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Non-psychotic disorders due to organic damage to the central nervous system. Forensic psychiatric assessment of stress-related mental disorders

I remind you that this is not a textbook, but rather observations of my patients, and they may differ from the canonical and observations of other doctors.

These are mental disorders that arise as a result of brain damage. The latter can be direct - trauma, stroke or indirect - syphilis, diabetes, etc. It can be combined - a tumor against the background of a progressive HIV infection, head injury due to alcoholism, carbon monoxide poisoning in a hypertensive patient. And the depth of these disorders should not reach a psychotic level.

An extensive and diverse group of pathologies. Includes mood disorders, asthenic, anxiety, dissociative disorders, psychopathic states, mild cognitive decline not reaching the level of dementia, manifestations of psychoorganic syndrome.

Symptoms are often nonspecific, but sometimes bear the features of the underlying disease. Thus, anxiety-asthenic disorders often accompany lesions of the cerebral vessels, dysphoria - epilepsy, and a kind of psychopathic-like symptoms when the frontal lobes are affected.

The combination of hypertension and diabetes mellitus is very productive in terms of the development of non-psychotic symptoms. If we take all of our organics from the advisory group, then almost half will have this duet. Traditionally, we ask what you are taking - yes, kapoten, when you press it, and I try not to drink tea with sugar. That's all. And his sugar level is 10-15, and his working pressure is 170. And that’s the point of treating.

They can be short-term, reversible, if the underlying disease is acute and curable. Thus, mild cognitive decline in TBI and stroke can be reversible when the functions of the affected area of ​​the brain are restored, or with good compensation due to the general reserves of the brain. Asthenia and depression that occur against the background of acute infections are reversible.

Most organic non-psychotic disorders are persistent, protracted or undulating in nature. Some of them are well compensated by our maintenance therapy, while some cannot be dealt with. These patients may be prone to the formation of hospitalism syndrome.

Often, persistent personality changes develop against the background of various brain lesions.

With epilepsy - pedantry, keen attention to detail, tediousness, a tendency to gloom, gloominess; irritability, which can last for a long time.

With vascular lesions - viscosity of thinking, fatigue, tearfulness, absent-mindedness, deterioration of short-term memory, touchiness.

In case of injuries, serious consequences may be a combination of cognitive deficit with psychopathization; in less severe cases, asthenia and attention disorders.

If we have short-term symptoms in acute conditions, then we don’t need to call a psychiatrist, it will go away on its own upon recovery.
If everything is persistent and won’t go away, it’s better to contact, sometimes there is an opportunity to help, if nothing can be done, we’ll say so.

Unfortunately, the human brain, despite all the degrees of protection and good ability to compensate, is still too complex to endure all the hardships due to our sometimes careless attitude towards it without any consequences. Take care of yourself.

Maksutova E.L., Zheleznova E.V.

Research Institute of Psychiatry, Ministry of Health of the Russian Federation, Moscow

Epilepsy is one of the most common neuropsychiatric diseases: its prevalence in the population is in the range of 0.8–1.2%.

It is known that mental disorders are an essential component of the clinical picture of epilepsy, complicating its course. According to A. Trimble (1983), A. Moller, W. Mombouer (1992), there is a close relationship between the severity of the disease and mental disorders, which occur much more often with an unfavorable course of epilepsy.

In the last few years, as statistical studies show, in the structure of mental morbidity there has been an increase in forms of epilepsy with non-psychotic disorders. At the same time, the proportion of epileptic psychoses is decreasing, which reflects the obvious pathomorphism of the clinical manifestations of the disease, caused by the influence of a number of biological and social factors.

One of the leading places in the clinical picture of non-psychotic forms of epilepsy is occupied by affective disorders, which often tend to become chronic. This confirms the position that despite the achieved remission of seizures, disturbances in the emotional sphere are an obstacle to the full restoration of patients’ health (Maksutova E.L., Fresher V., 1998).

