Acute psychosis is associated with a special mental state of a person, in which he is not able to adequately perceive the surrounding reality. The patient's thinking is disturbed, memory problems are possible, hallucinations appear.

A person is not able to assess his condition and realize that he is sick. He does not consider it necessary to go to the hospital. Meanwhile, the disease progresses, the patient's consciousness worsens more and more, and every day it becomes more and more difficult for him to adapt to the world around him.

The sick person begins to isolate himself, to separate from people. He rejects the help offered by others, does not want to hear about visiting a doctor.

And if treatment is started earlier, then various problems can be avoided in the near future, including irreversible pathological processes in the psyche.

What are the causes of the disease and its types

Various forms of psychosis are more likely to affect women. The reasons for the development of its acute form are of three types: endogenous, exogenous, organic.

It develops due to some disturbances in the body itself. These can be diseases of the endocrine system, neurological ailments, hereditary factors, schizophrenic abnormalities. This group also belongs, since it occurs as a result of age-related changes in the body - usually after 60 years due to existing diseases (hypertension, atherosclerosis, etc.).

The causes of exogenous psychosis lie in external factors. First of all, these are severe stresses experienced by a person. Infectious diseases - tuberculosis, influenza and others - can also cause psychosis.

In addition, exogenous psychosis can cause drug use. But the main reason, according to doctors, is alcohol. It is the abuse of it that shatters even the most persistent nervous system. Organic psychosis leads to various lesions of brain cells that have arisen due to injuries or tumors.

In some cases, it is difficult to identify the root cause of psychosis, since it can begin due to an external factor, and an internal one gradually arises.

Acute psychosis can take many forms, the most common of which are:

1. Manic-depressive. This is a rather severe form. With her, depressive periods are replaced by excessive excitability. During the depressive phase, the patient is indifferent to everything, but as soon as the manic period sets in, he does not sleep for several days, he constantly does something.
2. Manic. This condition is characterized by constant agitation of the patient.
3. Reactive. It usually develops against the background of some stressful situations in the life of a sick person (for example, a fire or an earthquake). This psychosis has the most favorable outcome. It usually goes away as soon as the cause of its appearance is eliminated.
4. Polymorphic. This form is usually inherent in adolescents 10-15 years old. It is believed that this is the beginning of schizophrenia.

All forms of psychosis are known only to psychiatrists. It is they who diagnose the disease, identify its form, prescribe treatment, and if it is not started in a timely manner, then the psyche changes irreversibly, the disease goes into a chronic stage, and the person's personality is distorted beyond recognition.

Back to index

What are the symptoms of this disease

At the initial stage of the disease, some signs of psychosis are in many ways similar to those that occur with genetic abnormalities. But psychosis usually starts like this:

• others notice that a person's behavior has changed;
• the patient ceases to perceive reality properly;
• Emotions do not manifest themselves in the way that a certain moment requires.

A little later, the symptoms become more acute. Doctors call the special thinking of a sick person psychotic. The patient has his own opinion on everything that surrounds him, which differs from the generally accepted one. At the same time, he tries to assure everyone that he is right. All this takes the form of delusions, which doctors divide into the following types:

• depressive - with him, the patient is sure that he did something bad, committed a sin;
• somatic - it seems to the patient that a stench comes from his body, and it decomposes;
• megalomania - a person is sincerely sure that he is a VIP person;
• persecution mania - the patient believes that he is being persecuted in order to offend;
• relationships - the sick person is sure that some things concern him personally, for example, a television program is a kind of message to him personally from some world.

Symptoms of acute psychosis are also expressed in hallucinations. A person hears or sees something that is not really there. The same goes for odors. For psychosis, auditory hallucinations are more characteristic.

The patient sincerely believes that he hears a certain voice that gives him the order to perform some action.

In rare cases, hallucinations may be associated with sensations. For example, the patient begins to feel pain, which has nowhere to come from in reality.

The next sign of the disease are violations of the emotional state. Emotions can change very quickly, from depressive thoughts to overly high spirits.

The patient has a communication problem. Sometimes he cannot explain to others what he needs. The patient speaks at the same time chaotically, the sentences remain unfinished, the patient is not able to express a thought. He begins to help himself by gesturing.

The last symptom is called the final one. This is such a state when the personality disintegrates completely. There is no connection between thoughts, emotions and actions of the patient. A person cannot work, it is difficult for him to live in society, he cannot take care of himself. If all this lasts more than 3 weeks, then it can be argued that the person is sick with psychosis.

Back to index

How to treat the disease

Many of the initial signs of the disease appear long before the diagnosis is made. They are difficult to recognize at the moment. But some changes in character, excessive nervousness, excessive anxiety, poor sleep and appetite, a strange appearance can alert loved ones.

A thorough examination for the purpose of making a diagnosis is carried out by a doctor. To do this, he uses high-tech techniques.

