REACTIVE PSYCHOSES

From Big Medical Encyclopedia

REACTIVE PSYCHOSES (Latin re-the prefix meaning repetition, resuming, + activus efficient, active; psychoses) — the temporary reversible disorders of mental activity resulting from a mental injury.

The term «reactive psychoses» is accepted preferential in the Soviet psychiatric literature; in foreign — the states similar to Genitive are described under the name abnormal reactions, psychogenic reactions, etc.

In development of the doctrine about Genitive it is possible to allocate three directions: psychopathological [K. Jaspers, Schneider (To. Schneider)], kliniko-descriptive [Ganzer (S. J. M of Ganser), R. Raecke, Dyupre (E. Dupre), Birnbaum (To. Birnbaum), I. N. Vvedensky, P. B. Gannushkin, E. K. Krasnushkin, A. N. Buneev, S. G. Zhislin] and complex kliniko-pathogenetic (N. I. Felinskaya, G.V. Morozov).

A clinical picture

On features of emergence and a current allocate shock (acute), subacute and long Genitive.

Shock (acute) reactive psychoses (psychogenic shock) arise under the influence of the sudden severe mental injury posing a threat to existence (an earthquake, the fire, a flood, etc.). They are shown in hypokinetic and hyperkinetic forms. A hypokinetic form of Genitive (an acute psychogenic stupor) — suddenly come condition of a full obezdvizhennost (see below the Psychogenic stupor); a hyperkinetic form — suddenly come chaotic senseless motive excitement (see. Hyperkinesias ). Both forms of psychosis are followed twilight stupefaction (see), amnesia (see), vegetative frustration (tachycardia, sharp blanching or erubescence, profuse sweat, etc.) several minutes or also proceed hours.

Subacute reactive psychoses meet most often. Carry psychogenic paranoid, hallucinatory paranoid psychosis, a psychogenic depression, a syndrome of bredopodobny imaginations, hysterical psychoses, a psychogenic stupor to them. Psychogenic paranoid — Genitive with a figurative persecution complex (see. Nonsense ), the followed fear, alarm. Arises at the persons which are in an unusual situation (relative isolation); at the same time is of great importance sleeplessness (see). In an initial stage patients have an unclear painful alarm. Then the nonsense joins, to-ry reflects the specific injuring situation. Patients are protected from imaginary persecutors, sometimes become aggressive. Such state proceeds of 2 weeks to two months. Gradually the nonsense disappears, the criticism to painful frustration is recovered, passing the period of doubts.

Hallucinatory paranoid psychosis, as a rule, meets in forensic-psychiatric practice. It is defined by a combination of a persecution complex to verbal hallucinations (see) and the separate phenomena of mental automatism (see. Kandinsky — Klerambo a syndrome ). In an initial stage there is a mentism (non-stop, without volition a current of thoughts). Memoirs of the forgotten episodes emerge long ago. Along with it there is a feeling of «pulling», «reading» thoughts, feeling of «an internal raskrytost» what is combined with acoustical pseudohallucinations of psychogenic contents (usually a situation of the investigation). Patients speak about internal voices, to-rye interfere with the course of their thoughts, repeat process of the investigation, sound in their head. There are separate components of senestopathetic automatism (e.g., unpleasant feelings in a body, cold sense, burnings). At height of psychosis against the background of intensive affect of fear true verbal hallucinations, contents prevail to-rykh it is connected with the injuring situation. Voices have multiple character (poly-vocal hallucinosis) or can have the form of dialogue (voices discuss behavior of the patient, threaten, predict death). Sometimes there are separate visual hallucinations which are also reflecting a situation. In a wedge, a picture the nonsense of the relation, value and prosecution, nonsense of the external influence, constant control and influence which is carried out by means of hypnosis, special devices figures prominently. The maintenance of hallucinatory-dilision psychosis is connected with the psychogene-but-injuring situation. Modification of a picture of a disease comes right after arrival of patients in a hospital. The first hallucinations disappear; intense affect of fear is replaced by a depression; the nonsense gains residual character. The criticism to the postponed painful frustration is recovered gradually. Within a month the adynamy is also more noted (see. Asthenic syndrome ).

