1. WHAT ARE PSYCHOSES

The purpose of this material 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 development due to the influence of external causes 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 master 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.

2. 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 that do not 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.

3. WHO ARE THEY – THE MENTALLY 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 mellitus. If two parents are sick, the child gets sick in about 50% of cases; if one, 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.

4. 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:

· Self-talk that resembles a conversation or remarks in response to someone'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 fears for one’s life and well-being, or for the life and health of loved ones without obvious grounds.

· Individual, meaningful statements that are incomprehensible to others, adding mystery and special significance to everyday topics.

· Refusal to eat or carefully checking the contents of food.

· 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:

· Statements by the patient 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.

5. YOUR RELATIVE GOT 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 a consultation with a psychiatrist with various serious consequences: 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 reception of 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"

6. 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 notify her doctor if she is pregnant or breastfeeding. Often, relatives or the 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 for, 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 accounting for one’s own finances, cleaning the house, shopping, using public transport, etc., vocational training, which includes the actions necessary to obtain and job retention, and training for those patients who want to graduate from high school or college. Auxiliary psychotherapy is also often used to help mentally ill people. Psychotherapy helps mentally ill people feel better about themselves, especially those who experience feelings of inferiority as a result of their illness and those who seek to deny the presence of the illness. Psychotherapy helps the patient master ways to solve everyday problems. An important element of social rehabilitation is participation in peer support groups with other people who understand what it means to be mentally ill. Such groups, led by patients who have undergone hospitalization, allow other patients to experience help in understanding their problems, and also expand their opportunities for participation in recovery activities and community 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.

8. NEUROLEPTICS IN THE TREATMENT SYSTEM OF PSYCHOTIC DISORDERS

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 means of treating 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 neuroleptics, 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 in the treatment of acute psychosis?

1. The possibility of achieving a greater therapeutic effect, including in cases of symptom resistance or intolerance to typical neuroleptics by the patient.

2. Significantly greater effectiveness in treating negative disorders than classical antipsychotics.

3. Security, i.e. insignificant severity of both extrapyramidal and other side effects characteristic of classical antipsychotics.

4. No need to take correctors in most cases with the possibility of monotherapy, i.e. treatment with one drug.

5. Admissibility of use in weakened, elderly and somatically burdened patients due to low interaction with somatotropic drugs and low toxicity.

8. SUPPORTIVE AND PREVENTIVE THERAPY

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 relapse 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 performing 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 holiday period.

Advantages of atypical antipsychotics in preventive 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 - $300, Seroquel - $250, Rispolept - $150. 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.

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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.

Psychosis is a common form of mental degradation and disorders, characterized by pronounced disturbances in the consciousness of one’s own self and libido, and also accompanied by pronounced disorganization of the individual’s personality. Psychoses in medical practice are usually divided into two broad groups.

The first of them - organic psychoses - are disorders that progress against the background of physical (somatic) pathologies, for example, due to brain injuries, developing atherosclerosis, progressive syphilis of the brain, etc.

Functional psychoses are primarily associated with psychosocial factors. Man is a socially oriented being who realizes his capabilities through activity in society. Of no small importance is the biological predisposition to the manifestation of psychoses in this group. According to the main types of functional psychoses, affective disorders (manic-depressive psychosis) and thinking disorders (schizophrenia, paranoia) are distinguished.

Psychoses and their types are determined by the conditions of their occurrence. At the same time, the influence of genetic and constitutional neuroendocrine, as well as somatic and metabolic factors is recognized as important. In addition, ontogenetic and environmental relationships and connections also play an important role in the development of pathology. The personal experiences and emotions of the individual, his aspirations and ideals, as well as the psychological forms of his response also remain important. All this creates a general climate in the process of etiology and development of the psychotic destructive process and its symptomatic manifestation.

Properties of manifestation of psychosis:

• strange behavior;
• delusional, inadequate in their manifestation and intensity affective reactions;
• autarky and severe disorders of awareness of reality and reality testing functions;
• perceptual disturbances (eg, hallucinatory experiences);
• difficulties in comprehension and generalization (loose associations and “blocking” of thoughts);
• tendency towards hypochondria.

Patients in a state of psychosis begin to perceive other people (even family and friends) as alien, “strange” or hostile. This perception is associated with hallucinogenic ideas about transformations or sharp unusualness of the surrounding world, people and objects.

