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» Psychoses: their main manifestations and treatment guidelines
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Psychoses: their main manifestations and treatment guidelines
Psychosis - is expressed in the form of mental disorders in which the patient's mental activity characterized by a sharp discrepancy between reality, a reflection of grossly distorted the real world, which manifests itself in behavioral disturbances and unusual manifestation of psychosis in her normal pathological symptoms and syndromes (disorders of perception, memory, thinking, affectivity and others). Psychosis does not generate new phenomena, and is the result of loss of the higher levels.
There are psychoses:
hallucinatory
raving
hallucinatory-delusional
affective
depressive
manic
maniac-depressive
alcoholic
hysterical
affective schizophrenia, etc.
Affective psychosis - a mental disorder characterized by frequency of occurrence of mood disorders in the form of manic, depressive or mixed states (phases episodes of attacks), full of their reversibility and the development of remission with restoration of mental function and personality traits, not leading to dementia. Affective psychosis is characterized by only affective phases, which may be different in depth and duration. Manic depressive phase is usually shorter. The average duration of 4.9 months past, manic - 5-6 months. The maximum duration of affective phases may be several months or even years (18 years).
There are affective psychosis:
unipolar depression, when the clinical picture of the disease in its entirety from time to time arise exclusively depressive phases
unipolar mania, which are recorded only manic phase
with a predominance of bipolar depression
with a predominance of bipolar mania
clearly bipolar type with the same depressive and manic phases.
Schizoaffective psychosis - is neprogredientnoe endogenous mental illness with a relatively favorable prognosis, recurrent seizures, and the dynamics of the film which co-exist simultaneously or sequentially develop circular affective disorders (depressive, manic or mixed) of endogenous nature inherent in schizophrenia and psychotic symptoms (delusions and hallucinations).
The features of schizoaffective psychosis are:
periodic alternation of the flow with schizoaffective and affective episodes
favorable prognosis with no visible signs of negative growth disorders
the absence of visible disease in the dynamics of personality shift and no signs of schizophrenic defect
required combination of the circular pattern of psychosis and affective disorders delusional schizophrenic symptoms.
Hallucinatory-paranoid psychosis syndrome (Kandinsky Clerambault) - is characterized by a predominance of the clinical picture of hallucinatory-paranoid syndrome (a combination of auditory hallucinations with delusions of persecution often, influence, relationships) with the phenomena of mental automatism (the feeling of mastering that occurs when the alleged impact on the patient to some form of energy). Observed in schizophrenia.
The functional psychoses in old age - the emergence of mental illness which is associated with aging, characterized by the beginning in the late age period and the lack of trends in the development of organic dementia (dementia), even with prolonged duration. There are late-life depression and late-life paranoia.
Alcoholic psychosis frequently develops in stages II and III of alcoholism. The most common form - drunken delirium tremens (delirium tremens), alcoholic hallucinosis, alcoholic delusional psychosis. Alcoholic psychoses occur at high flow limitation alcoholism.
Hysterical psychosis. Usually occurs after massive psychogenic trauma. An important role played by personal predisposition, a tendency to hysterical forms of response. The most common clinical variants - delusional fantasy (unstable, with no tendency to systematize the ideas of grandeur, wealth, of particular importance), Ganser's syndrome (characterized by a clouded state, narrowing the field of consciousness, disorientation, demonstrative behavior of patients: the laughter, singing, crying, imitating animals ), hysterical stupor (manifested psychomotor inhibition, mutism, narrowing of consciousness), pseudodementia (imaginary, apparent dementia), puerilism (childishness, childlike behavior on the background of hysterical restricted consciousness), a syndrome of "savagery" (accompanied by the disintegration of mental functions, loss of skills, human behavior , patients are deprived of speech, move on all fours and eat with their hands, etc.)
Treatment
In the treatment of psychosis more likely to use combination therapy. With the predominance of psychotic depression in the film is primarily prescribed tricyclic antidepressants (imipramine, Anafranil, amitriptyline), monoamine oxidase inhibitors (auroriks), SSRIs (Paxil, tsipramil, Luvox).
When administered maniyah typical (haloperidol) and atypical (rispolept, azaleptin, Zyprexa) antipsychotics.
In bipolar illness, or for frequent changes of mood phases prescribe mood stabilizers (lithium carbonate).
In hallucinatory-delusional psychosis in the first appoint typical neuroleptics (haloperidol, stelazin) or high doses of atypical neuroleptics
