Psychosis manifestations. Psychosis
Psychosis– a mental illness in which a person cannot adequately perceive the surrounding reality and respond to it appropriately. Psychoses are very diverse in their manifestations. They accompany many diseases, such as schizophrenia, senile dementia, delirium tremens, or can be an independent pathology.
So what is psychosis?
This is a mental disorder in which reality is so distorted in a person’s mind that this “picture” no longer has anything in common with what other people see. What prevents a person from being objective is constant fear for his life, voices in his head that order him to do something, visions that are no longer available to anyone... These internal prisms change the patient’s behavior. His reactions become completely inadequate: causeless laughter or tears, anxiety or euphoria. Psychosis manifests itself differently in all patients. Some are confident that the special services are hunting for them, others assure others of their superpowers, and still others persistently pursue the object of their love, groundlessly laying claim to it. It is impossible to list all the manifestations of psychosis, but psychiatrists managed to systematize them by combining them into groups.
Psychosis is not just a wrong train of thought. There is no need to think that the sick person is mistaken or cannot keep his nerves under control. There is no point in arguing, much less condemning him. Psychosis is the same disease as diabetes. This is also a metabolic disorder, but only in the brain. You are not afraid of diabetics, you do not judge them for their disease. You sympathize with them. Patients with neurosis deserve the same treatment. By the way, scientists have proven that mentally healthy people commit crimes more often than people with psychosis.
You shouldn't put a mark on a person. Psychosis is not a life sentence. It happens that after a period of illness, which can be quite severe, the psyche is completely restored and problems never arise again. But more often the disease is cyclical. In this case, after a long period of health, an exacerbation occurs: hallucinations and delusional ideas appear. This happens if you do not strictly follow the recommendations of your doctor. In severe cases, the disease becomes chronic, and mental health does not return.
Psychosis is a fairly common problem. According to statistics, 15% of patients in mental hospitals are patients with psychosis. And 3-5% of the total population suffer from psychosis caused by various diseases: asthma, cerebral atherosclerosis, etc. But there are still thousands of people whose psychosis is associated with external causes - taking drugs, alcohol, medications. To date, doctors cannot calculate the exact number of patients with psychosis.
Psychosis affects both children and adults, men and women. But some forms of the disease predominantly affect women. Thus, women suffer from manic-depressive syndrome 3-4 times more often. Psychoses most often occur during menstruation, menopause and after childbirth. This suggests that mental illness is associated with fluctuations in hormone levels in the female body.
If you or someone close to you shows signs of psychosis, do not despair. Modern medicine successfully copes with this disease. And the infamous “registration” was replaced by a consultation with a local psychiatrist - advisory and therapeutic assistance. Therefore, the fact of treatment will not ruin your future life. But attempts to cope with the disease on your own can lead to irreparable changes in the psyche and disability.
Causes of psychosis
The mechanism of psychosis. Psychosis is based on dysfunction of brain cells (neurons). Inside the cell there are components - mitochondria, which ensure cellular respiration and give it energy for activity in the form of ATP molecules. These compounds act as an electrical current for a special sodium-potassium pump. It pumps into the neuron the chemical elements necessary for its operation: potassium, sodium, calcium.If the mitochondria do not produce ATP, the pump does not work. As a result, the vital activity of the cell is disrupted. This neuron remains “hungry” and experiences oxygen deficiency, despite the fact that the person eats normally and spends enough time in the fresh air.
Neurons in which the chemical balance is disturbed cannot form and transmit nerve impulses. They disrupt the functioning of the entire central nervous system, leading to the development of psychosis. Depending on which parts of the brain are more affected, the manifestations of the disease depend. For example, lesions in the subcortical emotional centers lead to manic-depressive psychosis.
Factors and pathologies that lead to psychosis
- Bad heredity.
There is a group of genes that are passed on from parents to children. These genes control the brain's sensitivity to external influences and signaling substances. For example, the neurotransmitter dopamine, which causes feelings of pleasure. People with a family history are more susceptible to the influence of negative factors than others, be it illness or psychological trauma. Their psychosis develops at an early age, quickly and in severe form.
If both parents are sick, the child has a 50% chance of developing psychosis. If only one of the parents is sick, then the risk for the child is 25%. If the parents did not suffer from psychosis, then their children may also face the same problem, having received “defective genes” from previous generations.
- Brain injuries:
- injuries received by the child during childbirth;
- bruises and concussions;
- closed and open craniocerebral injuries.
- Brain intoxication can be caused by various substances.
- Nervous system diseases: multiple sclerosis, epilepsy, stroke, Alzheimer's disease, Parkinson's disease, temporal lobe epilepsy. These brain diseases cause damage to nerve cell bodies or their processes. The death of cells in the cortex and deeper structures of the brain causes swelling of the surrounding tissue. As a result, the functions for which the damaged areas of the brain are responsible are disrupted.
- Infectious diseases: influenza, mumps (mumps), malaria, leprosy, Lyme disease. Living and dead microorganisms release toxins that poison nerve cells and cause their death. Brain intoxication negatively affects a person’s emotions and thinking.
- Brain tumors. Cysts, benign and malignant tumors compress the surrounding brain tissue, disrupt blood circulation, and the transmission of excitation from one brain structure to another. Nerve impulses are the basis of emotions and thinking. Therefore, a violation of the signal transmission manifests itself in the form of psychosis.
- Bronchial asthma. Severe asthma attacks are accompanied by panic attacks and oxygen starvation of the brain. Lack of oxygen for 4-5 minutes causes the death of nerve cells, and stress disrupts the smooth functioning of the brain, leading to psychosis.
- Diseases accompanied by severe pain: ulcerative colitis, sarcoidosis, myocardial infarction. Pain is stress and anxiety. Therefore, physical suffering always has a negative impact on emotions and psyche.
- Systemic diseases associated with impaired immunity: systemic lupus erythematosus, rheumatism. Nervous tissue suffers from toxins secreted by microorganisms, from damage to cerebral vessels, and from an allergic reaction that occurs during systemic diseases. These disorders lead to failure of higher nervous activity and psychosis.
- Lack of vitamins B1 and B3 that affect the functioning of the nervous system. They are involved in the production of neurotransmitters, ATP molecules, normalize metabolism at the cellular level, and have a positive effect on a person’s emotional background and mental abilities. Vitamin deficiency makes the nervous system more sensitive to external factors that cause psychosis.
- Electrolyte imbalance associated with a deficiency or excess of potassium, calcium, sodium, magnesium. Such changes can be caused by persistent vomiting or diarrhea, when electrolytes are washed out of the body, long-term diets, and uncontrolled use of mineral supplements. As a result, the composition of the cytoplasm in nerve cells changes, which negatively affects their functions.
- Hormonal disorders caused by abortion, childbirth, disruption of the ovaries, thyroid gland, pituitary gland, hypothalamus, adrenal glands. Long-term hormonal imbalances disrupt brain function. There is a direct relationship between the nervous system and the endocrine glands. Therefore, strong fluctuations in hormone levels can cause acute psychosis.
- Mental trauma: severe stress, situations in which life was endangered, loss of a job, property or loved one and other events that radically change future life. Nervous exhaustion, overwork and lack of sleep also provoke mental disorders. These factors disrupt blood circulation, the transmission of nerve impulses between neurons, metabolic processes in the brain and lead to psychosis.
Risk factors for psychosis
Age factorDifferent psychoses manifest themselves at different periods of a person’s life. For example, in adolescence, when a hormonal explosion occurs, the likelihood of schizophrenia is high.
Manic-depressive psychosis most often affects young, active people. At this age, fateful changes occur that place a heavy burden on the psyche. This means entering a university, finding a job, starting a family.
During maturity, syphilitic psychoses occur. Since changes in the psyche begin 10-15 years after infection with syphilis.
In old age, the appearance of psychosis is associated with menopause in women, age-related changes in blood vessels and nerve cells. Poor circulation and destruction of nervous tissue leads to senile psychosis.
Gender factor
The number of men and women suffering from psychosis is approximately the same. But some types of psychosis may affect more than one sex. For example, manic-depressive (bipolar) psychosis develops 3 times more often in women than in men. And unipolar psychosis (attacks of depression without a period of excitement) has the same tendency: there are 2 times more female representatives among patients. This statistics is explained by the fact that the female body more often experiences hormonal surges, which affect the functioning of the nervous system.
In men, psychosis due to chronic alcoholism, syphilitic and traumatic psychosis are more common. These “male” forms of psychosis are not related to the level of hormones, but to the social role and behavioral characteristics of the stronger sex. But early cases of psychosis in Alzheimer's disease in men are associated with genetic characteristics.
Geographical factor
It has been noticed that mental illnesses, including psychosis, more often affect residents of large cities. And those who live in small towns and rural areas are at less risk. The fact is that life in big cities is fast paced and full of stress.
Illumination, average temperature and daylength have little effect on the prevalence of diseases. However, some scientists note that people born in the northern hemisphere during the winter months are more prone to psychosis. The mechanism of disease development in this case is not clear.
Social factor
Psychosis often appears in people who have failed to realize themselves socially:
- women who did not marry and did not give birth to a child;
- men who were unable to build a career or achieve success in society;
- people who are not happy with their social status, have failed to demonstrate their inclinations and abilities, and have chosen a profession that does not suit their interests.
Factor of psychophysiological constitution
Hippocrates described 4 types of temperament. He divided all people into melancholic, choleric, phlegmatic and sanguine. The first two types of temperament are considered unstable and therefore more prone to the development of psychosis.
Kretschmer identified the main types of psychophysiological constitution: schizoid, cycloid, epileptoid and hysteroid. Each of these types is equally at risk of developing psychosis, but depending on the psychophysiological constitution, the manifestations will differ. For example, the cycloid type is prone to manic-depressive psychosis, and the hysteroid type more often than others develops hysteroid psychosis and has a high tendency to attempt suicide.
How psychosis manifests itself
The manifestations of psychosis are very diverse, since the disease causes disturbances in behavior, thinking, and emotions. It is especially important for patients and their relatives to know how the disease begins and what happens during an exacerbation in order to begin treatment in a timely manner. You may notice unusual behavior, refusal to eat, strange statements, or an overly emotional reaction to what is happening. The opposite situation also happens: a person ceases to be interested in the world around him, nothing touches him, he is indifferent to everything, does not show any emotions, moves and talks little. Main manifestations of psychosis
Hallucinations. They can be auditory, visual, tactile, gustatory, olfactory. Most often, auditory hallucinations occur. The person thinks he hears voices. They can be in the head, come from the body, or come from outside. The voices are so real that the patient does not even doubt their authenticity. He perceives this phenomenon as a miracle or a gift from above. Voices can be threatening, accusing or commanding. The latter are considered the most dangerous, since a person almost always follows these orders.
You can guess that a person has hallucinations based on the following signs:
- He suddenly freezes and listens for something;
- Sudden silence mid-sentence;
- Conversation with oneself in the form of replicas to someone else’s phrases;
- Laughter or depression for no apparent reason;
- The person cannot concentrate on a conversation with you and is staring at something.
- Manifestations of depressive disorders:
- A person sits in one position for a long time; he has no desire or strength to move or communicate.
- Pessimistic attitude, the patient is dissatisfied with his past, present, future and the entire environment.
- To relieve anxiety, a person can eat constantly or, conversely, refuse food completely.
- Sleep disturbances, early awakenings at 3-4 o'clock. It is at this time that mental suffering is most severe, which can lead to a suicide attempt.
- Manifestations of manic disorders:
- The person becomes extremely active, moves a lot, sometimes aimlessly.
- Unprecedented sociability and verbosity appear, speech becomes fast, emotional, and may be accompanied by grimacing.
- An optimistic attitude; a person does not see problems or obstacles.
- The patient makes unrealistic plans and significantly overestimates his strength.
