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Etiological factors influencing the occurrence of mental illness. The concept of pathogenesis and pathokinesis of mental illness

Section 2. General psychopathology

Etiology of mental illness

General health is defined as the state of a person characterized not only by the absence of disease or physical infirmity, but also by complete physical, mental and social well-being (according to WHO).

Basic criteria for general health:

1) structural and functional preservation of organs and systems;

2) the organism’s individually sufficiently high adaptability to changes in its typical natural and social environment;

3) preservation of the usual state of health.

Mental health– one of the most important components of overall health. Mental health criteria (according to WHO):

1) awareness and feeling of continuity, constancy, identity of one’s physical and mental “I”;

2) a sense of constancy and identity of experiences in similar situations;

3) criticality of oneself and one’s own mental production (activity) and its results;

4) correspondence of mental reactions (adequacy) to the strength and frequency of environmental influences, social circumstances and situations;

5) the ability to self-manage behavior in accordance with social norms, rules, laws;

6) the ability to plan and implement one’s own life activities – this is the ability to change the way of behavior depending on changing life situations and circumstances.

The modern definition of mental health emphasizes that it is characterized by an individual dynamic set of mental properties of a particular person, which allows the latter to understand the surrounding reality adequately for his age, gender, social status, adapt to it and perform his biological and social functions in accordance with emerging personal and public interests, needs, generally accepted morality.

ICD-10 (International Classification of Diseases, 10th revision) replaces the concept of “mental illness” with a more general and amorphous concept "mental disorder". The latter is defined in ICD-10 as “a disease state with psychopathological or behavioral manifestations associated with impaired functioning of the body as a result of the influence of biological, social, psychological, genetic or chemical factors. It is determined by the degree of deviation from the concept of mental health taken as a basis.” Thus, mental illness, disorder or abnormality should be considered as a narrowing, disappearance or perversion of the criteria of mental health.

Mental illness- the result of complex and varied disorders of the activities of various systems of the human body, with predominant damage to the brain, the main signs of which are disorders of mental functions, accompanied by a violation of criticism and social adaptation.

The concept of “mental illness” is not limited to expressed forms of mental disorders (psychoses), i.e. such pathological states of mental activity in which mental reactions grossly contradict real relationships (I.P. Pavlov), which is found in a disorder of reflection of the real world and disorganization of behavior.

Mental illnesses in a broad sense, in addition to psychoses, also include milder mental disorders that are not accompanied by a pronounced disturbance in the reflection of the real world and a significant change in behavior. They include neuroses, psychopathy, mental underdevelopment and mental disorders of various origins that do not reach the degree of psychosis, for example, caused by organic diseases of the brain, somatogenies, intoxications, etc. S. S. Korsakov once wrote that psychiatry is the study of mental disorders in general, and not just about severe psychoses.

Psychiatry is divided into general psychiatry (general psychopathology), exploring the basic patterns of manifestation and development of pathology of mental activity, characteristic of many mental illnesses, general issues of etiology and pathogenesis, the nature of psychopathological processes, their causes, principles of classification, problems of recovery, research methods, and private psychiatry, exploring relevant issues in selected mental illnesses.

The main method of understanding mental illness remains the clinical-descriptive method, which studies in unity the statics and dynamics of mental disorders. A. B. Gannushkin (1924) defended the following principles for the study of mental illnesses: first, the study of all diseases from the same angle, using the same clinical techniques; secondly, a study of the personality of patients as a whole. In this case, he meant not only the study of patients in their relationship with the environment, but also the identification of somatic correlations of mental disorders; thirdly, knowledge of patients not only within the limits of the disease, but throughout their entire life. The central role among regulatory mechanisms belongs to the nervous system as the leading system through which the functional connection of all parts of the body and the latter with the environment is carried out. The pathophysiological basis of mental illness should be considered primarily as dysfunction of the central nervous system - a violation of the basic processes of higher nervous activity.

The etiology of most mental illnesses remains largely unknown. The relationship in the origin of most mental illnesses to heredity, internally determined characteristics of the body and environmental hazards, in other words, endogenous and exogenous factors, is unclear. The pathogenesis of psychoses has also been studied only in general terms. The basic patterns of gross organic pathology of the brain, the effects of infections and intoxications, and the influence of psychogenic factors have been studied. Substantial data have been accumulated on the role of heredity and constitution in the occurrence of mental illness.

There is no single reason that causes the development of mental pathology and cannot exist. Diseases can be congenital or acquired, resulting from traumatic brain injuries or infections, and can be detected at a very early or advanced age. Some of the reasons have already been clarified by science, others are not yet precisely known. Let's look at some of them.

There are many facts in psychiatry that indicate a significant role heredity in the etiology and pathogenesis of endogenous and other mental diseases (Vartanyan M. E., 1983; Milev V., Moskalenko V. D., 1988; Trubnikov V. I., 1992). The main ones are the accumulation of repeated cases of the disease in the families of patients and the different frequency of affected relatives depending on the degree of relationship with the patients. However, in the vast majority of cases we are talking about a hereditary predisposition to mental illness.

The frequency of corresponding diseases in relatives of patients is higher than in the general population. Thus, if the prevalence of schizophrenia among the population is about 1%, then the frequency of those affected among first-degree relatives of patients is approximately 10 times higher, and among second-degree relatives - 3 times higher than in the general population. A similar situation occurs in families of patients with affective psychoses, epilepsy, and depression.

The prevalence of alcoholism among the population, as is known, reaches 3–5)% in men and 1% in women. Among first-degree relatives of patients, the incidence of this disease is 4 times higher, and among second-degree relatives – 2 times higher.

An accumulation of cases of the disease has also been noted in families of patients with dementia of the Alzheimer's type. Moreover, there is a familial variant of Alzheimer's disease. Huntington's chorea and Down's disease are examples of diseases that have been well studied in the clinical and genealogical aspect, due to the clearly established localization of chromosomal abnormalities (on chromosomes 4 and 21, respectively).

Intrauterine injuries, infectious and other diseases of the mother during pregnancy

As a result of the action of these factors, the nervous system, and primarily the brain, are formed incorrectly. Some children experience developmental delays and sometimes disproportionate brain growth.

Brain damage due to traumatic brain injury, cerebrovascular accidents, progressive sclerosis of cerebral vessels and other diseases

Contusions, wounds, bruises, and concussions suffered at any age can lead to mental disorders. They appear either immediately, directly after the injury (psychomotor agitation, memory loss, etc.), or after some time (in the form of various deviations, including mental illnesses).

Infectious diseases– typhus and typhoid fever, scarlet fever, diphtheria, measles, influenza and (especially) encephalitis and meningitis, syphilis, which primarily affects the brain and its membranes.