During the initial stage of development of the problem, the patient gradually changes his ideas about other people and objects; a person’s libido occupies all the free space of his consciousness, filling the individual himself, thereby creating the basis for the formation of hypochondriacal symptoms. The second stage of psychosis - restorative - the patient often, with the participation of hallucinatory or delusional forms of inferences and perception of reality, tries to compensate for object representations in order to restore any connections with the outside world. Naturally, such remission is clearly pathological in nature.

Within the two groups of psychoses described above, its narrower manifestations are distinguished. Let's consider the most common disorders of neural connections.

• Cocaine psychosis. The pathology develops against the background of drug intoxication. As you get used to drugs, the body requires a larger dose of the drug, which can affect the course and course of the type of psychosis. Symptoms of cocaine psychosis usually boil down to flash-onset delusions of persecution. Everything that happens around inspires strong suspicion. At first, the patient may experience pleasure and even curiosity, but this will soon give way to bitterness and rejection. The faces of strangers seem distorted with evil intentions. Tactile hallucinations predominate: insects and nasty worms seem to crawl on the skin; there is a certainty of their penetration under the skin itself. Patients actually try to get them out of there, causing the skin to be wounded by many deep scratches. Auditory and visual hallucinations in cocaine psychosis do not always appear and are episodic in nature. Along with delusions of persecution, delusions of jealousy and delusions of grandeur can sometimes appear.
• Alcoholic psychosis develops in severe stages of alcoholism. Acute psychosis can also develop against the background of a hangover, heavy drinking, or prolonged abstinence from drinking alcohol. Accompanied by hallucinogenic phenomena of various natures, a state of anxiety, and delusions of persecution. The behavior of those affected by the disease is impulsive. In particular, the patient may suddenly start to flee from persecution or to fight “enemies.”
• Manic depressive psychosis. A disorder that occurs in the form of depressive and manic attacks that are situational in nature. Accompanied by long-term remissions. The absence of personality distortions even after repeated and protracted attacks is evidence of a positive prognosis for this disease in general. This is endogenous (internal) psychosis. The causes of this disease are often attributed to a hereditary factor, as well as situational factors.
• Traumatic psychoses are disorders of psychomotor reactions that develop remotely against the background of damage to the head and central nervous system organs. May be accompanied by sleep disorders, headaches, and dizziness. Provoking factors for the manifestation of disorders are alcohol consumption, atypical stressful situations, and somatic diseases.
• Epileptic psychosis is an acute paranoid reaction that has the properties of seizures. Accompanies individuals suffering from epilepsy, most often temporal epilepsy. The duration of epileptic psychosis can reach several weeks, passing with or without clouding of reason.
• Vascular psychosis develops against the background of cerebral vascular damage. Manifestations of the problem: increased state of jealousy, poisoning mania, suspicion, etc.
• psychosis during pregnancy is associated with a transformation of the body caused by the state of pregnancy with a sharp change in the lifestyle and functional state of a woman. In some ways, the state of anxiety and irritability, and sometimes irritability, is similar in its mechanism to PMS syndrome. Psychosis can develop differently in each girl, but it can also occur in a completely mild form without pronounced symptoms. The main symptoms of psychosis in pregnant women: extreme absent-mindedness, a forgetful state, difficulty concentrating, blurred reality (everything is like a fog), difficulties in perceiving information.
• hysterical psychosis - characteristic of people with increased excitability of psychomotor reactions of subjects with hysterical personal characteristics. Accompanied by stupor, twilight state of consciousness, pseudodementia (incorrect answers to obvious questions), Ganser syndrome, anxiety and flight reaction, as well as damage to the perception of reality.
• schizophrenic psychosis is a broad subgroup of a group of mental disorders that is characterized by loss of orientation, perception of reality and the individual’s self, which is accompanied by hallucinations of various kinds, delusions and atypical behavior.

Self-medication of psychosis is ineffective and even dangerous. Modern medicine is able to offer a number of traditional as well as new ways to combat the disease.