When close people of a sick person ask a doctor if acute psychosis can be cured, the doctor will answer that it is possible, but this is done in a hospital. It is impossible to provide qualified assistance at home.

The only exception is an attack of which will pass on its own with the elimination of the cause of its development. In other cases, hospitalization is necessary. The patient cannot control his own actions, and is capable of harming himself or others.

Before treating acute psychosis, a specialist necessarily identifies the severity of psychosis, the characteristics of the patient's personality, and the state of physical health.

The patient is prescribed psychotropic drugs. It can be antipsychotics and tranquilizers. Fortifying drugs are prescribed and, according to indications, antidepressants.

The modern pharmaceutical industry produces drugs that are able to treat a patient from a very specific type of psychosis, that is, they act strictly selectively. The doctor approaches all patients individually. The existing diseases of the patient, his age and many other factors are taken into account.

Diseases

In the scientific medical literature, there are several definitions of the pathological state of a person, when his psyche sharply distorts the surrounding reality, and mental activity does not correspond to the norms of the real world. This condition is called psychosis. It can be both an independent disease and a concomitant with schizophrenia, meningitis, epilepsy, Alzheimer's disease, tuberculosis and many others. The number of people suffering from psychosis is extremely difficult to determine. This is primarily due to many factors that affect the occurrence and dynamics of the disease. In addition, such a pathological condition can occur at any age and has almost no gender distribution.

Acute psychosis

The term acute psychosis is used when disturbances of mental activity begin suddenly and progress rapidly. Mandatory is the presence of a provoking factor that acts as a trigger. Depending on the causes of acute forms of psychosis may be of a different nature. In the typology of the disease, they are distinguished by the following:

• situational;
• reactive;
• organic;
• intoxication;
• withdrawal symptoms;
• polymorphic.

Situational psychosis most often occurs against the background of some difficult or intractable situation. It is accompanied by various kinds of experiences and leads to mental strain. In this state, a person is acutely experiencing negative emotions, and his knowledge and life experience do not work.

Intoxication or withdrawal psychoses occur under the influence of various toxic elements on the brain. These include:

• medications;
• alcohol;
• narcotic substances;
• industrial poisons.

Reactive psychosis is similar to other disorders that appear due to severe psychosocial stress, but is more pronounced affective saturation, lability and variability. It occurs at the moment of serious shocks for a person, catastrophes, cataclysms.

Symptoms

Depending on the nature of the clinical picture, psychosis can be:

• hysterical;
• paranoid;
• manic;
• depressive.

There are also combined forms of the disease, which are directly related to the individual characteristics of the psyche, age, gender, existing somatic diseases.

Manic and depressive forms of psychosis often accompany each other and constitute the so-called bipolar disorder. Common features include:

• inadequacy of thought processes;
• stiffness of movements or psychomotor agitation;
• changeable mood;
• disinhibition of instincts.

Symptoms of acute psychosis can be grouped into separate areas that cover various areas of human life. The presence of the disease is evidenced by changes in:

• sensations;
• character;
• habits;
• working capacity;
• interests;
• social behavior.

Many of the symptoms of psychosis may not be perceived by the person himself and his environment as harbingers of the disease. They may not pay attention to them for quite a long time and thereby delay the moment of seeking help.

Causes of the disorder

Like any disease, acute psychosis has its own causes. In psychiatry, two groups of factors that provoke a disorder are defined - external (exogenous) and internal (endogenous).

External causes include:

• brain injury;
• psychological trauma;
• physical violence;
• rape;
• infectious diseases.

But the primacy among exogenous causes belongs to the use of alcohol, narcotic and toxicological substances. Regular poisoning of the body with these poisons leads to the depletion of the nervous system, the destruction of the brain, and, as a result, the occurrence of psychosis. The uncontrolled use of drugs leads to the same consequences.

Internal causes of the disease are most often associated with:

• dysfunctions of the nervous system;
• malfunctions of the endocrine system;
• lack of vitamins B1 and B3.

The imbalance of the hormonal background disrupts the brain, and fluctuations in the level of hormones cause acute psychoses. In addition, there is a close dependence of psychosis on age-related changes. In the process of aging of the body, the vessels of the brain are affected by atherosclerosis, and senile psychosis develops.

Which doctor will help?

The first signs of the disease may be mild and short-lived. It can be very difficult for an uninformed environment to recognize impending problems. Therefore, it is very important to consult with experts without fear of public outcry. After all, early diagnosis and timely treatment of psychosis, with the achievements of modern medicine, gives a positive and stable result. For help, you should contact a psychoneurological dispensary to a qualified doctor of the following specialty:

During a medical examination, the doctor will determine the patient's somatic health, namely:

• age;
• growth;
• diet;
• the presence of bad habits;
• physical activity;
• past illnesses.