The action of toxic, poisonous substances, primarily alcohol and other drugs, the abuse of which can lead to mental disorders. The latter can occur due to poisoning with industrial poisons (tetraethyl lead), or due to improper use of medications.

Social upheaval and traumatic experiences can lead to mental trauma, which can be acute, often associated with an immediate threat to the life and health of a person or his loved ones, as well as chronic, relating to the most significant and difficult aspects for a given person (honor, dignity, social prestige, etc.) . Reactive psychoses are characterized by a clear causal dependence, the “sounding” of an exciting theme in all the patient’s experiences, and relative short duration.

Numerous studies have shown that a person’s mental state is also influenced by personality type, individual character traits, level of intelligence, profession, external environment, state of health and biological rhythms.

In most cases, psychiatry generally divides diseases into “endogenous”, i.e. those arising from internal causes (schizophrenia, manic-depressive psychosis), and “exogenous” - provoked by environmental influences. The reasons for the latter seem more obvious. The pathogenesis of most mental illnesses can only be presented at the level of hypotheses.

Frequency of occurrence, classification, course of mental illnesses

Frequency of occurrence

Nowadays, in many countries of Europe and North America there are more mentally ill people than there are patients with cancer, tuberculosis and cardiovascular diseases combined.

In addition, for every patient in a psychoneurological hospital (according to UNESCO), there are two people outside the walls of medical institutions with certain mental disabilities. These people cannot be hospitalized - they are “not sick enough,” but they cannot live a healthy mental life.

In the United States, mental illness is a major national problem. The Federal Health Service estimates that one in sixteen people in America spends some time in a mental hospital, and the National Association on Mental Illness reports that one in ten Americans “suffers from some form of mental or nervous illness, ranging from mild to severe.” requiring referral to a psychiatrist."

Despite the enormous difficulties of statistical research associated with the unequal use of counting methods in different countries, the unique understanding of certain forms of diseases, different possibilities for identifying mental patients, and so on, the available figures give reason to assume that in general there are at least 50 million mentally ill people in the world, which represents approximately 17 people for every thousand of the population.

According to the State Scientific Center for Social and Forensic Psychiatry (State Scientific Center for Social and Forensic Psychiatry) named after. V.P. Serbsky in the Russian Federation in recent years, the prevalence of neuropsychiatric disorders among the population is about 25%.

It is known that different mental health services identify different numbers of patients. This is an objective and, given the current level of knowledge, an insurmountable fact that has to be taken into account.

It should be emphasized that as the capabilities of the psychiatric service expand, the already known contingent of patients is not simply additionally identified, but new contingents to which the concept of “mentally ill” was not previously applied at all come into the field of view of psychiatrists, i.e. there is a gradual expansion of the concept of “mental disease".

Recently, more and more patients with non-psychotic disorders are seeking help from a psychiatrist. This is undoubtedly a positive fact, indicating that people have become less afraid of the social consequences associated with turning to a psychiatrist, and that it has become easier for them to get the necessary help.

Classification

Most domestic classifications of mental illness invariably list three main types of mental pathology:

– endogenous mental illnesses, the occurrence of which involves exogenous factors;

– exogenous mental illnesses, the occurrence of which involves endogenous factors;

– conditions caused by developmental pathology.

ICD-10 identifies the following forms of mental illness.

1. Endogenous mental illnesses:

1) schizophrenia;

2) affective diseases;

3) affective psychoses;

4) cyclothymia;

5) dysthymia;

6) schizoaffective psychoses;

7) functional psychoses of late age.

2. Endogenous organic diseases:

1) epilepsy;

2) degenerative (atrophic) processes of the brain;

3) Alzheimer's type dementia;

4) Alzheimer's disease;

5) senile dementia;

6) systemic organic diseases;

7) Pick's disease;

8) Huntington's chorea;

9) Parkinson's disease;

10) special forms of psychoses of late age;

11) acute psychoses;

12) chronic hallucinosis;

13) vascular diseases of the brain;

14) hereditary organic diseases;

15) exogenous organic diseases;

16) mental disorders due to brain injuries;

17) mental disorders due to brain tumors;

18) infectious organic diseases of the brain.

3. Exogenous mental disorders:

1) alcoholism;

2) drug addiction and substance abuse;

3) symptomatic psychoses;

4) mental disorders due to somatic non-infectious diseases;

5) mental disorders in somatic infectious diseases;

6) mental disorders due to intoxication with drugs, household and industrial toxic substances.

4. Psychosomatic disorders:

1) reactive psychoses;

2) post-traumatic stress syndrome.

5. Borderline mental disorders:

1) neurotic disorders;

2) anxious-phobic states;

3) neurasthenia;

4) obsessive-compulsive disorders;

5) hysterical disorders of a neurotic level;

6) personality disorders.

6. Pathology of mental development:

1) mental retardation;

2) mental retardation;

3) distortions of mental development.

Course of mental illness

The course of mental illnesses, including those of the same disease, may be different, but at the same time it is possible to identify certain types or forms.

Some mental illnesses, once they begin, continue chronically until the end of the patient’s life; it is a continuous, processual, progressive flow. However, within this form the development of mental illness is not the same. In one group of patients, the pathological process develops catastrophically from the very beginning and quickly leads to pronounced mental decay. In other cases, the disease progresses slowly, deficiency changes appear gradually, without reaching deep decay. In the third group of patients, the pathological process develops less intensively, ultimately affecting only a change in the mental makeup of the individual. The mildest variants of this type of course form the so-called latent forms of one or another mental illness. Regardless of the severity of the disease, during each of its varieties, periodic exacerbations can be detected, indicating a hidden circularity, periodicity in the development of the disease process.

In many patients, the disease from the very beginning is characterized by attacks with light intervals between them - a paroxysmal course. In one group of patients attacks occur at regular intervals, in another - without any regularity. Sometimes attacks of the disease entail persistent changes in the mental makeup of the individual with a deepening of the defect from attack to attack (paroxysmal-progressive course). In other cases, attacks, even numerous ones, pass without a trace, without leading to any defect (intermittent course). Such attacks are called phases. Finally, sometimes personality changes occur after the first attack, and subsequent phases are noted (recurrent or remitting).

There are also cases of psychosis in the form of a single attack in a lifetime (single-attack course) and a rapidly passing episode (transient psychoses).

Mental illnesses can end with complete recovery or with residual disorders in the form of persistent, varying severity of mental decline - recovery with residual changes, with a defect. Often, mental illness continues until death as a result of some physical illness (death directly from mental illness is rare).

Clinical pictures of mental illness are not constant. They change over time, and the degree of change and the pace of this dynamics may vary.

The concept of symptoms and syndromes of mental illness

As stated earlier, psychiatry is divided into two main sections - general psychopathology and special psychiatry.

Private psychiatry studies individual mental illnesses, their clinical manifestations, causes, mechanisms of development, diagnosis and treatment.

