ENDOCRINE MENTAL SYNDROME (Greek endon inside + krino to separate, allocate; Greek psyche of a shower; a syndrome) — the mental disorders which are found at endocrine diseases. Mental disorders arise in the form of a psychopatholike syndrome (see Psychopathies), disturbances of memory and intelligence (see. Psychoorganic syndrome), and also acute and long psychoses (see. Mental diseases) various syndromal structure.
Mental disorders at endocrine disturbances were described by domestic and foreign researchers — E. K. Krasnush-kin (1920, 1948), M. Ya. Sereysky (1925), V. A. Gilyarovsky (1935), E. A. Popov (1949), S. G. Zhisli-ny (1962), A. K. Dobrzhanskoy (1973), K. S. Lebedinskoy (1969), Russy (M. of Russ, 1944, 1945), Hoskinsom (R. G. Hoskins, 1949), Sandsom (D. Sands, 1956), Klegkhorn (R. Cleghorn, 1957), etc. They noted polymorphism of mental disorders as the main feature of endocrine pathology. In this regard it is more correct to speak not about a syndrome, and about the syndromes corresponding to the broad range of frustration — from personal deviations and neurosis-like states to psychoses and organic dementia (see Weak-mindedness).
The term «endocrine mental syndrome» was entered into psychiatric practice by Bleyler (M. of Bleuler) in 1954, meaning psychopatholike frustration or a psychopatholike syndrome, i.e. personal and characterologic deviations of different degree of manifestation, and also nek-ry features of behavior and reactions of patients with endocrine diseases. Bleyler determined the general consistent patterns of development of mental disturbances at endocrine diseases, to-rye come down to a certain change of syndromes during a disease. At early stages and at rather high-quality course of an endocrine disease the psychopatholike syndrome develops, to-ry in process of progressing of a disease gradually is replaced by psychoorganic; against the background of each of them (is more often at sharp weighting of a condition of the patient or emergence of complications) there can be acute and long psychoses.
Functional and structural basis E. the item of page is damage of a brain as encephalopathy, a cut arises in c. N of page under the influence of hormonal shifts, and also exchange vascular and other somatic disorders caused by them.
Clinical picture. The main manifestations of a psychopatholike syndrome, and also change by its psychoorganic syndrome and acute psychoses are inherent to all endocrine diseases. Similar mental disturbances can arise both at hyperfunction, and at hypofunction of separate closed glands. The psychopatholike syndrome is characterized by decrease in mental activity, change of inclinations and instincts, frustration of mood. Decrease in mental activity can be expressed in various degree — from the raised exhaustion and passivity to a full aspontannost with considerable narrowing of a focus of interest and primitivization of contacts with people around when the state comes nearer to apatiko-abu-licheskomu. Unlike apathetic states at schizophrenia at patients with an endocrine mental syndrome even in cases of the expressed decrease in mental activity the proper response to incentives, emotionally significant for them, remains. Changes of inclinations and instincts (e.g., sexual desire, appetite, thirst) are expressed in their decrease or strengthening, patients aim at vagrancy, or, on the contrary, try to remain in a situation, usual for them, their sleep disorder is observed, etc. The quantitative, but not qualitative change of inclinations is more peculiar to patients; perversions (e.g., homosexuality) meet seldom; dissociation of inclinations — increase in one and decrease in others is possible. Change of mood (increase or oppression) is noted. In affective disturbances the mixed states — depressions with a dysphoria, maniacal and depressions with malignancy and feeling of hatred, depressive and apathetic states, asthenic depressions prevail; also situational depressions (e.g., reaction to change of appearance can develop at an adrenogenital syndrome or Itsenko's disease — Cushing). Also conditions of alarm and fear are observed. Idiosyncrasy of affective disturbances is lability of mood. Inherent to affective syndromes (see. Depressive syndromes, Maniacal syndromes) disorders of process of thinking and disturbance of a physical activity (block at a depression and a hyperactivity at a mania) are not characteristic of the psychopatholike syndrome which arose at endocrine diseases. Quite often the dissociated frustration meet (e.g., high spirits a full divergence and motive block). Affective frustration at a psychopatholike syndrome can be long or incidental, reminding affective paroxysms or atypical periodic psychoses.
