Organic mood disorder. Organic anxiety disorder. Diagnostics of affective disorders in drug addiction and alcoholism

organic mental disorders(organic diseases of the brain, organic brain damage) is a group of diseases in which certain mental disorders occur as a result of damage (damage) to the brain.

Causes of occurrence and development

Varieties

As a result of brain damage, various mental disorders gradually (from several months to several years) develop, which, depending on the leading syndrome, are grouped as follows:
- Dementia.
- Hallucinosis.
- Delusional disorders.
- Psychotic affective disorders.
- Non-psychotic affective disorders
- Anxiety disorders.
- Emotionally labile (or asthenic) disorders.
- Mild cognitive impairment.
- Organic personality disorders.

What do all patients with organic mental disorders have in common?

All patients with organic mental disorders in varying degrees attention deficits, difficulty remembering new information, slowing down of thinking, difficulty in setting and solving new problems, irritability, "getting stuck" on negative emotions, sharpening the features that were previously characteristic of this person, a tendency to aggression (verbal, physical).

What is characteristic of certain varieties of organic mental disorders?

What to do if you find yourself or your loved ones described mental disorders?

In no case should you ignore these phenomena and, moreover, self-medicate! It is necessary to independently contact a district psychiatrist at a neuropsychiatric dispensary at the place of residence (a referral from a polyclinic is not necessary). You will be examined, diagnosed, and treated. Therapy of all the mental disorders described above is carried out on an outpatient basis, by a local psychiatrist or in a day hospital. However, there are times when a patient needs to be treated in psychiatric hospital round-the-clock stay:
- with delusional disorders, hallucinosis, psychotic affective disorders, conditions are possible when the patient refuses to eat for painful reasons, he has persistent suicidal tendencies, aggressiveness towards others (as a rule, this happens if the patient violates the maintenance therapy regimen or completely refuses medical treatment);
- with dementia, if the patient, being helpless, was left alone.
But usually, if the patient follows all the recommendations of the doctors of the neuropsychiatric dispensary, he mental condition so stable that even with a possible deterioration there is no need to stay in a round-the-clock hospital, the district psychiatrist gives a referral to a day hospital.
NB! There is no need to be afraid of contacting a neuropsychiatric dispensary: ​​firstly, mental disorders greatly reduce the quality of a person’s life, and only a psychiatrist has the right to treat them; secondly, nowhere in medicine is the legislation in the field of human rights so observed as in psychiatry, only psychiatrists have their own law - the Law of the Russian Federation "On psychiatric care and guarantees of the rights of citizens in its provision."

General principles of medical treatment of organic mental disorders

1. Striving for maximum restoration of the functioning of damaged brain tissue. This is achieved by the appointment of vascular drugs (drugs that expand the small arteries of the brain, and, accordingly, improve its blood supply), drugs that improve metabolic processes in the brain (nootropics, neuroprotectors). Treatment is carried out in courses 2-3 times a year (injections, higher doses of drugs), the rest of the time continuous maintenance therapy is carried out.
2. Symptomatic treatment, that is, the effect on the leading symptom or syndrome of the disease, is prescribed strictly according to the indications of a psychiatrist.

Is there a prevention of organic mental disorders?

Ekaterina DUBITSKAYA,
Deputy Chief Physician of the Samara Psychoneurological Dispensary
on inpatient care and rehabilitation work,
candidate of medical sciences, psychiatrist the highest category

- a long-term disturbance of the emotional state, characterized by depression, mania or bipolar manifestations, arising from a medical illness or the use of drugs. With mania, a feeling of joy, happiness prevails, the behavior is relaxed, fussy, hyperactive. Depression is accompanied by depression of the mental sphere, depression, longing, physical inactivity. In bipolar and mixed disorder, the phases of mania and depression follow each other. Diagnosis is carried out by a psychiatrist, a psychologist. Clinical and psychodiagnostic methods are used. Medical treatment.

General information

In the International Classification of Diseases 10 revision, organic mood disorder is allocated to a separate heading (F06). Synonymous names - organic affective disorder, organic depression, mania, bipolar disorder. The prevalence of the disease remains unknown, since not all patients apply for medical care. Women are found to be affected twice as often as men. Usually there is a predominance of depressive symptoms. Often the presence of the disorder is not recognized by the patient, complaints describe the deterioration of the somatic condition. Diagnosis is difficult, about 30% of cases are detected in a timely manner.

Causes of Organic Mood Disorder

At the heart of an organic affective disorder is always a physiological factor - a disease, long-term use or abrupt withdrawal of drugs, postoperative condition, long-term period of traumatic brain injury. The high-risk group includes women and patients over 35 years of age. Among the most common causes organic mania, depression and bipolar manifestations are distinguished by:

• Endocrine pathologies. affective disorders occur with thyrotoxicosis, Itsenko-Cushing's disease, after thyroidectomy. Transient disorders are observed within the climacteric and premenstrual syndromes.
• The use of hormonal drugs. Depressive episodes develop with prolonged use of these drugs and as a manifestation of the withdrawal syndrome. The risk group includes patients with autoimmune diseases taking glucocorticosteroids.
• Drug overdose. The most common cause of mood disorders is the overuse of antihypertensive drugs. Less commonly, the disorder occurs with an overdose of narcotic analgesics, antitumor, sedative, antiparkinsonian drugs, antibiotics.
• Brain damage. Symptoms of the disorder appear after traumatic brain injuries and with brain tumors. The most common cause is damage to the frontal lobes.

Pathogenesis

Organic mood disorders are polyetiological, but a number of common links can be distinguished in the pathogenesis. The basis is the violation of biochemical level, an imbalance of neurotransmitters - biologically active substances that ensure the transmission of an electrochemical impulse between nerve cells and from neurons to muscle tissue, glands. In manic states, an excess of norepinephrine and serotonin is determined, hypersensitivity receptors, as a result of which the speed of neurotransmission increases, purposefulness decreases. Depression is triggered by a deficiency of serotonin and/or norepinephrine. Shifts at the level of biochemical processes occur in the parts of the brain responsible for the formation of emotions, instinctive behavior, and motives.

Classification

According to the severity of these disorders are divided into psychotic and non-psychotic. In the first case hallmarks are pronounced inadequacy of reactions, reduced criticism of one's own state, insufficient control of behavior. Non-psychotic disorders are characterized by a sharpness of emotions, while patients are able to assess their condition, partially regulate their behavior in accordance with the norms of society. According to clinical manifestations, disorders are classified into:

• Depressive. Depression, sadness, melancholy are constantly or periodically noted.
• Manic. The condition is characterized by increased excitability, elevated background of mood.
• Bipolar. There is a cyclic change of depression and mania.
• Mixed. Depressive and manic states manifest themselves chaotically.

Symptoms of organic mood disorder

The clinical picture depends on the form of the disorder. At organic depression reduced mood and hypodynamia come to the fore. The patient does not show interest in the outside world, is in a state of sadness and melancholy, is passive and apathetic. Has difficulty performing mental and physical work: complains of muscle weakness, dizziness, gets tired quickly. Attention is distracted, thought processes are slowed down. The ideas of the uselessness of existence, the lack of meaning in life, the experience of disappointment and guilt prevail. Characterized by insomnia, decreased appetite. The atypical course of depression is accompanied by dysphoria.

At manic disorder there is increased motor activity, high spirits. The patient is fussy, purposefulness of activity is reduced, movements are accelerated, chaotic at the peak of excitation. Cognitive processes are characterized increased speed but with a decrease in stability. Prolonged thinking, deep analysis of tasks are not available. This is manifested by impulsiveness in behavior, aggressiveness in the event of difficulties. With a psychotic variant of the disorder, delusional states are possible. In patients with bipolar disorder, phases of depression alternate with phases of mania.

Complications

Without adequate therapy, an organic mood disorder leads to social maladaptation, a state of personal decompensation. Depressed patients become withdrawn, avoid contact with others, spend most of the time alone, lying in bed. In severe cases, they make suicide attempts, they need constant monitoring and outside help. In manic patients, the inability to slow down the affect is manifested by outbreaks of aggression, antisocial acts. With uncontrolled excitement, they provoke fights, damage other people's property, and cause unintentional harm.

