Manic-depressive psychosis: causes, signs, course. Affective insanity

Psychosis- a mental illness in which a person cannot adequately perceive the surrounding reality and respond to it appropriately. Psychoses are very diverse in their manifestations. They accompany many diseases, such as schizophrenia, senile dementia, delirium tremens, or may be an independent pathology.

So what is psychosis?

This is a mental disorder in which reality is so distorted in the mind of a person that this “picture” no longer has anything to do with what other people see. Being objective prevents a person from constant fear for his life, voices in his head that order him to do something, visions that are not available to anyone else ... These internal prisms change the patient's behavior. His reactions become completely inadequate: causeless laughter or tears, anxiety or euphoria. All patients with psychosis manifest differently. Some are sure that special services are hunting for them, others assure others of their superpowers, and still others persistently pursue the object of their love, groundlessly laying claim to it. It is impossible to list all the manifestations of psychosis, but psychiatrists managed to systematize them by combining them into groups.

Psychosis is not just a wrong train of thought. One should not think that the sick person is deluded or cannot keep his nerves under control. Do not argue and even more so condemn him. Psychosis is the same disease as diabetes mellitus. This is also a violation of metabolic processes, but only in the brain. You are not afraid of diabetics, you do not condemn them for their disease. You sympathize with them. Patients with neurosis deserve the same attitude. By the way, scientists have proven that mentally healthy people commit crimes more often than those with psychosis.

Don't label a person. Psychosis is not a life sentence. It happens that after a period of illness, which can be quite difficult, the psyche is completely restored and problems never arise again. But more often the disease has a cyclical nature. In this case, after a long period of health, an exacerbation occurs: hallucinations and delusions appear. This happens if you do not strictly follow the recommendations of the attending physician. In severe cases, the disease becomes chronic, and mental health does not return.

Psychosis is a fairly common problem. According to statistics, 15% of patients in mental hospitals are patients with psychosis. And 3-5% of the total population suffer from psychosis caused by various diseases: asthma, cerebral atherosclerosis, etc. But there are still thousands of people whose psychosis is associated with external causes - taking drugs, alcohol, medicines. To date, doctors cannot calculate the exact number of patients with psychosis.

Psychosis affects both children and adults, both men and women. But some forms of the disease predominantly affect women. So, women suffer from manic-depressive syndrome 3-4 times more often. Psychoses are more likely to occur during menstruation, menopause, and after childbirth. This suggests that mental illness is associated with fluctuations in hormone levels in the female body.

If you or someone close to you has signs of psychosis, do not despair. Modern medicine successfully copes with this disease. And the notorious "accounting" was replaced by the consultation of the local psychiatrist - consultative and medical assistance. Therefore, the fact of treatment will not spoil your future life in any way. But attempts to cope with the disease on their own can lead to irreparable changes in the psyche and to disability.

Causes of psychosis

If the mitochondria are not producing ATP, then the pump is not working. As a result, cell activity is disrupted. This neuron remains “hungry” and experiences an oxygen deficiency, despite the fact that a person eats normally and gets enough fresh air.

Neurons in which the chemical balance is disturbed cannot form and transmit nerve impulses. They disrupt the entire central nervous system, leading to the development of psychosis. Depending on which parts of the brain are more affected, the manifestations of the disease depend. For example, lesions in the subcortical emotional centers lead to manic-depressive psychosis.

Factors and pathologies that lead to psychosis

1. Bad heredity.

   There is a group of genes that are passed from parents to children. These genes control the sensitivity of the brain to external influences and signal substances. For example, the neurotransmitter dopamine, which causes a feeling of pleasure. People with burdened heredity are more susceptible to the influence of negative factors, whether it be illness or psychological trauma. Their psychosis develops at an early age, quickly and in severe form.

   If both parents are sick, there is a 50% chance that the child will have psychosis. If only one of the parents is sick, then the risk for the child is 25%. If the parents did not suffer from psychosis, then their children may also face such a problem, having received “defective genes” from past generations.

2. Brain Injuries:
   • injuries received by the child during childbirth;
   • bruises and concussions of the brain;
   • closed and open craniocerebral injuries.
   A mental disorder may occur hours or weeks after the injury. There is a pattern, the more severe the injury, the stronger the manifestations of psychosis. Traumatic psychosis is associated with an increase in intracranial pressure and has a cyclical nature - periods of manifestation of psychosis are replaced by periods of mental health. When the pressure rises, the symptoms of psychosis worsen. When the outflow of cerebrospinal fluid improves, then relief comes.
3. brain poisoning can be caused by various substances.
4. Diseases of the nervous system: multiple sclerosis, epilepsy, stroke, Alzheimer's disease, Parkinson's disease, temporal lobe epilepsy These diseases of the brain cause damage to the bodies of nerve cells or their processes. The death of the cells of the cortex and deeper structures of the brain causes swelling of the surrounding tissue. As a result, the functions for which the damaged areas of the brain are responsible are disrupted.
5. Infectious diseases: influenza, mumps (mumps), malaria, leprosy, Lyme disease. Living and dead microorganisms secrete toxins that poison nerve cells and cause their death. Intoxication of the brain negatively affects the emotions and thinking of a person.
6. brain tumors. Cysts, benign and malignant tumors compress the surrounding brain tissues, disrupt blood circulation, and the transfer of excitation from one brain structure to another. Nerve impulses are the basis of emotions and thinking. Therefore, a violation of the passage of the signal manifests itself in the form of psychosis.
7. Bronchial asthma. Severe asthma attacks are accompanied by panic attacks and oxygen starvation of the brain. Lack of oxygen for 4-5 minutes causes the death of nerve cells, and stress disrupts the smooth functioning of the brain, leading to psychosis.
8. Diseases accompanied by severe pain Key words: ulcerative colitis, sarcoidosis, myocardial infarction. Pain is stress and anxiety. Therefore, physical suffering always has a negative impact on emotions and the psyche.
9. systemic diseases, associated with impaired immunity: systemic lupus erythematosus, rheumatism. The nervous tissue suffers from toxins secreted by microorganisms, from damage to the cerebral vessels, from an allergic reaction that occurs with systemic diseases. These disorders lead to a failure of higher nervous activity and psychosis.
10. Lack of vitamins B1 and B3 that affect the functioning of the nervous system. They are involved in the production of neurotransmitters, ATP molecules, normalizes metabolism at the cellular level, positively affect the emotional background and mental abilities of a person. Vitamin deficiency makes the nervous system more sensitive to external factors that cause psychosis.
11. Electrolyte imbalance associated with deficiency or excess of potassium, calcium, sodium, magnesium. Such changes can be caused by persistent vomiting or diarrhea when electrolytes are washed out of the body, prolonged diets, uncontrolled use of mineral supplements. As a result, the composition of the cytoplasm in nerve cells changes, which negatively affects their functions.
12. hormonal disorders, caused by abortion, childbirth, disruption of the ovaries, thyroid gland, pituitary gland, hypothalamus, adrenal glands. Prolonged hormonal imbalance disrupts the brain. There is a direct relationship between the nervous system and the endocrine glands. Therefore, strong fluctuations in hormone levels can cause acute psychoses.
13. Mental trauma: severe stress, situations in which life was endangered, loss of a job, property or loved one, and other events that radically change future life. Nervous exhaustion, overwork and lack of sleep also provoke mental disorders. These factors disrupt blood circulation, the transmission of nerve impulses between neurons, metabolic processes in the brain and lead to the appearance of psychosis.

Risk factors for psychosis

Different psychoses manifest themselves in different periods of a person's life. For example, in adolescence, when a hormonal explosion occurs, the likelihood of schizophrenia is high.

Manic-depressive psychosis most often affects young active people. At this age, fateful changes occur, which are a heavy burden on the psyche. This is admission to a university, finding a job, starting a family.

In the period of maturity, syphilitic psychoses occur. Since changes in the psyche begin 10-15 years after infection with syphilis.

