PERIODIC PSYCHOSES (grech, periodikos which is regularly alternating, periodic; psychoses) — nosologically diverse group of mental diseases which general symptoms is tendency to periodic emergence of psychotic attacks with dominance of affective frustration and psychomotor excitement, lack of a tendency to a progreduated current and development of the expressed defect of the personality. The Kliniko-nozologichesky provision of Pct is uncertain.
Studying of Pct began at the end of 19 century. Carried periodic forms of a mania, melancholy, an amentia, paranoia, crazy confusion to this group of psychoses. After allocation by E. Krepelin in 1899. maniac-depressive psychosis (see) the problem of Pct for a long time lost the value. Allocation of rather independent group of Pct is connected with the description of degenerative psychoses Schröder (P. Schroder, 1920) and with developed in 40 — the 50th there are 20 century Kleyst's concept (To. Kleist) and Leon-garda (To. Leonhard) about existence of special group of the endogenous psychoses (so-called regional psychoses, cycloid psychoses, the third endogenous disease) combining symptoms of maniac-depressive psychosis and schizophrenia. In an amer. psychiatry for designation of this group the term «schizoaffective psychoses» which entered the International statistical classification of diseases of the 8th and 9th reviews is used. Since the end of 19 century a number of researchers describe the Pct of an ek-zogenno-organic origin connected preferential with effects of brain injuries and infections. The terms «dienets-falopatichesky psychoses with a periodic current», «periodic psychoses after the postponed injuries and infections of a brain», «teenage periodic diencephalic psychoses» are applied to designation of this group of Pct in the Soviet psychiatry. A number of psychiatrists carry Pct to atypical forms of maniac-depressive psychosis or to recurrent schizophrenia.
The clinical picture
the Clinical picture of Pct has essential distinctions at different forms. At psychoses of schizoaffective type attacks (phases) of atypical depressive and maniacal states prevail (see. Depressive syndromes , Maniacal syndromes ), at which affective frustration are combined with the crazy ideas of prosecution, the relation, influence (see. Nonsense ), symptoms of mental automatism (see. Kandinsky — Klerambo a syndrome ), hallucinations (see), phenomena depersonalization (see) and derealization (see). Quite often affective and oneiric states meet (see. Oneiric syndrome ), not developed catatonic manifestations — a substupor, a mutism (see. Catatonic syndrome ). On a psychopathological picture attacks are not same. Their duration from several days to several weeks. The first attacks usually are not followed by changes of the personality. After repeated attacks superficial changes of the personality — decrease of the activity, unsociability, changes of thinking are possible.
At Pct of an exogenous and organic origin, to-rye are inherent preferential to teenagers, along with affective attacks attacks with dominance of syndromes of stupefaction are often observed (oneiric, twilight, sometimes amental conditions and conditions of devocalization). In structure of attacks the phenomena of a catatonic substupor or excitement, psychosensorial frustration meet. As a rule, the expressed vegetative disturbances — headaches, dizzinesses, perspiration, increase or a perversion of appetite, the speeded-up urination, subfebrile condition take place; the phenomena of toxicosis are frequent. Attacks have the same character more often (as a cliche), have the acute beginning and the termination, last from 1 to 2 weeks and come to an end with either an absolute recovery, or a passing adynamy. After repeated attacks occasionally can develop psychoorganic syndrome (see).
Differential diagnosis of Pct is carried out with pristupoobrazno-progreduated and recurrent schizophrenia (see), and also with maniac-depressive psychosis (see), however presents considerable difficulties in view of lack of accurate criteria of differentiation of the phase proceeding psychoses.
The etiology and a pathogeny
the Aetiology and a pathogeny of Pct are studied insufficiently. In an origin of schizoaffective psychoses significance mixed hereditary burdened ti is attached (schizophrenia and maniac-depressive psychosis). Emergence of exogenous and organic Pct contacts the postponed infections and craniocereberal injuries. In a pathogeny of Pct the main role is played by disturbances of diencephalic functions.
Treatment depends from a wedge, forms. At schizoaffective psychoses depending on the leading syndrome apply antidepressants (amitriptyline, Melipraminum), neuroleptics — aminazine, a haloperidol, chlorprothixene, levomepromazinum (Tisercinum). At Pct of an exogenous and organic origin along with the transferred funds appoint dehydrational therapy, fortifying means, the lumbar puncture is quite often effective.
the Forecast of Pct is various — at Items of an exogenous and organic origin it is more favorable, at schizoaffective psychoses with repeated attacks development of changes of the personality in schizophrenic type is possible.
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B. B. Kovalyov.