General psychopathology is a branch of psychiatry whose purpose is to study the general patterns and nature of mental disorders. General psychopathology studies individual symptoms and symptom complexes, or syndromes, that can be observed in various mental illnesses. Its subject is the identification and study of the diagnostic value of individual signs and their connection with pathology. The description and designation of pathological signs is carried out using a system of symptoms.

Symptom– an abstract concept (the result of a medical judgment or inference), denoting a description of a sign, strictly fixed in form, correlated with a specific pathology. This is a terminological designation for a pathological symptom. Not every sign is a symptom, but only one named when establishing its cause-and-effect relationship with pathology.

Identification of symptoms in most cases only allows us to state the fact of the presence of a disease in general and attribute it to one or another branch of medicine, since each clinical science has a special set of them. Psychopathological symptoms are specific to psychiatry. They are divided into positive and negative.

Positive signs indicate signs of pathological production (newly emerging maladaptive signs) of mental activity (senestopathies, hallucinations, delirium, melancholy, fear, anxiety, euphoria, psychomotor agitation, etc.).

Negative ones include signs of reversible or persistent, progressive, stationary or regressive damage, loss, flaw, defect of a particular mental process (hypomnesia, amnesia, hypobulia, abulia, apathy, etc.).

Positive and negative symptoms in the clinical picture of the disease appear in unity, combination and, as a rule, have an inversely proportional relationship: the more pronounced the negative symptoms, the less, poorer and more fragmented the positive ones.

The phenomenon of the disease is manifested not by a single sign and symptom, but by a set of them. The structure and characteristics of the latter depend on the type of disease (exo-, endo-, psycho- and somatogenic origin or their combination), the nature of the damage (inflammation, intoxication, degeneration, etc.), features of neurohumoral mechanisms associated with the formation of a complex of disease symptoms etc.

The totality of all symptoms identified during the examination of a particular patient forms a symptom complex. Isolating it is the next higher level of knowledge of the disease compared to identifying symptoms. But this level is still far from sufficient to determine the disease, since the set of symptoms can be caused by a variety of factors (pathogenetic, constitutional-individual, social, modifying, etc.).

The symptom complex reflects the real picture of the disease at the time of examination and is a specific manifestation of the patient’s cumulative pathology. It identifies a number of symptoms that naturally combine with each other to form a syndrome.

Syndrome– stable, regular combinations of symptoms that are interconnected by a single pathogenesis and correlate with certain nosological forms. The definition of a symptom complex occurs with the direct perception of a specific pathology. The symptom complex may not coincide in the number of symptoms with the syndrome, may include symptoms that are not yet included in any syndrome, and may also be a combination of several syndromes (psychopathological, vegetovisceral, neurological, somatic).

The study of a mental state, i.e., the assessment of a psychopathological picture, is a complex process - from the assessment of obvious signs to knowledge of the essence of the disorder, which cannot be perceived directly, but is determined as a result of observation and generalization of signs and the construction of a logical conclusion on this basis. The identification of a separate sign - a symptom - is also a multi-stage process, in which an essential place is occupied by its combination with other signs that are similar in their internal structure. The basic unit of general psychopathology is a syndrome - a natural combination of individual symptoms, which is a kind of integration of the previous course of the disease and contains signs that make it possible to judge the further dynamics of the condition and the disease as a whole. An individual symptom cannot, despite its significance, be considered a psychopathological unit, since it acquires significance only in its totality and in interaction with other symptoms - in a symptom complex or in a syndrome.

The set of symptoms and syndromes observed over time develops into a clinical picture of the disease, which, taking into account the etiology (causes), course, outcome and pathological anatomy, forms separate nosological units of diseases.

Mental disorders of a sick person can affect the processes of perception, thinking, will, memory, consciousness, drives, and emotions. These disorders occur in patients in various combinations and only in combination.

Concept of mental illness

Section II. General psychopathology

The development of psychiatry in recent years is associated with the growth of a number of biological sciences - anatomy, physiology of the central nervous system, pathological anatomy, physiology, biochemistry, etc.

An important stage in the evolution of psychiatric knowledge dates back to the mid-19th century, when it was established that mental illnesses are diseases of the brain. Subsequently, the position that mental disorders are caused by a disease of the central nervous system was somewhat modified, since the importance of the general state of the body for the psyche was established.

Mental illness- the result of complex and varied disorders of the activity of various systems of the human body, with predominant damage to the brain, the main signs of which are disorders of mental functions, accompanied by a violation of criticism and social adaptation.

There is no one reason that causes mental illness and cannot exist. Οʜᴎ can be congenital or acquired, resulting from traumatic brain injury or as a result of previous infections, and are detected at a very early or old age. Some of the reasons have already been clarified by science, others are not yet precisely known. Let's look at the main ones.

Intrauterine injuries, infectious and other diseases of the mother during pregnancy, and as a result, “deformities” of the newborn. As a result, the nervous system and, first of all, the brain are formed incorrectly. Some children experience developmental delays and sometimes disproportionate brain growth.

Hereditary factors caused by incorrect chromosome segregation. In particular, nondisjunction of chromosome 21 causes Down syndrome. Modern genetics believes that the information that determines the structure of the body is contained in chromosomes - structures found in every living cell. Human cells have 23 pairs of chromosomes. Anomalies in the 21st pair system are the cause of Down syndrome. At the same time, in the overwhelming majority of cases we are talking about a hereditary predisposition to mental illness.

Brain damage due to traumatic brain injury, cerebrovascular accident, progressive sclerosis of cerebral vessels and other diseases. Contusions, wounds, bruises, and concussions suffered at any age can lead to mental disorders. Οʜᴎ appear either immediately, immediately after the injury (psychomotor agitation, memory loss, etc.), or after some time (in the form of various deviations, including convulsive seizures).

Infectious diseases- typhus and typhoid fever, scarlet fever, diphtheria, measles, influenza and, especially, encephalitis and meningitis, syphilis, which primarily affects the brain and its membranes.

Effect of toxic, poisonous substances. This is primarily alcohol and other drugs, the abuse of which can lead to mental disorders. The latter can occur due to poisoning with industrial poisons (teraethyl lead), due to improper use of medications (large doses of quinine, etc.).

Social upheaval and traumatic experiences. Mental trauma should be acute, often associated with an immediate threat to the life and health of the patient or his loved ones, as well as chronic, relating to the most significant and difficult aspects for a given individual (honor, dignity, social prestige, etc.). These so-called reactive psychoses are characterized by a clear causal dependence, the “sounding” of an exciting theme in all the patient’s experiences and relative short duration.

