INTOKSIKATSIONNY PSYCHOSES (Latin in in, inside + grech, toxikon poison; grech, psyche of a shower + - osis) — the group of diseases including the mental disorders, various on depth and weight, caused by the poisons which came to an organism.
Distinguish the following toxicants causing Nominative: applied in the industry and agriculture (lead, insecticides and pesticides); applied in life (lighting gas); toxic agents; contained in food (mushrooms, an ergot); defiant drug and toxicomanias; various pharmaceuticals; psychotomimetics. Such group is insufficiently exact. So, insecticides can be applied both in agriculture, and in life, the long use of medicine (stimulators of c. the N of page, analgetics, somnolent) can lead to toxicomania etc. However more accurate classification based on chemical structure and mechanisms of effect of toxicants is not developed. There are no authentic data on the frequency of Nominative.
The clinical picture
Variety of toxicants and mechanisms of their action causes also variety a wedge. pictures of Nominative — practically at them meet everything psikhopatol, symptoms and syndromes. Emergence of new, earlier not known poisons (organophosphorous connections, new pharmaceuticals, psikhotomimet ki) did not lead to emergence of new symptoms and syndromes. Thus, the concept E did not come true. Krepelina (1912) according to whom each poison causes mental disturbances, specific to it. It is established that the same poison can cause various frustration of mentality. So, poisoning with tricyclic antidepressants can cause a coma, epileptiform convulsive attacks, maniacal states, a delirium, twilight states; poisoning with Teturamum — an adynamy, delirious, delirious and oneiric, twilight states, depressive, maniacal, catatonic, paranoid and hallucinatory paranoid, pseudoparalytic syndromes, convulsive attacks. Poisoning is perfect different substances can lead to similar mental disturbances; so, delirious states are described after a poisoning with carbon monoxide, lead, ether, barbiturates, anticholinergic drugs etc. Attempts to allocate the shades specific to effect of this or that substance in structure of similar syndromes were not generally recognized. However also the statement is illegal that in a wedge, the picture of Nominative is present nothing characteristic and that any substance with identical probability can lead to development of any syndrome. It is schematically possible to allocate three main forms of Nominative.
Sharply proceeding forms — «quantitative» disturbances of consciousness (a coma, a sopor, devocalization) — arise at short-term influence of massive doses or sharp increase in doses is long active ingredient more often, is more rare at hron, intoxications the same dose. Against the background of the broken consciousness usually chaotic, not purposeful motive excitement, sketchy hallucinations can be observed.
Forms with preferential long current — mental disturbances characteristic of effect of a certain substance or group of substances. Their emergence is more often connected with influence (short-term or long) moderate doses of poison. In this group of Nominative are observed various psikhopatol. syndromes: syndromes of the dulled consciousness, most often as a delirium (at intoxication atropine, bromine, drugs of a digitalis), are more rare oneiric, twilight, amental states, convulsive attacks (at intoxication lead, penicillin), maniacal (at intoxication tricyclic antidepressants, quinacrine), depressive syndromes (at intoxication Reserpinum, derivatives of a fenotiazid, dopegity, l-dofoy), syndromes of verbal hallucinosis (at intoxication bromine), paranoid and hallucinatory paranoid (at intoxication cocaine, Phenaminum, Teturamum), catatonic, Hebephrenic syndromes (at intoxication bulbokapniny, carbon monoxide, acetilsalicylic to - that). The picture of Nominative can have considerable looking alike endogenous psychoses — maniac-depressive psychosis (at intoxication quinacrine), schizophrenia (at intoxication Phenaminum, hashish, mercury). Looking alike schizophrenia is not exhausted only by existence of verbal hallucinations and nonsense of the relation, prosecution, physical impact against the background of clear consciousness; can be observed and peculiar, considered characteristic of schizophrenia of disturbance of thinking, the emotional and strong-willed sphere (at intoxication by hashish, ephedrine, Phenaminum). Sometimes bystry change of syndromes, polymorphism psikhopatol, the symptomatology which is not keeping within a framework of a certain syndrome (is noted at intoxication corticosteroids and AKTG). At Nominative also syndromes of organic lesion of a brain — pseudoparalytic (develop at intoxication barbiturates), Korsakovsky (at intoxication alcohol, carbon monoxide), parkinsonicheskiya (at intoxication manganese, neuroleptics) etc.
These syndromes can be passing, napr, disappear the Korsakovsky syndrome caused by a poisoning with carbon monoxide, antipsychotic parkinsonism, the pseudoparalytic syndrome caused by a poisoning with barbiturates. But also the return dynamics is possible: some disturbances of motility caused by neuroleptics are similar with psychogenic in the beginning, i.e. they arise or suggestions, etc. disappear under the influence of nervousness, and but to a measure of continuation of drug intake they lose communication with a psychogenia, become constants and further at a part of patients irreversible. Thus, development of syndromes of organic lesion of a brain in itself does not allow to draw a conclusion about the organic nature of defeat of c. N of page. Features of the identity of the patient in this group of frustration play a supporting role, being reflected hl. obr. on specific contents painful (hallucinatory and crazy) experiences, but influencing structure of a syndrome a little.
