Manic phase. What is manic-depressive syndrome? What to do to avoid manic psychosis
Psychosis- a mental illness in which a person cannot adequately perceive the surrounding reality and respond to it appropriately. Psychoses are very diverse in their manifestations. They accompany many diseases, such as schizophrenia, senile dementia, delirium tremens, or may be an independent pathology.
So what is psychosis?
This is a mental disorder in which reality is so distorted in the mind of a person that this “picture” no longer has anything to do with what other people see. Being objective prevents a person from constant fear for his life, voices in his head that order him to do something, visions that are not available to anyone else ... These internal prisms change the patient's behavior. His reactions become completely inadequate: causeless laughter or tears, anxiety or euphoria. All patients with psychosis manifest differently. Some are sure that special services are hunting for them, others assure others of their superpowers, and still others persistently pursue the object of their love, groundlessly laying claim to it. It is impossible to list all the manifestations of psychosis, but psychiatrists managed to systematize them by combining them into groups.
Psychosis is not just a wrong train of thought. One should not think that the sick person is deluded or cannot keep his nerves under control. Do not argue and even more so condemn him. Psychosis is the same disease as diabetes mellitus. This is also a violation of metabolic processes, but only in the brain. You are not afraid of diabetics, you do not condemn them for their disease. You sympathize with them. Patients with neurosis deserve the same attitude. By the way, scientists have proven that mentally healthy people commit crimes more often than those with psychosis.
Don't label a person. Psychosis is not a life sentence. It happens that after a period of illness, which can be quite difficult, the psyche is completely restored and problems never arise again. But more often the disease has a cyclical nature. In this case, after a long period of health, an exacerbation occurs: hallucinations and delusions appear. This happens if you do not strictly follow the recommendations of the attending physician. In severe cases, the disease becomes chronic, and mental health does not return.
Psychosis is a fairly common problem. According to statistics, 15% of patients in mental hospitals are patients with psychosis. And 3-5% of the total population suffer from psychosis caused by various diseases: asthma, cerebral atherosclerosis, etc. But there are still thousands of people whose psychosis is associated with external causes - taking drugs, alcohol, medicines. To date, doctors cannot calculate the exact number of patients with psychosis.
Psychosis affects both children and adults, both men and women. But some forms of the disease predominantly affect women. So, women suffer from manic-depressive syndrome 3-4 times more often. Psychoses are more likely to occur during menstruation, menopause, and after childbirth. This suggests that mental illness is associated with fluctuations in hormone levels in the female body.
If you or someone close to you has signs of psychosis, do not despair. Modern medicine successfully copes with this disease. And the notorious "accounting" was replaced by the consultation of the local psychiatrist - consultative and medical assistance. Therefore, the fact of treatment will not spoil your future life in any way. But attempts to cope with the disease on their own can lead to irreparable changes in the psyche and to disability.
Causes of psychosis
mechanism of psychosis. At the heart of psychosis are violations of the brain cells (neurons). Inside the cell there are components - mitochondria, which provide cellular respiration and give it energy for activity in the form of ATP molecules. These compounds act as an electrical current for a special sodium-potassium pump. It pumps into the neuron the chemical elements necessary for its work: potassium, sodium, calcium.If the mitochondria are not producing ATP, then the pump is not working. As a result, cell activity is disrupted. This neuron remains “hungry” and experiences an oxygen deficiency, despite the fact that a person eats normally and gets enough fresh air.
Neurons in which the chemical balance is disturbed cannot form and transmit nerve impulses. They disrupt the entire central nervous system, leading to the development of psychosis. Depending on which parts of the brain are more affected, the manifestations of the disease depend. For example, lesions in the subcortical emotional centers lead to manic-depressive psychosis.
Factors and pathologies that lead to psychosis
- Bad heredity.
There is a group of genes that are passed from parents to children. These genes control the sensitivity of the brain to external influences and signal substances. For example, the neurotransmitter dopamine, which causes a feeling of pleasure. People with burdened heredity are more susceptible to the influence of negative factors, whether it be illness or psychological trauma. Their psychosis develops at an early age, quickly and in severe form.
If both parents are sick, there is a 50% chance that the child will have psychosis. If only one of the parents is sick, then the risk for the child is 25%. If the parents did not suffer from psychosis, then their children may also face such a problem, having received “defective genes” from past generations.
- Brain Injuries:
- injuries received by the child during childbirth;
- bruises and concussions of the brain;
- closed and open craniocerebral injuries.
- brain poisoning can be caused by various substances.
- Diseases of the nervous system: multiple sclerosis, epilepsy, stroke, Alzheimer's disease, Parkinson's disease, temporal lobe epilepsy These diseases of the brain cause damage to the bodies of nerve cells or their processes. The death of the cells of the cortex and deeper structures of the brain causes swelling of the surrounding tissue. As a result, the functions for which the damaged areas of the brain are responsible are disrupted.
- Infectious diseases: influenza, mumps (mumps), malaria, leprosy, Lyme disease. Living and dead microorganisms secrete toxins that poison nerve cells and cause their death. Intoxication of the brain negatively affects the emotions and thinking of a person.
- brain tumors. Cysts, benign and malignant tumors compress the surrounding brain tissues, disrupt blood circulation, and the transfer of excitation from one brain structure to another. Nerve impulses are the basis of emotions and thinking. Therefore, a violation of the passage of the signal manifests itself in the form of psychosis.
- Bronchial asthma. Severe asthma attacks are accompanied by panic attacks and oxygen starvation of the brain. Lack of oxygen for 4-5 minutes causes the death of nerve cells, and stress disrupts the smooth functioning of the brain, leading to psychosis.
- Diseases accompanied by severe pain Key words: ulcerative colitis, sarcoidosis, myocardial infarction. Pain is stress and anxiety. Therefore, physical suffering always has a negative impact on emotions and the psyche.
- systemic diseases, associated with impaired immunity: systemic lupus erythematosus, rheumatism. The nervous tissue suffers from toxins secreted by microorganisms, from damage to the cerebral vessels, from an allergic reaction that occurs with systemic diseases. These disorders lead to a failure of higher nervous activity and psychosis.
- Lack of vitamins B1 and B3 that affect the functioning of the nervous system. They are involved in the production of neurotransmitters, ATP molecules, normalizes metabolism at the cellular level, positively affect the emotional background and mental abilities of a person. Vitamin deficiency makes the nervous system more sensitive to external factors that cause psychosis.
- Electrolyte imbalance associated with deficiency or excess of potassium, calcium, sodium, magnesium. Such changes can be caused by persistent vomiting or diarrhea when electrolytes are washed out of the body, prolonged diets, uncontrolled use of mineral supplements. As a result, the composition of the cytoplasm in nerve cells changes, which negatively affects their functions.
- hormonal disorders, caused by abortion, childbirth, disruption of the ovaries, thyroid gland, pituitary gland, hypothalamus, adrenal glands. Prolonged hormonal imbalance disrupts the brain. There is a direct relationship between the nervous system and the endocrine glands. Therefore, strong fluctuations in hormone levels can cause acute psychosis.
- Mental trauma: severe stress, situations in which life was endangered, loss of a job, property or loved one, and other events that radically change future life. Nervous exhaustion, overwork and lack of sleep also provoke mental disorders. These factors disrupt blood circulation, the transmission of nerve impulses between neurons, metabolic processes in the brain and lead to the appearance of psychosis.
Risk factors for psychosis
age factorDifferent psychoses manifest themselves in different periods of a person's life. For example, in adolescence, when a hormonal explosion occurs, the likelihood of schizophrenia is high.
Manic-depressive psychosis most often affects young active people. At this age, fateful changes occur, which are a heavy burden on the psyche. This is admission to a university, finding a job, starting a family.
In the period of maturity, syphilitic psychoses occur. Since changes in the psyche begin 10-15 years after infection with syphilis.
In old age, the appearance of psychosis is associated with menopause in women, age-related changes in blood vessels and nerve cells. Violation of blood circulation and destruction of nervous tissue leads to senile psychosis.
gender factor
The number of men and women suffering from psychosis is about the same. But some types of psychosis can affect more members of the same sex. For example, manic-depressive (bipolar) psychosis in women develops 3 times more often than in men. And monopolar psychosis (attacks of depression without a period of excitement) has the same tendency: there are 2 times more female representatives among patients. Such statistics are explained by the fact that the female body often experiences hormonal surges that affect the functioning of the nervous system.
In men, psychosis due to chronic alcoholism, syphilitic and traumatic psychosis are more common. These "male" forms of psychosis are not associated with the level of hormones, but with the social role, the behavior of the stronger sex. But early cases of psychosis in Alzheimer's disease in men are associated with genetic characteristics.
Geographic factor
It has been noticed that mental illnesses, including psychosis, more often affect residents of large cities. And those who live in small towns and in rural areas are less at risk. The fact is that life in megacities has a high pace and is full of stress.
Illumination, average temperature and daylight hours have little effect on the prevalence of diseases. However, some scientists note that people born in the northern hemisphere during the winter months are more prone to developing psychosis. The mechanism of development of the disease in this case has not been elucidated.
social factor
Psychosis often appears in people who have failed to realize themselves socially:
- women who did not marry did not give birth to a child;
- men who could not build a career, succeed in society;
- people who are not satisfied with their social status, have not been able to show their inclinations and abilities, have chosen a profession that does not correspond to their interests.
Psychophysiological constitution factor
Hippocrates described 4 types of temperament. He divided all people into melancholic, choleric, phlegmatic and sanguine. The first two types of temperament are considered unstable and therefore more prone to the development of psychosis.
Kretschmer singled out the main types of psychophysiological constitution: schizoid, cycloid, epileptoid and hysteroid. Each of these types is equally at risk of developing psychosis, but depending on the psychophysiological constitution, the manifestations will differ. For example, the cycloid type is prone to manic-depressive psychosis, and the hysteroid type is more likely to get hysteroid psychosis than others, and has a high tendency to attempt suicide.
How does psychosis manifest?
The manifestations of psychosis are very diverse, since the disease causes disturbances in behavior, thinking, and emotions. It is especially important for patients and their relatives to know how the disease begins and what happens during an exacerbation in order to start treatment in a timely manner. You may notice unusual behavior, refusal of food, strange statements, too emotional reaction to what is happening. The opposite situation also happens, a person ceases to be interested in the world around him, nothing touches him, he is indifferent to everything, does not show any emotions, moves and talks little. The main manifestations of psychosis
hallucinations. They can be auditory, visual, tactile, gustatory, olfactory. The most common are auditory hallucinations. The person seems to hear voices. They can be in the head, come from the body, or come from outside. The voices are so real that the patient does not even doubt their authenticity. He perceives this phenomenon as a miracle or a gift from above. Voices are threatening, accusing or commanding. The latter are considered the most dangerous, since a person almost always follows these orders.
You can guess that a person has hallucinations by the following signs:
- He suddenly freezes and listens to something;
- Sudden silence in the middle of a phrase;
- Conversation with oneself in the form of replicas to someone's phrases;
- Laughter or depression for no apparent reason;
- The person cannot concentrate on a conversation with you, stares at something.
- Manifestations of depressive disorders:
- A person sits in one position for a long time, he has no desire and strength to move or communicate.
- Pessimistic attitude, the patient is dissatisfied with his past, present, future and the whole environment.
- To alleviate anxiety, a person can constantly eat or vice versa, completely refuse food.
- Sleep disturbances, early awakenings at 3-4 o'clock. It is at this time that mental suffering is most severe, which can lead to a suicide attempt.
- Manic symptoms:
- A person becomes extremely active, moves a lot, sometimes aimlessly.
- Unprecedented sociability, verbosity appears, speech becomes fast, emotional, and may be accompanied by grimacing.
- Optimistic attitude, a person does not see problems and obstacles.
- The patient builds unrealizable plans, significantly overestimates his strength.
- The need for sleep decreases, the person sleeps little, but feels vigorous and rested.
- The patient may abuse alcohol, engage in promiscuity.
Delusion is a mental disorder that manifests itself in the form of an idea that does not correspond to reality. A hallmark of delusions is that you can't convince a person with logical arguments. In addition, the patient always tells his crazy ideas very emotionally and is firmly convinced that he is right.
Distinctive signs and manifestations of delirium
- Brad is very different from reality. Incomprehensible cryptic statements appear in the patient's speech. They may relate to his guilt, doom, or vice versa greatness.
- The patient's personality always takes center stage. For example, a person not only believes in aliens, but also claims that they flew in specifically to establish contact with him.
- Emotionality. A person very emotionally talks about his ideas, does not accept objections. He does not tolerate disputes about his idea, immediately becomes aggressive.
- Behavior obeys a delusional idea. For example, he may refuse to eat, fearing that they want to poison him.
- Unreasonable defensive actions. A person curtains windows, installs additional locks, fears for his life. These are manifestations of delusions of persecution. A person is afraid of the special services that follow him with the help of innovative equipment, aliens, "black" magicians who send damage to him, acquaintances who conspire around him.
- Delusions related to one's own health (hypochondriac). The person is convinced that he is seriously ill. He "feels" the symptoms of the disease, insists on numerous repeated examinations. Angry at doctors who can't find the reason for feeling unwell and don't confirm his diagnosis.
- Delusion of damage manifests itself in the belief that ill-wishers spoil or steal things, pour poison into food, act with the help of radiation, want to take away the apartment.
- Brad of invention. A person is confident that he has invented a unique device, a perpetual motion machine, or a way to fight a dangerous disease. He fiercely defends his invention, persistently trying to bring it to life. Since the patients are not mentally impaired, their ideas can sound quite convincing.
- Love delirium and delirium of jealousy. A person concentrates on his emotions, pursues the object of his love. He comes up with a reason for jealousy, finds evidence of betrayal where there is none.
- Brad of litigation. The patient floods various authorities and the police with complaints about his neighbors or organizations. Files numerous lawsuits.
- Lethargy or stupor. A person freezes in one position, for a long time (days or weeks) remains without movement. He refuses food and communication.
- Motor excitement. Movements become fast, jerky, often aimless. The facial expressions are very emotional, the conversation is accompanied by grimaces. Can mimic someone else's speech, imitate the sounds of animals. Sometimes a person is unable to perform simple tasks due to the fact that he loses control over his movements.
What to do if someone close to you has alarming symptoms?
