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Mental development disorders in somatic diseases. Mental changes in somatic diseases

Any illness is always accompanied by unpleasant emotions, because somatic (physical) illnesses are difficult to separate from worries about the severity of the health condition and concerns about possible complications. But it happens that diseases cause serious changes in the functioning of the nervous system, disrupting the interaction between neurons and the very structure of nerve cells. In this case, a mental disorder develops against the background of a somatic illness.

The nature of mental changes largely depends on the physical illness on the basis of which they arose. For example:

oncology provokes depression;
a sharp exacerbation of an infectious disease - psychosis with delusions and hallucinations;
severe prolonged fever - seizures;
severe infectious lesions of the brain - states of loss of consciousness: stupor, stupor and coma.

Moreover, most diseases also have common mental manifestations. Thus, the development of many diseases is accompanied by asthenia: weakness, weakness and low mood. An improvement in the condition corresponds to an increase in mood - euphoria.

The mechanism of development of mental disorders. A person's mental health is ensured by a healthy brain. For normal operation, its nerve cells must receive enough glucose and oxygen, not be affected by toxins and interact correctly with each other, transmitting nerve impulses from one neuron to another. Under such conditions, the processes of excitation and inhibition are balanced, which ensures the proper functioning of the brain.

Diseases interfere with the functioning of the entire body and affect the nervous system through various mechanisms. Some diseases impair blood circulation, depriving brain cells of a significant portion of nutrients and oxygen. In this case, neurons atrophy and may die. Such changes can occur in specific areas of the brain or throughout its tissue.

In other diseases, there is a failure in the system of transmission of nerve impulses between the brain and spinal cord. In this case, the normal functioning of the cerebral cortex and its deeper structures is impossible. And during infectious diseases, the brain suffers from poisoning by toxins released by viruses and bacteria.

Below we will look in detail at what physical diseases cause mental disorders and what their manifestations are.

Mental disorders in vascular diseases

Vascular diseases of the brain in most cases affect mental health. Atherosclerosis, hypertension and hypotension, cerebral thromboangiitis obliterans have a common complex of mental symptoms. Their development is associated with a chronic deficiency of glucose and oxygen, which nerve cells in all parts of the brain experience.

With vascular diseases, mental disorders develop slowly and imperceptibly. The first signs are headaches, flashing spots before the eyes, sleep disturbances. Then signs of organic brain damage appear. Absent-mindedness occurs, it becomes difficult for a person to quickly navigate a situation, he begins to forget dates, names, and the sequence of events.

Mental disorders associated with vascular diseases of the brain are characterized by a wave-like course. This means that the patient’s condition periodically improves. But this should not be a reason to refuse treatment, otherwise the processes of brain destruction will continue and new symptoms will appear.

If the brain suffers from insufficient blood circulation for a long time, it develops encephalopathy(diffuse or focal damage to brain tissue associated with neuronal death). It can have various manifestations. For example, visual disturbances, severe headaches, nystagmus (involuntary oscillatory eye movements), instability and poor coordination.

Over time, encephalopathy becomes more complicated dementia(acquired dementia). In the patient’s psyche, changes occur that resemble age-related ones: criticality of what is happening and of one’s condition decreases. General activity decreases, memory deteriorates. Judgments may be delusional. A person is unable to restrain his emotions, which is manifested by tearfulness, anger, a tendency to emotion, helplessness, and fussiness. His self-care skills are reduced and his thinking is impaired. If the subcortical centers suffer, then incontinence develops. Illogical judgments and delusional ideas may be accompanied by hallucinations that occur at night.

Mental disorders caused by cerebrovascular accidents require special attention and long-term treatment.

Mental disorders in infectious diseases

Despite the fact that infectious diseases are caused by different pathogens and have different symptoms, they affect the brain in approximately the same way. Infections disrupt the functioning of the cerebral hemispheres, making it difficult for nerve impulses to pass through the reticular formation and diencephalon. The cause of the damage is viral and bacterial toxins released by infectious agents. Metabolic disorders in the brain caused by toxins play a certain role in the development of mental disorders.

In most patients, mental changes are limited asthenia(apathy, weakness, powerlessness, reluctance to move). Although for some, on the contrary, motor agitation occurs. In severe cases of the disease, more severe disorders are possible.

Mental disorders in acute infectious diseases represented by infectious psychoses. They can appear at the peak of a rise in temperature, but more often against the background of the attenuation of the disease.

Infectious psychosis can take various forms:

Delirium. The patient is excited, overly sensitive to all stimuli (he is disturbed by light, loud sounds, strong odors). Irritation and anger are poured out on others for the most insignificant reasons. Sleep is disturbed. The patient finds it difficult to sleep and is haunted by nightmares. While awake, illusions arise. For example, the play of light and shadow creates pictures on wallpaper that can move or change. When the lighting changes, the illusions disappear.
Rave. Feverish delirium occurs at the peak of infection, when there is the greatest amount of toxins in the blood and high temperature. The patient perks up and looks alarmed. The nature of delusions can be very different, from unfinished business or adultery to delusions of grandeur.
Hallucinations Infections can be tactile, auditory or visual. Unlike illusions, they are perceived by the patient as real. Hallucinations can be frightening or "entertaining" in nature. If during the first one a person looks depressed, then when the second one appears he perks up and laughs.
Oneiroid. Hallucinations have the nature of a holistic picture, when a person may feel that he is in a different place, in a different situation. The patient appears distant and repeats the same movements or words spoken by other people. Periods of inhibition alternate with periods of motor excitation.

Mental disorders in chronic infectious diseases take on a protracted nature, but their symptoms are less pronounced. For example, prolonged psychoses pass without disturbance of consciousness. They are manifested by a feeling of melancholy, fear, anxiety, depression, which is based on delusional thoughts about condemnation from others, persecution. The condition worsens in the evening hours. Confusion is rare with chronic infections. Acute psychoses are usually associated with the use of anti-tuberculosis drugs, especially in combination with alcohol. And convulsive seizures can be a sign of tuberculoma in the brain.

During the recovery period, many patients experience euphoria. It manifests itself as a feeling of lightness, satisfaction, uplifting mood, and joy.

Infectious psychoses and other mental disorders due to infections do not require treatment and go away on their own with improvement.

Mental disorders in endocrine diseases

Disruption of the endocrine glands significantly affects mental health. Hormones can disrupt the balance of the nervous system, having an exciting or inhibitory effect. Hormonal changes impair blood circulation in the brain, which over time causes cell death in the cortex and other structures.

At the initial stage many endocrine diseases cause similar mental changes. Patients experience desire disorders and affective disorders. These changes may resemble symptoms of schizophrenia or manic depression. For example, there is a perversion of taste, a tendency to eat inedible substances, refusal to eat, increased or decreased sexual desire, a tendency to sexual perversion, etc. Among mood disorders, depression or alternating periods of depression and increased mood and performance are more common.

Significant deviation in hormone levels from the norm causes the appearance of characteristic mental disorders.

Hypothyroidism. A decrease in the level of thyroid hormones is accompanied by lethargy, depression, deterioration of memory, intelligence and other mental functions. Stereotypic behavior may appear (repetition of the same action - washing hands, “flicking a switch”).
Hyperthyroidism and high levels of thyroid hormones have the opposite symptoms: fussiness, mood swings with a rapid transition from laughter to crying, there is a feeling that life has become fast and hectic.
Addison's disease. When the level of adrenal hormones decreases, lethargy and resentment increase, and libido decreases. In case of acute insufficiency of the adrenal cortex, a person may experience erotic delirium, confusion, and neurosis-like states are characteristic during the waxing period. They suffer from loss of strength and decreased mood, which can develop into depression. For some, hormonal changes provoke hysterical states with excessively violent expression of emotions, loss of voice, muscle twitching (tics), partial paralysis, and fainting.

Diabetes mellitus more often than other endocrine diseases causes mental disorders, since hormonal disorders are aggravated by vascular pathology and insufficient blood circulation to the brain. An early sign is asthenia (weakness and significant decrease in performance). People deny the disease, experience anger directed at themselves and others, they have breakdowns in taking glucose-lowering medications, diet, insulin administration, and may develop bulimia and anorexia.

70% of patients suffering from severe diabetes mellitus for more than 15 years experience anxiety and depressive disorders, adaptation disorders, personality and behavioral disorders, and neuroses.

Adjustment disorders make patients very sensitive to any stress and conflict. This factor can cause failures in family life and at work.
Personality disorders a painful strengthening of personality traits that interferes with both the person himself and his environment. In patients with diabetes mellitus, grumpiness, resentment, stubbornness, etc. may increase. These traits prevent them from adequately responding to situations and finding solutions to problems.
Neurosis-like disorders manifested by fear, fears for one’s life and stereotypical movements.

Mental disorders in cardiovascular diseases

Heart failure, coronary disease, compensated heart defects and other chronic diseases of the cardiovascular system are accompanied by asthenia: chronic fatigue, impotence, mood instability and increased fatigue, weakening of attention and memory.

Almost everything chronic heart disease accompanied by hypochondria. Increased attention to one’s health, interpretation of new sensations as symptoms of a disease, and fears about the deterioration of the condition are characteristic of many “heart patients”.

For acute heart failure, myocardial infarction and 2-3 days after heart surgery, psychosis may occur. Their development is associated with stress, which provoked disruption of the functioning of cortical neurons and subcortical structures. Nerve cells suffer from oxygen deficiency and metabolic disorders.

Manifestations of psychosis may vary depending on the nature and condition of the patient. Some experience severe anxiety and mental activity, while others experience lethargy and apathy as the main symptoms. With psychosis, patients find it difficult to concentrate on a conversation; their orientation in time and place is disturbed. Delusions and hallucinations may occur. At night, the patients' condition worsens.

