Vascular psychosis symptoms. What are vascular diseases? Vascular psychosis as an acute complication of cerebrovascular diseases. History of the disease according to the son

Treatment of senile depression, sclerosis, atherosclerosis, vascular dementia and encephalopathy in the elderly. You can trust us with the health of your family and friends.

Psychiatry and neurology are one of the main areas of our work. In our clinic you will find doctors with experience in caring for elderly patients: psychiatrist, neurologist, therapist, cardiologist and others. In most cases, the state of mind and brain function can be improved even in a very elderly person. It is clear that in old age several health problems are usually relevant at once, but the amount of medications taken must be adequate and consistent. If a brain disease is combined with other diseases, we practice a patient management scheme in which one responsible attending physician (usually a therapist) combines and adjusts the prescriptions of narrow specialists.

Why are mental disorders more common among older people?

Modern medicine has the ability to optimize the functioning of the nervous system of even a very elderly person. There are people over 80 years of age without any signs of dementia or “senile sclerosis.” Old age is not a disease. Dementia (senile dementia or senile insanity) and age-related depression are diseases with clearly defined causes and treatment options.

The nervous system of an elderly person has a number of features.

Insufficient blood supply to the brain. With age, blood vessels, including those of the brain, become less elastic, and “plugs” – atherosclerotic plaques – appear inside the vessels. The brain finds itself in a state of lack of blood flow and nutrition. And brain cells are very “gluttonous” and under conditions of nutritional deficiency they work worse and then die. During this period, a kind of senile egoism and insomnia often appear.
Slow brain cell renewal. The older we get, the slower the renewal process goes, especially in conditions of reduced blood flow.
Changes in biochemical processes in the brain. An electrical impulse is transmitted from one nerve cell to another with the participation of special chemicals - neurotransmitters. These include, for example, serotonin, dopamine, norepinephrine. In older people, the ability to produce and accumulate these substances decreases. Therefore, the conduction of nerve impulses suffers, and, as a result, the overall productivity of the brain weakens, deviations in behavior, emotional, mental and motor spheres arise.

Our task at the examination stage is clearly determine the dominant cause of brain suffering, then our treatment will be exactly as intended.

Two cases of vascular dementia (senile dementia) from our practice. The symptoms are similar, but the treatment required is different.

MRI of the brain. The brain appears gray, the cerebrospinal fluid appears black, and the affected areas of the brain appear white.

LEFT - normal brain.
IN THE CENTER – the brain is partially replaced by fluid, arrows indicate areas of reduced blood circulation. The reason is the formation of blood clots due to heart rhythm disturbances + the entry of these blood clots into the brain.
ON RIGHT – brain mass is seriously reduced with replacement by fluid, white spots are an area of massive death of brain cells. Reason: narrowing carotid arteries 75% and 80% cholesterol plaques.

Symptoms of age-related depression

The older age group, the more often depression and dementia (senile insanity) are registered in it. Often elderly patients at our clinic complain of the following symptoms:

Negative view of objects and events in life. Old man expresses dissatisfaction with youth, authorities, and the weather. Everything that was before is good, but what is now is bad.
Constant grievances, especially to close people, feeling of "damage done". An elderly family member unreasonably reproaches his loved ones that everyone has abandoned him, they want to take something away from him, they don’t love him, and no one needs him, that they are plotting something against him and want to harm him. This is not behavioral egoism or “harmfulness of character” - but a symptom vascular disease brain (dementia or senile dementia).
Impaired ability for integrative brain functions - recall, memorization, thinking. More often, memory for recent events suffers, while events that happened many years ago are remembered well.
Cardiovascular attacks due to the slightest stress. A small stimulus is perceived as large, and the released stress hormones “hit” the blood vessels, hence a disruption of the heart rhythm, a hypertensive crisis or a heart attack.
Pain in the back, joints, legs, head. Against the background of depression, it always decreases pain threshold And slight pain from arthrosis and osteochondrosis are perceived more clearly.

If you see such symptoms, seek help from a neurologist or psychiatrist. Perhaps brain cells are dying daily and large quantities, and waiting is dangerous. In the same time, If you start treatment on time, the results can be very noticeable. We often see cases of rapid, within 1-2 months, transformation of older people into energetic, positive, active and internally young people. Blood pressure and heart behavior are much calmer.