If you notice such manifestations, then talk to the person. Find out what is bothering him, what is the reason for the changes in his behavior. At the same time, it is necessary to exercise maximum tact, avoid reproaches and claims, and not raise your voice. One carelessly spoken word can lead to a suicide attempt.Convince the person to seek psychiatric help. Explain that the doctor will prescribe medications that will help to calm down, it is easier to endure stressful situations.
Types of psychoses
The most common are manic and depressive psychoses - in an outwardly healthy person, signs of depression or significant arousal suddenly appear. Such psychoses are called monopolar - the deviation occurs in one direction. In some cases, the patient may alternately show signs of both manic and depressive psychosis. In this case, doctors talk about bipolar disorder - manic-depressive psychosis.
manic psychosis
Manic psychosis - a severe mental disorder that causes the appearance of three characteristic symptoms: elevated mood, accelerated thinking and speech, noticeable motor activity. The periods of excitation last from 3 months to one and a half years.
depressive psychosis
depressive psychosis is a disease of the brain, and psychological manifestations are the external side of the disease. Depression begins slowly, imperceptibly for the patient himself and for others. As a rule, good, highly moral people fall into depression. They are tormented by a conscience that has grown to pathological dimensions. Confidence appears: “I am bad. I am not doing my job well, I have not achieved anything. I'm bad at raising kids. I am a bad husband. Everyone knows how bad I am and they talk about it." Depressive psychosis lasts from 3 months to a year.Depressive psychosis is the opposite of manic psychosis. He also has triad of characteristic symptoms
- pathologically depressed mood
Thoughts are centered around your personality, your mistakes and your shortcomings. Concentration on one's own negative sides gives rise to the belief that everything was bad in the past, the present cannot please with anything, and in the future everything will be even worse than it is now. On this basis, a person with depressive psychosis can lay hands on himself.
Since a person's intellect is preserved, he can carefully hide his desire for suicide so that no one violates his plans. At the same time, he does not show his depressed state and assures that he is already better. At home, it is not always possible to prevent a suicide attempt. Therefore, people with depression who are focused on self-destruction and their own low value are treated in a hospital.
A sick person experiences unreasonable longing, it crushes and oppresses. It is noteworthy that he can practically show with his finger where unpleasant sensations are concentrated, where “the soul hurts”. Therefore, this condition even received the name - precordial longing.
Depression in psychosis has a distinguishing feature: the condition is worst in the early morning, and by the evening it improves. The person explains this by the fact that in the evening there are more worries, the whole family gathers and this distracts from sad thoughts. But with depression caused by neurosis, on the contrary, the mood worsens in the evening.
Characteristically, in the acute period of depressive psychosis, patients do not cry. They say they would like to cry, but there are no tears. Therefore, crying in this case is a sign of improvement. Both patients and their relatives should remember this.
- Mental retardation
Mental and metabolic processes in the brain proceed very slowly. This may be due to a lack of neurotransmitters: dopamine, norepinephrine and serotonin. These chemicals ensure proper signal transmission between brain cells.
As a result of a deficiency of neurotransmitters, memory, reaction, and thinking deteriorate. A person quickly gets tired, does not want to do anything, he is not interested in anything, does not surprise and does not please. From them you can often hear the phrase “I envy other people. They can work, relax, have fun. I'm sorry I can't."
The patient constantly looks gloomy and sad. The look is dull, unblinking, the corners of the mouth are lowered, avoids communication, tries to retire. He slowly reacts to the appeal, answers in monosyllables, reluctantly, in a monotonous voice.
- Physical retardation
Depressive psychosis physically changes a person. Appetite falls, and the patient quickly loses weight. Therefore, weight gain with depression says that the patient is on the mend.
A person's movements become extremely slow: a slow, uncertain gait, stooped shoulders, a lowered head. The patient feels a loss of strength. Any physical activity worsens the condition.
In severe forms of depressive psychosis, a person falls into a stupor. He can sit for a long time without moving, looking at one point. If you try to read notations at this time; “get together, pull yourself together”, then only aggravate the situation. A person will have the thought: “I have to, but I can’t – that means I’m bad, good for nothing.” He cannot overcome depressive psychosis by an effort of will, since the production of norepinephrine and serotonin does not depend on our desire. Therefore, the patient needs qualified assistance and medical treatment.
There are a number of physical signs of depressive psychosis: diurnal mood swings, early awakenings, weight loss due to poor appetite, menstrual irregularities, dry mouth, constipation, some people may develop insensitivity to pain. These signs indicate that you need to seek medical attention.
Basic rules for communicating with patients with psychosis
- Do not argue or object to people if you see signs of manic arousal in them. This can provoke an attack of anger and aggression. As a result, you can completely lose trust and turn the person against you.
- If the patient shows manic activity and aggression, keep calm, self-confidence and goodwill. Take him away, isolate him from other people, try to calm him down during the conversation.
- 80% of suicides are committed by patients with psychosis in the stage of depression. Therefore, be very attentive to loved ones during this period. Don't leave them alone, especially in the morning. Pay special attention to signs warning of a suicide attempt: the patient talks about an overwhelming sense of guilt, about voices ordering to kill himself, about hopelessness and uselessness, about plans to end his life. Suicide is preceded by a sharp transition of depression into a bright, peaceful mood, putting affairs in order, drawing up a will. Do not ignore these signs, even if you think that this is just an attempt to attract attention to yourself.
- Hide all items that can be used in a suicide attempt: household chemicals, medicines, weapons, sharp objects.
- Eliminate the traumatic situation if possible. Create a calm environment. Try to keep the patient surrounded by loved ones. Reassure him that he is now safe and everything is over.
- If a person is delusional, do not ask clarifying questions, do not ask for details (What do aliens look like? How many are there?). This may make the situation worse. "Seize on" any non-delusional statement he utters. Develop the conversation in that direction. You can focus on the person's emotions by asking, “I see you're upset. How can I help you?"
- If there are signs that the person has experienced hallucinations, then calmly and confidently ask him what happened now. If he saw or heard anything unusual, then find out what he thinks and feels about it. To cope with hallucinations, you can listen to loud music with headphones, do something exciting.
- If necessary, you can firmly recall the rules of behavior, ask the patient not to scream. But do not ridicule him, argue about hallucinations, say that it is impossible to hear voices.
- Do not seek help from traditional healers and psychics. Psychosis is very diverse, and for effective treatment it is necessary to accurately determine the cause of the disease. For this, it is necessary to use high-tech diagnostic methods. If you lose time on treatment with non-traditional methods, then acute psychosis will develop. In this case, it will take several times more time to fight the disease, and in the future it will be necessary to constantly take medication.
- If you see that the person is relatively calm and ready to communicate, try to convince him to see a doctor. Explain that any symptoms of illness that are bothering him can be relieved with medication prescribed by the doctor.
- If your relative flatly refuses to go to a psychiatrist, persuade him to go to a psychologist or psychotherapist to deal with depression. These specialists will help convince the patient that there is nothing to worry about in a visit to a psychiatrist.
- The most difficult step for loved ones is to call the psychiatric emergency team. But this must be done if a person directly declares his intention to end his life, can injure himself or harm other people.
Psychological treatments for psychosis
In psychosis, psychological methods successfully complement drug treatment. A psychotherapist can help a patient:- reduce the symptoms of psychosis;
- avoid relapses;
- raise self-esteem;
- learn to adequately perceive the surrounding reality, correctly assess the situation, one's condition and respond accordingly, correct behavioral errors;
- eliminate the causes of psychosis;
- improve the effectiveness of medical treatment.
Psychotherapy eliminates personality disorders that occurred during the period of psychosis, puts thoughts and ideas in order. Working with a psychologist and psychotherapist makes it possible to influence future events and prevent the recurrence of the disease.
Psychological treatments are aimed at restoring mental health and at socializing a person after recovery in order to help him feel comfortable in the family, work team and society. This treatment is called psychosocialization.
Psychological methods that are used to treat psychosis are divided into individual and group. During individual sessions, the psychotherapist replaces the personal core lost during the illness. It becomes an external support for the patient, calms him down and helps to correctly assess reality and adequately respond to it.
group therapy helps to feel like a member of society. A group of people struggling with psychosis is led by a specially trained person who has managed to successfully cope with this problem. This gives patients hope for recovery, helps to overcome awkwardness and return to normal life.In the treatment of psychosis, hypnosis, analytical and suggestive (from Latin Suggestio - suggestion) methods are not used. When working with altered consciousness, they can lead to further mental disorders.
Good results in the treatment of psychosis are given by: psychoeducation, addiction therapy, cognitive behavior therapy, psychoanalysis, family therapy, occupational therapy, art therapy, as well as psychosocial trainings: social competence training, metacognitive training.
Psychoeducation is the education of the patient and his family members. The psychotherapist talks about psychosis, about the features of this disease, the conditions for recovery, motivates them to take medication and lead a healthy lifestyle. Tells relatives how to behave with the patient. If you disagree with something or have questions, then be sure to ask them at the time specially allotted for discussions. It is very important for the success of the treatment that you have no doubts.
Classes are held 1-2 times a week. If you visit them regularly, then you will form the right attitude towards the disease and drug treatment. Statistics say that thanks to such conversations, it is possible to reduce the risk of repeated episodes of psychosis by 60-80%.
addiction therapy necessary for those people whose psychosis has developed against the background of alcoholism and drug addiction. Such patients always have an internal conflict. On the one hand, they understand that they should not use drugs, but on the other hand, there is a strong desire to return to bad habits.
Classes are held in the form of an individual conversation. A psychotherapist talks about the relationship between drug use and psychosis. He will tell you how to behave in order to reduce the temptation. Addiction therapy helps build a strong motivation to abstain from bad habits.
Cognitive (behavioral) therapy. Cognitive therapy is recognized as one of the best treatments for psychosis accompanied by depression. The method is based on the fact that erroneous thoughts and fantasies (cognitions) interfere with the normal perception of reality. During the sessions, the doctor will bring out these wrong judgments and the emotions associated with them. He will teach you how to be critical of them, and not let these thoughts influence your behavior, tell you how to look for alternative ways to solve the problem.
To achieve this goal, a protocol of negative thoughts is used. It contains the following columns: negative thoughts, the situation in which they arose, the emotions associated with them, the facts “for” and “against” these thoughts. The course of treatment consists of 15-25 individual sessions and lasts 4-12 months.
Psychoanalysis. Although this technique is not used to treat schizophrenia and affective (emotional) psychoses, its modern "supportive" version is effectively used to treat other forms of the disease. At individual meetings, the patient reveals his inner world to the psychoanalyst and transfers to him feelings directed at other people. During the conversation, the specialist identifies the reasons that led to the development of psychosis (conflicts, psychological trauma) and the defense mechanisms that a person uses to protect himself from such situations. The treatment process takes 3-5 years.
Family Therapy - group therapy, during which the specialist conducts classes with family members where the patient with psychosis lives. Therapy is aimed at eliminating conflicts in the family, which can cause exacerbations of the disease. The doctor will talk about the features of the course of psychosis and the correct behavior in crisis situations. Therapy is aimed at preventing relapses and ensuring that all family members are comfortable living together.
Ergotherapy. This type of therapy is most often group therapy. The patient is recommended to attend special classes where he can engage in various activities: cooking, gardening, working with wood, textiles, clay, reading, writing poetry, listening to and writing music. Such activities train memory, patience, concentration, develop creative abilities, help open up, establish contact with other members of the group.
The specific setting of tasks, the achievement of simple goals gives the patient confidence that he again becomes the master of his life.
Art therapy - method of art therapy based on psychoanalysis. It is a “no-words” healing method that activates the possibilities for self-healing. The patient creates a picture expressing his feelings, an image of his inner world. Then the specialist studies it from the point of view of psychoanalysis.
Social competence training. A group activity in which people learn and put into practice new forms of behavior in order to apply them in everyday life. For example, how to behave when meeting new people, when applying for a job or in conflict situations. In subsequent sessions, it is customary to discuss the problems that people encountered when implementing them in real situations.metacognitive training. Group training sessions that are aimed at correcting the thinking errors that lead to delusions: distorted attribution of judgments to people (he does not love me), hasty conclusions (if he does not love, he wants me dead), depressive way of thinking, inability to empathize , feel other people's emotions, painful confidence in memory impairment. The training consists of 8 sessions and lasts 4 weeks. At each module, the trainer analyzes thinking errors and helps to form new models of thoughts and behavior.
Psychotherapy is widely used in all forms of psychosis. It can help people of all ages, but is especially important for teenagers. At a time when life attitudes and stereotypes of behavior are just being formed, psychotherapy can radically change life for the better.
Drug treatment of psychoses
Medicinal treatment of psychosis is a prerequisite for recovery. Without it, it will not be possible to get out of the trap of the disease, and the condition will only worsen.There is no single drug therapy for psychosis. The doctor prescribes drugs strictly individually, based on the manifestations of the disease and the characteristics of its course, gender and age of the patient. During treatment, the doctor monitors the patient's condition and, if necessary, increases or reduces the dose in order to achieve a positive effect and not cause side effects.
Treatment of manic psychosis
Drug group The mechanism of the treated action Representatives How is it prescribed Antipsychotic drugs (neuroleptics) They are used for all forms of psychosis. Block dopamine receptors. This substance is a neurotransmitter that promotes the transfer of excitation between brain cells. Thanks to the action of neuroleptics, it is possible to reduce the severity of delusions, hallucinations and thought disorders. Solian (effective for negative disorders: lack of emotions, withdrawal from communication) In the acute period, 400-800 mg / day is prescribed, up to a maximum of 1200 mg / day. Take with or without food.
Maintenance dose 50-300 mg / day.Zeldox 40-80 mg 2 times a day. The dose is increased over 3 days. The drug is administered orally after meals. Fluanxol The daily dose is 40-150 mg / day, divided into 4 times. Tablets are taken after meals.
