SENILE PSYCHOSES (synonym: neurosis tardas, senile insanity) — group etiologically the diverse mental diseases arising, as a rule, after 60 years. Are shown by exogenous types of reactions (see. Bongeffera exogenous types of reactions ), endoformny and endogenous a wedge, pictures (see. Schizophrenia , Maniac-depressive psychosis ). Unlike senile dementia of S. of the item, as a rule, do not attract development of total weak-mindedness (see. Senile dementia ).
Nosological accessory can be established for considerable part C. of the item having exogenous and in some cases endoforms-nuyu a wedge, a picture. Most of C. items with endoformny a wedge, a picture and all cases of S. of the item with an endogenous picture are selected by the syndromologic principle. Villages of the item with endoformny and endogenous a wedge, a picture do not find a feedforward with schizophrenia and maniac-depressive psychosis. At the same time nek-ry of them, napr, endoformny hallucinatory-dilision psychoses, have features of a genealogical background, similar to schizophrenia. Nek-rye S. items in the form of exogenous types of reactions and endoformny pictures can be followed by signs psychoorganic syndrome (see), depth to-rogo fluctuates with the broad range — from insignificant age decrease in level of the personality to the weak-mindedness adjoining with senile.
Exogenous types of reactions meet during all periods preceding an old age; an endogenous wedge, pictures (depressions and crazy states) arise since presenile age. The villages of the item proceeding about a wedge, a picture of gallyutsinoz, hallucinatory-dilision, konfabulyatorno-paraphrenic states demonstrate almost only in old age.
Studying of the psychoses for the first time arising in old age, which are not followed by development of the weak-mindedness inherent which is quickly progressing and reaching deep degrees first of all to senile dementia (see. Senile dementia), began in the last quarter of 19 century. The detailed research of such psychoses was conducted by Fyurstne-rom, Segla and Ritti (To. Furstner; J. E. Seglas; A. Ritti). Fyurstner and Ritti described the psychopath of l. features of the most often found forms C. of the item, gave their first classifications. However since the beginning of 20 century the main researches in the field of geriatric psychiatry were directed to studying of various processes leading to weak-mindedness and arising in an after-life — senile dementia, weak-mindedness at vascular damages of a brain, Alzheimer's disease (see Alzheimer a disease), diseases of Peak (see Peak a disease), etc. Interest in studying of these diseases in many respects was defined by progress patol. anatomy and absolutization of pathoanatomical data in damage a wedge, to the facts. Especially it concerned senile dementia. Till 40th 20 century among most of psychiatrists there was an opinion that S. of the item are psychotic forms of senile dementia. Reduction of interest of psychiatrists in S.'s studying of the item is connected also with E. Krepelin's concept about presenile psychoses (see).
Resuming of researches C. of the item was influenced by the following circumstances. It turned out that gistopatol. the changes which were considered characteristic only of senile dementia occur at healthy old men in the mental relation, and, on the contrary, they can be absent at the severe forms of senile dementia which are followed by total dementia. Y. N. Robinson, V. V. Sreznevsky, V. Maier G by Ross, etc. achieved success in therapy of separate forms C. of the item relating to senile dementia. The demographic shift accruing since the beginning of 20 century in economically developed countries was expressed in significant increase in number of elderly people, at the same time the number of mentally sick increased.
Studying of the case record, progress of therapy, review of views of a wedge, the facts allowed V. Maier-Gross and to Roth (M. of Both) to divide mental diseases of an old age into group of the processes leading to weak-mindedness of senile and atrophic and vascular genesis and also group of functional psychoses of an old age, at to-rykh weak-mindedness is absent or is not expressed or it arises later a long time after an onset of the illness.
In 1958 the special commission of WHO published new classification of mental diseases of an old age. A. V. Snezhnevsky participated in its drawing up. Group of functional psychoses of an old age affective psychoses (depressive and maniacal) made, paraphrenias (the psychoses which are defined by crazy, hallucinatory-dilision or hallucinatory frustration) and conditions of confusion (the psychoses which are defined by stupefaction) arising at sokhmatichesky diseases. Thus, functional psychoses of an old age were allocated by the sindromologpche-sky principle, to-ry remains to leaders; a considerable part of the American, English and Scandinavian psychiatrists adheres to it. Domestic and the most part it is mute. psychiatrists aimed to resolve a problem of functional psychoses of an old age, leaning on but - it is evil. principle. In development of the last domestic psychiatrists have big merits. The studying of functional psychoses undertaken by them in dynamics (affective and paraphrenias) taking into account a long catamnesis showed that their considerable part represents late demonstrating endogenous psychoses (CxM. M aniakaljno-depressive psychosis, Schizophrenia), many are the eidoformny psychoses arising at the special course of senile dementia less often at vascular diseases of a brain. Pictures of diseases were also revealed (depressions, paranoiac states, gallyutsinoza), at to-rykh only all-age changes of mentality were observed.
