PRESENILE PSYCHOSES (synonym: presenile psychoses, involutional psychoses) — group of the mental diseases arising preferential at the age of 45 — 60 years. Pct include presenile melancholy (the alarming agitated depression with nonsense), presenile nonsense of damage, Krepelin's disease (sharp motive and speech excitement with confusion and incoherence of thinking).
More often women are ill. Influence of an age factor on clinical manifestations of mental diseases was for the first time formulated in 1879 by K. Kalbaum; along with the psychoses arising during puberty, in particular a hebephrenia (see. Schizophrenia ), it allocated psychoses of the period of sexual withering for which offered the term «presbiofreniye». E. Krepelin, creating the doctrine about early weak-mindedness and maniac-depressive psychosis, allocated Pct in presumably independent group in the nosological relation. It was based on the fact that in this age period the certain pictures of diseases which are not found during the previous age periods are observed; they differ from the known psychoses arising in old age as a result of vascular and atrophic processes markedly. The basis of the group of Pct allocated with E. Krepelin was made by presenile melancholy and crazy psychoses in which the ideas of damage, jealousy and prosecution dominated. Diseases proceeded chronically from the outcome in mental weakness — permanent decline in the ability to perform former work, narrowing of an outlook, increased fatigue, deleting of features of the personality; at the same time memory and emotional affection for relatives sharply did not suffer. The changes of the personality accompanying psychoses differed from the changes observed at endogenous psychoses (schizophrenia and maniac-depressive psychosis) and organic processes (senile and vascular) arising in old age.
In the first half of 20 century the nosological concept of Pct, despite the skeptical attitude of a number of psychiatrists towards her, was widely adopted both in domestic, and in foreign psychiatry. Not only the forms described E underwent detailed studying. Krepelin, but also other forms of Pct allocated with various researchers — involutional hysteria, a late catatonia, involutional hallucinosis etc. Nosological independence of Pct especially in 20 — the 30th 20 century was proved, in addition to an age factor and features a wedge. manifestations, existence of certain pathogenetic factors (special characteristics of the premorbidal personality and developing of psychoses usually after the injuring outside influences). In the subsequent the point of view on nosological independence of Pct became a subject of further discussion in connection with the postareniye of the population which caused increase in number mentally sick. It created conditions for the accelerated development of geriatric psychiatry, including for studying of Pct. It turned out that such diseases as schizophrenia and maniac-depressive psychosis, can often demonstrate for the first time and in presenile (45 — 60 years), and at later age, and the vascular and atrophic diseases of a brain arising in old age can begin with the psychoses originally very similar to endogenous. Studying of psychopathological features of the listed psychoses showed that the pictures of depressions and crazy states which were considered earlier specific only to Pct meet in an after-life, including in old age, and at other diseases. Such similarity of displays of psychoses at different nosological forms is caused by nonspecific influence of an age factor on a current of the mental diseases demonstrating at identical age.
Researches of a catamnesis of sick Pct (see. Catamnesis ) showed that presenile melancholy most often proceeds pristupoobrazno. At the same time repeated attacks of a disease become indistinguishable from those which are observed in typical cases maniac-depressive psychosis (see). The presenile nonsense of damage often proceeds in the form of more or less outlined attacks with the symptoms inherent schizophrenia (see) — with figurative nonsense, false recognitions, alarming and timid excitement, etc. At hron, a current several years later there can be a transformation a wedge. pictures (as well as at paranoid schizophrenia): the expressed complication of the initial crazy ideas of damage nonsense of other contents (poisoning, prosecution, etc.) and accession of touch frustration up to emergence of the reduced paraphrenic states (see. Paraphrenic syndrome ). More rare the psychoses diagnosed originally as presenile melancholy or presenile nonsense of damage are replaced by the states inherent to senile to weak-mindedness (see) or to weak-mindedness at vascular damages of a brain.
Studying of the anamnesis of sick Pct showed that during the period preceding development of the expressed psychosis it is especially frequent at presenile nonsense of damage, it is possible to reveal the neurosis-like, affective and crazy frustration arising at the subclinical level. They are observed incidentally or months and even years last, without differing on manifestations from those which occur in the anamnesis of patients with late demonstrating schizophrenia. Studying of late arising endogenous psychoses showed also that at them some pathogenetic mechanisms (features of the personality, accessory external factors) which were considered before characteristic only of Pct constantly meet.
The new facts received during the studying by Pct allowed a nek-eye to foreign and domestic psychiatrists or to deny nosological independence of Pct, carrying them to schizophrenia, maniac-depressive psychosis or endoformny psychoses (to the psychoses similar on symptomatology to schizophrenia and maniac-depressive psychosis) at the organic processes arising at late age or to consider Pct a rare disease. At the same time many domestic psychiatrists continue to make the diagnosis to Pct rather widely.
