MANIAC-DEPRESSIVE PSYCHOSIS

From Big Medical Encyclopedia

MANIAC-DEPRESSIVE PSYCHOSIS [fr. maniacal, from grech, mania madness, a sincere disease, lat. depressio depression; grech, psyche of a shower + - osis; synonym: maniacal and melancholic psychosis, the alternating (intermittent) psychosis, a tsiklofreniya, circular psychosis] — the disease proceeding in the form of the depressive and maniacal phases divided by intermissiya, i.e. states with total disappearance of mental disorders and with safety of premorbidal properties of the personality.

Data on M.'s prevalence - dative are heterogeneous; it is in many respects connected with those diagnostic criteria, to-rymi use for definition of its borders.

M.'s frequency - dative among mental diseases, according to various clinics, fluctuates from 3% to 18%. Depressions meet more often at women whereas manias and bipolar psychoses — at men.

History

Formation of the concept «maniac-depressive psychosis» is connected with names of fr. psychiatrists. A kind of affective psychoses — circular insanity is described by Zh. Falre (1851), insanity in a double form — Bayarzhe (J. G. F. Baillarger, 1854). They combined maniacal and depressions in one wedge, a complex, having determined the general consistent patterns in their development and a current. Further K. Kalbaum (1882) and V. Manyan (1890, 1895) studied pristupoobrazno the proceeding affective psychoses, comparing them to continuous forms of a course of mental diseases. Authors created a wedge, base for further studying of psychoses and classification (1899, 1913) by their E. Krepelin on nozol, to the principle.

Modern idea of M. - dative as independent nozol, a form was created by E. Krepelin at the end of 19 — the beginning of 20 century (it for the first time applied this term) and was opposed allocated to them another nozol, a form — the early weak-mindedness which is characterized by a progreduated current and an outcome in weak-mindedness. However in group M. - it were dative included and some atypical wedge, forms.

At further development of the doctrine about M. - dative the number of the forms relating to it with inclusion atypical increased, decreased and a number of «regional» intermediate psychoses was allocated in the independent disease which is not connected with M. - dative. The origin of atypical forms was tried to be explained or development of psychosis on special, not inherent M. - dative the constitutional background, or mixing of hereditary inclinations of M. - dative and schizophrenia (see).

From the middle of 20 century, on the one hand, there is a certain pathomorphism a wedge, M.'s manifestations - dative, namely, the increasing number of the erased, masked forms of a disease develops, and with another — the number of depressions with somatic frustration in combination with reactive components accrues. Emergence of a large number of affective psychoses of late age considerably increased interest of psychiatrists in a research M. - dative in age aspect.

The clinical picture

In M.'s clinic - dative is noted the general dominance of depressions (to 80%). The age of the beginning of a disease — more often is later 30 years though the first manifestations can arise even at children and teenagers. Display of a disease a single phase meets in 12 — 70%, a disease repeated phases — in 9 — 27% of cases. The average duration of phases 3 — 18 months. The maniacal phase can be shorter depressive by 2 — 3 times. M. is more often - dative begins with a depressive phase (in 60 — 80% of cases). Quite often long before the first expressed phase there are subdepressive frustration (see. Depressive syndromes ) or hypomanias (see. Maniacal syndromes ). Duration of these states is various — from several hours to several months; they arise or is spontaneous, or are connected with some additional factors (a mental injury, an infection, hormonal shifts).

The first expressed phase can develop through a row of years after initial superficial manifestations of M. - dative. It quite often begins with harbingers: at a depression — in the form of disorders of somatovegetativny character (unpleasant feelings in a body, increased fatigue, the general slackness, an indisposition, headaches, frustration of a dream, appetite, uncertain fear); at the beginning of a mania — in the form of frustration of a dream, the general concern, excitement, irritability. Most of authors distinguish three stages in development of a phase: initial symptoms with dominance of superficial affective frustration, the culmination with the largest depth of frustration, a stage of involution. More often phases develop gradually, is more rare — sharply.