In most cases, psychiatry generally divides diseases into “endogenous”, i.e. those arising from internal causes (schizophrenia, manic-depressive psychosis), and “exogenous”, provoked by environmental influences. The reasons for the latter seem more obvious. The pathogenesis of most mental illnesses should be presented only at the level of hypotheses.

Concept, etiology and pathogenesis of mental illnesses - concept and types. Classification and features of the category “Concept, etiology and pathogenesis of mental illnesses” 2017, 2018.

From the standpoint of practical expediency, mental illnesses are classified as endogenous in origin. Exogenous diseases are a consequence of the pathological influence of “in” on brain activity

various external (relative to brain tissue) physical, chemical and psychogenic-traumatic factors. These include harmful infectious-allergic, metabolic, intoxication, thermal, mechanical cerebrotraumatic, radiation and other physical and chemical effects, as well as those caused by unfavorable social circumstances, in particular, those entailing intrapersonal conflicts. Most researchers of psychogenic-traumatic mental disorders belong to a third independent group called “psychogeny.”

If the main causes of exogenous diseases are well known, then the questions of the etiology of endogenous mental illnesses (schizophrenia, manic-depressive or bipolar psychosis, so-called idiopathic or genuin epilepsy, some psychoses of late age) cannot be called resolved. Diseases develop under the influence of hereditary, constitutional, age-related and other characteristics of the body, which dictate certain biochemical, immune and other changes, which leads to primary pathological disorders of mental activity. According to generally accepted ideas, any external factors can influence the onset and further course of endogenous diseases, and not be their root cause.

However, some authors consider it inappropriate to distinguish groups of endogenous mental diseases, because they associate the occurrence of these disorders with the consequences of exogenous influences that are fixed in the genetic matrix for future generations. That is, the listed diseases in a particular patient are caused by certain exogenous (or environmental) influences on his close or distant relatives, which are inherited by the patient.

Thus, the doctrine of the etiology of mental illness is still far from perfect. At the same time, the least known, as in all other pathologies, are the cause-and-effect relationships of many factors influencing mental activity.

A person’s encounter with any potentially pathogenic agent does not at all mean the fatal inevitability of mental illness. Whether or not the disease develops depends on a number of factors. they can be divided as follows: constitutional-typological (genetic and congenital zoomlet ~ yakbstT, features, morphological and functional constitution, individual characteristics of biochemical, immune, vegetative and other processes) somatic (acquired characteristics of metabolic processes due to the state of internal organs and systems and ecology) psychosocial (the uniqueness of interpersonal, including industrial, family, etc. relationships of the patient in the micro- and macro-environment).

By analyzing the mutual influence of constitutional-typological, somatogenic and psychosocial aspects in each specific case, we can come closer to understanding why, for example, during an influenza epidemic, the mental reaction of one patient is limited to an adequate individual reaction within the limits of mental reserves, while another is limited to a short-term pathological reaction of the psyche , in another patient it takes the form of a stable neurosis-like or neurotic state, or an obvious mental disorder of a similar nature is observed. Therefore, the occurrence of mental illness cannot be methodologically made strictly dependent on any, even powerful factors. It is more correct to talk about the interaction of a certain factor with the individual mechanisms of biological, psychological and social adaptation of a person. So, mental illness is a consequence of an individual’s unsatisfactory integral adaptation to biopsychological influences. Moreover, each mental illness has its own main cause, without which the disease cannot develop. For example, post-traumatic encephalopathy will not occur without traumatic brain injury.

It should be noted the high importance of all three of the above groups of factors leading to mental disorders, and emphasize the not absolutely pathogenic significance of each of them separately. For example, pointing out the important role of heredity in the occurrence of diseases such as schizophrenia and manic-depressive psychosis, we must remember that even if one of the identical twins has any of these diseases, the risk of this disease in the other is quite large, but it is not 100 %. Therefore, we should talk about heredity not of endogenous mental pathology, but of predisposition to it. This also applies to the influence of innate personality traits, morphological constitution, typical vegetological characteristics, etc.

In the implementation of hereditary predisposition, the influence of additional harmful factors plays a large role. Most researchers indicate that the onset of schizophrenia and its relapses in almost two-thirds of cases are provoked by mental or physical trauma, somatic illness, intoxication, etc. Psychogenies (neuroses, reactive psychoses), delirium delirium and other disorders of consciousness most often occur against the background of somatic problems.

The origin of some mental illnesses is directly related to age. For example, oligophrenia causes mental retardation, forms in early childhood, or is a consequence of congenital underdevelopment of the brain. Pycnoleptic attacks in children stop during puberty. Pre-senile and senile psychoses occur at a late age. During crisis age periods (puberty and menopause), mental disorders such as neuroses and psychopathy more often debut or decompensate.

The gender of patients is of some importance. Thus, affective mental disorders occur more often in women than in men. In women, the following diseases predominate: Pick, Alzheimer's, involutional, hypertensive and menopausal psychoses. Naturally, they experience mental disorders due to hormonal and other changes during pregnancy or childbirth. And among people with atherosclerotic, intoxication, syphilitic psychoses, as well as patients with alcoholism and alcoholic psychoses, with neuropsychic disorders caused by traumatic brain injuries, men predominate.

A number of psychosocial and exogenous factors that lead to mental disorders, directly related to the patient’s professional activities. We are talking about such harmful production factors as mental and physical overload, emotional stress, intoxication, hypothermia and overheating, high levels of vibration, radiation pollution, noise, hypoxia, physical inactivity, various types of deprivation, etc. Each of these adverse effects has psychopathological consequences are quite typical. For example, psychosocial situations accompanied by excessive mental stress more often lead to neurotic disorders. While a pronounced deficit of sensory and other types of stimulation predominantly causes deviations in the psychotic register.

It is advisable to mention seasonal changes in mental activity. In some psychopathological conditions, especially endogenous psychoses with a phase course, exacerbations are observed in the autumn and spring periods. The adverse effects of intense changes in meteorological factors should be noted. Patients with vascular, cerebrotraumatic and other organic brain disorders are very sensitive to them.

The situation negatively affects the neuropsychic state, leading to so-called desynchronosis. This refers to disturbances in biological rhythms, for example, daytime wakefulness and sleep at night, the division of mental and physical stress of an inadequate type of character (“night owl” and “lark”), artificially provoked disturbances of the menstrual cycle, etc.

The pathogenesis (or mechanism of development) of mental illness is determined by the interaction in the prenatal and postnatal periods of hereditarily determined factors in the individual’s body and unfavorable psychosocial, physical and chemical effects on his personality, brain and extracerebral somatic sphere. Biochemical, electrophysiological, immune, morphological, systemic and personal changes that arise as a result of such interaction and which can be studied using modern methods are accompanied by characteristic pathophysiological disorders. In turn, such changes are subject to certain spatiotemporal patterns, which ultimately determine the stereotypical manifestations of painful neuropsychic signs, their dynamics and specificity.

