Brief signs of mental illness. How to recognize mental illness

Psychosis is a serious mental disorder, such a deep violation of the mental, emotional and affective components is considered quite dangerous for patients.

The disease manifests itself in a sharp change in the patient's behavior, the loss of an adequate attitude to life and others, in the absence of a desire to perceive the existing reality. At the same time, they interfere with the awareness of the presence of these very problems, a person cannot eliminate them on his own.

Due to the emotional component, hormonal explosions and susceptibility, women and other mental disorders are twice as common as (7 vs. 3%, respectively).

What are the reasons and who is most at risk?

The main causes of the development of psychosis in females are as follows:

One of the main reasons is increased emotional excitability or the presence of a similar disease in the woman's family, mother, sister, that is, the genetic component.

Who is at risk

The root cause of the appearance of psychosis is often alcohol abuse and subsequent intoxication of the body. In most cases, men are most susceptible to alcoholism, so the female suffers from much less often and endure it faster and easier.

But there is also a reason that is characteristic only for women, which increases the risk of the disease. This is pregnancy and childbirth. The physical factors of the appearance of psychosis in this case include toxicosis, vitamin deficiency, a decrease in the tone of all body systems, various diseases or complications due to difficult gestation and childbirth.

Psychological ones include fear, worries, increased emotional sensitivity, unwillingness to become a mother. At the same time, postpartum mental disorder is more common than during pregnancy.

Behavioral features

For a woman with mental disorders, such changes in behavior and life activity are characteristic (with the symptoms noticeable only from the outside, the sickest and unaware that she is sick):

• lack of resistance to, which often leads to or scandals;
• the desire to isolate oneself from communication with colleagues, friends and even relatives;
• there is a craving for something unreal, supernatural, interest in magical practices, shamanism, religion and similar areas;
• the emergence of various fears, phobias;
• decreased concentration, mental retardation;
• loss of strength, apathy, unwillingness to show any activity;
• sudden mood swings for no apparent reason;
• sleep disturbances, which can manifest itself both in excessive drowsiness and insomnia;
• decrease or complete lack of desire to eat food.

If a woman herself was able to detect any signs of psychosis, or if her relatives noticed them, then it is urgent to seek qualified help.

Varieties of deviations in the mental state

Psychosis can be conditionally divided into two large groups:

1. organic. In such cases, it is a consequence of a physical illness, a secondary disorder after disturbances in the functioning of the central nervous and cardiovascular systems.
2. Functional. Such disorders are initially due to the psychosocial factor and the presence of a predisposition to their occurrence. These include violations of the process of thinking and perception. Among others, the most common:, schizophrenia,.

Separately, it can be distinguished, it appears in 1 - 3% of women in the first months after the birth of a child, unlike the more common postpartum depression, a psychotic deviation does not go away on its own and requires treatment under the qualified supervision of specialists.

Symptoms:

• decreased appetite and rapid weight loss;
• constant anxiety, sudden mood swings;
• desire for isolation, refusal to communicate;
• violation of the level of self-esteem;
• thoughts about committing suicide.

Symptoms appear individually, some may be within a day after giving birth, others a month later.

The causes of this type of psychotic disorder may be different, but they are not fully understood by scientists. It is reliably known that patients who have a genetic predisposition are susceptible to it.

The failure of the psyche can be accompanied by various conditions that provoke disturbances in the work of the whole body of a woman.

Violation of diet, activity and rest, emotional tension, taking medications. These factors "hit" the nervous, cardiovascular, respiratory, digestive and endocrine systems. The manifestation of concomitant diseases individually.

Who to turn to for help?

Self-medication in this case is contraindicated. You should also not contact familiar doctors of various specialties, psychologists, traditional healers. Treatment should be carried out only by a public or private doctor - a highly qualified psychotherapist!

Unfortunately, a woman suffering from psychosis cannot seek help herself, because she does not notice the signs of her illness. Therefore, the responsibility lies with the relatives and friends of the mother. Seek help from a doctor as soon as possible.

The specialist will examine the patient, refer him for additional tests and, based on their results, prescribe treatment and the necessary drugs.

Treatment can take place in a hospital with the participation of medical staff, or at home. When treating at home, a mandatory safety measure will be taking care of the baby with the least intervention of the mother (in case of postpartum mental failure). The nanny or relatives should take care of these concerns until the disappearance of all symptoms of the disease in the patient.

Treatment usually consists of a complex, which includes:

• medicines, usually this,;
• psychotherapy - regular sessions with a psychotherapist and a family psychologist;
• social adaptation.

The patient can not immediately realize, accept her condition to the end. Relatives and friends must be patient to help the woman return to normal life.

The consequences of the lack of therapy are extremely unfavorable. The patient loses touch with reality, her behavior becomes inadequate and dangerous not only for her own life and health, but also for those around her.

A person is suicidal, may become a victim or cause of violence.

How to prevent mental breakdown?

Preventive measures include:

Prevention should be a priority, especially in those women who are prone to emotional disruption or have a hereditary predisposition to psychotic disorders.

According to the presumption of mental health, a person is not required to prove that he is not sick. In particular, if the symptoms of mental illness are not pronounced in him, they do not appear systematically, but in general he is quite stable. But there are a number of signs of mental disorders that give sufficient grounds for a psychiatric examination.

Signs of neuropsychiatric disorders: symptoms of impaired perception

The first group of mental illnesses includes symptoms of impaired perception

Senestopathy- this is a breakthrough of signals from internal organs, muscles into consciousness. These symptoms of mental disorders are manifested in the form of painful, unpleasant, often migrating sensations in the head, chest, abdomen, limbs. This is when it twists, hurts, shimmers, burns somewhere inside, and the doctors say that nothing can hurt. In many cases, they are manifestations of hidden depression, neuroses.

Illusions- this is a distorted perception of real-life objects and things of the surrounding world. They are divided into auditory, tactile, gustatory, olfactory and visual.

An example of a visual illusion is a bush by the road taken for an animal, the lace on the curtain folds into a face.

Falling drops of water can serve as an example of auditory illusions, the noise from which is taken for conversation, the sound of train wheels - for music.

Illusions as signs of mental illness often occur in infectious patients, with chronic poisoning and intoxication, at the beginning of the development of delirium tremens. But they are also observed in healthy people. This may be in cases where the perception of the environment is indistinct (twilight, noisy room) or a person is in a state of emotional stress.

An example of a physical illusion: a spoon dipped into a glass of water seems to be broken.

In addition, there are psychosensory disorders, when the perception of signs of objects and one's own body is disturbed. They appear larger or smaller, further or closer than they really are, the proportions are distorted, the quantity, lighting, color change.

How to understand that a person has a mental disorder: hallucinations

Hallucinations are imaginary perceptions that do not have an external object as their source. They can be elementary (knocking, noise, roar, color spots) and complex (voices, music, pictures, objects, people).

How to understand that a person has a mental disorder, and what are the hallucinations? These imaginary perceptions are divided into auditory, visual, gustatory, tactile and olfactory. They may be in the nature of "made" or seem real, real.

Auditory (verbal) hallucinations are characterized by the fact that the patient hears individual words, phrases, songs, music. Sometimes the words are threatening or commanding in nature, and then it can be difficult to disobey them.

Visual hallucinations can be represented by figures, objects or whole pictures, films.

Tactile hallucinations are felt as a touch to the body of foreign objects, as crawling over the body or inside the body of insects, snakes.

Taste hallucinations are represented by the feeling that the patient has bitten off something.

Olfactory - a sensation of a non-existent smell, most often unpleasant.

Hallucinations are nonspecific, occur in a variety of diseases and, like delusions, are signs of psychosis. They occur in schizophrenia, intoxication, and alcoholic delirium (delirious tremens), and in organic (vascular, tumor) diseases of the brain, and in senile psychosis.

The presence of these signs of mental illness in a person can be judged by his behavior. He gets irritated, scolds, laughs, cries, talks to himself, responds to an imaginary attack with a defensive reaction.

A symptom of mental illness is thought disorder

The second group of signs of mental illness are symptoms of impaired thinking.

The patient may change the pace of thinking. It can be so accelerated that the patient does not have time to express his thoughts and feelings in words. When talking, he skips words and whole phrases. A similar condition is observed more often in a state of mania with manic-depressive psychosis. The state of slowing down of thinking is characterized by lethargy of patients, they answer in monosyllables, with long pauses between words. These symptoms of mental illness are characteristic of dementia, deafness.

Sometimes they talk about the viscosity of thinking. In this condition, the patient is very thorough. If he is asked to tell about something, then he gets stuck for a long time on minor details and hardly gets to the most significant in the story. It is extremely difficult to listen to such people. The viscosity of thinking reflects its stiffness; occurs in organic lesions of the brain, epilepsy.

Thinking disorders also include the so-called reasoning - a tendency to empty ranting and sophistication.

The fragmentation of thinking is manifested in the fact that individual phrases are not interconnected; the phrases of such patients are completely impossible to understand.

Reasoning and fragmented thinking are more common in schizophrenia.

Such symptoms of neuropsychiatric diseases as disorders of the content of thinking can be conditionally divided into obsessive, overvalued and delusional ideas.

Compulsive states include states that occur in patients against their will; patients evaluate them critically and try to resist them.

For example, obsessive doubts are constant uncertainty about the correctness of committed actions and actions. This obsessive obscurity exists contrary to reason and logic. Patients check 10 times whether the devices are turned off, whether the doors are closed, etc.

Obsessive memories are annoying memories of an unnecessary, often unpleasant fact or event.

Obsessive abstract thoughts - constant scrolling in the head of various abstract concepts, operating with numbers.

There is a large group of symptoms of neuropsychiatric disorders such as. These are fears of getting sick: alienophobia (fear of going crazy), carcinophobia (fear of cancer), cardiophobia (fear of heart disease), vertigophobia (fear of fainting), mysophobia (fear of pollution that can lead to an infectious disease); fears of space: agoraphobia (fear of open space), claustrophobia (closed space), acrophobia (fear of heights); social phobias: lalophobia (fear of speaking, speaking in front of the audience, fearing incorrect pronunciation of words, stuttering), mythophobia (fear of telling a lie), ereitophobia (fear of blushing), gynecophobia (fear of communicating with women) and androphobia (with men). There are also zoophobia (fear of animals), triskaidekaphobia (fear of the number "13"), phobophobia (fear of fear) and many others.

Obsessive ideas can be observed in obsessive-compulsive disorder, schizophrenia.

With overvalued ideas, logically justified beliefs arise, based on real events, associated with personality traits and extremely charged emotionally. They encourage a person to narrowly focused activities, which often leads him to maladaptation. Criticism remains for overvalued ideas, and there is the possibility of their correction.

How to identify a mental disorder: symptoms of delusions

It is possible to identify a mental disorder as a harbinger of impending instability by the presence of delirium in a person.

According to the mechanism of development, delirium is divided into chronically developing (systematized) and acutely emerging (not systematized).

Crazy ideas are understood as false judgments arising on the basis of mental illness that do not correspond to reality. These judgments are inaccessible to correction, there is no criticism for them, and they completely take over the consciousness of patients, change their activities and maladjust in relation to society.

Systematized delusions of interpretation develop slowly, gradually and are accompanied by a general change in personality. Crazy ideas and judgments are carefully substantiated by the patient, who leads a consistent chain of evidence that has a subjective logic. But the facts that the patient cites in support of his ideas are interpreted by him one-sidedly, abstractly and biasedly. Such nonsense is persistent.

One of the symptoms of a mental personality disorder is a delusional attitude. The patient believes that all the facts and events surrounding him are relevant to him. If two people are talking somewhere, then it is definitely about him. If there is a fork or knife on the table, then this is directly related to it, done with some purpose or intent.