Senile dementia, dementia and vascular psychosis

With serious circulatory disorders, more severe deviations in the nervous system, manifested dementia: senile dementia or insanity. This condition develops when a significant part of the nerve cells V frontal lobes brain Here are the centers providing higher mental functions.

Possible symptoms:

Behavioral disorders, fear, aggression, senile egoism;
Decreased mood, anxiety, restlessness;
Sleep disturbance (difficulty falling asleep, waking up earlier, interrupted sleep, night trips to the toilet);
Significant deterioration in thinking, logic, memory, and then disorientation in space, time, and self.

Vascular psychosis is an extreme manifestation of vascular insufficiency of the brain. It is associated with disorganization of brain function and rapid loss of nerve cells due to lack of nutrition. The behavior of an elderly person becomes uncontrollable, it is possible hallucinations, delusions, agitation, leaving home.

Here it is important to choose the right combination of vascular and psychotropic drugs, so we will offer you the help of a neurologist and psychiatrist.

ATTENTION! It is risky to use in elderly patients (especially those with dementia, i.e. senile insanity) a number of common drugs:

Cinnarizine(stugeron, fezam, omaron) due to the risk of developing parkinsonism;
Nootropil (piracetam) due to the risk of agitation, anxiety, insomnia, psychosis;
Tranquilizers, like Phenazepam, Alprazolam, Valocordin with long-term use reduce memory and intelligence.

The earlier treatment is started, the large quantity brain cells can be preserved, and less effort will have to be made to restore normal well-being.

Treatment at the Echinacea Clinic

Treatment of older people with age-related depression, senile dementia and vascular problems– a process that requires patience and a positive attitude. We will be happy to help you.

If necessary, we will offer you the help of a neurologist, psychiatrist, psychotherapist, cardiologist, examination of the heart and blood vessels, and the necessary laboratory tests.
Visits to the clinic are only when absolutely necessary.
We need cooperation between the doctor, the patient and his relatives, you must be prepared for this.

What do we do. First of all, we will find out what led to the brain damage. The reasons may be in different combinations: for assessment , , blood clotting and cholesterol levels in an elderly person. If any types of diagnostics have already been performed before, be sure to show their results to the doctor, this will help avoid unnecessary tests.

Treatment will be based on the results of the research. It may include a number of medications, diet, daily routine and exercise, psychotherapy and, if necessary, even therapeutic hypnosis.

Mental disorders associated with pathology vascular system, have different clinical manifestations, which may be caused by different diseases (atherosclerosis, hypertension, thromboangiitis) or their combinations. For example, in cases of development of atherosclerosis of cerebral vessels, symptoms mental disorders depend on whether they are affected small vessels brain or large great vessels. But in practice, it is possible to systematize mental pathology of vascular origin according to a nosological principle only in some cases, only by highlighting forms with a predominance of pathology of an atherosclerotic or hypertensive nature.
The exact prevalence of vascular mental disorders is unknown. A clinical and epidemiological examination of the population of mentally ill people aged 60 years and older, registered at Moscow Psychiatric Dispensary No. 2, found vascular mental disorders in 22.9% of mentally ill patients (M.G. Shchirina). Only 57.4% of these patients had vascular psychoses, the rest had disorders of a non-psychotic level (neurosis-like, psychopath-like, affective, psychoorganic personal stigmas). A similar picture was noted in foreign research(G. Huber, 1972).
In this regard, the most convenient in practical terms, reflecting both clinical diversity and possible differences in mental disorders taking into account their pathogenesis, the following taxonomy of vascular mental disorders appears (E.Ya. Sternberg): initial, or non-psychotic, neurosis-like, pseudo-neurasthenic syndromes; Various types vascular dementia; vascular psychoses (syndromes of exogenous type, affective, delusional, hallucinatory, etc.).
The validity of the special identification of “initial syndromes” of vascular origin is confirmed not only by the frequency of their occurrence, but also by the fact that in a significant proportion of cases vascular pathology It is these syndromes that may exhaust the clinical picture of the disease throughout its entire duration. In such cases, further progression of the disease does not occur; the process stabilizes precisely at this stage of its development.