Psychological and psychosocial analysis consists of studying the psycho-emotional sphere of a person, identifying motor skills, establishing the level of social and cognitive and development.

The study of the characteristics of education or work activity involves the collection of information on school attendance, academic performance for juvenile patients, and professional functioning, working conditions for adults.

In addition, the psychiatrist will establish the presence of hereditary mental illness in the patient's family or genetic abnormalities.

Treatment Methods

The complex of treatment includes several directions that complement each other. Among them:

• drug treatment;
• physiotherapy;
• family psychotherapy;
• social rehabilitation.

Modern medicine has achieved significant results in the treatment of the disease and has a large database of therapeutic tools. But the most effective is still considered the use of drugs. Treatment of psychosis involves a strictly individual plan, taking into account:

• patient's age;
• his gender;
• the presence of other diseases.

Pharmacotherapy involves the use of psychotropic drugs, tranquilizers or neuroleptics, and, if necessary, antidepressants. It is recommended to add general tonic or preparations that cleanse the body to the complex.

Psychotherapy is both individual and family in nature. The most effective are cognitive-behavioral methods. During treatment, the patient receives important skills for a fulfilling life. Social rehabilitation involves the preparation of an individual program for teaching patients adequate ways of rational behavior in society.

How to deal with a psychotic person?

In order to avoid the dangerous consequences of psychosis for the patient and his environment, it is important to know how to behave with a person in a state of disorder. If the signs of psychosis are clearly visible, the first thing to do is to try to remain calm, demonstrate self-confidence and goodwill. In a conversation with a person in a state of psychosis, you cannot:

• argue;
• mind;
• to ironize;
• shout;
• tease.

It is better to try to talk about the emotions and feelings of the person in this situation. You can ask about the help you can give him. If the patient is in an extreme degree of excitement, you need to hide all sharp and heavy objects and things that can injure him or others. It is also recommended to ensure that the patient does not get into the field of view:

• flammable substances;
• chemically active drugs;

If the patient in a state of psychosis is in the room, it is desirable to remove all unnecessary viewers. If possible, switch his attention, for example, ask a person for help, entrust him with hard physical work.

How dangerous is the patient to himself and others?

The disease can provoke irreversible consequences for the psyche. Progressing, acute psychosis constantly reduces the adequacy of the patient. A person rejects the help and advice of others, his world narrows, leading to self-isolation, negative habits arise. Loss of interest in life becomes dangerous for the patient himself. This is accompanied by:

• sleep disorders;
• loss of appetite;
• increased fatigue;
• suicidal tendencies.

Extremely dangerous for the patient is the occurrence of auditory and visual hallucinations, obsessive and delusional states. A person is unable to distinguish fictional pseudo-reality from reality, he gradually deepens into the world of his fantasies, loses a sense of his own personality.

Patients in acute psychosis, defending themselves from imaginary threats, can commit acts that are dangerous for themselves and others. Often the disorder is accompanied by psychomotor agitation. The patient is chaotically rushing about, his movements are not purposeful. Fleeing from an imaginary danger, people in a state of psychosis can jump out of windows, balconies, and bridges. They can take the same actions, protecting loved ones and relatives.

Should I call an ambulance for symptoms of psychosis?

If a person is in a state of psychosis, others need to understand one way or another that they are not able to cope with the problem themselves. Urgent psychiatric help should be sought. If the symptoms of psychosis are relatively mild, the person makes contact, and the situation is under control, then you can not resort to an urgent call to the NPP team. But this does not mean that you do not need to contact a psychiatrist. It may be possible to convince the patient to consult a specialist.

The mental health emergency team should be called when:

• affective disturbances are increasing;
• there is a risk of self-harm;
• the patient commits suicidal acts;
• there is a threat to the lives of others.

The medics who arrived on the scene

• assess the complexity of the situation;
• immobilize the patient if necessary;
• will carry out relief of the condition;
• decide on hospitalization.

Treatment in a psycho-neurological hospital may be agreed or compulsory. Consent to hospitalization can be given by the patient himself, and his relatives. Compulsory placement is determined by a psychiatrist in accordance with existing legislation.

Prevention

Unfortunately, psychosis is a disorder characterized by relapses. Therefore, an important component of a favorable prognosis of the disease is prevention. The treatment of psychosis is long and laborious. And in the intervals of remission, you need to adhere to certain rules and prescriptions of doctors.

The main preventive methods include:

• maintenance therapy;
• compliance with the daily routine;
• avoidance of emotional shocks;
• getting rid of bad habits;
• constructive change of circle of communication;
• walks, sports, yoga.

Physiotherapy procedures are considered a good preventive method, including:

• electrosleep;
• acupuncture;
• massage;
• Su-Jok therapy;
• physiotherapy.

Many of them help reduce emotional overstrain, normalize sleep, improve metabolism, and increase vitality. Of particular importance in the prevention of the disease are individual and group psychotherapeutic sessions based on cognitive-behavioral and art therapy for the patients themselves and their relatives.