Thus, the pathogenesis, and consequently the form of mental illness, is determined by the unique individual reactions that have developed in the process of ontogenesis and phylogenesis to many situations of both an exogenous and endogenous nature. It should be noted that the neuropsychic sphere of each individual person responds to various pathogenic influences with typical limitations for a given individual and a stereotypical set of reactions.

Moreover, the same harmful effect in different people, depending on the individual compensatory capabilities of the body and a number of other circumstances, can lead to a variety of psychopathological complexes. For example, alcohol abuse is accompanied by psychotic states, which differ markedly from each other. Here it is worth recalling alcoholic delirium, acute and chronic alcoholic hallucinosis, acute and chronic alcoholic paranoid, Korsakov's polyneurotic psychosis, alcoholic pseudoparalysis, Gaye-Wernicke encephalopathy. The same infectious disease can lead to febrile delirium, or amentia, epileptiform syndrome, symptomatic mania, and in the long term - to Korsakoff amnestic syndrome, post-infectious encephalopathy, etc.

Examples of monoetiological monopatho-genetic diseases should also be given. Thus, genetically determined metabolic disorders play a leading role in the origin of phenylpyruvic-inflammatory oligophrenia. Or a second example: cytological studies have revealed a specific chromosomal disorder on which the pathogenesis of Down disease is based.

At the same time, various etiological factors can “trigger” the same pathogenetic mechanisms that form the same psychopathological syndrome. As already mentioned, a delirious state, for example, occurs in patients with alcoholism and infectious diseases in a state of fever. It is also observed after traumatic brain injury, intoxication with various substances, and in somatic diseases (somatogenic psychosis). A convincing illustration of the existence of such psychopathological conditions that arise for various reasons is epilepsy, which belongs to the polyetiological monopathogenetic diseases.

However, the stability of an individual psychopathological reaction is relative. Qualitative and quantitative characteristics of painful symptoms depend on many circumstances. In particular, on the age of the person. So, for children, due to the morphological immaturity of the central nervous system, and then the insufficiency of abstract-logical, mental processes, atypical ideational, formerly delusional, deviations. For this reason, pathological psychomotor (convulsions, agitation, stupor), as well as emotional (weakness, excessive lability, fear, aggression) phenomena are observed quite often in them. As the child transitions to adolescence, adolescence and adulthood, elements of delusion may first appear, and then delusional disorders, and finally persistent delusional states.

The study of the etiology of a mental disorder in each case is a mandatory prerequisite for the rational construction of so-called etiological therapy, the purpose of which is to sanitize the external and internal environment of the patient. Disclosure of pathogenesis contributes to the choice of strategy, tactics and methods of pathogenetic treatment, aimed at destroying internal pathological connections that determine individual symptoms and syndrokinesis.

Knowledge of the etiological factors and pathogenetic mechanisms of mental illness, along with the analysis of clinical psychopathological and somatoneurological signs, is the basis for classifying the disorder, and therefore predicting, solving social problems of psychiatric care.

Modern teaching about the etiology of mental illnesses is still imperfect. And now, to some extent, the old statement of H. Maudsley (1871) has not lost its significance: “The causes of insanity, usually listed by authors, are so general and vague that it is very difficult when meeting face to face with a reliable case of insanity and under all favorable research conditions determine with certainty the causes of the disease."

In psychiatry, as in all other pathologies, the connection between cause and effect represents the most unknown area.

For the occurrence of mental illness, like any other, the external and internal conditions in which the cause operates are of decisive importance. The cause does not always cause the disease, not fatally, but only when a number of circumstances coincide, and for different causes the significance of the conditions determining their action is different. This applies to all causes, including pathogens of infectious diseases. One type of infection, once in the body, almost inevitably causes illness (the causative agent of plague, smallpox), other infectious diseases develop only in appropriate conditions (scarlet fever, influenza, diphtheria, dysentery). Not every infection causes illness, and not every infectious disease leads to psychosis. It follows from this that a “linear” understanding of etiology does not explain the complexity of the occurrence of mental illnesses, as well as any others [Davydovsky I.V., 1962]. The “linear” understanding of influenza as the cause of infectious psychosis and mental trauma as the cause of neurosis is obvious. At the same time, such an unconditionally correct interpretation of cause and effect at first glance becomes simplified and helpless when interpreting not only the nature of the diseases that arise in such cases, but also the disease of the individual patient. It is impossible, for example, to answer the question why the same cause, in this case the flu, causes transient psychosis in one person, chronic psychosis in another, and does not lead to any mental disorder at all in the vast majority of people. The same applies to psychogenic trauma, in some cases causing neurosis, in others - decompensation of psychopathy, and in others - not causing any painful abnormalities. Further, it is discovered that very often the cause that directly caused the pathology is not equal to the effect - an insignificant cause results in far-reaching changes. Thus, at first glance, the main and only cause of the disease, the same flu or mental trauma, as the mental pathological process develops, turns into something completely secondary, into one of the conditions for the occurrence of the disease. An example of this is a chronic progressive mental illness (schizophrenia), which occurs immediately after influenza or psychogenic trauma, or even a physiological process - normal childbirth.

In all such cases, inevitably obeying the laws of determinism, the initial “linear” connections begin to expand and, in addition to them, various individual properties of the sick person are introduced. As a result of this, the visible external cause (causa externa) becomes internal (causa interna), i.e. in the process of analyzing the origin and development of the disease, extremely complex cause-and-effect relationships are discovered (I.V. Davydovsky).

The occurrence of diseases, including mental ones, their development, course and outcome depend on the interaction of the cause, various harmful environmental influences and the state of the body, i.e. from the ratio external (exogenous) And internal (endogenous) factors (driving forces).

Endogenous factors are understood as the physiological state of the body, determined by the type of higher nervous activity and its characteristics at the time of exposure to harmful effects, gender, age, hereditary inclinations, immunological and reactive characteristics of the body, trace changes from various harmful effects in the past. Thus, endogenous is not considered either as a purely hereditary condition or as an unchangeable state of the organism [Davydovsky I.V., 1962].

The importance of exogenous and endogenous driving forces varies in different mental illnesses and in different patients. Each disease, arising from a cause, develops as a result of its characteristic interaction of the named driving forces. Thus, acute traumatic psychoses occur when direct external influence predominates. For infectious psychoses, endogenous features are often of great importance (febrile delirium most often develops in children and women). Finally, there are certain mental illnesses in which, in the words of I.V. Davydovsky, the producing etiological factor is not directly felt, and the very development of painful phenomena sometimes comes as if from the basic physiological (endogenous) state of the subject, without a tangible push from the outside. A number of mental illnesses not only begin in infancy, but are also detected in subsequent generations (in children and grandchildren). Each nosologically independent disease has its own history (hystoria morbi), which in some species spans not one, but several generations.