In old age, the appearance of psychosis is associated with menopause in women, age-related changes in blood vessels and nerve cells. Violation of blood circulation and destruction of nervous tissue leads to senile psychosis.

gender factor

The number of men and women suffering from psychosis is about the same. But some types of psychosis can affect more members of the same sex. For example, manic-depressive (bipolar) psychosis in women develops 3 times more often than in men. And monopolar psychosis (attacks of depression without a period of excitement) has the same tendency: there are 2 times more female representatives among patients. Such statistics are explained by the fact that the female body often experiences hormonal surges that affect the functioning of the nervous system.

In men, psychosis due to chronic alcoholism, syphilitic and traumatic psychosis are more common. These "male" forms of psychosis are not associated with the level of hormones, but with the social role, the behavior of the stronger sex. But early cases of psychosis in Alzheimer's disease in men are associated with genetic characteristics.

Geographic factor

It has been noticed that mental illnesses, including psychosis, more often affect residents of large cities. And those who live in small towns and in rural areas are less at risk. The fact is that life in megacities has a high pace and is full of stress.

Illumination, average temperature and daylight hours have little effect on the prevalence of diseases. However, some scientists note that people born in the northern hemisphere during the winter months are more prone to developing psychosis. The mechanism of development of the disease in this case has not been elucidated.

social factor

Psychosis often appears in people who have failed to realize themselves socially:

• women who did not marry did not give birth to a child;
• men who could not build a career, succeed in society;
• people who are not satisfied with their social status, have not been able to show their inclinations and abilities, have chosen a profession that does not correspond to their interests.

Psychophysiological constitution factor

Hippocrates described 4 types of temperament. He divided all people into melancholic, choleric, phlegmatic and sanguine. The first two types of temperament are considered unstable and therefore more prone to the development of psychosis.

Kretschmer singled out the main types of psychophysiological constitution: schizoid, cycloid, epileptoid and hysteroid. Each of these types is equally at risk of developing psychosis, but depending on the psychophysiological constitution, the manifestations will differ. For example, the cycloid type is prone to manic-depressive psychosis, and the hysteroid type is more likely to get hysteroid psychosis than others, and has a high tendency to attempt suicide.

How does psychosis manifest?

The main manifestations of psychosis

hallucinations. They can be auditory, visual, tactile, gustatory, olfactory. The most common are auditory hallucinations. The person seems to hear voices. They can be in the head, come from the body, or come from outside. The voices are so real that the patient does not even doubt their authenticity. He perceives this phenomenon as a miracle or a gift from above. Voices are threatening, accusing or commanding. The latter are considered the most dangerous, since a person almost always follows these orders.

You can guess that a person has hallucinations by the following signs:

• He suddenly freezes and listens to something;
• Sudden silence in the middle of a phrase;
• Conversation with oneself in the form of replicas to someone's phrases;
• Laughter or depression for no apparent reason;
• The person cannot concentrate on a conversation with you, stares at something.

1. Manifestations of depressive disorders:
   • A person sits in one position for a long time, he has no desire and strength to move or communicate.
   • Pessimistic attitude, the patient is dissatisfied with his past, present, future and the whole environment.
   • To alleviate anxiety, a person can constantly eat or vice versa, completely refuse food.
   • Sleep disturbances, early awakenings at 3-4 o'clock. It is at this time that mental suffering is most severe, which can lead to a suicide attempt.
2. Manic symptoms:
   • A person becomes extremely active, moves a lot, sometimes aimlessly.
   • Unprecedented sociability, verbosity appears, speech becomes fast, emotional, and may be accompanied by grimacing.
   • Optimistic attitude, a person does not see problems and obstacles.
   • The patient builds unrealizable plans, significantly overestimates his strength.
   • The need for sleep decreases, the person sleeps little, but feels vigorous and rested.
   • The patient may abuse alcohol, engage in promiscuity.

Delusion is a mental disorder that manifests itself in the form of an idea that does not correspond to reality. A hallmark of delusions is that you can't convince a person with logical arguments. In addition, the patient always tells his crazy ideas very emotionally and is firmly convinced that he is right.

Distinctive signs and manifestations of delirium

• Brad is very different from reality. Incomprehensible cryptic statements appear in the patient's speech. They may relate to his guilt, doom, or vice versa greatness.
• The patient's personality always takes center stage. For example, a person not only believes in aliens, but also claims that they flew in specifically to establish contact with him.
• Emotionality. A person very emotionally talks about his ideas, does not accept objections. He does not tolerate disputes about his idea, immediately becomes aggressive.
• Behavior obeys a delusional idea. For example, he may refuse to eat, fearing that they want to poison him.
• Unreasonable defensive actions. A person curtains windows, installs additional locks, fears for his life. These are manifestations of delusions of persecution. A person is afraid of the special services that follow him with the help of innovative equipment, aliens, "black" magicians who send damage to him, acquaintances who conspire around him.
• Delusions related to one's own health (hypochondriac). The person is convinced that he is seriously ill. He "feels" the symptoms of the disease, insists on numerous repeated examinations. Angry at doctors who can't find the reason for feeling unwell and don't confirm his diagnosis.
• Delusion of damage manifests itself in the belief that ill-wishers spoil or steal things, pour poison into food, act with the help of radiation, want to take away the apartment.
• Brad of invention. A person is confident that he has invented a unique device, a perpetual motion machine, or a way to fight a dangerous disease. He fiercely defends his invention, persistently trying to bring it to life. Since the patients are not mentally impaired, their ideas can sound quite convincing.
• Love delirium and delirium of jealousy. A person concentrates on his emotions, pursues the object of his love. He comes up with a reason for jealousy, finds evidence of betrayal where there is none.
• Brad of litigation. The patient floods various authorities and the police with complaints about his neighbors or organizations. Files numerous lawsuits.

1. Lethargy or stupor. A person freezes in one position, for a long time (days or weeks) remains without movement. He refuses food and communication.


2. Motor excitement. Movements become fast, jerky, often aimless. The facial expressions are very emotional, the conversation is accompanied by grimaces. Can mimic someone else's speech, imitate the sounds of animals. Sometimes a person is unable to perform simple tasks due to the fact that he loses control over his movements.

What to do if someone close to you has alarming symptoms?

Convince the person to seek psychiatric help. Explain that the doctor will prescribe medications that will help to calm down, it is easier to endure stressful situations.
Types of psychosis

The most common are manic and depressive psychoses - in an outwardly healthy person, signs of depression or significant arousal suddenly appear. Such psychoses are called monopolar - the deviation occurs in one direction. In some cases, the patient may alternately show signs of both manic and depressive psychosis. In this case, doctors talk about bipolar disorder - manic-depressive psychosis.

manic psychosis

depressive psychosis

Depressive psychosis is the opposite of manic psychosis. He also has triad of characteristic symptoms

1. pathologically depressed mood

   Thoughts are centered around your personality, your mistakes and your shortcomings. Concentration on one's own negative sides gives rise to the belief that everything was bad in the past, the present cannot please with anything, and in the future everything will be even worse than it is now. On this basis, a person with depressive psychosis can lay hands on himself.

   Since a person's intellect is preserved, he can carefully hide his desire for suicide so that no one violates his plans. At the same time, he does not show his depressed state and assures that he is already better. At home, it is not always possible to prevent a suicide attempt. Therefore, people with depression who are focused on self-destruction and their own low value are treated in a hospital.

   A sick person experiences unreasonable longing, it crushes and oppresses. It is noteworthy that he can practically show with his finger where unpleasant sensations are concentrated, where “the soul hurts”. Therefore, this condition even received the name - precordial longing.

   Depression in psychosis has a distinguishing feature: the condition is worst in the early morning, and by the evening it improves. The person explains this by the fact that in the evening there are more worries, the whole family gathers and this distracts from sad thoughts. But with depression caused by neurosis, on the contrary, the mood worsens in the evening.

   Characteristically, in the acute period of depressive psychosis, patients do not cry. They say they would like to cry, but there are no tears. Therefore, crying in this case is a sign of improvement. Both patients and their relatives should remember this.

2. Mental retardation

   Mental and metabolic processes in the brain proceed very slowly. This may be due to a lack of neurotransmitters: dopamine, norepinephrine and serotonin. These chemicals ensure proper signal transmission between brain cells.