Diagnostics

The examination is aimed at identifying affective deviations and their organic basis - an endocrine or neurological disease, taking or canceling drugs, their overdose. The main diagnosis is carried out by a psychiatrist and a psychologist, consultations of narrow specialists are additionally assigned (if the main diagnosis is not established). The complex of procedures includes:

• Collection of anamnesis. The psychiatrist interviews the patient, in case of a severe course of the disorder - in the presence of relatives. Check availability somatic diseases, the use of drug treatment, the severity of symptoms of emotional distress.
• observation. During the conversation, the doctor evaluates the patient's affective and behavioral reactions, their adequacy to the examination situation, the safety of arbitrary control and criticism. Determines the ability to establish and maintain productive contact.
• Psychodiagnostics. The psychologist conducts a study of the emotional-personal sphere. Complex questionnaires and projective methods (drawing, interpretation) are used. According to the results, the severity of depression or mania, the risk of maladaptation, and suicidal tendencies are specified.
• Surveys by narrow specialists. Consultation with an endocrinologist or neurologist is necessary in the absence of a primary diagnosis. Doctors carry out a clinical and physical examination (survey, examination), if necessary, refer the patient to laboratory tests, instrumental diagnostics.

Emotional disorders of organic origin must be differentiated from similar disorders of endogenous origin due to the use of psychoactive substances. The main differences between endogenous emotional disorders– daily and seasonal dependence, absence of somatic symptoms. The use of surfactants is determined anamnestically, character traits such emotional deviations - delirium, periods of withdrawal, pseudo-paralysis clinic, symptoms of Korsakov's psychosis.

Treatment of organic mood disorder

The main therapy is carried out by an endocrinologist and a neurologist, aimed at eliminating the organic etiological factor. Nootropics are used, hormone therapy is adjusted. To mitigate emotional disturbances, the psychiatrist prescribes symptomatic. With depressive manifestations, tricyclic antidepressants (mianserin) and selective serotonin reuptake inhibitors (fluoxetine, sertraline) are used. Patients with manic states are shown carbamazepine, beta-blockers, anxiolytics. In severe condition, antipsychotics (haloperidol, clozapine) can be used.

Forecast and prevention

With properly prescribed treatment and compliance with all medical recommendations, the prognosis is positive. Within a few weeks, improvement occurs, emotional stability is restored, duration full course treatment is several months. Specific prophylaxis has not been developed. Measures to prevent disorders of this group are in the timely diagnosis and adequate treatment of the underlying somatic pathology, compliance with the dosages prescribed by the doctor and the duration of medication, especially corticosteroids, antihypertensives.

DISEASES AND CONDITIONS

F06.3 Organic mood disorders [affective]

Organic mood disorders [affective]

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General information

Mood disorders - disorders in which the main disturbance is a change in affect or mood towards an upsurge (mania) or depression (depression), accompanied by a change in the overall level of activity. Depressive and manic states can occur with many somatic, almost all mental illnesses, and can also be caused by drugs (for example, narcotic analgesics, antihypertensive, antitumor, sedative, antiparkinsonian drugs, antibiotics, neuroleptics, GC).

Code according to the international classification of diseases ICD-10:

• F06.3

Frequency. The lifetime risk of various forms of mood disorders is 8–9%. Women get sick 2 times more often with a predominance of depressive variants. Only 20% of patients go to medical institutions, half of them are not aware of the nature of their disease and present somatic complaints, and only 30% are recognized by a doctor. 25% of patients receive adequate therapy.
CLINICAL PICTURE
The clinical picture of mood disorders includes depressive and manic syndromes.
Depressive syndromes
Depending on the number and severity of symptoms, depressive syndromes are classified as mild, moderate and severe.

• Moderately severe depressive syndrome:
  • Decreased mood with a feeling of melancholy, a slowdown in the pace of thinking and motor inhibition are the main signs of a depressive syndrome.
  • The appearance of patients is characteristic: a sad expression on the face, a suffering vertical crease between the eyebrows, a hunched posture, the head is lowered, the gaze is directed downward. Despite a difficult mental state, some patients are able to joke and smile ("smiling depression")
  • Motor retardation is a common symptom of depression (although arousal, as described below in agitated depression, is not ruled out). The movements of patients are slow, performed only when absolutely necessary. With severe motor inhibition, patients spend most of their time lying in bed or sitting, not feeling the need for active action. The slowdown in the pace of thinking is reflected in the speech of patients: questions are answered with a long delay, after long pauses.
  • Patients especially painfully experience a lowered mood with a feeling of melancholy. Patients rarely describe their condition as depressed mood. More often they complain of sadness, a feeling of melancholy, lethargy, apathy, depression, depression. Longing is described by patients as mental heaviness in the chest, in the region of the heart, in the head, sometimes in the region of the neck or abdomen; explain that this mental, "moral" pain
  • Other common symptoms depression - anxiety (see Anxiety Disorders) and irritability. The increase in anxiety most often occurs in the evening. With the deepening of depression, anxiety turns into agitation: patients in this state are unable to sit still, rush about, groan, wring their hands; often try to commit suicide in the presence of medical personnel or other persons. Irritability in depression is manifested by constant irritation, gloom, dissatisfaction with oneself and others
  • Loss of interest and ability to enjoy. Patients complain of their insensitivity, they say that the feelings of other people are inaccessible to them, everything around them loses value (here this condition should not be confused with emotional emptiness in patients with schizophrenia). In severe cases, patients claim that they have lost love for people who were previously dear to them, have ceased to feel the beauty of nature, music, that they have generally become insensitive; talking about this, patients are hard pressed by their change, so this condition is called painful mental insensitivity (anaesthesia psychica dolorosa)
  • Almost all patients with depression complain of a decrease in energy, it is difficult for them to start some business, to finish what they started; reduced performance and productivity. Many patients attribute their lack of energy to some kind of physical illness.
  • Biological symptoms are often observed in the depressive syndrome. These include sleep disorders (early awakenings are the most typical: the patient wakes up 2-3 hours before the usual awakening time and can no longer fall asleep, experiences anxiety, anxiety, thinks about the upcoming day), diurnal mood swings (worse mood in the morning), loss of appetite, weight loss, constipation, amenorrhea, decreased sexual function
  • Depressive thoughts (depressive thinking) - important symptom depression. Identification of depressive thoughts helps the doctor predict and prevent possible suicidal attempts. Depressive thoughts can be divided into three groups:
    • The first group belongs to the present. Patients perceive the environment in a gloomy light, focused on thoughts of self-deprecation. For example, the patient believes that he is not doing his job well, and others consider him a failure, despite obvious successes.
    • The second group concerns the future tense. Patients completely lose hope for anything good in the future, full of feelings of hopelessness, hopelessness of their situation and aimlessness of their future life. For example, the patient is sure that in the future he will become unemployed, get cancer). Suicidal attempts in depression are most often caused by this particular group of depressive thoughts.
    • The third group refers to the past tense. Patients experience an inadequately strong sense of guilt, remembering minor misconduct from a past life, cases when they behaved insufficiently ethically, made mistakes, etc.
  • Complaints about somatic symptoms are often noted in depression. They can be very diverse, but the most common complaints are constipation and pain (or discomfort) in any part of the body.
  • With a depressive syndrome, other mental disorders are observed: depersonalization, obsessive-compulsive disorders (see Obsessive Compulsive Disorder), phobias (see Phobic Disorders), etc.
  • Patients often complain of memory impairment, which is associated with impaired concentration. However, if the patient makes an effort on himself, then the processes of memorization and reproduction themselves turn out to be intact. But sometimes these memory impairments, especially in the elderly, become so pronounced that the clinical picture is similar to dementia.
• Masked Depression:
  • Masked (larvated, hidden) depression is a subdepressive state, combined with somatic disorders dominant in the clinical picture, which mask a low mood. The frequency of masked depressions exceeds the number of overt depressions by 10–20 times. Initially, such patients are treated by doctors of various specialties, most often by therapists and neuropathologists. Masked depression is most often observed with mild and moderately severe depressive syndrome, with severe depressive syndrome - much less frequently.
  • The most frequently noted complaints of disorders from the CCC (attacks of pain in the heart) and digestive organs (loss of appetite, diarrhea, constipation, flatulence, pain in the abdomen). Very often, various sleep disorders are noted. Patients complain of a feeling of loss of energy, weakness, loss of interest in favorite activities, a feeling of vague anxiety, rapidly developing fatigue when reading a book or watching television.
  • It is not uncommon for states of masked depression to become the cause of alcohol abuse.