Environmental and internal environmental conditions, depending on specific circumstances, can prevent or contribute to the onset of the disease. At the same time, conditions alone, even in extreme combination, cannot cause illness without a reason. Neutralization of the cause prevents the occurrence of the disease even under all the conditions necessary for it. Thus, timely intensive treatment of infectious diseases with antibiotics and sulfonamide drugs prevents the development of delirium, including with an endogenous predisposition to it. With the beginning of aseptic management of childbirth, the number of septic postpartum psychoses decreased many times in all countries.

The nosological independence of each individual mental illness is determined by the unity of etiology and pathogenesis (Nosology - classification of diseases (Greek nosos - disease). In the classification of animals and plants, the designation taxonomia is used (Greek taxis - order of arrangement, nomos - law). The nomenclature is a list of categories or designations. When compiling the classification itself, it is necessary to define categories according to general and particular characteristics; categories are established according to an ordinal (family, genus, species) or hierarchical principle.). In other words, a nosologically independent mental illness (nosological unit) consists only of those cases of the disease that arise as a result of the same cause and exhibit the same development mechanisms. Diseases that arise from the same cause, but with a different mechanism of development, cannot be combined into a nosologically independent disease. An example of such etiologically homogeneous, but nosologically different diseases can be syphilitic psychosis, tabes dorsalis, and progressive paralysis. All these diseases arise as a result of syphilitic infection, but their pathogenesis is completely different, which makes them nosologically different diseases. The same can be said about delirium tremens, Korsakoff psychosis, alcoholic delirium, jealousy, alcoholic hallucinosis: their etiology is the same - chronic alcoholism, but the pathogenesis is different, so each is an independent disease. In exactly the same way, diseases with the same pathogenesis but different etiologies cannot be considered as a nosologically unified disease. The pathogenesis of delirium is the same in chronic alcoholism, rheumatism, and pellagra, but its etiology is different. In accordance with this, independent diseases (individual nosological units) are distinguished: delirium tremens, rheumatic psychosis, pellagrosis psychosis.

The unity of etiology and pathogenesis has not yet been established for all mental illnesses: in some cases the cause has been found, but the pathogenesis has not yet been studied; in others, the pathogenesis is more completely studied, but the etiology is unknown. Many mental illnesses are identified as nosological units only on the basis of uniformity of clinical expression. This establishment of the nosological independence of diseases is justified by the fact that clinical manifestations, their development and outcome are an external expression of the characteristics of the pathogenesis and pathokinesis of the disease and, therefore, indirectly reflect its etiological characteristics. A historical example of this could be progressive paralysis, which in the middle of the 19th century. identified as a nosological entity only on the basis of clinical examination data. Establishment at the beginning of the 20th century. its syphilitic etiology and pathogenesis, different from other forms of syphilis of the central nervous system, confirmed the nosological independence of this disease, first substantiated exclusively by the clinical method.

Such a significant difference in knowledge of the nature of individual mental illnesses reflects both the history of development and the current state of psychiatry. There is no doubt that further progress in the study of the pathogenesis, etiology and clinical picture of mental illnesses will make further significant adjustments to the modern nosological classification of diseases.

Nosos and pathos(Reproduced in an abbreviated form from the book: “Schizophrenia. Multidisciplinary research.” - M.: Medicine, 1972. - P. 5-15.) . Nosos - disease process, dynamic, ongoing formation; pathos - pathological condition, persistent changes, the result of pathological processes or a defect, developmental deviation. Nosos and pathos are not separated by a rigid boundary. The transition from one state to another can be detected experimentally and modeled. Repeated sensitization of an animal to some protein, bringing sensitivity to it to the highest degree, does not yet cause disease in the animal in the clinical-anatomical sense, but only creates readiness for it in the form of new reactive abilities based on existing physiological specific and individual prerequisites [Davydovsky I.V., 1962]. When a phenomenon of local or general anaphylaxis of this kind is caused in the same animal, the newly emerged mechanisms are realized, creating the disease. Based on the data provided by I.V. Davydovsky argued that the existence of pathogenetic mechanisms should be strictly distinguished from the presence of a pathological process, i.e. pathos and nosos are not identical. Pathogenetic mechanisms consist only in the possibility of a pathological process.

Pathos also include diathesis, characterized by peculiar reactions to physiological stimuli and manifested by more or less pronounced pathological changes and predisposition to certain diseases. Diathesis, interpreted in a broad sense, refers to an illness in the understanding of I.V. Davydovsky. He wrote the following about this: “The ailments of old age, like other illnesses or ailments with a general decline in vital activity, indicate that the range of adaptive abilities is not measured by the alternative - illness or health. Between them there is a whole range of intermediate states, indicating special forms of adaptation , close sometimes to health, sometimes to diseases, and yet being neither one nor the other.” Close to the concept of “diathesis”, in particular schizophrenic, schizosis by H. Claude, schizopathy by E. Bleuler, schizophrenic spectrum by S. Kety, P. Wender, D. Rosenthal.

It is quite possible that none of the deviations in the activity of the body of a patient with schizophrenia, currently established by biological research, relates to manifestations of the actual processual development of the disease, but represents a sign, stigma of pathos, diathesis. In relation to schizophrenia we are talking about pathological, i.e. schizophrenic constitution, as P.B. said for the first time in 1914. Gannushkin in the article “Raising the question of the schizophrenic constitution.”

Nosos and pathos are not identical, but their absolute difference, opposition would be erroneous. In the past, domestic psychiatrists were quite absolutist-critical of E. Kretschmer’s concept of an exclusively quantitative difference between schizoidia and schizophrenia. Meanwhile, the merit of E. Kretschmer, as well as E. Bleuler, I. Berze, E. Stransky and other researchers is that they discovered and described the presence of soil (sources) in the form of schizoidia, latent schizophrenia, on which, under the influence of not yet Under conditions known to us, the schizophrenic process crystallizes in a limited number of cases. In 1941, J. Wyrsch wrote about the relationship between the schizoid constitution and schizophrenia. All these authors described carriers of the pathogenetic mechanisms of schizophrenia, which contained the prerequisites for its development as a disease. I.V. Davydovsky constantly emphasized that pathological processes in humans arose in distant eras as a product of insufficient human adaptation to the environment (social and natural); Many of human diseases are hereditary, the manifestation of a number of them is due to ontogenetic factors - childhood, puberty, old age. S.N. Davydenkov, exploring the pathogenesis of obsessional neurosis, also believed that the painful factors of neuroses arose in society a very long time ago and it is likely that prehistoric man was not free from them. In the light of the natural-historical and biological understanding of the problems of medicine, it is indisputable that diseases arose with the first signs of life on Earth, that disease is a natural, adaptive phenomenon (S.P. Botkin (Cit. Borodulin F.R. S.P. Botkin and the neurogenic theory of medicine. - M., 1953.), T. Sokolsky (Cit. Davydovsky I.V. Problems of causality in psychiatry. Etiology. - M., 1962. - 176 p.)).