When clinically qualifying certain syndromes of the affective register, it is fundamental to assess their place in the structure of the disease, the characteristics of the dynamics, as well as the relationship with the range of paroxysmal syndromes themselves. In this regard, we can conditionally distinguish two mechanisms of syndrome formation of a group of affective disorders - primary, where these symptoms act as components of paroxysmal disorders themselves, and secondary - without a cause-and-effect relationship with the attack, but based on various manifestations of reactions to the disease, as well as to additional psychotraumatic influences.

Thus, according to studies of patients in a specialized hospital at the Moscow Research Institute of Psychiatry, it has been established that phenomenologically non-psychotic mental disorders are represented by three types of conditions:

1) depressive disorder in the form of depression and subdepression;

2) obsessive-phobic disorders;

3) other affective disorders.

Depressive spectrum disorders include the following:

1. Melancholy depression and subdepression were observed in 47.8% of patients. The predominant feeling in the clinic here was an anxious and melancholy affect with a persistent decrease in mood, often accompanied by irritability. Patients noted mental discomfort and heaviness in the chest. In some patients, there was a connection between these sensations and physical illness (headache, unpleasant sensations in the chest) and were accompanied by motor restlessness, less often they were combined with adynamia.

2. Adynamic depression and subdepression were observed in 30% of patients. These patients were distinguished by the course of depression against the background of adynamia and hypobulia. They spent most of the time in bed, had difficulty performing simple self-care functions, and were characterized by complaints of fatigue and irritability.

3. Hypochondriacal depression and subdepression were observed in 13% of patients and were accompanied by a constant feeling of physical damage and heart disease. In the clinical picture of the disease, the leading place was occupied by hypochondriacal phobias with fears that sudden death might occur during an attack or that they would not receive help in time. Rarely did the interpretation of phobias go beyond the specified plot. Senestopathies were characterized by hypochondriacal fixation, the peculiarity of which was the frequency of their intracranial localization, as well as various vestibular inclusions (dizziness, ataxia). Less commonly, the basis of senestopathies was vegetative disorders.

The variant of hypochondriacal depression was more typical for the interictal period, especially in conditions of chronicity of these disorders. However, their transient forms were often noted in the early postictal period.

4. Anxiety depression and subdepression occurred in 8.7% of patients. Anxiety, as a component of an attack (less commonly, an interictal state), was distinguished by an amorphous plot. Patients more often could not determine the motives for anxiety or the presence of any specific fears and reported that they experienced vague fear or anxiety, the cause of which was unclear to them. A short-term anxious affect (several minutes, less often within 1–2 hours), as a rule, is characteristic of a variant of phobias as a component of a seizure (within the aura, the attack itself or the post-seizure state).

5. Depression with depersonalization disorders was observed in 0.5% of patients. In this variant, the dominant sensations were changes in the perception of one’s own body, often with a feeling of alienation. The perception of the environment and time also changed. Thus, patients, along with a feeling of adynamia and hypothymia, noted periods when the environment “changed”, time “accelerated”, it seemed that the head, arms, etc. were enlarged. These experiences, in contrast to true paroxysms of depersonalization, were characterized by the preservation of consciousness with full orientation and were fragmentary in nature.

Psychopathological syndromes with a predominance of anxious affect comprised predominantly the second group of patients with “obsessive-phobic disorders.” Analysis of the structure of these disorders showed that their close connections can be traced with almost all components of a seizure, starting with precursors, aura, the attack itself and the post-seizure state, where anxiety acts as a component of these states. Anxiety in the form of a paroxysm, preceding or accompanying an attack, was manifested by a sudden fear, often of uncertain content, which patients described as an “impending threat”, increasing anxiety, giving rise to a desire to urgently do something or seek help from others. Individual patients often indicated fear of death from an attack, fear of paralysis, insanity, etc. In several cases, there were symptoms of cardiophobia, agoraphobia, and less frequently, social phobic experiences were noted (fear of falling in the presence of employees at work, etc.). Often in the interictal period, these symptoms were intertwined with disorders of the hysterical circle. There was a close connection between obsessive-phobic disorders and the vegetative component, reaching particular severity in viscero-vegetative seizures. Among other obsessive-phobic disorders, obsessive states, actions, and thoughts were observed.