The drug is also produced in the form of a solution for injection, which is done 1 time in 2-4 weeks.Benzodiazepines They are prescribed for acute manifestations of psychosis in conjunction with antipsychotic drugs. They reduce the excitability of nerve cells, have a calming and anticonvulsant effect, relax muscles, eliminate insomnia, and reduce anxiety. Oxazepam Take 5-10 mg twice or thrice a day. If necessary, the daily dose can be increased to 60 mg. The drug is taken regardless of food, drinking plenty of water. The duration of treatment is 2-4 weeks. Zopiclone Take 7.5-15 mg 1 time per day half an hour before bedtime, if psychosis is accompanied by insomnia. Mood stabilizers (normotimics) Normalize mood, preventing the onset of manic phases, make it possible to control emotions. Actinerval (derivative of carbamazepine and valproic acid) The first week the daily dose is 200-400 mg, it is divided into 3-4 times. Every 7 days, the dose is increased by 200 mg, bringing up to 1 g. The drug is also canceled gradually so as not to cause a deterioration in the condition. Contemnol (contains lithium carbonate) Take 1 g per day once in the morning after breakfast, drinking plenty of water or milk. Anticholinergic drugs (anticholinergics) Necessary to neutralize side effects after taking antipsychotics. Regulates the sensitivity of the nerve cells of the brain, blocking the action of the mediator acetylcholine, which ensures the transmission of nerve impulses between the cells of the parasympathetic nervous system. Cyclodol, (Parkopan) The initial dose is 0.5-1 mg / day. If necessary, it can be gradually increased to 20 mg / day. Multiplicity of reception 3-5 times a day, after meals. Treatment of depressive psychosis
Drug group The mechanism of the treated action Representatives How is it prescribed Antipsychotic drugs They make brain cells less sensitive to excess amounts of dopamine, a substance that promotes signaling in the brain. Drugs normalize thought processes, eliminate hallucinations and delusions. Quentiax During the first four days of treatment, the dose is increased from 50 to 300 mg. In the future, the daily dose may be from 150 to 750 mg / day. The drug is taken 2 times a day, regardless of food intake. Eglonil Tablets and capsules are taken 1-3 times a day, regardless of food intake. Daily dose of 50 to 150 mg for 4 weeks. The drug is not advisable to use after 16 hours, so as not to cause insomnia. Rispolept Konsta A suspension is prepared from microgranules and the solvent included in the kit, which is injected into the gluteal muscle 1 time in 2 weeks. Risperidone The initial dose is 1 mg 2 times a day. Tablets of 1-2 mg are taken 1-2 times a day. Benzodiazepines It is prescribed for acute manifestations of depression and severe anxiety. The drugs reduce the excitability of the subcortical structures of the brain, relax the muscles, relieve the feeling of fear, and calm the nervous system. Phenazepam Take 0.25-0.5 mg 2-3 times a day. The maximum daily dose should not exceed 0.01 g.
Assign short courses so as not to cause dependence. After the onset of improvement, the dosage is gradually reduced.Lorazepam Take 1 mg 2-3 times a day. With severe depression, the dose can be gradually increased to 4-6 mg / day. Cancel the drug gradually because of the risk of seizures. Normotimics Drugs designed to normalize mood and prevent periods of depression. lithium carbonate Take orally 3-4 times a day. The initial dose is 0.6-0.9 g / day, gradually the amount of the drug is increased to 1.5-2.1 g. The drug is taken after meals to reduce the irritating effect on the gastric mucosa. Antidepressants Remedies to fight depression. Modern 3rd generation antidepressants reduce the uptake of serotonin by neurons and thereby increase the concentration of this neurotransmitter. They improve mood, relieve anxiety and longing, fear. Sertraline Take orally 50 mg, 1 time per day after breakfast or dinner. If there is no effect, the doctor may gradually increase the dose to 200 mg / day. Paroxetine Take 20-40 mg / day in the morning during breakfast. The tablet is swallowed without chewing and washed down with water. Anticholinergic drugs Drugs that can eliminate the side effects of taking antipsychotics. Slowness of movement, muscle stiffness, trembling, impaired thinking, increased or absent emotions. Akineton 2.5-5 mg of the drug is administered intravenously or intramuscularly.
In tablets, the initial dose is 1 mg 1-2 times / day, gradually the amount of the drug is adjusted to 3-16 mg / day. The dose is divided into 3 doses. Tablets are taken during or after meals with liquid.
Recall that any independent change in dose can have very serious consequences. Reducing the dosage or refusing to take medication causes an exacerbation of psychosis. Increasing the dose increases the risk of side effects and addiction.Prevention of psychoses
What should be done to prevent a relapse of psychosis?Unfortunately, people who have experienced psychosis are at risk of experiencing a relapse of the disease. A repeated episode of psychosis is a difficult test for both the patient himself and his relatives. But you can reduce your risk of relapse by up to 80% if you take your doctor's prescription medications.
- Medical therapy- the main point of prevention of psychosis. If you find it difficult to take your medications every day, talk to your doctor about switching to a depot form of antipsychotic medication. In this case, it will be possible to make 1 injection in 2-4 weeks.
It has been proven that after the first case of psychosis, the use of drugs for one year is necessary. With manic manifestations of psychosis, lithium salts and Finlepsin are prescribed at 600-1200 mg per day. And with depressive psychosis, Carbamazepine is needed at 600-1200 mg per day.
- Regularly attend individual and group psychotherapy sessions. They boost your self-confidence and motivation to get well. In addition, a psychotherapist can notice signs of an approaching exacerbation in time, which will help adjust the dosage of drugs and prevent a recurrence.
Follow the daily routine. Train yourself to get up, take food and medicine at the same time every day. A daily schedule can help with this. From the evening, plan tomorrow. Make a list of all the things you need to do. Mark which of them are important and which are secondary. Such planning will help you not to forget anything, to be in time for everything and to be less nervous. When planning, set realistic goals.- Communicate more. You will feel comfortable around people who have managed to overcome psychosis. Communicate in self-help groups or on specialized forums.
- Exercise daily. Suitable for running, swimming, cycling. It is very good if you do this in a group of like-minded people, then the classes will bring both benefit and pleasure.
- Make a list of early symptoms of a coming crisis, the appearance of which must be reported to the attending physician. Pay attention to these signals:
- Behavior changes: frequent leaving the house, prolonged listening to music, unreasonable laughter, illogical statements, excessive philosophizing, conversations with people with whom you usually do not want to communicate, fussy movements, squandering, adventurism.
- Mood changes: irritability, tearfulness, aggressiveness, anxiety, fear.
- Feeling changes: sleep disturbance, lack or increased appetite, increased sweating, weakness, weight loss.
- Don't drink too much coffee. It can have a strong stimulating effect on the nervous system. Give up alcohol and drugs. They have a bad effect on the brain, cause mental and motor excitement, attacks of aggression.
- Don't overwork. Physical and mental exhaustion can cause extreme confusion, inconsistent thinking, and overreaction to external stimuli. These deviations are associated with a violation of the absorption of oxygen and glucose by nerve cells.
- Do not sweat in the bath, try to avoid overheating. An increase in body temperature often leads to the appearance of delirium, which is explained by an increase in the activity of electrical potentials in the brain, an increase in their frequency and amplitude.
- Don't conflict. Try to resolve conflicts constructively to avoid stress. Strong mental stress can become a trigger for a new crisis.
- Don't refuse treatment. During an exacerbation, the temptation to refuse to take medication and visit a doctor is especially great. Do not do this, otherwise the disease will become acute and hospital treatment will be required.
What is postpartum psychosis?
postpartum psychosis quite rare mental illness. It develops in 1-2 out of 1000 women in labor. Signs of psychosis most often appear during the first 4-6 weeks after childbirth. Unlike postpartum depression, this mental disorder is characterized by delusions, hallucinations, and a desire to harm yourself or your baby. Manifestations of postpartum psychosis.
The first signs of the disease are sudden mood swings, anxiety, severe anxiety, unreasonable fears. Further delusions and hallucinations appear. A woman may claim that the child is not hers, that he is stillborn or crippled. Sometimes a young mother develops paranoia, she stops going for walks and does not let anyone near her child. In some cases, the disease is accompanied by megalomania, when a woman is confident in her superpowers. She can hear voices ordering her to kill herself or the child.
According to statistics, 5% of women in a state of postpartum psychosis kill themselves, and 4% of their child. Therefore, it is very important for relatives not to ignore the signs of the disease, but to contact a psychiatrist in a timely manner.
Causes of postpartum psychosis.
The cause of mental disorders can be difficult childbirth, unwanted pregnancy, conflict with her husband, fear that the spouse will love the child more than her. Psychologists believe that psychosis can be caused by conflict between a woman and her mother. It can also be caused by damage to the brain as a result of injury or infection. A sharp decrease in the level of the female hormone estrogen, as well as endorphins, thyroid hormone and cortisol, can affect the development of psychosis.
In about half of the cases, postpartum psychosis develops in patients with schizophrenia or manic-depressive syndrome.
Treatment of postpartum psychosis.
Treatment must be started as soon as possible because the woman's condition is rapidly deteriorating. If there is a risk of suicide, then the woman will be treated in a psychiatric ward. During the period while she is taking medicines, it is impossible to breastfeed the baby, since most of the drugs penetrate the mother's milk. But communication with the child will be useful. Caring for the baby (provided that the woman herself wants it) helps to normalize the state of the psyche.
If a woman is depressed, then antidepressants are prescribed. Amitriptyline, Pirlindol are indicated if anxiety and fear predominate. Citalopram, Paroxetine have a stimulating effect. They will help in the case when psychosis is accompanied by stupor - a woman sits motionless, refuses to communicate.
With mental and motor agitation and manifestations of a manic syndrome, lithium preparations (lithium carbonate, Micalit) and antipsychotics (Clozapine, Olanzapine) are necessary.
Psychotherapy for postpartum psychosis is used only after the elimination of acute manifestations. It is aimed at identifying and resolving conflicts that led to a mental disorder.
What is reactive psychosis?
Reactive psychosis or psychogenic shock - a mental disorder that arose after a severe psychological trauma. This form of the disease has three features that distinguish it from other psychoses (Jaspers' triad): - Psychosis begins after a severe emotional shock is very significant for this person.
- Reactive psychosis is reversible. The more time has passed since the injury, the weaker the symptoms. In most cases, recovery occurs after about a year.
- Painful experiences and manifestations of psychosis depend on the nature of the trauma. Between them there is a psychologically understandable connection.
A mental disorder occurs after a strong shock: a catastrophe, an attack by criminals, a fire, a collapse of plans, a career collapse, a divorce, illness or death of a loved one. In some cases, positive events that caused an explosion of emotions can also provoke psychosis.
Especially at risk of developing reactive psychosis are emotionally unstable people, those who have suffered a bruise or concussion, severe infectious diseases, whose brain has suffered from alcohol or drug intoxication. As well as teenagers in puberty and women going through menopause.
Manifestations of reactive psychosis.
Symptoms of psychosis depend on the nature of the injury and the form of the disease. There are such forms of reactive psychosis:
- psychogenic depression;
- psychogenic paranoid;
- hysterical psychosis;
- psychogenic stupor.
Psychogenic paranoid accompanied by delirium, auditory hallucinations and motor excitation. It seems to the patient that he is being persecuted, he fears for his life, is afraid of exposure and is fighting imaginary enemies. Symptoms depend on the nature of the stressful situation. The person is very excited, commits rash acts. This form of reactive psychosis often occurs on the road, as a result of lack of sleep, alcohol consumption.
hysterical psychosis has several forms.
- delusional fantasies - crazy ideas that relate to greatness, wealth, persecution. The patient tells them very theatrically and emotionally. Unlike delirium, a person is not sure of his words, and the essence of statements changes depending on the situation.
- Ganser syndrome patients do not know who they are, where they are, what year it is. They answer simple questions incorrectly. They commit illogical actions (eat soup with a fork).
- pseudodementia - short-term loss of all knowledge and skills. A person cannot answer the simplest questions, show where his ear is, or count his fingers. He is naughty, grimaces, cannot sit still.
- Puerilism Syndrome - an adult has a child's speech, children's emotions, children's movements. May develop initially or as a complication of pseudodementia.
- Syndrome of "wildness" - human behavior resembles the habits of an animal. Speech is replaced by a growl, the patient does not recognize clothes and cutlery, moves on all fours. This condition, with an unfavorable course, can change puerilism.
Treatment of reactive psychosis.
The most important step in the treatment of reactive psychosis is the elimination of the traumatic situation. If you manage to do this, then the probability of a quick recovery is high.
Drug treatment of reactive psychosis depends on the severity of the manifestations and characteristics of the psychological state.At reactive depression prescribe antidepressants: Imipramine 150-300 mg per day or Sertraline 50-100 mg 1 time per day after breakfast. Supplement therapy with tranquilizers Sibazon 5-15 mg / day or Phenazepam 1-3 mg / day.
Psychogenic paranoid treated with neuroleptics: Triftazin or Haloperidol 5-15 mg / day.
With hysterical psychosis, it is necessary to take tranquilizers (Diazepam 5-15 mg / day, Mezapam 20-40 mg / day) and neuroleptics (Alimemazine 40-60 mg / day or Neuleptil 30-40 mg / day).
Psychostimulants can bring a person out of a psychogenic stupor, for example, Sydnocarb 30-40 mg / day or Ritalin 10-30 mg / day.Psychotherapy can save a person from excessive fixation on a traumatic situation and develop protective mechanisms. However, it is possible to proceed to consultations with a psychotherapist only after the acute phase of psychosis has passed, and the person has regained the ability to perceive the arguments of a specialist.
Remember - psychosis is curable! Self-discipline, regular medication, psychotherapy and the help of loved ones guarantee the return of mental health.
Manic-depressive psychosis is an outdated name for an endogenous mental illness, which in the international classification is defined as or BAD. The original name of this disorder, circular psychosis, reflects the main symptom of the disease or the change in mood phases. The disease has two opposite phases - mania or abnormally elevated mood and depression. Phases can alternate, replacing each other immediately or through a light gap called intermission.
Sometimes the same person has manifestations of both phases at the same time, or one phase is fully expressed, and the other is partially. At the height of mood disorders, persistent hallucinatory-delusional constructions can form. Some patients end up in a psychiatric hospital once and get by with a disability certificate, others become permanently disabled.
Is there a cure for manic-depressive psychosis? Unfortunately, a full recovery is not possible. However, the regular use of potent psychotropic drugs allows a person to stay in society, to live a relatively normal life for many years.
It has not been definitively established, although there are indisputable statistics. The reasons for the development of manic-depressive psychosis are:
Several studies performed in different countries have shown that in 80% the cause is a genetic defect. The BAD study was conducted on identical twins, which excludes random factors. This means that twins living in different conditions and countries showed the same clinical picture at the same age. Defects were found in different parts of the 18th and 21st chromosomes. The hereditary factor is considered decisive.