RELATED ARTICLES

They call a pronounced form of disorders that have a mental type. The companions of psychosis are delusional states, abrupt mood changes, hallucinations, states of arousal, uncontrollable or depressive behavior, a violation of the thought process and a complete lack of the ability to critically assess one's condition.

Causes of psychosis

The occurrence of psychosis is facilitated by causes that have a variety of characteristics. The causes of psychosis are primarily classified according to internal and external factors. The presence of external factors leads to the development of an exogenous type of psychosis. External sources of psychosis are: various infections (flu, typhus, and so on), alcohol and drug addiction, poisons of industrial origin, any stress or trauma of a psychological nature. The leader of external causes is alcohol, its abuse results in alcoholic psychosis.

Internal factors that influence the development of psychosis lead to the manifestation of an endogenous type of psychosis. The sources of this type are predominantly impaired functions of the nervous system and imbalance of the endocrine system. Endogenous psychosis is closely related to age-related changes occurring in the body, the so-called senile psychosis. It develops as a result of hypertensive processes, with lesions of the brain vessels by atherosclerosis and with.

The difference between endogenous psychosis is the duration and the possibility of repetition. This psychosis causes a complex condition in which it is problematic to establish the true causes of its occurrence. Sometimes the primary source may lie in external factors, and then it is supplemented by internal problems. Senile psychoses require allocation in a separate group. As a rule, they appear no earlier than 60 years of age with endomorphic disorders and a state of clouding of consciousness, but without the development of complete dementia.

Psychosis can occur in a reactive and acute form. The reactive form includes psychoses that occur in the form of temporary reversible disorders of a mental nature and arising from any type of mental trauma. The acute form of psychosis occurs suddenly and develops rapidly. Any unexpected news, for example, about the death of a close relative or the loss of something, can serve as an impetus for development. Observations show that women are more susceptible to psychosis than men, and this does not depend on race and financial situation.

Symptoms of psychosis

The rich human psyche enables psychosis to manifest without limit. The main symptoms of the disease include hallucinations, the occurrence of delusional ideas, motor disorders and mood disorders. Hallucinations are auditory, olfactory, visual, tactile and gustatory. Their manifestations can be in a simple (call, call) and complex (speech) form. The most common hallucinations are auditory in the form of voices sounding in the head of the patient or coming from outside.

Ideas of delusional content constitute judgments and conclusions that do not correspond to reality. They completely capture the consciousness of the patient, while it is impossible to dissuade him or explain anything to him. The most common are delusional ideas about persecution (surveillance, intrigue), about negative impact (special services, aliens, damage, and so on), about causing damage (surviving from an apartment, stealing things, poisoned food), about a terrible deadly disease. Sometimes there is delusions of grandeur, jealousy, love, and so on.

Disorders of motor functions are manifested by lethargy (stupor), when the patient maintains one position for a long time, is inactive, his gaze is directed to one point, he does not answer the questions posed and stops eating. The other side of motor disorders is the patient's being in a state of excitement, when he is constantly on the move, speaks non-stop, sometimes makes faces, mimics the interlocutor, is possibly aggressive, can commit an unmotivated act.

Disorders in the mood of the patient are expressed by states of a depressive or manic nature. can be seen by a lowered mood, manifested in the form of longing, depression, mental retardation, a pessimistic assessment of the past and future, suicidal thoughts. The manic state is assessed by an unreasonably elevated mood, by the acceleration of thinking and speed of movement, by planning unrealistic (fantastic) prospects, by lack of sleep, by abusing something.

A person in a state of psychosis changes in behavior, emotional manifestations and thinking. Such metamorphoses testify to the loss of the ability to really perceive the world around, which is affected by the complete lack of awareness of what is happening and the inability to assess one's altered psyche. Patients with altered consciousness, who are in a depressed state, resist treatment and hospitalization.

Diagnosis of psychosis

When making a diagnosis, the doctor takes as a basis the features of the symptoms and the nature of the dynamics of this disorder. Many symptoms of psychosis occur in a mild form long before the onset of the disease and are serious precursors of the disease. The first signs of psychosis are very difficult to recognize. These include changes in character, when a person shows excessive irritability, nervousness or anxiety, his sleep is disturbed, his appetite disappears, his appearance can be described as strange or unusual.

A sign of incipient psychosis may be a change in performance, which is expressed in a decline in activity, and in a sharp form, reduced resistance to stress, and the inability to maintain attention. Feelings can change: mood swings, the appearance of fears, depression due to trifles. Another sign is a change in habits manifested in isolation, distrust, problems in communication, complete withdrawal into oneself. The onset of psychosis can be indicated by a sudden change in interests and perceptions (colors, sounds).

