From Big Medical Encyclopedia

SYMPTOMATIC PSYCHOSES (Greek symptomatikos accidental, spontaneous; psychoses; synonym exogenous psychoses) — the mental disorders, various on depth and weight, arising at somatic (infectious and noninfectious) diseases and intoxications. Pages of the item are one of manifestations and (or) the investigations of a basic disease.

There is a point of view that the item should carry to S. only somatopsychoses, i.e. diseases, in that, time as the psychoses developing at intoxications to allocate psychoses observed at somatic (noninfectious and infectious) in independent group — intoksikatsionny psychoses (see). However full identity of sharply developing psychoses with stupefaction at acute poisonings and long endoformny psychoses (similar to psychoses at endogenous diseases) allows to describe intoksikatsionny psychoses in group C. of the item.

The doctrine about S. is considerably connected by the item with a name of K. Bongeffer, to-ry not only described typical exogenous psychoses — exogenous type of reactions (devocalization, a delirium, an amentia, epileptiform excitement, acute verbal hallucinosis), but also expressed not specificity of the mental disorders arising at influence of exogenous vrednost. In a crust, time does not arise doubts that the nonspecific exogenous reactions described by K. Bongeffer (are characteristic of separate somatopathies and intoxications see. Bongeffera exogenous types of reactions ). It was shown also that along with exogenous type of reactions at S. of the item there are endoformny psychoses — depressions (see. Depressive syndromes ), depressive and paranoid, maniacal states (see. Maniacal syndromes ) and paranoid states (see. Paranoid syndrome ). The form C. of the item depends on intensity and duration of impact on an organism of the reason (harm). At the same time the age matters, in Krom there is S. of the item. So, at chest age reaction to harm is limited to a convulsive syndrome, at more advanced age epileptiform excitement most often develops, at mature age practically all types of classical exogenous reactions and endoformny psychoses meet, at senile age pictures of a delirium are most characteristic (see. Delirious syndrome ) with explicit dissociation between its abortivnost and short duration and a serious somatic condition of the patient.

A clinical picture

items divide S. on acute and protragirovanny (synonym: long, intermediate, transitional syndromes according to Vick, late symptomatic psychoses). Acute S. of the item in most cases proceed with syndromes of obscuring consciousnesses (see) — devocalization (see), a delirium, an amentia (see. Amental syndrome ), epileptiform and oneiric states (see. Oneiric syndrome ), acute verbal hallucinosis (see. Hallucinations ); protragirovanny S. of the item — with depressions, depressive and paranoid, gallyutsinatornoparanoidny states, an apathetic stupor (see. Struporous states ), manias, pseudoparalytic states, on a wedge, to features close to paralytic to weak-mindedness (see), with psychotic korsakovsky episode (see. Korsakovsky syndrome ), konfabulezy (see).

Acute S. of the item are preceded by asthenic frustration with the increased physical and mental fatigue, the phenomena of irritable weakness, a hyperesthesia (see. Asthenic syndrome ). Against the background of an adynamy acute S. of the item develops, the basis to-rogo, as a rule, is made by a syndrome of stupefaction. In one cases the wedge, a picture C. of the item is exhausted by one syndrome of stupefaction, in others (at an aggravation of symptoms) this syndrome is replaced by other syndrome of stupefaction. So, at height of a delirium the picture of a professional or mussitans delirium can develop (see. Delirious syndrome ); also transition of a delirium to an amentia or change by its devocalization are possible. Such modification a wedge, pictures C. of the item always testifies to an adverse current of a basic disease and deterioration in a somatic condition of the patient.

At protragirovanny S. of the item against the background of asthenic frustration there are endoformny syndromes (depressive, paranoid, maniacal, etc.), and exogenous types of reactions appear episodes. Protragirovannye S. items can be shown by one psikhopatol. a state or this state is replaced by another. So, after a depression development of a depressive and paranoid and hallucinatory paranoid state, then apathetic stupor is observed. Similar change of states (a pathokinesis of syndromes) reflects increase of weight of a somatic condition of the patient. Similarly it is necessary to consider also change of a maniacal state pseudoparalytic with the subsequent development of konfabulyatorny confusion.