Mental disorders in systemic and autoimmune diseases

With autoimmune diseases, 60% of patients suffer from various mental disorders, most of which are anxiety and depressive disorders. Their development is associated with the impact of circulating immune complexes on the nervous system, with chronic stress that a person experiences in connection with his illness and the use of glucocorticoid drugs.

Systemic lupus erythematosus and rheumatism accompanied by asthenia (weakness, impotence, weakening of attention and memory). It is common for patients to show increased attention to their health and interpret new sensations in the body as a sign of deterioration. There is also a high risk of adjustment disorder, when people react atypically to stress, most of the time they experience fear, hopelessness, and are overcome by depressive thoughts.

During exacerbation of systemic lupus erythematosus, against the background of high temperature, psychosis with complex manifestations may develop. Orientation in space is impaired as the person experiences hallucinations. This is accompanied by delirium, agitation, lethargy, or stupor (stupor).

Mental disorders due to intoxication

Intoxication– damage to the body by toxins. Substances that are toxic to the brain disrupt blood circulation and cause degenerative changes in its tissue. Nerve cells die throughout the brain or in individual foci - encephalopathy develops. This condition is accompanied by mental dysfunction.

Toxic encephalopathy cause harmful substances that have a toxic effect on the brain. These include: mercury vapor, manganese, lead, toxic substances used in everyday life and in agriculture, alcohol and drugs, as well as some medications in case of overdose (anti-tuberculosis drugs, steroid hormones, psychostimulants). In children under 3 years of age, toxic brain damage can be caused by toxins released by viruses and bacteria during influenza, measles, adenovirus infection, etc.

Mental disorders in acute poisoning, when a large amount of a toxic substance enters the body, they have serious consequences for the psyche. Toxic brain damage is accompanied by confusion. The person loses clarity of consciousness and feels detached. He experiences bouts of fear or rage. Poisoning of the nervous system is often accompanied by euphoria, delirium, hallucinations, mental and motor agitation. There have been cases of memory loss. Depression during intoxication is dangerous due to thoughts of suicide. The patient's condition may be complicated by convulsions, significant depression of consciousness - stupor, and in severe cases - coma.

Mental disorders due to chronic intoxication, when the body is exposed to small doses of toxins for a long time, they develop unnoticed and have no pronounced manifestations. Asthenia comes first. People feel weakness, irritability, decreased attention and mental productivity.

Mental disorders in kidney diseases

When kidney function is disrupted, toxic substances accumulate in the blood, metabolic disorders occur, the functioning of brain vessels deteriorates, edema and organic disorders develop in the brain tissue.

Chronic renal failure. The condition of patients is complicated by constant muscle pain and itching. This increases anxiety and depression and causes mood disorders. Most often, patients exhibit asthenic phenomena: weakness, decreased mood and performance, apathy, sleep disturbances. As kidney function deteriorates, motor activity decreases, some patients develop stupor, and others may experience psychosis with hallucinations.

For acute renal failure Asthenia may be accompanied by disorders of consciousness: stupor, stupor, and with cerebral edema, coma, when consciousness completely turns off and basic reflexes disappear. During mild stages of stunning, periods of clear consciousness alternate with periods when the patient’s consciousness becomes clouded. He does not make contact, his speech becomes sluggish, and his movements are very slow. When intoxicated, patients experience hallucinations with a variety of fantastic or “cosmic” images.

Mental disorders in inflammatory diseases of the brain

Neuroinfections (encephalitis, meningitis, meningoencephalitis)- This is damage to brain tissue or its membranes by viruses and bacteria. During the disease, nerve cells are damaged by pathogens, suffer from toxins and inflammation, attack by the immune system and nutritional deficiencies. These changes cause mental disorders in the acute period or some time after recovery.

Encephalitis(tick-borne, epidemic, rabies) – inflammatory diseases of the brain. They occur with symptoms of acute psychosis, convulsions, delusions, and hallucinations. Affective disorders (mood disorders) also appear: the patient suffers from negative emotions, his thinking is slow, and his movements are inhibited.

Sometimes depressive periods can be replaced by periods of mania, when the mood becomes elevated, motor excitement appears, and mental activity increases. Against this background, outbursts of anger occasionally arise, which quickly fade away.

Majority encephalitis in the acute stage have general symptoms. Against the background of high fever and headaches occur syndromes confusion.

Stun when the patient reacts poorly to his surroundings, becomes indifferent and inhibited. As the condition worsens, stupor progresses to stupor and coma. In a comatose state, a person does not react to stimuli in any way.
Delirium. Difficulties arise in orienting to the situation, place and time, but the patient remembers who he is. He experiences hallucinations and believes they are real.
Twilight stupefaction when the patient loses orientation in his surroundings and experiences hallucinations. His behavior is completely consistent with the plot of the hallucinations. During this period, the patient loses memory and cannot remember what happened to him.
Amentive clouding of consciousness– the patient loses orientation in the environment and his own “I”. He doesn’t understand who he is, where he is and what’s happening.

Encephalitis due to rabies differs from other forms of the disease. Rabies is characterized by a strong fear of death and hydrophobia, speech impairment and drooling. As the disease progresses, other symptoms appear: paralysis of the limbs, stupor. Death occurs from paralysis of the respiratory muscles and heart.

For chronic encephalitis symptoms reminiscent of epilepsy develop - seizures of one half of the body. Usually they are combined with twilight stupefaction.

Meningitis– inflammation of the membranes of the brain and spinal cord. The disease most often develops in children. Mental disorders at an early stage are manifested by weakness, lethargy, and slow thinking.

In the acute period, asthenia is accompanied by various forms of clouding of consciousness described above. In severe cases, stupor develops when inhibition processes predominate in the cerebral cortex. The person looks asleep; only a sharp loud sound can force him to open his eyes. When exposed to pain, he can withdraw his hand, but any reaction quickly fades away. With further deterioration of the patient's condition, the patient falls into a coma.

Mental disorders in traumatic brain injuries

The organic basis for mental disorders is the loss of electrical potential by neurons, injury to brain tissue, swelling, hemorrhage, and subsequent immune attack on damaged cells. These changes, regardless of the nature of the injury, lead to the death of a certain number of brain cells, which is manifested by neurological and mental disorders.

Mental disorders due to brain injuries can appear immediately after the injury or in the long term (after several months or years). They have many manifestations, since the nature of the disorder depends on which part of the brain is affected and how much time has passed since the injury.

Early consequences of traumatic brain injuries. At the initial stage (from a few minutes to 2 weeks), the injury, depending on the severity, manifests itself:

Stunned– slowing down of all mental processes, when a person becomes drowsy, inactive, indifferent;
Stupor– a precomatose state, when the victim loses the ability to act voluntarily and does not react to the environment, but reacts to pain and sharp sounds;
Coma– complete loss of consciousness, respiratory and circulatory disorders and loss of reflexes.

After normalization of consciousness, amnesia - loss of memory - may appear. As a rule, events that occurred shortly before and immediately after the injury are erased from memory. Patients also complain of slowness and difficulty in thinking, high fatigue from mental stress, and mood instability.

Acute psychoses may occur immediately after injury or within 3 weeks after it. The risk is especially high in people who have suffered a concussion (brain contusion) and open head injury. During psychosis, various signs of impaired consciousness may appear: delusions (usually persecution or grandeur), hallucinations, periods of unreasonably elevated mood or lethargy, attacks of complacency and tenderness, followed by depression or outbursts of anger. The duration of post-traumatic psychosis depends on its form and can last from 1 day to 3 weeks.

Long-term consequences of traumatic brain injury may become: decreased memory, attention, perception and learning ability, difficulties in thought processes, inability to control emotions. The formation of pathological personality traits such as hysteroidal, asthenic, hypochondriacal or epileptoid character accentuation is also likely.

Mental disorders in cancer and benign tumors

Malignant tumors, regardless of their location, are accompanied by pre-depressive states and severe depression caused by patients’ fears for their health and the fate of loved ones, and suicidal thoughts. The mental state noticeably worsens during chemotherapy, in preparation for surgery and in the postoperative period, as well as intoxication and pain in the later stages of the disease.

If the tumor is localized in the brain, then patients may experience disturbances in speech, memory, perception, difficulty coordinating movements and seizures, delusions and hallucinations.

Psychoses in cancer patients develop at stage IV of the disease. The degree of their manifestation depends on the strength of intoxication and the physical condition of the patient.

Treatment of mental disorders caused by somatic diseases

When treating mental disorders caused by somatic diseases, attention is first paid to the physical illness. It is important to eliminate the cause of the negative impact on the brain: remove toxins, normalize body temperature and vascular function, improve blood circulation in the brain and restore the acid-base balance of the body.

Consulting a psychologist or psychotherapist will help ease your mental state during treatment of a somatic illness. For severe mental disorders (psychosis, depression), the psychiatrist prescribes appropriate medications:

Nootropic drugs– Encephabol, Aminalon, Piracetam. They are indicated for most patients with brain disorders due to somatic diseases. Nootropics improve the condition of neurons, making them less sensitive to negative influences. These drugs promote the transmission of nerve impulses through the synapses of neurons, which ensures the coherence of the brain.
Neuroleptics used to treat psychosis. Haloperidol, Chlorprothixene, Droperidol, Tizercin - reduce the transmission of nerve impulses by blocking the work of dopamine at the synapses of nerve cells. This has a calming effect and eliminates delusions and hallucinations.
Tranquilizers Buspirone, Mebicar, Tofisopam reduce the level of anxiety, nervous tension and restlessness. They are also effective for asthenia, as they eliminate apathy and increase activity.
Antidepressants are prescribed to combat depression in cancer and endocrine diseases, as well as injuries that lead to serious cosmetic defects. When treating, preference is given to drugs with the fewest side effects: Pyrazidol, Fluoxetine, Befol, Heptral.