The depressive phase at typical manifestation develops of the following main symptoms: 1) the suppressed mood with vital «corporal» feeling of melancholy (depressive affect); 2) motor and speech block; 3) intellectual block (the slowed-down course of mental processes). According to mood and the maintenance of thoughts of the patient has depressive character. Same treats also the supervaluable and crazy ideas: the ideas of fault, sinfulness, self-accusation, the self-abasements which are quite often leading to suicide prevail; the ideas of condemnation, nonsense of hugeness and denial appear in more hard cases (see. Kotara syndrome ).

At depressions character of melancholy vital, «corporal» (the melancholy is perceived physically, as «stone», as weight, as a stethalgia, in heart of a pla other parts of a body). Schneider (To. Schneider) in this regard allocated two types of depressions — a depression with dominance of corporal feelings and a depression of spirit without vital component, edges is shown by the depressive, gloomy maintenance of thoughts. With increase of weight of a depressive phase in typical cases psychomotor block can reach a condition of a depressive stupor (see. Struporous states ) with deep ideatorny braking and lack of daily fluctuations is able.

Despite significant differences in manifestation of the depressive frustration significantly deviating from a typical depressive triad are characteristic of all types of the depression (agitated, adynamic, depressions with depersonalization, navyazchivost, a depressive and paranoid syndrome, etc.) as somatovegetativny frustration (changes from cardiovascular system, a trophicity, exchange processes, frustration of a dream), and decrease in vitality. Protopopov's triad — a mydriasis, tachycardia, a spastic lock is characteristic of a depressive phase (is more rare for maniacal). Separate types of depressions — see. Depressive syndromes .

The maniacal phase on the manifestations in a typical look is opposite to depressive and develops of the following symptoms: 1) the increased mood (maniacal affect); 2) motor and speech excitement; 3) intellectual excitement (the accelerated course of mental processes).

Unlike depressive frustration, the maniacal syndrome develops at the subclinical level more often and rather seldom reaches heavy manifestations.

According to the increased mood and the maintenance of thoughts of patients is full of optimism; revaluation of the personality, the idea of greatness up to the crazy ideas of fantastic contents prevail. With increase of maniacal excitement the thinking loses the orientation up to «a gallop of thoughts» and the incoherence which is combined with motive fury. Separate types of maniacal states — see. Maniacal syndromes .

The mixed states are characterized by substitution of some signs of one affective syndrome signs of another when the depression joins symptoms of a mania, and in a mania — symptoms of a depression. So, e.g., depressions meet ideatorny excitement at which melancholy is combined with a rapid current of the thoughts carrying, however, depressive contents, psychomotor block is superficial or is absent absolutely. The unproductive mania and a mania with psychomotor block belong to the mixed states. The unproductive mania is characterized by the fact that the increased mood and health is not followed by ideatorny and motor excitement; patients at the same time are cheerful, but are not active at all. The mania with psychomotor block can reach degree of a so-called maniacal stupor (see. Catatonic syndrome , Struporous states ); in these cases, despite the increased mood, patients are silent and slowed deeply down. A number of authors carries also alarming agitated depression to the mixed states, at a cut psychosis proceeds against the background of sharp alarm and motive excitement.

In a wedge, practice the mixed states meet most often upon transition of affective psychosis of one pole to another at disease by dual phases or at continuous change of affective states. Much less often the mixed states meet as the isolated psychosis; the last is more peculiar to atypical forms M. - E. Krepelin explains to dative emergence of the mixed states with uneven, nonsynchronous replacement of one signs with others upon transition of a state to a syndrome, opposite on an affective sign, thanks to what signs of a maniacal and depressive phase at the same time coexist. However not all authors recognize allocation of the mixed states which manifestation they consider within atypical affective psychoses.

The current

Approximately at 70% of sick M. - dative flows in the form of superficial affective phases and only at 30% — with development of manifest psychosis.

According to various authors, periodic and single-phase depressions (48 — 80% of patients) — so-called monopolar type of a current are most characteristic of M. - dative, alternation maniacal and depressions (from 18 to 41,5%) — circular (bipolar) type of a current is less often noted; extremely seldom the current meets existence only of maniacal states (from 2 to 9,6%) — monopolar maniacal type of a current. Emergence of phases or strictly regular, quite often dated for certain seasons, or irregular with a tendency to increase of phases at late age. At a bipolar current various combination of affective phases is noted: or in the form of dual phases with the subsequent light interval, or in the form of an alternating current when everyone maniacal and the depression is divided by light intervals, or in the form of a circular continual (continuous) current when maniacal and depressions follow one after another without light intervals. However these types of a current are not strictly invariable.