The psychogenic depression most often meets in the following a wedge, options: simple situational depression, depressive and hysterical and depressive and paranoid syndromes. Simple situational depression is shown by ponizhennotosklivy mood with motive and ideatorny block. Content of representations of patients reflects the psychoinjuring situation.

The depression at a depressive and hysterical syndrome (a hysterical depression) is characterized by extreme expressiveness of all external manifestations. Affective frustration are shown by a combination of depression, alarm, malignancy, tearfulness; they are changeable and depend on a situation. The ideas of self-accusation and even self-reproaches are absent. Patients accuse of all people around, along with it express the exaggerated fears about the health, considering that their state is so serious that excludes an opportunity to impose on them any requirements. The mimicry, motility and statements of patients differ in theatricality, aspiration to draw attention to themselves and to cause sympathy. At the same time psychomotor block is absent. Sometimes the melancholy is combined with irascibility, the depression gains the agitated character, patients put themselves damages or make demonstrative suicide attempts. Course of a hysterical depression favorable. Disappearance of painful frustration can gradually happen or right after the changed situation or the carried-out treatment. At recovery partial amnesia is noted that demonstrates existence in the period of psychosis of change of the consciousness defined as iste - richeski - narrowed. Depressive is-terichesky the syndrome is, as a rule, combined with such hysterical manifestations as a pseudodementia (see. Pseudo-dementive syndrome ), puerilism (see), bredopodobny imaginations (see below a syndrome of bredopodobny imaginations).

The depressive and paranoid syndrome develops gradually. In the beginning there is a sad mood and motive block. However ideatorny braking is absent. At patients the abundance of thoughts, contents is noted to-rykh it is connected with the psychoinjuring situation; consciousness concentrates on the dominating experiences that allows to define it as affective narrowed. The surrounding situation is perceived as unreal, «in gray tones» as «through fog» or «thickness of water». During the deepening of a depression crazy interpretation surrounding (in words and gestures of people around patients see hints on the forthcoming punishment, etc.) otkhmechatsya. At the same time there is a mental block. Further the depressive stupor can develop. The disease usually lasts 2 — 3 months, patients lose flesh, their the expressed vegetative disturbances are noted — tachycardia, fluctuations of the ABP, feeling of a prelum, pain and weight in heart. Quite often there are persistent suicide attempts. At change of a situation or at treatment first of all the depressive stupor, then crazy interpretation surrounding disappears and in the last turn affect is normalized. Along with improvement of mood there is a criticism to the postponed disease state. Within a month the adynamy is also more observed.

Syndrome of bredopodobny imaginations (see) it is shown by the unstable changeable ideas, to-rye do not develop in a certain system and have fantastic contents. In one cases bredopodobny imaginations develop sharply against the background of the hysterical narrowed consciousness. The unstable ideas of greatness, wealth prevail, to-rye reflect aspiration to leaving from an excessive situation in an exaggerated form. So, patients tell about the flights to the moon, about infinite riches, to-rymi they possess, the great opening having the state value. The contents of these statements contradict the main alarming background of mood, a cut change in hanged imost from the external moments, questions of the doctor. In other cases bredopodobny imaginations have more difficult and resistant character, finding a tendency to systematization. In the period of involution of Genitive into the forefront the situational caused depression acts, fantastic statements turn pale, quickening only for a short time at the nervousness of patients connected with impact of the additional psychoinjuring experiences.