- The need for sleep decreases, the person sleeps little, but feels alert and rested.
- The patient may abuse alcohol and engage in promiscuous sex.
Delusion is a thinking disorder that manifests itself in the form of ideas that do not correspond to reality. A distinctive feature of delusion is that you cannot convince a person using logical arguments. In addition, the patient always tells his delusional ideas very emotionally and is firmly convinced that he is right.
Distinctive signs and manifestations of delirium
- Delusion is very different from reality. Incomprehensible, mysterious statements appear in the patient’s speech. They may concern his guilt, doom, or, conversely, greatness.
- The patient's personality always takes center stage. For example, a person not only believes in aliens, but also claims that they arrived specifically to establish contact with him.
- Emotionality. A person talks about his ideas very emotionally and does not accept objections. He does not tolerate arguments about his idea and immediately becomes aggressive.
- Behavior is subordinated to a delusional idea. For example, he may refuse to eat, fearing that they want to poison him.
- Unreasonable defensive actions. A person curtains the windows, installs additional locks, and fears for his life. These are manifestations of delusions of persecution. A person is afraid of special services that monitor him with the help of innovative equipment, aliens, “black” magicians who send damage to him, acquaintances who weave conspiracies around him.
- Delusions related to one's own health (hypochondriacal). The person is convinced that he is seriously ill. He “feels” the symptoms of the disease and insists on numerous repeated examinations. He is angry with doctors who cannot find the cause of his poor health and do not confirm his diagnosis.
- Delirium of damage manifests itself in the belief that ill-wishers spoil or steal things, add poison to food, influence with the help of radiation, or want to take away the apartment.
- Nonsense of invention. A person is confident that he has invented a unique device, a perpetual motion machine, or a method of combating a dangerous disease. He fiercely defends his invention and persistently tries to bring it to life. Since patients are not mentally impaired, their ideas can sound quite convincing.
- Delirium of love and delirium of jealousy. A person concentrates on his emotions, pursues the object of his love. He comes up with reasons for jealousy, finds evidence of betrayal where there is none.
- Nonsense of litigiousness. The patient inundates various authorities and the police with complaints about his neighbors or organizations. Files numerous lawsuits.
- Lethargy or stupor. A person freezes in one position and remains motionless for a long time (days or weeks). He refuses food and communication.
- Motor excitement. Movements become fast, jerky, and often aimless. Facial expressions are very emotional, the conversation is accompanied by grimaces. Can mimic other people's speech and imitate animal sounds. Sometimes a person is unable to perform simple tasks because he loses control of his movements.
What to do if someone close to you has alarming symptoms?
If you notice such manifestations, then talk to the person. Find out what bothers him and what is the reason for the changes in his behavior. In this case, it is necessary to show maximum tact, avoid reproaches and claims, and not raise your voice. One carelessly spoken word can cause a suicide attempt.Convince the person to seek help from a psychiatrist. Explain that the doctor will prescribe medications that will help you calm down and make it easier to endure stressful situations.
Types of psychoses
The most common are manic and depressive psychoses - an apparently healthy person suddenly shows signs of depression or significant agitation. Such psychoses are called monopolar - the deviation occurs in one direction. In some cases, the patient may alternately show signs of manic and depressive psychosis. In this case, doctors talk about bipolar disorder - manic-depressive psychosis.
Manic psychosis
Manic psychosis – a severe mental disorder that causes three characteristic symptoms: elevated mood, accelerated thinking and speech, and noticeable motor activity. Periods of excitement last from 3 months to one and a half years.
Depressive psychosis
Depressive psychosis is a disease of the brain, and psychological manifestations are the external side of the disease. Depression begins slowly, unnoticed by the patient and those around him. As a rule, good, highly moral people fall into depression. They are tormented by a conscience that has grown to pathological proportions. Confidence appears: “I am bad. I don't do my job well, I haven't achieved anything. I'm bad at raising children. I'm a bad spouse. Everyone knows how bad I am and they talk about it.” Depressive psychosis lasts from 3 months to a year.Depressive psychosis is the opposite of manic psychosis. He also has triad of characteristic symptoms
- Pathologically low mood
Thoughts are centered around your personality, your mistakes and your shortcomings. Concentrating on one’s own negative sides gives rise to the belief that everything was bad in the past, the present cannot please anyone, and in the future everything will be even worse than now. On this basis, a person with depressive psychosis can commit suicide.
Since a person’s intellect is preserved, he can carefully hide his desire for suicide so that no one disturbs his plans. At the same time, he does not show his depressed state and assures that he is already better. It is not always possible to prevent a suicide attempt at home. Therefore, people with depression who are focused on self-destruction and their own low value are treated in a hospital.
A sick person experiences causeless melancholy, it presses and oppresses. It is noteworthy that he can practically show with his finger where the unpleasant sensations are concentrated, where the “soul hurts.” Therefore, this condition even received a name - pre-cardiac melancholy.
Depression in psychosis has a distinctive feature: the condition is worst early in the morning, and in the evening it improves. The person explains this by saying that in the evening there are more worries, the whole family gathers and this distracts from sad thoughts. But with depression caused by neurosis, on the contrary, the mood worsens in the evening.
It is characteristic that in the acute period of depressive psychosis, patients do not cry. They say they would like to cry, but there are no tears. Therefore, crying in this case is a sign of improvement. Both patients and their relatives should remember this.
- Mental retardation
Mental and metabolic processes in the brain proceed very slowly. This may be due to a lack of neurotransmitters: dopamine, norepinephrine and serotonin. These chemicals ensure proper signal transmission between brain cells.
As a result of a deficiency of neurotransmitters, memory, reaction, and thinking deteriorate. A person gets tired quickly, doesn’t want to do anything, nothing interests him, doesn’t surprise or make him happy. You can often hear them say, “I envy other people. They can work, relax, have fun. It’s a pity that I can’t do that.”
The patient always looks gloomy and sad. The gaze is dull, unblinking, the corners of the mouth are downcast, avoids communication, tries to retire. He reacts slowly to calls, answers in monosyllables, reluctantly, in a monotonous voice.
- Physical inhibition
Depressive psychosis physically changes a person. Appetite drops and the patient quickly loses weight. Therefore, weight gain during depression indicates that the patient is getting better.
A person’s movements become extremely slow: a slow, uncertain gait, hunched shoulders, a lowered head. The patient feels a loss of strength. Any physical activity causes the condition to worsen.
In severe forms of depressive psychosis, a person falls into a stupor. He can sit for a long time without moving, looking at one point. If you try to read notation at this time; “Get yourself together, pull yourself together,” then you will only make the situation worse. A person will have the thought: “I should, but I can’t - that means I’m bad, good for nothing.” He cannot overcome depressive psychosis through willpower, since the production of norepinephrine and serotonin does not depend on our desire. Therefore, the patient needs qualified help and drug treatment.
There are a number of physical signs of depressive psychosis: daily mood swings, early awakenings, weight loss due to poor appetite, menstrual irregularities, dry mouth, constipation, and some people may develop insensitivity to pain. These signs indicate that you need to seek medical help.
Basic rules for communicating with patients with psychosis
- Don't argue or talk back to people if you see signs of manic excitement in them. This can provoke an attack of anger and aggression. As a result, you can completely lose trust and turn the person against you.
- If the patient exhibits manic activity and aggression, remain calm, self-confident and friendly. Take him away, isolate him from other people, try to calm him down during the conversation.
- 80% of suicides are committed by patients with psychosis in the stage of depression. Therefore, be very attentive to your loved ones during this period. Don't leave them alone, especially in the morning. Pay special attention to signs warning of a suicide attempt: the patient talks about an overwhelming feeling of guilt, about voices ordering him to kill himself, about hopelessness and uselessness, about plans to end his life. Suicide is preceded by a sharp transition from depression to a bright, peaceful mood, putting things in order, and drawing up a will. Don't ignore these signs, even if you think it's just an attempt to attract attention.
- Hide all items that could be used to attempt suicide: household chemicals, medicines, weapons, sharp objects.
- If possible, eliminate the traumatic situation. Create a calm environment. Try to ensure that the patient is surrounded by close people. Reassure him that he is safe now and that everything is over.
- If a person is delusional, do not ask clarifying questions, do not ask about details (What do aliens look like? How many are there?). This may make the situation worse. “Get hold of” any nonsense statement he makes. Develop the conversation in this direction. You can focus on the person's emotions by asking, “I can see you're upset. How can I help you?
- If there are signs that the person has experienced hallucinations, then calmly and confidently ask him what just happened. If he saw or heard something unusual, find out what he thinks and feels about it. To cope with hallucinations, you can listen to loud music on headphones or do something exciting.
- If necessary, you can firmly remind about the rules of behavior and ask the patient not to scream. But you shouldn’t make fun of him, argue about hallucinations, or say that it’s impossible to hear voices.
- You should not turn to traditional healers and psychics for help. Psychoses are very diverse, and for effective treatment it is necessary to accurately determine the cause of the disease. To do this, it is necessary to use high-tech diagnostic methods. If you waste time on treatment with unconventional methods, acute psychosis will develop. In this case, it will take several times longer to fight the disease, and in the future it will be necessary to constantly take medications.
- If you see that a person is relatively calm and in the mood for communication, try to convince him to see a doctor. Explain that all the symptoms of the disease that bother him can be eliminated with the help of medications prescribed by the doctor.
- If your relative flatly refuses to see a psychiatrist, persuade him to see a psychologist or psychotherapist to combat depression. These specialists will help convince the patient that there is nothing wrong with a visit to a psychiatrist.
- The most difficult step for loved ones is calling an emergency psychiatric team. But this must be done if a person directly declares his intention to commit suicide, may injure himself or cause harm to other people.
Psychological treatments for psychosis
In psychosis, psychological methods successfully complement drug treatment. A psychotherapist can help a patient:- reduce symptoms of psychosis;
- avoid recurrent attacks;
- increase self-esteem;
- learn to adequately perceive the surrounding reality, correctly assess the situation, your condition and react accordingly, correct behavioral errors;
- eliminate the causes of psychosis;
- increase the effectiveness of drug treatment.
Psychotherapy eliminates personality disorders that occurred during the period of psychosis, puts thoughts and ideas in order. Working with a psychologist and psychotherapist makes it possible to influence future events and prevent relapse of the disease.
Psychological treatment methods are aimed at restoring mental health and socializing a person after recovery to help him feel comfortable in his family, work team and society. This treatment is called psychosocialization.
Psychological methods that are used to treat psychosis are divided into individual and group. During individual sessions, the psychotherapist replaces the personal core lost during illness. It becomes the patient’s external support, calms him down and helps him correctly assess reality and respond adequately to it.
Group therapy helps you feel like a member of society. A group of people struggling with psychosis is led by a specially trained person who has managed to successfully cope with this problem. This gives patients hope for recovery, helps them overcome awkwardness and return to normal life.Hypnosis, analytical and suggestive (from the Latin Suggestio - suggestion) methods are not used in the treatment of psychosis. When working with altered consciousness, they can lead to further mental disorders.
Good results in the treatment of psychosis are given by: psychoeducation, addiction therapy, cognitive behavior therapy, psychoanalysis, family therapy, occupational therapy, art therapy, as well as psychosocial trainings: social competence training, metacognitive training.
Psychoeducation– this is the education of the patient and his family members. The psychotherapist talks about psychosis, the characteristics of this disease, the conditions for recovery, motivates to take medications and lead a healthy lifestyle. Tells relatives how to behave correctly with the patient. If you disagree with something or have questions, be sure to ask them in the time designated for discussion. It is very important for the success of treatment that you have no doubts.
Classes take place 1-2 times a week. If you visit them regularly, you will develop the right attitude towards the disease and drug treatment. Statistics say that thanks to such conversations, it is possible to reduce the risk of repeated episodes of psychosis by 60-80%.