Unlike paroxysmal anxiety, anxious affect in remissions approaches in form the classical variants in the form of unmotivated fears for one’s health, the health of loved ones, etc. A number of patients have a tendency to develop obsessive-phobic disorders with obsessive concerns, fears, behaviors, actions, etc. In some cases, there are protective mechanisms of behavior with unique measures to counteract the disease, such as rituals, etc. In terms of therapy, the most unfavorable option is a complex symptom complex, including obsessive-phobic disorders, as well as depressive disorders.

The third type of borderline forms of mental disorders in the epilepsy clinic were affective disorders, which we designated as “other affective disorders.”

Being phenomenologically close, there were incomplete or abortive manifestations of affective disorders in the form of affective fluctuations, dysphoria, etc.

Among this group of borderline disorders, occurring both in the form of paroxysms and prolonged states, epileptic dysphoria was more often observed. Dysphoria, occurring in the form of short episodes, more often took place in the structure of the aura, preceding an epileptic attack or a series of seizures, but they were most widely represented in the interictal period. According to clinical features and severity, astheno-hypochondriacal manifestations, irritability, and anger affect prevailed in their structure. Protest reactions often formed. Aggressive actions were observed in a number of patients.

The emotional lability syndrome was characterized by a significant amplitude of affective fluctuations (from euphoria to anger), but without noticeable behavioral disturbances characteristic of dysphoria.

Among other forms of affective disorders, mainly in the form of short episodes, there were reactions of weakness, manifested in the form of incontinence of affect. Usually they acted outside the framework of a formalized depressive or anxiety disorder, representing an independent phenomenon.

In relation to the individual phases of an attack, the frequency of borderline mental disorders associated with it is presented as follows: in the aura structure - 3.5%, in the attack structure - 22.8%, in the post-ictal period - 29.8%, in the interictal period - 43.9 %.

Within the framework of the so-called precursors of attacks, various functional disorders are well known, mainly of a vegetative nature (nausea, yawning, chills, drooling, fatigue, loss of appetite), against the background of which anxiety, decreased mood or its fluctuations with a predominance of irritable-sullen affect occur. A number of observations during this period noted emotional lability with explosiveness and a tendency to conflict reactions. These symptoms are extremely labile, short-lived and can be self-limiting.

An aura with affective feelings is a common component of subsequent paroxysmal disorder. Among them, the most common is sudden anxiety with increasing tension and a feeling of “lightheadedness.” Less common are pleasant sensations (increased vitality, a feeling of particular lightness and elation), which are then replaced by anxious anticipation of an attack. Within the framework of an illusory (hallucinatory) aura, depending on its plot, either an affect of fear and anxiety may occur, or a neutral (less often excited-elated) mood may be noted.

In the structure of the paroxysm itself, affective syndromes most often occur within the framework of the so-called temporal lobe epilepsy.

As is known, motivational and emotional disorders are one of the leading symptoms of damage to the temporal structures, mainly the mediobasal formations, which are part of the limbic system. At the same time, affective disorders are most widely represented in the presence of a temporal focus in one or both temporal lobes.

When the focus is localized in the right temporal lobe, depressive disorders are more common and have a more defined clinical picture. As a rule, the right-sided localization of the process is characterized by a predominantly anxious type of depression with various plots of phobias and episodes of excitement. This clinic fits completely into the distinguished “right hemisphere affective disorder” in the taxonomy of organic syndromes ICD-10.

Paroxysmal affective disorders (within an attack) include attacks of fear, unaccountable anxiety, and sometimes with a feeling of melancholy that suddenly appear and last for several seconds (less often than minutes). There may be impulsive short-term states of increased sexual (food) desire, a feeling of increased strength, and joyful anticipation. When combined with depersonalization-derealization inclusions, affective experiences can acquire both positive and negative tones. It is necessary to emphasize the predominantly violent nature of these experiences, although individual cases of their arbitrary correction using conditioned reflex techniques indicate a more complex pathogenesis.