Along with studying of functional psychoses of an old age researches of presenile psychoses were conducted. It turned out that the main presenile psychoses (depressive and paranoiac) which were considered earlier specific only to presenile age have the similar forms arising for the first time in old age. In the beginning they were called late options of presenile psychoses. Nek-ry domestic psychiatrists, e.g. N. F. Shakhmatov, E. Ya. Shternberg, came to a conclusion that existence similar the wedge, forms of the psychoses demonstrating during various periods of an after-life (after 45 — 50 years), speaks about artificiality of division of a number of the mental diseases which are not accompanied with organic decrease (dysmnesias, etc.), on presenile and senile. It is more preferable to their designation the terms «age psychoses» or «psychoses of late age». Such generalizing terms, perhaps, are lawful for depressive and paranoiac conditions of an after-life. However there is a row a wedge, the forms (a gallyutsinoza, hallucinatory-dilision and konfabulyatorno-paraphrenic psychoses) demonstrating is almost exclusive in old age.
In genesis of the most part of S. of the item the following major factors matter: softly proceeding organic process relating to atrophic is more rare the atrophic process coming in svovkhm an outcome to the process observed at senile slaboukhmiya; constitutional and genetic factor (depressions, paranoiac, hallucinatory-dilision and paraphrenic states); defeat of hearing and sight (gallyutsinoza).
Pages of the item divide into acute forms — exogenous pictures (the psychoses accompanied with stupefaction) and hron. forms — depressions (see. Depressive syndromes), paranoiac states (see. Paranoiac syndrome ), gallyutsinoza (see. Hallucinations ), a senile paraphrenia (see. Paraphrenic syndrome ) and hallucinatory-dilision states.
Acute forms C. of the item meet most often. Such patients are concentrated generally not in psychiatric-tsakh, and in somatic. At acute forkhma of S. of the item the fragmentary, dissociated and rudimentary wedges, symptoms prevail. They are defined by various forms of stupefaction — a delirium (see. Delirious syndrome), an amentia (see. An amental syndrome), devocalization (See. Devocalization ) etc. Often during psychosis there is a change of one form of stupefaction another: napr, a delirium — an amentia or devocalization, devocalizations — a delirium etc. In such cases quite often use the generalized terms «confusion of consciousness» or «conditions of senile confusion». Much less often clinically accurately outlined picture, most often in the form of a delirium meets. The picture of psychosis is fragmentarier and erased, the previous manifestations of a psychoorganic syndrome are expressed stronger. Usually a wedge, features of conditions of the dulled consciousness at S. items consist available age so-called senile lines: motive excitement takes the form of fussiness, is followed by nonsense, in particular in the form of «collecting to the road»; in crazy statements the ideas of damage, a robbery, an impoverishment prevail; hallucinations and illusions are not numerous and static; affect of alarm and fear is expressed unsharply. The disease quite often proceeds in the form of the separate repeatedly repeating flashes. During recovery manifestations of a psychoorganic syndrome of various depth and duration, and also the adynamy which is followed by an adynamia are expressed. Quite often after the postponed psychosis there is clear strengthening of dysmnesias. Heart failure, acute and chronic respiratory diseases, hypovitaminoses, diseases of uric system, and also operation, etc. are the main reasons of acute forms C. of the item, i.e. acute forms C. of the item represent symptomatic psychoses (see). Accessory factor — the decrease in sight observed approximately at a half of patients. The diagnosis of a somatopathy is often complicated since many diseases proceed at old people is erased and almost a demon-simptokhmno. Mortality in this group of patients can be very high. However at early diagnosis mental and a somatopathy after the corresponding treatment about a half of patients recovers.
Among patients hron. forms C. of the item women prevail. The states designated usually as late option of presenile melancholy (see belong to depressions. Presenile psychoses ). Despite duration of a disease (5 — 15 years and more), frustration of a pakhmyata do not exceed age or are defined by superficial dismnestichesky disturbances (see. Memory, frustration ). In genesis of such depressions the constitutional and genetic factor matters.
