PSYCHOORGANIC SYNDROME (grech, psyche of a shower + organikos organic, low; syndrome; synonym: organic psychosyndrome, diffusion brain psychosyndrome) — one of forms of nonspecific psychopathological frustration in the nosological relation, the main symptoms to-rogo are disturbances of memory and intelligence.
For the first time detailed the wedge, P.'s description of page were made in 1921 by E. Bleyler who gave it the name «organic symptom complex». However domestic psychiatrists at the end of 19 century used the term «laesio cerebri organica» at statement of the preliminary diagnosis when suspected organic conditionality of a mental disease. In the subsequent in domestic and German psychiatry the terms «psychoorganic syndrome» and «organic psychosyndrome», distribution in the English psychiatry — «a chronic brain syndrome», in the American psychiatry — «an organic brain syndrome» gained. The term, the used amer. psychiatrists, along with frustration, inherent P. of page, includes also some forms relating to exogenous type of reaction (see. Bongeffera exogenous types of reactions ), first of all a delirium (see. Delirious syndrome ).
A clinical picture
disturbances of memory, intelligence, affectivity — a so-called triad H. Walther-Büel belong To the main manifestations of P. of page. Frequent manifestation of P. of page is also the adynamy (see. Asthenic syndrome). The listed symptoms can have various degree of manifestation. In the most mild cases their combination is defined as «organic decrease in level of the personality»; in the heaviest — as «organic dementia» (see Weak-mindedness). The main disturbances at P. are combined by page in the most various ratios.
Bleyler (M. of Bleuler) offered P.'s classification by the village based on preferable defeat of this or that mental function. So, dysmnesias dominate at a korsakovsky syndrome (see); various parties of intelligence first of all suffer at a disease of Peak (see. Peak disease ), a general paralysis (see) or a pseudoparalytic syndrome (emergence at various organic diseases of c. N of page of the same mental and neurologic disturbances, as at a general paralysis); affective frustration prevail at tumors of a brain of a certain localization. However it would seem selective defeat of separate mental functions always relatively. At P. of page various mental disorders closely intertwine, forming a complex structure; separate symptoms at the same time are isolated with a sufficient share of convention.
Disturbances of memory at P. pages mention in a varying degree its main types: storing, a retention (ability to hold apprehended) and a reproduction (ability to activate stocks of memory). In one cases dismnestichesky frustration prevail (see. Memory , frustration), in others — anamnestic, first of all the fixating and (or) progressing amnesia (see). Disturbances of memory, especially in the form of amnesia, quite often are followed by emergence of figurative memories of events of antecedents, and in some cases and confabulations (see. Paramnesias ).
Disturbance of perception surrounding — decrease or even lack of ability to capture any situation entirely in this connection patients catch only particulars is characteristic of P. of page. The volume of attention, especially passive — automatic reaction to the appeared irritant is limited. Disturbances of memory and perception are closely connected with deterioration in attention and orientation in surrounding in the beginning, and at P.'s weighting by the village — in own personality.
Various parties of intellectual activity at P. of page are surprised not at the same time: first of all the acquired skills while old remain long suffer later. Disturbance of intellectual activity is demonstrated by decrease in level of judgments and conclusions. One of signs of decrease in level of judgments and conclusions is disturbance of critical abilities at a self-assessment and assessment surrounding.
Affective reactions are unstable, sometimes change every minute, are shown sharply (an incontience of affect, an affective inkontinention), but are usually short and quickly die away. Changes of affect happen spontaneously or under the influence of external, time of the most insignificant factors. In particular, affect of the patient easily and repeatedly changes depending on tone, in Krom with it the conversation is conducted — affective induction. The dominating affect, napr, the increased carefree mood (euphoria) or povyshenno-foolish mood (Moria), easily subordinates to themselves actions of the patient, and simultaneous decrease in level of judgments and criticism can cause commission of socially dangerous acts. Restriction of a focus of interest. impossibility of judgment of difficult situations, depletion of representations, disturbance of the highest emotions (step, call of duty, etc.) can result in emotional indifference of the patient to everything that has not a direct bearing on the affect dominating at it at present and its interest. The broken affectivity and decrease in critical abilities are combined with the increased suggestibility, with raised and even not knowing when to stop obstinacy, or and another coexist.
Rate of mental processes is slowed usually more or less down. The speech is grown poor by words, often consists of verbal templates. Patients easily get stuck on the same representations, cannot switch from one thought to another at once, are not capable to allocate the main thing in this connection concentrate on insignificant details in a conversation. Most listed frustration with an aspontannost are noted at the frontal syndrome (see) which arose, e.g., at a disease of Peak or at tumors of a brain. Often at P. pages meet a dysarthtia (see) in various degree and perseveration (numerous repetition of the answer by the patient to the first offered question while ask it new questions).
Patients with P. of page often complain of headaches, pressure sense in the head, dizziness, badly transfer a heat and differences of atmospheric pressure. At P. of page symptoms are possible various nevrol. At the same time in one cases (vascular defeats of c. the N of page, a tumor of a brain, some endocrine diseases) prevail symptoms of the raised exhaustion, up to an adynamia; in others (effects of craniocereberal injuries, syphilis of vessels of a brain) — an acrimony with explosiveness (explosibility) or rage. Fluctuations of manifestations of P. of page amplify at increase of depth of an adynamy. Asthenic frustration are poorly expressed or are absent at the atrophic processes of a brain developing in an after-life, napr, a disease of Peak, a trochee of Gentington (see. Gentington chorea ), senile dementia (see).