CLINICAL MANIFESTATIONS.

Initial syndromes
Usually, the initial manifestations of mental disorders of vascular origin are defined as “pseudo-neurasthenic syndrome,” meaning the non-psychotic nature of the symptoms and the significant proportion of asthenic inclusions associated with organic (vascular) pathology. At the same time, actually psychopathological symptoms are closely intertwined with neurological stigmas, which are also not clearly expressed.
Such patients express very characteristic complaints of tinnitus that occurs suddenly, often rhythmically repeating the pulse wave (“I hear the heart beating in my ears and in my head”), or also suddenly appearing “ringing” in the head, quickly growing and just as quickly passing. Often there are pains in the head, especially in the back of the head, which are of the nature of compression (spasm of the occipital, vertebral artery); in many patients, such pain occurs right after waking up in the morning. Many people note the feeling of a “heavy”, “stale” head. Against the background of these symptoms, but often outside of them, patients experience sensations of “numbness” in the area of the nose, cheeks, chin, and slight twitching of individual small muscles on the face and in other parts of the body. A constant symptom is sleep disturbance. Usually, sleep is short, superficial, waking up after 2-3 hours, patients then cannot sleep, the next day they experience a state of “brokenness”, feel weak and tired. They develop heightened sensitivity to all stimuli (sounds, light); The phenomena of hyperpathy (hyperacusis) are very characteristic of the clinical picture of the disease. Occasional attacks of dizziness and imbalance when walking occur. Forgetfulness, emotional instability, tearfulness, and sentimentality are noted. It becomes more difficult to work due to fatigue, instability of attention, and the need to rest more often. As a rule, the awareness of one’s own change and pain remains. From the description of characteristic initial symptoms it is clear that along with the phenomena of irritable weakness, although subtle, but still evident signs of organic decline are expressed mental activity. It is almost always possible to register a decrease in the volume of perception; patients very often do not notice or do not perceive all objects in their field of vision. This just explains the rather typical searches for glasses, keys, and other small items. Quite obvious are the slowdowns in motor reactions and speech, which leads to difficulties in everyday life. In some cases, thinking becomes detailed, and a tendency toward edifying reasoning may be revealed. Memorizing and recording new events, new information weaken, chronological orientation may be disrupted, especially the ability to accurately date events. Many patients notice that in right moment cannot quickly remember what is needed (a name, the date of an event, a fragment of what they just read, numbers, etc.). All this contributes to a decrease in the overall productivity of mental activity, weakening of cognitive abilities and capabilities.
Instability of the emotional-affective sphere is constantly noted; irritability, capriciousness, and touchiness easily arise; tearfulness for a minor reason is a fairly constant sign of this pathology (incontinence of affect). Many patients develop a tendency to worry about their health and their loved ones; they can develop quite persistent hypochondriasis and decreased mood.
In cases where patients experience transient somatic disorders, and this happens quite often, they easily develop reactive states, neurosis-like disorders. At the same time, depressive reactions, hypochondriacal symptoms, fears of death, the development of paralysis with helplessness, dependence, especially in persons without relatives living alone, are constant.