“Affective” seizures occur either in isolation or are part of the structure of other seizures, including convulsive ones. Most often they are included in the structure of the aura of a psychomotor seizure, less often - vegetative-visceral paroxysms.

The group of paroxysmal affective disorders within temporal lobe epilepsy includes dysphoric states, the duration of which can range from several hours to several days. In some cases, dysphoria in the form of short episodes precedes the development of the next epileptic seizure or series of seizures.

The second place in the frequency of affective disorders is occupied by clinical forms with dominant vegetative paroxysms within the framework of diencephalic epilepsy. Analogues of the common designation of paroxysmal (crisis) disorders as “vegetative attacks” are concepts widely used in neurological and psychiatric practice such as “diencephalic” attack, “panic attacks” and other conditions with large vegetative accompaniment.

Classic manifestations of crisis disorders include sudden development: shortness of breath, a feeling of lack of air, discomfort from the organs of the chest cavity and abdomen with “heart sinking,” “interruptions,” “pulsation,” etc. These phenomena are usually accompanied by dizziness, chills, and tremor , various paresthesias. Possible increased frequency of bowel movements and urination. The most powerful manifestations are anxiety, fear of death, fear of going crazy.

Affective symptoms in the form of individual unstable fears can be transformed into both affective paroxysm itself and permanent variants with fluctuations in the severity of these disorders. In more severe cases, a transition to a persistent dysphoric state with aggression (less often, auto-aggressive actions) is possible.

In epileptological practice, vegetative crises occur mainly in combination with other types (convulsive or non-convulsive) paroxysms, causing polymorphism in the clinical picture of the disease.

Regarding the clinical characteristics of the so-called secondary reactive disorders, it should be noted that we include a variety of psychologically understandable reactions to the disease that occur with epilepsy. At the same time, side effects as a response to therapy, as well as a number of professional restrictions and other social consequences of the disease, include both transient and prolonged conditions. They more often manifest themselves in the form of phobic, obsessive-phobic and other symptoms, in the formation of which a large role belongs to the individual personality characteristics of the patient and additional psychogenies. At the same time, the clinic of protracted forms in a broad sense of situational (reactive) symptoms is largely determined by the nature of cerebral (deficient) changes, which gives them a number of features associated with organic soil. The clinical picture of emerging secondary reactive disorders is also reflected in the degree of personal (epithymic) changes.

As part of reactive inclusions, patients with epilepsy often have concerns:

    development of a seizure on the street, at work

    be injured or die during a seizure

    go crazy

    transmission of disease by inheritance

    side effects of anticonvulsants

    forced withdrawal of drugs or untimely completion of treatment without guarantees for relapse of attacks.

The reaction to a seizure at work is usually much more severe than when it occurs at home. Due to the fear that a seizure will occur, some patients stop studying, working, and do not go out.

It should be pointed out that, according to induction mechanisms, fear of a seizure may also appear in relatives of patients, which requires a large participation of family psychotherapeutic assistance.

Fear of a seizure is more often observed in patients with rare paroxysms. Patients with frequent attacks during a long illness become so accustomed to them that, as a rule, they hardly experience such fear. Thus, in patients with frequent seizures and a longer duration of the disease, signs of anosognosia and uncritical behavior are usually observed.

Fear of bodily harm or fear of death during a seizure is more easily formed in patients with psychasthenic personality traits. It also matters that they have previously had accidents and bruises due to seizures. Some patients fear not so much the attack itself as the possibility of bodily harm.

Sometimes the fear of a seizure is largely due to the unpleasant subjective sensations that appear during an attack. These experiences include frightening illusory, hallucinatory inclusions, as well as body schema disorders.

This distinction between affective disorders is of fundamental importance in determining further therapy.