In the vast majority of cases, after treatment of the underlying disease, a person’s mental health is restored. Rarely, if the disease has caused damage to brain tissue, signs of mental illness may persist after recovery.

Patients with somatic diseases may experience a wide range of mental disorders, both neurotic and psychotic or subpsychotic levels.
K. Schneider proposed to consider the presence of the following signs as conditions for the appearance of somatically caused mental disorders: 1) the presence of a pronounced clinical picture of a somatic disease; 2) the presence of a noticeable connection over time between somatic and mental disorders; 3) a certain parallelism in the course of mental and somatic disorders; 4) possible, but not obligatory, appearance of organic symptoms
The likelihood of the occurrence of somatogenic disorders depends on the nature of the underlying disease, the degree of its severity, the stage of the course, the level of effectiveness of therapeutic interventions, as well as on such properties as heredity, constitution, premorbid personality, age, sometimes gender, reactivity of the body, the presence of previous hazards.

Thus, the etiopathogenesis of mental disorders in somatic diseases is determined by the interaction of three groups of factors:
1. Somatogenic factors
2. Psychogenic factors
3. Individual characteristics of the patient
In addition, additional psychotraumatic factors not related to the disease may be involved in the development of somatogenic disorders.

1. Somatogenic mental disorders
Somatogenic mental disorders develop as a result of the direct influence of the disease on the activity of the central nervous system and manifest themselves mainly in the form of neurosis-like symptoms, however, in some cases, against the background of severe organic pathology, the development of psychotic states, as well as significant impairment of higher mental functions up to dementia, is possible.
ICD-10 specifies the following general criteria for somatogenic (including organic) disorders:
1. Objective data (results of physical and neurological examinations and laboratory tests) and/or anamnestic information about CNS lesions or disease that may cause cerebral dysfunction, including hormonal disorders (not associated with alcohol or other psychoactive substances) and the effects of non-psychoactive drugs.
2. Time dependence between the development (exacerbation) of the disease and the onset of a mental disorder.
3. Recovery or significant improvement in mental state after eliminating or weakening the action of presumably somatogenic (organic) factors.
4. Absence of other plausible explanations for the mental disorder (for example, a high family history of clinically similar or related disorders).
If the clinical picture of the disease meets criteria 1, 2 and 4, a temporary diagnosis is justified, and if all criteria are met, the diagnosis of a somatogenic (organic, symptomatic) mental disorder can be considered definite.
In ICD-10, somatogenic disorders are presented mainly in Section F00-F09 (Organic, including symptomatic mental disorders) -
Dementia
F00 Dementia due to Alzheimer's disease
F01 Vascular dementia
F02 Dementia in other diseases (Pick's disease, epilepsy, traumatic brain injury, etc.)
F03 Dementia, unspecified
F04 Organic amnestic syndrome (severe memory impairment - anterograde and retrograde amnesia - against the background of organic dysfunction)
F05 Delirium not caused by alcohol or other psychoactive substances (stupidity due to severe physical illness or brain dysfunction)
Other mental disorders caused by brain damage or dysfunction or physical illness:
F06.0. Organic hallucinosis
F06.1. Organic catatonic state
F06.2 Organic delusional (schizophrenia-like) disorder.
F06.3 Organic mood disorders: manic, depressive, bipolar disorders of the psychotic level, as well as hypomanic, depressive, bipolar disorders of the non-psychotic level
F06.4 Organic anxiety disorder
F06.5 Organic dissociative disorder
F06. Organic emotionally labile (asthenic) disorder
F06.7 Mild cognitive impairment due to cerebral dysfunction or physical illness

1.
1.1. Syndromes of confusion.
Most often, in somatic pathology, delirious stupefactions occur, characterized by disorientation in time and place, influxes of vivid true visual and auditory hallucinations, and psychomotor agitation.
In somatic pathology, delirium can be both wavy and episodic in nature, manifesting itself in the form of abortive delirium, often combined with stunning or oneiric (dreaming) states.
Severe somatic diseases are characterized by such variants of delirium as excruciating and occupational with frequent transition to coma
In the presence of organic brain damage of various origins, various variants of twilight disorders are also possible.

1.2. Syndromes of switching off consciousness.
When consciousness is switched off to varying degrees of depth, there is an increase in the threshold of excitability, a slowdown in mental processes in general, psychomotor retardation, impaired perception and contact with the outside world (up to complete loss in a coma).
Loss of consciousness occurs in terminal conditions, with severe intoxication, traumatic brain injuries, brain tumors, etc.
Degrees of switching off consciousness:
1. somnolence,
2. stun,
3. stupor,
4. coma.

1.3 Psychoorganic syndrome and dementia.
Psychoorganic syndrome is a syndrome of impaired intellectual activity and emotional-volitional sphere due to brain damage. It can develop against the background of vascular diseases, as a consequence of traumatic brain injuries, neuroinfections, chronic metabolic disorders, epilepsy, atrophic senile processes, etc.
Disorders of intellectual activity are manifested by a decrease in its overall productivity and impairment of certain cognitive functions - memory, attention, thinking. A decrease in tempo, inertia and viscosity of cognitive processes, impoverishment of speech, and a tendency to perseveration are clearly evident.
Violations of the emotional-volitional sphere are manifested by emotional instability, viscosity and incontinence of affect, dysphoria, difficulties in self-control of behavior, changes in the structure and hierarchy of motives, and impoverishment of the motivational-value sphere of the individual.
With the progression of the psychoorganic syndrome (for example, against the background of neurodegenerative diseases), dementia may develop.
A characteristic sign of dementia is a significant impairment of cognitive activity and learning ability, loss of acquired skills and knowledge. In some cases, disturbances of consciousness, disturbances of perception (hallucinations), phenomena of catatonia, and delirium are observed.
With dementia, there are also pronounced emotional and volitional disorders (depression, euphoric states, anxiety disorders) and distinct personality changes with a primary sharpening of individual traits and subsequent leveling of personal characteristics (up to general personal disintegration).

1.4. Asthenic syndrome in somatic diseases.
Asthenic phenomena are observed in most patients with somatic diseases, especially with decompensation, unfavorable course of the disease, the presence of complications, and polymorbidity.
Asthenic syndrome is manifested by the following symptoms:
1. increased physical/mental fatigue and exhaustion of mental processes, irritability, hyperesthesia (increased sensitivity to sensory, proprio- and interoceptive stimuli)
2. somato-vegetative symptoms;
3. sleep disorders.
There are three forms of asthenic syndrome:
1. hypersthenic form;
2. irritable weakness;
3. hyposthenic form.
Characteristic signs of the hypersthenic variant of asthenia are increased irritability, short temper, emotional lability, inability to complete an energetically started task due to instability of attention and rapid fatigue, impatience, tearfulness, predominance of anxious affect, etc.
The hyposthenic form of asthenia is more characterized by persistent fatigue, decreased mental and physical performance, general weakness, lethargy, sometimes drowsiness, loss of initiative, etc.
Irritable weakness is a mixed form, combining signs of both hyper- and hyposthenic variants of asthenia.
Somatogenic and cerebrogenic asthenic disorders are characterized by (Odinak M.M. et al., 2003):
1. Gradual development, often against a background of decreasing severity of the disease.
2. Clear, persistent, monotonous symptoms (as opposed to dynamic symptoms in psychogenic asthenia with the typical addition of other neurotic symptoms).
3. Decreased working capacity, especially physical, independent of the emotional state (as opposed to a decrease in predominantly mental working capacity in psychogenic asthenia with a clear dependence on emotional factors).
4. Dependence of the dynamics of asthenic symptoms on the course of the underlying disease.

1.5. Somatogenic emotional disorders.
The most typical emotional disorders due to somatogenic influences are depression.
Organic depression (depression in organic disorders of the central nervous system) is characterized by a combination of affective symptoms with symptoms of intellectual decline, the predominance of negative affectivity in the clinical picture (adynamia, aspontaneity, anhedonia, etc.), and the severity of asthenic syndrome. With vascular depression, multiple persistent somatic and hypochondriacal complaints may also be noted. With brain dysfunctions, dysphoric depression often develops with a predominance of a melancholy-angry mood, irritability, and expulsiveness.
Depression against the background of somatic pathology is characterized by a significant severity of the asthenic component. Typical symptoms are increased mental and physical exhaustion, hyperesthesia, irritable weakness, weakness, and tearfulness. The vital component of depression in somatic disorders often prevails over the actual affective one. Somatic symptoms in the structure of a depressive disorder can imitate the symptoms of the underlying disease and, accordingly, significantly complicate the diagnosis of a mental disorder.
It should be emphasized that the pathogenesis of depressive states in somatic disorders, as a rule, includes the interaction and mutual reinforcement of somatogenic and psychogenic factors. Depressive experiences often appear in the structure of maladaptive personal reactions to illness, developing in patients against the background of general increased mental exhaustion and insufficient personal resources to overcome the stress of illness.

2. Nosogenic mental disorders
Nosogenic disorders are based on a maladaptive personality reaction to the disease and its consequences.
In somatopsychology, the peculiarities of a person’s response to illness are considered within the framework of the problem of “internal picture of illness,” attitude to illness, “personal meaning of illness,” “experience of illness,” “somatonosognosia,” etc.
In the psychiatric approach, the most important are those maladaptive personal reactions to illness, which in their manifestations correspond to the criteria of psychopathology and qualify as nosogenic mental disorders.