Addiction therapy necessary for those people who have developed psychosis against the background of alcoholism and drug addiction. Such patients always have an internal conflict. On the one hand, they understand that they should not use drugs, but on the other hand, there is a strong desire to return to bad habits.
Classes are conducted in the form of individual conversation. A psychotherapist talks about the connection between drug use and psychosis. He will tell you how to behave to reduce temptation. Addiction therapy helps to create strong motivation to abstain from bad habits.
Cognitive (behavioral) therapy. Cognitive therapy is recognized as one of the best methods of treating psychosis accompanied by depression. The method is based on the fact that erroneous thoughts and fantasies (cognitions) interfere with the normal perception of reality. During the sessions, the doctor will identify these incorrect judgments and the emotions associated with them. It will teach you to be critical of them and not let these thoughts influence your behavior, and will tell you how to look for alternative ways to solve the problem.
To achieve this goal, the Negative Thought Protocol is used. It contains the following columns: negative thoughts, the situation in which they arose, emotions associated with them, facts for and against these thoughts. The course of treatment consists of 15-25 individual sessions and lasts 4-12 months.
Psychoanalysis. Although this technique is not used to treat schizophrenia and affective (emotional) psychoses, its modern “supportive” version is effectively used to treat other forms of the disease. At individual meetings, the patient reveals his inner world to the psychoanalyst and transfers to him feelings directed at other people. During the conversation, the specialist identifies the reasons that led to the development of psychosis (conflicts, psychological trauma) and the defense mechanisms that a person uses to protect himself from such situations. The treatment process takes 3-5 years.
Family therapy – group therapy, during which a specialist conducts sessions with family members where the person with psychosis lives. Therapy is aimed at eliminating conflicts in the family, which can cause exacerbations of the disease. The doctor will talk about the peculiarities of the course of psychosis and the correct models of behavior in crisis situations. Therapy is aimed at preventing relapses and ensuring that all family members can live comfortably together.
Occupational therapy. This type of therapy most often occurs in a group setting. The patient is recommended to attend special classes where he can engage in various activities: cooking, gardening, working with wood, textiles, clay, reading, composing poetry, listening and writing music. Such activities train memory, patience, concentration, develop creative abilities, help open up, and establish contact with other members of the group.
Specific setting of goals and achievement of simple goals gives the patient confidence that he again becomes the master of his life.
Art therapy – art therapy method based on psychoanalysis. This is a “no words” treatment method that activates self-healing capabilities. The patient creates a picture that expresses his feelings, an image of his inner world. Then a specialist studies it from the point of view of psychoanalysis.
Social competence training. A group lesson in which people learn and practice new forms of behavior so that they can then apply them in everyday life. For example, how to behave when meeting new people, when applying for a job, or in conflict situations. In subsequent classes, it is customary to discuss the problems that people encountered when implementing them in real situations.Metacognitive training. Group training sessions that are aimed at correcting thinking errors that lead to delusions: distorted attribution of judgments to people (he doesn’t love me), hasty conclusions (if he doesn’t love me, he wants me dead), depressive way of thinking, inability to empathize , feeling other people's emotions, painful confidence in memory impairment. The training consists of 8 lessons and lasts 4 weeks. At each module, the trainer analyzes thinking errors and helps to form new patterns of thoughts and behavior.
Psychotherapy is widely used for all forms of psychosis. It can help people of all ages, but is especially important for teenagers. During the period when life attitudes and behavioral stereotypes are just being formed, psychotherapy can radically change life for the better.
Drug treatment of psychosis
Drug treatment of psychosis is a prerequisite for recovery. Without it, it will not be possible to get out of the trap of the disease, and the condition will only get worse.There is no single regimen for drug therapy for psychosis. The doctor prescribes drugs strictly individually, based on the manifestations of the disease and the characteristics of its course, gender and age of the patient. During treatment, the doctor monitors the patient’s condition and, if necessary, increases or decreases the dose in order to achieve a positive effect and not cause side effects.
Treatment of manic psychosis
Group of drugs Mechanism of treated action Representatives How is it prescribed? Antipsychotic drugs (neuroleptics) Used for all forms of psychosis. Block dopamine-sensitive receptors. This substance is a neurotransmitter that promotes the transfer of excitation between brain cells. Thanks to the action of neuroleptics, it is possible to reduce the severity of delusions, hallucinations and thought disorders. Solian (effective for negative disorders: lack of emotions, withdrawal from communication) In the acute period, 400-800 mg/day is prescribed, up to a maximum of 1200 mg/day. Take regardless of meals.
Maintenance dose 50-300 mg/day.Zeldox 40-80 mg 2 times a day. The dose is increased over 3 days. The drug is prescribed orally after meals. Fluanxol The daily dose is 40-150 mg/day, divided into 4 times. The tablets are taken after meals.
The drug is also available in the form of an injection solution, which is given once every 2-4 weeks.Benzodiazepines Prescribed for acute manifestations of psychosis together with antipsychotic drugs. They reduce the excitability of nerve cells, have a calming and anticonvulsant effect, relax muscles, eliminate insomnia, and reduce anxiety. Oxazepam Take 5-10 mg twice or three times a day. If necessary, the daily dose can be increased to 60 mg. The drug is taken regardless of food, washed down with a sufficient amount of water. Duration of treatment is 2-4 weeks. Zopiclone Take 7.5-15 mg 1 time per day half an hour before bedtime, if psychosis is accompanied by insomnia. Mood stabilizers (mood stabilizers) They normalize mood, preventing the onset of manic phases, and make it possible to control emotions. Actinerval (a derivative of carbamazepine and valproic acid) The first week the daily dose is 200–400 mg, divided into 3-4 times. Every 7 days, the dose is increased by 200 mg, bringing it to 1 g. The drug is also discontinued gradually so as not to cause a worsening of the condition. Contemnol (contains lithium carbonate) Take 1 g per day once in the morning after breakfast, with a sufficient amount of water or milk. Anticholinergic drugs (cholinergic blockers) Necessary to neutralize side effects after taking antipsychotics. Regulates the sensitivity of nerve cells in the brain by blocking the action of the mediator acetylcholine, which ensures the transmission of nerve impulses between cells of the parasympathetic nervous system. Cyclodol, (Parkopan) The initial dose is 0.5-1 mg/day. If necessary, it can be gradually increased to 20 mg/day. Frequency of administration: 3-5 times a day, after meals. Treatment of depressive psychosis
Group of drugs Mechanism of treated action Representatives How is it prescribed? Antipsychotic drugs Makes brain cells less sensitive to excess amounts of dopamine, a substance that promotes signal transmission in the brain. The drugs normalize thinking processes, eliminate hallucinations and delusions. Quentiax During the first four days of treatment, the dose is increased from 50 to 300 mg. In the future, the daily dose can range from 150 to 750 mg/day. The drug is taken 2 times a day, regardless of meals. Eglonil Tablets and capsules are taken 1-3 times a day, regardless of meals. Daily dose from 50 to 150 mg for 4 weeks. It is not advisable to use the drug after 16 hours so as not to cause insomnia. Rispolept Konsta A suspension is prepared from microgranules and the included solvent, which is injected into the gluteal muscle once every 2 weeks. Risperidone The initial dose is 1 mg 2 times a day. Tablets of 1-2 mg are taken 1-2 times a day. Benzodiazepines Prescribed for acute manifestations of depression and severe anxiety. The drugs reduce the excitability of the subcortical structures of the brain, relax muscles, relieve fear, and calm the nervous system. Phenazepam Take 0.25-0.5 mg 2-3 times a day. The maximum daily dose should not exceed 0.01 g.
Prescribed in short courses so as not to cause dependence. After improvement occurs, the dosage is gradually reduced.Lorazepam Take 1 mg 2-3 times a day. For severe depression, the dose can be gradually increased to 4-6 mg/day. The drug is discontinued gradually due to the risk of seizures. Normotimics Medicines intended to normalize mood and prevent periods of depression. Lithium carbonate Take orally 3-4 times a day. The initial dose is 0.6-0.9 g/day, gradually the amount of the drug is increased to 1.5-2.1 g. The medicine is taken after meals to reduce the irritant effect on the gastric mucosa. Antidepressants Remedies to combat depression. Modern 3rd generation antidepressants reduce the uptake of serotonin by neurons and thereby increase the concentration of this neurotransmitter. They improve mood, relieve anxiety, melancholy, and fear. Sertraline Take 50 mg orally, 1 time per day after breakfast or dinner. If there is no effect, the doctor may gradually increase the dose to 200 mg/day. Paroxetine Take 20-40 mg/day in the morning with breakfast. Swallow the tablet without chewing and wash it down with water. Anticholinergic drugs Medicines that help eliminate the side effects of taking antipsychotics. Slowness of movements, muscle stiffness, trembling, impaired thinking, increased or absent emotions. Akineton 2.5-5 mg of the drug is administered intravenously or intramuscularly.
In tablets, the initial dose is 1 mg 1-2 times a day, gradually the amount of the drug is increased to 3-16 mg/day. The dose is divided into 3 doses. The tablets are taken during or after meals with liquid.
Let us remember that any independent change in dose can have very serious consequences. Reducing the dosage or stopping taking medications causes an exacerbation of psychosis. Increasing the dose increases the risk of side effects and dependence.Prevention of psychosis
What needs to be done to prevent another attack of psychosis?Unfortunately, people who have experienced psychosis are at risk of experiencing a relapse of the disease. A repeated episode of psychosis is a difficult ordeal for both the patient and his relatives. But you can reduce your risk of relapse by 80% if you take the medications prescribed by your doctor.
- Drug therapy– the main point of prevention of psychosis. If you have difficulty taking your medications on a daily basis, talk to your doctor about switching to a depot form of your antipsychotic medications. In this case, it will be possible to give 1 injection every 2-4 weeks.
It has been proven that after the first case of psychosis, it is necessary to use drugs for one year. For manic manifestations of psychosis, lithium salts and Finlepsin are prescribed at 600-1200 mg per day. And for depressive psychosis, Carbamazepine 600-1200 mg per day is needed.
- Regularly attend individual and group psychotherapy sessions. They will increase your self-confidence and motivation to get better. In addition, the psychotherapist can notice signs of an approaching exacerbation in time, which will help adjust the dosage of medications and prevent a recurrence of the attack.
Follow a daily routine. Train yourself to get up and take food and medications at the same time every day. A daily schedule can help with this. Plan tomorrow in the evening. Add all necessary things to the list. Mark which ones are important and which ones are unimportant. Such planning will help you not to forget anything, get everything done and be less nervous. When planning, set realistic goals.- Communicate more. You will feel comfortable among people who have overcome psychosis. Communicate in self-help groups or specialized forums.
- Exercise daily. Running, swimming, cycling are suitable. It’s very good if you do this in a group of like-minded people, then the classes will bring both benefit and pleasure.
- Make a list of the early symptoms of an approaching crisis., the appearance of which must be reported to the attending physician. Pay attention to these signals:
- Behavior Changes: frequent leaving the house, prolonged listening to music, unreasonable laughter, illogical statements, excessive philosophizing, conversations with people with whom you usually do not want to communicate, fussy movements, squandering, adventurism.
- Mood changes: irritability, tearfulness, aggressiveness, anxiety, fear.
- Changes in health: sleep disturbance, lack or increased appetite, increased sweating, weakness, weight loss.
- Don't drink a lot of coffee. It can have a strong stimulating effect on the nervous system. Avoid alcohol and drugs. They have a bad effect on brain function, cause mental and motor agitation, and attacks of aggression.
- Don't overwork yourself. Physical and mental exhaustion can cause severe confusion, inconsistent thinking, and increased responsiveness to external stimuli. These deviations are associated with impaired absorption of oxygen and glucose by nerve cells.