   As a result of a deficiency of neurotransmitters, memory, reaction, and thinking deteriorate. A person quickly gets tired, does not want to do anything, he is not interested in anything, does not surprise and does not please. From them you can often hear the phrase “I envy other people. They can work, relax, have fun. I'm sorry I can't."

   The patient constantly looks gloomy and sad. The look is dull, unblinking, the corners of the mouth are lowered, avoids communication, tries to retire. He slowly reacts to the appeal, answers in monosyllables, reluctantly, in a monotonous voice.

3. Physical retardation

   Depressive psychosis physically changes a person. Appetite falls, and the patient quickly loses weight. Therefore, weight gain with depression says that the patient is on the mend.

   A person's movements become extremely slow: a slow, uncertain gait, stooped shoulders, a lowered head. The patient feels a loss of strength. Any physical activity worsens the condition.

   In severe forms of depressive psychosis, a person falls into a stupor. He can sit for a long time without moving, looking at one point. If you try to read notations at this time; “get together, pull yourself together”, then only aggravate the situation. A person will have the thought: “I have to, but I can’t – that means I’m bad, good for nothing.” He cannot overcome depressive psychosis by an effort of will, since the production of norepinephrine and serotonin does not depend on our desire. Therefore, the patient needs qualified assistance and medical treatment.

   There are a number of physical signs of depressive psychosis: diurnal mood swings, early awakenings, weight loss due to poor appetite, menstrual irregularities, dry mouth, constipation, some people may develop insensitivity to pain. These signs indicate that you need to seek medical attention.

   Basic rules for communicating with patients with psychosis

   1. Do not argue or object to people if you see signs of manic arousal in them. This can provoke an attack of anger and aggression. As a result, you can completely lose trust and turn the person against you.
   2. If the patient shows manic activity and aggression, keep calm, self-confidence and goodwill. Take him away, isolate him from other people, try to calm him down during the conversation.
   3. 80% of suicides are committed by patients with psychosis in the stage of depression. Therefore, be very attentive to loved ones during this period. Don't leave them alone, especially in the morning. Pay special attention to signs warning of a suicide attempt: the patient talks about an overwhelming sense of guilt, about voices ordering to kill himself, about hopelessness and uselessness, about plans to end his life. Suicide is preceded by a sharp transition of depression into a bright, peaceful mood, putting affairs in order, drawing up a will. Do not ignore these signs, even if you think that this is just an attempt to attract attention to yourself.
   4. Hide all items that can be used in a suicide attempt: household chemicals, medicines, weapons, sharp objects.
   5. Eliminate the traumatic situation if possible. Create a calm environment. Try to keep the patient surrounded by loved ones. Reassure him that he is now safe and everything is over.
   6. If a person is delusional, do not ask clarifying questions, do not ask for details (What do aliens look like? How many are there?). This may make the situation worse. "Seize on" any non-delusional statement he utters. Develop the conversation in that direction. You can focus on the person's emotions by asking, “I see you're upset. How can I help you?"
   7. If there are signs that the person has experienced hallucinations, then calmly and confidently ask him what happened now. If he saw or heard anything unusual, then find out what he thinks and feels about it. To cope with hallucinations, you can listen to loud music with headphones, do something exciting.
   8. If necessary, you can firmly recall the rules of behavior, ask the patient not to scream. But do not ridicule him, argue about hallucinations, say that it is impossible to hear voices.
   9. Do not seek help from traditional healers and psychics. Psychosis is very diverse, and for effective treatment it is necessary to accurately determine the cause of the disease. For this, it is necessary to use high-tech diagnostic methods. If you lose time on treatment with non-traditional methods, then acute psychosis will develop. In this case, it will take several times more time to fight the disease, and in the future it will be necessary to constantly take medication.
   10. If you see that the person is relatively calm and ready to communicate, try to convince him to see a doctor. Explain that any symptoms of illness that are bothering him can be relieved with medication prescribed by the doctor.
   11. If your relative flatly refuses to go to a psychiatrist, persuade him to go to a psychologist or psychotherapist to deal with depression. These specialists will help convince the patient that there is nothing to worry about in a visit to a psychiatrist.
   12. The most difficult step for loved ones is to call the psychiatric emergency team. But this must be done if a person directly declares his intention to end his life, can injure himself or harm other people.

   Psychological treatments for psychosis

   In psychosis, psychological methods successfully complement drug treatment. A psychotherapist can help a patient:
   • reduce the symptoms of psychosis;
   • avoid relapses;
   • raise self-esteem;
   • learn to adequately perceive the surrounding reality, correctly assess the situation, one's condition and respond accordingly, correct behavioral errors;
   • eliminate the causes of psychosis;
   • improve the effectiveness of medical treatment.
   Remember, psychological treatments for psychosis are used only after the acute symptoms of psychosis have been relieved.

   Psychotherapy eliminates personality disorders that occurred during the period of psychosis, puts thoughts and ideas in order. Working with a psychologist and psychotherapist makes it possible to influence future events and prevent the recurrence of the disease.

   Psychological treatments are aimed at restoring mental health and at socializing a person after recovery in order to help him feel comfortable in the family, work team and society. This treatment is called psychosocialization.

   Psychological methods that are used to treat psychosis are divided into individual and group. During individual sessions, the psychotherapist replaces the personal core lost during the illness. It becomes an external support for the patient, calms him down and helps to correctly assess reality and adequately respond to it.

   group therapy helps to feel like a member of society. A group of people struggling with psychosis is led by a specially trained person who has managed to successfully cope with this problem. This gives patients hope for recovery, helps to overcome awkwardness and return to normal life.

   In the treatment of psychosis, hypnosis, analytical and suggestive (from Latin Suggestio - suggestion) methods are not used. When working with altered consciousness, they can lead to further mental disorders.

   Good results in the treatment of psychosis are given by: psychoeducation, addiction therapy, cognitive behavior therapy, psychoanalysis, family therapy, occupational therapy, art therapy, as well as psychosocial trainings: social competence training, metacognitive training.

   Psychoeducation is the education of the patient and his family members. The psychotherapist talks about psychosis, about the features of this disease, the conditions for recovery, motivates them to take medication and lead a healthy lifestyle. Tells relatives how to behave with the patient. If you disagree with something or have questions, then be sure to ask them at the time specially allotted for discussions. It is very important for the success of the treatment that you have no doubts.

   Classes are held 1-2 times a week. If you visit them regularly, then you will form the right attitude towards the disease and drug treatment. Statistics say that thanks to such conversations, it is possible to reduce the risk of repeated episodes of psychosis by 60-80%.

   addiction therapy necessary for those people whose psychosis has developed against the background of alcoholism and drug addiction. Such patients always have an internal conflict. On the one hand, they understand that they should not use drugs, but on the other hand, there is a strong desire to return to bad habits.

   Classes are held in the form of an individual conversation. A psychotherapist talks about the relationship between drug use and psychosis. He will tell you how to behave in order to reduce the temptation. Addiction therapy helps build a strong motivation to abstain from bad habits.

   Cognitive (behavioral) therapy. Cognitive therapy is recognized as one of the best treatments for psychosis accompanied by depression. The method is based on the fact that erroneous thoughts and fantasies (cognitions) interfere with the normal perception of reality. During the sessions, the doctor will bring out these wrong judgments and the emotions associated with them. He will teach you how to be critical of them, and not let these thoughts influence your behavior, tell you how to look for alternative ways to solve the problem.

   To achieve this goal, a protocol of negative thoughts is used. It contains the following columns: negative thoughts, the situation in which they arose, the emotions associated with them, the facts “for” and “against” these thoughts. The course of treatment consists of 15-25 individual sessions and lasts 4-12 months.

   Psychoanalysis. Although this technique is not used to treat schizophrenia and affective (emotional) psychoses, its modern "supportive" version is effectively used to treat other forms of the disease. At individual meetings, the patient reveals his inner world to the psychoanalyst and transfers to him feelings directed at other people. During the conversation, the specialist identifies the reasons that led to the development of psychosis (conflicts, psychological trauma) and the defense mechanisms that a person uses to protect himself from such situations. The treatment process takes 3-5 years.