In the predictive relation bipolar forms of a current are less favorable, than monopolar. At the expressed bipolar forms hereditary Burdeness (to 80% of patients) by preferential affective psychoses, earlier beginning of psychosis, bigger number of phases in comparison with monopolar forms is noted. Often the explicit tendency to complication of structure of phases with their atipization while at typiforms of M. - dative of a phase proceed the same comes to light, without changing for many years (a current in the form of «cliche»). The phenomena of a tsirkulyarnost between phases (disease «at the cyclotymic level»), less favorable outcome of the disease are characteristic of bipolar M. - dative. With age at all types of psychosis the tendency to increase in duration of phases and shortening of light intervals is noted.

Hron, depressions arise in elderly more often, is more rare at mature age. Are characterized long (10 — 15 years and more) the current, however did not exclude a possibility of escaping of these states. Most of authors believes that hron, depressions are uncharacteristic for true, typiforms of M. - dative. More often they develop at so-called regional forms on the geteronomny soil, i.e. in the presence of hereditary schizophrenia. In premorbidal features of these persons rigidity, small sociability, sensitivity, irritability is noted. The clinic hron, depressions is monotonous («the stiffening depressions»). Depression, irritability, gloom, alarm prevail, relevance of experiences is lost. Across Klages (W. Klages), these depressions proceed with falloff of vitality, sub depressive affect, the general astenisation and a paranoidnost. Peters and Gluck (U.H. Peters, A. Gluck, 1973) carry to hron, to depressions the states, resistant to therapy, arising upon transition of depressions to post-depressive changes of the personality with decrease of the activity, power opportunities with existence of feeling of uncertainty, fault, isolation, and connect their emergence with timoleptichesky therapy. Hron, manias meet less often and proceed usually at the subclinical level. They appear either upon termination of a depression, or from the very beginning of a disease,

In typical cases, the disease as if is long proceeded, the identity of the patient does not change, keeping the main lines. In intervals between attacks health and working capacity is almost completely recovered. Decrease in working capacity can occur in case of frequent change of phases, especially at a continuous circular current. At M. - dative of a phase remain throughout life, but in old age their intensity becomes much weaker. At some atypical forms with more difficult the wedge, a picture in some cases after many years of a disease develops «mental aging» in the form of feeling of own inferiority, increased fatigue, loss of initiative, activity, cheerfulness. However the essence of the personality, an emotional resonance, former installations remain, though without a possibility of their implementation. Hron, the affective states arising after a long current of M. - dative, are also considered as an outcome of a disease. Vaytbrekht (N. of I. Weitbrecht, 1967) as residual states slackness, decrease in an affective resonance, the general pessimism, «derevyannost» of affect notes. These changes are considered by a number of authors as manifestation of the prolonged erased affective states.

The erased forms

the Cyclotymia. K. Kalbaum (1889), Yu. V. Kannabikh (1914) and Page A. Sukhanov (1907) consider a cyclotymia as the softened option of a current of M. - dative. Belonging of a cyclotymia to M. - dative is proved not only its wedge, similarity, but also identical with M. - dative hereditary burdeness psychoses and anomalies of the personality, and also similar constitutional premorbidal personal features.

This form of a disease is widespread much more (approximately by 2,5 times) the expressed forms M. - dative. Patients with a cyclotymia not always come into the view of psychiatrists and, therefore, do not receive the corresponding treatment. In this regard danger of suicide tendencies sharply increases. Affective phases at a cyclotymia do not reach psychotic states, and proceed at the subclinical level quite often with preservation of working capacity throughout a disease. Phases remind the initial stages of development of affective frustration at M. - dative. According to statistical data, in cases of cyclotymias monopolar forms in the form of periodic depressions prevail, bipolar circular forms are much more rare.