- Do not take a steam bath, try to avoid overheating. An increase in body temperature often leads to delirium, which is explained by an increase in the activity of electrical potentials in the brain, an increase in their frequency and amplitude.
- Don't conflict. Try to resolve conflicts constructively to avoid stress. Severe mental stress can become a trigger for a new crisis.
- Don't refuse treatment. During periods of exacerbation, the temptation to refuse to take medications and visit a doctor is especially great. Do not do this, otherwise the disease will become acute and require hospital treatment.
What is postpartum psychosis?
Postpartum psychosis Quite a rare mental illness. It develops in 1-2 women giving birth out of 1000. Signs of psychosis most often appear during the first 4-6 weeks after birth. Unlike postpartum depression, this mental disorder is characterized by delusions, hallucinations, and desires to harm yourself or the baby. Manifestations of postpartum psychosis.
The first signs of the disease are sudden mood swings, anxiety, severe restlessness, and unreasonable fears. Subsequently, delusions and hallucinations appear. A woman may claim that the child is not hers, that he is stillborn or crippled. Sometimes a young mother develops paranoia, she stops going for walks and does not allow anyone near the child. In some cases, the disease is accompanied by delusions of grandeur, when a woman is confident in her superpowers. She may hear voices telling her to kill herself or her child.
According to statistics, 5% of women in a state of postpartum psychosis kill themselves, and 4% kill their child. Therefore, it is very important for relatives not to ignore the signs of the disease, but to consult a psychiatrist in a timely manner.
Causes of postpartum psychosis.
The cause of mental disorders can be difficult childbirth, unwanted pregnancy, conflict with the husband, fear that the spouse will love the child more than her. Psychologists believe that psychosis can be caused by a conflict between a woman and her mother. It can also cause brain damage due to injury or infection. A sharp decrease in the level of the female hormone estrogen, as well as endorphins, thyroid hormone and cortisol, can affect the development of psychosis.
In approximately half of cases, postpartum psychosis develops in patients with schizophrenia or manic-depressive syndrome.
Treatment of postpartum psychosis.
Treatment must be started as soon as possible because the woman’s condition is rapidly deteriorating. If there is a risk of suicide, the woman will be treated in a psychiatric department. While she is taking medications, the baby cannot be breastfed, since most drugs pass into mother's milk. But communication with the child will be useful. Taking care of the baby (provided that the woman herself wants it) helps to normalize the state of the psyche.
If a woman is severely depressed, antidepressants are prescribed. Amitriptyline, Pirlindol are indicated if anxiety and fear predominate. Citalopram and Paroxetine have a stimulating effect. They will help in cases where psychosis is accompanied by stupor - the woman sits motionless and refuses to communicate.
For mental and motor agitation and manifestations of manic syndrome, lithium preparations (Lithium Carbonate, Micalite) and antipsychotics (Clozapine, Olanzapine) are needed.
Psychotherapy for postpartum psychosis is used only after acute manifestations have been eliminated. It is aimed at identifying and resolving conflicts that led to mental disorders.
What is reactive psychosis?
Reactive psychosis or psychogenic shock - a mental disorder that occurs after severe psychological trauma. This form of the disease has three characteristics that distinguish it from other psychoses (Jaspers triad): - Psychosis begins after a severe emotional shock that is very significant for a given person.
- Reactive psychosis is reversible. The more time has passed since the injury, the weaker the symptoms. In most cases, recovery occurs after about a year.
- Painful experiences and manifestations of psychosis depend on the nature of the trauma. There is a psychologically understandable connection between them.
Mental disorders occur after a strong shock: a disaster, attack by criminals, fire, collapse of plans, career failure, divorce, illness or death of a loved one. In some cases, psychosis can also be triggered by positive events that cause an outburst of emotions.
Emotionally unstable people, those who have suffered a bruise or concussion, severe infectious diseases, or whose brains have been damaged by alcohol or drug intoxication are especially at risk of developing reactive psychosis. As well as teenagers going through puberty and women going through menopause.
Manifestations of reactive psychosis.
Symptoms of psychosis depend on the nature of the injury and the form of the disease. The following forms of reactive psychosis are distinguished:
- psychogenic depression;
- psychogenic paranoid;
- hysterical psychosis;
- psychogenic stupor.
Psychogenic paranoid accompanied by delusions, auditory hallucinations and motor agitation. The patient feels that he is being persecuted, he fears for his life, is afraid of exposure and is fighting with imaginary enemies. Symptoms depend on the nature of the stressful situation. The person is very excited and commits rash acts. This form of reactive psychosis often occurs on the road, as a result of lack of sleep and alcohol consumption.
Hysterical psychosis has several forms.
- Delusional fantasies – delusional ideas that relate to greatness, wealth, persecution. The patient tells them very theatrically and emotionally. Unlike delusion, a person is not sure of his words, and the essence of the statements changes depending on the situation.
- Ganser syndrome patients do not know who they are, where they are, or what year it is. They answer simple questions incorrectly. They perform illogical actions (eating soup with a fork).
- Pseudo-dementia – short-term loss of all knowledge and skills. A person cannot answer the simplest questions, show where his ear is, or count his fingers. He is capricious, grimaces, and cannot sit still.
- Puerilism syndrome – an adult develops childish speech, childish emotions, and childish movements. It may develop initially or as a complication of pseudodementia.
- The "feral" syndrome – human behavior resembles the habits of an animal. Speech gives way to a growl, the patient does not recognize clothes and cutlery, and moves on all fours. This condition, if unfavorable, can replace puerilism.
Treatment of reactive psychosis.
The most important stage in the treatment of reactive psychosis is the elimination of the traumatic situation. If you manage to do this, then there is a high probability of a quick recovery.
Drug treatment of reactive psychosis depends on the severity of manifestations and characteristics of the psychological state.At reactive depression antidepressants are prescribed: Imipramine 150-300 mg per day or Sertraline 50-100 mg once a day after breakfast. Therapy is supplemented with tranquilizers Sibazon 5-15 mg/day or Phenazepam 1-3 mg/day.
Psychogenic paranoid treated with antipsychotics: Triftazin or Haloperidol 5-15 mg/day.
For hysterical psychosis, it is necessary to take tranquilizers (Diazepam 5-15 mg/day, Mezapam 20-40 mg/day) and antipsychotics (Alimemazine 40-60 mg/day or Neuleptil 30-40 mg/day).
Psychostimulants, for example Sidnocarb 30-40 mg/day or Ritalin 10-30 mg/day, can bring a person out of a psychogenic stupor.Psychotherapy can free a person from excessive fixation on a traumatic situation and develop defense mechanisms. However, it is possible to begin consultations with a psychotherapist only after the acute phase of psychosis has passed and the person has regained the ability to accept the specialist’s arguments.
Remember – psychosis is curable! Self-discipline, regular medication, psychotherapy and the help of loved ones guarantee the return of mental health.
Before we look at the symptoms of psychosis and learn about its treatment, let's define the concept itself. Psychosis is not a specific disease, but a generalized class. Their common feature is a disrupted process of reflecting objective reality. In other words, a sick person perceives the world around him in a distorted form.
Psychosis: symptoms, treatment
The big picture
A distorted vision of the real world manifests itself in the manifestation of unusual syndromes and symptoms. Psychosis in no way gives rise to any new phenomena; it simply represents a loss of activity at higher brain levels.
Symptoms of psychosis
In general, all kinds of delusional states and various hallucinations are considered common signs of this condition. Regardless of the type, symptoms of psychosis include an obligatory agitation of actions.
All of the above symptoms of psychosis are its main signs, but, note, not the only ones! In order to accurately determine the type of specific mental disorder, it is necessary to conduct a long-term observation with a psychiatrist, after which the doctor will make an official conclusion and prescribe appropriate treatment.
How to treat?
Usually the patient is placed in Today's therapy is not complete without the use of special psychotropic drugs - antipsychotics (sometimes tranquilizers or antidepressants). The treatment process is accompanied by the use of drugs that strengthen the patient’s body, or medications that help reduce the phenomenon of intoxication.
Senile psychosis
Symptoms
This is a generalized group of mental illnesses that occur in people after 60 years of age. This manifests itself in a state of darkened consciousness on the part of an elderly person, as well as in various endoform disorders. Important! does not cause total dementia!
Species
Today doctors distinguish between two types of senile psychosis:
- acute forms, which are manifested by clouding of consciousness;
- chronic forms, manifested in paranoid and hallucinatory states.
Treatment
It should be carried out depending on the physical condition of the patient. Psychotropic drugs such as Pyrazidol, Azafen, Amitriptyline and others are used. In some cases, treatment occurs using two drugs. In addition, it is necessary to constantly monitor the somatic condition of patients.
A violation of the perception of objective reality, manifested in hallucinations, delusional states, changes in consciousness and complete disorganization of the personality, is called psychosis. This phenomenon is characterized by gross disturbances in human mental activity.
Psychoses can occur under the influence of many internal or external factors. Mental disorders caused by endogenous causes, such as somatic and mental illnesses, age-related pathology, develop gradually. Acute psychosis develops suddenly and intensely. The main source of such a spontaneous state is the influence of exogenous factors, these include mental trauma, intoxication and infection. With properly selected therapy, exogenous psychoses can be treated fairly quickly.
Main types of psychoses and their symptoms
According to their origin, they are divided into two groups:
- endogenous,
- exogenous.
Endogenous pathology is understood as the influence of negative factors of internal origin: somatic diseases, hereditary mental pathologies, age aspect. The exogenous type of psychosis is caused by exposure to external destructive stimuli: traumatic brain injury, psychogenicity, infection and intoxication.
The endogenous group includes the following mental disorders:
- manic-depressive psychosis,
- senile,
- schizophrenic,
- cycloid,
- symptomatic psychosis caused by a somatic disease (hypertensive, epileptic).
The exogenous group of psychoses includes:
- jet acute,
- intoxication,
- infectious.
Psychosis can develop slowly, progressing with the intensity of the stressor, or occur suddenly - an acute type of disease. The main signs of psychosis include:
- delirium, delirium-like states,
- hallucinations,
- complete or partial amnesia,
- motor-motor disorders,
- changes in consciousness
- cognitive impairment,
- pathology of emotions.
Classification of endogenous psychoses
Shifting changes in mood, irresistible mania, delusional manifestations, severe depressive states with suicidal thoughts may indicate manic-depressive psychosis. The peculiarity of the disease is the change in phases of mood and arousal processes: from the manic stage to the depressive stage. Such a pathology may arise due to a hereditary predisposition to the disorder, the symptoms of which may progress as provoking factors act: stress, brain injuries, diseases of internal organs.
They develop due to age-related dysfunctions and destructive changes in the brain. Elderly people suffering from this disease become withdrawn, depressed, aggressive and completely inert towards themselves and others. Mental disorders include amnesia, disorientation in the area, dementia, and impaired consciousness.
Schizophrenic psychosis is characterized by pathological changes in personality, thinking and perception are disrupted, and inadequate affective reactions are observed. The clinical picture of this psychosis sometimes manifests itself in hallucinations, delusional states, and patients are presented with fictitious pictures of fantastic content. The disease does not always occur with hallucinosis and delusions; the personality structure is mainly affected.
Cycloid psychoses occupy a transitional position between schizophrenic and manic-depressive symptoms. Signs of pathology are manifested in constant changes in mood, excitability, and motor activity. An example of such psychosis could be a sharp change in the emotions of fear and happiness, stupor and chaotic movement. The disease is highly treatable at any stage of development.
Sometimes the human body reacts to illness not only with physiological, but also with mental changes. The sudden development of symptomatic psychosis manifests itself in the form of emotional exhaustion, decreased motor activity, affective reactions and confusion. A gradual increase in symptoms is called a protracted type of disorder, in which hallucinosis, depression and manic phases are observed.