   Family Therapy - group therapy, during which the specialist conducts classes with family members where the patient with psychosis lives. Therapy is aimed at eliminating conflicts in the family, which can cause exacerbations of the disease. The doctor will talk about the features of the course of psychosis and the correct behavior in crisis situations. Therapy is aimed at preventing relapses and ensuring that all family members are comfortable living together.

   Ergotherapy. This type of therapy is most often group therapy. The patient is recommended to attend special classes where he can engage in various activities: cooking, gardening, working with wood, textiles, clay, reading, writing poetry, listening to and writing music. Such activities train memory, patience, concentration, develop creative abilities, help open up, establish contact with other members of the group.

   The specific setting of tasks, the achievement of simple goals gives the patient confidence that he again becomes the master of his life.

   Art therapy - method of art therapy based on psychoanalysis. It is a “no-words” healing method that activates the possibilities for self-healing. The patient creates a picture expressing his feelings, an image of his inner world. Then the specialist studies it from the point of view of psychoanalysis.
   
   Social competence training. A group activity in which people learn and put into practice new forms of behavior in order to apply them in everyday life. For example, how to behave when meeting new people, when applying for a job or in conflict situations. In subsequent sessions, it is customary to discuss the problems that people encountered when implementing them in real situations.

   metacognitive training. Group training sessions that are aimed at correcting the thinking errors that lead to delusions: distorted attribution of judgments to people (he does not love me), hasty conclusions (if he does not love, he wants me dead), depressive way of thinking, inability to empathize , feel other people's emotions, painful confidence in memory impairment. The training consists of 8 sessions and lasts 4 weeks. At each module, the trainer analyzes thinking errors and helps to form new models of thoughts and behavior.

   Psychotherapy is widely used in all forms of psychosis. It can help people of all ages, but is especially important for teenagers. At a time when life attitudes and stereotypes of behavior are just being formed, psychotherapy can radically change life for the better.

   Drug treatment of psychoses

   Medicinal treatment of psychosis is a prerequisite for recovery. Without it, it will not be possible to get out of the trap of the disease, and the condition will only worsen.

   There is no single drug therapy for psychosis. The doctor prescribes drugs strictly individually, based on the manifestations of the disease and the characteristics of its course, gender and age of the patient. During treatment, the doctor monitors the patient's condition and, if necessary, increases or reduces the dose in order to achieve a positive effect and not cause side effects.

   Treatment of manic psychosis

   Drug group	The mechanism of the treated action	Representatives	How is it prescribed
   Antipsychotic drugs (neuroleptics)	They are used for all forms of psychosis. Block dopamine receptors. This substance is a neurotransmitter that promotes the transfer of excitation between brain cells. Thanks to the action of neuroleptics, it is possible to reduce the severity of delusions, hallucinations and thought disorders.	Solian (effective for negative disorders: lack of emotions, withdrawal from communication)	In the acute period, 400-800 mg / day is prescribed, up to a maximum of 1200 mg / day. Take with or without food. Maintenance dose 50-300 mg / day.
   		Zeldox	40-80 mg 2 times a day. The dose is increased over 3 days. The drug is administered orally after meals.
   		Fluanxol	The daily dose is 40-150 mg / day, divided into 4 times. Tablets are taken after meals. The drug is also produced in the form of a solution for injection, which is done 1 time in 2-4 weeks.
   Benzodiazepines	They are prescribed for acute manifestations of psychosis in conjunction with antipsychotic drugs. They reduce the excitability of nerve cells, have a calming and anticonvulsant effect, relax muscles, eliminate insomnia, and reduce anxiety.	Oxazepam	Take 5-10 mg twice or thrice a day. If necessary, the daily dose can be increased to 60 mg. The drug is taken regardless of food, drinking plenty of water. The duration of treatment is 2-4 weeks.
   		Zopiclone	Take 7.5-15 mg 1 time per day half an hour before bedtime, if psychosis is accompanied by insomnia.
   Mood stabilizers (normotimics)	Normalize mood, preventing the onset of manic phases, make it possible to control emotions.	Actinerval (derivative of carbamazepine and valproic acid)	The first week the daily dose is 200-400 mg, it is divided into 3-4 times. Every 7 days, the dose is increased by 200 mg, bringing up to 1 g. The drug is also canceled gradually so as not to cause a deterioration in the condition.
   		Contemnol (contains lithium carbonate)	Take 1 g per day once in the morning after breakfast, drinking plenty of water or milk.
   Anticholinergic drugs (anticholinergics)	Necessary to neutralize side effects after taking antipsychotics. Regulates the sensitivity of the nerve cells of the brain, blocking the action of the mediator acetylcholine, which ensures the transmission of nerve impulses between the cells of the parasympathetic nervous system.	Cyclodol, (Parkopan)	The initial dose is 0.5-1 mg / day. If necessary, it can be gradually increased to 20 mg / day. Multiplicity of reception 3-5 times a day, after meals.

   Treatment of depressive psychosis

   Drug group	The mechanism of the treated action	Representatives	How is it prescribed
   Antipsychotic drugs	They make brain cells less sensitive to excess amounts of dopamine, a substance that promotes signaling in the brain. Drugs normalize thought processes, eliminate hallucinations and delusions.	Quentiax	During the first four days of treatment, the dose is increased from 50 to 300 mg. In the future, the daily dose may be from 150 to 750 mg / day. The drug is taken 2 times a day, regardless of food intake.
   		Eglonil	Tablets and capsules are taken 1-3 times a day, regardless of food intake. Daily dose of 50 to 150 mg for 4 weeks. The drug is not advisable to use after 16 hours, so as not to cause insomnia.
   		Rispolept Konsta	A suspension is prepared from microgranules and the solvent included in the kit, which is injected into the gluteal muscle 1 time in 2 weeks.
   		Risperidone	The initial dose is 1 mg 2 times a day. Tablets of 1-2 mg are taken 1-2 times a day.
   Benzodiazepines	It is prescribed for acute manifestations of depression and severe anxiety. The drugs reduce the excitability of the subcortical structures of the brain, relax the muscles, relieve the feeling of fear, and calm the nervous system.	Phenazepam	Take 0.25-0.5 mg 2-3 times a day. The maximum daily dose should not exceed 0.01 g. Assign short courses so as not to cause dependence. After the onset of improvement, the dosage is gradually reduced.
   		Lorazepam	Take 1 mg 2-3 times a day. With severe depression, the dose can be gradually increased to 4-6 mg / day. Cancel the drug gradually because of the risk of seizures.
   Normotimics	Drugs designed to normalize mood and prevent periods of depression.	lithium carbonate	Take orally 3-4 times a day. The initial dose is 0.6-0.9 g / day, gradually the amount of the drug is increased to 1.5-2.1 g. The drug is taken after meals to reduce the irritating effect on the gastric mucosa.
   Antidepressants	Remedies to fight depression. Modern 3rd generation antidepressants reduce the uptake of serotonin by neurons and thereby increase the concentration of this neurotransmitter. They improve mood, relieve anxiety and longing, fear.	Sertraline	Take orally 50 mg, 1 time per day after breakfast or dinner. If there is no effect, the doctor may gradually increase the dose to 200 mg / day.
   		Paroxetine	Take 20-40 mg / day in the morning during breakfast. The tablet is swallowed without chewing and washed down with water.
   Anticholinergic drugs	Drugs that can eliminate the side effects of taking antipsychotics. Slowness of movement, muscle stiffness, trembling, impaired thinking, increased or absent emotions.	Akineton	2.5-5 mg of the drug is administered intravenously or intramuscularly. In tablets, the initial dose is 1 mg 1-2 times / day, gradually the amount of the drug is adjusted to 3-16 mg / day. The dose is divided into 3 doses. Tablets are taken during or after meals with liquid.

   
   Recall that any independent change in dose can have very serious consequences. Reducing the dosage or refusing to take medication causes an exacerbation of psychosis. Increasing the dose increases the risk of side effects and addiction.

   Prevention of psychoses

   What should be done to prevent a relapse of psychosis?

   Unfortunately, people who have experienced psychosis are at risk of experiencing a relapse of the disease. A repeated episode of psychosis is a difficult test for both the patient himself and his relatives. But you can reduce your risk of relapse by up to 80% if you take your doctor's prescription medications.