If such symptoms are present in the clinical picture initial stage cerebral vascular pathology begins to show personality changes with peculiar psychopath-like manifestations. The sharpening of character traits characteristic of patients becomes noticeable. The basis for personality transformation is the appearance of a kind of rigidity throughout mental sphere, but at the same time, it is a completely obvious fact that “psychopathy” depends on the age factor. With the development of the vascular process in the involutionary period, one can note, first of all, an increase in asthenic structural components of character - such as indecision, self-doubt, a tendency to anxious suspiciousness, anxious-depressive, hypochondriacal reactions. If the vascular process begins in old age, “psychopathic-like” manifestations are in many ways similar to those noted in the initial period of senile dementia, when, indeed, mental rigidity, egocentrism, general coarsening of the personality, a general gloomy, dissatisfied, gloomy mood with a hostile attitude towards others are most pronounced. Of course, premorbid personality traits play a major role in the clinical picture of personality anomalies in the early stages of development of the vascular process. At the same time, such traits as anxious suspiciousness, capriciousness, hysterical demonstrativeness, and explosiveness become grotesquely exaggerated. The characteristics of personal changes are also influenced by the characteristics of the vascular process itself - such as the degree of progression, localization of vascular lesions, the presence of arterial hypertension, various somatic, i.e. extracerebral manifestations.
IN clinical practice the presence of pseudoneurasthenic disorders of vascular origin does not exclude their combination with various signs weakening, reduction mental activity varying degrees of severity. In such patients, various dysmnestic disorders are constantly present; a decrease in the pace and productivity of mental activity, criticism, and the level of judgment can be noted. The combination of these manifestations corresponds to the concept of “organic psychosyndrome” or “psycho-organic syndrome”. With increasing progression of vascular lesions, the development of cerebral infarctions, micro-strokes, a picture of vascular dementia is revealed.
Vascular dementia
Vascular dementia is the main syndrome in the development of severe atherosclerosis and hypertension (these types of vascular pathology are often combined). Dementia often develops in people who have had a stroke. According to Yu.E. Rakhalsky, the frequency of strokes in the history of patients suffering from atherosclerotic dementia, is 70.1%.
Vascular dementia as a special qualitative pathological condition is formed as a result of a gradual (or rapid) increase in mnestic disturbances, stiffness, rigidity of thinking, and incontinence of affect. In the presence of strokes, the course of the vascular process becomes jerky.
The classic type of vascular dementia is considered to be “lacunar”, partial dementia, which is characterized by uneven damage to various aspects of the psyche and intellect with increasing impairments in memory and selective reproduction, disruption of chronological orientation (at the same time, relative preservation of allopsychic and autopsychic orientation is observed). Difficulty and slowdown of all mental processes progresses. Asthenia and a decrease in mental activity, difficulty in verbal communication, difficulty in finding the right words, a decrease in the level of judgment and criticism are observed, with a certain preservation of the consciousness of one’s own insolvency and basic personal attitudes (preservation of the “core of personality”). At the same time almost persistent symptoms are tearful mood, weakness. This type of dementia develops with atherosclerotic processes that manifest themselves between the ages of 50 and 65 years. In some cases, it can develop gradually due to the intensification of psychoorganic disorders that arose in the early stages of the disease. In some patients, lacunar dementia syndrome occurs more acutely (postapoplectiform dementia). In such cases, the onset of dementia is preceded by a transitional (in the understanding of X. Vick) amnestic, Korsakoff-like syndrome.
After acute disorder cerebral circulation (stroke, severe hypertensive crises, subarachnoid hemorrhages), and sometimes after acute vascular psychoses, the onset of amnestic dementia syndrome with severe memory impairments such as fixation amnesia, gross disorientation and confabulations is possible. The picture of such amnestic dementia in some cases is reversible and represents the picture of “acute dementia” described by X. Weitbrecht.