Myocardial infarction may be accompanied by panic, depression or euphoria, and cases of delirium are not uncommon. A malignant tumor causes a constant feeling of anxiety, hallucinations and illusions are observed, and in severe stages, motor activity decreases and an apathetic stupor sets in.
Types of exogenous psychoses
Acute psychosis indicates that the disease arose suddenly, for example, as a result of psychotrauma, intoxication with toxic fumes, etc. In reactive acute psychosis, hallucinations, delusions, pathology of affect, behavioral disturbances and self-criticism are observed. When exposed to a negative psychogenic stimulus, a person begins to manifest affective reactions. The following types of psychoses of psychogenic origin are distinguished:
- hysterical psychosis,
- affective shock reaction,
- psychogenic psychopathy.
Hysterical psychosis develops in cases where a person is subjected to all kinds of psychological infringement and discrimination. The duration of the pathology directly depends on the effect of the stressor. The following forms of hysterical psychogenic psychosis are distinguished:
- feral syndrome,
- puerilism,
- pseudodementia,
- delusional fantasies,
- Ganser's syndrome.
Feralization syndrome is understood as a gross behavioral disorder in which a person imitates the habits of an animal: grimaces, moves on all fours, sniffs, etc. This form of psychogenic psychosis manifests itself extremely rarely and mainly in the presence of idiopathic personality traits. Puerilism is a kind of “playing like a child,” when a person becomes extremely infantile, foolish and naive. With pseudodementia, there is a sharp depression of the intellectual sphere, the patient answers questions incorrectly, and commits ridiculous acts. Delusional fantasies are characterized by ideas about hyper-significance, reformist delusions or self-deprecation, and the patient himself believes in his fantasies. The pathology of consciousness, manifested in disorientation and selective perception, is called Ganser syndrome.
A sudden affective state, characterized by distortion and narrowing of conscious activity, which occurs in life-threatening moments, is called a shock reaction. Pathological affect manifests itself in the experience of horror, fear and extreme despair. There are two types of specific reactions during an affective-shock reaction:
- hyperkinetic,
- hypokinetic.
Hyperkinetic behavior is manifested by motor excitability in the form of erratic, aimless movements, increased gesticulation, exclamations, screams, fragmentary or complete amnesia. Lack of motor activity, stupor, and mutism are characteristic of the hypokinetic response option. Both types of reactions may be accompanied by involuntary defecation or urination, vegetative-somatic changes and memory impairment.
Among the acute psychogenic changes in the psyche of the individual, the following are also distinguished:
- depressive states,
- crazy ideas.
Psychogenic acute depression most often occurs due to emotional loss, be it the death of a loved one or isolation from relatives. Depressive experiences can occur in various forms: hysterical, anxious, auto-aggressive, etc. The melancholy state may be preceded by anxious-affective reactions in the form of stupor, immobility or hyperkinetic manifestations. Psychogenic depression usually begins on the second day after exposure to a negative stimulus and can last from several days to a year. Reactive delusional states result from discrimination, insult, or injury to a person who becomes obsessed with revenge, paranoia, or reformist thoughts.
Intoxication psychoses develop due to toxic effects on the functioning of the brain and its structure. The disease can occur suddenly due to the action of a large dose of a toxic substance or develop gradually (substance abuse, drug addiction). The clinical picture of this pathology manifests itself in hallucinations, cognitive impairment, and confusion.
Infectious diseases can have a destructive effect on the human psyche, for example, with Botkin’s disease, disturbances in consciousness, thinking and perception are often observed, and the flu sometimes causes depressive states with suicidal overtones. Acute forms of the disease are characterized by fragmented amnesia and cognitive impairment.
Treatment of psychosis
Therapy for psychosis is carried out in psychiatric hospitals, since patients must be under the strict supervision of doctors. Psychogenic, affective-shock conditions require immediate hospitalization, since the consequences of acute psychosis can be quite serious. Often, failure to provide timely assistance to patients resulted in suicidal and socially aggressive cases. So, how to treat psychosis in a hospital setting? The main approach to treating the disease is the use of medications: tranquilizers, antidepressants, sedatives. Sometimes psychotherapy is prescribed, in particular, the cognitive approach, hypno-suggestion, but their effectiveness in correcting these psychotic conditions does not always justify itself.
Many patients are interested in... Doctors strongly recommend that you seek medical help at the first signs of the disease and under no circumstances resort to self-treatment. The consequences of acute psychosis can be very diverse: most patients, with properly selected therapy, are completely cured of the disease, and some of them acquire chronic forms of personal psychopathization. The course of the disorder largely depends on the nature and strength of the psychogenic stressor. In general, the prognosis for the treatment of this disease is favorable; the main thing is not to postpone a visit to the doctor, especially in the acute stages of psychosis.
Psychosis is a mental disorder with a characteristic disorder of mental activity that grossly contradicts the real situation. These disturbances of the mental state are classified as severe forms of mental disorders, while the mental activity of the patient is distinguished by a discrepancy with the surrounding reality.Psychosis refers to the collective name of a group of various mental disorders that are accompanied by psychopathological productive symptoms: delusions, pseudohallucinations, hallucinations, derealization, depersonalization. The patient has a distorted reflection of the real world, which is expressed in behavioral disorders, as well as the manifestation of pathological disorders of memory, perception, thinking, and affectivity. Psychosis does not give rise to new phenomena; it represents a loss of activity at higher levels.
Causes of psychosis
The causes of psychoses of a diverse nature are identified, and they are divided into internal and external. External causes include: stress, psychological trauma, infections (tuberculosis, influenza, syphilis, typhoid); consumption of alcohol, drugs, poisoning with industrial poisons. If the cause of a disturbance in the state of mind is within a person, then endogenous psychosis occurs. It is provoked by disorders of the nervous system or endocrine balance. Endogenous mental disorders occur due to age-related changes in the body or as a consequence of hypertension, schizophrenia, and cerebral atherosclerosis. The course of an endogenous disorder is marked by duration, as well as a tendency to relapse.
Psychosis is a complex condition and it is often impossible to identify what exactly triggered its appearance. The first push can be caused by an external influence, to which an internal problem is added. The first place among external causes is given to alcohol, which can provoke. The cause of psychosis is also old age and endomorphic disorders. According to the characteristics of the course, reactive as well as acute psychoses are noted. is a temporary as well as reversible disorder that occurs due to (mental) trauma.
Acute psychosis has a sudden onset. It can be triggered by unexpected news of the loss of property, as well as the loss of a loved one.
Signs of psychosis
This condition manifests itself in a distorted perception of the real world, as well as disorganization of behavior. The first signs of psychosis are a sharp decline in activity at work, increased stress, and impaired attention. The patient experiences various fears, mood swings, and is characterized by isolation, mistrust, withdrawal, cessation of all contacts, and problems communicating with people. The sufferer develops interests in unusual things, for example, religion, magic. A person often worries, his perception of sounds and colors changes, it seems to him that he is being watched.
Often the disease has a paroxysmal course. This means that the course of this mental state is characterized by outbreaks of acute attacks, which are replaced by periods of remission. The attacks are characterized by seasonality and spontaneity. Spontaneous outbursts appear under the influence of traumatic factors. There are also so-called single-attack courses that are observed at a young age. Such an attack is characterized by a significant duration and gradual recovery. In this case, working capacity is completely restored. Severe cases of psychosis progress to a chronic, ongoing stage. Such cases are characterized by symptoms that manifest themselves throughout life, even despite treatment.
Psychosis symptoms
A person suffering from mental disorders experiences a number of changes in behavior, emotions, and thinking. The basis of this metamorphosis is the loss of adequate perception of the real world. It becomes impossible for a person to realize what is happening, as well as to assess the severity of mental changes. The patient experiences a depressed state, he is haunted by hallucinations and delusional statements.
Hallucinations include talking to oneself, laughing for no reason, listening and falling silent, looking preoccupied. The feeling that a relative of the patient hears something that he is unable to perceive.
Delusions are understood as changed behavior, the appearance of secrecy and hostility, direct statements of a dubious nature (persecution, one’s own greatness or irredeemable guilt.)
Psychosis classification
All mental state disorders are classified according to etiology (origin), as well as causes, and are distinguished as endogenous, organic, reactive, situational, somatogenic, intoxication, post-withdrawal and abstinence.
In addition, the classification of mental disorders necessarily takes into account the clinical picture and the prevailing symptoms. Depending on the symptoms, hypochondriacal, paronoid, depressive, manic mental disorders and their combinations are distinguished.
Postpartum psychosis
This condition rarely occurs in women after childbirth; it appears in the second to fourth week. The woman herself often does not feel postpartum psychosis. It is very important to diagnose the disease in a timely manner and begin treatment. Late diagnosis may delay recovery.
The cause of this condition is complications during childbirth and pain shock.
The more trauma a woman receives (physical, psychological) during childbirth, the more difficult the mental state disorder occurs. The first birth has a higher likelihood of mental disturbances than the second. A woman during her second birth already knows what to expect psychologically and does not experience such fear as during the first. Qualified medical care often does not reach the mother in labor, since no one pays attention to her psychological state. Relatives and doctors are more concerned about the physical health of the woman and the newborn, so the mother in labor is left alone with her psychological state.
Postpartum psychosis is often confused with. Postpartum psychosis is characterized by anxiety, insomnia or restless sleep, confusion, loss of appetite, delusions, lack of adequate self-esteem, and hallucinations.
Psychosis after childbirth is treated in a hospital. It is strictly forbidden for a mother to remain alone with her baby. Psychotherapy is indicated for nursing mothers; drug therapy is prescribed very carefully and under the mandatory supervision of medical staff.
Mass psychosis
This state is typical for a team, a group of people, a nation, where the basis is suggestibility and imitation. Mass psychosis also has a second name - a mental epidemic. As a result of a massive disturbance of the state of mind, people lose adequate judgment and become obsessed.
Cases of mass psychosis have a common formation mechanism. An inadequate state is characterized by non-collective behavior called a crowd. The crowd refers to the public (a large group of people) who are united by common interests and act very unanimously, as well as emotionally. Often in a crowd there is a collection of amorphous individuals who do not have direct contacts with each other, but are connected by a constant common interest.
Cases of mass psychosis include mass self-immolation, mass religious worship, mass migrations, mass hysteria, mass passion for computer games and social networks, mass patriotic, as well as false-patriotic frenzy.
In mass disturbances of the mental state of non-collective behavior, a huge role is assigned to unconscious processes. Emotional arousal is based on spontaneous actions that arise from impressive events and necessarily affect significant values. For example, the fight for your rights and interests. Sigmund Freud viewed this crowd as a human mass under hypnosis. Very dangerous and significant in the psychology of the crowd is its acute susceptibility to suggestion. The crowd either accepts or completely rejects any belief, opinion, idea, and hence treats them either as absolute truths or as absolute delusions.
All cases of suggestion are based on an illusion that is born in one of the individuals who has more or less oratory skills. The evoked idea, namely the illusion, becomes the core of crystallization, which fills the entire area of the mind, and also paralyzes people's ability to criticize. People with a weak psyche, with a history of deviations, depression and mental illness are especially susceptible to massive disturbances in their state of mind.
Paranoid psychosis
This condition is considered a more severe manifestation than paranoia, but it is milder than paraphrenia. Paranoid mental disorders are characterized by ideas of persecution, as well as influence with affective disorders. Often this condition is observed in organic and somatogenic disorders, as well as toxic mental disorders (alcoholic psychosis). Paranoid psychosis in schizophrenia is combined with mental automatisms and pseudohallucinosis.
Paranoid psychosis is characterized by vindictiveness and constant dissatisfaction with others. A person is sensitive to all refusals, as well as failures. The individual turns into an arrogant, jealous person, watching over his other half - his spouse.