   • Medical therapy- the main point of prevention of psychosis. If you find it difficult to take your medications every day, talk to your doctor about switching to a depot form of antipsychotic medication. In this case, it will be possible to make 1 injection in 2-4 weeks.

     It has been proven that after the first case of psychosis, the use of drugs for one year is necessary. With manic manifestations of psychosis, lithium salts and Finlepsin are prescribed at 600-1200 mg per day. And with depressive psychosis, Carbamazepine is needed at 600-1200 mg per day.

   • Regularly attend individual and group psychotherapy sessions. They boost your self-confidence and motivation to get well. In addition, a psychotherapist can notice signs of an approaching exacerbation in time, which will help adjust the dosage of drugs and prevent a recurrence.
   • Follow the daily routine. Train yourself to get up, take food and medicine at the same time every day. A daily schedule can help with this. From the evening, plan tomorrow. Make a list of all the things you need to do. Mark which of them are important and which are secondary. Such planning will help you not to forget anything, to be in time for everything and to be less nervous. When planning, set realistic goals.
   
   
   • Communicate more. You will feel comfortable around people who have managed to overcome psychosis. Communicate in self-help groups or on specialized forums.
   • Exercise daily. Suitable for running, swimming, cycling. It is very good if you do this in a group of like-minded people, then the classes will bring both benefit and pleasure.
   • Make a list of early symptoms of a coming crisis, the appearance of which must be reported to the attending physician. Pay attention to these signals:
     1. Behavior changes: frequent leaving the house, prolonged listening to music, unreasonable laughter, illogical statements, excessive philosophizing, conversations with people with whom you usually do not want to communicate, fussy movements, squandering, adventurism.
     2. Mood changes: irritability, tearfulness, aggressiveness, anxiety, fear.
     3. Feeling changes: sleep disturbance, lack or increased appetite, increased sweating, weakness, weight loss.
     What not to do?
     • Don't drink too much coffee. It can have a strong stimulating effect on the nervous system. Give up alcohol and drugs. They have a bad effect on the brain, cause mental and motor excitement, attacks of aggression.
     • Don't overwork. Physical and mental exhaustion can cause extreme confusion, inconsistent thinking, and overreaction to external stimuli. These deviations are associated with a violation of the absorption of oxygen and glucose by nerve cells.
     • Do not sweat in the bath, try to avoid overheating. An increase in body temperature often leads to the appearance of delirium, which is explained by an increase in the activity of electrical potentials in the brain, an increase in their frequency and amplitude.
     • Don't conflict. Try to resolve conflicts constructively to avoid stress. Strong mental stress can become a trigger for a new crisis.
     • Don't refuse treatment. During an exacerbation, the temptation to refuse to take medication and visit a doctor is especially great. Do not do this, otherwise the disease will become acute and hospital treatment will be required.

     
     

     What is postpartum psychosis?

     postpartum psychosis quite rare mental illness. It develops in 1-2 out of 1000 women in labor. Signs of psychosis most often appear during the first 4-6 weeks after childbirth. Unlike postpartum depression, this mental disorder is characterized by delusions, hallucinations, and a desire to harm yourself or your baby.

     Manifestations of postpartum psychosis.

     The first signs of the disease are sudden mood swings, anxiety, severe anxiety, unreasonable fears. Further delusions and hallucinations appear. A woman may claim that the child is not hers, that he is stillborn or crippled. Sometimes a young mother develops paranoia, she stops going for walks and does not let anyone near her child. In some cases, the disease is accompanied by megalomania, when a woman is confident in her superpowers. She can hear voices ordering her to kill herself or the child.

     According to statistics, 5% of women in a state of postpartum psychosis kill themselves, and 4% of their child. Therefore, it is very important for relatives not to ignore the signs of the disease, but to contact a psychiatrist in a timely manner.

     Causes of postpartum psychosis.

     The cause of mental disorders can be difficult childbirth, unwanted pregnancy, conflict with her husband, fear that the spouse will love the child more than her. Psychologists believe that psychosis can be caused by conflict between a woman and her mother. It can also be caused by damage to the brain as a result of injury or infection. A sharp decrease in the level of the female hormone estrogen, as well as endorphins, thyroid hormone and cortisol, can affect the development of psychosis.

     In about half of the cases, postpartum psychosis develops in patients with schizophrenia or manic-depressive syndrome.

     Treatment of postpartum psychosis.

     Treatment must be started as soon as possible because the woman's condition is rapidly deteriorating. If there is a risk of suicide, then the woman will be treated in a psychiatric ward. During the period while she is taking medicines, it is impossible to breastfeed the baby, since most of the drugs penetrate the mother's milk. But communication with the child will be useful. Caring for the baby (provided that the woman herself wants it) helps to normalize the state of the psyche.

     If a woman is depressed, then antidepressants are prescribed. Amitriptyline, Pirlindol are indicated if anxiety and fear predominate. Citalopram, Paroxetine have a stimulating effect. They will help in the case when psychosis is accompanied by stupor - a woman sits motionless, refuses to communicate.

     With mental and motor agitation and manifestations of a manic syndrome, lithium preparations (lithium carbonate, Micalit) and antipsychotics (Clozapine, Olanzapine) are necessary.

     Psychotherapy for postpartum psychosis is used only after the elimination of acute manifestations. It is aimed at identifying and resolving conflicts that led to a mental disorder.

     What is reactive psychosis?

     Reactive psychosis or psychogenic shock - a mental disorder that arose after a severe psychological trauma. This form of the disease has three features that distinguish it from other psychoses (Jaspers' triad):
     1. Psychosis begins after a severe emotional shock is very significant for this person.
     2. Reactive psychosis is reversible. The more time has passed since the injury, the weaker the symptoms. In most cases, recovery occurs after about a year.
     3. Painful experiences and manifestations of psychosis depend on the nature of the trauma. Between them there is a psychologically understandable connection.
     Causes of reactive psychosis.

     A mental disorder occurs after a strong shock: a catastrophe, an attack by criminals, a fire, a collapse of plans, a career collapse, a divorce, illness or death of a loved one. In some cases, positive events that caused an explosion of emotions can also provoke psychosis.

     Especially at risk of developing reactive psychosis are emotionally unstable people, those who have suffered a bruise or concussion, severe infectious diseases, whose brain has suffered from alcohol or drug intoxication. As well as teenagers in puberty and women going through menopause.

     Manifestations of reactive psychosis.

     Symptoms of psychosis depend on the nature of the injury and the form of the disease. There are such forms of reactive psychosis:

     • psychogenic depression;
     • psychogenic paranoid;
     • hysterical psychosis;
     • psychogenic stupor.
     Psychogenic depression manifested by tearfulness and depression. At the same time, these symptoms may be accompanied by irascibility and quarrelsomeness. This form is characterized by the desire to cause pity, to draw attention to their problem. Which can end in a demonstrative suicide attempt.

     Psychogenic paranoid accompanied by delirium, auditory hallucinations and motor excitation. It seems to the patient that he is being persecuted, he fears for his life, is afraid of exposure and is fighting imaginary enemies. Symptoms depend on the nature of the stressful situation. The person is very excited, commits rash acts. This form of reactive psychosis often occurs on the road, as a result of lack of sleep, alcohol consumption.

     hysterical psychosis has several forms.

     1. delusional fantasies - crazy ideas that relate to greatness, wealth, persecution. The patient tells them very theatrically and emotionally. Unlike delirium, a person is not sure of his words, and the essence of statements changes depending on the situation.
     2. Ganser syndrome patients do not know who they are, where they are, what year it is. They answer simple questions incorrectly. They commit illogical actions (eat soup with a fork).
     3. pseudodementia - short-term loss of all knowledge and skills. A person cannot answer the simplest questions, show where his ear is, or count his fingers. He is naughty, grimaces, cannot sit still.
     4. Puerilism Syndrome - an adult has a child's speech, children's emotions, children's movements. May develop initially or as a complication of pseudodementia.
     5. Syndrome of "wildness" - human behavior resembles the habits of an animal. Speech is replaced by a growl, the patient does not recognize clothes and cutlery, moves on all fours. This condition, with an unfavorable course, can change puerilism.
     psychogenic stupor- after a traumatic situation, a person for some time loses the ability to move, speak and respond to others. The patient can lie in the same position for weeks until he is turned over.