In initial stages of development of P. of page and when its manifestations are expressed poorly, there is a point of characterologic lines inherent in the patient more often, in particular there are psychopatholike disturbances (see. Psychopathies ). At the page expressed to P. leveling of features of the personality is observed, up to their total disappearance. At some diseases, napr, a general paralysis, a disease of Peak, leveling of features of the personality is noted already from the very beginning of P.'s emergence by the village that testifies to its weight.
Symptomatic lability — emergence of exogenous types of reaction under the influence of intercurrent diseases and various intoxications, and in some cases and therapies, including psikhofarmakol is characteristic of most of patients. means. More often than others, usually at night, there is a delirium and twilight stupefaction. Symptomatic lability increases parallel to strengthening of weight of P. of page.
Many patients with easy manifestations of P. of page are inclined to psychogenic reactions (see Psychogenias) most of which frequent form are subdepressions (see. Depressive syndromes ). Easy manifestations of P. of page, including observed in an initial stage of a disease can be followed by development productive the psychopath of l. frustration: affective, maniacal and depressive; crazy — paranoiac, paranoid, paraphrenic; than hallucinatory — in the form of gallyutsinoz, most often verbal, is more rare tactile and visual (see. Hallucinations ). In such cases speak about developing of endoformny psychoses the, i.e. psychoses similar on a wedge, a picture with maniac-depressive psychosis (see) and schizophrenia (see). Their duration fluctuates from several days to several years. In process of P.'s progressing by the village the possibility of emergence of such psychoses decreases, and the endoformny psychoses which already developed and accepted a long current are exposed to simplification and disappear.
Distinguish acute and chronic P. of page. Acute arises suddenly, quite often after exogenous type of reaction, several days or weeks, rarely proceed longer. It can be the only episode in life of the patient, but can accept the recuring current with the subsequent transition to chronic P. of page which begins usually hardly noticeably. Chronic P.'s current of page variously: at a disease of Peak, a chorea of Gentington, senile dementia the disease progresses from the outcome in dementia; after craniocereberal injuries, encephalitis — approaches stationary; at a general paralysis, benign tumors of a brain the long remissions resulting usually from treatment are characteristic of P. of page.
the Reasons of development of P. of page are diverse. The item of page arises usually at diffusion defeat of tissue of brain. In this regard M. Bleyler defined it as a diffusion brain psychosyndrome. At the same time at many, sick diffusion disturbances of tissue of brain can be combined with local, napr, with defeat of a diencephalon, departments of a brain trunk. At the same time the wedge, a picture P. of page becomes complicated: sharply raise or, on the contrary, motives, the inclinations, affects accompanied with certain forms of behavior decrease. Considering first of all these, the connected with local damage of a brain, mental disorders and quite often sufficient safety at such patients intellectual mnesticheskikh functions, M. Bleyler allocated a local brain psychosyndrome, opposing it to P. page. Other researchers, e.g. A. V. Snezhnev of skiya, deny independence of a local brain psychosyndrome.
Items of page can cause vascular diseases of a brain, craniocereberal injuries, encephalitis, syphilitic diseases of c. N of page, a tumor and abscesses of a brain, atrophic processes of a brain at presenile and senile age, the diseases accompanied with epileptic seizures and also intoxications (alcohol, drugs, barbiturates, lead and other heavy metals, carbon monoxide gas). The great value in P.'s formation by the village belongs to an age factor. At influence of the same reason, the more the age of the patient, the is more distinct than P.'s manifestation by the village. So, at tumors of a brain of P. of page does not occur at children in general, at mature age it arises only in easy forms and only after 40 years accompanies a disease constantly and its wedge is expressed clearly, in old age, the picture is close to displays of senile dementia.
Diagnosis put a wedge, pictures on the basis. It is very complicated in an initial stage of chronic P. of page, and also at emergence in this period of endoformny psychoses. Difficulty of diagnosis increases at patients of advanced and senile age since the mental changes observed at this age cannot be differentiated accurately with initial symptoms of P. of page. In many cases in P.'s diagnosis by the village crucial importance belongs to the anamnesis, and also dynamics allowing to reveal P.'s symptoms of page. At diagnosis of P. of page, including nosological, a number of researches, napr, elektroentsefalografichesky, pnevmoentsefalografichesky, etc. is of great importance.
Differential diagnosis most often carry out with the endogenous depressions which are especially arising at patients in an after-life. Diagnostic difficulties at the same time are caused by the fact that patients with a depression very often complain of decrease in memory and mental abilities.
Treatment it is directed to a basic disease. At all types of P. of page nootropic means are recommended (see). At development of psychoses depending on features their wedge, pictures use other psychopharmacological means (see).
Forecast depends on a basic disease.
Bibliography: Bleyler E. The guide to psychiatry, the lane with it., Berlin, 1920; Kerbikov O. V., etc. Psychiatry, page 72, M., 1968; Bleuler E. Lehrbuch der Psychiatrie, S. 193, V. u. and., 1979; Lauter H. Psychosyndrom organisches, in book: Lexikon d. Psychiat., hrsg. v. Ch. Müller, S. 418, B. u. a., 1973; San-d about k B. A. Organic brain syndrom, in book: Comprehens. textbook of psychiat., ed. by A. M. Freedman and. o., v. 2, p. 1060, Baltimore — L., 1975; about and e, Organic mental disorders, in book: Comprehens. textbook of psychiat., ed. by H. J. Kaplan and. o., \. 2, p. 1392, Baltimore — L., 1980; Walther-Büel H. Die Psychiatrie der Hirngeschwülste, Wien, 1951.
H. G. Shumsky.