2.2. Actually nosogenic mental disorders
In the presence of predisposing conditions (special personal premorbidity, history of mental disorders, hereditary burden of mental disorders, threat to life, social status, external attractiveness of the patient), a maladaptive personal reaction to the disease can take the form of a clinically pronounced mental disorder - nosogenic disorder.
Depending on the psychopathological level and clinical picture of nosogenic disorders, the following types are distinguished:
1. Reactions of a neurotic level: anxious-phobic, hysterical, somatized.
2. Reactions at the affective level: depressive, anxious-depressive, depressive-hypochondriacal reactions, “euphoric pseudodementia” syndrome.
3. Reactions of a psychopathic level (with the formation of overvalued ideas): “hypochondria of health” syndrome, litigious, sensitive reactions, syndrome of pathological denial of illness.
It is also fundamental to differentiate nosogenic disorders according to the criterion of the degree of awareness and personal involvement of the patient in the situation of the disease. Based on this criterion, the following are distinguished:
1. Anosognosia
2. Hypernosognosia
Anosognosia is a clinical and psychological phenomenon characterized by complete or partial (hyponosognosia) unawareness and distorted perception by the patient of his disease state, mental and physical symptoms of the disease.
Accordingly, hypernosognosia is characterized by the patient’s overestimation of the severity and danger of the disease, which determines his inadequate personal involvement in the problems of the disease and associated disorders of psychosocial adaptation.
One of the risk factors for the development of hypernosognosic reactions is the incorrect (unethical) behavior of the doctor (medical staff), leading to the patient’s incorrect interpretation of the symptoms and severity of the disease, as well as the formation of maladaptive attitudes towards the disease. In this case, in some cases, the development of (iatrogenic) neurotic symptoms with a pronounced anxiety and somato-vegetative component is possible.

Primary prevention of somatogenic disorders is closely related to the prevention and earliest possible detection and treatment of somatic diseases. Secondary prevention is associated with timely and most adequate treatment of interrelated underlying diseases and mental disorders.
Considering that psychogenic factors (reaction to the disease and everything associated with it, reaction to a possible unfavorable environment) are of no small importance both in the formation of somatogenic mental disorders and in the possible aggravation of the course of the underlying somatic illness, it is necessary to apply preventive measures this kind of influence. Here, the most active role belongs to medical deontology, one of the main aspects of which is to determine the specifics of deontological issues in relation to the characteristics of each specialty.

3. Particular aspects of mental disorders in somatic diseases (according to N.P. Vanchakova et al., 1996)

3.1 Mental disorders in cancer
With cancer, both somatogenic and psychogenic mental disorders can develop.
Somatogenic:
a) tumors with primary localization in the brain or metastases to the brain: the clinic is determined by the affected area, represented by neurological symptoms, insufficiency or destruction of individual mental functions, as well as asthenia, psychoorganic syndromes, cerebral symptoms, convulsive syndrome and, less often, hallucinosis;
b) disorders caused by intoxication of tissue decay and narcotic analgesics: asthenia, euphoria, stupefaction syndromes (amentive, delirious, delirious-oneiroid), psychoorganic syndrome.
Psychogenic:
They represent the result of the individual’s reaction to the disease and its consequences. One of the most significant components is the reaction to the diagnosis of cancer. In this regard, it is necessary to understand that the issue of communicating a diagnosis to a cancer patient remains ambiguous. In favor of reporting the diagnosis, as a rule, indicate:
1. the opportunity to create a more trusting atmosphere in the relationship between the patient, doctors, family and friends, and reduce the patient’s social isolation;
2. more active participation of the patient in the treatment process;
3. the possibility of the patient taking responsibility for his future life.
Failure to report a diagnosis is motivated primarily by the high likelihood of severe depressive reactions, including suicide attempts.
So go the other way, regardless of the source of information about the presence of cancer, a person goes through a crisis characterized by the following stages:
1. shock and denial of the disease;
2. anger and aggression (experience of unfair fate);
3. depression;
4. acceptance of the disease.
The idea of what stage of the crisis the patient is at is the basis of psychocorrectional work aimed at optimizing the treatment process and improving the quality of his life.

5. Clinical and clinical-psychological characteristics of dissociative disorders.

Dissociative (conversion) disorders of movement and sensation are mental disorders manifested by disturbances in motor and sensory functions that mimic organic pathology and cannot be explained by structural damage to the nervous system.

Dissociative disorders are a group of mental illnesses, the main symptom of which is a partial or complete loss of the normal relationship between memory of the past, awareness of one’s self and immediate sensations, on the one hand, and control of body movements, on the other.

Dissociation is essentially a psychological defense. Many people, describing their behavior in stressful situations, say: “as if it wasn’t happening to me,” “it seemed to me that it wasn’t me doing this,” etc. This is a completely normal psychological mechanism. But when “losing oneself” takes on such forms that a person loses control, memory and awareness of his surroundings, it becomes a disease.

Accordingly, the influence of a somatic illness on the patient’s mental state can lead to the development of predominantly somatogenic or predominantly psychogenic mental disorders. In the structure of the latter, nosogenies and iatrogenies are of greatest importance.
Determining the role of somatogenic and psychogenic factors in the pathogenesis of mental disorders in each individual patient with somatic pathology is a necessary condition for choosing an adequate treatment strategy and tactics. At the same time, correct qualification of a mental disorder and its pathogenetic mechanisms is possible only by taking into account the somatic and mental status of the patient, somatic and psychiatric history, characteristics of treatment and its possible side effects, data on hereditary burden and other predisposition factors.
Mental disorders in a patient with a somatic illness necessitate joint management by an internist and a psychiatrist (psychotherapist), which can be carried out within the framework of different models. The most widely used model is the consultation-interaction model, which involves the direct and indirect (through counseling and training of somatologists) participation of a psychiatrist in the therapeutic management of somatic patients with mental disorders: the psychiatrist acts as an expert consultant and, interacting with the patient and internists, participates in the development and adjustment of treatment tactics.
The priority for the consultant psychiatrist is the task of recognizing and differential diagnosis of mental disorders associated and not associated with the patient’s physical illness, as well as prescribing adequate treatment taking into account his mental and somatic status.
1. Somatogenic mental disorders
Somatogenic mental disorders develop as a result of the direct influence of the disease on the activity of the central nervous system and manifest themselves mainly in the form of neurosis-like symptoms, however, in some cases, against the background of severe organic pathology, the development of psychotic states, as well as significant impairment of higher mental functions up to dementia, is possible.
ICD-10 specifies the following general criteria for somatogenic (including organic) disorders:
1. Objective data (results of physical and neurological examinations and laboratory tests) and/or anamnestic information about CNS lesions or disease that may cause cerebral dysfunction, including hormonal disorders (not associated with alcohol or other psychoactive substances) and the effects of non-psychoactive drugs.
2. Time dependence between the development (exacerbation) of the disease and the onset of a mental disorder.
3. Recovery or significant improvement in mental state after eliminating or weakening the action of presumably somatogenic (organic) factors.
4. Absence of other plausible explanations for the mental disorder (for example, a high family history of clinically similar or related disorders).
If the clinical picture of the disease meets criteria 1, 2 and 4, a temporary diagnosis is justified, and if all criteria are met, the diagnosis of a somatogenic (organic, symptomatic) mental disorder can be considered definite.
In ICD-10, somatogenic disorders are presented mainly in Section F00-F09 (Organic, including symptomatic mental disorders) -
Dementia
F00 Dementia due to Alzheimer's disease
F01 Vascular dementia
F02 Dementia in other diseases (Pick's disease, epilepsy, traumatic brain injury, etc.)
F03 Dementia, unspecified
F04 Organic amnestic syndrome (severe memory impairment - anterograde and retrograde amnesia - against the background of organic dysfunction)
F05 Delirium not caused by alcohol or other psychoactive substances (stupidity due to severe physical illness or brain dysfunction)
Other mental disorders caused by brain damage or dysfunction or physical illness:
F06.0. Organic hallucinosis
F06.1. Organic catatonic state
F06.2 Organic delusional (schizophrenia-like) disorder.
F06.3 Organic mood disorders: manic, depressive, bipolar disorders of the psychotic level, as well as hypomanic, depressive, bipolar disorders of the non-psychotic level
F06.4 Organic anxiety disorder
F06.5 Organic dissociative disorder
F06. Organic emotionally labile (asthenic) disorder
F06.7 Mild cognitive impairment due to cerebral dysfunction or physical illness

1.1. Syndromes of confusion.
Most often, in somatic pathology, delirious stupefactions occur, characterized by disorientation in time and place, influxes of vivid true visual and auditory hallucinations, and psychomotor agitation.
In somatic pathology, delirium can be both wavy and episodic in nature, manifesting itself in the form of abortive delirium, often combined with stunning or oneiric (dreaming) states.
Severe somatic diseases are characterized by such variants of delirium as excruciating and occupational with frequent transition to coma
In the presence of organic brain damage of various origins, various variants of twilight disorders are also possible.

2. Nosogenic mental disorders
Nosogenic disorders are based on a maladaptive personality reaction to the disease and its consequences.
In somatopsychology, the peculiarities of a person’s response to illness are considered within the framework of the problem of “internal picture of illness,” attitude to illness, “personal meaning of illness,” “experience of illness,” “somatonosognosia,” etc.
In the psychiatric approach, the most important are those maladaptive personal reactions to illness, which in their manifestations correspond to the criteria of psychopathology and qualify as nosogenic mental disorders.