Along with consideration of a question of nosological independence of Pct in domestic and foreign geriatric psychiatry the problem various on the wedge is intensively developed. to displays of the affective and crazy psychoses arising in old age. In this regard there were researches concerning features of late options of Pct. More correct is not allocation of such even more doubtful options of Pct in the nosological plan, but their association with the psychoses demonstrating in old age in group of psychoses of late age, i.e. 60 — 65 years arising later.
Each of three forms of Pct has the features.
Presenile melancholy (involutional melancholy)
Presenile melancholy (involutional melancholy) — single psychosis in the form of alarming agitated depres these with nonsense and development at height of a disease of a picture of a melancholic paraphrenia; proceeds in the form of a long long-term attack or chronically. Occurs almost only at women. A certain warehouse of the personality is typical for most of the diseased: conservatism, napr, the aspiration to observe the developed rhythm of life and any fear of changes; pedantry, «jamming» on negatively painted emotional events — the so-called mental rigidity which is combined with tendency to alarming fears even in connection with insignificant circumstances; gravity and lack of sense of humour; conscientiousness and superconscientiousness, and also the economy reaching in some cases avarice. At many the pessimistic relation to life, i.e. lines of a so-called constitutional depression prevails. At mature age the known point of lines of the personality is often observed, first of all mental rigidity, alarming suspiciousness, besides, there are such new properties as callousness and egoism. Usually the onset of the illness is preceded, as a rule, by mental injuries — from rather lungs (retirement, change of the residence) to very heavy (the death of the next, especially only, the relative); much less often psychosis arises after somatopathies.
The initial stage lasts of several weeks (after severe mental injuries) about one year and more. Than this period, that a high probability is more long that with other things being equal psychosis will chronically proceed. From the very beginning of a disease affect of alarm concerning separate, including specific, situations — own health, especially in the presence dominates senesthopathias (see) or real somatic trouble, health of close, possible material difficulties, etc. Further the alarm along with sharp increase of its intensity accepts diffusion character, extending to any event in last, real or future. At the same time there is a suppressed mood which is combined in the beginning with irritability or discontent; in the subsequent affect of melancholy develops. From the very beginning of a disease the agitation expressed in a varying degree is observed (see. Depressive syndromes ). Often there are crazy ideas of ruin, damage, hypochiondrial character, self-accusations and self-abasements which according to contents are sketchy and uniform (see are more rare. Nonsense ). In spite of the fact that the disease often begins after mental injuries, the reactive component which is contained in statements of patients disappears quickly. In some cases, along with mental symptoms or being ahead of them, there are frustration of a dream, loss of appetite, locks, weight loss; the premature postareniye and aging is quite often noted. Complication wedge. pictures of a disease it is expressed by emergence confusions (see), sharp strengthening of alarm, melancholy and agitation, the accompanied difficult pictures of depressive nonsense. The intense alarm which is not knowing shades or fluctuations prevails; force of affect as if exceeds limits of human endurance and remains for vaguely long period. Strengthening of affective frustration is followed by emergence of fear. Patients are not able to be in one place — they incessantly move, from time to time rush about up to emergence of frenzied excitement. Often, especially in a condition of a melancholic raptus, they try to put themselves mutilations or to commit suicide; speech excitement at them is shown by moaning, groans, uniform lamentations, cries, shouts, at many alarming verbigeration is observed (see. Depressive syndromes ). Speech motor excitement sharply amplifies at a talk with patients, at their transfer from one room in another, medical manipulations (a symptom of disorder of adaptation). Conditions of motive excitement can be interrupted by episodes of a depressive substupor and even a stupor (see. Struporous states ). However almost always in these states there are rudiments of agitation, most often in the form of the incessant movement or breaking off of fingers of hands. The crazy ideas receive more and more fantastic contents, at height of development there is a Cotard delusion (see. Kotara syndrome ). Touch frustration are presented verbal illusions (see), illusory hallucinosis of the condemning or menacing contents, a symptom of the negative double (see. Kapgra symptom ).
The developed picture of a disease can remain for years in an invariable look. Then under the influence of therapy or spontaneously there is a gradual easing of the main mental disorders — alarms, depressive affect, agitation, speech excitement; separate crazy statements remain in the reduced form. Regress of behavior (untidiness, gluttony appears) and decrease in mental level, in particular dismnestichesky frustration are quite often possible (see. Memory ). At remissions as a result of treatment usually there are a tendency to alarming reactions and subdepressive affect.
Some domestic psychiatrists allocate option of late presenile melancholy, edges also even 80 years can begin after 60. It differs in smaller expressiveness of agitation and alarm, dominance of melancholy and ideomotor block.