Carry Ganzer's syndrome to reactive hysterical psychoses (see. Ganzera syndrome ), pseudo-dementive syndrome (see), puerilism (see), and also the syndrome of regress of mentality (a syndrome of running wild), to-ry is among the most seldom found forms of Genitive and is shown by hysterical stupefaction and special psychomotor excitement (patients creep, growl, drink up from a plate etc.). Sometimes such behavior is followed by nonsense of transformation (patients move on all fours as dogs, make hands of the movement, the reminding waves of wings of birds, etc.).

The psychogenic stupor is characterized by a full obezdvizhennost and a mutism (failure from the speech). On psikhopatol. manifestations can allocate a hysterical, depressive and hallucinatory paranoid stupor. Most often the hysterical stupor meets. Sometimes it arises sharply, directly after a mental injury as an independent form of Genitive. In most cases the hysterical stupor develops gradually, being the last stage during the change of various hysterical syndromes (a hysterical depression, pseudo dementias, a puerilism). The main line defining a wedge, a picture of a hysterical stupor is the affect inherent to a hysterical depression. Despite an immovability and a mutism, a mimicry and a pantomimika of such patients are expressive; they reflect the dominating affect. So, the look can be gloomy, spiteful; sometimes the mimicry reflects the stiffened suffering and despair. Against the background of psychomotor block a number of the hysterical symptoms inherent pseudo to dementia or a puerilism comes to light. Consciousness at patients is changed and on the structure approaches affective narrowed. Physical condition of patients, despite long failure from food, usually rather good. Disappearance of struporous frustration can occur suddenly or gradually.

The depressive stupor develops gradually, being a final stage of the psychogenic depression which is followed by psychomotor block (see. Depressive syndromes ). In its wedge, a picture affect of melancholy remains, to-ry it is shown in a mimicry and motility of patients (usually they are not roused and if it occurs, then not movably sit in a uniform pose, having bent, having low hung the head). Patients do not watch the appearance, quite often refuse food, as a result sharply lose flesh, cease to keep in touch with people around. A look at them oppressed and suffering, the stone look, corners of a mouth are lowered, lips shiver. Psychomotor block reaches degree of a substupor more often. Patients hardly comprehend the questions asked them and or do not answer at all, or give short terse answers after repeated repetition of a question. Speak slowly, by the low low-modulated voice, interrupting the speech with long pauses. Their separate statements reflect existence of the ideas of self-accusation which are directly connected with a specific situation and also suicide thoughts. Escaping of a struporous state more often happens through a stage of a depression, to the subsequent partial amnesia of events surrounding. On a nek-swarm time remains an adynamy.

The hallucinatory paranoid stupor develops gradually. In its wedge, a picture the previous psychopathological frustration are reflected. At patients the alarming and sad mood is combined with the crazy ideas of the relation, the special importance, prosecution, external influence, to-rye are combined by the general contents connected with the psychogenic injuring situation. The dominating depressive and alarming affect is followed by motive block, edges is shown in the slowed-down uncertain movements, a uniform mournful and at the same time alarming look. Separate statements of patients reflect existence at them psychogenic caused patol. experiences. They consider that their children, a family died, state the ideas of guilt, claiming that they dishonored the behavior a family, are guilty of death of relatives. The ideas of self-accusation are followed by failure from food, the accruing exhaustion and psychomotor block is as a result noted (see. Paranoid syndrome ). During the escaping of a struporous state patients keep reminiscence of the postponed crazy and hallucinatory experiences.

Long reactive psychoses on features the wedge, pictures and to patterns of dynamics subdivide into three groups. Long Genitive of the first group is characterized by the same neprogre-diyentny current. At the same time throughout all disease the certain, strictly outlined psychopathological syndrome remains, most often it is a hysterical depression, a pseudodementia, a pseudo-and dementive and puerile syndrome or bredopodobny imaginations.

In a wedge, a picture of long psychoses of the second group gradually there is a change of hysterical syndromes, the tendency to deepening of a reactive state is observed. The hysterical depression is replaced by a psev-dodementny or psevdodementno-puerile syndrome. Deepening of a reactive state is shown by development of a stupor, in a wedge, to a picture to-rogo the previous frustration (separate displays of a depression, a pseudodementia, puerilism) are reflected. Recovery happens slowly, to repetition of the previous frustration, and for a long time there are separate monosymptoms (paralyzes, paresis, a mutism, etc.).

