. After all, a hallucinating person becomes unpredictable, and can harm himself or others. Consider what are psychoses and their types, what are the symptoms of the disease and methods of their treatment.

What is psychosis

Psychosis is defined as a mental disorder (), confusion and protest of the unconscious part of the personality against society. According to Jung, all symptoms of psychosis should be considered in terms of symbolism. Various manifestations of psychosis can be encrypted messages of the patient, and thus, he indicates the problem that torments him. Perhaps if you decipher these "messages", you can find the source of the disorder.

The consciousness of a patient with psychosis is almost entirely filled with unconscious content, and the person lives more by instincts. Depending on the severity and variety of the disease, psychoses are protracted and deep, or appear from time to time, as a temporary clouding of the mind.

What are psychoses

Psychoses and their types are divided into categories, depending on their etiology. Some of the psychoses are temporary in nature, and are quite easy to treat, leaving no significant consequences. These psychoses are referred to as situational psychosis. It occurs suddenly, has an acute form, but with timely help quickly passes.

Somatogenic psychosis - occurs as a side disease of a somatic illness.
Reactive psychosis - characterized by a sudden onset, and, as a rule, this is the body's reaction to stress.

Alcoholic psychosis

Alcoholic psychosis is ICD code 10, and it is more correct to call it metal-alcoholic psychosis, since this disease is divided into many subspecies. Alcoholic psychosis is characterized by the fact that it does not occur directly due to the effects of alcohol on the brain, but already against the background of a withdrawal syndrome.

Most often among alcoholic psychoses there is delirium, delusional psychosis, hallucinosis, acquired encephalopathy and pathological intoxication.

Acute alcoholic psychosis is not intoxication, but a consequence of prolonged intoxication of the body with alcoholic beverages, and often it occurs a few days after the last use of alcohol.

Signs of alcoholic psychosis in men can be confused with intoxication, a cold, or attributed to the nature of the patient. The patient has a fever, insomnia and irritability. Tremor of limbs and excessive sweating. Further, depending on the characteristics of the patient, the following types of psychosis may develop:

The most common alcoholic psychosis is Delirium (delirious tremens). The patient loses the sense of time and space, and this loss is accompanied by delusions and hallucinations. Often the patient becomes aggressive because of the visions he sees. Basically, in delirium tremens, hallucinations take the form of the most terrible nightmares and horrors. The patient sees devils, demons, and even the faces of people close to him are distorted, taking frightening forms. The patient is completely disoriented, and without medical assistance, these changes can become irreversible.

Hallucinosis

With this psychosis, the patient retains common sense and intellect, and the resulting auditory and visual hallucinations confuse him. He realizes that these are just hallucinations, and this drives him into depression. Over time, against the background of hallucinations, persecution mania and obsessive delusions may develop. The patient most often lies down and often talks to himself.

Pseudoparalysis

There is pain in the joints and muscles. It is difficult for the patient to breathe, speak, swallow, and there is a feeling of apathy towards everything. Over time, the patient turns into a "vegetable" and simply lies motionless on the bed.

Alcoholic encephalopathy

As a result of acute alcohol intoxication, brain functions are impaired. Acute manifestations with this type of disorder there is no, but there is a headache, absent-mindedness, impaired memory and sleep. The patient is lethargic, depressed and gradually becomes indifferent to everything. Encephalopathy usually appears after Delirium.

Alcoholic paranoid

In the acute form, the patient may become suspicious and aggressive. He can attack others or run away. In the evening, all the fears of the patient are aggravated, and this condition can last for several days. In a chronic or protracted form, usually men have a persistent suspicion of loved ones. Often the wives of the sick suffer from this, as they become victims of unfounded suspicions of infidelity. The patient follows his wife, makes scandals, and at the same time, he can be jealous, both of a real person and a fictional character.

Alcoholic psychosis: clinic and treatment

All alcoholic psychoses are the result of prolonged exposure to alcohol breakdown products on the brain, hereditary diseases, and, oddly enough, the patient's social status.

A person with low social responsibility has no motivation to heal. After the removal of the acute state of psychosis and the relief of unpleasant symptoms, as a rule, the alcoholic is again taken for the old.