Principles of therapy

The main direction of therapeutic tactics in relation to individual affective components of the attack itself and post-ictal emotional disorders closely associated with it is the adequate use of anticonvulsants with a thymoleptic effect (cardimizepine, valproate, lamotrigine).

While not anticonvulsants, many tranquilizers have an anticonvulsant spectrum of action (diazepam, phenazepam, nitrazepam). Their inclusion in the therapeutic regimen has a positive effect on both the paroxysms themselves and secondary affective disorders. However, it is advisable to limit the time of their use to three years due to the risk of addiction.

Recently, the anti-anxiety and sedative effect of clonazepam, which is highly effective in absence seizures, has been widely used.

For various forms of affective disorders with depressive radicals, antidepressants are most effective. At the same time, in outpatient settings, drugs with minimal side effects are preferred, such as tianeptil, miaxerin, fluoxetine.

If the obsessive-compulsive component predominates in the structure of depression, the prescription of paroxetine is justified.

It should be noted that a number of mental disorders in patients with epilepsy may be caused not so much by the disease itself as by long-term therapy with phenobarbital drugs. In particular, this can explain the slowness, rigidity, and elements of mental and motor retardation that appear in some patients. With the advent of highly effective anticonvulsants in recent years, it has become possible to avoid side effects of therapy and classify epilepsy as a curable disease.

Psychotic disorders are a group of serious mental illnesses. They lead to impaired clarity of thinking, the ability to make correct judgments, react emotionally, communicate with people and adequately perceive reality. People with severe symptoms of the disease are often unable to cope with everyday tasks. Interestingly, such deviations are most often observed among residents of developed countries.

However, even severe types of diseases are amenable to drug treatment to one degree or another.

Definition

Psychotic-level disorders cover a range of illnesses and associated symptoms. Essentially, such disorders are some form of altered or distorted consciousness that persists for a significant period of time and interferes with the normal functioning of a person as a full-fledged member of society.

Psychotic episodes may occur as isolated events, but most often they are a sign of significant mental health problems.

Risk factors for the occurrence of psychotic disorders include heredity (especially for schizophrenia), frequent drug use (mainly hallucinogenic drugs). The onset of a psychotic episode can also be triggered by stressful situations.

Species

Psychotic disorders have not yet been fully considered; some points differ depending on the approach to their study, so certain disagreements may arise in classifications. This is especially true due to conflicting data on the nature of their occurrence. In addition, it is not always possible to clearly determine the cause of a particular symptom.

Nevertheless, the following main, most common types of psychotic disorders can be distinguished: schizophrenia, psychosis, bipolar disorder, polymorphic psychotic disorder.

Schizophrenia

The disorder is diagnosed when symptoms such as delusions or hallucinations persist for at least 6 months (with at least 2 symptoms occurring continuously for a month or more), with corresponding changes in behavior. Most often, the result is difficulty performing everyday tasks (for example, at work or while studying).

Diagnosis of schizophrenia is often complicated by the fact that similar symptoms can also occur with other disorders, and patients can often lie about the degree of their manifestation. For example, a person may not want to admit that they hear voices due to paranoid delusions or fear of stigmatization, and so on.

Also distinguished:

  • Schizophreniform disorder. It includes but lasts a shorter period of time: from 1 to 6 months.
  • Schizoaffective disorder. It is characterized by symptoms of both schizophrenia and diseases such as bipolar disorder.

Psychosis

Characterized by some distorted sense of reality.

A psychotic episode may include so-called positive symptoms: visual and auditory hallucinations, delusions, paranoid reasoning, and disoriented thinking. Negative symptoms include difficulties in constructing indirect speech, commenting and maintaining a coherent dialogue.

Bipolar disorder

Characterized by sudden mood swings. The condition of people with this disease usually changes sharply from maximum excitement (mania and hypomania) to minimum (depression).

Any episode of bipolar disorder may be characterized as an “acute psychotic disorder,” but not vice versa.