This adaptation is extremely variable. Its range extends from deviations, indicated by accentuation, pronounced stigmatization, diathesis, to qualitative differences, marking the transformation of pathogenetic mechanisms into a pathogenetic process (pathokinesis).

The above comparisons allow us to consider nosos and pathos in unity, despite their qualitative differences. Now many years of experience have shown that the most justified study of schizophrenia, as well as many other diseases, is possible if, firstly, it is not limited to statics, but is constantly combined with dynamics, with a thorough study of all the features of the course; secondly, when it is not limited to the clinical picture, but becomes clinical and biological; thirdly, when it is not limited to the study of only the sick person, but extends, if possible, to many relatives, i.e. the study of nosos is combined with the study of pathos. This approach opens up the greatest opportunities for establishing both pathogenetic mechanisms and the reasons that turn them into pathokinesis.

Speaking about nosos and pathos, it should be noted that their relationships are dynamic. A completed schizophrenic process or attack usually leaves behind lasting personality changes. However, complete recovery from any disease “is not a restoration of previously existing health, it is always new health, i.e. some sum of new physiological correlations, a new level of neuroreflex humoral immunological and other relationships” (I.V. Davydovsky).

Differential diagnosis of remissions and persistent personality changes is difficult and becomes even more difficult if there is an additional disorder in the form of continuous cyclothymic phases. Phases such as the expression of a nonspecific disorder can occur not only during schizophrenia, but also many other mental illnesses - epilepsy and organic psychoses (for example, progressive paralysis). It is possible that in some cases this is the result of persistent changes that arise in the process, merging with the pathos. In this regard, it should be recalled that P.B. Gannushkin attributed cyclothymia to constitutional psychopathy, and I.P. Pavlov at one time said: “Disturbed nervous activity seems to fluctuate more or less regularly... One cannot help but see analogies in these fluctuations with cyclothymia and manic-depressive psychosis, it would be most natural to reduce this pathological periodicity to a disruption of the normal relationship between irritable and inhibitory processes, as regards their interaction.” P.D. Gorizontov also notes that the course of any functional changes most often has a wave-like character with alternation of different phases.

Since cyclothymic phases are combined with residual symptoms, there is reason to consider them as an expression of a weakened, but still ongoing process. True, it is not uncommon to encounter patients who have suffered an attack in whom mild continuous cyclothymic phases most likely belong to a persistent, residual condition. The pathogenetic nature of the cyclothymic phases remains far from clear.

Persistent post-processual personality changes, manifested by psychopathic disorders in the broad sense (the dynamics of psychopathy), must be distinguished from psychopathic (psychopath-like) changes that characterize the initial period or low-progressive course of the schizophrenic process. Their similarity lies not only in the fact that they are limited to personality changes, but very often in the presence of infantilism or juvenileism in such patients (general or just mental). However, there are also significant differences: changes in personality that arose as a result of post-processual development are unchanged in the intensity of manifestations; with the psychopathic type of onset of schizophrenia, these changes are extremely labile and have a clear tendency to intensify; the personality in the latter case is changed, but not modified, “represents only a pronounced development and strengthening of the outstanding character traits and properties of the individual” (W. Griesinger).

A comparison of the above personality changes - initial and post-processual, as well as cyclothymic - illustrates the unity of nosos and pathos and at the same time their difference. The unity of pathos (persistent changes) and nosos (development of the process) is especially clear in cases of childhood schizophrenia. Its clinical manifestations include, along with schizophrenic disorders themselves, changes in the form of delay or arrest of mental development, i.e. in the form of secondary oligophrenia or in the form of signs of mental infantilism.

Initial psychopathic personality disorder, which arises as an expression of a low-progressive schizophrenic process, indicates a relatively favorable course of the disease and the sufficiency of compensatory and adaptive mechanisms.

E. Kraepelin once defined the special personality type of those predisposed to manic-depressive psychosis as the initial, prodromal, rudimentary manifestation of this psychosis, which can remain throughout life without further dynamics or, under certain circumstances, become the starting point for the full development of the disease. The same thing can apply to schizophrenia to the same extent.

As already mentioned, “compensatory and adaptive mechanisms and reactions become more important the slower the main pathological process unfolds” (I.V. Davydovsky). To the credit of psychiatrists, it must be said that the attempt to understand the symptoms of the disease as a manifestation of adaptive-compensatory mechanisms belongs to them. In the first half of the 19th century. V.F. Sabler considered, for example, delirium as an adaptive, compensatory phenomenon that “relegates into the background and covers the primary melancholy affect.” In this case, he interpreted the adaptive, compensatory meaning of psychopathological disorders in a psychological sense. Psychologically, a number of authors interpret autism as an adaptive disorder, for example, when it is considered as compensation, as a kind of isolation from the outside world due to imperfection and weakness of adaptation to it.

Interpretation by V.F. The understanding of some mental disorders as adaptive mechanisms goes beyond the actual psychological aspect and, in a certain sense, extends to pathogenesis. So, for example, he writes: “In most cases, we observe that with the onset of insanity, the physically formidable symptoms weaken. If, for example, insanity sets in in old people after apoplexy, then we can predict for them several more years of life.”

Considering psychopathological symptoms as manifestations of the action of adaptive mechanisms, it can be assumed that disorders such as changes in personality (psychopathic-like states, psychopathic personality development, cyclothymic disorders, as well as paranoid changes) indicate not only the slow development of the pathological process, but also the defeat relatively shallow levels of biological systems underlying mental activity. The latter is confirmed by the insignificant severity of signs of a defect (regression) in the clinical picture of such conditions. G.Schtile believed that negative disorders (dementia) determine the extent of mental disorder. The severity of negative disorders can be judged by the extent of the mental disorder.

From all the above provisions, the conclusion follows about the relative specificity of the clinical manifestations of psychogenic and endogenous psychoses, minor and major psychiatry. Pathological development of personality can occur as a modification of it as a result of psychogenic trauma and as a result of an attack of schizophrenia. Neurotic disorders develop as a reaction to a situation and endogenously, in the form of “minor mental disorders” - asthenic, psychasthenic, hysterical. Psychopathy can be congenital or acquired as a result of a previous or current low-progressive process. V.Kh. spoke about this at one time. Kandinsky and S.S. Korsakov, who divided psychopathy into original (congenital) and acquired. They called the latter constitutional in the sense of a radical modification of the constitution under the influence of an experienced, easily ongoing disease process or, finally, a pathologically occurring age shift - youthful, menopausal, senile. The same applies to cyclothymic disorders. The question of the ambiguity of the concepts of “neurosis,” “psychopathy,” and “psychosis” was first raised by T.I. Yudin. They are both nosological categories and general pathological categories - the severity of a mental disorder.