Is there a favorable outcome of alcoholic psychosis

In most cases, alcoholic psychosis occurs after 3-5 years of continuous drinking, and this undermines not only the psyche. All organs suffer, without exception. Due to the huge amount of toxins, the liver and kidneys suffer. As a rule, during the period of binge, the patient does not eat, and over time this is reflected in the gastrointestinal tract. The vessels become thinner, and the heart muscle weakens. The patient dies not from psychosis, but from quite ordinary somatic diseases. Gastric ulcer, stroke, cirrhosis, tuberculosis, etc.

If the patient understands his condition, and his body is still strong enough, even after suffering alcoholic psychosis, the patient can live for a very long time. Of course, alcohol should be abandoned and regularly undergo a medical examination, including a psychiatrist.

Is it possible to treat alcoholic psychosis at home

In a state of acute psychosis, the patient becomes too dangerous for himself and for others. To remove toxins from the body, immobilization of the patient is required, that is, the patient must be immobilized. Sometimes it is very difficult to do this, because of the visions that haunt him, and the patient saves his life from demons, resisting with all his might.

At the first stage, infusion therapy is used to remove alcohol toxins, in combination with psychotropic substances. These substances relieve the symptoms of psychosis, and the patient calms down.

The second stage consists in a vitamin complex to restore the dehydrated and exhausted patient's body.

In the case of treatment of alcoholic psychosis, drug therapy is not enough. Without psychotherapy, the patient will soon return to the previous way of life, and another exacerbation can be fatal.

At home, it is impossible to carry out either drug therapy or provide proper psychological support. Even if the patient miraculously endures several exacerbations and survives, his brain degrades, down to the state two year old. But this is not for long either. Toxins will quickly do their job, and a person "burns out" in a matter of months, or even weeks.

affective psychoses

Affective psychosis is a group of disorders with ICD code 10. The main symptom of an affective disorder is a violation of the emotional mood of a person. Psychoses can be divided into groups:

Bipolar affective psychosis;

Manic affective psychosis;

Affective-shock reactive psychoses;

schizoaffective psychosis.

Each of these types is characterized by its own manifestations, symptoms, but the causes of the disorder in most cases are the same.

Affective psychoses are characterized by manifestations of two-phase. The mood ranges from severe depression to irrepressible joy and activity.

Most susceptible to the disease are creative individuals, with their fine mental organization. They explain periods of melancholy and despondency by the “lack of a muse”, but soon an attack of inspiration is observed, and the patient simply “flies”, working for days on end, without feeling hungry or tired. After such activity, a period of apathy sets in again and.

Women during menopause, pregnancy, adolescents during puberty are also at risk. An imbalance of hormones in the body destabilizes the psyche and sensitive people experience this especially acutely.

Affective disorders occur against the background prolonged stress. Under its influence, some waste products are not oxidized, and driven by the bloodstream enter the brain. These foods have an effect on the brain similar to hallucinogens, which leads to psychosis.

Affective psychosis: treatment, prognosis of the disease

Diagnosis of the disease, in addition to the conclusion of a psychiatrist, includes computed tomography of the brain and advanced biochemical analysis blood. The level of hormones and the level of electrical activity of the brain are examined using electroencephalography.

Since affective psychosis has a two-phase course, drugs are selected depending on the phase in which the patient is currently located. In the depressive phase, normotimics and antidepressants are used, in the active phase, sedatives are indicated.

During treatment affective psychosis psychotherapy shows itself well, aimed at learning to use one's mental energy more rationally. These are art therapy, occupational therapy, and relaxation therapy.

An affective disorder is not a sentence, and it is quite successfully treated. The patient is only required to observe the daily regimen, a more gentle mode of work and awareness of the importance of receiving positive emotions.

Reactive psychoses

Reactive psychoses, have the ICD-10 code, and refer to psychogenic disorders, that is, it is an acquired disorder due to mental trauma. The severity of psychosis is directly dependent on how closely the patient perceived the situation. Fire, war, catastrophe, rape, death of a loved one, all this can cause reactive psychosis.

Forms of reactive psychoses are divided into several groups:

Hysterical reactive psychosis;

Protracted psychosis;

Reactive delusional psychosis.