From crazy states most often meet paranoiac, the wedge, a picture to-rykh is limited to the small-scale nonsense of material damage and mockery similar on the features to presenile nonsense of damage (see. Presenile psychoses). Nek-ry researchers, e.g. N. F. Shakhmatov (1979), in such cases speak about late options of presenile nonsense of damage. Katamnestichesky inspection of patients showed what 10 years and more paranoiac state later begins to be reduced in connection with accession of the dysmnesias reaching in some cases the total progressing amnesia.
Gallyutsinoza demonstrate preferential or only in old age. Allocate verbal, visual and tactile gallyutsinoz. Verbal and visual gallyutsinoz call usually Bonnet's gallyutsinozam, to-ry for the first time described visual hallucinosis in 1759. The following main lines have both forms of hallucinosis of Bonnet: represent the only frustration, i.e. at it completely are absent or arise in rudimentary and tranzitor-ache to a form others psikhopatol. disturbances; the disease is combined with the expressed or total blindness (see) or deafness (see).
Verbal hallucinosis of Bonnet arises at patients, middle age to-rykh apprx. 70 years. In an onset of the illness there can be akoazma and phonemes (see Hallucinations). At height of development of psychosis the poly-vocal hallucinosis which is characterized by true verbal hallucinations is observed. In their contents abuse, threats, insults prevail, orders are more rare. Intensity of hallucinosis is subject to fluctuations. At flow of hallucinations the critical attitude towards them on a nek-swarm time is lost, the alarm and motive concern appears. In the rest of the time painful frustration are perceived with criticism. Hallucinosis amplifies in evening and night time. The current is long, long-term. Several years later after an onset of the illness it is possible to reveal dism-nestichesky frustration. Verbal hallucinosis of Bonnet needs to be differentiated with the similar states which are found at vascular and atrophic diseases of a brain, and also at schizophrenia.
Visual hallucinosis of Bonnet arises at patients, middle age to-rykh apprx. 80 years. Hallucinosis arises sharply and develops often on certain patterns. In the beginning there are separate plane visual hallucinations, then their number grows, they become stsenopodobny. In the subsequent hallucinations gain dimensions. At height of development of hallucinosis there are true visual hallucinations, multiple mobile, quite often color, the natural sizes, reduced (Lilliputian), projected in out of. Their contents are people, animals, pictures of a household situation or the nature. At the same time patients are the interested audience of the taking place events. They understand that they are in disease state, correctly estimate visible, but at the same time often do not keep and get into conversation with hallucinatory images or make actions according to contents visible, napr, set the table to feed the relatives seen by them. At flow of visual hallucinations, in particular at emergence of the hallucinatory images coming to patients or restricting them for a short time there are an alarm or fear, attempts to drive away visions. During this period the critical relation to hallucinations either decreases, or disappears absolutely. Complication of visual hallucinosis is possible also due to short-term emergence of separate tactile, olfactory or verbal hallucinations. Hallucinosis proceeds chronically, amplifying, weakening. Over time there is its gradual reduction and there are clearer dysmnesias of dismnestiche-sky type. Visual hallucinosis of Bonnet arises also in the initial period of senile dementia.
In genesis of gallyutsinoz of Bonnet the age changes happening in a brain and defeats of the peripheral analyzer — acoustical or visual matter.
Tactile hallucinosis (synonym: the dermatozoyny nonsense of Ekbom, nonsense of obsession skin parasites) arises usually at the age of 50 — 65 years. Tactile hallucinations are localized on a face, hands, in the field of an anus and generative organs, extending on the surface of skin and mucous membranes, under skin. Patients feel feelings of an itch, burning, stings, pricks, pains. They are convinced that painful feelings are connected with penetration into the corresponding body parts of small parasites (bugs, worms etc.) or the pricking inanimate objects (sand, splinters of glass). The accurate information on outward and the sizes of living beings or inanimate objects are usually supplied. Tactile hallucinosis is followed by quite often visual illusions — in skin scrapings, on the shelled its sites patients see the parasites who attacked them or the foreign bodys causing patol. feelings. In some cases joins hallucinosis hypochiondrial or nigilistic nonsense (see). Tactile hallucinosis often is followed by the irrepressible activity aiming to get rid of the imagined source of feelings. Patients see doctors, first of all dermatologists, self-medicate, continuously disinfect or wash the «struck» parts of a body, the room where they live, wash clothes. Thus, tactile hallucinosis often is followed by a crazy component. The disease proceeds regrediyentno (with simplification a wedge, pictures) or in the form of the recurrence close to attacks. Tactile hallucinosis arises in old age also at schizophrenia and vascular and atrophic processes of a brain.