How else do mental disorders manifest in a person? One of the options is delusions of jealousy. The patient believes that his partner is cheating on him. He finds a lot of facts to confirm this: she stayed at work for 30 minutes, put on a yellow dress; I brushed my teeth, didn't throw out the trash.

Delusions of damage are more common in patients aged, with senile dementia. It always seems to them that they are robbed, things, valuables and money are taken from them. Patients constantly hide what they have, and then forget about it and cannot find it hidden in any way, since their memory is usually impaired. Even while in the hospital, they hide everything they can from possible thieves and robbers.

Hypochondriacal delusion. Patients suffering from this kind of delirium constantly talk about their imaginary illness. Their "stomach rots", their heart "has not been working for a long time", "worms have started in their heads", and "the tumor is growing by leaps and bounds."

The delusion of persecution is characterized by the fact that it seems to the patient that people and organizations sent by enemies are following him. He claims that he is being watched day and night through the window, followed on the street, and listening devices have been installed in the apartment. Sometimes such people, when traveling in buses, constantly make transfers in order to hide from "enemies", leave for another city, remove wallpaper from walls, cut electrical wires.

With delirium of influence, patients believe that they are affected by "special rays", "psychotropic weapons", hypnosis, radio waves, specially created machines to destroy them, force them to obey, cause them unpleasant thoughts, sensations. This also includes the delusions of obsession.

Delusions of grandeur, perhaps the most pleasant. Patients consider themselves rich people who have wagonloads of money and barrels of gold; often they imagine themselves to be great strategists and commanders who conquered the world. It occurs with progressive paralysis (with syphilis), dementia.

There is a delusion of self-accusation and self-abasement, when patients accuse themselves of the sins that they allegedly committed: murder, theft, causing "terrible harm" to the world.

Delusions, like hallucinations, are a sign of psychosis. It occurs in schizophrenia, epilepsy, organic diseases of the brain, alcoholism.

The main clinical symptoms of a mental personality disorder: disturbance of emotions

The third group of the main symptoms of mental illness includes signs of emotional disturbance.

Emotions reflect a person's attitude to reality and to himself. The human body is closely connected with the environment, and it is constantly affected by internal and external stimuli. The nature of this impact and our emotional response determine our mood. Remember? If we cannot change the situation, we will change our attitude towards it. Emotions can be controlled both through thoughts (suggestion formulas, meditation) and through external bodily reflection of emotions (gestures, facial expressions, laughter, tears).

Emotions are divided into positive, negative, dual and indefinite (arise when something new appears and should quickly turn into positive or negative).

A violent manifestation of emotions (sadness, joy, anger) is called affect.

The affect can be pathological if it passes against the background of a clouded consciousness. It is at this moment that a person can commit serious crimes, since his actions at this moment are not controlled by the central nervous system.

Emotions are divided into positive (not in the sense of "good", but in the sense of newly appeared) - these are hypothymic, hyperthymic, parathymic - and negative (lost).

hypothymia- Decreased mood. It manifests itself in the form of longing, anxiety, confusion and fear.

Yearning- this is a state with a predominance of sadness, depression; it is the suppression of all mental processes. Everything around is seen only in gloomy colors. Movements are usually slow, a feeling of hopelessness is expressed. Often, life seems to have no meaning. High risk of suicide. Longing can be a manifestation of neuroses, manic-depressive psychosis.

Anxiety- this is an emotional state characterized by internal restlessness, tightness and tension localized in the chest; accompanied by a premonition and expectation of impending disaster.

Fear- a condition, the content of which is fear for one's well-being or life. It can be unaccountable, when patients are afraid, without knowing what, they are waiting for something terrible to happen to them. Some seek to escape somewhere, others are depressed, freeze in place.

Fear can have certainty. In this case, a person knows what he is afraid of (some people, cars, animals, etc.).

Confusion- a changeable emotional state with an experience of bewilderment and uselessness.

Hypothymic conditions are not specific and occur in a variety of conditions.

Hyperthymia- elevated mood. It manifests itself in the form of euphoria, complacency, anger and ecstasy.

Euphoria- a feeling of causeless joy, fun, happiness with an increased desire for activity. It occurs with drug or alcohol intoxication, manic-depressive psychosis.

Ecstasy- this is a state of the highest elation of mood, exaltation. Occurs in epilepsy, schizophrenia.

Complacency- a state of contentment, carelessness, without a desire for activity. Characteristic for senile dementia, atrophic processes of the brain.

anger- the highest degree of irritability, malice with a tendency to aggressive and destructive actions. The combination of anger with longing is called dysphoria. It is characteristic of epilepsy.

All of the above emotions are also found in everyday life in healthy people: it's all about their quantity, intensity and influence on human behavior.

Parathymia (the main symptoms of mental disorders of emotions) include ambivalence and emotional inadequacy.

Ambivalence- this is the duality of attitude towards something, the duality of experience, when one object evokes two opposite feelings in a person at the same time.

Emotional inadequacy- inconsistency of the emotional reaction to the occasion that caused it. For example, joyful laughter at the news of the death of a loved one.

How to recognize a mental disorder: emotional dullness

How can you recognize a mental disorder in a person by observing his emotional state?

Negative emotional disorders include emotional dullness. This symptom can be expressed in varying degrees. With a milder degree, patients become simply, more indifferent to the world around them, they treat relatives, relatives, and acquaintances coldly. Their emotions are somehow smoothed out and appear very indistinctly.

With more pronounced emotional dullness, the patient becomes apathetic to everything that happens, everything becomes indifferent to him, “paralysis of emotions” occurs.

The patient is absolutely inactive, seeks solitude. Such clinical symptoms of mental disorders as parathymia and emotional dullness are most often found in schizophrenia.

The regulation of emotional states is associated with the work of the deep structures of the brain (thalamus, hypothalamus, hippocampus, etc.), which are responsible for the functioning of internal organs (gastrointestinal tract, lungs, cardiovascular system), for the cellular and biochemical composition of blood. If a person is not aware of emotions, they are able to "record" in the muscles, creating muscle disorders, or "freeze" inside, manifesting themselves in the form of psychosomatic diseases (, colic, neurodermatitis, etc.).

What are the main signs of mental disorders: memory impairment

What other signs of mental disorders are described in modern psychiatry?

The fourth group of signs of mental disorders include symptoms of impaired memory.

Memory disorders are the loss or decrease in the ability to remember, retain and reproduce information and individual events. They are divided into two types: amnesia (lack of memory) and paramnesia (deception of memory).

Amnesia can be of a different nature. With retrograde amnesia (loss of memory of the days, months and years preceding the present disease), the patient may not remember not only some life events (partial retrograde amnesia), but the entire chain of events, including his first and last name (systemic retrograde amnesia). Congrade amnesia - loss of memory of only the disease or injury itself; anterograde - events following the disease.

There are also concepts of fixation and reproductive amnesia. In the first case, the patient is deprived of the opportunity to remember current events; in the second case, he cannot reproduce in memory the necessary information that is needed at the moment.

Progressive amnesia is the progressive breakdown of memory from new, recently acquired knowledge to old ones. The events of distant childhood are most clearly preserved in the memory, while the events of recent years fall out of memory completely ("fell into childhood").

Paramnesias are divided into false memories and memory distortion. The first includes fictitious events, facts and incidents that take the place of events that have completely fallen out of memory. To the second - the transfer of past events to the present time to the place of the disappeared.

Memory disorders are characteristic of systematic psychoses, epilepsy, brain injuries, and organic diseases of the central nervous system.

How to determine a mental disorder in a person: a violation of volitional activity

You can determine a mental disorder as a reason to consult a psychiatrist by the symptoms of a disorder of volitional activity - this is the fifth group of signs of a mental illness.

Will- this is a psychological activity aimed at achieving a goal, at overcoming the obstacles that have arisen in this case.

Volitional disorders can be manifested by a weakening of volitional activity (hypobulia) or its complete absence (aboulia), a perversion of volitional acts (parabulia).

Hypobulia- a decrease in the intensity and quantity of all urges to activity. Separate instincts can be oppressed: food (, loss of appetite); sexual (decreased libido - sexual desire); defensive (lack of defensive actions in response to an external threat).

As a transient phenomenon it occurs in neurosis, depression, more persistent - in some variants of organic brain damage, schizophrenia, dementia.

How else to recognize a mental illness by characteristic signs? A sharp increase in appetite, up to gluttony, is called bulimia, often occurs with mental retardation, dementia, hypothalamic syndrome. With the same diseases, some forms of psychopathy and manic-depressive psychosis, hypersexuality occurs (satiriasis in men and nymphomania in women).

There are also many perverted drives and instincts. For example, dromomania - a pathological attraction to vagrancy, pathological gambling - to games, suicide mania - to suicide, shopaholism - to shopping; this also includes paraphilia-perversions of sexual desire (sadism, masochism, fetishism, exhibitionism, etc.).

Paraphilias are found in psychopathy, schizophrenia and diseases of dependent behavior.

How Mental Disorders Manifest: Symptoms of Attention Disorder

How else do mental illnesses manifest in a person? The sixth group of the main signs of mental disorders include symptoms of impaired attention.

Attention is the focus of mental activity on the phenomena of the surrounding world and on the processes occurring in the body.

Distinguish between passive and active attention.

Passive (orienting) attention is based on a person's orienting reaction to signals. Active (voluntary) attention is reduced to focusing a person on solving a problem, achieving a goal.

Attention disorders are manifested by absent-mindedness, exhaustibility, distractibility and stiffness.

Scattered (unstable) attention is manifested in the inability to focus on a certain type of activity.

Attention exhaustion manifests itself in the increasing weakening of the intensity of the ability to concentrate in the process of work. As a result, enthusiasm for work becomes impossible, and its productivity decreases.

Distractibility- this is a painful mobility of attention, when the change of activity is too fast and unreasonable, as a result of which its productivity is sharply reduced.

Rigidity of attention- painful fixation, difficult switching from one object to another.

Attention disorders are almost always found in mental illness.

How to define a mental disorder in a person is described in psychiatric textbooks, but many special examinations are necessary to make a diagnosis.

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Mental illness is a whole group of mental disorders that affect the state of the human nervous system. Today, such pathologies are much more common than is commonly believed. Symptoms of mental illness are always very variable and varied, but they are all associated with a violation of higher nervous activity. Mental disorders affect the behavior and thinking of a person, his perception of the surrounding reality, memory and other important mental functions.

Clinical manifestations of mental diseases in most cases form whole symptom complexes and syndromes. Thus, in a sick person, very complex combinations of disorders can be observed, which only an experienced psychiatrist can assess for an accurate diagnosis.

Classification of mental illness

Mental illnesses are very diverse in nature and clinical manifestations. For a number of pathologies, the same symptoms may be characteristic, which often makes it difficult to diagnose the disease in a timely manner. Mental disorders can be short-term and long-term, caused by external and internal factors. Depending on the cause of the occurrence, mental disorders are classified into exogenous and exogenous. However, there are diseases that do not fall into one or the other group.

Group of exocogenic and somatogenic mental illnesses

This group is quite extensive. It does not include a wide variety of mental disorders, the occurrence of which is caused by the adverse effects of external factors. At the same time, endogenous factors may also play a certain role in the development of the disease.

Exogenous and somatogenic diseases of the human psyche include:

• drug addiction and alcoholism;
• mental disorders caused by somatic pathologies;
• mental disorders associated with infectious lesions located outside the brain;
• mental disorders arising from intoxication of the body;
• mental disorders caused by brain injuries;
• mental disorders caused by an infectious lesion of the brain;
• mental disorders caused by oncological diseases of the brain.