Exogenous and organic psychoses, as is known, can also occur in the form of endogenous disorders (so-called intermediate syndromes, late symptomatic psychoses, endoform syndromes). All this once again indicates the internal mediation (causa interna) of both mental and somatic manifestations of the disease. This relative specificity of mental disorders, however, does not exclude the nosological conditionality of the manifestations of the disease. The latter represents a set of positive and negative, constitutional and individual characteristics that express the unity of the etiology and pathogenesis of a nosologically independent disease and its implementation in a particular patient. G. Schule once said that the nosological independence of a mental illness (hence, the specificity of manifestations) can be established as a result of a clinical analysis of the quality, characteristics of the course and determination of the volume of a mental disorder.

The result of a clinical-pathogenetic and genealogical study of a nosologically independent disease depends on the detection and accuracy of recognition of all deviations in the mental activity of the proband’s relatives, deviations not only in the form of the disease, but also “pathologies” - true psychopathy, pseudopsychopathy, initial and post-processual states. However, all this can be done only by moving from knowledge of the expressed manifestations of the disease to the unexpressed, from its fully developed forms to barely outlined ones, from illness to illness and health (P.B. Gannushkin).

Principles of classification of mental disorders in accordance with the International Classification of Diseases, 10th revision (ICD-10).

ICD mental disorders F00-F09 Organic, including symptomatic, mental disorders F10-F19 Mental disorders and behavioral disorders associated with the use of psychoactive substances F20-F29 Schizophrenia, schizotypal and delusional disorders F30-F39 Mood disorders [affective disorders] F40-F48 Neurotic, stress-related and somatoform disorders F50-F59 Behavioral syndromes associated with physiological disorders and physical factors F60-F69 Personality and behavior disorders in adulthood F70-F79 Mental retardation F80-F89 Psychological development disorders F90-F98 Emotional disorders, behavioral disorders, usually beginning in childhood and adolescence F99 Unspecified mental disorders The following categories are designated by an asterisk: F00* Dementia in Alzheimer's disease F02* Dementia in other diseases classified elsewhere Classification of mental disorders is one of the most important and complex problems in psychiatry. There are three main principles for classifying mental disorders. 1. Syndromological principle. The theoretical basis of the syndromological approach is the concept of “single psychosis”. The concept is based on the idea of the unified nature of various mental disorders. The difference in the clinical picture is explained by observing patients at different stages of the disease. The establishment of the etiological factors of individual mental illnesses has called into question the concept of a single psychosis. However, since the second half of the twentieth century, the syndromic approach has again begun to be widely used in creating classifications.

Organization of psychiatric care for the population of the Russian Federation and the Republic of Sakha (Yakutia).

The organization of mental health care in the Russian Federation is based on 3 main principles: differentiation(special) assistance to large groups of patients, steps And succession help in the system of times, mental health institutions.

Diff n-schi for sick ps-mi b-mi otr-na in creating several types of ps-oh n-schi. Creation of a special department for patients with acute and borderline conditions, with age-related psychoses, children, etc. Organization of social support, creation of a home for the disabled (psychiatric boarding schools), for chronically ill patients, organization -mi education - boarding schools and schools for mentally retarded children and others.

Step org-and ps-oh n-schi vyr-xia in the presence of max closer to the population of non-sick, semi-stationary and stationary p-schi. Out-of-patient care including psychoneural dispensary, dispensary department of hospitals, psychiatric, psychotherapy and drug treatment rooms at the polycl, medical unit, as well as medical treatment, labor workshops. The semi-stationary station includes day stations, in the regular rel. and belonged to the psychoneurological dispensary; in the station - ps-e hospitals and ps-e departments in other hospitals.

Succession Ensure a close functional connection with the established departments, which is regulated by the fields and instruments of the Ministry of Health of the Russian Federation. This allows for continuous observation of the patient and his treatment during the transition from one hospital to another.

In the Russian Federation, there is a special accounting of the patients’ dogs, it is carried out by the region, city and paradise of the psychoneural disparities, the psychoneurosis offices of the paradise polycl and the paradise sick center, in which the health care organization is obliged to have complete lists of the patients’ dogs, having lived to serve them. The registration system makes it possible to identify with a sufficient degree of reliability the prevalence throughout the country of the main forms of mental illness, including mild ones and especially the so-called borderline conditions. Establishing the prevalence of mental illnesses is facilitated by the accessibility and proximity of the network of psychoneurological institutions to the population and their contact with neurological and other medical institutions. To carry out a study of the prevalence of mental illnesses, the Ministry of Health of the Russian Federation has developed and approved clinical accounting criteria. The relevant documents are adapted to the International Classification of Diseases compiled by WHO. Based on registration data and the results of clinical and statistical studies conducted by scientific and practical institutions, reliable information is obtained on the prevalence of mental illnesses, their structure and dynamics.

General patterns of the dynamics of mental illness. Etiology and pathogenesis of mental disorders.

Etiology answers the question of why a disease occurs, what is its cause, pathogenesis answers the question of how the disease process develops, what is its essence. Pathomorphology studies the morphological changes that occur in organs, tissues and cells of the body as a result of disease.

The causes of mental illness are varied. Basically they are the same as for other human somatic diseases. It is difficult to list the causes of mental illness and various variants of congenital and acquired dementia (dementia, mental retardation), since a number of diseases are caused not by one, but by a combination of many etiological factors. At the same time, knowledge of the causes of the disease is necessary for prevention and prevention of the development of the disease.

When an organism, especially a child’s, is exposed to pathogenic factors that subsequently lead to mental dysfunction, the outcome depends, firstly, on the strength of the pathogenic effect, secondly, on the stage of ontogenesis at which these factors act, and, thirdly, thirdly, on the state of the central nervous system, its ability to mobilize the body’s protective properties.

A causative pathogenic factor acting in the early stages of ontogenesis can cause not only temporary functional disorders, but also perverted development of the brain, as well as malformations of other organs and systems.

The cause of mental illness determines its most important qualitative features. However, the effect of the cause is not isolated, it is determined by the conditions in which the organism is located. Some conditions reduce the body's resistance, its protective properties and thereby enhance the effect of the cause, while others mobilize the body's protective properties and weaken and neutralize its effect. Thus, the occurrence of a disease, its course, prognosis and outcome depend on the cause that caused it and the totality of external and internal conditions in which it operates.

Pathogenesis (Greek παθος - suffering, disease and γενεσις - origin, occurrence) is the mechanism of the origin and development of the disease and its individual manifestations. It is considered at various levels - from molecular disorders to the organism as a whole.