The influence of the family and the environment in TIR is in the range from 7 to 20%. This is living together with mentally unstable individuals, severe social upheavals, armed conflicts, man-made and natural disasters.
Provoking factors
The distribution of the frequency of bipolar psychosis in people of both sexes is approximately the same, but biphasic disorder develops more often in men, and single-phase disorder in women. Women's psychiatric disorders are more vivid, often provoked by changes in hormonal status - the menstrual cycle, pregnancy, childbirth, menopause. The postpartum depression that occurs in women is subsequently classified as the onset of bipolar disorder, the diagnosis is established retrospectively.
It is believed that any psychiatric disorder that occurs within 14 days after birth almost always transforms into full-blown psychosis. Also, bipolar disorder can develop after childbirth in a woman who has ever had any psychiatric disorder.
In practice, there is a connection between the depressive phase and traumatic events. A person initially develops reactive depression in response to some event, and then transforms into a major psychosis. In relation to the manic phase, there is no such connection; mania develops according to its own endogenous laws.It has long been noted that affective disorders develop in those whose personality has special features. These are melancholics who never see anything good in the events of life.
Also at risk are overly ordered and responsible people who cross out all spontaneity and unpredictability from their lives. At risk, those who are quickly exhausted cannot endure hardships and troubles. Schizoids are always in danger - people - formulas prone to theorizing.
Classification of manic-depressive psychosis
Manic-depressive psychosis is the second most common endogenous mental illness after schizophrenia. The polymorphism of symptoms, delusional inclusions, social maladaptation, rapid phase change make this disease difficult to diagnose. According to statistics, it takes an average of 10 years from the onset of the disease to the final clarification of the diagnosis.
In the ICD-10, bipolar disorder is coded under F31 and F33. In practice, the type of course of the disease matters:
A certain pattern was noted between the type of course and the age of manifestation of the disease. According to statistics, at the onset of the disease before the age of 25, a classic bipolar course develops, after 30 years, a unipolar course is more common.
Symptoms of manic-depressive psychosis
What is MDP and how does manic-depressive psychosis manifest itself? This is a kind of “swing” of mood, with endless fluctuations of which a person has to live.
The manic phase is a combination of three symptoms: an abnormally elevated mood, accelerated thinking, and high motor activity. Clinically, the phase develops gradually, on the rise: if at first a sick person can be mistaken for a confident optimist, then at the height of the phase it is a riot that does not recognize any boundaries.
The mood first begins to rise, and there are no objective reasons for this. A person realizes that everything in his life is great, there are no barriers, the future is cloudless, and his abilities and capabilities exceed those of everyone else. The delusion of grandeur becomes a logical continuation, when the patient feels himself to be a god or the arbiter of destinies. Behavior changes - values and acquisitions that took the whole previous life are distributed, career and family collapse. There is no longer a need to eat and sleep - there is so much happiness that everything else is unimportant.
Undoubtedly, such behavior leads to the degradation of the individual. The patient needs inpatient treatment that limits his movements and activities.
The depressive phase carries the threat of suicide, especially in adolescence. The danger is that not only the mood decreases, but the way of thinking changes - a person believes that life has reached a dead end, from which there is no way out. From depression, who do not have life experience and are not able to withstand the blows of fate. No country or city, even Moscow, can finally cope with teenage suicides.The depressive phase can also be crowned with delirium, but its content is different: the patient may be convinced that not only is his life wasted, but his body is being destroyed - eaten by worms, burned from the inside or turned into jelly.
Depressive disorders are extremely dangerous if a person has never been treated. There are cases of extended suicide, when a parent, wanting to save his child from the inevitable end of the world, passes away with him.
In less severe cases, a person loses interest in life so much that they refuse food because of a change in its taste (“like grass”), stop taking care of themselves, do not change clothes and do not wash. In women in the depressive phase, menstruation often stops.
Diagnostics
The nosological affiliation becomes clear far from immediately. The manic phase, especially if it proceeds in the form of hypomania, is often not perceived as a disease state by either the patient himself or his relatives. A short phase, if it was interrupted before the patient had time to commit reckless acts, is perceived as an episode of a bright life.
For the diagnosis of manic-depressive psychosis, the following methods are used:
Treatment of manic-depressive psychosis
How is manic-depressive psychosis treated? Requires real art and extensive experience. A restrictive regime is used, sometimes strict supervision, medications, psychotherapy.
On an outpatient basis, only cyclothymia or an erased version of bipolar disorder can be treated, in which a person's social adaptation is not disturbed. All other forms of manic-depressive disorder will be treated in a hospital in a closed psychiatric ward. Hospitalization is carried out in accordance with applicable law, the patient gives informed consent to treatment.
If the patient's condition does not allow assessing everything that is happening around, the medical commission makes a decision on involuntary hospitalization at the request of the next of kin. Staying in a closed unit is the main condition for achieving remission, when the patient is safe and regularly taking medication.
The most effective treatment is the first episode. With all subsequent exacerbations, susceptibility to medications decreases, and the quality of intermission worsens.
Medical treatment
In the treatment of manic-depressive psychosis, drugs of the following groups are used:
This is a typical set of drugs that expands according to individual indications. The goal of treatment is to interrupt the current phase and resist its inversion, that is, a change to the opposite one. For this, high doses of drugs are used, combining them depending on the patient's condition. How to treat manic-depressive psychosis, the attending physician decides.
No folk remedies stop or change the course of the disease. It is allowed to use calming and restorative preparations during periods of calm.
Psychotherapeutic methods of treatment
The possibilities of this method are limited, they are used only in intermission. From exacerbation to exacerbation, the patient's personality disorders worsen, and this narrows the range of possibilities for the doctor. A chronic disorder requires a change in approach throughout the course of treatment.
The following methods are effective:
An important part of the work of a psychotherapist is to increase the patient's confidence in the doctor, develop a positive attitude towards treatment, and provide psychological support during long-term medication.
Forecast and prevention
The prognosis after treatment of manic-depressive psychosis depends entirely on the duration of the phases and their severity. Patients who fall ill for the first time with a short stay in the hospital are issued a temporary disability certificate with a rehabilitation diagnosis. Some harmless disease is indicated - a reaction to stress and the like.
If a person is in a hospital for a long time, a disability group is established - the third, second or first. Patients in the third group of disability have limited ability to work - they can do light work or the number of hours they have is reduced, night shift work is prohibited. With the stabilization of the state and the preservation of the intellect, the disability group can be removed.
If a sick person commits a crime, a forensic psychiatric examination is appointed. If the court establishes the fact of insanity at the time of the commission of the crime, compulsory treatment is prescribed. Prevention of the disease is the use of medicines prescribed by the doctor and a calm, measured life.
Manic-depressive psychosis (MDP) refers to severe mental illness that occurs with a succession of two phases of the disease - manic and depressive. Between them there is a period of mental "normality" (light interval).
Table of contents: 1. Causes of manic-depressive psychosis 2. How manic-depressive psychosis manifests itself - Symptoms of the manic phase - Symptoms of the depressive phase 3. Cyclothymia is a mild form of manic-depressive psychosis 4. How MDP proceedsCauses of manic-depressive psychosis
The onset of the development of the disease can be traced most often at the age of 25-30 years. Relative to common mental illnesses, the level of MDP is about 10-15%. There are 0.7 to 0.86 cases of the disease per 1000 population. Among women, pathology occurs 2-3 times more often than in males.
Note: the causes of manic-depressive psychosis are still under study. A clear pattern of transmission of the disease by inheritance was noted.
The period of pronounced clinical manifestations of pathology is preceded by personality traits - cyclothymic accentuations. Suspiciousness, anxiety, stress and a number of diseases (infectious, internal) can serve as a trigger for the development of symptoms and complaints of manic-depressive psychosis.
The mechanism of the development of the disease is explained by the result of neuropsychic breakdowns with the formation of foci in the cerebral cortex, as well as problems in the structures of the thalamic formations of the brain. The dysregulation of norepinephrine-serotonin reactions, caused by a deficiency of these substances, plays a role.
V.P. Protopopov.
How does manic-depressive psychosis manifest?
Depends on the phase of the disease. The disease can manifest itself in a manic and depressive form.
Symptoms of the manic phase
The manic phase can proceed in the classic version and with some features.
In the most typical cases, it is accompanied by the following symptoms:
- inadequately joyful, exalted and improved mood;
- sharply accelerated, unproductive thinking;
- inadequate behavior, activity, mobility, manifestations of motor excitation.
The beginning of this phase in manic-depressive psychosis looks like a normal burst of energy. Patients are active, talk a lot, try to take on many things at the same time. Their mood is upbeat, overly optimistic. Memory sharpens. Patients talk and remember a lot. In all the events that take place, they see an exceptional positive, even where there is none.
Excitation gradually increases. The time allotted for sleep decreases, patients do not feel tired.
Gradually, thinking becomes superficial, people suffering from psychosis cannot focus their attention on the main thing, they are constantly distracted, jumping from topic to topic. In their conversation, unfinished sentences and phrases are noted - "language is ahead of thoughts." Patients have to constantly return to the unsaid topic.
The patients' faces turn pink, facial expressions are overly lively, active hand gestures are observed. There is laughter, increased and inadequate playfulness, those suffering from manic-depressive psychosis talk loudly, scream, breathe noisily.
The activity is unproductive. Patients simultaneously "grab" a large number of cases, but none of them is brought to a natural end, they are constantly distracted. Hypermobility is often combined with singing, dancing, jumping.
In this phase of manic-depressive psychosis, patients seek active communication, intervene in all matters, give advice and teach others, and criticize. They show a pronounced reassessment of their skills, knowledge and capabilities, which are sometimes completely absent. At the same time, self-criticism is sharply reduced.
Increased sexual and food instincts. Patients constantly want to eat, sexual motives clearly appear in their behavior. Against this background, they easily and naturally make a lot of acquaintances. Women are beginning to use a lot of cosmetics to attract attention to themselves.
In some atypical cases, the manic phase of psychosis occurs with:
- unproductive mania- in which there are no active actions and thinking is not accelerated;
- solar mania– behavior is dominated by an overjoyful mood;
- angry mania- anger, irritability, dissatisfaction with others come to the fore;
- manic stupor- manifestation of fun, accelerated thinking is combined with motor passivity.
Symptoms of the depressive phase
In the depressive phase, there are three main signs:
- painfully depressed mood;
- sharply slowed down pace of thinking;
- motor retardation up to complete immobilization.
The initial symptoms of this phase of manic-depressive psychosis are accompanied by sleep disturbance, frequent nocturnal awakenings, and the inability to fall asleep. Appetite gradually decreases, a state of weakness develops, constipation, pain in the chest appear. The mood is constantly depressed, the face of patients is apathetic, sad. The depression is on the rise. Everything present, past and future is presented in black and hopeless colors. Some patients with manic-depressive psychosis have ideas of self-accusation, patients try to hide in inaccessible places, experience painful experiences. The pace of thinking slows down sharply, the range of interests narrows, symptoms of “mental chewing gum” appear, patients repeat the same ideas, in which self-deprecating thoughts stand out. Suffering from manic-depressive psychosis, they begin to remember all their actions and give them ideas of inferiority. Some consider themselves unworthy of food, sleep, respect. It seems to them that doctors are wasting their time on them, unreasonably prescribing them medicines, as unworthy of treatment.
Note: sometimes it is necessary to transfer such patients to forced feeding.
Most patients experience muscle weakness, heaviness throughout the body, they move with great difficulty.
With a more compensated form of manic-depressive psychosis, patients independently look for the dirtiest work. Gradually, the ideas of self-accusation lead some patients to thoughts of suicide, which they can fully translate into reality.
Depression is most pronounced in the morning, before dawn. By evening, the intensity of her symptoms decreases. Patients mostly sit in inconspicuous places, lie on beds, like to go under the bed, because they consider themselves unworthy of being in a normal position. They are reluctant to make contact, they respond monotonously, with a slowdown, without further ado.
On the faces there is an imprint of deep sorrow with a characteristic wrinkle on the forehead. The corners of the mouth are lowered down, the eyes are dull, inactive.
Options for the depressive phase:
- asthenic depression– patients with this type of manic-depressive psychosis are dominated by ideas of their own soullessness in relation to relatives, they consider themselves unworthy parents, husbands, wives, etc.
- anxious depression- proceeds with the manifestation of extreme anxiety, fears, leading patients to suicide. In this state, patients may fall into a stupor.
In almost all patients in the depressive phase, the Protopopov triad occurs - palpitations, constipation, dilated pupils.
Symptoms of disordersmanic-depressive psychosisfrom the internal organs:
- high blood pressure;
- dry skin and mucous membranes;
- lack of appetite;
- in women, disorders of the monthly cycle.
In some cases, TIR is manifested by dominant complaints of persistent pain, discomfort in the body. Patients describe the most versatile complaints from almost all organs and parts of the body.
Note: some patients try to mitigate complaints to resort to alcohol.
The depressive phase can last 5-6 months. Patients are unable to work during this period.
Cyclothymia is a mild form of manic-depressive psychosis.
There are both a separate form of the disease and a lighter version of TIR.
Cyclotomy proceeds with phases:
- hypomania- the presence of an optimistic mood, an energetic state, active activity. Patients can work hard without getting tired, have little rest and sleep, their behavior is quite ordered;
- subdepressions- conditions with a deterioration in mood, a decline in all physical and mental functions, craving for alcohol, which disappears immediately after the end of this phase.
How does TIR work?
There are three forms of the course of the disease:
- circular- periodic alternation of phases of mania and depression with a light interval (intermission);
- alternating- one phase is immediately replaced by another without a light gap;
- unipolar- the same phases of depression or mania go in a row.
Note: usually phases last for 3-5 months, and light intervals can last several months or years.
In children, the onset of the disease may go unnoticed, especially if the manic phase dominates. Juvenile patients look hyperactive, cheerful, playful, which does not immediately allow us to notice unhealthy traits in their behavior against the background of their peers.
In the case of the depressive phase, children are passive and constantly tired, complaining about their health. With these problems, they quickly get to the doctor.
In adolescence, the manic phase is dominated by symptoms of swagger, rudeness in relationships, and there is a disinhibition of instincts.
One of the features of manic-depressive psychosis in childhood and adolescence is the short duration of the phases (average 10-15 days). With age, their duration increases.
