Organic mental disorders. Particular forms of mental disorders and their forensic psychiatric significance. Symptoms of organic mental disorders

Organic mental disorders (organic brain diseases, organic brain lesions) are a group of diseases in which certain mental disorders occur as a result of damage (damage) to the brain.

Causes of occurrence and development

Varieties

As a result of brain damage, various mental disorders gradually (from several months to several years) develop, which, depending on the leading syndrome, are grouped as follows:
- Dementia.
- Hallucinosis.
- Delusional disorders.
- Psychotic affective disorders.
- Non-psychotic affective disorders
- Anxiety disorders.
- Emotionally labile (or asthenic) disorders.
- Mild cognitive impairment.
- Organic personality disorders.

What do all patients with organic mental disorders have in common?

All patients with organic mental disorders have varying degrees of attention impairment, difficulty in remembering new information, slowed thinking, difficulty in setting and solving new problems, irritability, “getting stuck” on negative emotions, sharpening of features previously characteristic of a given person, a tendency to aggression (verbal, physical).

What is characteristic of certain types of organic mental disorders?

What to do if you discover the described mental disorders in yourself or your loved ones?

In no case should you ignore these phenomena and, especially, self-medicate! You must independently contact your local psychiatrist at the psychoneurological dispensary at your place of residence (a referral from the clinic is not needed). You will be examined, the diagnosis clarified, and treatment prescribed. Therapy for all the mental disorders described above is carried out on an outpatient basis, by a local psychiatrist or in a day hospital. However, there are cases when a patient needs to be treated in a 24-hour psychiatric hospital:
- with delusional disorders, hallucinosis, psychotic affective disorders, conditions are possible when the patient refuses to eat for morbid reasons, has persistent suicidal tendencies, aggressiveness towards others (as a rule, this happens if the patient violates the maintenance therapy regimen or completely refuses drug treatment);
- for dementia, if the patient, being helpless, was left alone.
But usually, if the patient follows all the recommendations of the doctors at the psychoneurological dispensary, his mental state is so stable that even with a possible deterioration there is no need to stay in a 24-hour hospital, the local psychiatrist gives a referral to a day hospital.
NB! There is no need to be afraid of going to a psychoneurological clinic: firstly, mental disorders greatly reduce a person’s quality of life, and only a psychiatrist has the right to treat them; secondly, nowhere in medicine is human rights legislation observed as much as in psychiatry; only psychiatrists have their own law - the Law of the Russian Federation “On Psychiatric Care and Guarantees of the Rights of Citizens in its Provision.”

General principles of drug treatment of organic mental disorders

1.Striving for maximum restoration of the functioning of damaged brain tissue. This is achieved by prescribing vascular drugs (medicines that dilate small arteries of the brain, and, accordingly, improve its blood supply), drugs that improve metabolic processes in the brain (nootropics, neuroprotectors). Treatment is carried out in courses 2-3 times a year (injections, higher doses of medications), the rest of the time continuous maintenance therapy is provided.
2. Symptomatic treatment, that is, an impact on the leading symptom or syndrome of the disease, is prescribed strictly according to indications by a psychiatrist.

Is there a way to prevent organic mental disorders?

Ekaterina DUBITSKAYA,
Deputy Chief Physician of the Samara Psychoneurological Dispensary
on inpatient care and rehabilitation work,
Candidate of Medical Sciences, psychiatrist of the highest category

And I would like to start with one not very well-known quote: “ The term organic mental disorder is no longer used in DSM-IV because it implies that other "non-organic" mental disorders do not have a biological basis.» © 1994 American Psychiatric Association.

The love of some psychiatrists for the term “organic” mental disorder is so strong that it has already reached irrational strength. To begin with, the diagnosis F06 (Other mental disorders caused by damage and dysfunction of the brain or somatic illness) has turned into a real “garbage pit”, into which all pathologies, to one degree or another associated with typical neurological or therapeutic diseases. This is such a local VSD: depression in this section, schizophrenia in this, anxiety in this, personal here, dementia there, drug addiction somewhere there, and for everything else there is F04-09.