2.1. Attitude to illness
The concept of attitude towards illness is associated with a wide range of psychological phenomena considered when studying the problem of relationships in the personality-illness system.
Formed under the influence of objective and subjective factors, a value system and, first of all, the value of health, the attitude towards the disease reflects the personal meaning of a particular disease, which determines the external manifestations of the patient’s more or less successful adaptation to the disease.
The patient’s development of an attitude towards the disease, structural and functional changes in the entire system of his relationships in connection with the fact of the disease naturally influence not only the course of the disease and medical prognosis, but also the entire course of personality development. The patient’s attitude to the disease expresses the uniqueness of his personality, experience, and current life situation (including the characteristics of the disease itself).
The concept of attitude towards illness is substantively close to the concept of “internal picture of illness” (IPI), introduced by R.A. Luria (1944), who contrasted it with the “external picture of the disease”, accessible to the impartial examination of the doctor. R.A. Luria defined VKB as the entire set of sensations and experiences of the patient in connection with the disease and treatment.
Currently, VCD is understood as “a complex of secondary, psychological in nature, symptoms of the disease” (V.V. Nikolaeva), reflecting the subjective meaning of the disease for the patient. The structure of the VKB includes the following levels:
1. sensory – sensations and states in connection with the disease;
2. emotional – experiences and emotional states in connection with the disease and treatment, emotional reaction to the disease and its consequences;
3. intellectual – the patient’s ideas about the causes, essence, danger of the disease, its impact on various areas of life, treatment and its effectiveness, etc.
4. motivational – a change in the motivational structure (hierarchy, leading motives) in connection with the disease; the nature of changes in behavior and lifestyle due to illness.
It should be emphasized that the attitude towards illness and VCB cannot be reduced to ideas about the illness, an emotional reaction to the illness or a behavioral strategy in connection with the illness, although they include all these three components and are manifested in them.
Among the factors influencing the nature of attitude towards the disease are the following:
1. Clinical characteristics: the degree of threat of the disease to life, the nature of the symptoms, the characteristics of the course (chronic, acute, paroxysmal) and the current phase of the disease (exacerbation, remission), the degree and nature of functional limitations, the specifics of treatment and its side effects, etc.
2. Premorbid features of the patient’s personality: characterological features, features of the system of significant relationships and values, features of self-awareness (self-perception, self-esteem, self-attitude), etc.
3. Socio-psychological factors: age at the onset of the disease, social status of the patient and the nature of the impact of the disease on him, adequacy/inadequacy of social support, likelihood of stigmatization, ideas about the disease characteristic of the patient’s microsocial environment, ideas about the disease and the patient’s norms of behavior, characteristic of society as a whole, etc.
Conventionally, the following types of attitude towards the disease are distinguished (Lichko A.E., Ivanov N.Ya., 1980; Wasserman L.I. et al., 2002):
1) Harmonious type – characterized by a sober assessment of one’s condition and the desire to contribute to the success of treatment.
2) Ergopathic type - manifested by “withdrawal to work from illness”, the desire to compensate for the feeling of personal inferiority due to illness with achievements in professional, educational activities and a generally high level of activity. Characterized by a selective attitude to treatment, preference for social values over health.
3) Anosognosic type - manifested by partial or complete ignoring of the fact of illness and medical recommendations, the desire to maintain the same lifestyle and the same image of the self, despite the illness. Often this attitude towards the disease is protective and compensatory in nature and is a way of overcoming anxiety in connection with the disease.
4) Anxious type - characterized by a constant feeling of concern about the physical condition, medical prognosis, real and imaginary symptoms of the disease and complications, the degree of effectiveness of treatment, etc. Anxiety in connection with the disease forces the patient to try new methods of treatment, contact many specialists, but without finding reassurance and the opportunity to get rid of concerns and fears.
5) Obsessive-phobic type - manifested by obsessive thoughts about the unlikely adverse consequences of the disease and treatment, constant thoughts about the possible impact of the disease on everyday life, the risk of disability, death, etc.
6) Hypochondriacal type - manifests itself in a focus on subjective painful, unpleasant sensations, exaggeration of suffering due to illness, and the desire to communicate about one’s illness to others. A typical combination of desire to be treated and disbelief in the success of treatment.
7) Neurasthenic type - characterized by symptoms of irritable weakness, increased fatigue, intolerance to pain, outbursts of irritation and impatience due to illness, followed by remorse for one’s own incontinence.
8) Melancholic type - determined by low mood due to illness, despondency, depression, disbelief in the success of treatment and the possibility of improving the physical condition, feelings of guilt due to illness/infirmity, suicidal ideas.
9) Apathetic type - characterized by indifference to one’s fate, the outcome of the disease, the results of treatment, passivity in treatment, a narrowing of the circle of interests and social contacts.
10) Sensitive type - manifested by increased sensitivity to the opinions of others regarding the fact of the disease, fear of becoming a burden to loved ones, the desire to hide the fact of the disease, expecting an unfavorable reaction, offensive pity or suspicion of using the disease for personal gain.
11) Egocentric type - characterized by the use of a disease for the purpose of manipulating others and attracting their attention, demanding exclusive care of oneself and subordinating their interests to one’s own.
12) Paranoid type - associated with the belief that the disease is the result of malicious intent, suspicion of medications and procedures, the behavior of the doctor and loved ones. Side effects and the occurrence of complications are considered as a consequence of dishonesty or malicious intent of medical personnel.
13) Dysphoric type - manifested by an angry and melancholy mood in connection with illness, envy, hostility towards healthy people, irritability, outbursts of anger, the demand for the subordination of others to personal interests, including those related to illness and treatment.

3. Particular aspects of mental disorders in somatic diseases (according to N.P. Vanchakova et al., 1996)

3.1 Mental disorders in cancer
With cancer, both somatogenic and psychogenic mental disorders can develop.
Somatogenic:
a) tumors with primary localization in the brain or metastases to the brain: the clinic is determined by the affected area, represented by neurological symptoms, insufficiency or destruction of individual mental functions, as well as asthenia, psychoorganic syndromes, cerebral symptoms, convulsive syndrome and, less often, hallucinosis;
b) disorders caused by intoxication of tissue decay and narcotic analgesics: asthenia, euphoria, stupefaction syndromes (amentive, delirious, delirious-oneiroid), psychoorganic syndrome.
Psychogenic:
They represent the result of the individual’s reaction to the disease and its consequences. One of the most significant components is the reaction to the diagnosis of cancer. In this regard, it is necessary to understand that the issue of communicating a diagnosis to a cancer patient remains ambiguous. In favor of reporting the diagnosis, as a rule, indicate:
1. the opportunity to create a more trusting atmosphere in the relationship between the patient, doctors, family and friends, and reduce the patient’s social isolation;
2. more active participation of the patient in the treatment process;
3. the possibility of the patient taking responsibility for his future life.
Failure to report a diagnosis is motivated primarily by the high likelihood of severe depressive reactions, including suicide attempts.
So go the other way, regardless of the source of information about the presence of cancer, a person goes through a crisis characterized by the following stages:
1. shock and denial of the disease;
2. anger and aggression (experience of unfair fate);
3. depression;
4. acceptance of the disease.
The idea of what stage of the crisis the patient is at is the basis of psychocorrectional work aimed at optimizing the treatment process and improving the quality of his life.

3.2. Mental disorders of the pre- and postoperative periods
Preoperative period
The leading factor in the pathogenesis is the individual’s reaction to the disease and the need for surgical intervention. The clinic is mainly represented by anxiety and anxiety-depressive disorders of varying severity. Essential in prevention is adequate preoperative psychological preparation, which includes an explanation of the nature and necessity of the operation, the formation of an attitude towards the operation and, if necessary, reducing the level of anxiety using both psychotherapeutic and medicinal methods. The degree of psychological preparedness of the patient as a result of psychosomatic relationships largely determines both the course of the operation itself and the postoperative period.
Postoperative period
The occurrence of mental disorders in the postoperative period is determined by the influence of all three main groups of factors. The clinic is represented by the main syndromes of mental disorders characteristic of somatic diseases (see above).

Questions for self-study

1. List the groups of factors contributing to the development of mental disorders in somatic patients
2. Objectives of psychiatric counseling for a somatic patient
3. List the general criteria for somatogenic mental disorder (according to ICD 10)
4. Clinic of asthenic syndrome
5. List the emotional disorders that are most common in somatic diseases
6. Internal picture of the disease - definition, content of the concept (components)
7. Variants of the internal picture of the disease
8. Define iatrogenics
9. List the most common mental disorders that occur in cancer patients (relationship with the etiological factor)
10. List the most common mental disorders in the pre- and postoperative period.
Tasks:
1. A 78-year-old patient is being treated for discirculatory encephalopathy at the neurological department of a somatic hospital for the second day. During the day he went into the department mode, visited his relatives, talked with the doctor, and showed a moderate intellectual-mnestic decline of the vascular type. At night, his condition changed sharply: he became restless, anxious, fussy, could not stay in place, wandered around the wards, was convinced that he was “at home,” looked for some things, and reacted aggressively to the nurse’s attempts to convince him otherwise.
Describe the patient’s altered consciousness, treatment tactics, and features of the therapy regimen.

Somatic diseases caused by damage to internal organs or entire systems often cause various mental disorders (“somatogenic psychoses”).
We can talk about “somatogenic psychosis” under certain conditions: the presence of a somatic disease, a temporary connection between somatic and mental disorders, interdependence and mutual influence in their course.
Symptoms and course of mental disorders depend on the nature and stage of development of the underlying disease, the degree of its severity, the effectiveness of the treatment, as well as on the individual characteristics of the patient (heredity, constitution, character, gender, age, the presence of additional psychosocial hazards).