Therapeutic measures are built depending on the phase of the disease. Severe clinical symptoms and the presence of complaints require the treatment of manic-depressive psychosis in a hospital. Because, being depressed, patients can harm their health or commit suicide.
The difficulty of psychotherapeutic work lies in the fact that patients in the phase of depression practically do not make contact. An important point of treatment during this period is the correct selection of antidepressants. The group of these drugs is diverse and the doctor prescribes them, guided by his own experience. Usually we are talking about tricyclic antidepressants.
With dominance in the status of lethargy, antidepressants with analeptic properties are selected. Anxious depression requires the use of drugs with a pronounced calming effect.
In the absence of appetite, the treatment of manic-depressive psychosis is supplemented with restorative drugs
In the manic phase, antipsychotics with pronounced sedative properties are prescribed.
In the case of cyclothymia, it is preferable to use milder tranquilizers and antipsychotics in small dosages.
Note: quite recently, lithium salt preparations were prescribed in all phases of MDP treatment, at present this method is not used by all doctors.
After leaving the pathological phases, patients should be included in various activities as early as possible, this is very important for maintaining socialization.
Explanatory work is carried out with relatives of patients about the need to create a normal psychological climate at home; a patient with symptoms of manic-depressive psychosis during light intervals should not feel like an unhealthy person.
It should be noted that, in comparison with other mental illnesses, patients with manic-depressive psychosis retain their intelligence and performance without degradation.
Interesting! From a legal point of view, a crime committed in the TIR aggravation phase is considered not subject to criminal liability, and in the intermission phase - criminally punishable. Naturally, in any state suffering from psychosis are not subject to military service. In severe cases, disability is assigned.
Lotin Alexander, medical columnist
Affective insanity is a mental illness that manifests itself as recurrent mood disorders. The social danger of the diseased is expressed in the tendency to commit an offense in the manic phase and suicidal acts in the depressive phase.
Manic-depressive psychosis is usually noted in the form of alternating manic and depressive mood. The manic mood is expressed in an unmotivated cheerful, and the depressive mood is expressed in an oppressed pessimistic mood.
Manic-depressive psychosis is classified as bipolar affective disorder. A milder form with a lesser severity of the symptoms of the disease is called cyclotomy.
Symptoms of manic-depressive psychosis are more often found among women. The prevalence of the disease on average is as follows: seven patients per 1000 people. Patients with manic-depressive psychosis represent up to 15% of the total number of patients who were hospitalized in psychiatric hospitals. Researchers define manic-depressive psychosis to endogenous psychoses. Burdened heredity can provoke manic-depressive psychosis. Up to a certain point, patients look completely healthy, but after stress, childbirth and a difficult life event, this disease can develop. Therefore, as a preventive measure, it is important to surround such people with a gentle emotional background, to protect them from stress, any stress.
Manic-depressive psychosis affects in most cases well-adapted able-bodied people.
Manic depressive psychosis causes
The disease is autosomal dominant and often passes from mother to child, so manic-depressive psychosis owes its origin to heredity.
The causes of manic-depressive psychosis lie in the failure of higher emotional centers, which are located in the subcortical region. It is believed that disturbances in the processes of inhibition, as well as excitation in the brain, provoke the clinical picture of the disease.
The role of external factors (stress, relationships with others) are considered as concomitant causes of the disease.
Manic depressive psychosis symptoms
The main clinical sign of the disease are manic, depressive, and mixed phases, which change without a definite sequence. A characteristic difference is considered to be light interphase gaps (intermissions), in which there are no signs of the disease and there is a complete critical attitude towards one's diseased state. The patient retains personal properties, professional skills and knowledge. Often, attacks of the disease change with intermediate full health. Such a classic course of the disease is rarely observed, in which only manic or only depressive forms occur.
The manic phase begins with a change in self-perception, the emergence of vivacity, a sense of physical strength, a surge of energy, attractiveness and health. The sick person ceases to feel the unpleasant symptoms associated with somatic diseases that bothered him earlier. The patient's mind is filled with pleasant memories, as well as optimistic plans. Unpleasant events from the past are forced out. The sick person is not able to notice the expected and real difficulties. The surrounding world perceives in rich, bright colors, while his olfactory and taste sensations are exacerbated. Strengthening of mechanical memory is fixed: the sick person remembers forgotten phones, movie titles, addresses, names, remembers current events. The speech of patients is loud, expressive; thinking is distinguished by speed and liveliness, good intelligence, but conclusions and judgments are superficial, very playful.
In a manic state, the sick are restless, mobile, fussy; their facial expressions are lively, the timbre of their voice does not match the situation, and their speech is accelerated. Patients are hyperactive, while sleeping little, not feeling tired and wanting constant activity. They make endless plans, and try to implement them urgently, while not completing them due to constant distractions.
It is common for manic depressive psychosis to overlook real difficulties. A pronounced manic state is characterized by the disinhibition of drives, which manifests itself in sexual arousal, as well as extravagance. Due to the strong distractibility and scattered attention, as well as fussiness, thinking loses focus, and judgments turn into superficial ones, but patients are able to show subtle observation.
The manic phase includes the manic triad: morbidly elevated mood, accelerated thought, and motor arousal. Manic affect acts as a leading sign of a manic state. The patient experiences an elevated mood, feels happiness, feels good and is happy with everything. Pronounced for him is the aggravation of sensations, as well as perception, the weakening of the logical and the strengthening of the mechanical memory. The patient is characterized by ease of conclusions and judgments, superficiality of thinking, overestimation of his own personality, raising his ideas to ideas of greatness, weakening of higher feelings, disinhibition of drives, as well as their instability and ease when switching attention. To a greater extent, the sick suffer from criticism of their own abilities or their success in all areas. The desire of patients to vigorous activity leads to a decrease in productivity. Ill with a desire to take on new cases, while expanding the range of interests, as well as acquaintances. Patients have a weakening of higher feelings - distance, duty, tact, subordination. The sick turn into untied ones, dressing in bright clothes and using flashy makeup. They can often be found in entertainment establishments, they are characterized by promiscuous intimate relationships.
The hypomanic state retains some awareness of the unusualness of everything that happens and leaves the patient with the ability to correct behavior. In the climax period, the sick do not cope with domestic and professional duties, they cannot correct their behavior. Often, patients are hospitalized at the time of transition of the initial stage to the climax. In patients, increased mood is noted in the reading of poetry, in laughter, dancing and singing. The ideational excitement itself is assessed by the ill as an abundance of thoughts. Their thinking is accelerated, one thought interrupts another. Thinking often reflects surrounding events, much less often memories from the past. The ideas of reassessment are manifested in organizational, literary, acting, language, and other abilities. Patients willingly read poetry, offer help in the treatment of other patients, give orders to health workers. At the peak of the culminating stage (at the moment of manic frenzy), the sick do not make contact, are extremely agitated, and also viciously aggressive. At the same time, their speech is confused, semantic parts fall out of it, which makes it similar to schizophrenic fragmentation. Moments of reverse development are accompanied by motor calm and the emergence of criticism. The intervals of calm currents gradually increase and the states of excitation decrease. The exit from the phases in patients can be observed for a long time, while short-term hypomanic episodes are noted. After a decrease in excitement, as well as an equalization of mood, all judgments of the sick person take on a realistic character.
The depressive phase of patients is characterized by unmotivated melancholy, which goes in combination with motor inhibition and slowness of thinking. Low mobility in severe cases can turn into complete stupor. This phenomenon is called depressive stupor. Often, inhibition is expressed not so sharply and has a partial character, while being combined with monotonous actions. Depressed patients often do not believe in their own strength, they are prone to ideas of self-accusation. Those who become ill consider themselves worthless individuals and unable to bring happiness to loved ones. Such ideas are closely related to the danger of committing suicide attempts, and this, in turn, requires special observation from the immediate environment.
A deep depressive state is characterized by a feeling of emptiness in the head, heaviness and stiffness of thoughts. Patients with a significant delay speak, are reluctant to answer elementary questions. At the same time, sleep disturbances and a decrease in appetite are noted. Often the disease occurs at the age of fifteen, but there are cases in a later period (after forty years). The duration of the attacks ranges from a couple of days to several months. Some attacks with severe forms last up to a year. Depressive phases are longer than manic phases, especially in the elderly.
Diagnosis of manic-depressive psychosis
Diagnosis of the disease is usually carried out along with other mental disorders (psychopathy, neurosis, depression, schizophrenia, psychosis).
To exclude the possibility of organic brain damage after injuries, intoxications or infections, the patient is sent for electroencephalography, radiography, MRI of the brain. An error in the diagnosis of manic-depressive psychosis can lead to incorrect treatment and aggravate the form of the disease. Most patients do not receive appropriate treatment, since individual symptoms of manic-depressive psychosis are easily confused with seasonal mood swings.
Manic-depressive psychosis treatment
Treatment of exacerbations of manic-depressive psychosis is carried out in a hospital, where sedative (psycholeptic) and antidepressant (psychoanaleptic) agents with a stimulating effect are prescribed. Doctors prescribe antipsychotic drugs, which are based on Chlorpromazine or Levomepromazine. Their function lies in the relief of excitation, as well as in a pronounced sedative effect.
Haloperedol or Lithium salts act as additional components in the treatment of manic-depressive psychosis. Lithium carbonate is used, which helps in the prevention of depressive states, and also contributes to the treatment of manic states. The intake of these drugs is carried out under the supervision of doctors due to the possible development of neuroleptic syndrome, which is characterized by tremor of the limbs, impaired movement, and general muscle stiffness.
How to treat manic depressive psychosis?
Treatment of manic-depressive psychosis in a protracted form is carried out by electroconvulsive therapy in combination with unloading diets, as well as therapeutic fasting and deprivation (deprivation) of sleep for several days.
Manic-depressive psychosis can be successfully treated with antidepressants. Prevention of psychotic episodes is carried out with the help of mood stabilizers, which act as mood stabilizers. The duration of taking these drugs significantly reduces the manifestations of signs of manic-depressive psychosis and maximally delays the approach of the next phase of the disease.
manic psychosis refers to a disorder of mental activity in which affective disturbances predominate (
sentiments
). It should be noted that manic psychosis is only a variant of affective
psychoses
which may proceed in different ways. So, if a manic psychosis is accompanied by depressive symptoms, then it is called manic-depressive (
this term is the most popular and widespread among the general public
Statistical data To date, there are no accurate statistics on the prevalence of manic psychosis in the population. This is due to the fact that from 6 to 10 percent of patients with this pathology are never hospitalized, and more than 30 percent - only once in a lifetime. Thus, the prevalence of this pathology is very difficult to identify. On average, according to world statistics, from 0.5 to 0.8 percent of people suffer from this disorder. According to a study conducted under the leadership of the World Health Organization in 14 countries of the world, the dynamics of the incidence has recently increased significantly.
Among hospitalized patients with mental illness, the incidence of manic psychosis varies from 3 to 5 percent. The difference in the data explains the disagreement of the authors in diagnostic methods, the difference in understanding the boundaries of this disease, and other factors. An important characteristic of this disease is the likelihood of its development. According to doctors, this figure for each person is from 2 to 4 percent. Statistics show that this pathology occurs in women 3-4 times more often than in men. In most cases, manic psychosis develops between 25 and 44 years of age. This age should not be confused with the onset of the disease, which occurs at an earlier age. Thus, among all registered cases, the proportion of patients at this age is 46.5 percent. Pronounced attacks of the disease often occur after 40 years.
Interesting Facts
Some modern scientists suggest that manic and manic-depressive psychosis are the result of human evolution. Such a manifestation of the disease as a depressive state can serve as a defense mechanism in case of a strong
Biologists believe that the disease could have arisen in the process of human adaptation to the extreme climate of the northern temperate zone. Increased sleep duration, decreased appetite and other symptoms
depression
helped to get through the long winters. The affective state in the summer season increased the energy potential and helped to perform a large number of tasks in a short period of time.
Affective psychoses have been known since the time of Hippocrates. Then the manifestations of the disorder were attributed to separate diseases and were defined as mania and melancholia. As an independent disease, manic psychosis was described in the 19th century by scientists Falre and Bayarzhe.
One of the interesting factors about this disease is the relationship of mental disorders and the patient's creative skills. The first to declare that there is no clear line between genius and insanity was the Italian psychiatrist Cesare Lombroso, who wrote the book “Genius and Insanity” on this topic. Later, the scientist admits that at the time of writing the book he himself was in a state of ecstasy. Another serious study on this topic was the work of the Soviet geneticist Vladimir Pavlovich Efroimson. While studying manic-depressive psychosis, the scientist came to the conclusion that many famous people suffered from this disorder. Efroimson diagnosed the signs of this disease in Kant, Pushkin, Lermontov.
A proven fact in world culture is the presence of manic-depressive psychosis in the artist Vincent van Gogh. The bright and unusual fate of this talented person attracted the attention of the famous German psychiatrist Karl Theodor Jaspers, who wrote the book Strindberg and Van Gogh.
Among the celebrities of our time, Jean-Claude Van Damme, actresses Carrie Fisher and Linda Hamilton suffer from manic-depressive psychosis.
Causes of manic psychosis The causes (etiology) of manic psychosis, like many other psychoses, are currently unknown. There are several compelling theories regarding the origin of this disease.
Hereditary (genetic) theoryThis theory is partly supported by numerous genetic studies. The results of these studies show that in 50 percent of patients with manic psychosis, one of the parents suffers from some kind of affective disorder. If one of the parents suffers from a monopolar form of psychosis (
i.e. either depressive or manic
), then the risk for a child to acquire a manic psychosis is 25 percent. If the family has a bipolar form of the disorder (
that is, a combination of both manic and depressive psychosis
), then the percentage of risk for the child increases two or more times. Studies among twins note that psychosis among twins develops in 20 - 25 percent, among identical twins in 66 - 96 percent.
Proponents of this theory argue in favor of the existence of a gene that is responsible for the development of this disease. So some studies have identified a gene that is localized on the short arm of chromosome 11. These studies were conducted in families with a burdened history of manic psychosis.
Relationship between heredity and environmental factors Some experts attach importance not only to genetic factors, but also to environmental factors. Environmental factors are, first of all, family and social. The authors of the theory note that under the influence of external adverse conditions, decompensation of genetic anomalies occurs. This is confirmed by the fact that the first attack of psychosis falls on that period of a person's life in which some important events take place. It can be family problems (divorce), stress at work or some kind of socio-political crisis.