In case of psychoses of the described origin and other provoking factors, immediate hospitalization of the patient is necessary. The fact is that in such a state the patient is not aware of his actions and actions, which can lead to unconscious harm to himself or others. For loved ones and relatives of a suffering individual, it is important to understand that in a state of acute or chronic psychosis, a person is not able to bear responsibility for his actions and decisions. Most often, patients resist hospitalization, insisting on their “good” state of health. It is only necessary to provide full assistance and still hospitalize the patient. Sometimes the patient may refuse to take medications, which is quite common. However, refusing inpatient medical care can lead to the most undesirable consequences.

– a mental illness in which a person is unable to normally perceive the world around him and respond to it appropriately. Clinically, this mental disorder manifests itself in different ways. It can be an independent pathology or combined with other diseases - senile dementia, brain tumors, schizophrenia, delirium tremens.

At psychosis a distortion of reality occurs and the resulting “picture” is radically different from what other people see. Normal perception is hampered by voices in the head ordering something to be done, fear for one’s life, and visions. These changes lead to the patient’s reactions becoming completely inadequate: causeless anxiety or euphoria, tears or laughter. Some of the patients are sure that they have superpowers, others that the special services are hunting for them, and still others are compulsively pursuing someone.

There are examples when, after an experience psychosis the psyche is completely restored, but more often the disease takes on a cyclical course. Then, after a long period of mental well-being, an exacerbation occurs: delusional ideas and hallucinations arise.

Types and classification of the disease

According to etiology and causes, psychoses are:

Endogenous– they are usually facilitated by neurological, endocrine disorders, age-related changes (senile or senile psychosis). They can also be a complication of cerebral atherosclerosis, schizoaffective disorder, hypertension (somatogenic psychoses) and the result of pathomorphological changes in the brain (organic psychoses). The course of this type of psychosis is manifested by a protracted nature, constant recurrence, confusion, or depressive, paranoid and other conditions.
Exogenous- an external source of the disease can be industrial poisons, infections (influenza, syphilis, typhoid, tuberculosis), drugs, as well as severe stress. The main reason for the development is alcohol, which, if abused, can cause alcohol psychosis.

At the same time psychoses are divided according to syndromic classification(main predominant symptoms) for certain types. Most common depressive And manic psychoses, in which an apparently healthy person exhibits symptoms of depression or excessive agitation. Such psychoses are called monopolar. If these 2 types alternate, then doctors talk about bipolar affective disorder.

Manic(or hypomanic) psychosis has 3 striking symptoms, observed from 3 months to 1.5 years: accelerated thinking and speech, causeless elevated mood, excessive motor activity. In this case, a painful increase in memory occurs, the actions of others are a source of anger, a desire to fight appears, what is started is rarely completed, it is difficult to concentrate, delusional ideas arise, and impulsive decisions are made.

Postpartum psychosis rarely develops. The first symptoms of the disease appear on average 5 weeks after birth. This mental disorder is manifested by hallucinations, paranoia, delusions and a desire to harm a child or oneself. The disorder can also begin during pregnancy, for example due to inattention, misunderstanding and cruel treatment of a loved one.

Mass psychosis is a crowd epidemic based on suggestibility and imitation. A disease affects a group of people, causing them to become possessed. The most popular mass psychoses these days are considered to be: virusophobia, computer gambling addiction, freebie mania, upgrade mania, chatomania and aerophobia. The induced form of the disease is approximately the same, the only difference being that here one person, usually mentally ill, purposefully instills delusional ideas in others.

Late psychosis– develops due to long-term use of metoclopramide or antipsychotics. It can also form against the background of its cancellation.

Involutional psychosis– occurs in older people, more often in women. Depression, melancholia, hallucinosis and paranoid behavior of late age may develop. The disease occurs more often in patients living in nursing homes.

Amphetamine psychosis- amphetamine and its derivatives, when taken regularly or in high dosages, cause constant anxiety and tension, delirium, visual and auditory hallucinations.

Vascular psychosis– the source of formation is vascular disorders of the brain (hypertension, atherosclerosis, thrombosis, hypotension). In this case, patients complain of ringing in the ears, morning headache in the occipital region, twitching of the facial muscles and numbness in the chin, cheeks, and nose.

Epileptic psychosis– often occurs as a complication of epilepsy, especially in childhood and adolescence. It usually goes away quickly, but in the later stages it can last for up to a year.