Group of endogenous mental illnesses

The occurrence of pathologies belonging to the endogenous group is caused by various internal, primarily genetic factors. The disease develops when a person has a certain predisposition and the participation of external influences. The group of endogenous mental illnesses includes diseases such as schizophrenia, cyclothymia, manic-depressive psychosis, as well as various functional psychoses characteristic of older people.

Separately, in this group, one can single out the so-called endogenous-organic mental illnesses that arise as a result of organic damage to the brain under the influence of internal factors. Such pathologies include Parkinson's disease, Alzheimer's disease, epilepsy, senile dementia, Huntington's chorea, atrophic brain damage, and mental disorders caused by vascular pathologies.

Psychogenic disorders and personality pathologies

Psychogenic disorders develop as a result of the influence of stress on the human psyche, which can occur against the background of not only unpleasant, but also joyful events. This group includes various psychoses characterized by a reactive course, neuroses and other psychosomatic disorders.

In addition to the above groups in psychiatry, it is customary to single out personality pathologies - this is a group of mental diseases caused by abnormal personality development. These are various psychopathy, oligophrenia (mental underdevelopment) and other defects in mental development.

Classification of mental illness according to ICD 10

In the international classification of psychosis, mental illness is divided into several sections:

• organic, including symptomatic, mental disorders (F0);
• mental and behavioral disorders arising from the use of psychotropic substances (F1);
• delusional and schizotypal disorders, schizophrenia (F2);
• affective disorders associated with mood (F3);
• neurotic disorders caused by stress (F4);
• behavioral syndromes based on physiological defects (F5);
• mental disorders in adults (F6);
• mental retardation (F7);
• defects in psychological development (F8);
• behavioral disorders and psycho-emotional background in children and adolescents (F9);
• mental disorders of unknown origin (F99).

Main symptoms and syndromes

The symptomatology of mental illness is so diverse that it is rather difficult to somehow structure the clinical manifestations characteristic of them. Since mental illness negatively affects all or practically all the nervous functions of the human body, all aspects of his life suffer. Patients have disorders of thinking, attention, memory, mood, depressive and delusional states occur.

The intensity of the manifestation of symptoms always depends on the severity of the course and the stage of a particular disease. In some people, the pathology can proceed almost imperceptibly to others, while others simply lose the ability to interact normally in society.

affective syndrome

An affective syndrome is usually called a complex of clinical manifestations associated with mood disorders. There are two large groups of affective syndromes. The first group includes states characterized by a pathologically elevated (manic) mood, the second group includes states with a depressive, that is, depressed mood. Depending on the stage and severity of the course of the disease, mood swings can be both mild and very bright.

Depression can be called one of the most common mental disorders. Such states are characterized by extremely depressed mood, volitional and motor inhibition, suppression of natural instincts, such as appetite and the need for sleep, self-deprecating and suicidal thoughts. In particularly excitable people, depression can be accompanied by outbursts of rage. The opposite sign of a mental disorder can be called euphoria, in which a person becomes careless and contented, while his associative processes are not accelerated.

The manic manifestation of the affective syndrome is accompanied by accelerated thinking, fast, often incoherent speech, unmotivated elevated mood, and increased motor activity. In some cases, manifestations of megalomania are possible, as well as an increase in instincts: appetite, sexual needs, etc.

obsession

Obsessive states are another common symptom that accompanies mental disorders. In psychiatry, such disorders are referred to as obsessive-compulsive disorder, in which the patient periodically and involuntarily has unwanted, but very obsessive ideas and thoughts.

This disorder also includes various unreasonable fears and phobias, constantly repeating meaningless rituals with which the patient tries to alleviate anxiety. There are a number of features that distinguish patients suffering from obsessive-compulsive disorders. First, their consciousness remains clear, while obsessions are reproduced against their will. Secondly, the occurrence of obsessive states is closely intertwined with the negative emotions of a person. Thirdly, intellectual abilities are preserved, so the patient is aware of the irrationality of his behavior.

Consciousness disorders

Consciousness is usually called the state in which a person is able to navigate in the world around him, as well as in his own personality. Mental disorders very often cause disturbances in consciousness, in which the patient ceases to perceive the surrounding reality adequately. There are several forms of such disorders:

Perceptual disturbances

Perceptual disturbances are usually the easiest to recognize in mental disorders. Simple disorders include senestopathy - a sudden unpleasant bodily sensation in the absence of an objective pathological process. Seneostapathia is characteristic of many mental illnesses, as well as hypochondriacal delusions and depressive syndrome. In addition, with such violations, the sensitivity of a sick person may be pathologically reduced or increased.

Depersonalization is considered more complex violations, when a person ceases to live his own life, but seems to be watching it from the side. Another manifestation of pathology can be derealization - misunderstanding and rejection of the surrounding reality.

Thinking disorders

Thinking disorders are symptoms of mental illness that are quite difficult to understand for an ordinary person. They can manifest themselves in different ways, for some, thinking becomes inhibited with pronounced difficulties when switching from one object of attention to another, for someone, on the contrary, it is accelerated. A characteristic sign of a violation of thinking in mental pathologies is reasoning - the repetition of banal axioms, as well as amorphous thinking - difficulties in orderly presentation of one's own thoughts.

One of the most complex forms of impaired thinking in mental illness is delusional ideas - judgments and conclusions that are completely far from reality. Delusional states can be different. The patient may experience delusions of grandeur, persecution, depressive delusions, characterized by self-abasement. There can be quite a few options for the course of delirium. In severe mental illness, delusional states can persist for months.

Violations of will

Symptoms of a violation of will in patients with mental disorders are a fairly common phenomenon. For example, in schizophrenia, both suppression and strengthening of the will can be observed. If in the first case the patient is prone to weak-willed behavior, then in the second he will forcibly force himself to take any action.

A more complex clinical case is a condition in which the patient has some painful aspirations. This may be one of the forms of sexual preoccupation, kleptomania, etc.

Memory and attention disorders

Pathological increase or decrease in memory accompanies mental illness quite often. So, in the first case, a person is able to remember very large amounts of information that are not characteristic of healthy people. In the second - there is a confusion of memories, the absence of their fragments. A person may not remember something from his past or prescribe to himself the memories of other people. Sometimes whole fragments of life fall out of memory, in this case we will talk about amnesia.

Attention disorders are very closely related to memory disorders. Mental illnesses are very often characterized by absent-mindedness, a decrease in the concentration of the patient. It becomes difficult for a person to maintain a conversation or focus on something, remember simple information, as his attention is constantly scattered.

Other clinical manifestations

In addition to the above symptoms, mental illness can be characterized by the following manifestations:

• Hypochondria. Constant fear of getting sick, increased concern about one's own well-being, assumptions about the presence of any serious or even fatal disease. The development of hypochondriacal syndrome has depressive states, increased anxiety and suspiciousness;
• Asthenic syndrome is chronic fatigue syndrome. It is characterized by the loss of the ability to conduct normal mental and physical activity due to constant fatigue and a feeling of lethargy, which does not go away even after a night's sleep. Asthenic syndrome in a patient is manifested by increased irritability, bad mood, headaches. Perhaps the development of photosensitivity or fear of loud sounds;
• Illusions (visual, acoustic, verbal, etc.). Distorted perception of real-life phenomena and objects;
• hallucinations. Images that arise in the mind of a sick person in the absence of any stimuli. Most often, this symptom is observed in schizophrenia, alcohol or drug intoxication, some neurological diseases;
• catatonic syndromes. Movement disorders, which can manifest themselves both in excessive excitement and in stupor. Such disorders often accompany schizophrenia, psychoses, and various organic pathologies.

You can suspect a mental illness in a loved one by characteristic changes in his behavior: he stopped coping with the simplest household tasks and everyday problems, began to express strange or unrealistic ideas, and shows anxiety. Changes in the usual daily routine and nutrition should also alert. Outbursts of anger and aggression, long-term depression, suicidal thoughts, alcohol abuse or drug use will be signals about the need to seek help.

Of course, some of the symptoms described above can be observed from time to time in healthy people under the influence of stressful situations, overwork, exhaustion of the body due to an illness, etc. We will talk about a mental illness when pathological manifestations become very pronounced and negatively affect the quality of life of a person and his environment. In this case, the help of a specialist is needed and the sooner the better.

This chapter provides an overview of the psychiatric disorders common in women, including their epidemiology, diagnosis, and treatment approach (Table 28-1). Mental disorders are very common. The monthly incidence among American adults exceeds 15%. The lifetime incidence is 32%. Most common in women are major depression, seasonal affective disorder, manic-depressive psychosis, eating disorders, panic disorders, phobias, generalized anxiety disorders, somatic mental disorders, pain conditions, borderline and hysterical disorders, and suicidal attempts.

In addition to the fact that anxiety and depressive disorders are much more common in women, they are more resistant to drug therapy. However, most studies and clinical trials are conducted on men and then extrapolated to women, despite differences in metabolism, drug sensitivity, and side effects. Such generalizations lead to the fact that 75% of psychotropic drugs are prescribed to women, and they also have more serious side effects.

All doctors should be aware of the symptoms of mental disorders, first aid for them and available methods of maintaining mental health. Unfortunately, many cases of mental illness remain undiagnosed and untreated or undertreated. Only a small part of them reaches the psychiatrist. Most patients are seen by other specialists, so only 50% of mental disorders are recognized at the initial visit. Most patients present somatic complaints and do not focus on psycho-emotional symptoms, which again reduces the frequency of diagnosis of this pathology by non-psychiatrists. In particular, affective disorders are very common in patients with chronic diseases. The incidence of mental illness in GP patients is twice as high as in the general population, and even higher in severely ill hospitalized patients and those who seek medical attention frequently. Neurological disorders such as stroke, Parkinson's disease and Meniere's syndrome are associated with psychiatric disorders.

Untreated major depression can worsen the prognosis of physical illness and increase the amount of medical care required. Depression can intensify and increase the number of somatic complaints, lower the pain threshold, and increase functional disability. A study of patients who frequently use medical care found depression in 50% of them. Only those who had a decrease in the severity of their depressive symptoms during the year of observation showed an improvement in functional activity. Symptoms of depression (low mood, hopelessness, lack of satisfaction with life, fatigue, impaired concentration and memory) disrupt the motivation to seek medical help. Timely diagnosis and treatment of depression in chronic patients helps to improve the prognosis and increase the effectiveness of therapy.

The socioeconomic cost of mental illness is very high. Approximately 60% of suicidal cases are due to affective disorders alone, and 95% meet diagnostic criteria for mental illness. The cost of treatment, death, and disability due to clinically diagnosed depression is estimated to be more than $43 billion per year in the United States. Because more than half of people with mood disorders are either left untreated or undertreated, this figure is far below the total cost that depression is costing society. Mortality and disability in this undertreated population, most of which? women are particularly depressing, as 70 to 90% of depressed patients respond to antidepressant therapy.

Major Mental Disorders in Women

1. Eating disorders

Anorexia nervosa

bulimia nervosa

Bouts of gluttony

big depression

Adjustment disorder with depressed mood

postpartum affective disorder

seasonal affective disorder

Affective insanity

Dysthymia

4. Sexual disorders

Libido disorders

sexual arousal disorders

Orgasmic disorders

Painful sexual disorders:

vaginismus

dyspareunia

specific phobias

social phobia

agoraphobia

Panic Disorders

Generalized Anxiety Disorders

obsessive-compulsive disorder

post-traumatic stress

False Disorders:

simulation

Somatoform disorders:

somatization

conversion

hypochondria

somatoform pain

Schizophrenia

paraphrenia

Mental illness during a woman's life

There are specific periods in a woman's life during which she is at increased risk of developing mental illness. While major mental disorders? mood disorders and anxiety? can occur at any age, various triggering conditions are more common at specific age periods. During these critical periods, the clinician should include specific questions to identify psychiatric disorders by taking the history and examining the patient's mental status.