The Alzheimer-like type of vascular dementia (asemic dementia) is characterized by manifestations of focal cortical brain disorders, which is associated with a special localization of the vascular process. Similar types of dementia were previously designated as V.M. disease. Gakkebusha, T.A. Geyer, A.I. Geimanovich (1912). These researchers believed that with such a clinical picture, small vessels of the brain are locally affected (atherosclerosis of the smallest capillaries), simulating conditions characteristic of Alzheimer's disease. Later, such cases were described in the works of A.B. Snezhnevsky (1948), E.Ya. Sternberg (1968) indicating secondary developing phenomena of senile brain atrophy. Such patients are characterized by a more acute onset, as well as a further “flickering” of symptoms (described by G. Shtertz). Possible nighttime, observed for several hours, psychotic episodes, atypia of focal symptoms, which makes it possible to diagnose a vascular process.
The pseudoparalytic type of vascular dementia is characterized by symptoms that outwardly resemble the picture of progressive paralysis. In such patients, there is a combination of dementia with euphoria or an expansive-manic state with a predominance of general carelessness, talkativeness, disinhibition of drives and loss of criticism, sharp decline level of judgment, memory, orientation. The pseudoparalytic type of vascular dementia is more often found in younger patients (up to 65 years) with severe hypertensive encephalopathy or with frontal localization of the focus of softening of the brain.
In severe hypertensive encephalopathy, a rare form of vascular dementia sometimes occurs with stunned patients, adynamia and reduced motor and speech activity, expressed by difficulty in fixating attention, perceiving and comprehending what is happening. Due to the similarity of such symptoms with the patterns that develop with brain tumors, these conditions are defined as “pseudotumorous.”
The senile-like type of vascular dementia develops when the vascular process manifests itself in old age (after 70 years). As in cases of senile dementia, the initial stage of this type of vascular dementia is characterized by pronounced personality changes with distrust, dissatisfaction, grumbling, irritability, and a hostile attitude towards others. Clinical picture dementia is characterized by deeper and more diffuse memory impairments than is expressed in dysmnestic dementia. In patients, disorientation and signs of “shifting the situation into the past” are more pronounced, and there is a deeper decline in all types of mental activity. This suggests that dementia is more like “total dementia”, but at the same time it is not as catastrophic as with senile dementia.
Binswanger encephalopathy is a microangiopathic dementia and is associated with white matter subcortical brain structures (leukoencephalopathy, Binswanger's disease). It was first described by the author in 1894 as a form of vascular dementia with a predominant lesion of the white subcortical substance of the brain. The vascular nature of the disease was proven by A. Alzheimer after a histological study of the brain. He proposed to call this type of pathology Binswanger disease (BD). Brain pathology includes diffuse or patchy demyelination of the center semiovale with the exception of U-fibers, as well as astrocytic gliosis, microcysts in the subcortical white and gray matter. Single cortical infarcts are observed. Computed tomography and especially nuclear resonance imaging with visualization of the white subcortical matter and its pathology make it possible to diagnose BD intravitally. In this case, changes in the white subcortical matter characteristic of encephalopathy are found in the form of leukoariosis, often in combination with lacunar infarctions. It turned out that BB is quite common. According to clinical computed tomography studies, it accounts for about a third of all cases of vascular dementia (A.B. Medvedev et al.). A risk factor is persistent arterial hypertension. The picture of dementia has various degrees severity with variable symptoms. With the exception of asemic, almost all types of dementia are observed, as with ordinary vascular dementia. There is a predominance of signs of subcortical and frontal dysfunction; there may be epileptic seizures. The course is progressive, with periods of stabilization of varying duration. The causes of dementia are considered to be the disconnection of cortical-subcortical connections.
Multi-infarct dementia is caused by large or average size multiple infarctions, mainly cortical, which arise as a result of thromboembolism of large vessels. According to clinical computed tomography studies, it accounts for about a third of all cases of vascular dementia.