Some psychotic symptoms may only subside during mania or depression. For example, during a manic episode, a person may experience grandiose feelings and believe that they have incredible abilities (for example, the ability to always win any lottery).

Multiple psychotic disorder

It can often be mistaken for a manifestation of psychosis. Since it develops like psychosis, with all the accompanying symptoms, but it is also not schizophrenia in its original definition. Refers to the type of acute and transient psychotic disorders. Symptoms appear unexpectedly and constantly change (for example, each time a person sees new, completely different hallucinations), the overall clinical picture of the disease usually develops quite quickly. This episode usually lasts from 3 to 4 months.

There are polymorphic psychotic disorder with and without symptoms of schizophrenia. In the first case, the disease is characterized by the presence of signs of schizophrenia, such as prolonged persistent hallucinations and a corresponding change in behavior. In the second case, they are unstable, the visions often have an unclear direction, and the person’s mood constantly and unpredictably changes.

Symptoms

And with schizophrenia, and with psychosis and all other similar types of diseases, a person always has the following symptoms characterizing a psychotic disorder. They are often called “positive”, but not in the sense that they are good and useful to others. In medicine, a similar name is used in the context of the expected manifestations of a disease or a normal type of behavior in its extreme form. Positive symptoms include hallucinations, delusions, strange body movements or lack of movement (catatonic stupor), peculiar speech, and strange or primitive behavior.

Hallucinations

They include sensations that do not have a corresponding objective reality. Hallucinations can appear in various forms that parallel the human senses.

  • Visual hallucinations include deception and seeing objects that don't exist.
  • The most common type of hearing is voices in the head. Sometimes these two types of hallucinations can be mixed, that is, a person not only hears voices, but also sees their owners.
  • Olfactory. A person perceives non-existent odors.
  • Somatic. The name comes from the Greek “soma” - body. Accordingly, these hallucinations are physical, for example, the feeling of the presence of something on or under the skin.

Mania

This symptom most often characterizes an acute psychotic disorder with symptoms of schizophrenia.

Manias are strong irrational and unrealistic beliefs of a person that are difficult to change, even in the presence of indisputable evidence. Most people not associated with medicine believe that mania is only paranoia, persecution mania, excessive suspicion, when a person believes that everything around him is a conspiracy. However, this category also includes unfounded beliefs, manic love fantasies and jealousy bordering on aggression.

Megalomania is a common irrational belief that results in the importance of a person being exaggerated in various ways. For example, the patient may consider himself a president or a king. Often delusions of grandeur take on religious overtones. A person may consider himself a messiah or, for example, sincerely assure others that he is the reincarnation of the Virgin Mary.

Misconceptions related to the characteristics and functioning of the body can also often arise. There have been cases where people refused to eat due to the belief that all the muscles in the throat were completely paralyzed and all they could swallow was water. However, there were no real reasons for this.

Other symptoms

Other signs tend to characterize short-term psychotic disorders. These include strange body movements, constant grimaces and facial expressions uncharacteristic for the person and situation or, as the opposite, catatonic stupor - lack of movement.

There are distortions of speech: incorrect sequence of words in a sentence, answers that make no sense or do not relate to the context of the conversation, mimicking the opponent.

Aspects of childishness are also often present: singing and jumping in inappropriate circumstances, moodiness, unconventional uses of ordinary objects, for example, creating a tin foil hat.

Of course, a person with psychotic disorders will not experience all symptoms at the same time. The basis for diagnosis is the presence of one or more symptoms over a long period of time.