     Treatment of reactive psychosis.

     The most important step in the treatment of reactive psychosis is the elimination of the traumatic situation. If you manage to do this, then the probability of a quick recovery is high.
     Drug treatment of reactive psychosis depends on the severity of the manifestations and characteristics of the psychological state.

     At reactive depression prescribe antidepressants: Imipramine 150-300 mg per day or Sertraline 50-100 mg 1 time per day after breakfast. Supplement therapy with tranquilizers Sibazon 5-15 mg / day or Phenazepam 1-3 mg / day.

     Psychogenic paranoid treated with neuroleptics: Triftazin or Haloperidol 5-15 mg / day.
     With hysterical psychosis, it is necessary to take tranquilizers (Diazepam 5-15 mg / day, Mezapam 20-40 mg / day) and neuroleptics (Alimemazine 40-60 mg / day or Neuleptil 30-40 mg / day).
     Psychostimulants can bring a person out of a psychogenic stupor, for example, Sydnocarb 30-40 mg / day or Ritalin 10-30 mg / day.

     Psychotherapy can save a person from excessive fixation on a traumatic situation and develop protective mechanisms. However, it is possible to proceed to consultations with a psychotherapist only after the acute phase of psychosis has passed, and the person has regained the ability to perceive the arguments of a specialist.

     Remember - psychosis is curable! Self-discipline, regular medication, psychotherapy and the help of loved ones guarantee the return of mental health.

   The human brain is a complex mechanism that is difficult to study. The root of psychological deviations and psychosis lies deep in the subconscious of a person, destroys life and interferes with functioning. Manic-depressive psychosis is inherently dangerous not only for the patient, but also for the people around him, so you should immediately contact a specialist.

   Manic depressive disorder, or as it is also known, bipolar personality disorder, is a mental illness that manifests itself as a constant change in behavior from unreasonably agitated to complete depression.

   Reasons for TIR

   No one knows exactly the origins of this disease - it was known in ancient Rome, but the doctors of that time clearly separated manic psychosis and depression, and only with the development of medicine it was proved that these were stages of one disease.

   Manic-depressive psychosis (MDP) is a severe mental illness

   It may appear due to:

   • transferred stress;
   • pregnancy and menopause;
   • disruption of the brain due to a tumor, injury, chemical exposure;
   • the presence of this psychosis or other affective disorder in one of the parents (it has been scientifically proven that the disease can be inherited).

   Due to the instability of the psyche, women are more susceptible to psychosis. There are also two peaks in which a manic disorder can occur: menopause and 20-30 years. Manic-depressive psychosis has a pronounced seasonal pattern, as exacerbations most often occur in autumn and spring.

   Manic-depressive psychosis: symptoms and signs

   MDP expresses itself in two main stages, which appear for a certain period of time and replace each other. They are:

   
   

   Manic-depressive psychosis and its varieties

   Bipolar personality disorder is sometimes understood as a synonym for MDP, but in reality it is just one of the varieties of general psychosis.

   The usual course of the disease involves the following stages:

   • manic;
   • intermission (when a person returns to his usual behavior);
   • depressive.

   The patient may be missing one of the stages, which is called unipolar disorder. In this case, the same stage may alternate several times, changing only occasionally. There is also a dual psychosis, when the manic phase immediately turns into a depressive one without an intermediate intermission. Changes should be monitored by a physician who will recommend the appropriate treatment appropriate for the person's particular condition.

   

   The disease can manifest itself in a manic and depressive form.

   The difference between manic-depressive syndrome and other diseases

   Inexperienced doctors, as well as loved ones, may confuse MDP with ordinary depression. This is usually due to a short observation of the patient and quick conclusions. One stage can last up to a year, and most people rush into treatment for depression.

   It is worth knowing that in addition to a breakdown and lack of desire to live, TIR patients also experience physical changes:

   1. A person has inhibited and slow thinking, an almost complete absence of speech. It is not a matter of wanting to be alone - during this stage, the weakness can be so strong that it is difficult for a person to move his tongue. Sometimes this condition turns into complete paralysis. At this moment, the patient especially needs help.
   2. During a manic period, people often report dry mouth, insomnia or extremely short sleep, fast thinking, shallow judgment, and an unwillingness to think about problems.

   Dangers of manic-depressive psychosis

   Any psychosis, no matter how small or insignificant it is, is fundamentally capable of changing the life of the patient and his loved ones. In the depressive stage, a person is able to:

   

   The mechanism of the development of the disease is explained by the result of neuropsychic breakdowns with the formation of foci in the cerebral cortex

   • commit suicide;
   • to die of hunger;
   • get bedsores;
   • drop out of society.

   While in the manic stage, the patient may:

   • commit a rash act, up to murder, since causal relationships are violated in him;
   • endanger your own or others' lives;
   • start promiscuous sex.

   Diagnosis of TIR

   It often happens that the patient is diagnosed incorrectly, which complicates the treatment, so the patient must undergo a full set of studies and analyzes - x-rays, MRI of the brain and electroencephalography.

   At the time of diagnosis, a complete picture is needed in order to exclude other mental disorders, infections and injuries.

   Treatment of manic-depressive psychosis

   The doctor usually prescribes a hospital stay. So it is much easier to track the change of stages, identify patterns and help the patient in case of suicide or other unjustified actions.

   

   With dominance in the status of lethargy, antidepressants with analeptic properties are selected

   Often prescribed:

   • antipsychotics with a sedative effect in the manic period;
   • antidepressants at the time of the depressive stage;
   • Lithium therapy in the manic stage;
   • electroconvulsive therapy with a protracted form.

   At moments of activity, a manic syndrome patient is able to harm himself due to self-confidence, as well as endanger other people, so conversations with a psychologist who can calm the patient are very important.

   Also at the time of depression - a person needs constant care, since he has no appetite, he is taciturn and often motionless.

   How to live with manic-depressive psychosis?

   3-5% of people admitted to a hospital are diagnosed with TIR. With high-quality treatment of both stages, constant prevention and conversations with a psychiatrist, it is possible to live a normal and ordinary life. Unfortunately, few people think about recovery and make plans for life, so next to such a person there should always be close people who can, in the event of an exacerbation, forcibly put the patient on treatment and support him in every possible way.

   Why Treat Manic-Depressive Psychosis?

   Many people diagnosed with TIR pour themselves into creativity. For example, the famous impressionist artist Vincent van Gogh was also a hostage to this disease, while remaining a talented person, albeit incapable of socialization. The life path of this artist can serve as a good example for people who do not want to go to the hospital or solve the problem. Despite his talent and boundless imagination, the great impressionist committed suicide during one of the depressive stages. Due to problems with socialization and people, Vincent never sold a single painting in his entire life, but gained fame quite by accident, thanks to people who knew him.

   A disease called manic psychosis is a rather severe and serious mental disorder, which is accompanied by delusions, hallucinations, and inappropriate behavior of the patient. Manic psychosis is a diagnosis from the field of pediatrics. It is understood that such a patient must be hospitalized, the treatment in this case is always medication. Taking into account the causes of this disease, manic psychoses are distinguished, which have a different origin. With endogenous psychosis, internal psychological factors influence, exogenous psychoses are caused by various external factors. If we are talking about the organic origin of psychosis, then it can be a brain injury, tumors, and so on.

   There are certain symptoms that are characteristic of manic psychosis. This is derealization, delirium, disorderly thinking. Moreover, such symptoms can be observed in a patient for months. If you have found these signs in yourself, then it is possible that you have developed psychosis. In this case, the help of psychoanalysts is needed to get rid of the manic psychosis as quickly as possible. Experts believe that manic psychosis requires increased attention. This disease is characterized by a constant alternation of mood disorders and periods of normal mental health. It is impossible to predict how manic psychosis will develop, because the process is individual.

   If the diagnosis is depressive manic psychosis, then in this case there are two gaps. The course of manic psychosis turns into a depressive form, and these states are delimited by periods of normal mental health. The duration of depressive-manic psychosis is quite long, and phases can last up to a year. In manic psychosis, the patient experiences an emotional high, he is overexcited for no reason. In this state, various delusional ideas arise, a person constantly strives for some kind of activity. Such patients should not be left alone, it is necessary to conduct careful supervision, while the treatment should be soft, affectionate.