Signs of a mental disorder cause anxiety in the patient's relatives, who begin to suspect schizophrenia, although psychosis has other causes. Therefore, it is very important to conduct a timely, thorough examination of the patient in order to avoid serious consequences that manifest themselves as a psychotic state, stroke, and so on. The real cause of psychosis is found out by a qualified psychiatrist using complex high-tech methods.

Treatment of reactive psychosis at the first stage requires the elimination of the cause of the disease where possible. The reaction of affective shock, in the absence of its transition to a different state, does not require the help of a doctor. All other types of psychosis require rapid hospitalization of the patient, since the presence of psychosis does not allow him to control his actions and threatens to cause unconscious harm to himself or others.

For treatment, a clinical justification is necessary - the correct diagnosis, reliable identification of the severity of the disease, psychopathic symptoms, individual characteristics of the patient's personality and his physical health. In drug therapy, psychotropic drugs are used, mainly antipsychotics, sometimes tranquilizers. To them are added medicines of general strengthening action, if necessary - antidepressants.

To date, drugs have been created that can act selectively, only on a certain type of psychosis. In the case of psychosis, which appeared as a result of intoxication, drugs are used that help cleanse the body. In any case, the appointment of drugs takes into account an individual approach, a professional specialist. The doctor takes into account the causes of the disease, the age of the patient, other existing diseases and contraindications.

Drug treatment, as a rule, is carried out in parallel with the rehabilitation of a psychological nature. It is necessary to improve the effectiveness of the treatment. The task of the psychiatrist is to find contact with the patient and inspire him with positive thoughts about recovery, about the need to take medication, about his soon return to normal life. The patient is guaranteed complete anonymity of treatment.

The rehabilitation course also includes training programs. They help patients develop a different reaction to the world around them, teach a new form of life behavior. After the completion of the rehabilitation program, the patient must establish himself in a sense of his equality in society, have a better attitude towards himself and other people who also feel their inferiority due to their psychosis and those who deny their disease.

Physiotherapeutic methods relieve emotional overstrain. Promote better metabolism, increase the ability to work. They are prescribed as an addition to the main treatment and include such procedures as physiotherapy exercises, reflexology with needles, electrosleep, sanatorium treatment. If necessary, electroconvulsive treatment is carried out, which causes convulsive seizures by an artificial method using alternating current. It effectively affects certain areas of the brain.

Timely treatment to a greater extent increases the receipt of a positive result and quickly normalizes the patient's condition.

Expert editor: Mochalov Pavel Alexandrovich| MD general practitioner

Education: Moscow Medical Institute. I. M. Sechenov, specialty - "Medicine" in 1991, in 1993 "Occupational diseases", in 1996 "Therapy".

Definition of disease. Causes of the disease

Acute psychotic disorder(OPA) or acute psychosis is a painful mental condition in which there is difficulty in determining what is real and what is not. With this disorder, a person develops false beliefs that cannot be dissuaded (delusional ideas), he begins to perceive things that others do not see or hear (hallucinations).

Sometimes people with acute psychosis are distinguished by incoherent (torn or disorganized) speech and behavior that does not correspond to the external situation (in everyday life this is called inadequacy). They may also experience sleep problems, social withdrawal, lack of motivation, and difficulty performing daily activities.

This disorder was described in ancient times: Hippocrates mentions it already in the 4th century BC. e.

On average, about 3% of people experience psychosis at some point in their lives, and in a third of them it is developmental.

Acute psychosis has many different causes:

Separately, two reactive psychoses are distinguished:

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of acute psychotic disorder

There are four main symptoms of acute psychosis: senestopathies, delusions, hallucinations, and delusions.

Senestopathy- these are unusual, artsy, unpleasant somatic sensations that may be associated with diseases of the internal organs or exist in the imagination of a hypochondriac patient.

The most common senestopathies are:

Illusions - these are distorted, incorrect perceptions of a real-life object. They can also occur in mentally healthy people, since the distorted perception of an object depends, for example, on the illumination, the emotional state of a person or the state of the auditory analyzer (hard of hearing people).

Psychosis can cause:

• verbal illusions- the real speech of the surrounding people is perceived as hostile statements;
• pareidolicillusions- occurs in deliriums (mental disorders with clouding of consciousness) of intoxication or traumatic origin. Thus, a patient with delirium tremens (delirium tremens) in spots on the wallpaper notices stirring and bizarre, changing faces, and in cracks in the ceiling he notices snakes ready to pounce on him. With twilight confusion associated with trauma or epilepsy, the patient perceives the doctor as a killer, and the phonendoscope in his hand is like a gun aimed at him.

hallucinations is the perception of an object that does not actually exist. Most often they are auditory or verbal. For example, the patient hears non-existent "voices" that can play different roles:

• comment on his actions (commenting hallucinations);
• attack or defend (dramatic hallucinations);
• justify and praise (angelic hallucinations);
• obsessively and unsystematically repeating something (stereotypical or obsessive hallucinations);
• order to do something (imperative hallucinations) - can be dangerous for the patient and others.