Latent (larvirovanny) depression (synonym: the masked depression, the missed depression, a latent depression, a depression without depression, the somatized depression, a vegetative depression, depressive equivalents, affective equivalents, etc.) belongs to M. more often - dative, finding close connection with a cyclotymia. The latent depressions are very eurysynusic, however their diagnosis is complicated since at these states somatovegetativny frustration prevail, and slight affective frustration mask their depressive nature. Patients with similar disturbances constantly and unsuccessfully see doctors. In some cases the depressive nature of frustration is distinguished some years later and the corresponding treatment is carried out. Danger of such states because of a possibility of suicide tendencies is even more big, than at a cyclotymia (at 2/3 patients attempts to suicide are noted). The percent of larvirovanny depressions among other types of depressions, according to various authors, makes from 10 to 75%. Increase in number of larvirovanny depressions is connected not only with improvement of their diagnosis, but also with transition of explicit depressive forms in masked under the influence of treatment.

The wedge, a picture of a larvirovanny depression is characterized by abundance of somatic frustration and poverty affective owing to what the disease can take the form of any somatopathy, at Krom there is a need not only conservative treatment, but also an operative measure. Somatic frustration can imitate appendicitis, cholelithic or a nephrolithiasis, cardiovascular and other diseases. Patients can complain of periodic headaches, their damages of skin (psoriasis, neurodermatitis) are noted, uncertain character senesthopathias (see), a number of vegetative frustration, pains in various body parts. There can be nevrol, frustration in the form of radiculitis, neuralgia. At the same time, however, it is important not to miss a true somatopathy, a cut can accompany the latent depression. Somatic frustration are combined with the somatovegetativny phenomena inherent to endogenous depressions (sleep disorders, weight reduction, appetite, locks) which sometimes are followed by vital components of a depression (in the form of feeling of weight, «sincere» pain behind a breast), daily fluctuations of a state. The general depression, depression supplement these states. The nature of affect, according to a number of authors, is various — from alarming and sad to vyaloapatichesky.

All classifications of larvirovanny depressions are constructed proceeding from the nature of somatic frustration.

T. A. Nevzorova and BB. 3. Drobyshev (1962) allocate cardiological and gastrologichesky syndromes, a syndrome of dyskinesia of intestines and a diencephalic syndrome. Lopez Ibor (J. Lopez-Ibor, 1972) allocates depressions with dominance: 1) pains and paresthesias; 2) attacks of dizziness; 3) psychosomatic disturbances; 4) attacks with lack of appetite and t. p,

Belonging of these forms to the latent depressions is confirmed by frequency in emergence of all specified frustration, their reversibility, lack of an organic basis, existence, though the erased, depressive affect with daily fluctuations, positive therapeutic effect from use of antidepressants. A possibility of alternation of the latent depressions with true depressions during a disease, existence of the heredity burdened by affective psychoses once again emphasize their belonging to endogenous forms M. - dative.

Early recognition and treatment improve the forecast of larvirovanny depressions.

Endoreaktivnaya dysthymia it is described originally Vaytbrekhty as independent a wedge, a form of affective psychoses which feature is the combination of somatogenic and psychogenic factors with endogenous affective.

As an etiological factor at an endoreactive dysthymia an essential role is played by a somatogenia in the form of long somatic trouble in combination with the psychogenic moments. In the anamnesis there are no maniacal states, but depressive frustration often meet. The wedge, a picture of depressions is characterized by a gloomy and irritable or tearful and dysphoric background of mood, lack of the ideas of fault and depressive nonsense, abundance of asthenohypochondriac frustration. However the depression has vital components in the form of feeling of weight, «sincere» pain behind a breast; the tendency to a long current within one attack is noted. Hereditary Burdeness of M. - dative weak; in a premorbida sensitive, irritable, gloomy and gloomy persons prevail.