   When dealing with patients with manic psychosis, it is necessary to be tactful and caring, try to treat with understanding. In acute manic psychosis, delusional states, hallucinations of various types occur, and a person has a feeling of unreality of what is happening. One of the biggest problems is that the patient tries to isolate himself from others, there is a persistent alienation. The patient does not communicate with people, refuses help, and believes that he does not need advice. In acute psychosis, the adequacy of a person's consciousness is reduced. If the manic syndrome is moderately expressed, then we are talking about.

   At the same time, patients are extremely productive, because at this stage they do not yet suffer from increased disinhibition and distractibility. Patients retain good memory and working capacity, he is sure that he will be able to cope with any task. If a person is engaged in creative work, for example, is a poet, an artist, then in such a state he is able to create an outstanding scientific work or a masterpiece in the field of art. However, it is very difficult to cross the line between manic and hypomanic states. And further, beyond this line, the patient's condition is already more painful. In the case when the patient suffers only from hypomania and subdepression, then the disease has a name.

   The difference is that if when people do not seek help from a doctor, then in the presence of subdepression, such help is necessary. In most patients, there is usually one phase of the disease during life, and after it the person recovers. However, until the end of life, the possibility remains that a second and third phase may occur. It is known that in more than half of all patients the disease is a depressive phase, a manic course occurs in only five percent of cases. You should also be aware that manic phases can alternate with depressive ones, this type is called bipolar. With manic psychosis, the season also matters, exacerbations can occur in the autumn or early spring.

   Currently, the treatment of various psychotic conditions is carried out with the use of medications. In this case, the doctor takes into account many factors that are decisive in the treatment. This is the age of the person, the complexity of the disease, and so on. Therefore, the approach to the problem and the choice of treatment methods are strictly individual. The acute condition of the patient is normalized thanks to drugs, and the psychoanalytic treatment carried out makes it possible to prevent exacerbation. Pharmacotherapy rather quickly relieves the symptoms of manic psychosis, preventive measures provide a delay in the next attack. The effectiveness of the measures taken leading to recovery depends on the correct choice of drugs.

   

   
   

   Description:

   Manic-depressive (MDP) (circular psychosis, cyclophrenia) is a disease manifested by periodic manic and depressive states (phases), usually separated by intermissions; does not lead to the formation of a mental defect.

   
   

   Symptoms:

   The severity of affective disorders varies from mild disorders (cyclothymia), which are usually treated on an outpatient basis, to severe depression and mania, requiring urgent hospitalization. For MDP, a complete regression of painful disorders is typical, a return to the state that was before the disease. Less often, already after repeated relapses, during the period of remission, residual psychopathological manifestations are also noted, mainly in the form of erased hypomanic and subdepressive disorders. The number of phases during the course of the disease varies greatly. The duration of the phases is from 1 week to 1-2 years or more, the average duration is 6-12 months. Light intervals in some cases may be absent (the so-called continual course of the disease), but they are usually measured in months, years and even decades. A bipolar course - a change of depressive and manic phases - is observed in 1/3 of cases. Most often, the disease occurs in the form of periodic depression.

   The diagnosis of MDP is based on the autochthonous occurrence and subsequent recurrence of affective phases, on. a picture of mania typical of endogenous affective disorders and the presence among relatives of persons with cyclothymic manifestations or patients with MDP. MDP phases must be differentiated from endogenously, psychogenically, constitutionally (phases in psychopaths) and somatogenically conditioned affective states. The delimitation of TIR from periodic is based on the absence at the time of the attack, delusional ideas of attitude, persecution and formal ones. In cases that are difficult to differentiate, it is possible to make a diagnosis of MDP only with long-term observation, if personality changes do not increase in the development of the disease.

   
   

   Causes of occurrence:

   An important role is played by hereditary predisposition and constitutional factors. Most often, persons of a cycloid and psychasthenic warehouse get sick. Dysfunction of the hypothalamus and pathology of the endocrine system are also of some importance. Women get sick more often than men. The first seizures can occur both in puberty and in old age. In most cases, the disease begins in the 3-5th decade of life.

   
   

   Treatment:

   For treatment appoint:

   
   

   Treatment of depressive conditions is carried out with antidepressant drugs (amitriptyline, melipramine, pyrazidol, inkazan 50-300 mg / day). In severe cases, parenteral (i / m, i / v drip) administration of drugs is indicated. With depression resistant to psychotropic drugs, electroconvulsive therapy is performed. In hypomanic states, tranquilizers are effective [diazepam (seduxen), oxazepam (tazepam), chlordiazepoxide (elenium) 5-40 mg / day, phenazepam 1-3 mg], neuroleptics in small doses, lithium salts (lithium carbonate 900-1200 mg/day). Manic states are stopped by neuroleptics (chlorpromazine 100-400 mg/day, haloperidol 6-20 mg/day, triftazin 20-50 mg, leponex 50-200 mg, sonapax, chlorprothixen 100-300 mg/day). When phenomena are shown in / m administration of drugs (chlorpromazine, haloperidol, triftazin).

   The prognosis is favorable in most cases. In depressive phases, it is complicated due to the danger of suicidal attempts. The main means of preventing subsequent affective phases is preventive therapy (for several years) with lithium salts and finlepsip. Lithium salts are given under the control of the content of lithium in the blood (the optimal content of it, which provides a preventive effect, is 0.4-0.8 mmol / l).

   
   

   Manic-depressive psychosis (modern name - bipolar affective disorder, BAD) is a fairly common disease that affects 5-7 people per thousand of the population. This disorder was first described in 1854, but over the past centuries it has remained a big mystery not only for patients, but even for physicians.

   And the point here is not that BAD is somehow difficult to treat or it is impossible to predict its development, but that this psychosis is too "many-sided", which seriously complicates diagnosis. In fact, each doctor has his own idea of ​​​​how the clinical picture of this disease should look like, so patients are forced to face the “subjectivity of diagnosis” over and over again (as it is written about bipolar on Wikipedia).

   Manic-depressive psychosis is an endogenous disease, that is, based on hereditary predisposition. The mechanism of inheritance has not been studied enough, research is ongoing, but human chromosomes are definitely “to blame” for the onset of symptoms of BAD. If there are already patients with manic-depressive psychosis in the family, then the same disease may manifest itself in the next generations (although not necessarily).

   There are other factors that can provoke the onset of the disease (but only if there is a hereditary predisposition - if it is not there, then manic-depressive psychosis does not threaten a person). These include:

   1. Endocrine changes (transitional age, pregnancy and childbirth in women, etc.).
   2. Psychogenic factors (stress, serious overwork, work "for wear and tear" for a long time, etc.).
   3. Somatogenic factors (some diseases, especially those accompanied by hormonal changes).

   Since manic-depressive psychosis often occurs against the background of serious psycho-emotional shocks, it can be confused with neurotic states, for example, with reactive depression. In the future, the diagnosis is most often subject to adjustment if the patient shows symptoms and signs that are not characteristic of neuroses, but typical of manic-depressive psychosis.

   Useful video on the importance of distinguishing bipolar affective disorder from other mental disorders and diseases, what manifestations characterize manic-depressive psychosis and why this diagnosis is difficult for a teenager or child

   According to statistics, more often the symptoms of manic psychosis occur in men. The debut of the disease usually occurs between the ages of 25 and 44 (46.5% of all cases), but a person can get sick at any age. This diagnosis is extremely rare in children, since the diagnostic criteria used for adults can be used extremely limitedly in childhood. However, this does not mean that manic-depressive psychosis does not occur at all in children.

   How does it manifest

   Manic-depressive psychosis is characterized by the presence of several phases, which are also called affective states. Each of them has its own manifestations, sometimes the phases can be radically different from each other, and sometimes they can proceed quite blurry. On average, each phase lasts approximately 3-7 months, although this period can vary from a few weeks to 2 years or more.