• Severe depressive syndrome:
  • With further development and aggravation of the depressive syndrome, all of its symptoms described above appear with greater intensity. A distinctive feature of severe depressive syndrome is the addition of psychotic symptoms: delusions and hallucinations (which is why some authors call this disorder the term “psychotic depression”)
  • Delusions in severe depressive syndrome are represented by ideas of self-abasement, guilt, the presence of severe somatic diseases (hypochondriac delusions)
  • In severe depressive syndrome, patients most often experience auditory hallucinations, the content of which reflects the painful depressive state of patients. For example, the patient hears a voice telling about the hopelessness and senselessness of his suffering, recommendations to commit suicide, or the groans of dying loved ones, their calls for help, etc. Much less often, patients experience visual hallucinations, also reflecting a depressive mood (for example, scenes of death or execution).
• Agitated depression - depression with agitation. Agitation is motor restlessness combined with anxiety and fear. Patients are extremely tense and do not find a place for themselves: they stereotypically rub their hands, sort out clothes with their hands, walk a lot, intrusively turn to the staff and others with some kind of request or remark, sometimes stand at the door of the department for hours, shifting from foot to foot and grabbing clothes passing.

• Inhibited (adynamic) depression. In inhibited depression, the leading symptom is psychomotor retardation. In some cases, the severity of psychomotor retardation reaches the degree of stupor (depressive stupor). With the reverse development of symptoms during treatment, when depression is still strong, and motor inhibition disappears, the risk of suicide increases dramatically!
• Mild depressive syndrome (subdepression) - depression mild degree expressiveness. The affect of deep melancholy, motor inhibition are absent, outwardly the behavior of patients can remain ordered, although devoid of energy, activity. In the condition of patients, anhedonia, lack of mood, anxiety, self-doubt predominate. Patients note that in the morning it is difficult to force themselves to get out of bed, dress, wash; performing the usual duties at home and at work requires great effort, no desires, no confidence in the success of any business. Upon awakening, there is no sensation of transition from sleep to wakefulness - hence the unfounded complaints of "total insomnia". Anxiety common in subdepression is often accompanied by hypochondria, obsessive thoughts, and phobias.

manic syndrome
Manic syndrome is a combination of increased mood, acceleration of the pace of thinking and increased motor activity.

• Appearance patients often reflects elevated mood. Patients, especially women, tend to dress brightly and provocatively, use cosmetics immoderately. The eyes are shining, the face is hyperemic, when talking, saliva often comes out of the mouth. Facial expressions are lively, movements are fast and impetuous, gestures and postures are emphatically expressive.
• An elevated mood is combined with unshakable optimism. All experiences of patients are painted only in iridescent tones. Patients are carefree, they have no problems. Past troubles and misfortunes are forgotten, the future is drawn only in bright colors. Patients describe their own physical well-being as excellent, a feeling of excess energy is a constant phenomenon. At first glance, such patients can impress an outside observer as people who are mentally healthy, but unusually cheerful, cheerful and sociable. Other patients note irritability, reactions of anger, hostility easily appear. Orientation, as a rule, is not disturbed, but consciousness of the disease is often absent.
• Increased motor activity - patients are constantly on the move, cannot sit still, walk, interfere in everything, try to command the patients, etc. During conversations with a doctor, patients often change their position, turn around, jump up from their seats, start walking and often even run around the office. They take on any business, but only move from one to another, without bringing anything to the end. Patients with manic syndrome are very willing to communicate with others and actively intervene in conversations that do not concern them.
• Acceleration of the pace of thinking - patients talk a lot, loudly, quickly, often without ceasing. With prolonged speech excitation, the voice becomes hoarse. The content of the statements is inconsistent. Easily move from one topic to another. With an increase in speech excitation, a thought that does not have time to end is already replaced by another, as a result of which statements become fragmentary (“jump of ideas”). Speech alternates with jokes, witticisms, puns, foreign words, quotations.

• Sleep disturbances are manifested in the fact that patients sleep little (3-5 hours a day), but at the same time they always feel cheerful and full of energy.
• With a manic syndrome, an increase in appetite and an increase in sexual desire are almost always noted.
• Expansive ideas. Opportunities to realize numerous plans and desires seem to be limitless for patients, patients do not see any obstacles for their implementation. Self-esteem is always exaggerated. It is easy to overestimate one's capabilities - professional, physical, entrepreneurial, etc. For some time, patients can be dissuaded from exaggerating their self-esteem. Expansive ideas easily turn into expansive delusions, which are manifested most often by delusional ideas of greatness, invention and reformism.
• In severe manic syndrome, hallucinations are noted (rarely). Auditory hallucinations are usually praising (for example, voices telling the patient that he is a great inventor). With visual hallucinations, the patient sees religious scenes.
• Hypomanic state (hypomania) is characterized by the same features as severe mania, but all symptoms are smoothed out, there are no gross behavioral disorders leading to complete social maladjustment. Patients are mobile, energetic, prone to jokes, overly talkative. The increase in their mood does not reach the degree of striking indomitable gaiety, but is manifested by cheerfulness and optimistic faith in the success of any business started. Many plans and ideas arise, sometimes useful and sensible, sometimes overly risky and frivolous. They make dubious acquaintances, lead an indiscriminate sex life, begin to abuse alcohol, and easily take the path of breaking the law.

CLASSIFICATION OF MOOD DISORDERS
Classifications based on etiology

• Endogenous and reactive depression. The terms "endogenous" and "reactive" are not included in the modern classification of mental illness, but some psychiatrists still use these concepts. With endogenous depression, the symptoms are caused by factors not related to the patient's personality and do not depend on the traumatic situation. In reactive depression, the symptoms are directly related to traumatic situations. In practice, only endogenous or only reactive depressions are rare; mixed depression is much more common.
• Primary and secondary depressive syndromes. Secondary depressive syndromes are caused by another mental disorder (eg, schizophrenia, neurosis, alcoholism), somatic or neurological disease, the use of certain drugs (for example, GK). In the case of primary depressive syndrome, it is not possible to find any cause that caused depression.

Classification based on symptoms

• neurotic and psychotic depression. With neurotic depression, the symptoms characteristic of psychotic depression (severe depressive syndrome) are smoother, less pronounced, and are often caused by traumatic situations. Neurotic depression is often accompanied by neurotic symptoms such as anxiety, phobias, obsessions and, less commonly, dissociative symptoms. In the modern ICD-10 classification, neurotic depression is described as "dysthymia".

Current based classification

• Bipolar Mood Disorder:
  • In the previous ICD-10 classification, these disorders were described under the term "manic-depressive psychosis". Bipolar mood disorder is manifested by alternating manic or depressive phases (episodes). Episodes may follow each other directly (for example, a depressive state is immediately replaced by a manic syndrome) or at intervals of complete mental health (for example, the patient has recovered from a depressive state and a manic syndrome develops after a few months). The disorder does not lead to a decrease in mental functions, even if large numbers transferred phases and any duration of the disease
  • Bipolar disorder usually begins with depression. The development of at least one manic (or hypomanic) episode during the course of the illness is sufficient for a diagnosis of bipolar disorder.
  • Cyclothymia (cyclothymic disorder) is characterized by a chronic course with numerous and short episodes of hypomanic and subdepressive states. Cyclothymia can be thought of as more easy option bipolar disorder. Clinical manifestations similar to those of bipolar mood disorder, but they are either less pronounced or less persistent. The duration of the phases is much shorter than in bipolar disorder (2-6 days). Episodes of disturbed mood occur irregularly, often suddenly. In severe cases, there are no "light" intervals of normal mood. The onset of the disease is usually gradual, occurring between the ages of 15 and 25 years. 5-10% of patients develop drug dependence. In the anamnesis, frequent changes of residence, involvement in religious and occult sects are noted.
• Depressive disorders:
  • Recurrent depressive mood disorder (unipolar depression, unipolar mood disorder) is a disease that occurs in the form of several major depressive episodes throughout life, separated by periods of complete mental health. The first episode can occur at any age, from childhood to old age. The onset may be acute or insidious, and the duration may vary from a few weeks to many months. The danger that a person with recurrent depressive disorder will not experience a manic episode never completely disappears. If this happens, the diagnosis is changed to bipolar affective disorder. Depressive disorders do not lead to a decrease in mental functions, even with a large number of phases and any duration of illness
  • Seasonal affective disorder - depression that occurs in winter, with a reduction in daylight hours. Decreases and disappears with the onset of spring and summer. Characterized by drowsiness increased appetite and psychomotor retardation. Associated with abnormal melatonin metabolism
  • Currently, neurotic depressions and erased forms of recurrent depressive disorder are combined into dysthymic disorder. In the ICD-10 classification, dysthymic disorder (dysthymia) includes neurotic depression (depressive neurosis). Dysthymia is a less severe form of depression, usually caused by a long-term traumatic situation. The disorder tends to be chronic. With dysthymia, the symptoms characteristic of severe depressive syndrome are smoothed out, less pronounced.