The ideological moment is also very important here! While our teachers are competing “who can quote Gannushkin/Bleuler/Snezhnevsky/Jaspers/Smulevich, etc.” more, our colleagues are looking forward and are open to change and revision of the “old framework”. This is why the APA abandoned the term “organic” mental disorders more than twenty years ago, and why our poor students and residents are taught the NCMH classification with all “endogenous organic” mental disorders. The funny thing is that all those scientists quoted by our teachers were at the forefront of science at one time and with their work changed established views. Without this, we would still be stewing in the dark “bile” of Hippocrates, which is actually what is happening to us now (metaphorically).

Moreover, everyone clearly sees the trend of neurological expansion into the psychiatric field of action. Starting from the complete conquest of epilepsy, ending with the fact that neurologists are no longer ashamed to treat depression, various mild psychotic inclusions, as well as obscure but beloved “astheno-neurotic” disorders. How they do this is a separate topic. Another thing is that, following epilepsy, neurologists have almost annexed neurocognitive disorders. Thus, one very respected and, probably, the most advanced dementia specialist in Russia is Professor O.S. Levin. (a neurologist, of course), at one large conference tried to explain to psychiatrists why neurologists deal with dementia: “Because dementia is an organic disease of the brain with psychiatric complaints.”

Here we can only recall the above conclusion that other “inorganic” mental disorders in this case do not have a biological basis. Indeed, why do we, psychiatrists, need “organic”? If there is Ribot's law, which we learned in psychopathology, why learn to read and understand MRI data, which can greatly help us in making a diagnosis? We are specialists in “psychics”!

There is nothing more to add here, because the reason why we should abandon the term “organic” mental disorders was written back in the DSM-IV in 1994. And this, for a second, is a nomenclature classification, and not some leading article in scientific magazine with a large IF. And it’s not a matter of principle what to call this or that disorder; it won’t change much. The point is to understand the problem, and, therefore, to find ways to solve it.

It is also worth noting the pleasant changes in ICD 11, on which our practice will be based. The new classification will include a subheading: “Secondary mental or behavioral syndromes associated with disorders or diseases classified in other headings.” However, these categories of “secondary” mental disorders will need to be used only in addition to the main diagnosis in order to ensure clinical attention to them. What's good about this? Firstly, there will finally be no “organic” mental disorders. Secondly, everyone will have to repeat the rules for making diagnoses not related to psychiatry, in order to at least understand what is happening to the patient. Thirdly, perhaps this innovation will at least to some extent influence the spread of such an absurd term as “organic” mental disorders.

Organic mental disorders (organic brain diseases, organic brain lesions) are a group of diseases in which certain mental disorders occur as a result of damage (damage) to the brain.

Causes of occurrence and development

Varieties

What do all patients with organic mental disorders have in common?

What is characteristic of certain types of organic mental disorders?

What to do if you discover the described mental disorders in yourself or your loved ones?

General principles of drug treatment of organic mental disorders

Is there a way to prevent organic mental disorders?

Organic personality and behavior disorder can develop after receiving a certain type of brain injury, as well as some inflammatory and non-inflammatory diseases. A person’s behavior undergoes serious changes, the emotional sphere is affected, as well as the ability to control impulsive behavior

To make such a diagnosis, ICD-10 requires, in addition to determining evidence of disease, dysfunction, or brain injury, to also identify the presence of at least two of these criteria:

Decreased performance;
Tendency to affective manifestations;
Paranoid ideas and suspicion;
Impaired judgments about the social sphere;
The fluency and pace of speech changes;
The nature of sexual behavior is changing.