Paranoid psychosis– is more severe than paranoia, but more favorable than delusional disorder. In this case, affective disorders are accompanied by the idea of ​​persecution, and pseudohallucinosis is possible.

Intoxication psychoses– the disorder develops as a result of the toxic effect on the body of industrial and food poisons, medicines, pesticides, and alcohol. In this case, delirium is observed, turning into stupor and coma. In the future, memory is impaired, intellectual abilities are reduced, and dementia develops.

Postoperative psychosis– appears in patients after surgery, mainly due to intoxication. At the same time, the person is restless, tries to escape, jump out of the window, and is delirious.

Symptoms and signs

Hallucinations can be visual, olfactory, gustatory, tactile, but most often they are auditory, in which the patient thinks he hears accusing, threatening or commanding voices. Moreover, they are so real that a person believes in them without a doubt.

During hallucinations, the patient suddenly falls silent, without speaking, and listens, laughs for no reason, or conducts a dialogue with an invisible interlocutor.

Brief interesting data
- Psychosis is translated from Greek as a mental disorder, the word itself consists of two other souls and a disorder of the state.
- ZNF804A is a genome associated with psychosis.
- According to statistics, people with psychosis are less likely to commit crimes than mentally healthy people.

Delusional ideas are thoughts that do not correspond to reality, but it is impossible to convince the patient. Strange, mysterious phrases appear in speech. The patient’s personality always comes to the fore; for example, he is not only convinced that aliens exist, but is also sure that they came for him. A person uses protective actions (installs additional locks), is unreasonably convinced that he is sick or wants to harm him (they add poison to his food), etc.

Complications

Causes of the disease

1. Poor heredity - at birth, a group of genes can be transmitted, which sometimes cause a disease at an early age, which occurs quickly and in severe form.
2. Brain injuries - the disease can develop a couple of hours or weeks after the injury.
3. Infectious diseases - mental disorders can be caused by intoxication after suffering from mumps, influenza, Lyme disease, malaria, leprosy.
4. Intoxication of the brain - often associated with the use of various substances, such as drugs (amphetamine, heroin, LSD, opium, PCP) and medications (corticosteroids, cardiac glycosides, sulfa and anti-tuberculosis drugs, diuretics, NSAIDs, clonidine, H2-histamine blockers, antibiotics).
5. Alcoholism - psychosis, as a consequence of constant consumption of alcohol in large quantities, is not uncommon, and poisoning of the body and disruption of the functioning of nerve cells occurs.
6. Pathologies of the nervous system: epilepsy, multiple sclerosis, Alzheimer's disease, stroke, temporal lobe epilepsy and Parkinson's disease.
7. Diseases that occur with severe pain: sarcoidosis, ulcerative colitis, myocardial infarction.
8. Brain tumors - compressing brain tissue, disrupting the transmission of nerve impulses and blood circulation.
9. Systemic diseases: systemic lupus erythematosus, rheumatism.
10. Severe attacks of bronchial asthma.
11. Hormonal disorders due to childbirth, abortion, dysfunction of the thyroid gland, ovarian pituitary gland, adrenal gland and hypothalamus.
12. Deficiency of vitamins B1 and B3 and electrolyte imbalance caused by changes in the content of calcium, potassium, magnesium and sodium.
13. Mental trauma (stress) and nervous exhaustion (lack of sleep, overwork).

Diagnostics

Treatment

Therapy for psychosis consists of several groups of drugs:

Neuroleptics (Zeldox, Solian, Fluanxol);
Normotimics (actinerval, contemnol);
Benzodiazepines (zopiclone, oxazepam);
Anticholinergics (cyclodol, akineton);
Antidepressants (sertraline, paroxetine).

Relatives and friends should come to the aid of the patient and treat him with understanding. You can’t upset him, get into arguments, or provoke him into conflict.

There are psychological treatments aimed at raising self-esteem and learning to adequately perceive the world around. For this purpose, psychosocial training and addiction therapy, psychoeducation, psychoanalysis, cognitive behavioral therapy, occupational therapy, family therapy and art therapy are used.

Prevention

Communicate more;
take medications prescribed by the doctor;
maintain a daily routine;
regularly attend psychotherapy classes;
exercise daily (swimming, running, cycling);
avoid drinking coffee;
do not visit the bathhouse, avoid overheating;
don't get overtired.

Traditional methods of treatment