Girls have an increased risk of school phobias, anxiety disorders, attention deficit hyperactivity disorder and learning disorders. Adolescents are at increased risk for eating disorders. During menarche, 2% of girls develop premenstrual dysphoria. After puberty, the risk of developing depression rises sharply, and in women it is twice as high as in men of the same age. In childhood, by contrast, girls have less or the same incidence of mental illness as boys their age.

Women are prone to mental disorders during and after pregnancy. Women with a history of psychiatric disorders often refuse medical support when planning a pregnancy, which increases the risk of relapse. After giving birth, most women experience mood swings. Most have a short period of depression "baby blues" that does not require treatment. Others develop more severe, disabling symptoms of depression in the postpartum period, and a small number of women develop psychotic disorders. The relative risk of taking drugs during pregnancy and lactation makes it difficult to choose a treatment, in each case the question of the ratio of benefits and risks of therapy depends on the severity of symptoms.

The middle age period is associated with a continued high risk of anxiety and mood disorders, as well as other psychiatric disorders such as schizophrenia. Women may have impaired sexual function, and if they take antidepressants for mood or anxiety disorders, they are at increased risk of side effects, including reduced sexual function. Although there is no clear evidence that menopause is associated with an increased risk of depression, most women experience major life changes during this period, especially in the family. For most women, their active role in relation to children is replaced by the role of carers for elderly parents. Elderly parents are almost always cared for by women. It is necessary to monitor the mental status of this group of women to identify possible violations of the quality of life.

As women age, their risk of developing dementia and psychiatric complications of somatic conditions, such as stroke, increases. Because women live longer than men and the risk of dementia increases with age, most women develop dementia. Elderly women with multiple medical conditions and high medication use are at high risk of delirium. Are women at increased risk of paraphrenia? psychotic disorder, usually occurring after age 60. Due to the long life expectancy and greater involvement in interpersonal relationships, women experience the loss of loved ones more often and more strongly, which also increases the risk of developing mental illness.

Examination of a psychiatric patient

Psychiatry deals with the study of affective, cognitive and behavioral disorders that occur while maintaining consciousness. Psychiatric diagnosis and treatment selection follow the same logic of history taking, examination, differential diagnosis and treatment planning as in other clinical areas. A psychiatric diagnosis must answer four questions:

1) mental illness (what the patient has)

2) temperamental disorders (what the patient is)

3) behavioral disorders (what the patient is doing)

4) disorders that arose in certain life circumstances (what the patient encounters in life)

Mental illness

Examples of mental illnesses are schizophrenia and major depression. Are they similar to other nosological forms? have a discrete onset, course, clinical symptoms that can be clearly defined as present or absent in each individual patient. Like other nosologies, are they the result of genetic or neurogenic disorders of the organ, in this case? brain. With obvious abnormal symptoms? auditory hallucinations, manias, severe obsessive-compulsive states? The diagnosis of a mental disorder is easy to make. In other cases, it can be difficult to distinguish pathological symptoms, such as low mood in major depression, from normal feelings of sadness or disappointment caused by life circumstances. We need to focus on identifying known stereotyped symptom complexes that are characteristic of mental illness, while keeping in mind the diseases that are most common in women.

Temperament disorders

Understanding the characteristics of the patient's personality increases the effectiveness of treatment. Are personality traits such as perfectionism, indecisiveness, impulsiveness somehow quantified in humans, as well as physiological ones? height and weight. Unlike mental disorders, do they not have clear characteristics? "symptoms" opposed to "normal" values, and individual differences are normal in a population. Psychopathology or functional personality disorders occur when traits take on the character of extremes. When the temperament leads to impaired professional or interpersonal functioning, this is enough to qualify it as a possible personality disorder; in this case, medical assistance and cooperation with a psychiatrist is needed.

Conduct violations

Conduct disorders are self-reinforcing. They are characterized by purposeful, irresistible forms of behavior that subjugate all other activities of the patient. Eating disorders and abuse are examples of such disorders. The first goals of treatment are switching the patient's activity and attention, stopping problem behavior and neutralizing precipitating factors. Concomitant mental disorders, such as depression or anxiety disorders, illogical thoughts (the anorectic opinion that? If I eat more than 800 calories a day, will I become fat?) can be provoking factors. Group therapy can be effective in treating behavioral disorders. The final step in treatment is relapse prevention, since recurrence? this is a normal course of behavioral disorders.

Patient history

Stressors, life circumstances, social circumstances? factors that can modulate the severity of the disease, personality traits and behavior. Various life stages, including puberty, pregnancy, and menopause, may be associated with an increased risk of certain diseases. Social conditions and gender role differences may help explain the increased incidence of specific symptom complexes in women. For example, the focus of media attention on the ideal figure in Western society is a provoking factor in the development of eating disorders in women. Such contradictory female roles in modern Western society as "devoted wife", "madly loving mother"? and ?successful business woman? add stress. The purpose of collecting an anamnesis of life is a more accurate selection of methods of internally oriented psychotherapy, finding "the meaning of life". The healing process is facilitated when the patient comes to self-understanding, a clear separation of her past and recognition of the priority of the present for the future.

Thus, the formulation of a psychiatric case should include answers to four questions:

1. Whether the patient has a disease with a clear time of onset, a specific etiology, and a response to pharmacotherapy.

2. What personality traits of the patient influence her interaction with the environment and how.

3. Does the patient have goal-directed conduct disorders

4. What events in the life of a woman contributed to the formation of her personality, and what conclusions did she draw from them.

Eating Disorders

Of all the mental disorders, almost exclusively in women, only eating disorders occur: anorexia and bulimia. For every 10 women who suffer from them, there is only one man. The incidence and incidence of these disorders is increasing. Are young white women and girls from the middle and upper classes of Western society most at risk of developing anorexia or bulimia? four%. However, the prevalence of these disorders in other age, racial, and socioeconomic groups is also on the rise.

As with abuse, eating disorders are formulated as behavioral disorders caused by dysregulation of hunger, satiety, and absorption. Behavioral disorders associated with anorexia nervosa include restriction of food intake, cleansing manipulations (vomiting, abuse of laxatives and diuretics), debilitating physical exertion, abuse of stimulants. These behavioral responses are compulsive in nature, supported by the psychological attitude towards food and weight. These thoughts and behaviors dominate every aspect of a woman's life, disrupting physical, psychological and social functions. As with abuse, treatment can only be effective if the patient is willing to change the situation.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), anorexia nervosa includes three criteria: voluntary fasting with a refusal to maintain more than 85% of the required weight; psychological attitude with fear of obesity and dissatisfaction with one's own weight and body shape; endocrine disorders leading to amenorrhea.

Bulimia nervosa is characterized by the same fear of obesity and dissatisfaction with one's own body as in anorexia nervosa, accompanied by bouts of binge eating, and then compensatory behavior aimed at maintaining a low body weight. In DSM-IV, anorexia and bulimia are distinguished primarily on the basis of underweight and amenorrhea, and not on the basis of the behavior by which weight is controlled. Compensatory behaviors include intermittent fasting, exhausting exercise, laxatives, diuretics, stimulants, and vomiting.

Binge eating disorder differs from bulimia nervosa in the absence of compensatory weight-maintenance behaviors, resulting in obesity in these patients. Some patients change from one eating disorder to another during their lifetime; most often, the change goes in the direction from the restrictive type of anorexia nervosa (when food restriction and excessive physical activity predominate in behavior) towards bulimia nervosa. There is no single cause of eating disorders, they are considered as multifactorial. Known risk factors can be divided into genetic, social predispositions and temperamental characteristics.

Studies have shown a higher concordance of identical twins compared to fraternal twins for anorexia. One family study found a tenfold increased risk of anorexia in female relatives. In contrast, for bulimia, neither familial nor twin studies have shown a hereditary predisposition.

Temperamental and personality traits that contribute to the development of eating disorders include introversion, perfectionism, and self-criticism. Patients with anorexia who restrict food intake but do not engage in cleansing procedures are likely to have predominant anxiety that keeps them from life-threatening behavior; those suffering from bulimia expressed such personality traits as impulsiveness, the search for novelty. Women with binge eating and subsequent cleansing procedures may have other impulsive behaviors such as abuse, sexual promiscuity, kleptomania, self-harm.

Social conditions conducive to the development of eating disorders are associated with the idealization of a slender androgynous figure with underweight, common in modern Western society. Do most young women follow a restrictive diet? behaviors that increase the risk of developing eating disorders. Women compare their appearance with each other, as well as with the generally accepted ideal of beauty and strive to be like it. This pressure is especially pronounced in adolescents and young women, as the endocrine changes at puberty increase the amount of adipose tissue in a woman's body by 50%, and the psyche of adolescents simultaneously overcomes such problems as personality development, separation from parents and puberty. The incidence of eating disorders in young women has increased over the past few decades in parallel with increased media attention to slimness as a symbol of a woman's success.

Other risk factors for developing eating disorders are family conflict, loss of a significant person such as a parent, physical illness, sexual conflict, and trauma. Triggers can also be marriage and pregnancy. Do some professions require you to stay slim? ballerinas and models.

It is important to distinguish between primary risk factors that trigger a pathological process and those that maintain an already existing conduct disorder. Eating disorders periodically cease to depend on the etiological factor that triggered them. Supporting factors include the development of abnormal eating habits and voluntary fasting. Patients with anorexia start by maintaining a diet. They are often encouraged by their initial weight loss, receiving compliments on their looks and self-discipline. Over time, thoughts and behaviors related to nutrition become the dominant and subjective goal, the only one that relieves anxiety. Patients resort more and more intensely to these thoughts and behaviors to maintain their mood, as alcoholics increase the dose of alcohol to relieve stress and translate other ways of discharge into drinking alcohol.

Eating disorders are often underdiagnosed. Patients hide symptoms associated with a sense of shame, internal conflict, fear of condemnation. Physiological signs of eating disorders can be seen on examination. In addition to reduced body weight, fasting can lead to bradycardia, hypotension, chronic constipation, delayed gastric emptying, osteoporosis, and menstrual irregularities. Cleansing procedures lead to electrolyte imbalance, dental problems, hypertrophy of the parotid salivary glands and dyspeptic disorders. Hyponatremia can lead to the development of a heart attack. In the presence of such complaints, the clinician should conduct a standard questionnaire, including the patient's minimum and maximum weight during adulthood, a brief history of eating habits, such as counting calories and grams of fat in the diet. A further survey may reveal the presence of binge eating, the frequency of resorting to compensatory measures to restore weight. It is also necessary to find out whether the patient herself, her friends and family members believe that she has an eating disorder - and whether this bothers her.

Patients with anorexia who resort to cleansing procedures are at high risk of serious complications. Does anorexia have the highest mortality of all mental illnesses? more than 20% of anorectics die after 33 years. Death usually occurs due to physiological complications of starvation or due to suicide. In bulimia nervosa, death is often the result of hypokalemia-induced arrhythmias or suicide.

Psychological signs of eating disorders are regarded as secondary to or concomitant with the underlying psychiatric diagnosis. Symptoms of depression and obsessive-compulsive disorder can be associated with fasting: low mood, constant thoughts about food, decreased concentration, ritualistic behavior, decreased libido, social isolation. In bulimia nervosa, shame and the desire to hide binge eating and cleansing routines lead to increased social isolation, self-critical thoughts, and demoralization.