Hallucinations associated with ODA should be distinguished from hallucinations caused by illness, and from manifestations of eidetism - a phenomenal ability to visualize representations (memories) with extraordinary sensory brightness, which is found in artists and children, and in children bright and "live" images of visualized representations can play the role of heroes-friends and interlocutors.

crazy ideas- these are subjective judgments taken by the patient with OPD as true, which are objectively false, plausible, ridiculous and do not correspond to reality. It is impossible to dissuade the patient or psychologically correct such conclusions.

Crazy ideas are:

• primary - associated with the defeat of thinking
• secondary - occurring on the basis of illusions, hallucinations or mental automatisms (when a person ceases to be the master of his own thoughts);
• systematized - supported by subjective evidence of the patient himself (everything that does not agree with the evidence is rejected);
• unsystematized - devoid of evidence base and logic;
• encapsulated - sketchy;
• residual - residual, fading;
• figurative - reflecting the prevailing mood;
• interpretive - arbitrarily interpreting reality.

Delusional ideas can also occur in healthy people who are in close contact with "delusional" patients. This form of delusion is called induced. If a person with OPD has strong charisma and leadership qualities, then induced delusions can become a kind of "epidemic".

• paranoid - ideas of a special relationship;
• paranoid - ideas of persecution;
• paraphrenic - ideas of greatness, wealth and reassessment of one's capabilities.

The pathogenesis of acute psychotic disorder

ODA is traditionally seen as a consequence disruption of the dopamine neurotransmitter system of the brain. This hypothesis states that psychosis is the result of overactivity of dopamine in the brain, especially in the mesolimbic system. Dopamine is a substance involved in the transmission of impulses between nerve cells.

The main source of evidence for this hypothesis is the pharmacological effects of antipsychotic drugs, which block dopamine D2 receptors, thereby reducing the intensity of psychotic symptoms. Conversely, drugs that increase the production of dopamine or block its "return" and destruction (for example, amphetamines and cocaine) can provoke psychosis.

Which affect the intensity of the interaction of nerve cells, has also been proposed as a possible mechanism for the onset of psychosis. This theory is supported by the fact that partial NMDA receptor antagonists, such as ketamine and dextromethorphan, contribute to the onset of a psychotic state in large overdoses. The symptoms of such intoxication are considered mirror symptoms of schizophrenia, with both positive (productive) and negative symptoms occurring.

Antagonism of NMDA receptors, in addition to provoking symptoms resembling psychosis, is also manifested by other neurophysiological aspects: a decrease in the amplitude of P50, P300 and other evoked potentials of nerve cells.

Long-term use or high doses of psychostimulants can change the normal functioning of the brain, making it look like the manic phase of bipolar disorder, a type of psychotic condition. NMDA receptor antagonists replicate some of the so-called "negative" symptoms, such as thought disorder (at low doses) and catatonia (at high doses). Psychostimulants, especially in those who are already prone to a psychotic style of thinking, can cause some "positive" symptoms such as delusional beliefs, especially persecutory (haunting) content.

Classification and stages of development of acute psychotic disorder

Acute psychosis is:

Primary psychoses must be treated immediately with antipsychotic drugs, while secondary ones require the elimination of the root cause: brain tumors, intoxication and other pathologies.

ODEs are classified according to the psychiatric disorder to which they are classified. If they are associated with schizophrenia spectrum disorders, then acute psychoses can take the following forms:

In the next revision of ICD-11, it is proposed to abandon the forms of schizophrenia. This is due to the difficulty in differentiating the forms among themselves, as well as the fact that in practice the transition of the disease from one form to another is often observed.

Complications of acute psychotic disorder

People with a history of OCD are more likely to abuse drugs and/or alcohol than others. Some use them to treat psychotic symptoms. And although psychoactive substances do relieve psychosis (albeit briefly and slightly), their abuse can only aggravate psychotic symptoms or cause other problems.

For example, studies show that people with schizophrenia are more likely to smoke. Nicotine helps them cope with anxiety and also reduces some of the side effects of antipsychotic medication. But at the same time, the risk of lung cancer and vascular accidents (strokes and heart attacks) increases significantly. Therefore, drugs and alcohol are not used as medicines: their use does not solve the problem, but only through an imaginary relief adds another problem.

If left untreated, psychotic symptoms can lead to social disruption: school and work problems, strained family relationships, and loss of close social contacts such as friends and acquaintances. The longer the symptoms persist, the greater the risk of additional problems - frequent unreasonable calls to the ambulance, admission to a psychiatric hospital, problems with the law. In general, all this is called "social drift" - the loss of social status, professional skills, competencies with a violation of contacts accumulated throughout life. The end result of this drift is homelessness and the need for constant social support. Therefore, among the homeless people, the percentage of people with psychotic disorders is very high.