Depressions of exhaustion. Are close to endoreactive dysthymias of a depression of exhaustion of Kilkholts, however they differ in more expressed psychoreactive nature of a disease. In genetic works of J. Angst the doubt concerning independence of a part of so-called situational and neurotic depressions expresses and the tendency of reference them to endogenous affective diseases is noted, i.e. to M.'s kinds - dative

Age features

Due to the general postareniye of the population of a depression of advanced age gain the increasing value. Treat features of depressions of late age absence expressed to ideomotor) braking, alarm, fears, agitation, alarming verbigeration, dominance not of the depressive ideas, but ideas of the relation and a diffusion paranoidnost, tendency to alarming and hypochiondrial fears. At senile age slackness, uncomplaining humility, humility to destiny (designated sometimes as an opaque depression) or discontent, irritability, the increased sensitivity prevail.

According to E. Ya. Shternberg (1970), a wedge, a picture of depressions of late age it is in many respects caused obshchebiol. features of process of aging, changes of a social status of the person in an old age. There is «a snizhennost, degeneration» of depressions of late age, there is no depressive self-assessment and revaluation of the past. Fears for the state of health and fear of possible material disorder prevail. With age often a wedge, and psikhopatol, distinctions between depressions various nozol, forms due to complication of depressions, increase of their atipization smooth out at M. - dative with the advent of the lines similar to depressions at schizophrenia (existence of paranoid frustration, atypia of an affective triad). At M. - dative age features of depressions will be expressed especially, than the first manifest phase developed later. Duration of depressions and depth of frustration increase with age. However at deep senile age duration of depressions in some cases becomes shorter, depth of frustration decreases, the depression loses the sharpness, statements of patients are uniform, affect is maleficiated. The periodic type of a current prevails (at 54,6% of patients). Much less often single depressions occur (at 27,3% of patients), the circular current is even more rare (at 18,1% of patients). Duration of depressions fluctuates from 6 months to 3 years and more.

Maniacal states at late age take rather small place. As age manifestations unproductiveness, monotonous activity are noted dominance of fussiness over true aspiration to activity; the behavior of patients with time carries a foolish shade. Some patients easily have an irritability, irascibility, litigious behavior, the general paranoid mood. Transition in hron, pl Protragirovanny maniacal states is possible. In cases of earlier beginning of a disease age features of manias are less noticeable.

At children's age M.'s emergence - dative is observed very seldom (affective disorders of other genesis meet more often). Phases and all course of psychosis are characterized by a number of features: short phases with bipolar type of a current prevail, hypochiondrial frustration, fear, the phenomena of depersonalization, persistence, massive vegetative disturbances are noted. Nissen (G. Nissen, 1971) among depressive frustration notes existence at children of such symptoms as disturbance of contacts, alarm, block, uncertainty, aggression, sleeplessness, a mutism. Other authors point to feeling of fatigue, decrease in progress, self-accusation, psychosomatic frustration, suicide thoughts. G. K. Ushakov, N. M. Iovchuk note a possibility of change of depressive symptomatology during a disease. Very often depressions at children have the masked character with dominance of somatovegetativny frustration.

In the pubertal period of a depression gain even more typical lines. They meet more often than at children's age, quite often proceed at the subclinical level and are the initial, initial stage of M. - dative with development of a psychotic affective phase at mature age. At teenagers depressions approach on a wedge, a picture depressions at adults, however are characterized by big lability. Sense of guilt with a reflection can be rather brightly expressed. Suicide tendencies and attempts are frequent.

Maniacal phases at children's age are also extremely atypical. The psychomotor initiation and a condition of excitement which is shown in the beginning as if strengthening of game activity whereas at increase of weight of a phase excitement reaches a condition of fury prevail. At teenage age in maniacal states the ideatorny component of a mania in the form of acceleration of thought processes, tendencies to rhyming comes to light already more accurately. In the pubertal period maniacal states or approach cyclotymic frustration, proceeding at the superficial subclinical level, or gain a number of features in connection with counterinhibition of inclinations (e.g., an alcohol abuse, sexual excesses). In some cases the behavior carries lines of silliness. The expressed maniacal states in the pubertal period, especially if psychosis began with them, can raise a number of doubts concerning belonging of this psychosis to M. - Katamnestnchesky researches quite often confirm to dative legitimacy of these doubts. Usually such psychosis appears display of schizophrenia.