DIFFERENTIAL DIAGNOSIS OF MOOD DISORDERS

• Grief reaction. Depressive disorders must be distinguished from the normal grief reaction to severe emotional stress(for example, the death of a child). The grief reaction differs from a depressive disorder in the absence of thoughts of suicide, patients are easily persuaded, their condition is alleviated during communication with other people. Treatment of patients in a state of grief with antidepressants is ineffective. Some patients with grief later develop major depressive disorder.
• Anxiety disorder can be difficult to distinguish from subdepressive states, especially since anxiety and depression often coexist. For staging correct diagnosis it is necessary to assess the severity of anxiety and depression, as well as the sequence of their occurrence. If the patient has more pronounced and first symptoms of depression, and only then anxiety has joined, then the diagnosis of a depressive disorder is more likely. Conversely, if the illness begins with symptoms of anxiety, which are the only manifestations of the clinical picture, and then symptoms of depression appear, then the patient is likely to have an anxiety disorder. The same principle is used in the differential diagnosis with obsessive-compulsive and phobic disorders.
• Schizophrenia. Delusions and hallucinations are observed in both manic and depressive episodes. Mood disorders do not lead to a decrease in mental functions, even with a large number of transferred phases and any duration of the disease. Whereas in schizophrenia, negative symptoms are observed, leading to persistent personality changes.
• Schizoaffective disorder. In the case when the clinical picture manifests itself equally severe symptoms mood disorders (manic or depressive syndrome) and schizophrenia, a diagnosis of schizoaffective disorder is more likely (see Schizoaffective disorder).
• Dementia. Memory impairment in depression has a more acute onset and is due to impaired concentration; other symptoms of depression are also present in the clinical picture, for example, depressive thinking. Depressed patients who complain of memory impairment usually feel free to answer questions (“I don’t know”), while dementia patients try to avoid a direct answer. In depressed patients, memory for current and past events is equally impaired; in dementia patients, memory for current events is more affected than for past ones.
• Organic brain damage. When a manic state appears in old age, combined with gross behavioral disorders (for example, public urination) and especially the absence of manic and depressive episodes in history, one should think first of all about organic brain damage (most often the frontal lobe - "frontal lobe syndrome"), such as a tumor. In this case, additional studies are carried out - MRI / CT, EEG.
• Mood disorders caused by substance abuse (eg, heroin, amphetamines). Substance abuse and dependence tend to be accompanied by mood disorders. The differential diagnosis takes into account the data of the anamnesis, the results of urine tests for the content of psychoactive substances.
• Mood disorders caused by drug use. When assessing the patient's condition, it is necessary to find out which drugs he is currently taking, which in the past, and whether he had previously had changes in mental well-being while taking any drug. It is important to adhere to the principle that every drug that the patient takes can be a factor in the mood disorder.

Symptoms of organic mood disorders [affective]

Diagnosis of organic mood disorders [affective]

Research methods:

• Laboratory methods:
  • General blood and urine tests
  • Dexamethasone suppression test
  • Thyroid function test
  • Determination of the content of vitamin B12, folic acid
• Special methods:
  • ECG
  • CT/MRI
• Psychological methods:
  • Tsung Self-Esteem Scale
  • Hamilton Depression Scale
  • Rorschach test
  • Thematic apperception test.
    Differential Diagnosis
• Neurological disorders (eg, epilepsy, hydrocephalus, migraine, multiple sclerosis, narcolepsy, brain tumors)
• Endocrine disorders (eg, adrenogenital syndrome, hyperaldosteronism)
• Mental illness (eg, dementia, schizophrenia, personality disorders, schizoaffective disorder, adjustment disorder with depressed mood).
  CURRENT AND FORECAST
  depressive disorders. 15% of people with depression commit suicide. 10–15% make suicidal attempts, 60% plan suicide. It should be remembered that the likelihood of suicide is greatest during the recovery period during treatment with antidepressants. A typical depressive episode, if left untreated, lasts about 10 months. At least 75% of patients experience a second episode of depression, usually within the first 6 months after the first. The average number of depressive episodes during a lifetime is 5. The prognosis is generally favorable: 50% of patients recover, 30% do not fully recover, in 20% the disease takes chronic. Approximately 20-30% of patients with dysthymic disorder develop (in descending order of frequency) recurrent depressive disorder (double depression), bipolar disorder.
  bipolar disorders. Approximately one third of patients with cyclothymia develop bipolar mood disorder. In 45% of cases, manic episodes recur. Manic episodes, if left untreated, last 3–6 months with a high chance of relapse. Approximately 80-90% of patients with manic syndromes over time, a depressive episode occurs. The prognosis is quite favorable: 15% of patients recover, 50-60% do not fully recover (numerous relapses with good adaptation in between episodes), in a third of patients there is a possibility of the disease transition to chronic form with persistent social and labor maladaptation.

Treatment of organic mood disorders [affective]

Basic principles:

• Combination drug therapy with psychotherapy
• Individual selection of drugs depending on the prevailing symptoms, efficacy and tolerability of drugs. Prescribing small doses of drugs with a gradual increase
• Appointment for exacerbation of drugs that were previously effective
• Revision of the treatment regimen if there is no effect within 4–6 weeks
  Treatment of depressive episodes
• TAD - amitriptyline and imipramine. With psychomotor agitation, anxiety, restlessness, irritability or insomnia, amitriptyline is prescribed - 150-300 mg / day; with psychomotor retardation, drowsiness, apathy - imipramine 150-300 mg / day
• Selective inhibitors serotonin reuptake. If depression is resistant to treatment with high doses of amitriptyline or imipramine, this does not mean that more modern antidepressants will be effective in this case. The development of anticholinergic side effects is the main reason for the unauthorized termination of TAD treatment. In addition, amitriptyline and imipramine are contraindicated in patients with heart disease, glaucoma, and prostatic hypertrophy. It is preferable for such patients to prescribe selective serotonin reuptake inhibitors, because. they are safer. Selective serotonin reuptake inhibitors are as effective as imipramine and amitriptyline, do not cause anticholinergic side effects, and are safer in overdose. The drugs are prescribed once in the morning: fluoxetine 20–40 mg/day, sertraline 50–100 mg/day, paroxetine 10–30 mg/day.
• MAO inhibitors (eg, nialamide 200-350 mg/day, preferably in 2 doses in the morning and afternoon) are usually less effective than TADs in major depressive disorders, and show the same effect in mild disorders. But in some patients resistant to TAD treatment, healing effect provide MAO inhibitors. The action of drugs in this group develops slowly and reaches a maximum by 6 weeks from the start of treatment. MAO inhibitors enhance the action of vasoconstrictive amines (including tyramine found in some foods - cheese, cream, coffee, beer, wine, smoked meats, red wines) and synthetic amines, which can lead to severe arterial hypertension.
• Electroconvulsive therapy (ECT). Clinical studies have shown that the antidepressant effect of ECT develops faster and is more effective in patients with major depressive disorder with delusions than with TAD. Thus, ECT is the method of choice in the treatment of patients suffering from a depressive disorder with psychomotor retardation and delusions in case of ineffective drug therapy.
  Synonym. affective disorders
  Abbreviations. ECT - electroconvulsive therapy

Among reactive psychoses distinguish between short-term, flowing for several hours or days, disorders (affective-shock reactions, hysterical psychoses) and protracted, lasting weeks and months of the state (reactive depression and reactive paranoid).

The frequency of reactive psychoses can increase during periods of mass disasters (war, earthquake, etc.).

Affective-shock reaction(acute reaction to stress) develops as a result of an extremely strong simultaneous psychotrauma. The subject is a direct participant or witness of tragic events (catastrophes, murders, acts of violence). The strength of the psychotraumatic factor is such that it can cause a mental disorder in almost any person. Observed either reactive stupor(inability to move, answer questions, inability to take any action in life threatening situation, "reaction of imaginary death"), or reactive excitation(chaotic activity, screaming, throwing, panic, "flight reaction"). Psychosis is accompanied by clouding of consciousness and subsequent partial or complete amnesia. Random activity or inadequate inactivity in this case is often the cause of death: for example, an excited patient can jump out of a window during a fire. It is affective-shock reactions that cause dangerous panic in crowded places during disasters. Such psychoses are very short-lived (from several minutes to several hours). Special treatment is usually not required. In most cases, termination dangerous situation leads to a full restoration of health, however, in some cases, the experienced events continue for a long time disturb the patient in the form of obsessive memories, nightmares, this may be accompanied by sadness over the death of loved ones, loss of property and housing. The term is used to refer to these disorders. "post-traumatic stress disorder"(post-traumatic neurosis).

In situations of significant threat social status patient (litigation, mobilization into the active army, sudden break with a partner) hysterical psychoses. According to the mechanism of occurrence, these disorders do not differ from other hysterical phenomena (functional reversible mental disorders based on self-hypnosis and the conversion of internal anxiety into vivid demonstrative forms of behavior), however, the severity reaches a psychotic level, criticism is sharply impaired.

