Predtechenskii psychosis

Predtechenskii psychosis (synonym: presenilny psychosis, involutional psychosis) - a group of mental disorders that occur at the age of 45-60 years and are manifested mainly depression, or delusions of prejudice and persecution.
Presenilny depression (involutionary melancholy). The initial period lasts from several weeks to a year. Manifest anxiety, different by intensity motor excitation, hypochondria (see Hypochondriac syndrome), and sleep disorders, loss of appetite, constipation, weight loss and aging. Detailed picture of psychosis is defined by confusion, increased anxiety and agitation, the advent of speech excitation, persistent attempts suicide or samoizucheniya, development of complex forms of depressive Breda, as a rule - Breda Kotar (see Affective syndromes). These violations, once appeared in the subsequent, often for many years, almost not changed in its manifestations and intensity, and the entire picture of the disease characterized by monotony.
In cases where the clinical picture presenilny depression is determined by the long, continuous and intensive speech and motor excitation, with negativity, dream a clouding of consciousness (see) with fantastic views (the death of the world, the flood, the pictures of the funeral), as well as the sharp somatic disorders (diarrhea, urination disorders, perversion of appetite, rapidly growing cachexia)suggest malignant presenilny depression. - diseases Kraepelin. It occurs at the age of 45-50 years and without treatment is almost always ends in death.
Fresh think brad damage manifests itself slowly developing delirium, the content of which is determined primarily by the ideas of robbery and damage to property (poured from the pot soup, took some potatoes, burned an oilcloth, a scratched the door and so on), less ideas poisoning and persecution. Brad applies only to persons living with ill - relatives and neighbors. Patients usually complain of their abusers, orally and in writing to the authorities, is inserted in a new doors locks, protecting food and things. Background mood or somewhat reduced with a touch of anxiety or sick energetic, active, looking at the future with optimism. Predtechenskii psychosis occur chronically.
Treatment Predtechensky psychosis is always in the hospital. Presenilny depression and delusions of damage are treated with a combination of various psychotropic substances; malignant presenilny depression, electroconvulsive therapy.