Among patients with a senile paraphrenia, or senile konfabulez, persons aged prevail 68 years are more senior. For a wedge, pictures multiple confabulations are characteristic (see. Konfabulez ), contents to-rykh belongs to the past. Patients tell about the participation in unusual or significant events of social life, about acquaintances to the high-ranking people and relationship with them, to-rye usually have erotic character. These statements of patients differ in figurativeness and visualization. At patients povyshenno-euphoric affect is expressed, revaluation of own personality is clear, up to the crazy ideas of greatness. In some cases confabulations of fantastic contents are combined with the confabulations reflecting daily events of antecedents. Usually the maintenance of confabulations does not change, i.e. they as if take the form of a cliche. It concerns both the main subject, and its details. It is not possible to change contents of konfabulyatorny statements by means of appropriate questions or direct suggestion. Psychosis can exist in an invariable look within 3 — 4 years without noticeable disturbances of memory. In most cases after development of a manifest konfabulez and its stable existence there is a gradual reduction productive psikhopatol. frustration and at the same time slowly accruing disturbances of memory come to light, to-rye have preferential dismnestichesky character for a number of years and can not reach degrees of the total progressing amnesia. The senile paraphrenia demands a differentiation with a konfabulyatorny form of senile dementia, at a cut konfabulez is usually poor according to contents and represents only a short stage of a disease.
Hallucinatory-dilision states begin after 60 years with the psychopatholike frustration continuing many years, in some cases up to 10 — 15 years more often. Complication a wedge, pictures happens at the expense of paranoiac nonsense of damage and a robbery (small scope), to the Crimea the unsystematized ideas of poisoning and prosecution which are also extending to persons of the immediate environment can join. After emergence of nonsense it is quite often possible to note the expressed frustration of dismnestichesky type. The wedge, a picture changes, is preferential in 70 — 80 years, as a result of development of the polivokal-ny verbal hallucinosis similar in the manifestations to verbal hallucinosis of Bonnet. Hallucinosis can be combined with separate ideatorny avtomatizm — mental voices, feeling of openness, an echo thought (see. Kandinsky — Klerambo a syndrome ). Thus, the wedge, a picture of psychosis accepts the expressed shizofrenopodobny character. Hallucinosis quickly acquires the fantastic contents (i.e. the picture of a fantastic hallucinatory paraphrenia develops), and then is gradually replaced with crazy confabulations, and a wedge, the picture reminds a senile paraphrenia. Nek-ry patients in the subsequent have ekmnestiche-sky confabulations (shift of a situation in the past); at others — to death prevail couple - frenno-konfabulyatornye frustration; negative changes are defined by a dysmnesia without development of total weak-mindedness. Emergence of the expressed dysmnesias happens slowly, quite often mnesti-chesky disturbances arise only 12 — 17 years later after emergence of manifest symptoms of a disease.
In this S.'s genesis the item which is consistently becoming complicated and changing on a wedge, a picture, the constitutional and genetic factor is of great importance. Differential diagnosis is carried out with the hallucinatory-dilision schizophrenia demonstrating in old age.
Most part hron. Pages of the item are inherent the following general signs: restriction wedge, manifestations by only one circle of frustration, preferable one syndrome (e.g., stupefaction, depressive or paranoiac syndrome); expressiveness psikhopatol. disturbances, allowing to qualify accurately arisen psychosis; long existence of productive frustration and only their gradual reduction; duration of a combination of productive frustration to sufficient safety of intelligence, in particular memories (at the same time there is a slow impoverishment of productive frustration); dysmnesias rather seldom reach degree of the total progressing amnesia, much more often they are limited to dismne-stichesky frustration, napr, at such patients is long held affektny in remembrance — the memoirs connected with emotional influences; when psychosis is accompanied by the vascular disease which is shown usually arterial hypertension, it comes to light preferential after 60 years and proceeds at most of patients is good-quality (without strokes) and is not followed by an adynamy, most of patients keeps, despite psychosis, a considerable physical activity, they, as a rule, have no slowness of movements, edges is inherent to patients with vascular diseases of a brain.
Items carry out S.'s treatment by propazine, Stelazinum, aminazine, a haloperidol, amitriptyline, Theralenum (doses gradually increase them) in combination with proofreaders (Cyclodolum, etc.). Use is shown nootropic means (see). Treatment of the accompanying somatopathies is obligatory.
The forecast concerning recovery adverse. Treatment psikhofarmakol. means only weakens productive frustration. Patients die of intercurrent diseases, is frequent in an extreme old age, seldom death comes in a condition of marasmus.
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H. G. Shumsky.