Clinic: amnesia, psychomotor agitation or stupor, hallucinations, confusion, convulsions, thought disorders. Quite often, in the picture of the disease, the features of mental regression clearly appear - childishness, foolishness, helplessness, savagery. The following conditions are most often distinguished.

Puerilism manifested in childish behavior. Patients declare that they are “still small”, call others “uncles” and “aunts”, play with dolls, ride a stick, roll boxes on the floor like cars, ask to be “handled”, whimper, suck a finger, stick out their tongue . At the same time, they speak with a childlike intonation, making funny faces.

pseudodementia- this is an imaginary loss of the simplest knowledge and skills. Patients give ridiculous answers to the most elementary questions ("twice two - five"), but usually in terms of the question being asked (mimic answers). Patients demonstrate that they cannot dress themselves, eat on their own, do not know how many fingers are on their hands, etc.

Hysterical twilight disorder(hysterical fugue, hysterical trance, hysterical stupor) occurs suddenly in connection with psychotrauma, accompanied by disorientation, absurd actions, sometimes vivid hallucinatory images that reflect a traumatic situation. Amnesia.

At Ganser's syndrome All of the disorders listed above can occur at the same time. Helplessness in answering the simplest questions, inability to correctly name parts of the body, to distinguish between right and left side combined in these patients with childishness and disorientation. The answers, although incorrect, indicate that the patient understands the meaning of the question asked (mimorepech, passing-rhenium).

Typical delirium in hysterical psychosis rarely develops - more often observed delusional fantasies, in the form of bright, absurd, emotionally colored statements that are very changeable in the plot, unstable, easily overgrown with new details, especially when the interlocutor shows interest in them.

Hysterical psychoses are usually short-lived, closely related to the urgency of the traumatic situation, always end in complete recovery, and can pass without special treatment. Reactive depression and reactive paranoid tend to last longer, often requiring psychiatric intervention.

Symptoms reactive depression manifested by a pronounced feeling of melancholy, helplessness, sometimes lethargy, often suicidal thoughts and actions. Unlike endogenous depression all experiences are closely connected with the transferred psychotrauma. Usually the causes of reactive depression are situations of emotional loss - death loved one, divorce, dismissal or retirement, moving from home, financial collapse, mistake or misconduct that may affect the rest of your life. Any reminder of a traumatic event or, conversely, loneliness, predisposing to sad memories, increase the acuteness of the patient's experience. The ideas of self-accusation, self-abasement reflect the existing psychotrauma. Patients blame themselves for the death of a loved one, for sluggishness, for not being able to save their families.

Jet paranoid- delusional psychosis that occurs as a reaction to psychological stress. Such nonsense is usually unsystematized, emotionally saturated (accompanied by anxiety, fear), occasionally combined with auditory deceptions. In typical cases, the onset of psychosis is facilitated by a sudden change of scenery, the appearance of a large number of strangers(military operations, long journeys through unfamiliar areas), social isolation (solitary confinement, a foreign language environment), increased human responsibility, when any mistake can cause serious consequences.

Treatment:

Relief of psychomotor agitation, panic, anxiety and fear - intravenous or intramuscular administration of tranquilizers (diazepam up to 20 mg, lorazepam up to 2 mg, alprazolam up to 2 mg). With the ineffectiveness of tranquilizers, antipsychotics are prescribed (chlorpromazine up to 150 mg, tizercin up to 100 mg, chlorprothixene up to 100 mg).

Affective-shock reactions often resolve without special treatment. Of greater importance are helping the patient in a threatening situation and preventing panic. To prevent the development of post-traumatic stress disorder, mild tranquilizers and antidepressants are prescribed, and psychotherapy is carried out.

Hysterical psychoses are quite well treated with the help of directive methods of psychotherapy (suggestion in the waking state, hypnosis, drug hypnosis). A good effect can be given by small doses of neuroleptics (chlorpromazine, tizercinum, neuleptil, sonapax). Sometimes drug disinhibition is used.

Treatment of reactive depression begins with the appointment of sedative antidepressants and tranquilizers (amitriptyline, diazepam). Elderly and somatically debilitated patients are recommended to prescribe drugs with least amount side effects (fluvoxamine, gerfonal, azafen, lorazepam, nozepam). As soon as the patient begins to show interest in talking with the doctor, psychotherapeutic treatment begins.

Treatment of reactive paranoids begins with the introduction of antipsychotics. Depending on the leading symptoms, sedatives are chosen (for anxiety, confusion, psychomotor agitation) or antipsychotics (for suspicion, distrust, delusions of persecution). From sedatives, you can use chlorpromazine, chlorprothixene, tizercin, from antipsychotics, haloperidol, triftazin are most often used.

organic disorder personalities It is a permanent brain disorder caused by a disease or injury that causes a significant change in the behavior of the patient. This condition is marked by mental exhaustion and a decrease in mental functions. Disorders are found in childhood and are able to remind themselves throughout life. The course of the disease depends on age and are considered dangerous critical periods: pubertal and climacteric. At favorable conditions a stable compensation of the individual with saving the ability to work can occur, and in the event of negative impacts(organic disorders, infectious diseases, emotional stress), there is a high probability of decompensation with pronounced psychopathic manifestations.

In general, the disease is chronic course, and in some cases progresses and leads to social maladaptation. With appropriate treatment, it is possible to improve the patient's condition. Often, patients avoid treatment without recognizing the fact of the disease.

Causes of Organic Personality Disorder

organic disorders due to huge amount traumatic factors are very common. The main causes of disorders include:

- injuries (craniocerebral and damage to the frontal or temporal lobe heads;

- brain diseases (tumor, multiple sclerosis);

- infectious lesions of the brain;

— vascular diseases;

- encephalitis in combination with somatic disorders (parkinsonism);

- cerebral palsy;

- chronic manganese poisoning;

- temporal lobe epilepsy;

- the use of psychoactive substances (stimulants, alcohol, hallucinogens, steroids).

In patients suffering from epilepsy for more than ten years, an organic personality disorder is formed. It is hypothesized that there is a relationship between the degree of impairment and the frequency of seizures. Despite the fact that organic disorders have been studied since the end of the century before last, the features of the development and formation of symptoms of the disease have not been fully identified. There is no reliable information about the influence of social and biological factors on this process. The pathogenetic link is based on brain lesions of exogenous origin, which lead to impaired inhibition and the correct correlation of excitation processes in the brain. At present, the integrative approach in detecting the pathogenesis of mental disorders is considered the most correct approach.

An integrative approach involves the influence of the following factors: socio-psychological, genetic, organic.

Symptoms of Organic Personality Disorder

The symptoms are characterized by characterological changes, expressed in the appearance of viscosity, bradyphrenia, torpidity, sharpening of premorbid features. The emotional state is noted either, or unproductive, for the later stages it is characteristic and emotional lability. The threshold in such patients is low, and an insignificant stimulus can provoke an outbreak. In general, the patient loses control over impulses and impulses. A person is not able to predict his own behavior in relation to others, he is characterized by paranoia and suspicion. All his statements are stereotypical and are marked by characteristic flat and monotonous jokes.

At later stages, organic personality disorder is characterized by dysmnesia, which can progress and transform into.

Organic personality and behavioral disorders

All organic behavioral disorders occur after a head injury, infections (encephalitis) or as a result of a brain disease (multiple sclerosis). There are significant changes in human behavior. Often the emotional sphere is affected, and the ability to control impulsiveness in behavior is also reduced in a person. The attention of forensic psychiatrists to the organic disorder of a person in behavior is caused by the lack of control mechanisms, an increase in self-centeredness, as well as a loss of social normal sensitivity.

Unexpectedly for everyone, previously benevolent individuals begin to commit crimes that do not fit into their character. Over time, these people develop an organic cerebral state. Often this picture is observed in patients with trauma to the anterior lobe of the brain.

An organic personality disorder is taken into account by the court as a mental illness. This disease is accepted as a mitigating circumstance and is the basis for referral for treatment. Often problems arise in antisocial individuals with brain injuries that exacerbate their behavior. Such a patient, due to an antisocial stable attitude to situations and people, indifference to the consequences and increased impulsivity, can appear very difficult for psychiatric hospitals. The case can also be complicated by the anger of the subject, which is associated with the fact of the disease.