Three mechanisms for the development of mental disorders in somatic diseases can be roughly distinguished:
1. Mental disorders as a reaction to the very fact of the disease, hospitalization and the associated separation from the family and familiar environment. The main manifestation of such a reaction is varying degrees of depressed mood with one shade or another. With a long, chronic course of the disease, when there is no hope for improvement, an indifferent attitude towards oneself and the outcome of the disease may arise. Patients lie indifferently in bed, refusing food and treatment.
2. The second, much larger group consists of patients in whom mental disorders are, as it were, an integral part of the clinical picture of the disease. These are patients with psychosomatic pathology, along with pronounced symptoms of internal diseases (hypertension, peptic ulcer, diabetes mellitus), neurotic and pathocharacterological reactions are observed.
3. The third group includes patients with acute mental disorders (psychosis). Such conditions develop either in severe acute diseases with high fever (lobar pneumonia, typhoid fever, other infectious diseases) or severe intoxication (acute renal failure, etc.), or in chronic diseases in the terminal stage (cancer, tuberculosis, kidney disease, etc.) etc.).
Different diseases and even different stages of one somatic disease can be accompanied by different mental disorders. At the same time, there are a number of syndromes that are especially characteristic of somatogenic mental disorders. These include: asthenic, affective, neurosis-like, psychoorganic syndromes, psychopathic-like, delusional disorders and states of stupefaction.
Asthenia is a core or end-to-end syndrome in many diseases. It can be either the initial manifestation or the end of the disease.
Asthenic conditions are expressed in various ways, but the typical ones are always increased fatigue, sometimes in the morning, difficulty concentrating, and slower perception. Emotional lability, increased vulnerability and touchiness, and easy distractibility are also characteristic. Patients cannot tolerate even minor emotional stress, get tired quickly, and get upset over any trifle. Hyperesthesia is characteristic, expressed in intolerance to sharp stimuli in the form of loud sounds, bright light, smells, touches. Sometimes hyperesthesia is so pronounced that patients are irritated even by quiet voices, ordinary light, or the touch of linen to the body. Various sleep disturbances are common.
In addition to asthenia in its pure form, its combination with depression, anxiety, obsessive fears, and hypochondriacal manifestations is quite common. The depth of asthenic disorders is usually associated with the severity of the underlying disease.
Neurosis-like disorders are associated with worsening somatic illness. The peculiarity of neurosis-like disorders, in contrast to neurotic disorders (neuroses), is that they are rudimentary, monotonous, and are typically combined with autonomic disorders, most often of a paroxysmal nature. However, autonomic disorders can be persistent and long-lasting.
Affective disorders. For somatic diseases, a decrease in mood with various shades is more typical: anxiety, melancholy, apathy. The clinical picture of depression is variable and depends on the nature and stage of the disease. If in the early stages of the disease anxiety and fear, sometimes with suicidal thoughts, are more typical, then with a long, severe course of the disease, indifference with a tendency to ignore the disease may prevail.
With the progression of a somatic disease, a long course of the disease, the gradual formation of chronic encephalopathy, melancholy depression gradually acquires the character of dysphoric depression, with grumpiness, dissatisfaction with others, pickiness, demandingness, and capriciousness. Unlike the earlier stage, anxiety is not constant, but usually occurs during periods of exacerbation of the disease, especially with a real threat of developing dangerous consequences. In the long-term stages of a severe somatic illness with severe symptoms of encephalopathy, often against the background of dystrophic phenomena, asthenic syndrome includes depression with a predominance of adynamia and apathy, indifference to the environment.
During a period of significant deterioration in the somatic condition, attacks of anxious and melancholy excitement occur, at the height of which suicidal acts can be committed.
Increased mood in the form of complacency and euphoria is much less common. The appearance of euphoria, especially in severe somatic diseases, is not a sign of recovery, but a harbinger of an unfavorable outcome and usually occurs in connection with oxygen starvation of the brain.
Psychopathic-like disorders (personality disorders). Most often they are expressed in an increase in egoism, egocentrism, suspicion, gloominess, hostile, wary or even hostile attitude towards others, hysteriform reactions with a possible tendency to aggravate (exaggerate, make heavier) one’s condition, the desire to constantly be in the center of attention, elements of attitudinal behavior. It is possible to develop a psychopath-like state with an increase in anxiety, suspiciousness, and difficulties in making any decisions.
Delusional states. In patients with chronic somatic diseases, delusional states usually occur against the background of a depressive, asthenic-depressive, anxiety-depressive state. Most often this is delirium of attitude, condemnation, material damage, less often nihilistic, damage or poisoning. Delusional ideas are unstable, episodic, often have the character of delusional doubts with noticeable exhaustion of patients, and are accompanied by verbal illusions. If a somatic illness entails some kind of disfiguring change in appearance, then dysmorphomania syndrome may form (an overvalued idea of a physical disability, an idea of a relationship, a depressive state).
A state of darkened consciousness, these include stupor, delirium, amentia, oneiroid, twilight stupefaction, etc.
Stun- a symptom of switching off consciousness, accompanied by a weakening of the perception of external stimuli. Patients do not immediately respond to questions surrounding the situation. They are lethargic, indifferent to everything happening around them, inhibited. As the severity of the disease increases, stupor can progress to stupor and coma.
Delirium- a state of darkened consciousness with a false orientation in place, time, environment, but maintaining orientation in one’s own personality. Patients develop abundant illusions of perception (hallucinations), when they see objects and people that do not exist in reality, or hear voices. Being absolutely confident in their existence, they cannot distinguish real events from unreal ones, therefore their behavior is determined by a delusional interpretation of the environment. There is strong excitement, there may be fear, horror, aggressive behavior, depending on the hallucinations. Patients in this regard can pose a danger to themselves and others. Upon recovery from delirium, the memory of the experience is preserved, while the events that actually occurred may fall out of memory. A delirious state is typical for severe infections and poisoning.
Oneiric state (waking dream) characterized by an influx of vivid scene-like hallucinations, often with unusual, fantastic content. Patients contemplate these pictures, feel their presence in the unfolding events (as in a dream), but behave passively, like observers, in contrast to delirium, where patients actively act. Orientation in the environment and one’s own personality is impaired. Pathological visions are retained in memory, but not completely. Similar conditions can be observed with cardiovascular decompensation (with heart defects), infectious diseases, etc.
Amentive state(amentia is a deep degree of confusion of consciousness) is accompanied not only by a complete loss of orientation in the environment, but also in one’s own “I”. The environment is perceived fragmentarily, incoherently, and disconnectedly. Thinking is also impaired; the patient cannot comprehend what is happening. There are deceptions of perception in the form of hallucinations, which are accompanied by motor restlessness (usually in bed due to a severe general condition), incoherent speech. Excitement may be followed by periods of immobility and helplessness. The dynamics of mental disorders are closely related to the severity of the physical condition. Amentia is observed in chronic or rapidly progressing diseases (sepsis, cancer intoxication), and its presence, as a rule, indicates the severity of the patient’s condition.
Twilight stupefaction- a special type of clouding of consciousness, acutely beginning and suddenly ending. Accompanied by complete loss of memory for this period. The content of psychopathological products can only be judged by the results of the patient’s behavior. Due to profound disorientation, possible frightening hallucinations and delusions, such a patient poses a social danger. Fortunately, in somatic diseases this condition is quite rare and is not accompanied by complete detachment from the environment, unlike epilepsy.
After suffering somatogenic psychoses, it can form psychoorganic syndrome. However, the manifestations of this symptom complex smooth out over time. The clinical picture of psychoorganic syndrome is expressed by intellectual disorders of varying intensity, a decrease in critical attitude towards one’s condition, and emotional lability. With a pronounced degree of this condition, apathy, indifference to one’s own personality and the environment, and significant intellectual and mnestic disorders are observed.

Treatment of the underlying (somatic) disease is paramount. However, adequate combination therapy (psychotherapy, drug therapy) not only suppresses psychopathological symptoms, but also has a positive effect on the course and prognosis of somatic illness, which allows the patient to undergo rehabilitation and return to their previous life. Therefore, a multiprofessional approach to the treatment of such patients is extremely important.

Medvedeva T.S.. psychiatrist

Information about the income of the head of the institution

General department: Nizhnevartovsk, st. International, 39 "B"

Clinical diagnostic laboratory: Nizhnevartovsk, st. International, 39V

Outpatient department: Nizhnevartovsk, st. Sportivnaya, 19

Reception room of the chief physician: Nizhnevartovsk, st. International, 39V

Chapter 18 MENTAL DISORDERS IN SOMATIC DISEASES AND ENDOCRINOPATHIES

Mental disorders in somatic diseases and endocrinopathies (endocrine disorders) are diverse in their clinical manifestations - from mild asthenic conditions to severe psychoses and dementia.