Vascular psychoses.

Psychopathological manifestations in the form of acute psychoses can occur at any stage of the vascular process, even in a state of dementia. F. Stern (1930) described “arteriosclerotic states of confusion.” Such psychoses are characterized by a number of common clinical properties. First of all, the syndromes of stupefaction that arise in the structure of these psychoses as reactions of an exogenous type are distinguished by their atypicality, lack of expression of all their components, and syndromic incompleteness. Manifestations of acute vascular psychoses do not always correspond to the most typical pictures of delirium, amentia, twilight state, oneiroid and others, which makes it possible to quite reasonably qualify them as states of “confusion” (M. Bleuler, 1966). Another property of vascular psychoses is that acute psychotic episodes are quite often short-lived, occur sporadically, and last no more than a few hours. As a rule, such an episode unfolds at night, and during the day patients can be in clear consciousness, without psychotic disorders. Common property vascular psychoses is also their recurrence, sometimes multiple times. This primarily applies to nocturnal states of confusion. The course of acute vascular psychoses differs from the course of symptomatic psychoses of other etiologies, such as delirium delirium, acute traumatic psychosis. Thus, in the dynamics of delirium tremens, the increase in the severity of the disease is most often expressed by the deepening of the delirious syndrome itself (the transition of “occupational delirium” to delirium), and in acute vascular psychoses various syndromes altered consciousness can replace each other (delirious syndrome can be followed by amentive, etc.).
In the subacute course of vascular psychoses with a more protracted course, in addition to stupefaction syndromes, reversible syndromes not accompanied by a disorder of consciousness, but also reversible syndromes, which X. Vick called “transitional” or “intermediate”, may occur. Compared with symptomatic psychoses Such protracted and more complex forms of vascular psychosis are much more common. E.Ya. Sternberg emphasizes that in vascular psychoses, almost all types of intermediate syndromes can occur, preceding the syndromes of clouded consciousness: neurotic, affective (asthenic, depressive, anxious-depressive), hallucinatory-delusional (schizoform), as well as organic circle syndromes (adynamic, apathetic-abulic, euphoric, expansive-confabulatory, amnestic, Korsak-like).
Depressive states occur, taking into account various data, in 5 - 20% of all cases. At the same time, along with the symptoms of melancholy and grumpiness, pronounced tearfulness and hypochondriasis are almost always observed (“tearful depression”, “aching depression”). With each new recurring episode of depression, an organic defect with the formation of dementia becomes more and more obvious. Depressive episodes are just as often accompanied by anxiety, unaccountable fear, and they often precede acute disorder cerebral circulation.
Paranoid (schizoform) psychoses are characterized by acute sensory delusions with ideas of relationship, persecution, poisoning, influence. Such psychoses are usually short-term and usually occur in the initial stages of cerebral atherosclerosis with signs of arterial hypertension. For more late stages Cerebral atherosclerosis is characterized by acute hallucinatory-paranoid states. Hallucinations in such cases are of a scenic nature and often occur visual illusions(both illusions and hallucinations).
Protracted endoform psychoses of vascular origin are the most difficult to recognize. In addition to the constitutional genetic predisposition important role special properties play a role in the development of prolonged vascular psychoses organic process. As a rule, protracted endoform psychoses develop with vascular processes that manifest themselves quite late (at the age of 60 - 70 years), occurring with slow progression and without severe focal disorders. So sick with the picture delusional psychosis the usual initial ones are not typical asthenic manifestations vascular process, sharpening of personal characteristics is more common.
Clinically, the most justified is the identification of protracted paranoid psychoses in men, mainly in the form of delusions of jealousy. It is characterized by little development of the topic and poorly systematized. At the same time, the predominance of sexual details with great nudity of this plot can be considered a distinctive feature. Typical topics in the descriptions of patients are his wife’s infidelity with young people, young members of the patient’s family, including his son and son-in-law. Delusions of jealousy are usually combined with ideas of damage (the wife feeds her rival lovers better, gives them the patient’s favorite things, etc.). The mood is tearful and depressed with outbreaks of irritability, anger and aggressiveness. Such organic stigmatization is more pronounced with deep psychoorganic changes.
Chronic verbal hallucinosis as part of vascular psychosis is also diagnosed quite often. It is revealed as a polyvocal (many “voices”) true verbal hallucinosis, flows in waves, sometimes at the height of development it becomes scenic, usually intensifies in the evening and at night, its content is predominantly threatening. The intensity of hallucinosis is subject to fluctuations. Its vascular nature is often proven in parallel by a recorded increase in blood pressure and an increase in other vascular stigmata ( headache, increased tinnitus, dizziness, etc.)

ETIOLOGY AND PATHOGENESIS.

The etiology of vascular mental disorders is determined by the main somatic disease - hypertension, atherosclerosis, endarteritis, thromboangiitis, etc. The pathogenesis of mental disorders of this group is still not completely clear; it is not known, first of all, why only some of the vascular lesions of the brain lead to the development of mental disorders. In some cases it is possible to observe parallelism vascular disorders(sharp changes in blood pressure) with the occurrence of acute or subacute psychoses (hallucinosis, confusion). In other patients, constitutional features, extracerebral factors, and general somatic causes apparently play a leading role.
With the development of acute vascular psychoses, including fairly typical states of confusion (nocturnal), an important role is played by nocturnal decreases in blood pressure when insufficient blood supply to the brain occurs. Such disorders often develop in the presence of atherosclerotic lesions of the heart vessels, infections and other somatic causes. There is no doubt the role of sharp shifts in cerebral circulation, as evidenced by the development of psychoses of this type in the pre-stroke or post-stroke period of the current vascular process.

DIFFERENTIAL DIAGNOSIS.