In development of presenile melancholy characterologic features of patients, a floor, additional matter harm (a mental injury, intoxications, etc.).
The diagnosis is based on features a wedge. pictures. Differential diagnosis is carried out with the maniac-depressive psychosis (see) for the first time demonstrating in an after-life with situational depressions (see. Reactive psychoses ) and schizophrenia (see). In some cases the Pct needs to be differentiated with the endoformny depressive syndromes arising at senile dementia against the background of vascular diseases of c. N of page.
At treatment of presenile melancholy in a rise period of alarming agitation aminazine, Triphtazinum (Stelazinum), Tisercinum with the subsequent accession of antidepressants, first of all amitriptyline are shown. In some cases, both at the beginning of psychosis, and in the period of a considerable reduction psikhopatol. frustration among which the persistent subdepression with elements of alarm begins to prevail the course is recommended electroconvulsive therapy (see).
The forecast concerning recovery is always doubtful. In rare instances there is a total disappearance psikhopatol. frustration.
Presenile nonsense of damage
Presenile nonsense of damage (involutional paranoid, involutional paranoia, an involutional paraphrenia) — chronic crazy psychosis in the form of nonsense of damage and prosecution of ordinary contents. Arises preferential at persons with paranoiac traits of character — persistent, stubborn, despotic, inclined to education supervaluable ideas (see) — and with mental rigidity. The crazy ideas develop hardly noticeably, extending first of all to persons of the immediate environment (neighbors, is more rare on jointly than the living relatives, colleagues). At change of a situation, e.g. change of the residence, the nonsense arises in relation to persons of a new environment while the former earlier crazy ideas are reduced up to total disappearance. The crazy ideas of material damage, mockery prevail, poisonings are more rare. The nonsense is always systematized in the most habit view, e.g. conviction that neighbors in the absence of the patient get into his room, spoil things and products, i.e. do everything that the patient left the apartment. As a rule, such crazy concept does not gain further development, hallucinations and mental avtomatizm the nonsense does not become complicated (see. Kandinsky — Klerambo a syndrome ); from touch frustration verbal illusions can be observed (see) and senesthopathias (see). Crazy statements of patients always contain a large number of specific details of household character in this connection such nonsense is called nonsense of the ordinary relations or nonsense of «small scope». Psychosis is followed by the expressed crazy behavior: in one cases patients are protected (put additional locks on a door, cook and store food in the room, change the residence or work), in others — complain to various public institutions. The ordinary of maintenance of nonsense, existence of the valid conflicts with surrounding quite often long time do not allow to estimate a condition of patients as pathological. In some cases the patient can induce relatives and acquaintances who, aiming to protect it, are also involved in litigious activity (see. Induced madness ). Usually the nonsense is followed either by the alarming, or a little increased mood with lines of optimism and conviction in success of exposure of the ill-wishers. As a rule, patients willingly tell about all prosecutions which are carried out against them and about the measures of protection undertaken by them. Despite chronic long-term disease. the expressed changes of the personality are not observed: sick, including lonely, are in most cases well adapted in life, and at many of them, despite age, the prof. working capacity long remains.
In development of presenile nonsense of damage characterologic features of patients, additional matter harm, and also isolation.
The diagnosis establish a wedge on the basis. pictures. Differential diagnosis is carried out with paranoiac schizophrenia, with the endoformny paranoiac syndromes arising at senile dementia against the background of vascular diseases of c. N of page.
At presenile nonsense of damage long, for many years, treatment is shown by aminazine, Triphtazinum (Stelazinum), a haloperidol.
The forecast concerning recovery is always doubtful; patients usually have residual nonsense.
Krepelin's disease (malignant presenile melancholy) meets extremely seldom. There is it preferential at the age of 45 — 50 years. Initial frustration are similar to those which are observed at presenile melancholy, but they are always short. In a stage of the developed psychosis the violent motive and speech excitement which is followed by senseless resistance dominates continuous, uniform, in some cases (failure from food and to lay down. procedures), self-torture, shouts, incoherent speech. It is impossible to get into conversation with the patient. It is possible to make the conclusion about existence at it of confusion and snovidny stupefaction with frightening fantastic contents of separate statements (see. Oneiric syndrome ). The accruing physical exhaustion quickly reaches degree cachexias (see).
The etiology and a pathogeny of a disease of Krepelin are unknown.
The diagnosis is based on features a wedge. pictures. Differential diagnosis is carried out with the agitated form general paralysis (see).
Treatment is same, as at presenile melancholy. Often only method of treatment is electroconvulsive therapy.
The forecast concerning life is very serious. In the absence of treatment the death which is able is inevitable marasmus (see) in connection with development of heavy collapses or from the joined intercurrent diseases.
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