Reasons

The following are the main causes of psychotic disorders:

  • Reaction to stress. From time to time, under severe prolonged stress, temporary psychotic reactions may occur. At the same time, the cause of stress can be both situations that many people face throughout life, for example, the death of a spouse or divorce, as well as more severe ones - a natural disaster, being in a place of war or in captivity. Typically, a psychotic episode ends as the stress decreases, but sometimes the condition can drag on or become chronic.
  • Postpartum psychosis. For some women, significant hormonal changes as a result of childbirth can cause. Unfortunately, these conditions are often misdiagnosed and mistreated, resulting in cases where the new mother kills her child or commits suicide.
  • Protective reaction of the body. It is believed that people with personality disorders are more susceptible to stress and are less able to cope with adult life. As a result, when life circumstances become more severe, a psychotic episode may occur.
  • Psychotic disorders based on cultural characteristics. Culture is an important factor in determining mental health. In many cultures, what is usually considered a deviation from the generally accepted norm of mental health is part of traditions, beliefs, and references to historical events. For example, in some regions of Japan there is a very strong, even manic, belief that the genitals can shrink and be pulled into the body, causing death.

If a behavior is acceptable in a given society or religion and occurs under appropriate conditions, then it cannot be diagnosed as an acute psychotic disorder. Treatment, accordingly, is not required under such conditions.

Diagnostics

In order to diagnose a psychotic disorder, a general practitioner needs to talk with the patient and also check the general state of health to rule out other causes of such symptoms. Most often, blood and brain tests are performed (for example, using MRI) to rule out mechanical brain damage and drug addiction.

If no physiological reasons for such behavior are found, the patient is referred to a psychiatrist for further diagnosis and determination of whether the person truly has a psychotic disorder.

Treatment

Most often, a combination of medication and psychotherapy is used to treat psychotic disorders.

As a medicine, specialists most often prescribe antipsychotics or atypical antipsychotics, which are effective in relieving anxiety symptoms such as delusions, hallucinations and distorted perception of reality. These include: "Aripiprazole", "Azenapine", "Brexpiprazole", "Clozapine" and so on.

Some drugs are available in the form of tablets that must be taken daily, others in the form of injections that only need to be given once or twice a month.

Psychotherapy includes various types of counseling. Depending on the patient’s personality characteristics and the course of the psychotic disorder, individual, group or family psychotherapy may be prescribed.

For the most part, people with psychotic disorders receive outpatient treatment, meaning they are not constantly in a medical facility. But sometimes, if there are severe symptoms, there is a threat of harm to oneself and loved ones, or if the patient is unable to take care of himself, hospitalization is performed.

Each patient being treated for a psychotic disorder may respond differently to therapy. For some, progress is noticeable from the first day, for others it will take months of treatment. Sometimes, if you have several severe episodes, you may need to take medication on an ongoing basis. Usually in such cases a minimum dose is prescribed to avoid side effects as much as possible.

Psychotic disorders cannot be prevented. But the sooner you seek help, the easier it will be to undergo treatment.

People at high risk of developing such disorders, such as those with close family members with schizophrenics, should avoid drinking alcohol and any drugs.

Borderline forms of psychotic disorders, or borderline states, usually include various neurotic disorders. This concept is not generally accepted, but is still used by many healthcare professionals. As a rule, it is used to combine milder disorders and separate them from psychotic disorders. Moreover, borderline states are generally not the initial, intermediate, or buffer phases or stages of the main psychoses, but represent a special group of pathological manifestations that, in clinical terms, have their onset, dynamics and outcome, depending on the form or type of the disease process.

Characteristic disorders for borderline states:

  • the predominance of the neurotic level of psychopathological manifestations throughout the course of the disease;
  • the leading role of psychogenic factors in the occurrence and decompensation of painful disorders;
  • the relationship between mental disorders themselves and autonomic dysfunctions, night sleep disorders and somatic diseases;
  • the relationship of painful disorders with the personality and typological characteristics of the patient;
  • the presence in most cases of an “organic predisposition” for the development and decompensation of painful disorders;
  • maintaining a critical attitude by patients to their condition and the main pathological manifestations.
  • Along with this, in borderline states there may be a complete absence of psychotic symptoms, progressively increasing dementia and personality changes characteristic of endogenous mental illnesses, for example, and.