Acute reactive psychosis - expressed in psychomotor agitation. The patient may randomly run, scream, or freeze in place. In the case of stupor, the patient does not speak, does not eat, does not move, and absolutely does not make contact. He is completely detached from the outside world and in this state he can stay for several hours or days.

Often, within the framework of hysterical protracted psychoses, deviations in behavior are observed, in the form of foolishness, falling into childhood, or "savagery".

Reactive depression occurs after a psychotrauma, and has a protracted character. The patient's consciousness narrows, and he experiences the traumatic situation again and again, and cannot break this circle. During an attack of despair, the patient may attempt suicide, and without appropriate treatment, the patient may die.

Reactive psychosis: treatment

Diagnosis of reactive psychosis is aimed at establishing the presence of a connection between a traumatic event and psychosis. If this connection is traced, drug treatment is prescribed, depending on the form of the disorder.

The tactics of providing medical care for reactive psychoses is aimed at removing the victim from the state of shock. Hospitalization for a shock reaction is optional, as a rule, in such cases, psychotherapy shows itself better (when state of shock will pass), and the study of a traumatic event.

The hospital shows the treatment of delusional and protracted psychosis. Initially, drug therapy is carried out with antipsychotics or antidepressants, depending on the form of the disease, and only then a psychotherapist joins the treatment.

nursing care in neuroses and reactive psychoses it is very important. As a rule, patients are more favorable to junior medical staff, and can tell the nurse what they cannot tell the attending physician. Nursing care for a patient with reactive depression is to monitor him, take medication and prevent suicide attempts.

Senile psychosis

Senile psychosis has the ICD-10 code and combines manic-depressive psychosis and other disorders of the schizophrenic type. Senile psychosis is not dementia, and not, although the symptoms are sometimes very similar. Psychosis does not lead to dementia and is purely a mental disorder. The patient can retain mental abilities and skills during the period of remission. Senile psychosis occurs in people after 60 years of age, and women are more susceptible to this.

Acute senile psychosis is characterized by a gradual change in the behavior of the patient. There is weakness, insomnia, absent-mindedness and appetite is disturbed. Over time, unmotivated fears, suspicion, stinginess and hallucinations are added to these symptoms.

There is an accentuation of character, and all character traits of the patient become aggravated. A cheerful person becomes euphoric, a thrifty person becomes stingy, and a stern person becomes cruel and aggressive.

Senile paraphrenia is distinguished by elements of delusions of grandeur. The patient "remembers" the events of his life, weaving into it the heroic deeds he committed, meetings with celebrities, and enthusiastically tells these stories to anyone who wants to listen to him.

Chronic senile depression also develops predominantly in women. Attacks are replaced by self-flagellation, anxiety, often accompanied by Kotara's delirium. The patient is prone to exaggeration, depersonalization and nihilism. The patient may claim that he killed all the people in the world, and he himself died long ago. The visions of such patients are incredibly vivid, clear and grotesque.

Senile psychosis: treatment

Senile psychoses are diagnosed mainly from the words of relatives, and their treatment is hampered by the abundance of somatic diseases of an elderly person. Often the patient refuses hospitalization, and coercion can lead to an exacerbation of the disease. Most often, after the diagnosis is made, the responsibility for treating the patient falls on close relatives who old man trusts.

There is no cure for senile psychosis as such. medical therapy aimed at alleviating symptoms and caring for the elderly. To improve well-being, and to distract the patient from thinking about his problems, walks in the fresh air, feasible physical exercises, art therapy, and the acquisition of a hobby are recommended.

Traumatic psychosis

Acute traumatic psychosis occurs when the head hits a hard surface. For the occurrence of traumatic psychosis, the force of impact is not important, since this species disorders appear due to cerebral edema. And this can happen with a severe traumatic brain injury, and from a slight concussion.

The initial period of traumatic psychosis is a loss of consciousness or coma. After leaving the unconscious state, there is a certain stupor, slow reactions and drowsiness. The severity of these symptoms indicates the depth of the injury.

In an acute form, retrograde amnesia may appear. Excessive talkativeness, with flat jokes, is interspersed with tearfulness and endless health complaints.