Paranoid psychosis mainly occurs at a young age, predominantly in men. All these suspicions, which are characteristic of the patient, significantly worsen his life and introduce social restrictions. Such individuals cannot tolerate criticism and have a reputation as scandalous and arrogant people. This condition inevitably drives a person into self-isolation and, without treatment, the patient’s life turns into torture. To get rid of a paranoid mental disorder, timely psychotherapy is necessary. The psychotherapeutic approach aims to improve general life skills, improve the quality of social interaction, and strengthen self-esteem.
Paranoid psychosis is treated only with medication. Antidepressants, tranquilizers, and antipsychotics are used in treatment.
Senile psychosis
The disease has a second name - senile psychosis. This disorder is typical for people over 60 years of age and is characterized by a state of confusion. Senile mental disorder often resembles.
Senile psychosis differs from senile dementia in the absence of total dementia. An acute form of senile mental disorder is observed very often. The cause is somatic diseases.
The cause of senile mental disorders is often chronic or acute diseases of the respiratory tract, as well as heart failure, diseases of the genitourinary system, hypovitaminosis, and surgical interventions. Sometimes the cause is physical inactivity, poor nutrition, sleep disturbances, decreased hearing and vision. Chronic forms of senile disorders tend to occur in the form of depressive states, which are often observed in women. In mild cases, subdepressive states occur, which are characterized by lethargy, adynamia, a feeling of emptiness, and aversion to life.
Psychoses in children
In children, psychosis is severe. The disease is characterized by impaired ability to distinguish between reality and fantasy, as well as the ability to adequately assess what is happening. Any type of mental disorder significantly harms the baby’s life. The disease creates problems in thinking, controlling impulses, expressing emotions, and also spoils relationships with other people.
Psychosis in children takes many forms. Hallucinations are common when a child hears, sees, touches, smells and tastes things that do not exist. The baby makes up words, laughs for no reason, gets very irritated for any reason, and also for no reason.
An example of psychosis in children: after reading the fairy tale “Cinderella,” the child perceives himself as the main character and believes that the evil stepmother is nearby in the room. This perception by the baby is classified as hallucinations.
Mental disturbances in children occur due to short-term as well as long-term physical conditions, long-term use of medications, hormonal imbalance, high fever, and meningitis.
Psychosis in a 2-3 year old child in many cases ends when his problems are resolved or become a little dull. In rare cases, complete recovery occurs after treatment of the underlying disease.
The disease in a 2-3 year old child is diagnosed after repeated examinations over several weeks. A child psychiatrist, neurologist, otolaryngologist, and speech therapist take part in the diagnosis.
Diagnostic procedures include a thorough physical and psychological examination, longitudinal observation of the baby's behavior, testing of mental abilities, as well as hearing and speech tests. The disease in children is treated by specialists only after a thorough examination.
Psychosis after anesthesia
Psychosis after surgery occurs immediately or two weeks later. Such disorders are observed after neurosurgical operations on the brain. Postoperative disturbances in mental state are characterized by confusion or stunned consciousness, affective-delusional disorder, and psychomotor agitation. The reason is the influence of anesthesia. Coming out of anesthesia is accompanied by oneiric episodes with autoscopic hallucinations or fantastic combined hallucinations, and is also marked by an emotional state that is close to ecstatic.
Psychosis after anesthesia is close in the patient's memories to flying in the direction of an alluring source of dazzling light, which seems to be a paradise in bright colors. Older people are much more likely to suffer from post-operative mental distress.
Psychosis after stroke
Mental disorders often appear immediately in the first week after a stroke. The cause of psychosis after a stroke is swelling of the brain tissue. Timely correct correction of the condition improves the patient’s well-being. Such disturbances during treatment disappear within a few days.
Diagnosis of psychosis
A diagnostic examination includes a study of the characteristics of the clinical picture, as well as the characteristic dynamics of the mental disorder. Most symptoms of the disease occur in a mild form, even before the onset of the disease and act as its harbingers.
The first signs are very difficult to recognize. The very first symptoms that you should pay attention to are changes in character (restlessness, irritability, anger, nervousness, sleep disturbance, hypersensitivity, loss of interests, lack of appetite, unusual and strange appearance, lack of initiative).
Psychosis treatment
Patients with psychosis require hospitalization because they often have no control over their actions and can unknowingly cause harm to themselves and those around them. Therapeutic treatment is prescribed after establishing an accurate diagnosis, as well as determining the severity of the condition and symptoms.
How is psychosis treated? Drug treatment includes psychotropic drugs, antipsychotics, tranquilizers, antidepressants and restorative drugs.
Can psychosis be cured? It depends on the type of disease and its severity.
The remedy for psychosis during agitation is the tranquilizers Seduxen, the antipsychotic Triftazin or Aminazine. Delusional ideas are eliminated with neuroleptics Stelazine, Etaperazine, Haloperidol. Reactive psychosis is treated after eliminating the cause of the disease, and if depression is added to the disease, then antidepressants Pyrazidol, Gerfonal, Amitriptyline are prescribed.
The way out of psychosis should include dynamic drug therapy. Psychological rehabilitation after psychosis increases the effectiveness of drug therapy. The main task of a psychiatrist is to establish trusting contact with the patient, and complex treatment: drug therapy with psychotherapeutic sessions accelerates recovery.
Rehabilitation after psychosis includes educational sessions. All kinds of physiotherapeutic procedures are widely used: electrosleep, acupuncture, physical therapy, occupational therapy. Physiotherapy can relieve fatigue, emotional stress, improve metabolism, and increase performance.
Recovery from psychosis can take months, as the body has a hard time with the disease and is exhausted emotionally, mentally, and physically. For a person recovering, rest and gradual integration into life are important. It is necessary to slowly test your memory, exercise your brain, and perform simple logical operations.
It will not be possible to immediately return to your previous emotional state and become the same person. Be patient. A passion for art therapy or some kind of creativity will help you, otherwise depression after psychosis will inevitably overtake you. This happens because a person begins to realize and analyze what happened to him. Therefore, it is important not to isolate yourself in your past states. This is already in the past, you need to do everything possible to prevent this from happening in the future, and learn to control yourself.
Recovery from psychosis is quick and easy for some, but difficult and long for others. Here it is important to take into account that the psyche is a flexible structure that responds to influences that are elusive to vision, hearing, and touch. It does not immediately return to the position it was originally in. Everything happens individually, gradually getting used to new conditions. This is similar to the mechanism of developing immunity.
Russian Academy of Medical Sciences
RESEARCH CENTER FOR MENTAL HEALTHMOSCOW
2004Oleychik I.V. - Candidate of Medical Sciences, Head of the Scientific Information Department of the National Center for Mental Health of the Russian Academy of Medical Sciences, Senior Researcher of the Department for the Study of Endogenous Mental Disorders and Affective States
2004, Oleychik I.V.
2004, Scientific Center for Public Health of the Russian Academy of Medical SciencesWHAT ARE PSYCHOSES
The purpose of this brochure is to convey in the most accessible form to all interested people (primarily relatives of patients) modern scientific information about the nature, origin, course and treatment of such serious diseases as psychosis.
Psychoses (psychotic disorders) are understood as the most striking manifestations of mental illnesses, in which the patient’s mental activity does not correspond to the surrounding reality, the reflection of the real world in the mind is sharply distorted, which manifests itself in behavioral disorders, the appearance of abnormal pathological symptoms and syndromes.
Most often, psychoses develop within the framework of so-called “endogenous diseases” (Greek. endo- inside,genesis- origin). A variant of the occurrence and course of a mental disorder due to the influence of hereditary (genetic) factors, which include: schizophrenia, schizoaffective psychosis, affective diseases (bipolar and recurrent depressive disorder). The psychoses that develop with them are the most severe and protracted forms of mental suffering.
The concepts of psychosis and schizophrenia are often equated, which is fundamentally wrong, since psychotic disorders can occur in a number of mental illnesses: Alzheimer's disease, senile dementia, chronic alcoholism, drug addiction, epilepsy, mental retardation, etc.
A person can suffer a transient psychotic state caused by taking certain medications, drugs, or the so-called psychogenic or “reactive” psychosis that occurs as a result of exposure to severe mental trauma (stressful situation with a danger to life, loss of a loved one, etc.). Often there are so-called infectious (developing as a result of a severe infectious disease), somatogenic (caused by severe somatic pathology, such as myocardial infarction) and intoxication psychoses. The most striking example of the latter is delirium tremens - “delirium tremens”.
Psychotic disorders are a very common type of pathology. Statistical data in different regions differ from each other, which is associated with different approaches and capabilities for identifying and accounting for these sometimes difficult to diagnose conditions. On average, the frequency of endogenous psychoses is 3-5% of the population.
Accurate information about the prevalence of exogenous psychoses among the population (Greek. exo- outside, genesis- origin. There is no option for the development of a mental disorder due to the influence of external causes located outside the body, and this is explained by the fact that most of these conditions occur in patients with drug addiction and alcoholism.
The manifestations of psychosis are truly limitless, which reflects the richness of the human psyche. The main manifestations of psychosis are:
- hallucinations(depending on the analyzer, auditory, visual, olfactory, gustatory, and tactile are distinguished). Hallucinations can be simple (bells, noise, calls) or complex (speech, scenes). The most common are auditory hallucinations, the so-called “voices”, which a person can hear coming from outside or sounding inside the head, and sometimes the body. In most cases, voices are perceived so clearly that the patient does not have the slightest doubt about their reality. Voices can be threatening, accusing, neutral, imperative (commanding). The latter are rightfully considered the most dangerous, since patients often obey the orders of voices and commit acts that are dangerous to themselves or others.
crazy ideas- judgments, conclusions that do not correspond to reality, completely take over the patient’s consciousness, and cannot be corrected by dissuading and explaining. The content of delusional ideas can be very diverse, but the most common are: delusions of persecution (patients believe that they are being spied on, they want to kill them, intrigues are woven around them, conspiracies are being organized), delusions of influence (by psychics, aliens, intelligence agencies with the help radiation, radiation, “black” energy, witchcraft, damage), delusion of damage (they add poison, steal or spoil things, want to survive from the apartment), hypochondriacal delusion (the patient is convinced that he is suffering from some kind of disease, often terrible and incurable, stubbornly proves that his internal organs are damaged and requires surgical intervention). There are also delusions of jealousy, invention, greatness, reformism, other origins, love, litigious, etc.
movement disorders, manifested in the form of inhibition (stupor) or agitation. When stupor occurs, the patient freezes in one position, becomes inactive, stops answering questions, looks at one point, and refuses to eat. Patients in a state of psychomotor agitation, on the contrary, are constantly on the move, talk incessantly, sometimes grimace, mimic, are foolish, aggressive and impulsive (they commit unexpected, unmotivated actions).
mood disorders manifested by depressive or manic states. Depression is characterized, first of all, by low mood, melancholy, depression, motor and intellectual retardation, disappearance of desires and motivations, decreased energy, a pessimistic assessment of the past, present and future, ideas of self-blame, and thoughts of suicide. A manic state is manifested by unreasonably elevated mood, acceleration of thinking and motor activity, overestimation of one’s own capabilities with the construction of unrealistic, sometimes fantastic plans and projections, disappearance of the need for sleep, disinhibition of drives (abuse of alcohol, drugs, promiscuity).
All of the above manifestations of psychosis belong to the circle positive disorders, so named because the symptoms that appear during psychosis seem to be added to the pre-morbid state of the patient’s psyche.
Unfortunately, quite often (though not always) a person who has suffered psychosis, despite the complete disappearance of his symptoms, develops so-called negative disorders, which in some cases lead to even more serious social consequences than the psychotic state itself. Negative disorders are so called because patients experience a change in character, personal properties, and a loss of powerful layers from the psyche that were previously inherent in it. Patients become lethargic, lack initiative, and passive. Often there is a decrease in energy tone, the disappearance of desires, motivations, aspirations, an increase in emotional dullness, isolation from others, a reluctance to communicate and enter into any social contacts. Often their previously inherent responsiveness, sincerity, and sense of tact disappear, and irritability, rudeness, quarrelsomeness, and aggressiveness appear. In addition, patients develop thinking disorders that become unfocused, amorphous, rigid, and meaningless. Often these patients lose their previous work skills and abilities so much that they have to register for disability.