Rather easily proceeding forms — boundary mental disorders. Usually they develop at action, is more often long, small doses of toxicant, but can appear also after disappearance of heavier mental disturbances caused by action of high doses of toxicant. The concept «small doses» is relative since it is about the doses causing toxic effect and therefore, excessive. To constants in these cases the asthenic syndrome is, against the background of to-rogo also psychopatholike changes, reaction of the personality to a disease can develop various nevrozo-. Features of the identity of the patient in this group of frustration play more essential role; features of a toxic factor exert impact on a wedge, a picture only in certain cases (e.g., uncontrollable laughter and crying, impulsive affective reactions at poisoning with manganese).
A. V. Snezhnevsky (1940) noted that specificity of symptomatic psychoses, including Nominative, is defined not by features of this or that psikhopatol, a syndrome, and patterns of change of these syndromes. This situation gained further development in the doctrine about transitional syndromes of Vick (see. Symptomatic psychoses ). These syndromes can be result of partial recovery of functions of c. N of page, at Krom come to light the disturbances of mentality before disguised by its more rough frustration. So, after disappearance at the patient of symptoms of coma disturbances of yet not recovered functions of memory, napr, in the form of a korsakovsky syndrome can come to light. Smoothing of disturbances of memory can lead to identification of an asthenic syndrome which was available for the patient and before, but was blocked by rough mnestichesky frustration. Such dynamics is described by Vick (H. H. Wieck, 1956), e.g., at a poisoning with barbiturates. Search of specific patterns of change of syndromes is perspective, but for many Nominative such consistent pattern is not determined.
Current of Nominative variously. Mental disturbances can develop as directly after single effect of poison, and at hron, its influence — in months and years from the beginning of intoxication. Acute poisonings usually lead to psychoses, is preferential in the form of various syndromes of the dulled consciousness and convulsive attacks which if there does not come the lethal outcome, completely disappear or smooth out within a short period of time. At obsolescence of frustration of mentality transitional syndromes when heavier and deep frustration are replaced easier are observed (from a coma to boundary mental disorders). Long effect of poisons can conduct to long and hron. Nominative at which change of syndromes can be also observed, but in the return sequence — from easy frustration of mentality to more difficult psikhopatol. to syndromes, and then and to stupefaction up to a coma. Cancellation of toxicants and in this case usually conducts to a full or partial reduction of symptomatology, edges can be as bystry (the majority of fenaminovy psychoses), and stretching for long terms (poisoning with mercury, lead). Reduction of symptomatology as at hron., and at acute Nominative it is shown by mitigation of expressiveness of disturbances within one syndrome and change of syndromes — from deeper to easier disturbances. Emergence of Nominative in response to cancellation of poison (abstinent deliriums or convulsive attacks) is possible at toxicomanias (see. Drug addiction ).
If poison is terminated during the first hours or days later began Nominative, psychosis stops quickly. If, despite emergence of symptoms And. and., action of a toxic factor continues, Nominative and after the termination of this action remains the longer, than the period of a combination of effect of poison to Nominative is longer. The progreduated current is connected with the continuing action. poison, but in rare instances (poisoning with manganese, carbon monoxide gas) it is observed also after bystry cancellation of poison. Psychoses (are rare and hron, at intoxication Phenaminum, alcohol). Communication of such psychoses with effect of poison is not always clear. A recurrence of Nominative, as a rule, arises only in connection with repeated influence of a toxic factor. At a number of patients after the termination of psychosis a nek-swarm time remains hypersensitivity to the substance which caused it. In these cases the recurrence can come at repeated action of a small dose of this substance (e.g., after the termination of an atropinic delirium introduction of a therapeutic dose of atropine can cause a repeated delirium). Usually come to an end with nominative with an absolute recovery, but also partial improvement with formation of residual frustration (weak-mindedness, parkinsonism, a psikhopatization of the personality etc.) is possible.
An etiology and a pathogeny
the Aetiology of Nominative can be considered known as connection of mental disturbances with effect of toxicant is established. Distinction of chemical structure and mechanisms of effect of the substances capable to cause Nominative, complexity of action of a number of such substances causes complexity and heterogeneity of a pathogeny of Nominative. It, however, does not exclude existence of some general links of a pathogeny, napr, the general adaptation syndrome the Selye (see. Adaptation syndrome ), being reaction to any influence, harmful to an organism. Other general mechanism is the mechanism of a protiregulyation — increase in potential activity of systems which activity is suppressed by the toxic agent. This mechanism is the cornerstone of abstinent psychoses and, perhaps, some Nominative arising against the background of long reception of standard dosages of drug. K. Bongeffer (1910) put forward the concept about the general «intermediate link» causing a wedge, similarity of Nominative, caused by different substances, but more precisely to speak about the cumulative final effect of effect of various toxicants. So, the hypoxia of a brain playing, apparently, an important role in genesis of Nominative can be a consequence of insufficient inflow of blood to a brain, its insufficient oxygenation, disturbance of utilization of oxygen nervous cells; at the same time each of disturbances can be caused by different mechanisms. Though the final effect of these diverse disturbances can be similar (e.g., a hypoxia), means of its elimination shall be various.