It is believed that the contribution of genetic prerequisites is about 70 percent, and environmental - 30 percent. The percentage of environmental factors increases in pure manic psychosis without depressive episodes.
The theory of constitutional predisposition
This theory is based on the study of Kretschmer, who found a certain relationship between the personality characteristics of patients with manic psychosis, their physique and temperament. So, he identified three characters (
or temperament
) - schizothymic, ixothymic and cyclothymic. Schizothymics are distinguished by unsociableness, isolation and shyness. According to Kretschmer, these are imperious natures and idealists. Ixotimics are characterized by restraint, calmness and inflexible thinking. Cyclothymic temperament is characterized by increased emotionality, sociability and rapid adaptation to society. They are characterized by rapid mood swings - from joy to sadness, from passivity to activity. This cycloid temperament is predisposed to the development of manic psychosis with depressive episodes, that is, manic-depressive psychosis. Today, this theory finds only partial confirmation, but is not considered as a pattern.
Monoamine theory
This theory has received the greatest distribution and confirmation. She considers a deficiency or excess of certain monoamines in the nervous tissue as the cause of psychosis. Monoamines are called biologically active substances that are involved in the regulation of such processes as memory, attention, emotions, arousal. In manic psychosis, such monoamines as norepinephrine and serotonin are of the greatest importance. They facilitate motor and emotional activity, improve mood, and regulate vascular tone. An excess of these substances provokes the symptoms of manic psychosis, a lack of depressive psychosis. Thus, in manic psychosis, there is an increased sensitivity of the receptors for these monoamines. In manic-depressive disorder, the fluctuation between excess and deficiency.
The principle of increasing or decreasing these substances underlies the action of drugs used in manic psychosis.
Theory of endocrine and water-electrolyte shifts
This theory considers functional disorders of the endocrine glands (
for example, sexual
) as a cause of the depressive symptoms of manic psychosis. The main role in this is given to the violation of steroid metabolism. Meanwhile, the water-electrolyte metabolism takes part in the origin of the manic syndrome. This is confirmed by the fact that the main drug in the treatment of manic psychosis is lithium. Lithium weakens the conduction of a nerve impulse in the brain tissues, regulating the sensitivity of receptors and neurons. This is achieved by blocking the activity of other ions in the nerve cell, such as magnesium.
Theory of disturbed biorhythms
This theory is based on disorders in the regulation of the sleep-wake cycle. So, in patients with manic psychosis, there is a minimal need for sleep. If manic psychosis is accompanied by depressive symptoms, then there are
sleep disorders
as its inverse (
change between day and night sleep
), in the form of difficulty falling asleep, frequent waking up at night, or in the form of a change in sleep phases.
It is noted that in healthy people, disruption of the frequency of sleep associated with work or other factors can cause affective disorders.
Symptoms and signs of manic psychosis
Symptoms of manic psychosis depend on its form. So, there are two main forms of psychosis - unipolar and bipolar. In the first case, in the clinic of psychosis, the main dominant symptom is manic syndrome. In the second case, the manic syndrome alternates with depressive episodes.
Monopolar manic psychosis
This type of psychosis usually begins at the age of 35. The clinic of the disease is very often atypical and inconsistent. Its main manifestation is the phase of a manic attack or mania.
manic attack This state is expressed in increased activity, initiative, interest in everything and in high spirits. At the same time, the patient's thinking accelerates and becomes jumping, fast, but at the same time, due to increased distractibility, unproductive. An increase in basic drives is observed - appetite, libido increase, and the need for sleep decreases. On average, patients sleep 3-4 hours a day. They become overly sociable, trying to help everyone and everything. At the same time, they make casual acquaintances, enter into chaotic sexual relationships. Often patients leave home or bring strangers into the house. The behavior of manic patients is ridiculous and unpredictable, they often begin to abuse alcohol and psychoactive substances. Often they "hit" politics - they chant slogans with heat and hoarseness in their voices. Such states are characterized by an overestimation of their capabilities.
Patients do not realize the absurdity or illegality of their actions. They feel a surge of strength and energy, considering themselves absolutely adequate. This state is accompanied by various overvalued or even crazy ideas. Ideas of greatness, high origin, or ideas of a special purpose are often observed. It should be noted that despite the increased excitement, patients in a state of mania treat others favorably. Only occasionally there are mood swings, which are accompanied by irritability and explosiveness.
Such a fun mania develops very quickly - within 3 to 5 days. Its duration is from 2 to 4 months. The reverse dynamics of this state can be gradual and last from 2 to 3 weeks.
"Mania Without Mania" This condition is observed in 10 percent of cases of unipolar manic psychosis. The leading symptom in this case is motor excitation without an increase in the rate of ideational reactions. This means that there is no increased initiative or drives. Thinking does not accelerate, but, on the contrary, slows down, concentration of attention is maintained (which is not observed with pure mania).
Increased activity in this case is characterized by monotony and lack of a sense of joy. Patients are mobile, easily establish contacts, but their mood differs in fading. Feelings of a surge of strength, energy and euphoria, which are characteristic of classical mania, are not observed.
The duration of this condition can be delayed and reach up to 1 year.
The course of monopolar manic psychosis Unlike bipolar psychosis, with monopolar psychosis, protracted phases of manic states can be observed. So, they can last from 4 months (average duration) to 12 months (protracted course). The frequency of occurrence of such manic states averages one phase in three years. Also, such a psychosis is characterized by a gradual onset and the same end of manic attacks. In the early years, there is a seasonality of the disease - often manic attacks develop in autumn or spring. However, over time, this seasonality is lost.
There is a remission between two manic episodes. During remission, the patient's emotional background is relatively stable. Patients do not show signs of lability or arousal. High professional and educational level is maintained for a long time.
bipolar manic psychosis
During bipolar manic psychosis, there is an alternation of manic and depressive states. The average age of this form of psychosis is up to 30 years. There is a clear relationship with heredity - the risk of developing bipolar disorder in children with a burdened family history is 15 times higher than in children without it.
Onset and course of the disease In 60 to 70 percent of cases, the first attack occurs during a depressive episode. There is a deep depression with pronounced suicidal behavior. After the end of the depressive episode, there is a long light period - remission. It may continue for several years. After remission, there is a relapse, which can be either manic or depressive.
The symptoms of bipolar disorder depend on its form.
Forms of bipolar manic psychosis include:
- bipolar psychosis with a predominance of depressive states;
- bipolar psychosis with a predominance of manic states;
- a distinct bipolar form of psychosis with an equal number of depressive and manic phases.
- circulatory form.
Bipolar psychosis with a predominance of depressive states In the clinical picture of this psychosis, long-term depressive episodes and short-term manic states are observed. The debut of this form, as a rule, is observed in 20-25 years. First depressive episodes are often seasonal. In half of the cases, depression is of an anxious nature, which increases the risk of suicide by several times.
The mood of depressed patients decreases, patients note a "feeling of emptiness." Also no less characteristic is the feeling of "mental pain". There is a slowdown both in the motor sphere and in the ideational one. Thinking becomes viscous, there is difficulty in assimilation of new information and in concentration. Appetite can either increase or decrease. Sleep is unstable and intermittent during the night. Even if the patient managed to fall asleep, then in the morning there is a feeling of weakness. A frequent complaint of the patient is superficial sleep with nightmares. In general, mood swings throughout the day are typical for such a state - an improvement in well-being is observed in the second half of the day.
Very often, patients express ideas of self-blame, blaming themselves for the troubles of relatives and even strangers. Ideas of self-accusation are often intertwined with statements about sinfulness. Patients blame themselves and their fate, overly dramatizing at the same time.
Hypochondriacal disorders are often observed in the structure of a depressive episode. In this case, the patient shows a very pronounced concern about his health. He is constantly looking for diseases in himself, interpreting various symptoms as fatal diseases. Passivity is observed in behavior, in dialogue - claims to others.
Hysteroid reactions and melancholy can also be observed. The duration of such a depressive state is about 3 months, but it can reach 6. The number of depressive states is more than manic. In strength and severity, they also surpass the manic attack. Sometimes depressive episodes can recur one after another. Between them, short-term and erased manias are observed.
Bipolar psychosis with a predominance of manic states In the structure of this psychosis, vivid and intense manic episodes are observed. The development of a manic state is very slow and sometimes delayed (up to 3-4 months). Recovery from this state can last from 3 to 5 weeks. Depressive episodes are less intense and short-lived. Manic attacks in the clinic of this psychosis develop twice as often as depressive ones.
The debut of psychosis falls on the age of 20 and begins with a manic attack. A feature of this form is that very often depression develops after mania. That is, there is a kind of phase doubling, without clear gaps between them. Such dual phases are observed at the onset of the disease. Two or more phases followed by a remission are called a cycle. Thus, the disease consists of cycles and remissions. The cycles themselves consist of several phases. The duration of the phases, as a rule, does not change, but the duration of the entire cycle increases. Therefore, 3 and 4 phases can appear in one cycle.
The subsequent course of psychosis is characterized by the occurrence of both dual phases (
manic-depressive
) and single ones (
purely depressive
). The duration of the manic phase is 4-5 months; depressive - 2 months.
As the disease progresses, the frequency of phases becomes more stable and is one phase in a year and a half. Between cycles, there is a remission, which lasts an average of 2-3 years. However, in some cases it can be more persistent and long-term, reaching a duration of 10-15 years. During the period of remission, the patient retains a certain lability in mood, a change in personality traits, and a decrease in social and labor adaptation.
Distinct bipolar form of psychosis This form is distinguished by a regular and distinct change of depressive and manic phases. The onset of the disease occurs at the age of 30-35 years. Depressive and manic states are characterized by a longer duration than in other forms of psychosis. At the onset of the disease, the duration of the phases is approximately 2 months. However, the phases are gradually increased to 5 or more months. There is a regularity of their appearance - one - two phases per year. The duration of remission is from two to three years.
At the beginning of the disease, seasonality is also observed, that is, the beginning of the phases coincides with the autumn-spring period. But gradually this seasonality is lost.
Most often, the disease begins with a depressive phase.
The stages of the depressive phase are:
- initial stage- there is a slight decrease in mood, a weakening of mental tone;
- stage of growing depression- characterized by the appearance of an alarming component;
- stage of severe depression- all symptoms of depression reach a maximum, suicidal thoughts appear;
- reduction of depressive symptoms Depressive symptoms begin to disappear.
The course of the manic phase The manic phase is characterized by high mood, motor excitation and accelerated ideational processes.
The stages of the manic phase are:
- hypomania- characterized by a sense of spiritual uplift and moderate motor excitement. Appetite moderately increases and sleep duration decreases.
- pronounced mania- ideas of grandeur and pronounced excitement appear - patients constantly joke, laugh and build new perspectives; sleep duration is reduced to 3 hours a day.
- manic frenzy- excitement is erratic, speech becomes incoherent and consists of fragments of phrases.
- motor sedation– elevated mood persists, but motor excitation goes away.
- mania reduction– the mood returns to normal or even slightly decreases.
Circular form of manic psychosis This type of psychosis is also called the continua type. This means that there are practically no remissions between the phases of mania and depression. This is the most malignant form of psychosis.
Diagnosis of manic psychosisDiagnosis of manic psychosis must be carried out in two directions - firstly, to prove the presence of affective disorders, that is, the psychosis itself, and secondly, to determine the type of this psychosis (
monopolar or bipolar
The diagnosis of mania or depression is based on the World Classification of Diseases diagnostic criteria (
) or American Psychiatric Association criteria (
Criteria for a manic and depressive episode according to the ICD
Type of affective disorder Criteria manic episode - increased activity;
- motor restlessness;
- "speech pressure";
- the rapid flow of thoughts or their confusion, the phenomenon of "leaps of ideas";
- reduced need for sleep;
- increased distractibility;
- increased self-esteem and reassessment of one's own capabilities;
- ideas of greatness and special purpose can crystallize into delirium; in severe cases, delusions of persecution and high origin are noted.
depressive episode - decreased self-esteem and self-confidence;
- ideas of self-accusation and self-abasement;
- decreased performance and reduced concentration;
- disturbance of appetite and sleep;
- suicidal thoughts.
After the presence of an affective disorder has been established, the doctor determines the type of manic psychosis.
Criteria for psychosis
The classification of the American Psychiatric Association distinguishes two types of bipolar disorder - the first and second types.
Diagnostic criteria for bipolar disorder according toDSM
Type of psychosis Criteria Bipolar disorder type 1 This psychosis is characterized by well-defined manic phases, in which social inhibition is lost, attention is not retained, and the mood rise is accompanied by energy and hyperactivity. Bipolar II Disorder
(may progress to type 1 disorder)Instead of the classic manic phases, there are hypomanic phases. Hypomania is a mild degree of mania without psychotic symptoms (no delusions or hallucinations that may be present with mania).
Hypomania is characterized by:
- slight mood lift;
- talkativeness and familiarity;
- feeling of well-being and productivity;
- increased energy;
- increased sexual activity and reduced need for sleep.
Hypomania does not lead to disturbances in work or daily life.
Cyclothymia A special variant of the mood disorder is cyclothymia. It is a state of chronic unstable mood with occasional episodes of mild depression and elation. However, this elation or, conversely, lowering of mood does not reach the degree of classical depression and mania. Thus, typical manic psychosis does not develop.
Such instability in mood develops at a young age and becomes chronic. Periodically there are periods of stable mood. These cyclical changes in the patient's activity are accompanied by changes in appetite and sleep.
To identify certain symptoms in patients with manic psychosis, various diagnostic scales are used.
Scales and questionnaires used in the diagnosis of manic psychosis
Mood Disorders Questionnaire
(Mood Disorders Questionnaire)This is a screening scale for bipolar psychosis. Includes questions about states of mania and depression. Young Mania Rating Scale The scale consists of 11 items that are evaluated during the interview. Items include mood, irritability, speech, thought content. Bipolar Spectrum Diagnostic Scale
(Bipolar Spectrum Diagnostic Scale)The scale consists of two parts, each of which includes 19 questions and statements. The patient must answer whether this statement suits him. ScaleBeck
(Beck Depression Inventory)Testing is conducted in the form of a self-survey. The patient himself answers the questions and evaluates the statements on a scale from 0 to 3. After that, the doctor adds up the total amount and determines the presence of a depressive episode. Treatment of manic psychosis How can a person in this condition be helped?