Most patients with eating disorders are at increased risk for other psychiatric disorders, with major depression, anxiety disorders, abuse, and personality disorders being the most common. Concomitant major depression or dysthymia was noted in 50-75% of patients with anorexia and in 24-88% of patients with bulimia. Obsessive neurosis during life occurred in 26% of anorectics.

Patients with eating disorders are characterized by social isolation, communication difficulties, problems in intimate life and professional activities.

Treatment of eating disorders occurs in several stages, beginning with an assessment of the severity of the pathology, identifying comorbid mental diagnoses, and establishing motivation for change. It is necessary to consult a nutritionist and a psychotherapist specializing in the treatment of patients with eating disorders. It must be understood that, first of all, it is necessary to stop pathological behavior, and only after it is brought under control, it will be possible to prescribe treatment aimed at internal processes. A parallel can be drawn with the primacy of withdrawal in the treatment of abuse, when therapy given concomitantly with continued alcohol intake fails.

Treatment by a general psychiatrist is less desirable from the point of view of maintaining the motivation for treatment, is treatment in special inpatient institutions such as sanatoriums more effective? the mortality rate in patients of such institutions is lower. Group therapy and rigorous monitoring of food intake and toilet use by medical staff in these facilities minimizes the chance of relapse.

Several classes of psychopharmacological agents are used in patients with eating disorders. Double-blind, placebo-controlled studies have proven the effectiveness of a wide range of antidepressants in reducing the frequency of binge eating and subsequent cleansing procedures in bulimia nervosa. Imipramine, desipramine, trazodone and fluoxetine reduce the frequency of such attacks, regardless of the presence or absence of comorbid depression. When using fluoxetine, a more effective dose is more effective than is usually used in the treatment of depression - 60 mg. Monoamine oxidase inhibitors (MAOIs) and buproprion are relatively contraindicated because dietary restrictions are required when using MAOIs, and buproprion increases the risk of a heart attack in bulimia. In general, treatment for bulimia should include an attempt to use tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs) along with psychotherapy.

In anorexia nervosa, no weight gain medication has been shown to be effective in controlled trials. Unless the patient is severely depressed or has obvious signs of obsessive-compulsive disorder, most clinicians recommend monitoring the mental status of patients during remission rather than prescribing drugs while weight is still underweight. Most of the symptoms of depression, ritualistic behavior, obsessions disappear when the weight approaches normal. When deciding to prescribe antidepressants, low-dose SSRIs are the safest choice, given the high potential risk of cardiac arrhythmias and hypotension with tricyclic antidepressants, as well as the generally higher risk of drug side effects in people who are underweight. A recent double-blind, placebo-controlled trial of fluoxetine in anorexia nervosa found that the drug may be useful in preventing post-weight loss.

Few studies have been conducted on the levels of neurotransmitters and neuropeptides in patients and recovered patients with eating disorders, but their results show dysfunction of the serotonin, noradrenergic and opiate systems of the CNS. Studies of eating behavior in animal models give the same results.

The efficacy of serotonergic and noradrenergic antidepressants in bulimia also supports the physiology of this disorder.

Evidence from human studies is inconsistent, and it remains unclear whether neurotransmitter level disturbances in patients with eating disorders are associated with this condition, whether they appear in response to fasting and bouts of binge eating and purging, or precede psychiatric disturbance and are personality traits susceptible to this condition. patient's disorder.

Studies of the effectiveness of the treatment of anorexia nervosa show that among hospitalized patients, after 4 years of follow-up, 44% had a good result with the restoration of normal body weight and menstrual cycle; in 28% the result was temporary, in 24% it was not and 4% died. Unfavorable prognostic factors are the variant of the course of anorexia with bouts of binge eating and purging, low minimum weight and the ineffectiveness of therapy in the past. More than 40% of anorexics develop bulimic behavior over time.

The long-term prognosis for bulimia is unknown. Episodic relapses are most likely. A decrease in the severity of bulimic symptoms is observed in 70% of patients with a short follow-up period after treatment with drugs in combination with psychotherapy. As with anorexia, the severity of symptoms in bulimia affects prognosis. Among patients with severe bulimia, 33% failed after three years.

Eating disorders are a complex psychiatric disorder most commonly seen in women. Their frequency of occurrence in Western society is growing, they are combined with high morbidity. The use of psychotherapeutic, educational and pharmacological techniques in treatment can improve the prognosis. Although no specific help may be needed initially, treatment failure requires early referral to a psychiatrist. Further research is needed to elucidate the reasons for the predominance of women among patients, to assess the real risk factors and to develop an effective treatment.

affective disorders

affective disorders? These are mental illnesses, the main symptom of which is mood changes. Everyone has mood swings in their lives, but their extreme expressions? affective disorders? few have. Depression and mania? the two main mood disturbances seen in affective disorders. These diseases include major depression, manic-depressive psychosis, dysthymia, adjustment disorder with depressive mood. Features of the hormonal status can serve as risk factors for the development of affective disorders during a woman's life, exacerbations are associated with menstruation and pregnancy.

Depression

Depression? one of the most common mental disorders, which is more common in women. Most studies estimate the incidence of depression in women to be twice as high as in men. This pattern may be partly explained by the fact that women have a better memory of past bouts of depression. Diagnosis of this condition is complicated by the wide range of symptoms and the lack of specific signs or laboratory tests.

When diagnosing, it is quite difficult to distinguish between short-term periods of sad mood associated with life circumstances and depression as a mental disorder. The key to differential diagnosis is recognizing the typical symptoms and monitoring their progress. A person without mental disorders usually does not have self-esteem disorders, suicidal thoughts, feelings of hopelessness, neurovegetative symptoms such as sleep disturbances, appetite, lack of vital energy for weeks and months.

The diagnosis of major depression is based on history taking and mental status examination. The main symptoms include low mood and anhedonia? loss of desire and ability to enjoy ordinary life manifestations. In addition to depression and anhedonia lasting at least two weeks, episodes of major depression are characterized by the presence of at least four of the following neurovegetative symptoms: significant weight loss or gain, insomnia or increased drowsiness, psychomotor retardation or revival, fatigue and loss of energy, reduced ability to concentrate attention and decision making. In addition, many people suffer from increased self-criticism with feelings of hopelessness, excessive guilt, suicidal thoughts, feeling like a burden to their loved ones and friends.

The duration of symptoms for more than two weeks helps to distinguish an episode of major depression from a short-term adjustment disorder with lowered mood. Adjustment disorder? it is reactive depression, in which the depressive symptoms are a response to an overt stressor, are limited in number, and respond to minimal therapy. This does not mean that an episode of major depression cannot be triggered by a stressful event or cannot be treated. An episode of major depression differs from an adjustment disorder in the severity and duration of symptoms.

In some groups, in particular the elderly, the classic symptoms of depression, such as lowered mood, are often not observed, which leads to an underestimation of the frequency of depression in such groups. There is also evidence that in some ethnic groups, depression is more pronounced with somatic signs than with classic symptoms. In older women, complaints of feelings of social worthlessness and a set of characteristic somatic complaints should be taken seriously as they may require medical antidepressant help. Although some laboratory tests, such as the dexamethasone test, have been suggested for diagnosis, they are not specific. The diagnosis of major depression remains clinical and is made after a thorough history and assessment of mental status.

In childhood, the incidence of depression in boys and girls is the same. Differences become noticeable at puberty. Angola and Worthman consider the cause of these differences to be hormonal and conclude that hormonal changes may be the trigger mechanism for the depressive episode. Starting with menarche, women are at increased risk of developing premenstrual dysphoria. This mood disorder is characterized by symptoms of major depression, including anxiety and mood lability, occurring in the last week of the menstrual cycle and ending in the early days of the folliculin phase. Although premenstrual emotional lability occurs in 20-30% of women, is its severe form quite rare? in 3-5% of the female population. A recent multicenter, randomized, placebo-controlled trial of sertraline 5–150 mg showed significant improvement in symptoms with treatment. 62% of women in the main group and 34% in the placebo group responded to treatment. Fluoxetine at a dose of 20-60 mg per day also reduces the severity of premenstrual disorders in more than 50% of women? according to a multicenter placebo-controlled study. In women with major depression, as with manic-depressive psychosis, do mental disorders worsen in the premenstrual period? it is unclear whether this is an exacerbation of one condition or a superimposition of two (an underlying psychiatric disorder and premenstrual dysphoria).

Pregnant women experience a full range of affective symptoms both during pregnancy and after childbirth. The incidence of major depression (about 10%) is the same as in non-pregnant women. In addition, pregnant women may experience less severe symptoms of depression, mania, periods of psychosis with hallucinations. The use of medications during pregnancy is used both during an exacerbation of a mental state and for the prevention of relapses. Interruption of medication during pregnancy in women with pre-existing mental disorders leads to a sharp increase in the risk of exacerbations. To make a decision about drug treatment, the risk of potential drug harm to the fetus must be weighed against the risk to both the fetus and the mother of recurrence.

In a recent review, Altshuler et al described existing therapeutic guidelines for the treatment of various psychiatric disorders during pregnancy. In general, medications should be avoided during the first trimester if possible due to the risk of teratogenic effects. However, if symptoms are severe, treatment with antidepressants or mood stabilizers may be necessary. Initial studies with fluoxetine have shown that SSRIs are relatively safe, but there are no reliable data on the prenatal effects of these new drugs. The use of tricyclic antidepressants does not lead to a high risk of congenital anomalies. Electroconvulsive therapy? another relatively safe treatment for severe depression during pregnancy. Taking lithium preparations in the first trimester increases the risk of congenital pathologies of the cardiovascular system. Antiepileptic drugs and benzodiazepines are also associated with an increased risk of congenital anomalies and should be avoided if possible. In each case, it is necessary to evaluate all indications and risks individually, depending on the severity of the symptoms. To compare the risk of untreated mental illness and the risk of pharmacological complications for the mother and fetus, a psychiatric consultation is necessary.

Many women experience mood disturbances after childbirth. The severity of symptoms ranges from ?baby blues? to severe major depression or psychotic episodes. For most women, these mood changes occur in the first six months after childbirth, at the end of this period, all signs of dysphoria disappear on their own. However, in some women, depressive symptoms persist for many months or years. In a study of 119 women after their first childbirth, half of the women who received medical treatment after childbirth had a relapse within the next three years. Early identification of symptoms and adequate treatment is essential for both mother and child, as depression can affect the mother's ability to adequately care for her child. However, antidepressant treatment in breastfeeding mothers requires caution and comparative risk assessment.

Mood changes during menopause have been known for a long time. Recent studies, however, have not confirmed a clear link between menopause and affective disorders. In a review on this issue, Schmidt and Rubinow found very few published studies to support this association.

Mood changes associated with menopausal hormonal changes may resolve with HRT. For most women, HRT is the first step in treatment before psychotherapy and antidepressants. If symptoms are severe, initial treatment with antidepressants is indicated.

Due to the long life expectancy of women compared to men, most women outlive their spouses, which is a stress factor in older age. At this age, monitoring is needed to identify symptoms of severe depression. History taking and examination of mental status in older women should include screening for somatic symptoms and identifying feelings of worthlessness, a burden on loved ones, because depression in the elderly is not characterized by a decrease in mood as a primary complaint. Treatment of depression in the elderly is often complicated by low tolerance to antidepressants, so they must be prescribed at a minimum dose, which can then be gradually increased. Are SSRIs undesirable at this age due to their anticholinergic side effects? sedation and orthostasis. When a patient takes several drugs, drug monitoring in the blood is necessary due to the mutual influence on metabolism.