- COURSE AND PROGNOSIS OF PSYCHOSES
The most common type (especially with endogenous diseases) is the periodic type of psychosis with acute attacks of the disease occurring from time to time, both provoked by physical and psychological factors, and spontaneous. It should be noted that there is also a single-attack course, observed more often in adolescence. Patients, having suffered one, sometimes protracted attack, gradually recover from the painful state, restore their ability to work and never come to the attention of a psychiatrist. In some cases, psychoses can become chronic and develop into a continuous course without disappearance of symptoms throughout life.
In uncomplicated and unadvanced cases, inpatient treatment usually lasts one and a half to two months. This is exactly the period doctors need to fully cope with the symptoms of psychosis and select the optimal supportive therapy. In cases where the symptoms of the disease turn out to be resistant to drugs, several courses of therapy are required, which can delay the hospital stay for up to six months or more. The main thing that the patient’s relatives need to remember is not to rush the doctors, do not insist on an urgent discharge “on receipt”! It takes a certain time to completely stabilize the condition, and by insisting on early discharge, you risk getting an undertreated patient, which is dangerous for both him and you.
One of the most important factors influencing the prognosis of psychotic disorders is the timeliness of initiation and intensity of active therapy in combination with social and rehabilitation measures.
- WHO ARE THEY - THE MINDALLY ILL?
Over the centuries, a collective image of a mentally ill person has formed in society. Unfortunately, in the minds of many people, he is still an unkempt, unshaven man with a burning gaze and an obvious or secret desire to attack others. They fear the mentally ill because, supposedly, “it is impossible to understand the logic of their actions.” Mental illnesses are considered to be sent down from above, strictly inherited, incurable, contagious, leading to dementia. Many believe that the cause of mental illness is difficult living conditions, prolonged and severe stress, complex family relationships, and lack of sexual contact. Mentally ill people are considered either “weaklings” who simply cannot pull themselves together or, going to the other extreme, sophisticated, dangerous and ruthless maniacs who commit serial and mass murders and sexual violence. It is believed that people suffering from mental disorders do not consider themselves sick and are unable to think about their treatment.
Unfortunately, the relatives of the patient often internalize the views typical in society and begin to treat the unfortunate person in accordance with the prevailing misconceptions in society. Often, families into which a mentally ill person appears try at all costs to hide their misfortune from others and thereby aggravate it even more, dooming themselves and the patient to isolation from society.
Mental disorder is a disease like any other. There is no reason to be ashamed that this disease runs in your family. The disease is of biological origin, i.e. occurs as a result of metabolic disorders of a number of substances in the brain. Suffering from a mental disorder is much the same as having diabetes, peptic ulcers, or other chronic illness. Mental illness is not a sign of moral weakness. Mentally ill people cannot eliminate the symptoms of their illness through willpower, just as it is impossible to improve their vision or hearing through willpower. Mental illnesses are not contagious. The disease is not transmitted by airborne droplets or other means of infection, so it is impossible to get psychosis by closely communicating with the patient. According to statistics, cases of aggressive behavior among mentally ill people are less common than among healthy people. The heredity factor in patients with mental illness manifests itself in the same way as in patients with cancer or diabetes. If two parents are sick, the child gets sick in about 50% of cases; if one parent is sick, the risk is 25%. Most people with mental disorders understand that they are ill and seek treatment, although in the initial stages of the illness it is difficult for a person to accept it. A person's ability to make decisions about his or her own treatment is greatly enhanced if family members are involved and approve and support their decisions. And, of course, we should not forget that many brilliant or famous artists, writers, architects, musicians, and thinkers suffered from serious mental disorders. Despite the serious illness, they managed to enrich the treasury of human culture and knowledge, immortalizing their name with the greatest achievements and discoveries.
SIGNS OF BEGINNING DISEASE OR EXCERNSATION
For relatives whose loved ones suffer from one or another mental disorder, information about the initial manifestations of psychosis or symptoms of the advanced stage of the disease may be useful. All the more useful may be recommendations on some rules of behavior and communication with a person in a painful condition. In real life, it is often difficult to immediately understand what is happening to your loved one, especially if he is scared, suspicious, distrustful and does not directly express any complaints. In such cases, only indirect manifestations of mental disorders can be noticed. Psychosis can have a complex structure and combine hallucinatory, delusional and emotional disorders (mood disorders) in various proportions. The following symptoms may appear during the disease, all without exception, or individually.
Manifestations of auditory and visual hallucinations:
Conversations with oneself that resemble a conversation or remarks in response to someone else's questions (excluding comments out loud like “Where did I put my glasses?”).
Laughter for no apparent reason.
Sudden silence, as if a person is listening to something.
Alarmed, preoccupied look; inability to concentrate on the topic of conversation or a specific task.
The impression that your relative sees or hears something that you cannot perceive.
The appearance of delirium can be recognized by the following signs:
Changed behavior towards relatives and friends, the appearance of unreasonable hostility or secrecy.
Direct statements of implausible or dubious content (for example, about persecution, about one’s own greatness, about one’s irredeemable guilt.)
Protective actions in the form of curtaining windows, locking doors, obvious manifestations of fear, anxiety, panic.
Expressing, without obvious grounds, fears for one’s life and well-being, or for the life and health of loved ones.
Separate, meaningful statements that are incomprehensible to others, adding mystery and special significance to everyday topics.
Refusal to eat or careful checking of food contents.
Active litigious activity (for example, letters to the police, various organizations with complaints about neighbors, co-workers, etc.).
How to respond to the behavior of a person suffering from delusions:
Do not ask questions that clarify the details of delusional statements and statements.
Do not argue with the patient, do not try to prove to your relative that his beliefs are wrong. Not only does this not work, but it can also worsen existing disorders.
If the patient is relatively calm, inclined to communicate and help, listen carefully, reassure him and try to persuade him to see a doctor.
Suicide Prevention
In almost all depressive states, thoughts of not wanting to live may arise. But depression accompanied by delusions (for example, guilt, impoverishment, incurable somatic illness) is especially dangerous. At the height of the severity of the condition, these patients almost always have thoughts of suicide and suicidal readiness.
The following signs warn of the possibility of suicide:
The patient’s statements about his uselessness, sinfulness, and guilt.
Hopelessness and pessimism about the future, reluctance to make any plans.
The patient's conviction that he has a fatal, incurable disease.
Sudden calming of the patient after a long period of sadness and anxiety. Others may have the false impression that the patient's condition has improved. He puts his affairs in order, for example, writes a will or meets with old friends whom he has not seen for a long time.
Precautionary measures:
Take any conversation about suicide seriously, even if it seems unlikely to you that the patient might try to commit suicide.
If you get the impression that the patient is already preparing for suicide, do not hesitate to immediately seek professional help.
Hide dangerous objects (razors, knives, pills, ropes, weapons), carefully close windows and balcony doors.
YOUR RELATIVE IS ILL
All members of the family where a mentally ill person appears initially experience confusion, fear, and do not believe what happened. Then the search for help begins. Unfortunately, very often people first turn not to specialized institutions where they can get advice from a qualified psychiatrist, but, at best, to doctors of other specialties, at worst - to healers, psychics, and specialists in the field of alternative medicine. The reason for this is a number of existing stereotypes and misconceptions. Many people distrust psychiatrists, which is associated with the problem of the so-called “Soviet punitive psychiatry” artificially inflated by the media during the years of perestroika. Most people in our country still associate various serious consequences with a consultation with a psychiatrist: registration at a psychoneurological dispensary, loss of rights (limitation of the ability to drive vehicles, travel abroad, carry weapons), the threat of loss of prestige in the eyes of others, social and professional discredit. The fear of this peculiar stigma, or, as they now say, “stigma”, the conviction in the purely somatic (for example, neurological) origin of their suffering, the confidence in the incurability of mental disorders by the methods of modern medicine and, finally, simply a lack of understanding of the painful nature of their condition force people to people and their relatives categorically refuse any contact with psychiatrists and psychotropic therapy - the only real opportunity to improve their condition. It should be emphasized that after the adoption in 1992 of the new Law of the Russian Federation “On psychiatric care and guarantees of the rights of citizens in its provision,” most of the above fears are unfounded.
The infamous “registration” was abolished ten years ago, and currently a visit to a psychiatrist does not threaten negative consequences. Nowadays, the concept of “accounting” has been replaced by the concepts of advisory and medical care and dispensary observation. The advisory population includes patients with mild and short-term mental disorders. Help is provided to them if they independently and voluntarily go to the dispensary, at their request and with their consent. Minor patients under the age of 15 are provided with assistance at the request or with the consent of their parents or legal representatives of their rights. The dispensary observation group includes patients suffering from severe, persistent or frequently exacerbating mental disorders. Dispensary observation can be established by the decision of a commission of psychiatrists, regardless of the consent of the person suffering from a mental disorder, and is carried out through regular examinations by doctors of psychoneurological dispensaries (PND). Dispensary observation is terminated upon condition of recovery or significant and persistent improvement in the patient’s condition. As a rule, observation is stopped if there are no exacerbations for five years.
It should be noted that often when the first signs of mental disorder appear, concerned relatives assume the worst - schizophrenia. Meanwhile, as already mentioned, psychoses have other causes, so each patient requires a thorough examination. Sometimes delay in seeing a doctor is fraught with the most severe consequences (psychotic conditions that develop as a result of a brain tumor, stroke, etc.). To identify the true cause of psychosis, consultation with a qualified psychiatrist using the most complex high-tech methods is necessary. This is also why turning to alternative medicine, which does not have the full arsenal of modern science, can lead to irreparable consequences, in particular, to an unjustified delay in bringing the patient to the first consultation with a psychiatrist. As a result, the patient is often brought to the clinic by ambulance in a state of acute psychosis, or the patient is examined in an advanced stage of mental illness, when time has already been lost and there is a chronic course with the formation of negative disorders that are difficult to treat.
Patients with psychotic disorders can receive specialized care in the primary care unit at their place of residence, in psychiatric research institutions, in psychiatric and psychotherapeutic care offices at general clinics, in psychiatric offices in departmental clinics.
The functions of the psychoneurological dispensary include:
Outpatient visits to citizens referred by doctors of general clinics or who applied independently (diagnosis, treatment, solution of social issues, examination);
Referral to a psychiatric hospital;
Emergency care at home;
Consultative and clinical observation of patients.
After examining the patient, the local psychiatrist decides in what conditions to carry out treatment: the patient’s condition requires urgent hospitalization in a hospital or outpatient treatment is sufficient.
Article 29 of the Law of the Russian Federation “On psychiatric care and guarantees of the rights of citizens during its provision” clearly regulates the grounds for involuntary hospitalization in a psychiatric hospital, namely:
“A person suffering from a mental disorder may be hospitalized in a psychiatric hospital without his consent or without the consent of his legal representative until a judge’s decision, if his examination or treatment is possible only in an inpatient setting, and the mental disorder is severe and causes:
a) his immediate danger to himself or others, or
b) his helplessness, that is, his inability to independently satisfy the basic needs of life, or
c) significant harm to his health due to a deterioration in his mental state if the person is left without psychiatric help"
TREATMENT: BASIC METHODS AND APPROACHES.