In the initial period of the vascular process, in the presence of symptoms reminiscent of neurotic or neurasthenic, somatic arteriosclerotic stigmas or symptoms of hypertension, changes in the fundus, and diffuse neurological microsymptoms serve as supporting signs for diagnosis.
It's harder to delimit vascular dementia from senile dementia. Distinctive feature can be considered a fluctuation, flickering of symptoms during vascular processes, while senile dementia is steadily increasing and no noticeable periods of stabilization are observed. S.G. Zhislin noted a more acute onset with vascular disorders with the presence of nocturnal paroxysms of undulation of consciousness, F. Sterz considered the main difference to be the flickering of symptoms in vascular patients with periods of complete recovery, after which sharp changes in mental functions can again be observed.

TREATMENT.

The main thing in the treatment of vascular mental disorders is the treatment of the underlying somatic disease(atherosclerosis, hypertension). Psychotropic drugs are prescribed in accordance with the predominance of certain mental disorders. At the initial stages, sedative tranquilizers (rudotel, phenazepam, atarax, etc.) are indicated. Of the neuroleptics, propazine in small doses (25-75 mg/day), haloperidol, and rispolept in drops, also in small doses, are preferable. In the presence of anxiety and depressive disorders, atypical antidepressants (Lerivon, Remeron, Cipramil) are indicated, since the use of amitriptyline can provoke confusion. Recommended restoratives, vitamins, nootropics (nootropil, piracetam, mexidol). It is necessary to eliminate as much as possible harmful effects which can negatively affect the course of vascular diseases (alcohol, smoking, overwork, emotional stress). It is important to strive to preserve labor activity patients in optimal conditions. Endomorphic psychoses

Endoform psychoses are observed with vascular diseases brain and are divided as follows.

Chronic hallucinosis, often verbal, less often visual, tactile or mixed. Verbal hallucinosis of threatening and condemning content is accompanied by hallucinatory delusions, as well as an affect of fear and anxiety, worsens at night and becomes stage-like, but the hallucinosis usually does not become more complicated.

Prolonged paranoid psychoses

Prolonged paranoid psychoses, most often in the form of delusions of jealousy in men, can occur in different stages vascular process, even with pronounced mental decline. Interpretative delirium in such cases is poor, poorly developed and poorly systematized.

Affective disorders

Mostly these are depressions in a wide range of variants: from clearly organically colored (“dull”, “tearful”, “complaining”, “apathetic” depressions) to endoform depressive syndromes.
Significant differential diagnostic difficulties often arise, and the classification of such depressions as mental illness vascular origin remains doubtful in some cases, especially when the organic decline does not increase. In the early stages of vascular diseases, especially when well-known criticism and feelings of inadequacy are preserved, depressive reactions and longer-term reactive depressive states are relatively often observed.

Affective-delusional, hallucinatory-delusional (schizoform) and other psychoses are relatively rare. Such psychoses usually develop with a relatively weak progression of vascular brain damage or in the case of a predominance of cardiac vascular pathology. As the direct parallelism between the vascular process and psychosis weakens, the role of other pathogenetic factors - constitutional, hereditary, premorbid, somatic - increases and becomes more distinct.

Treatment of vascular disorders

Treatment of the underlying vascular disease (improving nutrition and blood supply to the brain, eliminating heart failure, etc.) is of primary importance.
P.). Psychoregulators (metabolic drugs, nootropics) are indicated. Against this background and taking into account the characteristics of mental disorders, psychotropic drugs are prescribed in small doses.

Complete and permanent disability is observed only in cases of severe vascular dementia or psychosis. In the initial stages mental changes vascular origin, that is, with pseudo-neurological, psychopathic or mildly expressed psychoorganic disorders, as well as with relative stabilization of the vascular process, an individual recommendation of light labor is possible simultaneously with appropriate rehabilitation measures.

In a number of countries, including Russia, there has been an increase in the number of patients suffering. In the medical literature they are sometimes called the “disease of the era.”

Vascular psychoses are a consequence of impaired functioning of the blood vessels of the brain and the vascular system as a whole. What are the causes, symptoms and treatment options for the disease?

