The concept of "psychogenic" brings together a wide range of disorders, which are influenced by psychological trauma.
From a clinical point of view are the following forms of reactive disorders: acute stress reaction (affective-shock response) hysterical psychosis psychogenic depression psychogenic mania psychogenic paranoia.
Acute shock reactions are described under the name "psychosis of terror", but also appear in the literature, terms such as emotive shock, acute affektogennye response, crisis reactions, extreme situations. In all these cases it is a transient disorder are severe with abrupt shifts in endocrine and vasomotor, developing in persons without mental disorders in extreme conditions. As an implementing act stressors situation dangerous to life or well-being - Natural disasters (earthquakes, floods), environmental disasters, accidents, fires, shipwrecks, the events of the combat situation (the shelling, the attack of the enemy), leading to more destruction, causing death , injury, suffering a large number of people. Sensitivity to stress factors is increased in astenizirovannyh people, older people, and somatic disorders.
There are hyper-and hypokinetic form of acute reactions to stress. In hyperkinetic form, to some extent the corresponding reaction "motor storm," the behavior of patients lose focus, against the backdrop of rapidly increasing anxiety, fear arises from the chaotic jumble of agitated movements, aimless throwing, the desire to run away (fugiformnaya reaction). The orientation in the environment is disturbed. The duration of motor excitation is small, it usually stops after 15-25 minutes. For hypokinetic form corresponding reaction "apparent death" is characterized by abrupt state motor inhibition, amounting to total immobility and mutism (stupor affektogenny). Patients usually stay in the place where the emotion of fear arose, and they are indifferent to what is happening around, gaze directed into the space. The duration of stupor for several hours to 2-3 days. Experiences related to the acute period of psychosis, usually amneziruyutsya. Upon his release from acute psychosis there is a pronounced asthenia, lasting up to 2-3 weeks.
Hysterical (dissociative) psychoses are heterogeneous in the clinical picture of psychotic states - hysterical twilight stupor, pseudodementia, puerilism, a syndrome of delusional fantasies of regression syndrome, personality, hysterical stupor. Depending on the severity and duration of response observed in a picture of psychosis or a combination of various hysterical disorders, or sequential transformation of some hysterical symptoms in others. This type of psychogenic reactions in peacetime, more often seen in forensic psychiatric practice ("Prison hysteria"), but also formed in connection with situations of loss (death of close relatives, breaking the marital relationship), as well as with some other pathogenic factors. According to the psychodynamic concepts of hysterical psychosis treated as a "displacement reactions" trauma.
Acute depressive reactions most often directly related to the disaster occurred, the sudden impact of individually significant trauma. At the height of severe depression is dominated by fear, deep despair, thoughts of death. Such states are generally short-lived and come to the attention of a psychiatrist only when they involve self-harm or suicide attempts. Prolonged type of psychogenic nature for the ground troops with large reactive depression.
For the clinical picture of the past, along with depression, hopelessness, tearfulness, insomnia, and autonomic disorders characterized by the concentration of most of the contents of consciousness at the event had an accident. Subject experienced, often acquiring the properties of the dominant view, does not disappear completely, even when depression is prolonged and more worn. Suffice random reminders to renew at the time of increased depression, and even remote associations can trigger an outbreak of despair. If the current business day by patients can escape from oppressive memories, they come up for a long night in a nightmarish dream. Vital signs in reactive repression not clear. Patients soon disappointed and "wounded" life than sadness. Criticism of the consciousness of the disease is usually preserved. Although self-esteem of patients is usually low, expressed the idea of self-accusation are rare. Feelings of guilt often does not address itself, as in endogenous depression, and in the surrounding, all the claims are directed to the persons involved in the tragic event occurred.
The clinical picture of psychogenic mania from the start dominated flutter phenomenon, irritability, nervousness, with little expression of vital disorders - affect happiness, contentment, counterinhibition drives. Characterized by a combination of polar passions - grief and excitement of contrasting experiences of life and the collapse of the optimistic elation. Often to the fore sleep disorders: sleep difficulties associated with the influx of memories of the tragic events, short duration of nighttime sleep early awakening, and the lack of sleepiness during the day. Activity increased. Patients exhibit unusual for his earlier energy, mobility, and the desire for activity, which is adequate to the circumstances in nature, making efforts to prevent family breakdown, the search for rare drugs, "stars" of medicine for a dying relative's funeral, memorial services.
Clinical picture of acute psychogenic paranoia inherent simplicity, elementary, imagery, and emotional richness of delirium pronounced affect of fear and anxiety. Most often, there is delusions of persecution and relationships. The content of delusions reflects the forward or reverse (delusions of innocence and pardon convicts) as a traumatic situation.
In some cases, it is a threat to physical survival, violence, in others - moral and ethical damage to the patient and his family. There are also a visual and auditory hallucinations. After a short (sometimes more than a few hours) with a prodrome more obscure fears and anxiety of growing suspicion in patients with a sudden there is a sense of mortal danger: they are surrounded by enemies, and their relatives are dead, some heard an ominous whisper, and then a more distinct voices of the people plotting the murder.
Psychosis is transient, and in most cases a few days after hospitalization delusional disorder disappear. Post-traumatic stress disorder, or posttraumatic stress disorder (PTSD) - a complex mental disorders, arising from extreme events. PTSD occurs after a latent period lasting from several weeks to a few (usually no more than 6).