Mental disorders in somatic diseases

Somatogenic psychoses develop at various stages of the course of somatic illness. In the pathogenesis of somatic psychosis, a number of factors are important, including the severity and characteristics of the course of a particular disease. Great importance is given to hypoxia, hypersensitization, vascular

239 Chapter 18. Disorders in somatic diseases

distal and vegetative changes against the background of “altered soil” (various pathogenic factors suffered in the past and especially traumatic brain injuries, intoxication, etc.).
Progress in the treatment of somatic diseases and somatogenic psychoses has led to a decrease in the occurrence of severe acute psychotic forms and an increase in protracted, sluggishly progressive forms. The noted changes in the clinical characteristics of diseases (pathomorphoses) also manifested themselves in the fact that the number of cases of mental disorders in somatic diseases decreased by 2.5 times, and in forensic psychiatric practice, cases of mental state examination in somatic diseases do not occur often. At the same time, there was a change in the quantitative ratio of the forms of these diseases. The proportion of certain somatogenic psychoses (for example, amnestic states) and mental disorders that do not reach the level of psychosis has decreased.
The stereotype of the development of psychopathological symptoms in somatogenic psychoses is characterized by beginning with asthenic disorders, and then replacing the symptoms with psychotic manifestations and endoform “transitional” syndromes. The outcome of psychosis is recovery or development of psychoorganic syndrome.
Somatic diseases in which mental disorders are most often observed include heart disease, liver disease, kidney disease, pneumonia, peptic ulcer disease, and less commonly - pernicious anemia, nutritional dystrophy, vitamin deficiencies, as well as postoperative and postpartum psychoses.
In chronic somatic diseases, signs of personality pathology are detected; in the acute and subacute period, mental changes are limited to manifestations of the personality’s reaction with its inherent characteristics.
One of the main psychopathological symptom complexes observed in various somatic diseases is asthenic syndrome. This syndrome is characterized by severe weakness, fatigue, irritability and the presence of severe autonomic disorders. In some cases, phobic, hypochondriacal, apathetic, hysterical and other disorders are associated with asthenic syndrome. Sometimes the fo-oic syndrome comes to the fore. The fear characteristic of a sick person

240 Section III. Certain forms of mental illness

becomes persistent, painful, and develops anxiety about one’s health and future, especially before surgery and complex instrumental examination. Patients often experience cardio- or cancer-phobic syndromes. A state of euphoria is observed after anesthesia, during hypoxia in patients with cardiopulmonary pathology. Euphoria is characterized by inappropriately elevated mood, fussiness, lack of productivity of mental activity and a decrease in the patient’s critical abilities.
The leading syndrome in somatogenic psychoses is stupefaction (usually delirious, amentive and less often twilight type). These psychoses develop suddenly, acutely, without precursors against the background of previous asthenic, non-vroz-like, affective disorders. Acute psychoses usually last 2-3 days and are replaced by an asthenic state. If the course of the somatic disease is unfavorable, they can take a protracted course with a clinical picture of depressive, hallucinatory-paranoid syndromes, and apathetic stupor.
Depressive, depressive-paranoid syndromes, sometimes in combination with hallucinatory (usually tactile hallucinations), are observed in severe lung diseases, cancerous lesions and other diseases of internal organs that have a chronic course and lead to exhaustion.
After suffering somatogenic psychoses, a psychoorganic syndrome can form. However, the manifestations of this symptom complex smooth out over time. The clinical picture of psychoorganic syndrome is expressed by intellectual disorders of varying intensity, a decrease in critical attitude towards one’s condition, and affective lability. With a pronounced degree of this condition, apathy, indifference to one’s own personality and the environment, and significant mnestic-intellectual disorders are observed.

Among patients with heart pathology, mental disorders most often occur in patients with myocardial infarction.
Mental disorders in general are one of the most common manifestations in patients with myocardial infarction, aggravating the course of the disease (I. P. Lapin, N. A. Akalova, 1997; A. L. Syrkin, 1998; S. Sjtisbury, 1996, etc. .), increasing rates of death and disability (U. Herlitz et al., 1988;

241 GlAva 18. Disorders in somatic diseases

J. Denollet et al., 1996, etc.), worsening the quality of life of patients (V. P. Pomerantsev et al., 1996; Y. Y. His et al., 1990).
Mental disorders develop in 33-85% of patients with myocardial infarction (L. G. Ursova, 1993; V. P. Zaitsev, 1975; A. B. Smulevich, 1999; Z. A. Doezfler et al., 1994; M. J .Razada, 1996). The heterogeneity of statistical data provided by various authors is explained by a wide range of mental disorders, from psychotic to neurosis-like and pathocharacterological disorders.
There are different opinions about the preferability of the causes contributing to the occurrence of mental disorders during myocardial infarction. The importance of individual conditions is reflected, in particular the characteristics of the clinical course and severity of myocardial infarction (M. A. Tsivilko et al., 1991; N. N. Kassem, T. R. Naskett, 1978, etc.), constitutional, biological and social -environmental factors (V.S. Volkov, N.A. Belyakova, 1990; F. Bonaduidi et al., S. Rose, E. Spatz, 1998), comorbid pathology (I. Shvets, 1996; R. M. Carme et al., 1997), personality traits of the patient, adverse mental and social influences (V.P. Zaitsev, 1975; A. Arrels, 1997).
Precursors of psychosis in myocardial infarction include usually severe affective disorders, anxiety, fear of death, motor agitation, autonomic and cerebrovascular disorders. Other precursors of psychosis include a state of euphoria, sleep disturbances, and hypnogogic hallucinations. Violation of the behavior and routine of these patients sharply worsens their somatic condition and can even lead to death. Most often, psychosis occurs during the first week after myocardial infarction.
In the acute stage, psychosis during myocardial infarction most often occurs with a picture of upset consciousness, often of a delirious type: patients experience fears, anxiety, disoriented in place and time, and experience hallucinations (visual and auditory). Patients have motor restlessness, they strive to get somewhere, and are not critical. The duration of this psychosis does not exceed several days.
Depressive states are also observed: patients are depressed, do not believe in the success of treatment and the possibility of recovery, there is intellectual and motor retardation, hypochondriasis, anxiety, fears, especially at night, early awakenings and anxiety.

242 Section III. Certain forms of mental illness

After the disappearance of psychotic disorders of the acute period, which is interconnected with the main process of myocardial infarction, neurotic reactions such as cardiophobia and persistent asthenic conditions may occur, which largely determine the disability of patients who have suffered a myocardial infarction.
When diagnosing somatogenic psychosis, it becomes necessary to distinguish it from schizophrenia and other endoform psychoses (manic-depressive and involutional). The main diagnostic criteria are: a clear connection between a somatic disease, a characteristic stereotype of the development of the disease with a change in syndromes from asthenic to states of impaired consciousness, a pronounced asthenic background and a favorable recovery from psychosis for the individual with improvement of somatogenic pathology.
Treatment and prevention of mental disorders in somatic diseases. Treatment of mental disorders in somatic diseases should be aimed at the underlying disease, be comprehensive and individual. Therapy involves both impact on the pathological focus, and detoxification, normalization of immunobiological processes. It is necessary to provide strict round-the-clock medical supervision of patients, especially those with acute psychosis. Treatment of patients with mental disorders is based on general syndromic principles - the use of psychotropic drugs based on the clinical picture. For asthenic and psychoorganic syndromes, massive restorative therapy is prescribed - vitamins and nootropics (piracetam, nootropil).
Prevention of somatogenic mental disorders consists of timely and active treatment of the underlying disease, detoxification measures and the use of tranquilizers in case of increasing anxiety and sleep disorders.

Medical educational literature

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Mental disorders in somatic diseases

The patterns described in the previous section apply not only to intoxication, but also to a wide variety of exogenous mental disorders (radiation injury, long-term compartment syndrome, hypoxia, conditions after severe surgery), as well as to many somatic diseases.

Symptoms are largely determined by the stage of the disease. Thus, chronic somatic diseases, states of incomplete remission and convalescence are characterized by severe asthenia, hypochondriacal symptoms and affective disorders (euphoria, dysphoria, depression). A sharp exacerbation of a somatic illness can lead to acute psychosis (delirium, amentia, hallucinosis, depressive-delusional state). As a result of the disease, a psychoorganic syndrome may be observed (Korsakov's syndrome, dementia, organic personality changes, convulsive seizures).

Mental disorders in somatic diseases correlate quite accurately with changes in the general somatic condition. Thus, delirious episodes are observed at the height of a febrile state, a deep disorder of the basic metabolic processes corresponds to states of switching off consciousness (stunning, stupor, coma), an improvement in the state corresponds to an increase in mood (euphoria of convalescents).

Mental disorders of an organic nature in somatic diseases are quite difficult to separate from psychogenic experiences about the severity of a somatic illness, fears about the possibility of recovery, and depression caused by the awareness of one’s helplessness. Thus, the very need to see an oncologist can be a cause of severe depression. Many diseases (skin, endocrine) are associated with the possibility of developing a cosmetic defect, which is also a strong psychological trauma. The treatment process may cause concern in patients due to the possibility of side effects and complications.

Let's consider the psychiatric aspect of the most common diseases.

Chronic heart disease (coronary heart disease, heart failure, rheumatism) are often manifested by asthenic symptoms (fatigue, irritability, lethargy), increased interest in one’s health (hypochondria), and decreased memory and attention. If complications occur (for example, myocardial infarction), acute psychosis may develop (usually amentia or delirium). Often, against the background of myocardial infarction, euphoria develops with an underestimation of the severity of the disease. Similar disorders are observed after heart surgery. Psychosis in this case usually occurs on the 2nd or 3rd day after surgery.

Malignant tumors may already in the initial period of the disease manifest themselves as increased fatigue and irritability, and subdepressive states often form. Psychoses usually develop in the terminal stage of the disease and correspond to the severity of concomitant intoxication.

Systemic collagenoses (systemic lupus erythematosus) have a wide variety of manifestations. In addition to asthenic and hypochondriacal symptoms, against the background of exacerbation, psychoses of a complex structure are often observed - affective, delusional, oneiric, catatonic; Delirium may develop against the background of fever.

For renal failure All mental disorders occur against a background of severe adynamia and passivity: adynamic depression, low-symptomatic delirious and amental states with mild arousal, catatonic stupor.

Nonspecific pneumonia often accompanied by hyperthermia, which leads to delirium. In the typical course of tuberculosis, psychosis is rarely observed - asthenic symptoms, euphoria, and underestimation of the severity of the disease are more common. The occurrence of convulsive seizures may indicate the occurrence of tubercles in the brain. The cause of tuberculosis psychoses (manic, hallucinatory-paranoid) may not be the infectious process itself, but anti-tuberculosis chemotherapy.