The etiology and a pathogeny

M.'s Aetiology - dative is not clear. Most of authors carry it to endogenous diseases. Essential value in M.'s development - dative has a hereditary and constitutional factor. M.'s frequency - dative among families probands (see) in comparison with the general population it is raised. The number of patients in the descending generations in comparison with ascending is increased: if in the general population to sick M.' share - dative falls 0,4%, then parents of a proband have from 7 to 23%, and at children of a proband — to 33%. The twin method visually revealed value of heredity: according to F. J. Kallmann, the burdened heredity among brothers and sisters is revealed at 18% inspected among biovular twins — at 23%, among uniovular — at 92%, i.e. degree of blood proximity matters. In families where M. - dative meets, increase of number of cycloid constitutional and premorbidal persons with tsiklotimopodobny mood swings is noted (in population of their 0,7%, and parents of patients have 14,5%, brothers and sisters have 12,9%, biovular twins have 30%, at uniovular — 37%). In families where there are sick M. - dative, in addition to affective heredity, come to light as well patients with schizophrenia whose number increases in the descending generations. However heredity — only one of the factors creating development of psychosis. The great value is attached to the cyclotymic constitution, the special temperament favoring to a course of a disease. The cyclotymic constitution is characterized by mood swings, activity and somatic functions. E. Krechmer (1921) and E. Bleyler (1925) noted existence of correlation of a disease with a structure of a body and character. So, e.g., the pyknic constitution and open sociable character are inherent in the cycloid constitution. M.'s development - dative from other geteronomny constitutional basis, e.g., schizoid, promotes emergence of «atypical», more severe forms of a current of M. - dative.

In formation of psychosis the age factor, a floor, endocrine influences and so forth have a certain pathogenetic value. It is known that women are ill more often than men (about 70% of women and 30% of men). At women development of psychosis quite often matches periods, childbirth, the period of involution and so forth.

In M.'s development - dative external factors have a certain patoplastichesky or provocative value. The infections, intoxications psychoinjuring situations can cause development of a phase. However it is not possible to establish a reason for development of psychosis more often. In these cases maniacal and depressive phases arise and recur with surprising constancy, quite often repeat as a cliche and are dated for certain seasons.

Attempts of identification pathogenetic and patofiziol, mechanisms M. - dative become for many years. V. P. Osipov believed that disturbance of a tone of sympathoadrenal system is the cornerstone of affective frustration. Administration of adrenaline slows down the course of associative processes at patients with maniacal states, strengthens a depression, reduces maniacal excitement. V. P. Protopopov (1961) connected an origin of the main symptoms with pathology of talamo-hypothalamic area, with disturbance of regulation of the central mechanisms. I. P. Pavlov considered that at M. - dative breaks dynamic relationship of bark and a subcortex owing to a brake condition of the highest parts of the nervous system, and connected a tsirkulyarnost of frustration with weakness of nervous processes both internal inhibition, and excitement.

Researches of century of N of showed that at hypomaniacal patients new conditioned connections arise easily, but elaboration of brake reactions is complicated. At height of excitement there is a guarding braking extending on all to the second alarm system.

The Japanese authors Suva and Yamasita (N. Suwa, J. Yamashita, 1972) paid attention to day-night rhythms funkts, conditions of a bast layer of adrenal glands at depressions and to their communication with rhythms of activity of a hypothalamus and limbic system.

The increasing significance is attached to genetic factors in development of affective psychoses and subjects biochemical, to mechanisms which define a pathogeny of a disease. Work is conducted in three main directions: a research of disturbances of exchange of monoamines, exchange of steroid hormones, studying of shifts in water exchange and exchange of electrolytes. However, by data M. E. Vartanyana , 1970, the last two directions reflect the nonspecific shifts in an organism of patients connected with a stressful situation whereas disturbances of exchange of monoamines are connected with origins of affective frustration. A number of researchers found funkts, insufficiency of noradrenaline of a brain at depressions and the increased its activity at manias. In this regard disturbances of exchange of «central» are of particular importance catecholamines (see).

The diagnosis

the Diagnosis is made on the basis of the repeated affective phases in a wedge, a picture of a disease which are characterized by preferential affective structure, existence of light intervals during which patients are almost healthy lack of degradation of the personality.