The support of relatives plays an important role in the treatment of patients with psychosis. Depending on the form of the disease, loved ones should take measures to help prevent the disease from aggravating. One of the key factors in care is suicide prevention and assistance in timely access to a doctor.
Help with manic psychosis When caring for a patient with manic psychosis, the environment should monitor and, if possible, limit the activity and intentions of the patient. Relatives should be aware of the likely deviations in behavior in manic psychosis and do everything to reduce the negative consequences. So, if a patient can be expected to spend a lot of money, it is necessary to limit access to material resources. Being in a state of excitement, such a person does not have time or does not want to take medication. Therefore, it is necessary to ensure that the patient takes the medicines prescribed by the doctor. Also, family members should monitor the implementation of all recommendations given by the doctor. Given the increased irritability of the patient, tact and support should be discreet, showing restraint and patience. You can not raise your voice and shout at the patient, as this can increase irritation and provoke aggression on the part of the patient.
If signs of excessive arousal or aggression appear, loved ones of a person with manic psychosis should be ready to ensure that he is quickly hospitalized.
Support for family members with manic-depressive psychosis Patients with manic-depressive psychosis require close attention and support from their close environment. Being in a depressed state, such patients need help, since they cannot cope with the implementation of vital needs on their own.
The help of loved ones with manic-depressive psychosis is as follows:
- organization of daily walks;
- feeding the patient;
- involving patients in homework;
- monitoring the intake of prescribed drugs;
- providing comfortable conditions;
- visits to sanatoriums and resorts (in remission).
Walking in the fresh air has a positive effect on the general condition of the patient, stimulates appetite and helps to distract from experiences. Often patients refuse to walk, so relatives must patiently and persistently force them to go outside. Another important task in caring for a person with this disease is feeding. When preparing food, preference should be given to foods with a high content of vitamins. The patient's menu should include dishes that normalize bowel activity to prevent constipation. A beneficial effect is exerted by physical labor, which must be performed jointly. In this case, you need to ensure that the patient does not overwork. Spa treatment helps to speed up recovery. The choice of site should be made in accordance with the recommendations of the doctor and the preferences of the patient.
In a severe depressive episode, the patient may be in a state of stupor for a long time. At such moments, one should not put pressure on the patient and encourage him to be active, since in this way the situation can be aggravated. A person may have thoughts about his own inferiority and worthlessness. You should also not try to distract or entertain the patient, as this can cause more oppression. The task of the close environment is to ensure complete peace and qualified medical care. Timely hospitalization will help to avoid suicide and other negative consequences of this disease. One of the first symptoms of worsening depression is the patient's lack of interest in the events and actions taking place around him. If this symptom is accompanied by poor sleep and
lack of appetite
It is necessary to consult a doctor immediately.
Suicide Prevention When caring for a patient with any form of psychosis, the close environment should take into account possible suicide attempts. The highest frequency of suicide is observed in the bipolar form of manic psychosis.
To lull the vigilance of relatives, patients often use a variety of methods, which are quite difficult to foresee. Therefore, it is necessary to monitor the behavior of the patient and take measures when identifying signs that indicate that a person has ideas about suicide. Often, people prone to suicidal ideas reflect on their uselessness, their sins or great guilt. The patient's belief that he has an incurable (
in some cases - dangerous for the environment
) disease may also indicate that the patient may attempt suicide. To make loved ones worry should be a sharp calming of the patient after a long period of depression. It may seem to relatives that the patient's condition has improved, when in fact he is preparing for death. Often patients put their affairs in order, write wills, meet people whom they have not seen for a long time.
Steps to help prevent suicide include:
- Risk assessment- if the patient takes real preparatory measures (gives favorite things, gets rid of unnecessary items, is interested in possible methods of suicide), you should consult a doctor.
- Taking all talk of suicide seriously- even if it seems unlikely to relatives that the patient can commit suicide, it is necessary to take into account even indirectly touched topics.
- Restriction of opportunities- you need to keep piercing and cutting objects, medicines, weapons away from the patient. You should also close windows, doors to the balcony, gas supply valve.
The greatest vigilance should be exercised when the patient wakes up, since the vast majority of suicide attempts occur in the morning.
Moral support plays an important role in suicide prevention. Being depressed, people are not inclined to listen to any advice and recommendations. Most often, such patients need to be freed from their own pain, so family members need to be attentive listeners. A person suffering from manic-depressive psychosis needs to talk more himself and relatives should contribute to this.
It is not uncommon for people close to a patient with suicidal thoughts to experience resentment, feelings of powerlessness, or anger. Such thoughts should be fought and, if possible, remain calm and express understanding to the patient. A person should not be judged for suicidal ideas, as such behavior can cause withdrawal or push to commit suicide. You should not argue with the patient, offer unjustified consolations and ask incorrect questions.
Questions and remarks that should be avoided by relatives of patients:
- I hope you don't plan on killing yourself- such a wording contains a hidden answer “no”, which relatives want to hear, and it is likely that the patient will answer in this way. In this case, a direct question “are you contemplating suicide” is appropriate, which will allow the person to speak out.
- What do you lack, because you live better than others- such a question will cause even more depression in the patient.
- Your fears are unfounded- this will humiliate a person and make him feel unnecessary and useless.
Prevention of relapse of psychosis The assistance of relatives in organizing an orderly lifestyle for the patient, a balanced diet, regular medication, and good rest will help reduce the likelihood of relapse. An exacerbation can be provoked by premature cancellation of therapy, a violation of the medication regimen, physical overstrain, climate change, and emotional shock. Signs of an impending relapse are refusal to use medications or visits to the doctor, poor sleep, change in habitual behavior.
Actions to be taken by relatives when the patient's condition worsens include :
- an appeal to the attending physician for correction of treatment;
- elimination of external stressful and irritating factors;
- minimizing changes in the patient's daily routine;
- providing peace of mind.
Medical treatment Adequate medical treatment is the key to a long and stable remission, and also reduces mortality due to suicide.
The choice of medication depends on which symptom prevails in the clinic of psychosis - depression or mania. The main drugs in the treatment of manic psychosis are mood stabilizers. This is a class of drugs whose action is aimed at stabilizing mood. The main representatives of this group of drugs are lithium salts, valproic acid and some atypical antipsychotics. Of the atypical antipsychotics, aripiprazole is currently the drug of choice.
Also in the treatment of depressive episodes in the structure of manic psychosis,
antidepressants
e.g. bupropion
Drugs from the class of mood stabilizers used in the treatment of manic psychosis
Name of medication Mechanism of action How to use lithium carbonate Stabilizes mood, eliminates the symptoms of psychosis, has a moderate sedative effect. Inside in tablet form. The dose is set strictly individually. It is necessary that the selected dose provides a constant concentration of lithium in the blood within 0.6 - 1.2 millimoles per liter. So, with a dose of 1 gram per day, a similar concentration is achieved in two weeks. It is necessary to take the drug even during remission. sodium valproate Smoothes mood swings, prevents the development of mania and depression. It has a pronounced anti-manic effect, is effective in mania, hypomania and cyclothymia. Inside, after eating. The initial dose is 300 mg per day (divided into two doses of 150 mg). Gradually increase the dose to 900 mg (two times 450 mg), and in severe manic states - 1200 mg. Carbamazepine It inhibits the metabolism of dopamine and norepinephrine, thereby providing an anti-manic effect. Eliminates irritability, aggression and anxiety. Inside from 150 to 600 mg per day. The dose is divided into two doses. As a rule, the drug is used in combination therapy with other medicines. Lamotrigine It is mainly used for the maintenance treatment of manic psychosis and the prevention of mania and depression. Initial dose of 25 mg twice a day. Gradually increase to 100 - 200 mg per day. The maximum dose is 400 mg. In the treatment of manic psychosis, various schemes are used. The most popular is monotherapy (
one medication is used
) lithium preparations or sodium valproate. Other experts prefer combination therapy when two or more drugs are used. The most common combinations are lithium (
or sodium valproate
) with an antidepressant, lithium with carbamazepine, sodium valproate with lamotrigine.
The main problem associated with the appointment of mood stabilizers is their toxicity. The most dangerous drug in this regard is lithium. The lithium concentration is difficult to maintain at the same level. A single missed dose of the drug can cause an imbalance in the concentration of lithium. Therefore, it is necessary to constantly monitor the level of lithium in the blood serum so that it does not exceed 1.2 millimoles. Exceeding the permissible concentration leads to the toxic effects of lithium. The main side effects are associated with kidney dysfunction, cardiac arrhythmias, and inhibition of hematopoiesis (
process of blood cell formation
). Other normotimics also need constant
biochemical blood test
Antipsychotics and antidepressants used in the treatment of manic psychosis
Name of medication Mechanism of action How to use Aripiprazole Regulates the concentration of monoamines (serotonin and norepinephrine) in the central nervous system. The drug, having a combined action (both blocking and activating), prevents both the development of mania and depression. The drug is taken orally in the form of tablets once a day. The dose ranges from 10 to 30 mg. Olanzapine Eliminates the symptoms of psychosis - delusions, hallucinations. It dulls emotional arousal, reduces initiative, corrects behavioral disorders. The initial dose is 5 mg per day, after which it is gradually increased to 20 mg. A dose of 20 - 30 mg is the most effective. It is taken once a day, regardless of the meal. Bupropion Violates the reuptake of monoamines, thereby increasing their concentration in the synaptic cleft and in brain tissues. The initial dose is 150 mg per day. If the selected dose is ineffective, it is raised to 300 mg per day. Sertraline
It has an antidepressant effect, eliminating anxiety and anxiety. The initial dose is 25 mg per day. The drug is taken once a day - in the morning or in the evening. The dose is gradually raised to 50-100 mg. The maximum dose is 200 mg per day. Antidepressants are used to treat depressive episodes. It must be remembered that bipolar manic psychosis is accompanied by the greatest risk of suicide, so it is necessary to treat depressive episodes well.
Prevention of manic psychosis What should be done to avoid manic psychosis?
To date, the exact cause of the development of manic psychosis has not been established. Numerous studies suggest that heredity plays an important role in the occurrence of this disease, and most often the disease is transmitted through generations. It should be understood that the presence of manic psychosis in relatives does not cause the disorder itself, but a predisposition to the disease. Under the influence of a number of circumstances, a person develops disorders in the parts of the brain that are responsible for controlling the emotional state.
It is practically impossible to completely avoid psychosis and develop preventive measures.
Much attention is paid to early diagnosis of the disease and timely treatment. It is necessary to know that some forms of manic psychosis are accompanied by remission in 10-15 years. At the same time, there is no regression of professional or intellectual qualities. This means that a person suffering from this pathology can realize himself both professionally and in other aspects of his life.
At the same time, it is necessary to remember the high risk of heredity in manic psychosis. Couples where one of the family members suffers from psychosis should be instructed about the high risk of manic psychosis in future children.
What can trigger manic psychosis?
Various stress factors can provoke the onset of psychosis. Like most psychoses, manic psychosis is a polyetiological disease, which means that many factors are involved in its occurrence. Therefore, it is necessary to take into account a combination of both external and internal factors (
burdened history, character traits
Factors that can trigger manic psychosis are:
- character traits;
- disorders of the endocrine system;
- hormonal surges;
- congenital or acquired diseases of the brain;
- injuries, infections, various bodily diseases;
- stress.
The most susceptible to this personality disorder with frequent mood changes are melancholic, suspicious and insecure people. Such individuals develop a state of chronic anxiety, which exhausts their nervous system and leads to the onset of psychoses. Some researchers of this mental disorder assign a large role to such a character trait as an excessive desire to overcome obstacles in the presence of a strong stimulus. The desire to achieve the goal causes the risk of developing psychosis.
Emotional upheavals are more of a provocative than a causal factor. There is ample evidence that interpersonal relationship problems and recent stressful events contribute to the onset and relapse of manic psychosis. According to studies, more than 30 percent of patients with this disease have experience of negative relationships in childhood and early suicide attempts. Attacks of mania are a kind of manifestation of the body's defenses, provoked by stressful situations. Excessive activity of such patients allows them to escape from difficult experiences. Often the cause of the development of manic psychosis is hormonal changes in the body during puberty or
menopause
Postpartum depression can also act as a trigger for this disorder.
Many experts note the connection of psychosis with human biorhythms. So, the development or exacerbation of the disease often occurs in spring or autumn. Almost all doctors note a great connection in the development of manic psychosis with past brain diseases, endocrine system disorders and infectious processes.
Factors that can trigger an exacerbation of manic psychosis are:
- interruption of treatment;
- violation of the daily routine (lack of sleep, busy work schedule);
- conflicts at work, in the family.
Interruption of treatment is the most common cause of a new attack in manic psychosis. This is due to the fact that patients quit treatment at the first sign of improvement. In this case, there is no complete reduction of symptoms, but only their smoothing. Therefore, at the slightest stress, decompensation of the state and the development of a new and more intense manic attack occur. In addition, resistance (addiction) to the selected drug is formed.
With manic psychosis, compliance with the daily routine is no less important. Getting enough sleep is just as important as taking medication. It is known that sleep disturbance in the form of a decrease in the need for it is the first symptom of an exacerbation. But, at the same time, its absence can provoke a new manic or depressive episode. This is confirmed by various studies in the field of sleep, which revealed that in patients with psychosis, the duration of various phases of sleep changes.
- Reasons for the development of TIR
- Symptoms of manic-depressive psychosis
- Treatment of manic-depressive psychosis
What is manic-depressive psychosis?
A manic-depressive psychosis is a complex mental illness that occurs in a two-phase form. One of them - the manic form has an increased-excited disposition of the spirit, the other - the depressive one is determined by the lowered-oppressed mood of the patient. Between them, a time gap is formed when the patient shows completely adequate behavior - mental disorders fade away, and the main personal qualities of the patient's psyche are preserved.
The states of mania and depression were known to doctors back in the days of the Ancient Roman Empire, but the sharp difference between the phases from each other, for a long period, served as a basis to consider them as different diseases. Only at the end of the 19th century, the German psychiatrist E. Kraepelin, as a result of observations of patients suffering from attacks of mania and depression, concluded that there were two phases of one disease, consisting of extremes - vigorous, agitated (manic) and melancholic, depressed (depressive).