Therapy for somatogenic disorders should be primarily aimed at treating the underlying somatic disease, reducing body temperature, restoring blood circulation, as well as normalizing general metabolic processes (acid-base and electrolyte balance, preventing hypoxia) and detoxification. Among psychotropic drugs, nootropic drugs (aminalon, piracetam, encephabol) are of particular importance. If psychosis occurs, neuroleptics (haloperidol, droperidol, chlorprothixene, tizercin) must be used with caution. Safe remedies for anxiety and restlessness are tranquilizers. Among antidepressants, preference should be given to drugs with a small number of side effects (pyra- sidol, befol, fluoxetine, Coaxil, Heptral). With timely treatment of many acute somatogenic psychoses, complete restoration of mental health is noted. In the presence of clear signs of encephalopathy, the mental defect persists even after the improvement of the somatic condition.

A special position among the somatogenic causes of mental disorders is occupied by endocrine diseases . Severe manifestations of encephalopathy in these diseases are detected much later. At the first stages, affective symptoms and drive disorders predominate, which may resemble manifestations of endogenous mental illnesses (schizophrenia and MDP). The psychopathological phenomena themselves are not specific: similar manifestations can occur when various endocrine glands are affected, sometimes an increase and decrease in hormone production are manifested by the same symptoms. M. Bleuler (1954) described the psychoendocrine syndrome, which is considered as one of the variants of the psychoorganic syndrome. Its main manifestations are affective instability and drive disorders, manifested by a kind of psychopathic behavior. What is more characteristic is not the perversion of drives, but their disproportionate strengthening or weakening. Of the emotional disorders, depression is the most common. They often occur with hypofunction of the thyroid gland, adrenal glands, and parathyroid glands. Affective disorders are somewhat different from the pure depressions and manias typical of MDP. More often, mixed states are observed, accompanied by irritability, fatigue or irascibility and anger.

Describe some features of each endocrinopathy. Itsenko-Cushing's disease is characterized by adynamia, passivity, increased appetite, decreased libido without pronounced emotional dullness characteristic of schizophrenia.

The differential diagnosis with schizophrenia is complicated by the appearance of strange, pretentious sensations in the body - senestopathies (“the brain is dry,” “something is shimmering in the head,” “the insides are squirming”). These patients have an extremely difficult time experiencing their cosmetic defect. With hyperthyroidism, on the contrary, increased activity, fussiness, and emotional lability with a rapid transition from crying to laughter are observed. There is often a decrease in criticism with a false feeling that it is not the patient who has changed, but the situation (“life has become hectic”). Occasionally, acute psychosis occurs (depression, delirium, confusion). Psychosis may also occur after strumectomy surgery. With hypothyroidism, signs of mental exhaustion are quickly joined by manifestations of psychoorganic syndrome (decreased memory, intelligence, attention). Characterized by grumpiness, hypochondriasis, and stereotypical behavior. An early sign of Addison's disease is increasing lethargy, noticeable at first only in the evening and disappearing after rest. Patients are irritable, touchy; always trying to sleep; libido decreases sharply. Subsequently, the organic defect rapidly increases. A sharp deterioration in condition (Addisonian crisis) can be manifested by disturbances of consciousness and acute psychoses of a complex structure (depression with dysphoria, euphoria with delusions of persecution or erotic delusions, etc.). Acromegaly is usually accompanied by some slowness, drowsiness, and mild euphoria (at times followed by tears or outbursts of anger). If hyperproduction of prolactin is observed in parallel, increased caring and a desire to take care of others (especially children) may be observed. The organic defect in patients with diabetes mellitus is mainly due to concomitant vascular pathology and is similar to the manifestations of other vascular diseases.

In some endocrinopathies, psychopathological symptoms are completely devoid of specificity and it is almost impossible to make a diagnosis without a special hormonal study (for example, in case of dysfunction of the parathyroid glands). Hypogonadism, which arose in childhood, manifests itself only in increased daydreaming, vulnerability, sensitivity, shyness and suggestibility (mental infantilism). Castration in an adult rarely leads to severe mental pathology - much more often the experiences of patients are associated with the awareness of their defect.

Changes in hormonal status can cause some mental discomfort in women during menopause (more often in premenopause). Patients complain of hot flashes, sweating, increased blood pressure, and neurosis-like symptoms (hysterical, asthenic, subdepressive). In the premenstrual period, the so-called premenstrual syndrome often occurs, characterized by irritability, decreased performance, depression, sleep disturbances, migraine-like headaches and nausea, and sometimes tachycardia, blood pressure fluctuations, flatulence and edema.

Although the treatment of psychoendocrine syndrome often requires special hormone replacement therapy, the use of hormonal drugs alone does not always achieve complete restoration of mental well-being. Quite often it is necessary to simultaneously prescribe psychotropic drugs (tranquilizers, antidepressants, mild antipsychotics) to correct emotional disorders. In some cases, the use of hormonal drugs should be avoided. Thus, it is better to start the treatment of post-castration, menopausal and severe premenstrual syndrome with psychopharmacological drugs, since the unreasonable prescription of hormone replacement therapy can lead to the occurrence of psychoses (depression, mania, manic-delusional states). In many cases, general practitioners underestimate the importance of psychotherapy in the treatment of endocrinopathies. Almost all patients with endocrine pathology need psychotherapy, and with menopause and premenstrual syndrome, psychotherapy often gives a good effect without the use of drugs.

Let's consider the psychiatric aspect of the most common diseases.

Nonspecific pneumonia often accompanied by hyperthermia, which leads to delirium. In the typical course of tuberculosis, psychosis is rarely observed - asthenic symptoms, euphoria, and underestimation of the severity of the disease are more common. The occurrence of convulsive seizures may indicate the appearance of tubercles in the brain. The cause of tuberculosis psychoses (manic, hallucinatory-paranoid) may not be the infectious process itself, but anti-tuberculosis chemotherapy.

A special position among the somatogenic causes of mental disorders is occupied byendocrine diseases .Severe manifestations of encephalopathy in these diseases are detected much later. At the first stages, affective symptoms and drive disorders predominate, which may resemble manifestations of endogenous mental illnesses (schizophrenia and MDP). The psychopathological phenomena themselves are not specific: similar manifestations can occur when various endocrine glands are affected, sometimes an increase and decrease in hormone production are manifested by the same symptoms. M. Bleuler (1954) described the psychoendocrine syndrome, which is considered as one of the variants of the psychoorganic syndrome. Its main manifestations are affective instability and drive disorders, manifested by a kind of psychopathic behavior. What is more characteristic is not the perversion of drives, but their disproportionate strengthening or weakening. Of the emotional disorders, depression is the most common. They often occur with hypofunction of the thyroid gland, adrenal glands, and parathyroid glands. Affective disorders are somewhat different from the pure depressions and manias typical of MDP. More often, mixed states are observed, accompanied by irritability, fatigue or irascibility and anger.

Describe some features of each endocrinopathy. ForItsenko-Cushing's diseasecharacterized by adynamia, passivity, increased appetite, decreased libido without pronounced emotional dullness characteristic of schizophrenia.

The differential diagnosis with schizophrenia is complicated by the appearance of strange, pretentious sensations in the body - senestopathies (“the brain is dry,” “something is shimmering in the head,” “the insides are squirming”). These patients have an extremely difficult time experiencing their cosmetic defect. At hyperthyroidism, on the contrary, increased activity, fussiness, and emotional lability with a rapid transition from crying to laughter are observed. There is often a decrease in criticism with a false feeling that it is not the patient who has changed, but the situation (“life has become hectic”). Occasionally, acute psychosis occurs (depression, delirium, confusion). Psychosis may also occur after strumectomy surgery. At hypothyroidism signs of mental exhaustion are quickly joined by manifestations of psychoorganic syndrome (decreased memory, intelligence, attention). Characterized by grumpiness, hypochondriasis, and stereotypical behavior. An early signAddison's diseaseis an increasing lethargy, noticeable at first only in the evening and disappearing after rest. Patients are irritable, touchy; always trying to sleep; libido decreases sharply. Subsequently, the organic defect rapidly increases. A sharp deterioration in condition (Addisonian crisis) can be manifested by disturbances of consciousness and acute psychoses of a complex structure (depression with dysphoria, euphoria with delusions of persecution or erotic delusions, etc.). Acromegaly usually accompanied by some slowness, drowsiness, and mild euphoria (at times replaced by tears or outbursts of anger). If hyperproduction of prolactin is observed in parallel, increased caring and a desire to take care of others (especially children) may be observed. Organic defect in patients withdiabetes mellitusis mainly caused by concomitant vascular pathology and is similar to the manifestations of other vascular diseases.

In some endocrinopathies, psychopathological symptoms are completely devoid of specificity and it is almost impossible to make a diagnosis without a special hormonal study (for example, in case of dysfunction of the parathyroid glands). Hypogonadism, arising from childhood, manifests itself only in increased daydreaming, vulnerability, sensitivity, shyness and suggestibility (mental infantilism). Castration in an adult rarely leads to severe mental pathology - much more often the experiences of patients are associated with the awareness of their defect.

Changes in hormonal status can cause some mental discomfort in women inmenopause(usually in premenopause). Patients complain of hot flashes, sweating, increased blood pressure, and neurosis-like symptoms (hysterical, asthenic, subdepressive). INpremenstrual periodThe so-called premenstrual syndrome often occurs, characterized by irritability, decreased performance, depression, sleep disturbances, migraine-like headaches and nausea, and sometimes tachycardia, blood pressure fluctuations, flatulence and edema.