Forms of the disease and its symptoms

Organic mental disorders manifest themselves in the following forms:

Organic emotional labile asthenic disorder. The main clinical manifestation of this pathology is asthenic syndrome, which is characterized by weakness, hypersensitivity, decreased motor skills, dizziness, irritability, tearfulness, and fatigue.
Asthenic organic disorder– this is a persistent change in the psyche, which combines neurosis-like and cerebrasthenic syndromes, which is characteristic of vascular diseases of the brain. It appears at the beginning of the disease and persists until the final stage - vascular.
Symptomatic mental disorders are a fairly typical manifestation of somatic diseases, sometimes even their main syndrome. It is expressed in difficulty concentrating, increased fatigue, delayed perception, weakened memory, and mental vulnerability. Patients also suffer from hyperesthesia, sleep disturbances, and multiple vegetative manifestations.
. Clinical manifestations of this pathology are tremor, a feeling of trembling in the epigastrium, increased heart rate, hypertension, pallor, dry mouth, anxiety and panic, which the patient does not associate with any reason.
Schizophrenia-like disorder is characterized, which is either constantly present or occurs periodically, by negative personality changes, the appearance of hallucinatory-delusional images, often of religious subjects. Possible disturbances of consciousness, paraphrenia, which are characterized by ecstasy, excitement and statements of a messianic plan.
Exogenously organic disorders can be psychopathic and neurosis-like. They manifest themselves in the form of pronounced intellectual-mnestic, depressively colored vegetative disorders, as well as in the form of uncontrollability, conflict and anger.
personalities found in the practice of both neurologists and therapists. Its peculiarity lies in the predominance of somato-neurological symptoms over mental ones. Sleep disturbances, increased fatigue, memory problems, appetite disorders, dry mouth, and increased urination are observed.
Affective disorder develops mainly against the background of pathologies of the endocrine glands (thyrotoxicosis, thyroidectomy, Itsenko-Cushing's disease), upon discontinuation of hormonal drugs used for their treatment for a long time, as well as tumors of the frontal lobe of the brain and traumatic brain injuries. Manifests itself in the form of various affective disorders.
Speech disorders They occur both in childhood, due to various developmental pathologies, and in adults, due to cerebral atherosclerosis, diabetes mellitus and hypertension.
Residual organic disorders occur in adolescence and childhood as a consequence of organic cerebral pathology. They manifest themselves as mental retardation, as well as various psychogenic characterological and pathocharacterological reactions.
Vascular disorder develops as a consequence of various types of vascular diseases of the brain - atherosclerosis, thromboangiitis obliterans, hypertension and certain vascular pathologies, for example, myocardial infarction. The symptoms of this type of mental disorder differ from other similar pathologies in the almost complete absence of pronounced psychopathology and the predominance of neurological disorders.
Personality disorder of complex origin. This diagnosis is made when there is more than one cause for the development of this pathology.

Diagnosis of pathology

The diagnosis of this pathology is established on the basis of a complete comprehensive examination of the patient. Should also be carried out differential diagnosis with, the most important distinguishing feature is memory impairment (the only exception to this rule is Pick's disease). The most accurate diagnostic criterion is the results of a neuropsychological examination; neurological data, EEG and CT are also of great importance.

Eligibility criteria for recruits diagnosed with organic personality disorder

Such examination is also of great importance for conscripts. After all, with such a diagnosis as personality disorder, The fitness category is set depending on the severity of the disease. Conscripts are examined at an outpatient clinic or inpatient department. There is a technology that involves the use of special tables for differential diagnosis, with the help of which it is quite easy to determine whether or not a person has nervous system disorders. The experience of clinical application of this technique in psychiatric hospitals has shown its exceptional information value for making a decision by an expert military medical commission of adolescents regarding their suitability for military service.

Treatment

This disease requires careful examination and careful, long-term, complex therapy. Treatment is carried out using medications and psychotherapeutic techniques. These types of therapy should not be opposed to each other. However, medications do not play such a significant role in the treatment of patients with such pathologies. Antipsychotics in small doses should be used in cases of aggression or psychomotor agitation, as well as decompensated paranoid disorder (for example, haloperidol or levomepromazine). Anxiolytic drugs(such as diazepam) can reduce anxiety. (amitriptyline) are needed, respectively, in the presence of a depressive state. The best method of treating such diseases is psychotherapy - individual, psychoanalytic, family or group. With the help of this method, the patient’s attitudes change, he finds the right interpersonal relationships with others.