Reasons for the development of TIR
This mental illness has hereditary-constitutional origins. It is transmitted genetically, but only to those who have the right qualities of an anatomical and physiological nature, that is, a suitable cyclothymic constitution. To date, a connection has been established between this disease and impaired transmission of nerve impulses in certain parts of the brain, and more specifically in the hypothalamus. Nerve impulses are responsible for the formation of feelings - the main reactions of the mental type. TIR in most cases develops in young people, while among women the percentage of cases is much higher.
Found a mistake in the text? Select it and a few more words, press Ctrl + Enter
Symptoms of manic-depressive psychosis
In most cases, the depressive phase prevails over the manic phase in frequency of manifestation. The state of depression is expressed by the presence of melancholy and a look at the world around only in black. Not a single positive circumstance is capable of influencing the psychological state of the patient. The patient's speech becomes quiet, slow, the mood prevails, in which he plunges into himself, his head constantly bows down. The motor functions of the patient slow down, and the inhibition of movements at times reaches the level of a depressive stupor.
Often, a feeling of longing develops into bodily sensations (pain in the chest region, heaviness in the heart). The emergence of ideas about guilt and sin can lead the patient to suicidal attempts. At the peak of depression, manifested by inhibition, the ability to commit suicide is difficult due to the difficulty of translating thought into actual action. For this phase, the characteristic physical indicators are considered to be an increased heartbeat, dilated pupils and constipation of a spastic type, the presence of which is due to spasms of the muscles of the gastrointestinal tract.
The signs of the manic phase are expressed in complete contrast to the depressive phase. They are composed of three factors that can be called the main ones: the presence of a manic affect (mood is pathologically elevated), excitement in speech and movements, and the acceleration of processes of a mental type (mental arousal). A clear manifestation of the phase is rare, as a rule, it has an erased appearance of the flow. The patient's mood is at the peak of positive, ideas of greatness are born in him, all thoughts are filled with an optimistic mood.
The process of increasing this phase leads to confusion of the patient's thoughts and the appearance of frenzy in movements, sleep lasts a maximum of three hours a day, but this does not become an obstacle to cheerfulness and excitement. MDP can occur against the background of mixed states, where any symptoms inherent in one phase are replaced by symptoms of another. The course of manic-depressive psychosis in a blurred form is observed much more often than the traditional course of the disease.
The appearance of TIR in a milder form is called cyclothymia. With it, the phases proceed in a smoothed version, and the patient can even remain able to work. Hidden forms of depression are noted, the soil for which is a long-term illness or exhaustion. The pitfall of erased forms in their inexpressiveness, when the depressive phase is left without attention, it can lead the patient to a suicide attempt.
Treatment of manic-depressive psychosis
The treatment of this psychosis consists in drug therapy prescribed after examination by a psychiatrist. Depression with inhibition of the psyche and motor functions is treated with stimulants. In a depressive state of melancholy, psychotropic drugs are prescribed. You can stop manic excitability with chlorpromazine, haloperidol, tizercinum, introducing them into the muscle. These drugs reduce arousal, normalize sleep.
A large role in monitoring the patient's condition is assigned to people close to him, who can notice the initial messengers of depression in time and take the necessary measures. Important in the treatment of psychosis is to protect the patient from a variety of stresses that can be the impetus for a relapse of the disease.
Manic-depressive psychosis (MDP) refers to severe mental illness that occurs with a succession of two phases of the disease - manic and depressive. Between them there is a period of mental "normality" (light interval).
Table of contents:Causes of manic-depressive psychosis
The onset of the development of the disease can be traced most often at the age of 25-30 years. Relative to common mental illnesses, the level of MDP is about 10-15%. There are 0.7 to 0.86 cases of the disease per 1000 population. Among women, pathology occurs 2-3 times more often than in males.
Note:the causes of manic-depressive psychosis are still under study. A clear pattern of transmission of the disease by inheritance was noted.
The period of pronounced clinical manifestations of pathology is preceded by personality traits - cyclothymic accentuations. Suspiciousness, anxiety, stress and a number of diseases (infectious, internal) can serve as a trigger for the development of symptoms and complaints of manic-depressive psychosis.
The mechanism of the development of the disease is explained by the result of neuropsychic breakdowns with the formation of foci in the cerebral cortex, as well as problems in the structures of the thalamic formations of the brain. The dysregulation of norepinephrine-serotonin reactions, caused by a deficiency of these substances, plays a role.
V.P. Protopopov.
How does manic-depressive psychosis manifest?
Symptoms of manic-depressive psychosis depend on the phase of the disease. The disease can manifest itself in a manic and depressive form.
The manic phase can proceed in the classic version and with some features.
In the most typical cases, it is accompanied by the following symptoms:
- inadequately joyful, exalted and improved mood;
- sharply accelerated, unproductive thinking;
- inadequate behavior, activity, mobility, manifestations of motor excitation.
The beginning of this phase in manic-depressive psychosis looks like a normal burst of energy. Patients are active, talk a lot, try to take on many things at the same time. Their mood is upbeat, overly optimistic. Memory sharpens. Patients talk and remember a lot. In all the events that take place, they see an exceptional positive, even where there is none.Excitation gradually increases. The time allotted for sleep decreases, patients do not feel tired.
Gradually, thinking becomes superficial, people suffering from psychosis cannot focus their attention on the main thing, they are constantly distracted, jumping from topic to topic. In their conversation, unfinished sentences and phrases are noted - "language is ahead of thoughts." Patients have to constantly return to the unsaid topic.
The patients' faces turn pink, facial expressions are overly lively, active hand gestures are observed. There is laughter, increased and inadequate playfulness, those suffering from manic-depressive psychosis talk loudly, scream, breathe noisily.
The activity is unproductive. Patients simultaneously "grab" a large number of cases, but none of them is brought to a natural end, they are constantly distracted. Hypermobility is often combined with singing, dancing, jumping.
In this phase of manic-depressive psychosis, patients seek active communication, intervene in all matters, give advice and teach others, and criticize. They show a pronounced reassessment of their skills, knowledge and capabilities, which are sometimes completely absent. At the same time, self-criticism is sharply reduced.
Increased sexual and food instincts. Patients constantly want to eat, sexual motives clearly appear in their behavior. Against this background, they easily and naturally make a lot of acquaintances. Women are beginning to use a lot of cosmetics to attract attention to themselves.
In some atypical cases, the manic phase of psychosis occurs with:
- unproductive mania- in which there are no active actions and thinking is not accelerated;
- solar mania– behavior is dominated by an overjoyful mood;
- angry mania- anger, irritability, dissatisfaction with others come to the fore;
- manic stupor- manifestation of fun, accelerated thinking is combined with motor passivity.
In the depressive phase, there are three main signs:
- painfully depressed mood;
- sharply slowed down pace of thinking;
- motor retardation up to complete immobilization.
The initial symptoms of this phase of manic-depressive psychosis are accompanied by sleep disturbance, frequent nocturnal awakenings, and the inability to fall asleep. Appetite gradually decreases, a state of weakness develops, constipation, pain in the chest appear. The mood is constantly depressed, the face of patients is apathetic, sad. The depression is on the rise. Everything present, past and future is presented in black and hopeless colors. Some patients with manic-depressive psychosis have ideas of self-accusation, patients try to hide in inaccessible places, experience painful experiences. The pace of thinking slows down sharply, the range of interests narrows, symptoms of “mental chewing gum” appear, patients repeat the same ideas, in which self-deprecating thoughts stand out. Suffering from manic-depressive psychosis, they begin to remember all their actions and give them ideas of inferiority. Some consider themselves unworthy of food, sleep, respect. It seems to them that doctors are wasting their time on them, unreasonably prescribing them medicines, as unworthy of treatment.Note:sometimes it is necessary to transfer such patients to forced feeding.
Most patients experience muscle weakness, heaviness throughout the body, they move with great difficulty.
With a more compensated form of manic-depressive psychosis, patients independently look for the dirtiest work. Gradually, the ideas of self-accusation lead some patients to thoughts of suicide, which they can fully translate into reality.
Most pronounced in the morning, before dawn. By evening, the intensity of her symptoms decreases. Patients mostly sit in inconspicuous places, lie on beds, like to go under the bed, because they consider themselves unworthy of being in a normal position. They are reluctant to make contact, they respond monotonously, with a slowdown, without further ado.
On the faces there is an imprint of deep sorrow with a characteristic wrinkle on the forehead. The corners of the mouth are lowered down, the eyes are dull, inactive.
Options for the depressive phase:
- asthenic depression– patients with this type of manic-depressive psychosis are dominated by ideas of their own soullessness in relation to relatives, they consider themselves unworthy parents, husbands, wives, etc.
- anxious depression- proceeds with the manifestation of an extreme degree of anxiety, fears, bringing patients to. In this state, patients may fall into a stupor.
In almost all patients in the depressive phase, the Protopopov triad occurs - palpitations, dilated pupils.
Symptoms of disordersmanic-depressive psychosisfrom the internal organs:
- dry skin and mucous membranes;
- lack of appetite;
- in women, disorders of the monthly cycle.
In some cases, TIR is manifested by dominant complaints of persistent pain, discomfort in the body. Patients describe the most versatile complaints from almost all organs and parts of the body.
Note:some patients try to mitigate complaints to resort to alcohol.
The depressive phase can last 5-6 months. Patients are unable to work during this period.
Cyclothymia is a mild form of manic-depressive psychosis.
There are both a separate form of the disease and a lighter version of TIR.
Cyclotomy proceeds with phases:
How does TIR work?
There are three forms of the course of the disease:
- circular- periodic alternation of phases of mania and depression with a light interval (intermission);
- alternating- one phase is immediately replaced by another without a light gap;
- unipolar- the same phases of depression or mania go in a row.
Note:usually phases last for 3-5 months, and light intervals can last several months or years.
Manic-depressive psychosis in different periods of life
In children, the onset of the disease may go unnoticed, especially if the manic phase dominates. Juvenile patients look hyperactive, cheerful, playful, which does not immediately allow us to notice unhealthy traits in their behavior against the background of their peers.
In the case of the depressive phase, children are passive and constantly tired, complaining about their health. With these problems, they quickly get to the doctor.
In adolescence, the manic phase is dominated by symptoms of swagger, rudeness in relationships, and there is a disinhibition of instincts.
One of the features of manic-depressive psychosis in childhood and adolescence is the short duration of the phases (average 10-15 days). With age, their duration increases.
Treatment of manic-depressive psychosis
Therapeutic measures are built depending on the phase of the disease. Severe clinical symptoms and the presence of complaints require the treatment of manic-depressive psychosis in a hospital. Because, being depressed, patients can harm their health or commit suicide.The difficulty of psychotherapeutic work lies in the fact that patients in the phase of depression practically do not make contact. An important point of treatment during this period is the correct selection antidepressants. The group of these drugs is diverse and the doctor prescribes them, guided by his own experience. Usually we are talking about tricyclic antidepressants.
With dominance in the status of lethargy, antidepressants with analeptic properties are selected. Anxious depression requires the use of drugs with a pronounced calming effect.
In the absence of appetite, the treatment of manic-depressive psychosis is supplemented with restorative drugs
In the manic phase, antipsychotics with pronounced sedative properties are prescribed.
In the case of cyclothymia, it is preferable to use milder tranquilizers and antipsychotics in small dosages.
Note:quite recently, lithium salt preparations were prescribed in all phases of MDP treatment, at present this method is not used by all doctors.
After leaving the pathological phases, patients should be included in various activities as early as possible, this is very important for maintaining socialization.
Explanatory work is carried out with relatives of patients about the need to create a normal psychological climate at home; a patient with symptoms of manic-depressive psychosis during light intervals should not feel like an unhealthy person.
It should be noted that, in comparison with other mental illnesses, patients with manic-depressive psychosis retain their intelligence and performance without degradation.
Interesting! From a legal point of view, a crime committed in the TIR aggravation phase is considered not subject to criminal liability, and in the intermission phase - criminally punishable. Naturally, in any state suffering from psychosis are not subject to military service. In severe cases, disability is assigned.
Depressive syndrome is a mental disorder with active suppression of the mental activity of the cerebral cortex. To diagnose the condition, it is enough to identify a specific triad - lack of joy with impaired thinking, pessimism in relation to ongoing events, inhibition of the motor sphere.
Depressive syndrome - what it is, how it differs from psychosis
Experts attribute depressive syndrome to affective disorders, in which an active psycho-emotional background is suppressed, a person becomes lethargic, apathetic, immobile. Constant anxiety, restlessness and irritability are conditions that haunt a person throughout life.
Various psycho-emotional factors in the disease were described by many ancient healers. Even Hippocrates used the terms "mania" and "melancholia" to describe the depressive syndrome. The definition was applied to people who were constantly in the stage of anxiety, apathy, despondency.
The human psycho-emotional background is quite diverse. Mood changes are specific to a person, so it is difficult to consider a healthy patient who is constantly irritated, anxious, aggressive towards other people.
Other medieval healers used other synonyms to describe depression - blues, depression, melancholy, melancholy and sadness.
Famous poets also described the disease - "sadness-longing eats me", "a drop of hope will flash, and then the sea of despair will rage." Close attention to nosology is explained by the specific behavior of a person. Anxiety, irritability, negative mood - this is the "golden triad" of depressive disorder.
If you tell what a depressive syndrome is, you need to rely not only on the abnormal emotional sphere, anxiety, but also on the features of the work of the cerebral cortex. For the development of pathology, the formation of a stable focus of inhibition of the transmission of a nerve impulse is required.
The psycho-emotional state of a person will never become stable. Too many external events affect the quality of the functioning of the mental sphere. Problems at work, bad relationships in the family, unpleasant stock reports - all these factors are reflected in the work of the cerebral cortex.
Negative external circumstances are capable of influencing the quality of a person’s life - a divorce from her husband, the death of close relatives. It is not easy to cope with the blows of fate, but with the optimal functioning of the cerebral cortex, fear should disappear within 3 days, calmness should form.
With the correct behavior of the cerebral cortex, foci of inhibition are not formed. If anxiety and irritability lasts more than 2 weeks, there is a high probability of developing a depressive syndrome, which will require psychiatric consultation. Depending on the stage of severity, the specialist makes a decision regarding the need for inpatient or outpatient treatment of a person.