In the 70s of the 20th century, the term "episodic loss of control syndrome" was proposed by researchers. It has been suggested that there are individuals who do not suffer from brain damage, epilepsy, but who are aggressive due to a deep organic personality disorder. At the same time, aggressiveness is the only symptom this disorder. Most of persons endowed with this diagnosis are men. They have prolonged aggressive manifestations that go back to childhood, with an unfavorable family background. The only evidence in favor of such a syndrome is EEG anomalies, especially in the temples.

It has also been suggested that there is an abnormality in the functional nervous system leading to increased aggressiveness. Doctors have suggested that severe forms of this condition are due to brain damage, and they are able to remain in adulthood, as well as find themselves in disorders associated with irritability, impulsivity, lability, violence and explosiveness. According to statistics, a third of this category experienced antisocial disorder, and in adulthood most of them became criminals.

Diagnosis of organic personality disorder

Diagnosis of the disease is based on the identification of characterological, emotional typical, as well as cognitive changes in personality.

The following methods are used to diagnose an organic personality disorder: MRI, EEG, psychological methods (Rorschach test, MMPI, thematic apperceptive test).

Organic disorders of the brain structures (trauma, disease or brain dysfunction), the absence of memory and consciousness disorders, manifestations of typical changes in the nature of behavior and speech are determined.

However, for the reliability of the diagnosis, a long-term, at least six months, observation of the patient is important. During this period, the patient should show at least two signs in an organic personality disorder.

The diagnosis of organic personality disorder is established in accordance with the requirements of the ICD-10 in the presence of two of the following criteria:

- a significant decrease in the ability to carry out purposeful activities that require a long time and not so quickly leading to success;

- modified emotional behavior, which is characterized by emotional lability, unjustified fun (euphoria, easily turning into dysphoria with short-term attacks and anger, in some cases a manifestation of apathy);

- drives and needs that arise without taking into account social conventions and consequences (anti-social orientation - theft, intimate claims, gluttony, non-compliance with the rules of personal hygiene);

- paranoid ideas, as well as suspicion, excessive concern for an abstract topic, often religion;

- change in tempo in speech, hypergraphia, over-inclusion (inclusion of side associations);

- changes in sexual behavior, including a decrease in sexual activity.

Organic personality disorder must be differentiated from dementia, in which personality disorders are often combined with memory impairment, with the exception of dementia with. More precisely, the disease is diagnosed on the basis of neurological data, neuropsychological examination, CT and EEG.

Treatment of organic personality disorder

The effectiveness of the treatment of organic personality disorder depends on an integrated approach. It is important in the treatment of a combination of drug and psychotherapeutic effects, which, when used correctly, enhance the effect of each other.

Drug therapy is based on the use of several types of drugs:

- anti-anxiety drugs (Diazepam, Phenazepam, Elenium, Oxazepam);

- antidepressants (clomipramine, amitriptyline) are used in the development of a depressive state, as well as exacerbation of obsessive-compulsive disorder;

- neuroleptics (Triftazine, Levomepromazine, Haloperidol, Eglonil) are used for aggressive behavior, as well as during an exacerbation paranoid disorder and psychomotor agitation;

- nootropics (Phenibut, Nootropil, Aminalon);

— Lithium, hormones, anticonvulsants.

Often, medications affect only the symptoms of the disease, and after discontinuation of the drug, the disease progresses again.

The main goal in the application of psychotherapeutic methods is to ease the psychological state of the patient, help in overcoming intimate problems, depression, and , assimilation of new behaviors.

Help is provided both in the presence of physical and mental problems in the form of a series of exercises or conversations. Psychotherapeutic impact using individual, group, family therapy will allow the patient to build competent relationships with family members, which will provide him emotional support relatives. Placing a patient in a psychiatric hospital is not always necessary, but only in cases where he poses a danger to himself or to others.

Prevention of organic disorders includes adequate obstetric care and rehabilitation in the postnatal period. Great importance has a proper upbringing in the family and at school.

Interested in this question. How can a moderately pronounced organic personality disorder be diagnosed in connection with prenatal pathology at the age of 18 on examination from the military registration and enlistment office in a week, if, according to medical data. cards from the children's polyclinic the child was born full-term, the neonatal period was without pathologies, the Apgar score was 8/9 points, in the first year he grew and developed according to age, the examination by a neurologist at 2 months is healthy? Or is it a universal diagnosis for all conscripts who at least once turned to a psychiatrist in childhood and the psychiatrist does not want to risk sending them to the army? Judging by the comments, this universal diagnosis can be made to anyone, at the discretion of the psychiatrist. And for this, as you write, you do not need to be observed for half a year.

Hello! I had a problem when applying for a job (public service) in the certificate, the psychiatrist indicated that I applied for a referral from a therapist to pass the ITU for the main disease diabetes mellitus and diagnosed F07.09. I did not know about this diagnosis, I did not undergo examinations, I have no complaints and violations corresponding to this disease, I work as an engineer, I have a good characteristic, I drive a car. In 2013 I had a stroke, recovered quickly went to work, at about the same time I came Commission ITU, complaints of speech disorder, dementia, bad memory, there was no insomnia, there was a slight numbness in the left arm and headache, which after some time passed, was not observed by a psychiatrist and did not seek help, no examinations confirming such a diagnosis took place. Please tell me who can remove the diagnosis, or is it necessary to go to court, because the medical commission suggested going all necessary examinations and paid professionals.

• Hello Julia. To remove the diagnosis, you need to talk with your psychiatrist. Usually, to remove the diagnosis, the patient is sent to a psychiatric hospital for a psychiatric pseudo-examination; psychiatrists alone do not make such decisions. Before the beginning active action against PND, it is better to bypass all psychiatrists and if you find sympathy from someone, try to go to him. Young psychiatrists are more responsive.
  In PND, there is a lawyer, you can contact him, but you must remember that he defends PND, not you. But in any case, he will give information and will remember the law.
  To from the head. It was easier for the PND to find a common language, you can immediately inform him of your determination to go to the end, to the court, in which you will appeal, incl. and his actions or omissions. You just need to act judiciously: calmly, persistently, but without aggression and emotions. Try to focus on common interests- neither PND, nor you need extra troubles and problems. At the same time, you must follow the rules: you must not show behavior that will cause the psychiatrist to analogy with the symptoms of psychiatric diagnoses, otherwise psychiatrists can exacerbate you right there. You can first contact any paid psychiatrist for a mental health certificate. This certificate does not oblige anyone to anything, but will help the PND psychiatrists to relieve themselves of responsibility and show that you will have serious arguments in court. If the issue is not resolved, then you can go to court or the prosecutor's office. What documents the prosecutor's office will need, they will decide for themselves and request them from the MHP. For the court, you need to competently draw up a claim and provide evidence of your innocence. To do this, you need the advice of a lawyer or a lawyer. The lawyer draws up a statement of claim to recognize the diagnosis of a mental disorder as unfounded. In any case, the court appoints a forensic psychiatric pseudo-examination to confirm or refute the false diagnosis.
  In the pleading part of the statement of claim, it is necessary to ask the court not only to recognize the psychiatric false diagnosis made as unfounded, but also to ask the court to oblige the PND to “remove” (cancel) the previously made false diagnosis.

Hello, at the age of 22 I was diagnosed with a personality disorder of organic etiology, I was on a day hospital. Now for me the question of work is extremely difficult, the fact is that the contrast of my mood is very frequent and extreme in its maxims. Euphoria then depression, all this can happen day after day, therefore I practically cannot work at all, because it is not only mentally inconvenient to carry out any activity, but also physical suffering is terribly disturbing during actions. And who knows that in depressive episodes, doing something is absolutely unrealistic, everything falls out of hand, everyone is angry at you, ready to annoy, shout, insult and humiliate you. It used to work like this before. While I’m in euphoria, everything is fine, I’m showing excellent results, a lot of sales, people like everything, as soon as the emotional background has changed, so for my colleagues I’m immediately the number one enemy, people blame everything and in this state it’s difficult to do something with what is happening, you can only say that let's talk tomorrow or when I feel better. I told the doctor that I can't exercise labor activity I've been looking for a job for three months, all to no avail. I was told that it is necessary to lie in the hospital for 2-4 months before writing out a referral to the ITU. I can't go there yet. But the doctor also added to me that I was not very ill and I was very likely to be denied the establishment of a disability group. It’s very interesting, I can’t function, and I can’t even count on the third group of disability either. So I live on the provision of my girlfriend and I can’t do anything. Tell me, is it worth going to the clinic for an examination?

• Hello Daniel. Just for yourself, you can go through an examination in the clinic, get recommendations on your condition and medication. Regarding the group: You were given a specific answer, under what conditions they write out a referral to the ITU and establish a disability group.