Course of the disease and its prognosis

Adaptation of patients in the outside world depends on how disrupted their behavior is, as well as on a number of external factors. Patients adapt more easily in the presence of favorable external conditions, and the condition worsens if they encounter unfavorable ones. Factors causing decompensation are infectious and somatic diseases, stress and intoxication. The development of psychopathy depends on the age of the patient. The period of puberty is considered the most problematic. A common feature of each of these types of pathologies is non-progressiveness. But at the end of the period of decompensation, the patient’s personality returns to its original state. Patients usually try to avoid taking a course of treatment. The disease is chronic and progressive, gradually leading the patient to his social and labor decompensation, however, the condition of some patients may improve.

10,000 rub/day

Accommodation with a relative: x1.8

The hospital price includes:

each room has its own bathroom, TV, wi-fi, air conditioning;
all necessary treatment package; 24-hour medical monitoring;
consultations with general practitioners, neurologists, psychiatrists, psychotherapists, narcologists;
3 meals a day with a 24-hour buffet (fruits, snacks, sweets);
daily work with psychologists and group classes;
necessary types of tests, ECG, EEG, pulsometry;
daily massage and exercise therapy;
gym and table tennis;
board games and watching movies.

Single VIP rooms

20,000 rub/day

Accommodation with a relative: x1.8

Included in the price of the VIP room additionally included:

single stay;
soft chair;
extra pillows;
robe and slippers;
personal hygiene items (toothpaste and brush, soap);
fruits and water in the room;
electric kettle;

Organic and symptomatic mental disorders are a separate category in the ICD-10 (International Classification of Diseases, 10th revision), which includes mental and behavioral disorders caused by brain damage, and is designated by code F-0.

Doctors call all these diseases organic (in medical parlance – “organic”). You can find a detailed description of individual organic diseases on the pages of our website.

The existing belief that any organic brain damage is always an irreversible and progressive disease that leads to dementia is not true.

Modern research and long-term observation of patients with “organic” mental disorders show something else: newly emerging, timely identified and adequately treated (including rehabilitation) organic lesions of the central nervous system successfully resolve, in many cases without noticeable consequences. Although, it should be noted that a significant number of organic and symptomatic mental disorders become chronic and become more severe over time.

In almost all organic and symptomatic mental disorders, the functioning of the peripheral nervous system is disrupted and pathological neurological symptoms are revealed. There is such a pattern that in mild, incipient organic diseases, neurological symptoms are minimal, and mental disorders (behavioral disorders) are strongly expressed and even predominate in the clinical picture. Conversely, with severe organic brain damage, pathological neurological symptoms “prevail” over mental disorders.

The causes of organic and symptomatic mental disorders are varied: hereditary factors (genetic defects), consequences of traumatic brain injuries, strokes, intoxications and hypoxic conditions, vascular, endocrine and metabolic diseases and much more, which causes disruption of the normal structure of brain tissue.

Identification of organic mental disorders consists of several stages. The first is a consultation with a doctor. During the consultation, an anamnesis (life history and illness) is collected, the mental, neurological and somatic state of the patient is assessed. In the vast majority of cases, consulting an experienced doctor is enough to make a correct diagnosis.

In cases where there is not enough data for a conclusion or additional instrumental examinations are carried out to confirm the diagnosis - the second stage. Some of the most common studies for diagnosing organic damage to brain tissue are tomography (MRI, CT) and electroencephalography (EEG).

Tomographic studies make it possible to identify gross disturbances in the structure of brain tissue: foci of atrophy, proliferation of connective tissue, neoplasms, displacement, etc. Electroencephalography shows the state of electrical activity of the brain and can indicate the presence of foci of overexcitation, inhibition or disorganization.

Treatment of organic and symptomatic mental disorders is selected individually. The main methods of therapy are pharmacotherapy (neurometabolic, neuroleptic, normothymic, antidepressant, etc.), psychotherapy, physical therapy and rehabilitation.

The ROSA clinic provides diagnosis and treatment of all types of organic and symptomatic mental disorders and behavioral disorders:

We work around the clock.
Own hospital.
An established team of psychiatrists, psychotherapists, neurologists, clinical psychologists, and rehabilitation specialists with many years of experience.
Advanced and traditional treatment methods.
Study of the nervous system and mental sphere.
Rehabilitation programs developed by leading specialists of the ROSA clinic.
Individual approach. Anonymously. High level of medical service.