Acute S.' transformation the item in protragirovanny demonstrates that the acute current of a basic disease passes in subacute or chronic. Believe that protragirovanny S.' development by the item, and first of all endoformny states, is caused by development of a cachexia. In this regard protragirovanny S.' place of the item in classification of exogenous psychoses by many researchers is disputed. There is a point of view that in the absence of signs of a cachexia about-tragirovanny S. the item, apparently, is the endogenous process developing at persons with somatopathies and thereof has a number of features psikhopatol. manifestations of these states.

An etiology

In the Soviet psychiatry items connect S.'s emergence with somatopathies (infectious and noninfectious) and intoxications.

A pathogeny

the Same reason (harm) can cause acute and protragirovanny S. of the item, in some cases lead to organic changes of a brain. Distribution was gained by the point of view of G. Specht, according to a cut acute S. items with stupefaction arise at influence of intensive, but short harm while protragirovanny S. of the item with endoformny pictures arise at long influence of harm of weaker intensity.

The understanding of conditions of development of S. of the item requires carrying out a careful constitutional and genetic research of patients, first of all that who have endoformny psychoses or other types of the psychotic states which are beyond classical exogenous types of reactions of Bongef-fer.

The diagnosis

the Diagnosis is established on the basis by a wedge, pictures (existence of a somatopathy and psikhopatol. state).

Differential diagnosis is carried out with endogenous diseases, as a rule, of attacks schizophrenia (see) or phases maniacal depressive psychosis (see), provoked it is exogenous. The greatest difficulties at the same time arise at the beginning of an attack. However further the lines inherent to an endogenous disease become more obvious. In some cases S. of the item needs to be differentiated with febrile attacks of schizophrenia, for to-rykh the picture of catatonic excitement or a stupor with oneiric stupefaction at the beginning of an attack is characteristic (see. Catatonic syndrome ). Catatonic frustration at S. of the item can arise at the remote stages of development of psychosis. Asthenic frustration or states emotional giperesteticheskoy weaknesses are characteristic of involution of S. of the item.

Treatment, first of all, is directed to elimination of the reason which caused a basic disease. Treatment of psychotic states is carried out depending on character psikhopatol. pictures. Acute S. the item with various syndromes of stupefaction, excepting devocalization, and also with the phenomena of acute hallucinosis are successfully treated by aminazine. At protragirovanny S. the wedge, pictures is recommended to the item depending on features aminazine, Theralenum, Frenolonum, amitriptyline.

The forecast depends on a current of a basic disease. At a favorable outcome items pass acute S. completely. If the basic disease gets subacute or hron. the current is also followed by protragirovanny S.'s development by the item, there is a basis to believe that at the patient these or those lines can develop psychoorganic syndrome (see).

Prevention consists in timely recognition of a basic disease, assessment of its weight and purpose of adequate treatment.

Bibliography: Vangengeym K. A., Trifonov B. A. and Yu joint stock company about in V. N. Patomorfoz of somatogenic mental diseases on materials of kliniko-pathomorphologic comparisons, in book: New data on a pathogeny, clinic and treatment nervn. and psikhich. having got sick., under the editorship of G. V. Morozov, etc., page 82; Chisinau, 1977; Dvorkina N. Ya. Infectious psychoses, M., 1975; Polishchuk I. A. Modern problems of toxi-infectious and other somatopsychoses, Doctor, business, No. 9, page 1, 1974; Tselibeev B. A. Mental disturbances at somatopathies, M., 1972; Fleck U. Sympto-matische Psy chosen, Fortschr. Neurol. Psychiat., Bd 28, S. 1, 1960; W i e with k H. H. Zur Klinik der sogenannten symptomati-schen Psychosen, Dtsch. med. Wschr., S. 1345, 1956.

A.S. Tiganov.