Predtechenskii psychosis (synonym: presenilny, involutional psychosis) - insufficient outlined a group of mental disorders that occur more often in the age of 45-60 years and proceed with the painting anxiety-ajitirovanne depression with brad (presenilny melancholy), sudden agitation, confused incoherencia (illness Kraepelin), brad prejudice and persecution (presenilny nonsense damage), catatonic disorders (later, the involutionary catatonia).
Many psychiatrists deny nosological independence Predtechensky psychoses and refer them to depressive episodes circular psychosis and schizophrenia, partly to arteriosclerosis and reactive psychosis.
Etiology Predtechensky psychosis is unknown. In the quality of predisposing issues (with particular frequency and persistence when presenilny melancholy) can be marked psychogenic, changes in usual life stereotype, and different, usually mild, somatic diseases.
Women get predtechenskii psychosis significantly more often than men.
Clinical forms presenilny psychosis. Presenilny (involution) melancholy. The initial period usually lasts several months. Occasionally, usually after a hard Psychotrauma he is reduced to 3-4 weeks. In some cases the initial period is delayed to a year or more. At this time, mental disorders are manifested depressed mood, growing alarm about the various life circumstances, actual or anticipated trouble and motor concern. Often marked hypochondriac statements. At the same time, and in some cases before the emergence of the psychic changes in patients with disorders arise night of sleep, loss of appetite, constipation, weight loss, often accompanied by ageing and ageing.
The further complication of the disease depends on the occurrence of a loss, increasing agitation, and development of complex forms of depressive Breda. Patients do not understand what happens to them and around them, cannot be at the place, continually moving, rushing about, trying to escape, cause them injury, make frequent, often extremely persistent attempts to commit suicide. Many patients motor excitation takes on the character of frenzy. Language stimulation appears monotonous Ohanian, moans, screams and shouts. The same word or phrase patients repeated many times in a row. Speech and motor excitation of patients increases with the attempts to speak with them, transferring them from one room to another, medical procedures, and so on, the state of excitation can be interrupted retardation, reaching the intensity of stupor. However, the dominant form of musculoskeletal disorders is excitation (see the Excitement of the mentally ill).
From delusions most common ideas of self-blame, blame, hypochondriac ideas, combined in various proportions. As the complexity of psychosis, delirium more and more beginning to take fantastic character.
Patients blamed himself that in the past and present have committed terrible crimes that exceed the crimes most negative historical figures say about pending their eternal torment, about the death of the States of the Earth, of the Universe. Much less common are the statements that they have been destroyed or missing various internal organs.
Sometimes patients suggests that there is no time, space, the truth, i.e. the denial extends to abstract concepts. The combination of these fantastic statements is called delirium Kotar. When brad Kotar mood of patients, in addition to anxiety, often determined by fear and despair. Almost always it is possible to note verbale illusions and much less often a symptom of a double negative (relatives seem to patients strangers, imitates relatives). All mental disorders are characterized by uniformity and monotonous, especially noticeable after psychosis reached the climax of its development. For presenilny melancholy always protracted. The disease has persisted for years, and without treatment over time in patients developing mental weakness with monotonous, and anxiety affect and reduced in its manifestations delusional and movement disorders.
The disease Kraepelin (malignant presenilny melancholy) - a rare form of mental illness. It occurs mainly at the age of 45-50 years. After a short initial stage, similar in their clinical manifestations with primary mental disorders observed in normal forms presenilny melancholy, in patients appears unusually sharp, is not interrupted even at nights and monotonous uniformity motor excitation. It is usually accompanied by negativity and self-torture, and continued for many days. Patients continuously shouting, utter meaningless and incoherent phrases and separate words. To engage with the patients in the conversation impossible. Separate opinions of patients testify about their dream of aberrations of consciousness with fantastic views of impending disasters, global cataclysms. About the heat of passion can be judged as by statements of the sick and expression, which occurs alternately fear, terror, confusion and bewilderment. Sometimes speech and motor excitation replaced for a short time States adinamii with helplessness, prostration and clearly serving confusion.
Mental disorders are accompanied by insomnia, changes or perversions of appetite (no or voracity). A number of patients experiencing profuse diarrhea or urination disorders. Progressive increases physical exhaustion, quickly reaching extent of severe cachexia. Without treatment, the disease is always ends in death or from the growing of insanity or acceded somatic diseases.
Presenilny nonsense damage (involutionary paranoia, involutional paraphrenia) is hardly noticeable, slowly and gradually developing delirium damage and robbery, jealousy, rarely delusions of persecution and poisoning. Delusions are primarily apply to cohabiting relatives, neighbors in the apartment and the house, and usually do not touch the unfamiliar or unknown sick persons are Characterized by the emergence of new delusions towards others sick persons at changing the situation, for example, after moving to a new place of residence, when placed in the hospital and so on, while delusional ideas towards the people with whom the patient has stopped contacts, start to weaken. Delusions do not tend to progressive systematization or development (modification of content: not appear nonsense physical impacts of grandeur, delusions of mystical character, etc. do Not occur in this disease and expressed sensory disturbances, in particular psychic automatism. Despite a long period of disease occurs and is limited monothematic nonsense. Presenilny nonsense damage is often defined as the usual nonsense relations and small scale. Patients were characterized by delusional activity, manifested in relation to alleged offenders stejnym behaviour and adoption of protection measures. Features of Breda are concreteness with lots of small and initially quite probable everyday details. So patients can say that the neighbors were cast out of their pots bowl of soup, replaced potatoes, intentionally spilled the glass front door and so on, Similar complaints of patients in the state authorities often for a long time is not regarded as a manifestation of mental illness. The same "natural" seem at first taken ill protection measures (change of door locks, change of place of residence, careful monitoring of the cooking and so on).
Usually in patients noted either disturbing or slightly elevated mood traits with optimism and confidence in exposing his detractors. In the latter case, patients are particularly willing to tell strangers about what is happening in their home troubles, looking for sympathy, making them delirium more similar to ordinary worldly squabbles. Despite chronic and long-term course of the disease noticeable characteristic changes do not occur.
Late (involution) catatonia begins anxiety-delusional excitation makers soon clearly catatonic character. In the following occurs long, lasting for years substuporoznyh or stuporous state mutism, negativism, muscle tension, refusal to eat. Often develops or so-called negativities stupor or negativities stupor with perilicom. At the same time may experience delusions of persecution and delusional disorders. Most researchers relates late catatonia to disease associated with organic brain damage.

Treatment. When the involutionary melancholy recommended combined treatment of neuroleptic drugs (chlorpromazine) and antidepressants (melipramine). Therapy should be long-term, for many months. You must assign a high enough dose of drugs (chlorpromazine to 200-450 mg, melipramine up to 150-300 mg / day).
The ratio of drugs and dosages need to vary depending on the condition of the patients. More effectively than chlorpromazine treatment nozinan (tisercinum) in doses of 200 to 400 mg per day. Despite the success pharmacotherapy, the most effective method of treatment of the involutionary melancholy remains electroconvulsive therapy (see) - 10-12 sessions (2 sessions a week).
In malignant involutionary melancholy electroconvulsive therapy is the only means of treatment. Intramuscular administration of chlorpromazine with malignant involutionary melancholy not shown because of the frequent occurrence of tissue necrosis at the injection site.
When presenilny Brede damage (involutionary paranoia) and late catatonia shows long-term (3-6 months and more) treatment of neuroleptic means in high enough doses: chlorpromazine on 300-450 mg / day, stelazin 50-80 mg per day. Given the possibility of neurotic disorders, it is necessary from the very beginning therapy add corrective drugs: Artan, and other Dinesen
In all cases, treatment Predtechensky psychosis should apply symptomatic funds (vitamins, glucose, cardiovascular drugs, physiological solution). The highest value of this therapy has in cases of malignant presenilny melancholy.