   

   A patient in the manic phase of bipolar disorder experiences a great burst of energy, is in a great mood, motor excitation is also noted, appetite increases, sleep duration decreases (up to 3-4 hours a day). The patient may be obsessed with some very important idea for him, it is difficult for him to concentrate, he is easily distracted, his speech is fast, his gestures are fussy. At the peak of manic frenzy, it can be very difficult to understand the patient, as his speech loses coherence, he speaks in fragments of phrases or even single words, cannot sit still due to overexcitation. After passing the “peak”, the symptoms gradually fade away, and the person himself may not even remember his strange behavior, he is covered by a breakdown, asthenia and slight lethargy.

   The depressive phase of bipolar affective disorder is manifested by a reduced, depressed mood, inhibition of movements and thinking. The patient loses his appetite, food seems tasteless to him, and significant weight loss is also possible. Women sometimes miss their periods.

   As with ordinary depression, patients feel worst in the morning, waking up in a state of anxiety and melancholy. By evening, the condition improves, the mood rises slightly. It is difficult for the patient to fall asleep at night, insomnia can last for a very long time.

   In the stage of severe depression, a person can lie in one position for hours, he has delusional ideas about his own worthlessness or immorality. Hallucinations and “voices” are not typical for this phase of MDP, but dangerous suicidal thoughts may appear, which can develop into attempts to commit suicide.

   As in the case of the manic stage, after the most acute period has passed, depressive symptoms gradually disappear. For some time, the patient may remain rather lethargic and asthenic, or vice versa - becomes overly talkative and active.

   The signs of manic-depressive psychosis can be very diverse, it is very difficult to talk about all the variants of the course of the disease within the framework of one article. For example, the depressive and manic phases do not have to go strictly one after the other - they can alternate in any sequence. Also, in manic-depressive disorder, the manic phase can be expressed quite weakly, which sometimes leads to misdiagnosis. Another common variant is rapid-cycling bipolar disorder, when episodes of mania or depression recur more than 4 times a year. And these are only the most common forms of bipolar disorder; in fact, the clinical picture of the disease can be even more diverse and atypical.

   What is dangerous manic psychosis

   We have already mentioned the possibility of suicide during the depressive phase of the disease. But this is not the only thing that can harm both the patient himself and his environment.

   The fact is that at the moment of the highest euphoria, a person suffering from BAD is not aware of his own actions, he seems to be in an altered state of consciousness. In some way, this state is similar to drug intoxication, when it seems to the patient that nothing is impossible for him, and this can lead to dangerous impulsive actions. Delusional ideas of dominance also affect a person's perception of reality, and during such delusions, he can cause serious harm to his loved ones, who will refuse to "obey" him or do something with which he strongly disagrees.

   

   In the depressive phase, anorexia may develop due to loss of appetite, and this disorder itself is very difficult to cure. In some cases, the patient may inflict bodily harm on himself during an attack of hatred for his body.

   And both phases are extremely exhausting for the body itself and the human psyche. Constant throwing from one extreme to another exhausts moral strength, and physical symptoms and constant anxiety negatively affect the body of the patient. Therefore, it is very important to start the right treatment on time, always with the use of medications.

   Manic psychosis in children and adolescents

   It is believed that such a diagnosis is practically not made to children under 10 years of age. This is due to the difficulties of diagnosis and the atypical manifestation of the phases, which is very different from the "adult" course of the disease.

   In children, manic-depressive psychosis is blurred, the symptoms are difficult to separate from the usual children's behavior, which in itself is not very stable.

   The depressive phase of the disease in a child may manifest slowness, passivity, lack of interest in toys and books. The student's academic performance decreases, it is difficult for him to communicate with his peers, his appetite and sleep also worsen. The child also complains of physical ailments, pain in different parts of the body, weakness. This condition must be differentiated from endogenous depression, which requires long-term and careful monitoring of the mood and physical condition of the child.

   The manic phase is characterized by increased motor activity, a desire for new entertainment and a constant search for them. It is literally impossible to calm a child, while he practically does not support the rules of the game, his actions are spontaneous and largely devoid of logic. Unfortunately, such a state is quite difficult to distinguish from normal childhood behavior, especially if the symptoms of mania do not reach full frenzy.

   

   The older the child and the closer he is to adolescence, the clearer the differences between the depressive and manic phases become. It is during this period that diagnosis becomes possible, including with the help of tests that are used to diagnose adults.

   In the clinical picture of manic-depressive psychosis in adolescents, all the symptoms characteristic of this disease are usually present, especially in the depressive phase. The emerging suicidal thoughts are of great danger to adolescents, since in puberty the understanding of the value of life is not yet sufficiently developed, therefore the risk of “successful” attempts to commit suicide is higher.

   The manic phase at this age may not be so clear, some parents may even meet its manifestations with joy, especially if before that the child was in a state of anxiety and melancholy. A teenager in the phase of mania literally “gushes” with energy and new ideas, can stay awake at night, make grandiose plans, and endlessly look for entertainment and new companies during the day.

   In order to correctly diagnose a teenager, parents and a doctor need to carefully observe the behavior of a potential patient. In bipolar disorder, the symptoms of mania or depression most often occur at certain times of the year. Another important point is a quick change of mood, which is not typical for a healthy person: yesterday the teenager was in high spirits, and today he is sluggish, apathetic, and so on. All this can lead to the idea that the child suffers from a mental disorder, and not from the hormonal fluctuations typical of adolescence.

   Diagnosis and treatment

   On the Internet, you can find tests that you can take on your own and determine the symptoms of manic-depressive psychosis. However, you should not rely entirely on their results; this disease cannot be diagnosed using a single test.

   The main diagnostic method is the collection of anamnesis, that is, information about the patient's behavior over a fairly long period of time. The manifestations of bipolar disorder resemble the symptoms of many other mental illnesses, including those from the group of psychoses, so a thorough analysis of all the information received is necessary to make a diagnosis.

   Doctors also use special tests for diagnosis, but usually these are several different questionnaires, the results of which are processed by a computer, so that it is easier for a doctor to draw up a general picture of the disease.

   In addition to tests, the patient is offered to undergo examinations by narrow specialists and take tests. Sometimes the cause of manic-depressive psychosis can be, for example, endocrine disorders, in which case it is first necessary to treat the underlying disease.

   

   As for the treatment of manic psychosis, it does not always take place in a hospital. Urgent hospitalization is required for:

   • pronounced suicidal thoughts or suicide attempts;
   • hypertrophied sense of guilt and moral inferiority (due to the risk of suicide);
   • tendency to hush up their condition, symptoms of the disease;
   • a state of mania with pronounced psychopathic behavior, when the patient can be dangerous to other people;
   • severe depression;
   • multiple somatic symptoms.

   In other cases, the treatment of manic-depressive psychosis is possible at home, but under the constant supervision of a psychiatrist.

   For treatment, mood stabilizers (mood stabilizers), antipsychotics (antipsychotic drugs), antidepressants are used.

   It has been proven that lithium preparations are guaranteed to reduce the possibility of suicide by reducing the aggressiveness and impulsivity of the patient.

   How to treat manic-depressive psychosis in each case is decided by the doctor, the choice of medication depends on the phase of the disease and the severity of the symptoms. In total, the patient can receive 3-6 different drugs during the day. When the condition stabilizes, the doses of drugs are reduced, choosing the most effective maintenance combination, which the patient must take for a long time (sometimes for life) in order to remain in remission. If the patient strictly follows the recommendations of the doctor, then the prognosis for the course of the disease is favorable, although sometimes the doses of the drugs will need to be adjusted to avoid exacerbations.

   Manic psychosis is also treated with psychotherapy, but in this case this method should not be considered the main one. It is completely unrealistic to cure a genetically determined disease only by working with a psychotherapist, but this work will help the patient to perceive himself and his illness more adequately.

   Summarize

   Manic psychosis is a disorder that affects people regardless of their gender, age, social status and living conditions. The causes of this condition have yet to be known, and the features of the development of bipolar disorder are so diverse that doctors sometimes find it difficult to make a correct diagnosis.

   Can this disease be cured? There is no single answer, but if the patient is conscientious about all the appointments of his doctor, then the prognosis will be very optimistic, and the remission will be stable and long.