Hello. In 2008 he passed the draft board, was recognized as "B" - limitedly fit for military service, according to Article 14-b (mental disorders with moderate mental disorders), he was exempted from conscription for military service and enlisted in the reserve of the Armed Forces of the Russian Federation. The diagnosis was made at the recruiting station during the passage of the military medical commission (after a 2-3 minute examination by a psychiatrist), but was not sent to the hospital for examination. When making a conclusion on fitness for military service, the doctor had no information that I was suffering from the indicated diseases (because I do not suffer from them), just as the pre-conscription commission had no complaints about my health. Due to my young infantilism and frivolity, I had no idea what difficulties I might face in the future in finding a job after receiving an education with this diagnosis. The military registration and enlistment office refuses to carry out in relation to me resurvey They say they don't have to. (to be afraid to get “on the cap”) They don’t put them in the regional psychiatric clinic without a referral from the military registration and enlistment office to review the diagnosis. (I would even agree to compensation in order to receive the fitness category “B” with minor restrictions). Not a evader from the army purposefully did not "mow down", during the call he studied in absentia. Please advise what can be done in this situation, 3 years of attempts to change the category of validity were in vain.

• Hello, Alexander. Theoretically, the diagnosis can be removed after five years, of which the patient should be under the supervision of a specialist for a year. In this case, the latter must cancel therapy. With your diagnosis, you can be observed by a psychiatrist at the place of residence, which will help you in solving your problem.

  Good afternoon. Go to your local dispensary. You will be sent for medical examination. A psychologist, or you need to go to the hospital for an examination. Let them prove it. Let them assemble a commission headed by the chief physician. In general, everything needs to be decided in a local psychiatric dispensary

  • Thank you for the answer, but the hospital said that we are waiting for you with a referral from the military enlistment office (as I said earlier, the military enlistment office does not give a referral) or with a court decision on the appointment of a forensic medical examination. Now a lawsuit is being prepared. I ask you to answer one more question: At the legislative level, were they obliged to examine me in a hospital under Article 14-b (organic mental disorders with moderate mental disorders) or such a diagnosis can be made when examined by a psychiatrist (as in my case). We need a rule of law.

Good afternoon. My husband had a head injury at birth (he had his skull set back). According to his mother, he was never diagnosed. As a child, I was calm child. But against the backdrop of a family tragedy during his school years, he got out of hand and left home. Relations with his mother deteriorated greatly. There was a promiscuous sex life, infectious diseases. There were also drugs. But in the end, everything is in the past. However, she is very aggressive towards women. severely beaten mocked ex-girlfriend same situation with me. Och often promises to swear that he will be with me then sharply takes back his words. He says that his family is pulling him back, that he is a lone wolf and a bright, rich future awaits him, and he followed him. Then he makes trouble, comes back and asks to forgive everything. Och likes to talk about religion, but he himself does not observe anything. categorically does not want children. I observed a pattern that all these exacerbations of aggression, irritability and departures occur twice a year like clockwork: from the period February-March, and then August-November. sometimes there is an outbreak in July, but not strong. I've been watching this for six years. Tried to give sedatives, including phenozipam. At this time, he was calm, with a family man. Didn't suffer from insomnia. Can you tell me by the symptoms whether what is happening to him can be attributed to a mental disorder and specifically to an organic one?

While serving in the army, he had a shell shock. In 1992, the diagnosis was made: an organic lesion of the central nervous system of traumatic origin, astheno-depressive syndrome With vegetative crises, moderate - mixed hydrocephalus. Was on the third group of disability. The group was dropped this year. My condition is such that I can not work. Previously worked as a graphic designer. He filed an appeal with the central regional MREK. True, in our district clinic they said that disability would not be restored and this was a waste of time. I don't know what to do. Fainting and severe depression began. Can you tell me how I can restore the disability group. Thanks in advance.

• Hello Nikolay. To restore the disability group, you should collect the results of all surveys. It is necessary to take a referral to the ITU from the attending physician, and the decision of the commission, as a result of which the disability was removed, will also come in handy. Having all these documents, you should write a letter to the bureau that conducted the last examination (or immediately to the main ITU bureau). It is important to have time to submit an application within a month from the moment the group was withdrawn or transferred to another. The appeal should indicate your disagreement with the results of the ITU. Not later than 3 days from the date of receipt of your letter, the ITU Bureau must send your application and Required documents to the main office. On the basis of your application, a repeated ITU in a different composition should be appointed within a month. This commission may refute the decision of the previous one (i.e., leave the group) or agree that the group is not allowed for the patient (or is allowed, but different).

Hello! I am 39. An orphan since 33. I live alone. For a long time, my relatives themselves closed me off from the street, they ran after me everywhere. People laughed. From a regular school, they were transferred for 5 years to a boarding school for ZPR. From the age of 11 I read and sing in Orthodox church. I have a library degree. I studied hard. They are not accepted into religious institutions. Was in monasteries, but they say worldly and in the spirit of the family. And I have a tragedy. At the age of 12, they raped me, then they rejected everything, even in the temple. He became not a fool, not a holy fool. I tried to show everyone that I'm normal and I'm looking for friends. But they just took away my pension. I'm in group 3 for life. He was released from the army in 1998 due to organic matter, but is of limited use. Since childhood, I have been growing cheerful, open, trusting, willing to help people, and people shun me. Since 2008, he began to drink beer and port wine, in 2010 he got into the police. At the same time, my mother was very sick. She died in 2011. Then he graduated from Moscow State University of Arts and began to travel to monasteries. I saw that another life is still possible. Returned home, raped again, ran away to monasteries again. Sometimes he worked. From 2015 to this day, I sometimes meet a woman, she has a mental illness, she has a child. I suffer a lot with her, then she will come, then she won’t. She writes more SMS. In March 2015, our psychiatrist diagnosed me (Organic Personality Disorder, Stage 1). I was immediately asked from work. The girl also turned away, and I also have congenital sexual arousal, it is often required, I often masturbate. I want to look for another, but the ministers of the church either approve it, or forbid it, do not trust that the family will work out and again persuade me to the monastery. But I already know myself that the regimes of the monasteries are beyond my power and, I noticed, in a new place, my fornication intensifies. There is no time for prayers and the monastery. What should I do? Now I read and sing in the city church, I try to find a friend in faith, but they are somehow aloof, and I am cheerful. Even the priest sees a child in me, that it scares everyone away, that I am immature. But in my heart I've been ready for anything for a long time, but you can't prove it to people. I need a family and everything to be mutual, in faith and love. I tried to search the sites, but there women are looking for material support, they don’t need someone like me. What should I do?

Hello, please tell me, when diagnosing an organic personality disorder, you can form a group, an organic disorder arose against the background of epilepsy, and a cerebrospinal fluid cyst was also found on MRI.

my son is 22 years old. Until 2009, he was observed by a psychiatrist, graduated from high school. vocational school, served in the missile forces. Now I decided to get a job in the police, I went through the entire medical examination, everything is fine everywhere. But in the regional psychiatric hospital, a psychiatrist wrote a diagnosis of "organic personality disorder" and that it was observed until 2009. the doctor did not examine him, the nurse simply issued a certificate with this diagnosis. Is the diagnosis final and lifelong? Is it possible to get a job with the police? thanks in advance. Sincerely, Balatskaya Irina Viktorovna.

Hello！We are from Kazakhstan. City of Almaty. My brother has been diagnosed with an organic personality disorder. We do not know what to do ... when he drinks alcohol, he rushes at everyone. We fear. Once they did something on his head when he was using drugs ... or they drilled into his head, like they wanted to drown out the nerve so that he would not use drugs ... in general, this is the first time we are faced with such a situation. Tell me what to do Can we cure?

• Hello Erkegali. It is necessary to convince the brother to seek help from a psychotherapist. The family, for its part, must provide psychological support and believe in the cure of the sick.

When passing the commission in the military registration and enlistment office, the psychotherapist after 1 visit makes a diagnosis, graduated from school, college, received a diploma, rights, has never been observed by a psychotherapist, was not registered anywhere, an athlete, has medals, certificates, cups. Is this a way to get money out of your parents to pay at the military registration and enlistment office, or what! It's just some bullshit. What to do, where to run to save the guy, a stigma for life, none of the syndromes.

• Hello, Elena.
  We recommend that you appeal the diagnosis decision and suspend the implementation of this decision. To do this, you must file a complaint, first of all, against the decision of the draft board. If you do not agree with the conclusion of the expert doctors, you must indicate your claims in the complaint against the decision of the draft board.
  An application (complaint) of disagreement with the decision of the draft board is drawn up addressed to the chairman of the draft board of the subject.
  It is necessary to indicate the following data: full name, date of birth, address of registration; the approximate date of the medical examination and the meeting of the draft board, claims and requirements.
  In the complaint, demand: to cancel the decision of the draft board on the diagnosis of a psychiatrist and to conduct a control medical examination regarding the son.