Nominative — result of interaction of an exogenous factor with an organism. An important role is played by a dose of toxicant, duration and rate of its receipt, feature of his metabolism. Massive doses, especially at bystry rate of their action, are toxic practically for any healthy person (an exception — accustoming to drug and toxicomaniac means) and lead to the general disorganization of activity of c. N of page, expressed in not specific reactions (a coma, devocalization). At action of smaller, but toxic doses selectivity of effect of various substances on these or those systems is shown and the role of features of an organism increases. These features (age, sex, food, existence of somatopathies, constitutional features) change reaction to effect of poison. A part of Nominative — manifestation allergies (see).
the Diagnosis is made on the basis of the data of the anamnesis testimonial of influence of a certain poison (or poisons) on an organism, the laboratory researches finding availability of toxicants (mercury, Phenaminum, neuroleptics and so forth) or their metabolites in biol, liquids, parallelism (often incomplete) between continuation and cancellation of a toxic factor and dynamics of mental disturbances. If the group of toxicants causes characteristic (preferable) syndromes, then their features can help the diagnosis. Treat preferable syndromes: a delirium — at action of anticholinergics, hallucinatory paranoid syndromes — at action of stimulators of c. N of page, a depression — at reception of neuroleptics, a mania — at use of antidepressants and quinacrine, an anamnestic syndrome — at poisoning with carbon monoxide etc. The nature of somatic disturbances — various changes of skin and mucous membranes (skin rashes can give essential help at a bromism, brown pigmentation at poisoning with fluorine), internals (at a drunkenness), changes of century of N of page (at poisoning with various drugs) and c. N of page (defeat basal gangliyev at poisoning with manganese and carbon monoxide).
The differential diagnosis
Otgranicheny Nominative from other symptomatic psychoses (e.g., medicinal psychosis from somatogenic or infectious) can be difficult because of similarity of symptomatology and a current. The main criterion in this case is establishment of dependence between influence of a toxic factor and emergence or a reduction of psychosis, sometimes — existence of characteristic somatic symptoms. Otgranicheny Nominative from endogenous psychoses and organic lesions of c. the N of page is based on data of the anamnesis, communication of dynamics of mental disorders with the beginning, continuation or cancellation of toxicant.
Actions disintoxication therapy (see) are shown if the weight of evidence suggests that toxic agent still is available in an organism (during the first hours at acute poisoning, at chronic — in later terms). If the mechanism of effect of toxicant is known, means, the corrective broken functions of bodies and systems (atropine — are shown at poisoning with organophosphorous connections, antikholinesterazny drugs — at poisoning with atropine, sodium — at poisonings with salts of lithium etc.). If function of these or those systems is broken is irreversible, but the mechanism of this disturbance is known, therapy also shall be directed to correction of this disturbance (l-dofa at the syndrome of parkinsonism caused by poisoning with manganese). In other cases fortifying therapy, first of all vitamin therapy, and symptomatic means are applied: sedative — at excitement, analeptics, lobeline, Bemegridum, etc. — at comas, anticonvulsant — at convulsive attacks, cardiovascular — at disturbances of blood circulation etc. If on a minovaniya of Nominative residual mental disorders are observed, hold rehabilitation events, various depending on character and expressiveness of these frustration.
the Forecast is various: at an acute serious poisoning there can be death, in other cases perhaps absolute or incomplete recovery, seldom progreduated current.
Prevention is various depending on to what group the toxicant which caused psychosis concerns (industrial poisons, drugs etc.).
Bibliography: Avrutsky G. Ya., Gurovich I. Ya. and Gromova of V. V. Pharmakoterapiya of mental diseases, M., 1974; Goldenberg M. A. Mental disorders at acute infections and intoxications, Kharkiv, 1941; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 26, page 237, M., 1949; P and in to and I. G N. Mental disorders at poisoning with tetraethyllead (thermal power plant), in book: Psychological disturbances at poisoning with tetraethyllead (thermal power plant), under the editorship of F. X. Cech-latogo and S. M. Genkina, page 5, M., 1948; Stolyarov G. V. Medicinal psychoses and psychotomimetic means, M., 1964; Emotions, ed. by L. Levi, p. 677, N. Y., 1975; G of n v i 1 1 e-G r o s s-m a n K. Recent advances in clinical psychiatry, L., 1971; Psychiatric complications of medical drugs, ed. by R. I. Shder, N. Y., 1972.