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Manifestations of a psychopatholike syndrome at individual endocrine diseases are various. So, at patients with an acromegalia (see) decrease in mental activity it is expressed by apathy and an aspontannost, being combined with a complacent and euphoric background of mood, feeling of passive self-satisfaction, frustration of inclinations and behavior. At patients with a pituitary cachexia (see), Shikhen's syndrome (see Shikhen a syndrome), an addisonovy disease (see) the expressed decrease in mental activity is noted. At patients with a hyperthyroidism (see the Thyrotoxicosis) into the forefront act the increased affective excitability, lability of mood and brightness of emotional manifestations. For patients with Itsenko's disease — Cushing (see Itsenko — Cushing a disease) changes of mood are inherent, to-rye are quite often combined with hypochiondrial (see. A hypochiondrial syndrome) and senestopathetic frustration (see Senesthopathias). At an adrenogenital syndrome (see) psychopatholike changes at women can approach the psychopatholike changes observed at schizoid psychopathic personalities (see Psychopathies). At patients with a myxedema (see) manifestations of at the same time psychopatholike and psychoorganic syndromes are noted.
Acute psychoses can arise in any stage of an endocrine disease, often they develop in connection with weighting of a current of a basic disease or increase of exchange, vascular and other disorders, napr, at addisonichesky crises (see Addisonov a disease), hypertensive crises at patients with Itsenko's disease — Cushing. However acute psychoses can arise and for no apparent reason. Usually these psychoses proceed as acute exogenous reaction with syndromes, characteristic of it — a delirious syndrome (see), an amental syndrome (see), twilight stupefaction (see), etc.; also epileptiform attacks can be noted (see. Epileptiform syndrome) or excitement. Sometimes depressive syndromes (see), depressivnoparanoidny syndromes meet (see. The paranoid syndrome), is more rare maniacal syndromes (see). Also shizofrenopodobny states develop, to-rye often gain long character. Acute psychoses at endocrine diseases in some cases arise repeatedly; in this case it is about periodic psychoses (see), to-rye difficult to differentiate with endogenous psychoses — schizophrenia (see) and maniac-depressive psychosis
The diagnosis is established on the basis by a wedge, pictures. Because E. the item of page (especially early manifestations of a psychopatholike syndrome) can arise in the absence of the expressed symptoms of endocrine pathology, the great value is gained by laboratory diagnosis of hormonal disturbances.
The item of page from psychopathies (see) usually does not present to Otgranicheniye E. difficulties in connection with existence of symptoms of an endocrine disease. It must be kept in mind that modern replacement therapy by hormonal drugs and symptomatic means can change a wedge, a picture as endocrine disease (medicinal pathomorphism), and the most typical mental disturbances.
Treatment is directed to the basic endocrine disease and correction of separate mental disorders. Apply psychopharmacological means (see), and also various options of psychotherapy (see). It is necessary to appoint psychopharmacological means in moderate doses, their increase shall be gradual in order to avoid the perverted reaction to them. Extra care should be shown during the use of neuroleptics (see) at a pituitary cachexia, and at purpose of tranquilizers (see) to consider preferential stimulating them, and also myorelaxation action, a cut aggravates astheno - adynamic frustration. Irrespective of the nature of mental disorders at treatment of endocrine diseases the psychotherapy shall be applied. In the presence at sick reactive mental stratifications (e.g., connected with change of appearance at Itsenko's disease — Cushing, an adrenogenital syndrome, dwarfism, etc.) psychotherapeutic tactics of the doctor can prevent development of suicide tendencies. At nek-ry inborn frustration with the phenomena of weak-mindedness except drug treatment apply any rehabilitation and pedagogical influences directed to correction of behavior of patients.
In the organization of treatment of patients with mental disorders of endocrine genesis the large role is played by the psychiatrist-consultant of the corresponding somatic hospital or polyclinic establishment where patients with endocrine frustration are usually observed and treated.
The forecast depends on a basic disease.
Prevention of the mental disorders which are found at endocrine diseases comes down to early identification and treatment of a basic disease and correction of the somatic shifts arising in the course of its current.
Bibliography: And in r at c to and y G. Ya., etc., Biological therapy of mental diseases, L., 1975; D about r and nanosecond to and I am A. K. Mental and neurophysiological disturbances at endocrine diseases, M., 1973; Lebedinskaya K. S. Mental disturbances at children with pathology of rate of puberty, M., 1969; In 1 e u 1 e M. of Endo-krinologische Psychiatrie, Stuttgart, 1954.
D. D. Orlovskaya.