Long Genitive of the third group has vyaloprogrediyentny type of a current, at Krom in a psychopathological picture and dynamics, on the one hand, the wedge, signs inherent to the described groups of reactive psychoses, decide on another — the patterns inherent only in this group. According to it in one cases the wedge, a picture at the initial stage is characterized by a hysterical depression and other hysterical manifestations (see. Hysteria ), most often in the form of separate elements pseudo dementias, in others — prevail depressive and paranoid frustration without symptomatology inherent to a hysterical syndrome. The general distinctiveness of this group is the condition of psychomotor block arising at early stages. Further the wedge, a picture is characterized by slackness, monotony, monotony of a current, without any expressed fluctuations and change of syndromes, with steady progreduated deepening of psychomotor block, along with it there comes the progressing physical exhaustion with trophic disturbances and the expressed vegetative and exchange changes testimonial of suppression of adaptation and trophic functions of an organism. At the same time gradual fading and modification of the caused symptomatology initial nsikhogenno is noted. The alarm and melancholy gain monotonous character, without finding any fluctuations depending on psychogenic herbs - miruyushchey situations. The course of long psychoses of this group does not find direct dependence on the reason which caused a disease. Recovery in all its manifestations has as if partial character. At gradual recovery of separate mental functions for a long time it remains incomplete. Long Genitive proceeds 6 months and more.

The etiology and a pathogeny

In emergence of Genitive the defining value has a combination of nature of a mental injury and constitutional features of the personality. The changes caused by the postponed craniocereberal injuries, hron belong to the contributing factors. infections, intoxications, atherosclerosis, and also periods of age crises. Despite variety of the psychoinjuring factors, the psychogenic frustration caused by them in many respects are defined by system of values of this personality. Influence of the psychoinjuring factors can be acute and protragirovanny. Duration of the psychogenic injuring situation matters, but more — features of the relation of the personality to this situation (adaptation or a sensitization).

The diagnosis

the Diagnosis is made on the basis of characteristic a wedge, pictures, features of development of a disease in the conditions of the psychogenic injuring situation and the current connected with influence of a psychogenic injury.

Differential diagnosis For genitive it is most difficult with schizophrenia (see). It is carried out on the basis of comparative comparison a wedge, pictures and on identification of an ati-pichnost of a picture of the prevailing frustration and the patterns of their development characteristic of various options of Genitive. So, at Genitive, in a wedge, a picture to-rykh leaders hallucinatory paranoid or depressive and paranoid frustration are, the atipichnost is found in features of a syndrome of mental automatism. Characteristic signs of psychogenic option of a syndrome of mental automatism is the limited number of its manifestations (the phenomena of flow of thoughts, acoustical pseudohallucinations, unusual feelings), other their quality (dominance of elements of a nasilstvennost, disturbance of activity in the absence of the phenomena of extreneity of own thoughts, feelings and actions) and contents (it is connected with the injuring situation).

Treatment

As the main syndrome at Genitive is a depression, various on character, apply antidepressants (see) in combination with neuroleptics (see. Neuroleptics ) and tranquilizers (see) depending on features a wedge, manifestations and a stage of a current of Genitive. At getting out of patients of disease state appoint psychopharmacological means (see) in combination with psychotherapy (see). Fortifying therapy (is shown especially at Genitive with a picture of a sluggish stupor).

Forecast and Prevention

Forecast, as a rule, favorable. At long Genitive it is various; so, at vyaloprogrediyentny type of a current the forecast adverse.

Prevention consists in holding psychogienic actions (see. Psychohygiene ) and early treatment psikhopatol. the frustration arising after action of a mental injury.



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K. L. Immerman.

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