There is no single cause of depression. The main demographic risk factor is female gender. Analysis of population data shows that the risk of developing major depression is increased in divorced, single and unemployed people. The role of psychological causes is being actively studied, but so far no consensus has been reached on this issue. Family studies have demonstrated an increased incidence of affective disorders in the closest relatives of the proband. Twin studies also support the idea of ​​a genetic predisposition in some patients. Especially strongly hereditary predisposition plays a role in the genesis of manic-depressive psychosis and major depression. The likely cause is a malfunction of the serotonergic and noradrenergic systems.

Is the usual therapeutic approach to treatment a combination of pharmacological agents? antidepressants? and psychotherapy. The advent of a new generation of antidepressants with minimal side effects has increased the therapeutic options for patients with depression. Are 4 main types of antidepressants used: tricyclic antidepressants, SSRIs, MAO inhibitors, and others? see table. 28-2.

A key principle in the use of antidepressants is an adequate time to take them? a minimum of 6-8 weeks for each drug in a therapeutic dose. Unfortunately, many patients stop taking antidepressants before the effect develops, because they do not see improvement in the first week. When taking tricyclic antidepressants, drug monitoring can help confirm that adequate therapeutic blood levels have been achieved. For SSRIs, this method is less useful, their therapeutic level varies greatly. If a patient has not taken a full course of antidepressant and continues to experience symptoms of major depression, a new course of treatment with a different class of drug should be initiated.

All patients treated with antidepressants should be monitored for the development of manic symptoms. Although this is a fairly rare complication of antidepressants, it does happen, especially if there is a family or personal history of manic-depressive psychosis. Symptoms of mania include reduced need for sleep, a feeling of increased energy, and agitation. Prior to initiating therapy, patients should have a thorough history taken to identify symptoms of mania or hypomania, and if these symptoms are present or if there is a family history of manic-depressive psychosis, will a psychiatric consultation help select mood stabilizer therapy? preparations of lithium, valproic acid, possibly in combination with antidepressants.

Seasonal affective disorders

For some people, the course of depression is seasonal, worsening in the winter. The severity of clinical symptoms varies widely. For moderate symptoms, exposure to full spectrum non-ultraviolet light (fluorescent lamps - 10,000 lux) for 15-30 minutes every morning during the winter months is sufficient. If symptoms meet the criteria for major depression, antidepressant treatment should be added to light therapy.

Bipolar disorders (manic-depressive psychosis)

The main difference between this disease and major depression is the presence of both episodes of depression and mania. Criteria for depressive episodes? just like the big depression. Episodes of mania are characterized by bouts of high, irritable, or aggressive mood lasting at least a week. These mood changes are accompanied by the following symptoms: increased self-esteem, reduced need for sleep, loud and fast speech, racing thoughts, agitation, flashes of ideas. Such an increase in vitality is usually accompanied by excessive behavior aimed at obtaining pleasure: spending large sums of money, drug addiction, promiscuity and hypersexuality, risky business projects.

There are several types of manic-depressive disorder: the first type? the classic form, type 2 includes a change in episodes of depression and hypomania. Episodes of hypomania are milder than classical mania, with the same symptoms but without disrupting the patient's social life. Other forms of bipolar disorder include rapid mood swings and mixed states, where the patient has both manic and depressive symptoms at the same time.

Mood stabilizers such as lithium and valproate are first-line drugs for the treatment of all forms of bipolar disorder. Lithium starting dose? 300 mg once or twice daily, then adjusted to maintain blood levels of 0.8-1.0 mEq/L for bipolar I disorder. The level of valproate in the blood, effective for the treatment of these diseases, has not been precisely established; one can focus on the level recommended for the treatment of epilepsy: 50-150 mcg / ml. Some patients require a combination of mood stabilizers with antidepressants to treat symptoms of depression. A combination of mood stabilizers with low doses of neuroleptics is used to control the symptoms of acute mania.

Dysthymia

Dysthymia? This is a chronic depressive condition lasting at least two years, with symptoms less pronounced than in major depression. The severity and number of symptoms are not sufficient to meet the criteria for major depression, but they interfere with social functioning. Typically, symptoms include appetite disturbances, decreased energy, impaired concentration, sleep disturbances, and feelings of hopelessness. Studies conducted in different countries claim a high prevalence of dysthymia in women. Although there are few reports of therapy for this disorder, there is evidence that SSRIs such as fluoxetine and sertraline may be used. Some patients with dysthymia may experience episodes of major depression.

Coexisting affective and neurological disorders

There is much evidence of associations between neurological disorders and affective disorders, more often with depression than with bipolar disorders. Episodes of major depression are common in Huntington's chorea, Parkinson's disease, and Alzheimer's disease. Do 40% of patients with parkinsonism have episodes of depression? half? major depression, half? dysthymia. In a study of 221 patients with multiple sclerosis, 35% were diagnosed with major depression. Some studies have shown an association between stroke in the left frontal lobe and major depression. AIDS patients develop both depression and mania.

Neurological patients with features that meet the criteria for affective disorders should be treated with drugs, since drug treatment of psychiatric disorders improves the prognosis of the underlying neurological diagnosis. If the clinical picture does not meet the criteria for affective disorders, psychotherapy is sufficient to help the patient cope with the difficulties. The combination of several diseases increases the number of prescribed drugs and sensitivity to them, and hence the risk of delirium. In patients receiving a large number of drugs, antidepressants should be started at a low dose and increased gradually, monitoring for possible symptoms of delirium.

Alcohol abuse

Alcohol? the most commonly abused substance in the US, 6% of the adult female population has a serious alcohol problem. Although the rate of alcohol abuse in women is lower than in men, alcohol dependence and alcohol-related morbidity and mortality are significantly higher in women. Studies of alcoholism are focused on the male population, the validity of extrapolating their data to the female population is questionable. For diagnosis, questionnaires are usually used to identify problems with the law and employment, which are much less common in women. Women are more likely to drink alone and are less likely to have tantrums when intoxicated. One of the main risk factors for the development of alcoholism in a woman is an alcoholic partner who inclines her to drinking companionship and does not allow her to seek help. In women, the signs of alcoholism are more pronounced than in men, but doctors determine it less often in women. All this allows us to consider the official incidence of alcoholism in women underestimated.

Complications associated with alcoholism (fatty liver, cirrhosis, hypertension, gastrointestinal bleeding, anemia and digestive disorders) develop faster in women and at lower doses of alcohol than men, because women have a lower level than men gastric alcohol dehydrogenase. Dependence on alcohol, as well as on other substances? opiates, cocaine? women develops after a shorter time of admission than men.

There is evidence that the incidence of alcoholism and related medical problems is on the rise in women born after 1950. During the phases of the menstrual cycle, changes in the metabolism of alcohol in the body are not observed, however, women who drink are more likely to experience irregular menstrual cycles and infertility. During pregnancy, a complication is usually fetal alcohol syndrome. The incidence of cirrhosis increases dramatically after menopause, and alcoholism increases the risk of alcoholism in older women.

Women with alcoholism have an increased risk of comorbid psychiatric diagnoses, especially drug addictions, mood disorders, bulimia nervosa, anxiety, and psychosexual disorders. Depression occurs in 19% of alcoholic women and 7% of women who do not abuse alcohol. Although alcohol brings temporary relaxation, it exacerbates the course of mental disorders in susceptible people. It takes several weeks of withdrawal to achieve remission. Women with a paternal family history of alcoholism, anxiety disorder, and premenstrual syndrome drink more during the second phase of their cycle, possibly in an attempt to reduce symptoms of anxiety and depression. Alcoholic women are at high risk of suicide attempts.

Women usually seek relief from alcoholism in a roundabout way, turning to psychoanalysts or general practitioners with complaints of family problems, physical or emotional complaints. They rarely go to alcoholism treatment centers. Alcoholic patients need a special approach due to their frequent inadequacy and reduced sense of shame.

Although it is almost impossible to directly ask such patients about the amount of alcohol taken, screening for alcohol abuse should not be limited to indirect signs such as anemia, elevated liver enzymes and triglycerides. Q: Have you ever had problems with alcohol? and the CAGE questionnaire (Table 28-3) provides rapid screening with over 80% sensitivity for more than two positive responses. Support, explanation, and discussion with the doctor, psychologist, and members of Alcoholics Anonymous help the patient adhere to treatment. During the withdrawal period, it is possible to prescribe diazepam at a starting dose of 10-20 mg with a gradual increase by 5 mg every 3 days. Control visits should be at least twice a week, they assess the severity of signs of withdrawal syndrome (sweating, tachycardia, hypertension, tremor) and adjust the dose of the drug.

Although alcohol misuse is less common in women than in men, its harm to women, taking into account the associated morbidity and mortality, is much higher. New studies are needed to elucidate the pathophysiology and psychopathology of the sexual characteristics of the course of the disease.

CAGE Questionnaire

1. Have you ever felt like you need to drink less?

2. Have people ever bothered you with their criticism of your drinking?

3. Have you ever felt guilty about drinking alcohol?

4. Has it ever happened that alcohol was the only remedy that helps to become cheerful in the morning (open your eyes)

Sexual disorders

Sexual dysfunctions have three successive stages: disturbances of desire, arousal and orgasm. The DSM-IV considers painful sexual disorders as a fourth category of sexual dysfunction. Desire disorders are further subdivided into reduced sexual desire and perversions. Painful sexual disorders include vaginismus and dyspareunia. Clinically, women often have a combination of several sexual dysfunctions.

The role of sex hormones and menstrual disorders in the regulation of sexual desire remains unclear. Most researchers suggest that endogenous fluctuations in estrogen and progesterone do not significantly affect sexual desire in women of reproductive age. However, there is clear evidence of a decrease in desire in women with surgical menopause, which can be restored by the administration of estradiol or testosterone. Studies of the relationship between arousal and orgasm with cyclic fluctuations in hormones do not give unambiguous conclusions. There is a clear correlation between the plasma level of oxytocin and the psychophysiological magnitude of orgasm.

In postmenopausal women, the number of sexual problems increases: a decrease in vaginal lubrication, atrophic vaginitis, a decrease in blood supply, which are effectively solved with estrogen replacement therapy. The addition of testosterone helps to increase sexual desire, although there is no clear evidence of the supportive effect of androgens on blood flow.

Psychological factors, communication problems play a much more important role in the development of sexual disorders in women than organic dysfunction.

Special attention deserves the influence of medications taken by psychiatric patients on all phases of sexual function. Antidepressants and antipsychotics? two main classes of drugs associated with similar side effects. Anorgasmia has been observed with the use of SSRIs. Despite clinical reports on the effectiveness of adding cyproheptadine or stopping the main drug for the weekend, is it still more acceptable to change the class of antidepressant to another one with less side effects in this area, most often? for buproprion and nefazodone. In addition to the side effects of psychopharmacological agents, a chronic mental disorder in itself can lead to a decrease in sexual interest, as well as physical diseases accompanied by chronic pain, low self-esteem, changes in appearance, and fatigue. A history of depression may be the cause of reduced sexual desire. In such cases, sexual dysfunction occurs during the manifestation of an affective disorder, but does not disappear after the end of its episode.

Anxiety disorders

Anxiety? it is a normal adaptive emotion that develops in response to a threat. It works as a signal to activate behavior and minimize physical and psychological vulnerability. Anxiety reduction is achieved either by overcoming or avoiding a provoking situation. Pathological anxiety states differ from normal anxiety in the severity and chronicity of the disorder, provocative stimuli, or adaptive behavioral response.