Primary characteristics of the disease

Vascular psychosis can develop in several forms:

Acute form. Characterized by a state of “confusion” of consciousness. Psychotic state occurs periodically and lasts several hours. Most often, the attack occurs at night, and during the daytime the patient has a clear consciousness.
Subacute forms A. A complicated type in which psychosis lasts longer. It may be accompanied, or, with the patient clearly conscious, it may be characterized by intermediate syndromes. This form is characterized by disorders that are complicated by so-called “small-scale” delusions and verbal hallucinatory experiences.

From the point of view of the origin of mental disorders caused by vascular dysfunction, there are:

syndromes at the inception stage, in a pseudoneurotic form, - such disorders usually appear if vascular disease is on initial stage development;
: neurological and mental disorder associated with a certain stage of development of vascular disease;
other syndromes caused external factors (exogenous): , and others.

Causes and mechanisms of the disorder

The main reason for the development of this form of psychosis is diseases associated with disruption of the vascular system of the human body.

Among the diseases that most often provoke psychosis of vascular origin are:

hypertension;
thromboangiitis;
endarteritis.

What leads to mental disorders in the case of these deviations and diseases? What is the sequence of processes that determines the mechanisms of the appearance and progression of the disease? To date, there is no exact answer to this question. There is no clear understanding of why only some vascular diseases and brain injuries lead to the appearance of mental disorders.

We can only talk about the following cause-and-effect relationships:

Sudden jumps in blood pressure can lead to changes in the structures of the brain, which leads to the appearance of acute or subacute psychosis. Its main features are confused consciousness and...
The progress of psychotic abnormalities of vascular origin is influenced by individual characteristics of the body, which have developed on the basis of hereditary and acquired properties, as well as general somatic factors.
The acute form of the disorder may occur due to lower blood pressure at night, which, in turn, provokes a lack of blood supply to the brain. The development of abnormalities is facilitated by atherosclerotic lesions of the heart vessels, various kinds infectious diseases.
Mental disorder often occurs during a period of sudden, so vascular psychosis is a common occurrence after.

Features of the clinical picture

With this type of disorder there is no psychotic symptoms, intertwined with disturbances organic nature, are combined with symptoms of a psychopathological type. The latter have mildly expressed neurological features.

Symptoms that make it possible to diagnose vascular psychosis at the initial stage of development:

Symptoms characteristic of mental disorders arise much later and manifest themselves as delusions, hallucinations, and a schizophrenic picture.

Diagnosis of the disease

On early stage, when there are symptoms of a neurotic nature, vascular psychosis is diagnosed based on signs of hypertension, arteriosclerotic stigmas, changes in the fundus, slightly expressed.

It is more difficult when diagnosing. It is not easy to distinguish from. Characteristics dementia are random deviations and flickering of the main signs in vascular disorders.

With age-related dementia, symptoms will only increase and no periods of stabilization can be expected. In addition, the onset of vascular psychosis is more acute and may be accompanied by increased confusion.

Treatment options

Treatment is best started with treatment of the underlying vascular disease that caused the psychosis.

Psychotropic medications will definitely be prescribed. Their choice is determined by the type of mental disorder. At the first stage of treatment, the following are prescribed: Rudotel and others. Propazine is usually prescribed (normal this drug varies 25-75 mg/day), Rispolept in the form of drops.

If the patient has it, then atypical drugs, such as Remeron, and others are prescribed.

Treatment is not limited to the use specialized means. The patient should take vitamins, restorative drugs, medicines, intended to influence the higher mental functions of the brain (,).

The patient will have to give up smoking, alcohol, avoid overwork and emotional outbursts.

It is impossible to cure vascular psychosis or dementia. There is no chance for a person to recover completely, but you can try to raise your standard of living to the highest possible level.

Preventive measures

The prevention of mental disorders associated with dysfunction of the vascular system will be facilitated by:

timely diagnosed vascular disease;
establishing a constant and orderly daily routine;
preventing excessive loads;
giving up smoking, alcohol and other bad habits;
proper, balanced, dietary nutrition;
giving up a sedentary lifestyle;
physical therapy classes;
constant monitoring of blood pressure and taking measures to normalize it even with minor deviations from the norm.

The disorder never goes away without a trace. Modern medicine is not able to completely cure it; you can only take drugs that improve the blood supply to the brain, drugs that help strengthen memory, but in any case it will not be possible to completely get rid of all the symptoms. They will appear again at one time or another.