INFECTIOUS PSYCHOSES

From Big Medical Encyclopedia

INFECTIOUS PSYCHOSES — group of mental diseases which reason infections are.

Not all psychoses developing at infectious diseases are symptomatic; cases when the infection provokes an endogenous mental disease are frequent (schizophrenia, maniac-depressive psychosis, etc.). Depending on duration and intensity of intoxication operating on an organism And. and. can variously proceed.

Distinguish the acute infectious (symptomatic) psychoses in most cases proceeding with stupefaction and Protragirovanny, or intermediate, infectious (symptomatic) psychoses with dominance of endoformny pictures.

At long and intensive impact of intoxication on a brain the picture can develop pathopsyhosis (see).

A clinical picture

Acute infectious (symptomatic) psychoses proceed about a wedge, pictures devocalizations (see), a delirium (see. Delirious syndrome ), amentias (see. Amental syndrome ), epileptiform vozbuzh a deniya, acute hallucinosis (see. Hallucinations ) and oneiroid (see. Oneiric syndrome ).

Epileptiform excitement — suddenly arising disorder of consciousness with sharp excitement and fear. The patient rushes about, runs from imaginary persecutors, goes on the same words, shouts, on a face — expression of fear, horror. Psychosis comes to an end as well as arises — suddenly. It is replaced by deep, quite often soporous dream; psychosis can sometimes pass into a picture of an amentia that it is necessary to consider predictively an adverse sign. Quite often epileptiform excitement can precede the developed picture of an infectious disease, arising during the initial stage of a disease; the delirium can develop in this period before emergence of epileptiform excitement.

Acute verbal hallucinosis develops suddenly with the advent of verbal hallucinations of various contents. Hallucinations are followed by confusion, fear, alarm. Under the influence of hallucinations, especially imperative contents, these or those dangerous actions concerning surrounding persons or the own personality can be made.

Verbal hallucinosis tends to amplify at night. Duration of the described state — from several days to one month and more.

Full detachment of patients from surrounding, the drama content of the sick quite often fantastic events arising in imagination, active participation in them is characteristic of oneiric states. The motive concern is in most cases shown by confused and fussy excitement. Affect is extremely changeable. Ecstasy, fear, alarm prevails.

In some cases at patients the picture reminding oneiroid — a oneyroidnopodobny state with involuntary imagination, block, aspontannostyo, detachment develops. At the same time patients find the correct orientation in the place and time, surrounding persons, own personality. Such state can be interrupted with external influence: call, touch.

Development of delirious and oneiric (snovidny) states at which into the forefront act snovidny frustration with fantastic, fantastic or ordinary subject is possible, and patients are active participants of events, plentiful colourful, nari about Rami Ches ki e stsenopodobny visual hallucinations when patients feel as the audience or the victims. Patients usually are alarmed, fear, horror.

After infectious diseases with a picture of acute symptomatic psychoses the state emotional giperesteticheskoy weaknesses with the expressed adynamy, extreme lability of affect, intolerance of insignificant emotional pressure, loud sounds, bright light etc. is observed. In some cases such state precedes emergence of acute Nominative, its development in a prodrome of a disease testifies to difficult character of the developing infectious disease.

Protragirovanny infectious (symptomatic) psychoses proceed with a picture of a depression, a depressive and paranoid and hallucinatory paranoid state, with a picture of maniacal frustration, konfabuleza (see), tranzitorny korsakovsky syndrome (see).

Depressions in one cases are followed by ideatorny and motor block and resemble a phase superficially maniac-depressive psychosis (see), differing from it in the constant amplifying by the evening an adynamy. In other cases the picture of a depression is similar to a picture of involutional melancholy: patients are excited, agitated, disturbing, the same words or phrases go on. Difference consists in gradual weakening of excitement, in an adynamy, tearfulness. In evening and night time episodes of a delirium are frequent. Change of the described states by disorders of depressive and paranoid character is a sign of the increasing weight of an infectious disease.

Depressive and paranoid states are characterized by existence of verbal hallucinations, nonsense of condemnation, nigilistic nonsense. At the same time asthenic frustration, tearfulness, delirious episodes are always observed.