People with acute psychosis also have a high risk of self-harm and suicide. Therefore, if the patient harms himself, you should immediately contact a doctor or the Helpline service. Loved ones should be on the lookout for signs of unexplained cuts, bruises, or cigarette burns, which are commonly found on the wrists, arms, thighs, and chest.

People with OCD who self-harm can always wear covering clothing, even in hot weather. In view of the immediate danger, involuntary examination of such patients by psychiatrists is allowed, as well as involuntary treatment in psychiatric hospitals.

Diagnosis of acute psychotic disorder

Diagnosis of OPD is primarily carried out by observing the behavior of the patient and talking with him. In the process of such an examination, objective signs of the presence of psychotic experiences can be identified:

• disorganized behavior and speech - sometimes the patient's speech is so disturbed that it is impossible to understand what he wants to say (this is called "verbal okroshka");
• signs of hallucinations - the patient can constantly close his ears, talk when there is no one around, look past the interlocutor, etc .;
• indirect indicators of the presence of delusional experiences - for example, a patient can wrap his head with metal objects, because he thinks that his brain is affected by rays.

In addition, a list of additional paraclinical examinations is carried out in order to exclude an external cause other than mental disorders:

• brain tomography - to exclude tumors and vascular disorders;
• testing for psychoactive substances and others.

When all external causes are excluded, one proceeds to the differential diagnosis among the psychiatric causes of acute psychosis. Schizophrenia is the most common cause of OPD. For a long time, the diagnosis of schizophrenia was based on the symptoms of Kurt Schneider, who identified them by statistical analysis of case histories:

• sounding thoughts;
• third-person hallucinations;
• hallucinations in the form of comments;
• somatic hallucinations;
• withdrawal or insertion of thoughts;
• translation (openness) of thoughts;
• delusional perception;
• perception of sensations or actions as if they were caused by someone else's influence.

In modern classifications, there is a departure from these criteria, since they have shown their low specificity for schizophrenia.

Other psychiatric causes of ODA may include:

• bipolar affective disorder - then affective (emotional) disorders will prevail in the clinic of psychosis;
• - in this case, there will be many psycho-organic signs in the clinic of psychosis;
• withdrawal syndrome after substance abuse.

Treatment of acute psychotic disorder

Treatment for ODA involves a combination of antipsychotic medications, psychological therapies, and social support (support for a person's social needs, such as education, employment, or housing).

Antipsychotic medicines

Antipsychotic medications are not suitable for everyone, as their side effects can affect people in different ways. For example, antipsychotics must be carefully monitored and selected for people with cardiovascular disease, epilepsy, and other conditions that cause convulsions or seizures.

Side effects may include drowsiness, trembling, weight gain, agitation, muscle twitches and spasms, blurred vision, dizziness, constipation, loss of sex drive (libido), dry mouth, and others. They are all reversible and correctable.

Antipsychotics reduce feelings of anxiety within a few hours of using them. But to reduce directly psychotic symptoms, such as hallucinations or delusional thoughts, it may take several days or weeks.

Antipsychotics can be taken by mouth (by mouth) or by injection. There are several slow-release antipsychotics that require only one injection every two to six weeks (eg, maintenance prolongs).

After an episode of psychosis, most people who get better on medication need to continue taking it for at least a year. About 50% of people need to take medication for longer periods of time to prevent recurrence of symptoms. If a person has severe psychotic episodes, they may need to be sent to a psychiatric hospital for treatment.

Psychological treatment

Psychological treatments include:

• Cognitive Behavioral Therapy (CBT), based on individual conversation, has been very successful in helping people with psychosis;
• family interventions - the participation of family members and close friends in therapy reduces the need for inpatient treatment.

Forecast. Prevention

Before developing OPD, people usually experience criteria for ultra-high risk of developing psychosis:

1. episodic occurrence of one or more psychotic symptoms:
2. hallucinations;
3. delirium;
4. formal disorders of thinking (disconnection of thinking, feeling of "an influx of thoughts" or their "blocking", etc.);
5. the appearance of one attenuated (smoothed) psychotic symptom or more:
6. ideas of attitude (thoughts that others treat him in a special way);
7. strange beliefs or unusual "magical" thinking, including ideas of grandiosity;
8. paranoid ideas;
9. unusual perceptual experience (elementary deceptions of perception);
10. oddities of thinking and speech;
11. the presence of hereditary risk factors (history of psychosis, schizoid or schizotypal personality disorder in relatives).

It is very important to “catch” the development of OPD at the stage of the listed early manifestations, since only this makes it possible to stop the development of serious irreversible personality changes.

The period of symptom-precursors that occurs before the onset of acute psychotic manifestations is called the "window of opportunity" when it is possible to really change the course of the disease. All other attempts at therapeutic intervention after the manifestation of psychosis only alleviate the patient's condition, but do not allow to radically influence the course of the disease itself.