Despite the fact that psychoses are a complex group that includes conditions of various origins, the principles of treatment for them are the same. Throughout the world, drug therapy is considered the most effective and reliable method of treating psychosis. When it is carried out, an unconventional, strictly individual approach is used to each patient, taking into account age, gender, and the presence of other diseases. One of the main tasks of a specialist is to establish fruitful cooperation with the patient. It is necessary to instill in the patient faith in the possibility of recovery, to overcome his prejudice against the “harm” caused by psychotropic drugs, to convey to him his conviction in the effectiveness of treatment, subject to systematic adherence to the prescribed prescriptions. Otherwise, there may be a violation of medical recommendations regarding doses and medication regimen. The relationship between doctor and patient should be built on mutual trust, which is guaranteed by the specialist’s adherence to the principles of non-disclosure of information, medical confidentiality, and anonymity of treatment. The patient, in turn, should not hide from the doctor such important information as the fact of using psychoactive substances (drugs) or alcohol, taking medications used in general medicine, driving a car or operating complex mechanisms. A woman should inform her doctor if she is pregnant or breastfeeding. Often relatives or patients themselves, having carefully studied the annotations for the medications recommended to them, are perplexed, and sometimes even indignant, that the patient was prescribed a drug to treat schizophrenia, while he has a completely different diagnosis. The explanation is that almost all drugs used in psychiatry act nonspecifically, i.e. They help with a wide range of painful conditions (neurotic, affective, psychotic) - it’s all about the prescribed dose and the doctor’s skill in selecting optimal treatment regimens.
Undoubtedly, taking medications should be combined with social rehabilitation programs and, if necessary, with family psychotherapeutic and psychopedagogical work.
Social rehabilitation is a complex of programs for teaching patients with mental disorders ways of rational behavior both in a hospital setting and in everyday life. Rehabilitation is aimed at teaching social skills for interacting with other people, skills necessary in everyday life, such as taking into account one’s own T financial finances, cleaning the house, shopping, using society n transport, etc., vocational training, which includes activities T skills necessary to obtain and maintain employment, and training for those patients who want to graduate from high school or college. Auxiliary Psych O Therapy is also often used to help mentally ill people. Psychotherapy helps mentally ill people feel better O treat yourself, especially those who experience a feeling of inadequacy n anxiety due to their illness and to those who seek to deny the presence of the illness. Psychotherapy n O Helps the patient learn ways to solve everyday problems. An important element of social rehabilitation is participation in the work of mutual groups m noy on d hanging out with other people who understand what it means to be crazy And mentally ill. Such groups, led by patients who have undergone hospitalization, allow other patients to experience help in their lives. And mania of their problems, and also expand the possibilities of their participation in recovery b events and society n new life.
All these methods, when used wisely, can increase the effectiveness of drug therapy, but are not able to completely replace drugs. Unfortunately, science still does not know how to cure mental illnesses once and for all; psychoses often have a tendency to recur, which requires long-term preventive medication.
NEUROLEPTICS IN THE TREATMENT SYSTEM OF PSYCHOTIC DISEASESESKIH RAWITHBUILDINGS
The main drugs used to treat psychosis are the so-called neuroleptics or antipsychotics.
The first chemical compounds that have the property of stopping psychosis were discovered in the middle of the last century. Then, for the first time, psychiatrists had a powerful and effective treatment for psychosis in their hands. Such drugs as aminazine, haloperidol, stelazine and a number of others have proven themselves especially well. They stopped psychomotor agitation well, eliminated hallucinations and delusions. With their help, a huge number of patients were able to return to life and escape from the darkness of psychosis. However, over time, evidence has accumulated that these drugs, later called classical antipsychotics, affect only positive symptoms, often without affecting negative ones. In many cases, the patient was discharged from a psychiatric hospital without delusions or hallucinations, but became passive and inactive, and was unable to return to work. In addition, almost all classical antipsychotics cause so-called extrapyramidal side effects (drug-induced parkinsonism). These effects are manifested by muscle stiffness, tremors and convulsive twitching of the limbs, sometimes there is a hard-tolerable feeling of restlessness, which is why patients are in constant motion, unable to stop for a minute. To reduce these unpleasant phenomena, doctors are forced to prescribe a number of additional drugs, which are also called correctors (cyclodol, parkopan, akineton, etc.). The side effects of classical antipsychotics are not limited to extrapyramidal disorders; in some cases, drooling or dry mouth, urination problems, nausea, constipation, palpitations, a tendency to lower blood pressure and fainting, weight gain, decreased libido, erectile dysfunction and ejaculation may be observed. In women, galactorrhea (discharge from the nipples) and amenorrhea (disappearance of menstruation) are common. It is impossible not to note side effects from the central nervous system: drowsiness, deterioration of memory and concentration, increased fatigue, the possibility of developing the so-called. neuroleptic depression.
Finally, it should be emphasized that, unfortunately, traditional antipsychotics do not help everyone. There has always been a portion of patients (about 30%) whose psychoses were difficult to treat, despite adequate therapeutic tactics with timely change of drugs of various groups.
All these reasons explain the fact that patients often voluntarily stop taking medications, which in most cases leads to an exacerbation of the disease and re-hospitalization.
A real revolution in the treatment of psychotic disorders was the discovery and introduction into clinical practice in the early 90s of a fundamentally new generation of neuroleptics - atypical antipsychotics. The latter differ from classical neuroleptics in their selectivity of neurochemical action. By acting only on certain nerve receptors, these drugs, on the one hand, turned out to be more effective, and on the other, much better tolerated. They were found to cause virtually no extrapyramidal side effects. Currently, several such drugs are already available on the domestic market - rispolept (risperidone), Zyprexa (olanzapine), Seroquel (quetiapine) and azaleptin (leponex), which was previously introduced into clinical practice. The most widely used are Leponex and Rispolept, which are included in the “List of Vital and Essential Medicines”. Both of these drugs are highly effective in various psychotic conditions. However, while Rispolept is more often prescribed by practitioners in the first place, Leponex is justifiably used only in the absence of an effect from previous treatment, which is associated with a number of pharmacological features of this drug, the nature of side effects and specific complications, which, in particular, require regular monitoring general blood test.
What are the advantages of atypical antipsychotics for lein the acute phase of psychosis?
The ability to achieve a greater therapeutic effect, including in cases of symptom resistance or patient intolerance to typical antipsychotics.
The effectiveness of treating negative disorders is significantly greater than that of classical neuroleptics.
Security, i.e. insignificant severity of both extrapyramidal and other side effects characteristic of classical antipsychotics.
There is no need to take correctors in most cases with the possibility of monotherapy, i.e. treatment with one drug.
Acceptability of use in weakened, elderly and somatically burdened patients due to low interaction with somatotropic drugs and low toxicity.
SUPPORTIVE AND PREVENTIVE TERAFDI
Among psychotic disorders of various origins, psychoses developing as part of endogenous diseases make up the lion's share. The course of endogenous diseases differs in duration and tendency to relapse. That is why international recommendations regarding the duration of outpatient (maintenance, preventive) treatment clearly stipulate its terms. Thus, patients who have suffered the first attack of psychosis need to take small doses of drugs for one to two years as preventive therapy. If a repeated exacerbation occurs, this period increases to 3-5 years. If the disease shows signs of transition to a continuous course, the period of maintenance therapy is increased indefinitely. That is why there is a justified opinion among practical psychiatrists that in order to treat patients who become ill for the first time (during their first hospitalization, less often outpatient therapy), maximum efforts should be made, and the longest and most complete course of treatment and social rehabilitation should be carried out. All this will pay off handsomely if it is possible to protect the patient from repeated exacerbations and hospitalizations, because after each psychosis negative disorders increase, which are especially difficult to treat.
Preventing RecAnddivas of psychosis
Reducing the relapse of mental illness is facilitated by a structured daily lifestyle that has the maximum therapeutic effect and includes regular exercise, reasonable rest, a stable daily routine, a balanced diet, avoidance of drugs and alcohol, and regular use of medications prescribed by a doctor as maintenance therapy.
Signs of an approaching relapse may include:
Any significant changes in the patient’s behavior, daily routine or activity (unstable sleep, loss of appetite, appearance of irritability, anxiety, change in social circle, etc.).
Features of behavior that were observed on the eve of the previous exacerbation of the disease.
The appearance of strange or unusual judgments, thoughts, perceptions.
Difficulty doing ordinary, simple tasks.
Unauthorized termination of maintenance therapy, refusal to visit a psychiatrist.
If you notice warning signs, take the following measures:
Notify your doctor and ask him to decide if your therapy needs to be adjusted.
Eliminate all possible external stressors on the patient.
Minimize (within reasonable limits) all changes in your daily routine.
Provide the patient with as calm, safe and predictable an environment as possible.
To avoid exacerbation, the patient should avoid:
Premature withdrawal of maintenance therapy.
Violations of the medication regimen in the form of an unauthorized dosage reduction or irregular intake.
Emotional turmoil (conflicts in the family and at work).
Physical overload, including both excessive exercise and overwhelming housework.
Colds (acute respiratory infections, flu, sore throats, exacerbations of chronic bronchitis, etc.).
Overheating (solar insolation, prolonged stay in a sauna or steam room).
Intoxication (food, alcohol, medicinal and other poisoning).
Changes in climatic conditions during the holidays.
Advantages of atypical antipsychotics during professionalAndlactic treatment.
When carrying out maintenance treatment, the advantages of atypical antipsychotics over classical antipsychotics are also revealed. First of all, this is the absence of “behavioral toxicity,” that is, lethargy, drowsiness, inability to engage in any activity for a long time, slurred speech, and unsteady gait. Secondly, a simple and convenient dosing regimen, because Almost all new generation drugs can be taken once a day, say at night. Classical antipsychotics, as a rule, require three doses, which is caused by the peculiarities of their pharmacodynamics. In addition, atypical antipsychotics can be taken without regard to meals, which allows the patient to maintain their usual daily routine.
Of course, it should be noted that atypical antipsychotics are not a panacea, as some advertising publications try to present. Drugs that completely cure serious illnesses such as schizophrenia or bipolar disorder have yet to be discovered. Perhaps the main disadvantage of atypical antipsychotics is their cost. All new drugs are imported from abroad, produced in the USA, Belgium, Great Britain and, naturally, have a high price. Thus, the approximate costs of treatment when using the drug in average dosages for a month are: Zyprexa - $200, Seroquel - $150, Rispolept - $100. True, recently more and more pharmacoeconomic studies have appeared, convincingly proving that the total costs of patients’ families for the purchase of 3-5, and sometimes more, classical drugs, namely such complex regimens are used for the treatment and prevention of psychotic disorders, are approaching the costs per one atypical antipsychotic (here, as a rule, monotherapy is carried out, or simple combinations with 1-2 more drugs are used). In addition, a drug such as rispolept is already included in the list of drugs provided free of charge in dispensaries, which makes it possible, if not to fully meet the needs of patients, then at least partially to alleviate their financial burden.
It cannot be said that atypical antipsychotics have no side effects at all, because Hippocrates said that “an absolutely harmless medicine is absolutely useless.” When taking them, there may be an increase in body weight, a decrease in potency, disturbances in the menstrual cycle in women, and an increase in the level of hormones and blood sugar. However, it should be noted that almost all of these adverse events depend on the dosage of the drug, occur when the dose is increased above the recommended one and are not observed when using average therapeutic doses.
Extreme caution must be exercised when deciding whether to reduce dosages or discontinue an atypical antipsychotic. This question can only be decided by the attending physician. Untimely or abrupt withdrawal of the drug can lead to a sharp deterioration in the patient’s condition, and, as a result, to urgent hospitalization in a psychiatric hospital.
Thus, from all of the above it follows that psychotic disorders, although they are among the most serious and quickly disabling diseases, do not always fatally lead to severe outcomes. In most cases, provided that psychosis is correctly and timely diagnosed, early and adequate treatment is prescribed, and modern gentle methods of psychopharmacotherapy are used, combined with methods of social rehabilitation and psychocorrection, it is possible not only to quickly relieve acute symptoms, but also to achieve complete restoration of the patient’s social adaptation.