Anxiety disorders are widespread, with a monthly incidence of 10% among women. Average age of onset of anxiety disorders? adolescence and youth. Many patients never seek help for this or go to non-psychiatrists complaining of somatic symptoms associated with anxiety. Overdosing or withdrawal of medications, use of caffeine, weight loss drugs, pseudoephedrine can exacerbate anxiety disorder. The medical examination should include a thorough history, routine laboratory tests, ECG, and urinalysis. Some types of neurological pathology are accompanied by anxiety disorders: movement disorders, brain tumors, circulatory disorders of the brain, migraine, epilepsy. Somatic diseases accompanied by anxiety disorders: cardiovascular, thyrotoxicosis, systemic lupus erythematosus.

Anxiety disorders are divided into 5 main groups: phobias, panic disorders, generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress syndrome. With the exception of obsessive compulsive disorder, which is equally common in men and women, anxiety disorders are more common in women. Women are three times more likely to have specific phobias and agoraphobia, 1.5 times more common? panic with agoraphobia, 2 times more often? generalized anxiety disorder and 2 times more often? post-traumatic stress syndrome. The reasons for the predominance of anxiety disorders in the female population are unknown; hormonal and sociological theories have been proposed.

Sociological theory focuses on traditional sex-role stereotypes that prescribe helplessness, dependence, and avoidance of active behavior to a woman. Young mothers often worry about whether they will be able to ensure the safety of their children, reluctance to become pregnant, infertility? All of these conditions can exacerbate anxiety disorders. A large number of expectations and conflicting roles of a woman as a mother, wife, housewife and successful worker also increase the frequency of anxiety disorders in women.

Hormonal fluctuations exacerbate anxiety in the premenstrual period, during pregnancy and after childbirth. Progesterone metabolites function as partial GABA agonists and possible modulators of the serotonergic system. Alpha-2 receptor binding also changes throughout the menstrual cycle.

For anxiety disorders high combination with other psychiatric diagnoses, most often? affective disorders, drug dependence, other anxiety disorders and personality disorders. In panic disorders, for example, the combination with depression occurs more often than 50%, but with alcohol dependence? in 20-40%. Social phobia is combined with panic disorder in more than 50%.

The general principle of the treatment of anxiety disorders is the combination of pharmacotherapy with psychotherapy? the effectiveness of such a combination is higher than the use of these methods in isolation from each other. Drug treatment affects three major neurotransmitter systems: noradrenergic, serotonergic, and GABAergic. The following classes of drugs are effective: antidepressants, benzodiazepines, beta-blockers.

All drugs should be started at low doses and then gradually increased by a factor of two every 2 to 3 days or less frequently to minimize side effects. Patients with anxiety disorders are very sensitive to side effects, so gradually increasing the dose increases compliance with therapy. Patients need to be explained that most antidepressants take 8-12 weeks to work, tell them about the main side effects, help them continue the drug for the required amount of time, and explain that some of the side effects go away with time. The choice of antidepressant depends on the patient's set of complaints and on their side effects. For example, patients with insomnia may be better off starting with more sedating antidepressants such as imipramine. If effective, should treatment be continued for 6 months? of the year.

At the beginning of treatment, before the effect of antidepressants develops, the addition of benzodiazepines is useful, which can dramatically reduce symptoms. Long-term use of benzodiazepines should be avoided due to the risk of dependence, tolerance and withdrawal. When prescribing benzodiazepines, the patient should be warned about their side effects, the risks associated with their long-term use, and the need to consider them only as a temporary measure. Clonazepam 0.5 mg twice daily or lorazepam 0.5 mg four times daily for a limited period of 4–6 weeks may improve initial antidepressant compliance. When taking benzodiazepines for more than 6 weeks, discontinuation should be gradual to reduce anxiety associated with a possible withdrawal syndrome.

In pregnant women, anxiolytics should be used with caution, the safest drugs in this case are tricyclic antidepressants. Benzodiazepines can lead to the development of hypotension, respiratory distress syndrome and a low Apgar score in newborns. Clonazepam has a minimal potential teratogenic effect and may be used with caution in pregnant women with severe anxiety disorders. Should the first step be to try a non-pharmacological treatment? cognitive (training) and psychotherapy.

Phobic disorders

There are three types of phobic disorders: specific phobias, social phobia, and agoraphobia. In all cases, in a provoking situation, anxiety occurs and a panic attack may develop.

Specific phobias? they are irrational fears of specific situations or objects that cause them to be avoided. Examples are fear of heights, fear of flying, fear of spiders. They usually occur at the age of under 25, women are the first to develop a fear of animals. Such women rarely seek treatment because many phobias do not interfere with normal life and their stimuli (such as snakes) are fairly easy to avoid. However, in some cases, such as fear of flying, phobias can interfere with a career, in which case treatment is indicated. Simple phobias are fairly easy to deal with with psychotherapeutic techniques and systemic desensitization. Additionally, a single dose of 0.5 or 1 mg of lorazepam before flying helps to reduce this specific fear.

social phobia(fear of society) ? it is the fear of a situation in which a person is available for the close attention of other people. Avoidance of provoking situations with this phobia severely limits the working conditions and social function. Although social phobia is more common in women, it is easier for them to avoid a provoking situation and do housework, so men with social phobia are more common in the clinical practice of psychiatrists and psychotherapists. Social phobia can be associated with movement disorders and epilepsy. In a study of patients with Parkinson's disease, the presence of social phobia was revealed in 17%. Pharmacological treatment of social phobia is based on the use of beta-blockers: propranolol at a dose of 20-40 mg an hour before an alarming presentation or atenolol at a dose of 50-100 mg per day. These drugs block the activation of the autonomic nervous system in connection with anxiety. Antidepressants, including tricyclics, SSRIs, MAO blockers, can also be used? in the same doses as in the treatment of depression. A combination of pharmacotherapy with psychotherapy is preferred: short-term use of benzodiazepines or low doses of clonazepam or lorazepam in combination with cognitive therapy and systemic desensitization.

Agoraphobia? fear and avoidance of crowded places. Often combined with panic attacks. It is very difficult to avoid provoking situations in this case. As with social phobia, agoraphobia is more common in women, but men seek help more often because its symptoms interfere with their personal and social lives. Treatment for agoraphobia is systemic desensitization and cognitive psychotherapy. Because of their high association with panic disorder and major depression, antidepressants are also effective.

Panic Disorders

Panic attack? is a sudden onset of intense fear and discomfort that lasts for several minutes, resolves gradually and includes at least 4 symptoms: chest discomfort, sweating, trembling, hot flashes, shortness of breath, paresthesias, weakness, dizziness, palpitations, nausea, stool disorders, fear death, loss of self-control. Panic attacks can occur with any anxiety disorder. They are unexpected and accompanied by a constant fear of expecting new attacks, which changes behavior, directs it to minimize the risk of new attacks. Panic attacks also occur in many conditions of intoxication and some diseases such as emphysema. In the absence of therapy, the course of panic disorders becomes chronic, but treatment is effective, and the combination of pharmacotherapy with cognitive-behavioral psychotherapy causes a dramatic improvement in most patients. Antidepressants, especially tricyclics, SSRIs, and MAO inhibitors, at doses comparable to those used in the treatment of depression, are the drug of choice (Table 28-2). Imipramine or nortriptyline is started at a low dose of 10–25 mg daily and increased by 25 mg every three days to minimize side effects and improve compliance. Blood levels of nortriptyline should be maintained between 50 and 150 ng/mL. Fluoxetine, fluvoxamine, tranylcypromine, or phenelzine may also be used.

generalized anxiety disorder

DSM-IV defines generalized anxiety disorder as persistent, severe, poorly controlled anxiety associated with daily activities such as work, school, that interferes with life and is not limited to the symptoms of other anxiety disorders. At least three of the following symptoms are present: fatigue, poor concentration, irritability, sleep disturbances, restlessness, muscle tension.

Treatment includes medication and psychotherapy. Buspirone is the first line treatment for generalized anxiety disorder. Starting dose? 5 mg twice a day, gradually increase it over several weeks to 10-15 mg twice a day. An alternative is imipramine or an SSRI (sertraline) (see Table 28-2). Short-term use of long-acting benzodiazepines, such as clonazepam, may help manage symptoms in the first 4 to 8 weeks, before mainstream treatment takes effect.

Psychotherapeutic techniques used in the treatment of generalized anxiety disorder include cognitive behavioral therapy, supportive therapy, and an introspective approach that aims to increase the patient's tolerance for anxiety.

Compulsive disorder syndrome (obsessive-compulsive disorder)

Obsessions (obsessions) ? these are disturbing, repetitive, imperative thoughts, images. Examples include fear of infection, fear of committing a shameful or aggressive act. The patient always perceives obsessions as abnormal, excessive, irrational and tries to resist them.

Obsessive actions (compulsions)? it is repetitive behavior such as washing hands, counting, picking things up. Could it be mental actions? counting to oneself, repeating words, praying. The patient feels it necessary to perform these rituals in order to alleviate the anxiety caused by the obsessions, or to comply with some irrational rules supposedly preventing some danger. Obsessions and compulsions interfere with the patient's normal behavior, taking up most of her time.

The incidence of obsessive-compulsive disorder is the same in both sexes, but in women they begin later (at the age of 26-35 years), may occur at the beginning of the development of an episode of major depression, but persist after it ends. What is the course of the disorder? combined with depression? better amenable to therapy. Obsessions related to food and weight are more common in women. In one study, 12% of women with obsessive-compulsive disorder had previously had anorexia nervosa. Neurological disorders associated with obsessive-compulsive disorder include Tourette's syndrome (combined with obsessive-compulsive disorder in 60% of cases), temporal-dose epilepsy, and post-encephalitis conditions.

The treatment of this syndrome is quite effective, based on a combination of cognitive behavioral therapy and pharmacological treatment. Serotonergic antidepressants are the drugs of choice (clomipramine, fluoxetine, sertraline, fluvoxamine). Doses should be higher than those used for depression in particular? fluoxetine? 80-100 mg per day. All drugs are started at minimal doses and gradually increased every 7-10 days until a clinical response is obtained. To achieve the maximum therapeutic effect, 8-16 weeks of treatment are most often needed.

Post Traumatic Stress Disorder

Post-traumatic stress disorder develops after situations that can be traumatic for many people, so it is difficult to diagnose. Such situations can be war, life threat, rape, etc. The patient constantly returns her thoughts to the traumatic event and at the same time tries to avoid reminders of it. Personality traits, life stresses, genetic predisposition, family history of mental disorders explain why some people develop PTSD and some don't under the same triggering conditions. Studies show that women are more susceptible to developing this syndrome. Biological theories of the pathogenesis of post-traumatic stress disorder include dysfunction of the limbic system, dysregulation of the catecholamine and opiate systems. In women in the luteal phase of the menstrual cycle, symptoms worsen.

Treatment for PTSD includes medication and psychotherapy. The drugs of choice are imipramine or SSRIs. Psychotherapy involves gradually coming into contact with stimuli reminiscent of the traumatic event in order to overcome one's attitude towards it.

Anxiety disorders are more common in women than in men. Women rarely seek treatment for fear of being labeled "mentally ill". When women do seek help, they often present only associated somatic symptoms, which impair diagnosis and the quality of mental health care. Although anxiety disorders are treatable, if not properly diagnosed, they often become chronic and can seriously impair functioning. Future research will help explain sex differences in the incidence of anxiety disorders.

Somatoform and false disorders

Somatization as a psychiatric phenomenon? it is an expression of psychological distress in the form of somatic disorders. This is a common occurrence in many mental disorders. False disorders and simulation are suspected in the presence of unexplained symptoms that do not fit the picture of somatic and neurological disorders. The motivation for the simulation of diseases is the need of the individual to play the role of the patient. This intention can be completely unconscious? as in conversion disorders, and fully conscious? as in simulation. Getting used to the role of the patient leads to increased attention from family members and doctors and reduces the responsibility of the patient.