I was raped at the age of 5. When I began to realize what had happened, everything collapsed. At 12 he began to breathe gasoline, glue (up to 18), and at 13 already intravenous drugs. In 24 psychotropics (screw). Under the age of 17, 2 suicide attempts. At 18 the colony began. Wrote in the direction of F 18-26. Officially I have 117 B with a mark of limited capacity. Constant feeling of doom, unwillingness to live, social inadequacy. But you can't tell from the outside. Unexplained bouts of crying (deaf - just tears, hopelessness). Problems with the opposite sex. I'm 35 and I don't want to live anymore. It's in my head and I can't fight. I go to drugs, but only aggravate the situation.

• Hello Artem. We sympathize with your problem. It is necessary to seek and seek help from drug treatment centers rehabilitation centers, to social rehabilitation centers; volunteer centers and charitable foundations dealing with the problem of drug addiction treatment. This will allow you to return to a full life, adapt and fulfill yourself in society.
  Treatment in such places is anonymous, all information will be known only to you and the attending physicians (psychotherapist, narcologist, clinical psychologist, addiction counselor), so all sensitive information received from you will be kept secret.

I was in college, I got beat up badly. Before college, there were head injuries, against the backdrop of injuries, I went to work in a restaurant, I drank heavily. Now 35 years old - no profession, no memory, no mind, I live with my parents, I don’t pull on the opposite sex. I have been taking antidepressants for five years, Velaxin, nootropics, Cerebralysin, for MRI of a Verge cyst and a transparent septum, but they write a development option. I can hardly believe it, I think that the acquired cysts. The doctors said it was chronic. I said a lot that I drank heavily. Came new doctor young, did not fall in love with him because he drank, he does not pay attention to the injuries that were. On me - they pay you money for the group just like that, but he doesn’t take into account the fact that I can’t work. I had problems - I was attracted to my gender (paraphilias), I told them this, they did not like me. I told a new young doctor today that I was drawn to my floor, I wanted to sit next to him and cry. He hated me in general today, well, this is not normal - this is also a disease, not only is it not drawn to the opposite sex, for more than ten years I have been wanting to cry and hug with my own sex. Thirdly, I have a correspondence diploma from the Institute of Culture and Retraining of a Manager-Economist, but I can’t cope with it. When I don’t take antidepressants, I don’t even have a cognitive interest, I lie flat on the EEG, I used to be small, now the cortical rhythm is disorganized. I went to the capital, raised the issue of stem cell treatment, so these locals did not like it at all. The diagnosis says an organic personality disorder with moderate cognitive impairment of a mixed type, and a convulsive syndrome, but on the EEG petit mal is long gone, only disorganization of the cortical rhythm. I couldn’t sleep without chlorproxen for half a year, I thought they would put me in to make the diagnosis worse, but they say that they only gave me a third for a year. So that at least the third is not removed.

My nephew is 5 years old, he was given a disability, the diagnosis is: organic personality disorder, psychoverbal delay - CAN A CHILD ATTEND DOE? OR WHERE DO I NEED TO APPLY FOR THE CHILD TO ATTEND OU? I went to kindergarten, but there are problems, they say he fights, beats children, etc.

• Hello Bairm. In the Department of Education, you need to find out what documents you need to collect, where to go through a commission in order to arrange a child in a correctional group kindergarten given his diagnosis.

Hello. I was sentenced to 12 years of organic disorder! Right now I'm 19 years old. Right now, with this conclusion, I can’t go to serve in the army, I can’t get it! Yes, and the normal work will not work!!! What do I need to do to get this sentence removed from me!? And in general, is it possible to remove such a conclusion from oneself or not?

• Hello Vladislav. You need to apply to the PND and write an application addressed to the head physician, in which, in an arbitrary form, set out a request for a second psychiatric examination for a possible withdrawal of a psychiatric diagnosis. If the results of the examination allow, then the diagnosis will be removed for you.

Please tell me, I have a child of 7 years old, I started drawing with feces in the toilet and smearing them under the carpet, I took an appointment with a psychologist to help?
Or at once to the psychiatrist with such problem?

• Hello Anna. You did everything right. Based on the results of the examination of the child and the results of a face-to-face conversation with you, the child psychologist will make assumptions about the psychogenic nature (the presence of stressful situations) or the organic nature (due to intracerebral organic processes) of these behavioral disorders. And already according to the results of the consultation, the specialist, if he considers it necessary, will recommend visiting a pediatric neuropsychiatrist.

Hello! Tell me please! Such a diagnosis is sibling my husband. The mother of the spouse claims that this is a consequence of birth trauma. Also, there is a diagnosis of PEP, and a lag in physical. development at 9 years old, the boy hardly reaches parameters 5 summer child. I am pregnant - can this disease be inherited? And should I be afraid for my baby? From the first marriage, two healthy children.

• Hello Olga. Given your position, you absolutely can not be nervous. Follow all the recommendations of the doctor you are seeing during pregnancy.
  With regard to diagnoses of organic personality disorder and perinatal encephalopathy, then their occurrence is associated with numerous reasons, which also include persistent anomalies of character, consisting of a combination of genetic and acquired properties.

Hello, I have been “sick” of this since childhood - at that age (from the age of 4) I was whiny, wore fake “smiles”, then it grew, and was a jester in further companies. He experienced a lot of dramas, in kindergarten a brick fell on his head, then he constantly fell somewhere, or he himself, in psychosis, hit his head against the walls. In short, my life was very emotional, diverse, and I visited many “roles” - all this resulted in complete self-isolation, I lay at home for a year and a half in the deepest depressive psychosis after my “friends” betrayed me and the “girl” left. I've been going to psychiatrists for as long as I can remember. At the age of 16 there was an excited type of illness. Now apathy is on the rise. I want to be creative. Have you found a girlfriend. But I don’t stay at work, I changed about a dozen in a couple of years. I want to - but I know the outcome, at first everything is smooth - and then I am a slave. First I lock myself in the back room and cry, and then I beat the faces and send the bosses to hell. I drank very heavily - every day, a sea of ​​​​drugs. Tied up - 2 years clean. Sober psychoses even give some satisfaction. I will ask a direct question, please answer - is it possible to put a disability without lying in a dispensary? I know that this is chronic, and I don’t see the point in wasting time on something that will not bring any results (if only temporary - and if you take pills, then you need money that is not there). Thank you for your attention. Something I went too far with the volume of the message - the essence is precisely in disability and at least some funds for my life. I am 22.

• Hello Ivan. You need to contact your psychiatrist with your complaints of ill health and desire to receive a disability, who will tell you how best to act in your situation.

Hello, I have the following story:
I was expelled from school in the 3rd grade for absenteeism and poor performance. After that there was a commission and there it was decided to send me to a boarding school of the 8th type (for the mentally retarded), I studied there for 6 years and graduated after the ninth. (I was diagnosed with mental retardation)
When I passed the commission at the military registration and enlistment office, I was sent for an additional examination. Passed a series of tests and questions.
In general, other doctors removed this diagnosis from me and put another one.
They did not take me into the army, when I asked what they put me in, they said "Organic disorder." He asked: "What does this mean?" They said: "Nothing - live as you lived."
I read in the comments that disability is made with this diagnosis? Why didn't they put me on? I have never heard of her at all.
I read the whole article about this diagnosis. Well, this diagnosis doesn’t apply to me at all, the only thing I had was a concussion, I hit my head on the ice, I didn’t lose consciousness, I spent 10 days in the hospital and left. Unless it could serve as the reason of the diagnosis?

• Good afternoon, Igor. Traumatic brain injury (concussion) could serve as the onset of the disease and the diagnosis. If you disagree with your diagnosis, you can contact the head physician medical institution for additional research. To do this, you should contact him in writing, in the form of a statement in which you will justify your right and requirement for examination and research by other doctors.

My daughter was diagnosed with this at the age of 8. Only home-based education was allowed, but a certificate from a neurologist is needed, but she does not diagnose anything, and at the 9th Children's Hospital of Moscow they said that there are no examinations in the country. They did not give an extract and there is no diagnosis. Now 16 years old: there is no talk about school at all. Where to go next with such medicine? Tell. Relatives can't stand her, so we're homeless.

• Marina, seek help with your problem to other doctors. One, the other will refuse, and the third will help. It can be a neuropsychiatrist, psychiatrist, psychotherapist who will diagnose and prescribe the necessary treatment. Do not give up and everything will work out for you.