Primary prevention of psychosis includes:

• knowledge of risk factors for ODA;
• the use of methods to reduce the risk of these factors;
• knowledge of the neurobiological pathways that mediate the impact of various risk factors in the development of OPD, and the presence of specific interventions that block these risk factors leading to the disease.

Secondary prevention of psychosis(after a psychotic episode):

• identification of a group of people at high risk of relapse;
• the availability of safe and effective specific treatments that reduce the likelihood of relapses;
• the availability of specific, effective treatments that can prevent or slow the progression of the disease.

Juan Miro, The Rooster and the Sun (1972). Image from orwellwasright.wordpress.com

What is acute psychosis?

Acute psychosis is a clear violation of mental activity, a violation of consciousness. It manifests itself in a distorted perception of real events and oneself. In a state of acute psychosis, a person loses control over his behavior and cannot help himself - he is led by his painful condition.

Acute psychosis is of exogenous and endogenous origin. That is, it either arises from external influences on the psyche, or for internal reasons, for example, due to schizophrenia.

Symptoms of acute psychosis caused by external causes

Psychosis caused by external influences - intoxication (alcohol, drugs), trauma or stress - manifests itself through clouded consciousness, stunning, stupor, disorientation in space and time. A person begins to see what is not there, that is, to hallucinate.

A classic example is alcoholic delirium, delirium tremens. At a certain stage of withdrawal, swelling of the brain occurs, and the person begins to see something terrible, but not present in reality.

Because of these visions, the patient may begin to fight for his safety and harm others. And sometimes it can harm itself - a person is so scared that he tries to kill himself in order to end his visions. Alcoholic delirium is one of the most potentially fatal mental disorders.

Symptoms of acute psychosis caused by internal causes

If a person has schizophrenia - that is, an endogenous disease that does not have external causes - then acute psychosis manifests itself through a disorder of visual, auditory and olfactory perception. Crazy ideas come up. They occur more often than hallucinations.

What are crazy ideas?

Crazy ideas are a manifestation of the disease. They have their own internal logic, which is incomprehensible to other people, but is quite clear to a sick person. At the same time, the carrier of delusional ideas is not amenable to persuasion.

Where do crazy ideas come from?

There are several theories about how delusions are formed. Once a person begins to understand that something is wrong with him, somehow he is restless, anxious. And our brain is arranged in such a way that it needs to find the reason for what is happening - and it offers options.

Most often, a person stops at the idea that someone is following him. To strengthen the theory, a suitable candidate will be selected - classmates, neighbors, special services. The longer this goes on, the more complex the system of delirium will become. A crazy idea is like a ball of thread pulled by a person.

The idea of ​​persecution at some point is projected into behavior - a person can start hiding, hiding from wiretapping in the bathroom, not opening doors and windows, not going out into the street.

There is another theory of the emergence of crazy ideas, when their appearance is associated with an excess of dopamine in the body, the hormone of pleasure.

All people constantly perceive a large amount of information. Part of our brain is perceived as significant, the rest is filtered out. If there is no filter, we will go crazy from the abundance of colors, sounds and smells. Just such a broken filter, according to some researchers, is the cause of acute psychosis in endogenous diseases.

Insignificant information that has nothing to do with a person begins to be perceived by him as very significant. Things, events that are not connected with each other, are firmly connected in the mind of the patient. Suppose he saw a green cucumber in a store - this can make him go to the forest and climb a tall tree. Why this happens is unclear.

What determines the content of delusional ideas?

But more often all the same, crazy ideas are negative, scary, pushing for aggressive behavior. It must be understood that a person does not control himself, does not consciously participate in the process.

What causes acute psychosis in a schizophrenic?

Because schizophrenia is a disease caused by genetics, it can get worse for no apparent reason. It is believed that there is a seasonal dependence of exacerbations, but this is not always and not for everyone. Someone exacerbation can occur at any time of the year.

Acute psychosis can be triggered, as with any other disease, by stress, psychotrauma, forced sleep disturbance, and prolonged physical exertion. All of these factors can be a catalyst for psychosis.

How to recognize the onset of acute psychosis at an early stage?

The character of a person changes: he becomes more irritable, nervous. His sleep may be disturbed - a person may suddenly begin to wander at night, immersed in his thoughts. Loss of appetite, loss of interest in life is also a symptom.

Sudden mood swings, the emergence of some new fears, while the desire for self-isolation may also indicate that not everything is fine. A person becomes cold to loved ones, moves away from them, loses the ability to empathize.

What if the other person has acute psychosis?

If this is a familiar person, friend or relative, you need to call an ambulance.

If you see a person for the first time, then it is better not to make contact with him, but still try to somehow convey to those who know him that the person needs psychiatric help.

If a stranger poses a threat to themselves or others, it is also necessary to call a psychiatric team.