The differential diagnosis is carried out between affective attacks periodic schizophrenia (see) and situational depression. Unlike situational depression at M. - dative with the reactive beginning the psychogenic situation finds reflection in experiences of the patient only at the beginning of a phase or is not reflected in the content of experiences at all, and further the disease flows but to patterns, inherent M. - dative.

Affective frustration at toxi-infectious diseases are described, napr, maniacal states at a sapropyra, at intoxication by quinacrine and sp. Unlike M. - dative these frustration are temporary, are closely connected with a basic disease and are only one of its symptoms (see. Intoksikatsionny psychoses ).

At many organic diseases of a brain there can be affective syndromes with a tendency to their repetition (at a general paralysis, encephalitis, epilepsy, a brain injury). Unlike M. - dative at general paralysis (see) a maniacal syndrome proceeds against the background of dementia and other signs inherent to this disease: patients are foolish, unproductive, erotic, a background of mood is raised - complacent. The ideas of greatness of ridiculous contents prevail. Affective frustration are characteristic for epilepsies (see). Unlike M. - dative at epilepsy in depressions prevails a dysphoric shade with malignancy and tension of affect, an explosibility or a state with gloomy gloom, depression; in maniacal states patients are also easily excitable, irritable, irascible.

At other pathopsyhosis, napr, traumatic, unlike M. - dative affective syndromes proceed against the background of psychoorganic syndrome (see). At patients in a condition of a depression many asthenic lines with the general slackness, weakness, emotional lability come to light, in some cases they carry a dysphoric shade.

Treatment

the Wide arsenal psikhofarmakol, means with various action spectrum gives the chance to treat affective frustration of various structure. At depressions with dominance of psychomotor block without the expressed affect of melancholy, and also at adynamic depressions with decrease in strong-willed and mental activity the drugs with the stimulating effect activating the motives reducing block (nuredal) are shown. At depressions with dominance of feeling of melancholy, vital components, with motor and intellectual block drugs with a broad spectrum of activity, timoleptichesky means (Melipraminum) are most effective. At alarming depressions, depressions with irritability, tearfulness and peevishness without the expressed psychomotor block drugs with a sedative timolepticheskim or sedative tranquilizing action (amitriptyline, melleril, chlorprothixene, Tisercinum) are shown. At some types of alarming depressions effectively drop intravenous administration of such drugs as Seduxenum, Theralenum. Alarming patients are not recommended to appoint antidepressants with psychogogic action since they cause not only sharp strengthening of alarm, depressive excitement with suicide tendencies, but also an exacerbation of all psychosis in general with the advent of new symptoms in the form of nonsense, hallucinations.

At difficult depressive syndromes, napr, depressive and paranoid with Kotar's nonsense, the combination of antidepressants to neuroleptics is necessary. Almost everything antidepressants (see) possess side effect. As a result of medicinal intoxication transition from a depression to a maniacal condition or development of delirious or amentivnopodobny disorder of consciousness is possible. At increase in intraocular pressure purpose of amitriptyline is contraindicated. Despite broad use of psychotropic drugs, electroconvulsive therapy still matters, especially at long long forms of depressions, resistant to medicinal influences. At treatment of maniacal states broad application is found by neuroleptics (aminazine, Stelazinum, a haloperidol, mazhentit), and also high doses of salts of lithium (up to 1 g and above) under control of a somatic condition of the patient and level of salts of lithium in blood serum.

Preventive therapy by salts of lithium finds more and more broad application as in a wedge., and in out-patient conditions. Salts of lithium have ability not only to influence affective frustration during a phase, but also to prevent or remove emergence of a new attack on time and to remove its intensity.

The forecast

the Forecast concerning life favorable. However, considering existence of suicide tendencies, it is necessary to watch closely very much a condition of patients, especially during superficial depressive attacks when patients are treated on an outpatient basis. Each attack terminates practically in recovery of the patient, working capacity upon termination of an attack does not suffer.

Patients easily socially adapt. In cases of a continual current, at continuous change maniacal and depressions, patients are forced to leave work.



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B. M. Shamanina.

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