In 30% of the injured, late and distant reactions to trauma occur. Appears unmotivated aggression, conflict, decreased intelligence and acquisition bad habits previously uncharacteristic of the patient.

When drinking alcohol, the patient is completely disinhibited all base instincts, which often ends in prison.

Treatment of traumatic psychoses

Traumatic psychosis is a consequence of traumatic brain injury, treatment is carried out in the Department of Neurosurgery.

The success of treatment directly depends on the degree of brain damage, and in most cases only vitamin complexes are used to maintain health, and sedatives to reduce the patient's aggression.

Endogenous psychoses

The endogenous group of psychoses includes disorders that have an internal, somatic origin. This also includes hereditary diseases and senile pathologies. The main cause of endogenous psychosis is an imbalance in the central nervous and endocrine system. Such psychosis can manifest itself both in a child and in an adult, outwardly healthy person.

The most difficult diagnosis is to establish children and adolescents. After all, the main symptoms of psychosis are irritability, out of place laughter, fantasies, etc. All this is inherent in many children to one degree or another. In the case of childhood and adolescent endogenous psychosis, the main symptom is the presence of delusions and hallucinations.

Acute endogenous psychosis can be caused by the intake of alcohol, drug-containing drugs or uncontrolled use medical preparations without doctor's advice. In the acute form, psychosis manifests itself as a manic, agitated state, alternating with depression and apathy.

Acute organic psychosis can occur due to a head injury or brain tumor. In this case, the underlying disease should first be cured, and then the patient should be observed for the appearance of late traumatic psychosis.

Endogenous psychoses: treatment, prognosis

Endogenous psychoses are the most complex and whether endogenous psychoses are treated, no one will give a guarantee. Success depends on the provoking factor and the timeliness of the patient's request for help.

Often the patient is not aware of his condition due to confusion, increased anxiety and hallucinations. During such exacerbations, hospitalization is necessary, and there can be no talk of home treatment. The patient may become socially dangerous. Even if the attack has passed, it will soon recur, but without treatment, the personality of the patient is destroyed more and more.

It is impossible to completely cure endogenous psychosis, but antipsychotics, tranquilizers and psychocorrection can increase the time of remission and relieve acute attacks of psychosis.

Begin preventive actions with endogenous psychoses, with the acceptance by the patient of his diagnosis. No one is embarrassed by stomach ulcers, but mental disorders cause fear, shame and denial. A person is not to blame for poor heredity and this must be reconciled. If there is a history of patients with schizophrenia, paranoid disorders - this is a reason not to hide your head in the sand, but to be regularly examined by a psychiatrist, and in a timely manner to identify the onset of the disease.

The disease can be defeated if you know about it, and help your body cope with the disease. It is not so difficult and accessible to everyone. You just need to keep a sleep schedule, exercise regularly exercise eat right and eliminate alcohol from your life. A positive attitude and optimism is a huge plus in the treatment of mental and somatic diseases.

Conclusion

In most cases, patient care falls on the shoulders of the patient's relatives. Sometimes it is difficult, but the recommendations given by the attending physician to patients and their relatives must be strictly followed. The patient is not always aware of his condition, and long-term treatment may lead relatives to believe that this treatment is ineffective. In such cases, relatives stop the treatment prescribed by the doctor and turn to alternative medicine. This is dangerous, and one must understand that mental disorders are not treated in one day. It's a daily battle and it takes some getting used to.

Can psychosis be cured?

Some types of psychosis are quite successfully treated, and not all mental disorders are a lifelong diagnosis.

Alcoholic, senile, hereditary psychoses require long-term treatment. Medical treatment psychosis can achieve some remission, however, external factors, such as stress, conflicts in the family, at work, can again affect the psycho-emotional state, causing a relapse of the disease.

Patients should not completely write themselves off and refuse treatment. Even during bouts of psychosis, the personality is not destroyed, but only a part of it suffers. Having stopped the symptoms, the person becomes himself again and can continue to live a normal life, like millions of healthy people. Even with schizophrenia, you can live a full life, go to work and start a family.

Not to be afraid of your illness, but to resist it - this is the main key to the success of the treatment of psychosis.

The difference between neurosis and psychosis

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