Change of a depressive and paranoid state by a state hallucinatory paranoid is possible that it is an indicator of deterioration in a somatic condition of patients.

Hallucinatory paranoid states on a wedge, are close to a picture to acute paranoid to a persecution complex, verbal hallucinations and illusions, false recognitions. Feature of these hallucinatory-dilision states is the adynamy and frequent disappearance of frustration at change of a situation. In hard cases hallucinatory paranoid states are replaced by a picture of an apathetic stupor.

An apathetic stupor — the condition of an obezdvizhennost, an aspontannost accompanied with feeling of apathy, indifference, indifference to the events around and to an own state. The picture of an apathetic stupor needs to be distinguished from a condition of a depression with block.

Maniacal states are shown by unproductive cheerful manias with a divergence, is frequent with development at height of their pseudoparalytic states with euphoria.

Konfabulez — the psychosis which is expressed fictional stories of patients about feats, adventures, improbable events, but not followed by dysmnesias, stupefaction. Patients conduct typically increased mood, however the story about the events which were allegedly taking place quietly, tone of «reporter».

Tranzitorny Korsakovsky a syndrome is shown by the dysmnesias on events of the present (fixating amnesia) which are followed by the phenomena of a disorientation in surrounding (an anamnestic disorientation), at relative safety of memory on events of the past. Its feature is passing character of a dysmnesia, edge then is completely recovered.

All described frustration not only are followed, but also leave behind a long adynamy. In some cases after protragirovanny (infectious) psychoses the organic changes of the personality expressed in a varying degree — psychopatholike changes, sometimes an organic psychosyndrome are observed.

Psychoses at various infectious diseases

At flu acute symptomatic psychoses proceed in the form of a delirium or epileptiform excitement, Protragirovannye — in the form of long depressions with an adynamy and tearfulness. In hard cases psychopatholike states can be observed and development of an organic psychosyndrome is possible. At viral pneumonia Protragirovannye's emergence of psychoses in the form of lingering depressions with agitation, alarm and hallucinatory-dilision psychoses is characteristic.

Quite often mental disorders are observed at a sapropyra. In the acute period of a disease usually there are psychoses proceeding with stupefaction. In cases with a heavy current depressive and paranoid conditions, hallucinatory paranoid frustration, and also pictures of a konfabulez are observed. After a sapropyra with mental disturbances there is always an expressed adynamy, psychopatholike changes of the personality, and in some cases — an organic psychosyndrome can be observed.

Mental disorders at other infectious diseases — see. Rage , Brucellosis , viral hepatitis , Dysentery , Measles , Malaria , Meningitis , Ugly face , Scarlet fever , Toxoplasmosis , Tuberculosis of a respiratory organs , Encephalitis .

The psychoses connected with puerperal septic processes belong to Nominative. They have similar a wedge, a picture with the schizophrenia and maniac-depressive psychosis provoked by childbirth. Amental states with catatonic frustration and maniacal states with confusion are often observed. Existence delirious episodes and development of catatonic frustration at height of an amental state is told about infectious psychosis while development of an amentia after catatonic excitement is more characteristic of schizophrenia.

Cases of the puerperal psychoses which are followed by a hyperazotemia, an albuminuria, increase in the ABP with a lethal outcome are observed.

Developing of psychosis later and more after the delivery at an uncomplicated puerperal period calls into question two weeks the diagnosis of infectious psychosis.

The etiology and a pathogeny

the Same reason can cause acute and Protragirovanny symptomatic psychoses, and in some cases messages to an organic psychosyndrome.

The point of view gained distribution that acute psychoses with stupefaction arise at influence of the intensive, but shortly operating harm while the Protragirovanny psychoses coming on a wedge, to manifestations to endogenous arise at long influence of harm of weaker intensity. The age factor is of great importance: at elderly patients, e.g., with Nominative proceed abortally. A certain value in development of Nominative has also a konstitutsionalnogenetichesky factor.

As a result of evolution of relationship of the activator and a human body and emergence of effective methods of treatment the course of infectious diseases and infectious psychoses changed. It is shown by reduction of number of the acute psychotic states proceeding with stupefaction, and dominance of endoformny psychoses (first of all depressions, depressive and paranoid and hallucinatory paranoid states).