Borderline mental disorders can arise acutely or develop gradually; their course can be of different nature and limited to a short-term reaction, a relatively long-term condition or a chronic course. Taking this into account, as well as based on an analysis of the causes of occurrence, various forms and variants of borderline disorders are distinguished in clinical practice. In this case, different principles and approaches are used (nosological, syndromic, symptomatic assessment), and the course of the borderline state, its severity, stabilization, and the dynamic relationship of various clinical manifestations are analyzed.

Clinical diagnosis

Due to the non-specificity of many symptoms that fill the syndromic and nosological structures of borderline states, the external, formal differences between asthenic, vegetative, dyssomnic and depressive disorders are insignificant. Considered separately, they do not provide grounds either for differentiating mental disorders in the physiological reactions of healthy people who find themselves in stressful conditions, or for a comprehensive assessment of the patient’s condition and determining the prognosis. The key to diagnosis is the dynamic assessment of a particular painful manifestation, detection of the causes of occurrence and analysis of the relationship with individual typological psychological characteristics, as well as other psychopathological disorders.

In real medical practice, it is often not easy to answer the most important question for differential diagnostic assessment: when did this or that disorder begin; Is it a strengthening, sharpening of personal characteristics or is it fundamentally new in the individual uniqueness of a person’s mental activity? The answer to this seemingly trivial question requires, in turn, the solution of a number of problems. In particular, it is necessary to assess the typological and characterological characteristics of a person in the pre-morbid period. This allows us to see the individual norm in the neurotic complaints presented or qualitatively new, actually painful disorders not related to premorbid characteristics.

Paying great attention to the pre-morbid assessment of the condition of a person who has come to see a doctor in connection with his neurotic manifestations, it is necessary to take into account the characteristics of his character, which undergo dynamic changes under the influence of age-related, psychogenic, somatogenic and many social factors. Analysis of premorbid characteristics makes it possible to create a unique psychophysiological portrait of the patient, the starting point that is necessary for a differential assessment of the disease state.

Assessing current symptoms

What matters is not the individual symptom or syndrome itself, but its assessment in conjunction with other psychopathological manifestations, their visible and hidden causes, the rate of increase and stabilization of general neurotic and more specific psychopathological disorders of the neurotic level (senestopathy, obsession, hypochondria). In the development of these disorders, both psychogenic and physiogenic factors, most often their varied combination, are important. The causes of neurotic disorders are not always visible to others; they can lie in a person’s personal experiences, caused primarily by the discrepancy between the ideological and psychological attitude and physical capabilities of reality. This discrepancy can be viewed as follows:

  1. from the point of view of a lack of interest (including moral and economic) in this or that activity, in a lack of understanding of its goals and prospects;
  2. from the position of irrational organization of purposeful activity, accompanied by frequent distractions from it;
  3. from the point of view of physical and psychological unpreparedness to perform the activity.

What does borderline disorder include?

Taking into account the diversity of various etiopathogenetic factors, borderline forms of mental disorders include neurotic reactions, reactive states (but not psychoses), neuroses, character accentuations, pathological personality development, psychopathy, as well as a wide range of neurosis-like and psychopath-like manifestations in somatic, neurological and other diseases. In ICD-10, these disorders are generally considered as various variants of neurotic, stress-related and somatoform disorders, behavioral syndromes caused by physiological disorders and physical factors, and disorders of mature personality and behavior in adults.

Borderline states usually do not include endogenous mental illnesses (including sluggish schizophrenia), at certain stages of development of which neurosis- and psychopath-like disorders, which largely imitate the main forms and variants of borderline states themselves, predominate and even determine the clinical course.

What to consider when diagnosing:

  • the onset of the disease (when neurosis or a neurosis-like state arose), the presence or absence of its connection with psychogeny or somatogeny;
  • stability of psychopathological manifestations, their relationship with the patient’s personal-typological characteristics (whether they are a further development of the latter or not related to pre-morbid accentuations);
  • interdependence and dynamics of neurotic disorders in conditions of persistence of traumatic and significant somatogenic factors or a subjective decrease in their relevance.