The diagnosis

the Diagnosis is possible if the infectious disease is diagnosed for the patient and also if a wedge, the picture of psychosis is typical for exogenous types of reactions (acute or protragirovanny infectious psychoses). The acute Nominative which is shown in most cases this or that type of stupefaction while subacute and hron, the course of infectious diseases, as a rule, is followed by development of psychoses of protragirovanny character is characteristic of the acute course of an infectious disease.

Differential diagnosis Nominative causes certain difficulties. They should be distinguished from the endogenous psychoses (most often attacks of schizophrenia or phases of maniac-depressive psychosis) provoked by an infection. In these cases the beginning of psychosis can be similar to a picture of acute symptomatic psychosis, however in process of development of an attack of mental disease the endogenous structure of psychosis comes to light more and more clearly. Differentiation of Nominative with febrile attacks of schizophrenia is quite often necessary, which begin in all cases a condition of catatonic excitement or a stupor with oneiric stupefaction that is not typical and is not characteristic of Nominative. At infections development of substruporous and struporous states is also possible, but they arise, as a rule, in late stages of infectious diseases and confirm extreme weight of a somatic condition of patients. Change of catatonic frustration by a picture of the excitement reminding an amentia is also not typical for infectious diseases at which catatonic frustration can develop only at height of an amentia.

Treatment

Patients with acute and protragirovanny infectious psychoses are subject to hospitalization in infectious departments of psychiatric BCs or shall be in hospitals of an infectious profile under observation of the infectiologist and psychiatrist. Behind them it is necessary to provide the round-the-clock supervision. Treatment shall be directed to elimination of the reason which caused a psychotic state i.e. it is necessary to treat a basic disease, and also to carry out active disintoxication therapy (see). Treatment of psychosis is defined psikhopatol. picture of a disease.

The psychoses proceeding with stupefaction, and also a picture of hallucinosis treat aminazine.

Protragirovanny psychoses treat depending on features a wedge, pictures. At hallucinatory paranoid and maniacal conditions, and also pictures of a konfabulez appoint, in addition to aminazine, and other neuroleptics with the expressed sedative action. It is necessary to avoid use of such means as Triphtazinum (Stelazinum), majeptil, a haloperidol, Triperidolum, Tisercinum (Nozinanum) since they cause hyper thermal reaction in patients.

Depressions it is recommended to treat antidepressants like Triptizolum (amitriptyline), in cases of the agitated depression these drugs can be combined with aminazine or Frenolonum.

If serious infectious diseases are followed by falling of the ABP or an abnormal liver function, then appoint small doses of Frenolonum or Seduxenum intramusculary.

The forecast

As a rule, acute Nominative passes completely. After the infectious diseases proceeding with a picture of protragirovanny psychoses changes of the personality on organic type of this or that degree of manifestation can be observed. Quite often same infectious disease can lead to developing of psychoses acute, protragirovanny and lead to organic changes of the personality. The course of psychosis and its outcome depend also on age of the diseased and a condition of reactivity of an organism.

See also Symptomatic psychoses .



Bibliography: Dvorkina N. Ya. Infectious psychoses, M., 1975, bibliogr.; Zhislin S. G. A role of an age and somatogenic factor in emergence and a current of some forms of psychoses, M., 1956, bibliogr.; Polishchuk I. A. Modern problems of toxi-infectious and other somatopsychoses, Doctor, business, No. 9, page 1, 1974; Port N about in And, And., B about and the p e of N to about V. P. and L y with-kov B. D. Katamnez of the patients treated concerning infectious psychoses, Zhurn, a neuropath, and psikhiat., t. 67, No. 5, page 735, 1967; With N of e of N of e in with to and y A. V. O late symptomatic psychoses, Works Ying-that psikhiat, of P. B. Gannushkin, century 5, page 156, M., 1940; F 1 e with k U. Sympto-matische Psychosen, Fortschr. Neurol. Psychiat., Bd 28, S. 1, 1960; Schneider K. Klinische Psychopathologie, Stuttgart, 1962.

A.S. Tiganov.

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