Most studies confirm the high incidence of this group of disorders in women. This may be due to differences in gender upbringing and varying degrees of tolerance for physical discomfort.

False Disorders and Simulation

False disorders? conscious production of symptoms of mental illness in order to maintain the role of the patient. An example would be the administration of a dose of insulin to produce a hypoglycemic coma and hospitalization. In simulation, the goal of the patient is not to feel sick, but to achieve other practical results (avoiding arrest, obtaining insane status).

Somatoform disorders

There are four types of somatoform disorders: somatization, conversion, hypochondria, and pain. With all these disorders, there are physical symptoms that are not explained from the standpoint of existing somatic diseases. Most often, the mechanism for the development of these symptoms is unconscious (as opposed to false disorders). These symptoms must be severe enough to interfere with the patient's social, emotional, occupational, or physical functioning and be associated with an active search for medical care. Since these patients are self-diagnosed, one of the initial difficulties of treatment is their acceptance of the fact of a mental disorder. Only the acceptance of a real diagnosis helps to achieve cooperation with the patient and the implementation of her treatment recommendations. The next step is to find out the connection between exacerbations of symptoms and life stressors, depression or anxiety - and explain this connection to the patient. An illustrative example? exacerbation of peptic ulcer from stress? helps patients to link their complaints to the current psychological state. Treatment of comorbid depression or anxiety is very important.

somatization disorder

Somatization disorder usually includes many somatic symptoms that affect many organs and systems, has a chronic course and begins before the age of 30 years. DSM-IV diagnostic criteria require at least four pain symptoms, two gastrointestinal, one sexual, and one pseudoneurological, none of which are fully explained by physical and laboratory findings. Patients often present with strange and inconsistent combinations of complaints. In women, such disorders are 5 times more common than in men, and the frequency is inversely proportional to educational level and social class. The combination with other mental disorders, especially affective and anxiety disorders, is present in 50%, and its diagnosis is very important for the selection of therapy.

A prerequisite for successful therapy is the choice of one attending physician who coordinates treatment tactics, since such patients often turn to many doctors. Psychotherapy, both individual and group, often helps patients reformulate their condition.

Ovarian hormones and the nervous system

Hormones play an important role in the manifestation of many neurological conditions. Sometimes endocrine disorders are caused by an underlying neurological diagnosis, such as an abnormal insulin response to a glucose load in myodystrophy. In other cases, on the contrary, neurological disorders are caused by endocrine pathology? for example, peripheral neuropathy in diabetes mellitus. In other endocrine disorders, such as primary hypothyroidism, Cushing's disease, Addison's disease, neurological dysfunction may be less noticeable and manifest as an impairment in cognitive ability or personality traits. All these conditions are equally common in men and women. In women, cyclic changes in the level of ovarian hormones have specific effects, which are discussed in this chapter.

For a better understanding of the subject, the questions of anatomy, physiology of the ovaries, the pathogenesis of puberty and the physiological effects of ovarian hormones are first considered. There are various genetic conditions that affect the process of sexual development and maturation. Besides the fact that they can have a direct effect on neurological status, they also change it by influencing cyclic hormonal changes. The differential diagnosis with delayed sexual development is considered.

Clinically, congenital or acquired changes in certain brain structures can have a significant impact on sexual and neuronal development. Can damage to the central nervous system, such as tumors, interfere with sexual development or the menstrual cycle? depending on the age at which they develop.

Anatomy, Embryology and Physiology

The cells of the ventromedial and arcuate nuclei and the preoptic zone of the hypothalamus are responsible for the production of GnRH. This hormone controls the release of anterior pituitary hormones: FSH and LH (gonadotropins). Cyclic changes in FSH and LH levels regulate the ovarian cycle, which includes follicle development, ovulation, and maturation of the corpus luteum. Are these stages associated with varying degrees of production of estrogens, progesterone, and testosterone, which in turn have multiple effects on various organs and in a feedback manner? on the hypothalamus and cortical areas associated with the regulation of ovarian function. In the first three months of life, GnRH causes a marked response in LH and FSH production, which then decreases and recovers closer to menarche. This early LH surge is associated with a peak in oocyte replication. Many researchers consider these facts to be related, since the production of new oocytes is practically absent in the future. However, the exact role of FSH and LH in the regulation of oocyte production has not been determined. Immediately before puberty during sleep, the release of GnRH increases dramatically. This fact and the rise in LH and FSH levels are considered markers of approaching puberty.

Influences that increase the tone of the noradrenergic system increase the release of GnRH, and the activation of the opiate system? slows down. GnRH secreting cells are also affected by the levels of dopamine, serotonin, GABA, ACTH, vasopressin, substance P, and neurotensin. Although there are higher, cortical regions that directly affect areas of the hypothalamus that produce GnRH, the amygdala has the strongest influence. Located in the anterior limbic system of the temporal lobe, the amygdala is in reciprocal relationship with many areas of the neocortex and with the hypothalamus. In the amygdala nucleus there are two areas, the fibers of which go as part of various pathways of the brain. Fibers from the cortico-medial region go as part of the stria terminalis, but from the basolateral? in the ventral amygdalofugal tract. Both of these pathways are associated with areas of the hypothalamus containing GnRH-producing cells. Studies with stimulation and destruction of the amygdala and pathways have shown a clear response in LH and FSH levels. Stimulation of the corticomesial nucleus stimulated ovulation and uterine contraction. Stimulation of the basolateral nucleus blocked sexual behavior in females during ovulation. Destruction of the sria terminalis blocked ovulation. Destruction of the ventral amygdalofugal pathway had no effect, but bilateral damage to the basolateral nucleus also blocked ovulation.

GnRH is released into the portal system of the hypothalamus and enters the anterior pituitary gland, where it affects gonadotrophic cells that occupy 10% of the adenohypophysis. They usually secrete both gonadotropic hormones, but among them there are subspecies that secrete only LH or only FSH. GnRH secretion occurs in a circoral pulsatile rhythm. Answer? release of LH and FSH? develops rapidly, in the same pulse mode. The half-lives of these hormones are different: for LH it is 30 minutes, for FSH? about 3 hours. That. when measuring hormone levels in peripheral blood, it is less variable in FSH than in LH. LH regulates the production of testosterone in ovarian theca cells, which in turn is converted to estrogen in granulosa cells. LH also contributes to the maintenance of the corpus luteum. FSH stimulates follicular cells and controls aromatase levels by influencing estradiol synthesis (Fig. 4-1). Just before puberty, the pulsed release of GnRH causes a predominant stimulation of FSH production with little or no effect on LH levels. The sensitivity of LH to stimulation increases after the onset of menarche. During the reproductive period, the LH pulse is more stable than FSH. At the onset of menopause, the LH response begins to decline until postmenopause, when both FSH and LH levels are elevated, but FSH predominates.

In the ovaries, from LDL cholesterol circulating in the blood, under the influence of FSH and LH, sex hormones are synthesized: estrogens, progesterone and testosterone (Fig. 4-1). All cells of the ovary, except for the egg itself, are capable of synthesizing estradiol? main ovarian estrogen. LH regulates the first stage? conversion of cholesterol to pregnenolone, and FSH? final conversion of testosterone to estradiol. Estradiol, when accumulated in sufficient quantities, has a positive feedback effect on the hypothalamus, stimulating the release of GnRH and causing an increase in the pulse amplitude of LH and, to a lesser extent, FSH. The pulsation of gonadotropins reaches its maximum amplitude during ovulation. After ovulation, FSH levels decrease, resulting in a decrease in FSH-dependent estradiol production and hence estradiol-dependent LH secretion. The corpus luteum develops, leading to an increase in the levels of progesterone and estradiol synthesized by the cells of the theca and granulosa of the corpus luteum.

Estrogens? hormones that have many peripheral effects. They are essential for secondary puberty: the maturation of the vagina, uterus, fallopian tubes, stroma, and mammary ducts. They stimulate the growth of the endometrium during the menstrual cycle. They are also important for the growth of tubular bones and the closure of growth plates. They have an important influence on the distribution of subcutaneous fat and the level of HDL in the blood. Estrogens reduce calcium reabsorption from bones and stimulate blood clotting.

In the brain, estrogens act as both a trophic factor and a neurotransmitter. The density of their receptors is highest in the preoptic zone of the hypothalamus, but there is also a certain amount in the amygdala, CA1 and CA3 regions of the hippocampus, cingulate gyrus, locus coeruleus, raphe nuclei, and central gray matter. In many areas of the brain, the number of estrogen receptors changes throughout the menstrual cycle, in some? specifically in the limbic system? their level depends on serum. Estrogens activate the formation of new synapses, in particular the NMDA mediator system, as well as the reaction of the formation of new dendrites. Both of these processes are further enhanced in the presence of progesterone. The reverse processes do not depend on an isolated decrease in estrogen levels, but only on its decrease in the presence of progesterone. Without progesterone, a decrease in estrogen does not trigger the reverse processes. That. The effects of estrogens are enhanced in non-ovulating women who do not have adequate levels of progesterone during the luteal phase.

Estrogens exert their influence on the level of neurotransmitters (cholinergic system) by activating acetylcholinesterase (AChE). They also increase the number of serotonin receptors and the level of serotonin synthesis, which causes it to fluctuate during the cycle. In human and animal studies, increasing estrogen levels improves fine motor skills but decreases spatial orientation. With an initially reduced level of estrogen in women, its increase improves verbal short-term memory.

In animals treated with estrogens, resistance to convulsions provoked by electric shock decreases, and the threshold of sensitivity to convulsive drugs decreases. Local application of estrogen itself provokes spontaneous convulsions. In animals with structural but non-epileptic lesions, estrogens can also induce seizures. In humans, intravenous estrogens can activate epileptic activity. During periods of higher estrogen concentration, an increase in the basal EEG amplitude is observed compared to periods of minimal concentration. Progesterone has the opposite effect on epileptic activity, raising the threshold for seizure activity.

Disorders with a genetic predisposition

Genetic disorders can disrupt the normal process of puberty. They can directly cause the same neurological disorders, which also depend on hormone levels throughout the menstrual cycle.

Turner Syndrome? example of a chromosomal deletion. One out of every 5,000 live-born girls has a karyotype of 45, XO, i.e. deletion of one X chromosome. Many somatic developmental anomalies are associated with this mutation, such as coarctation of the aorta, delayed sexual development due to high levels of FSH, and gonadal dysgenesis. If it is necessary to replenish the level of sex hormones, hormone replacement therapy is possible. It has recently been found that some patients with Turner syndrome have a partial deletion in the long or short arm of the X chromosome or mosaicism, i.e. in some cells of the body, the karyotype is normal, while in others there is a complete or partial deletion of the X chromosome. In these cases, although the process of sexual development may proceed normally, some of the somatic features of the disease, such as short stature, pterygoid neck folds, may be present in patients. There are other cases when there is gonadal dysgenesis, but there are no somatic signs, and development occurs normally until the development of secondary sexual characteristics.

Another disorder with a genetic predisposition and various clinical manifestations is congenital adrenal hyperplasia. This autosomal recessive anomaly has 6 clinical forms and occurs in both men and women. In three of these forms, only the adrenal glands are affected, in the rest? adrenals and ovaries. In all 6 variants, women have virilization, which can delay the time of puberty. This disorder has a high incidence of PCOS.

Another genetic disorder is the P450 aromatase deficiency syndrome. With it, there is a partial violation of the placental conversion of circulating steroids to estradiol, which leads to an increase in the level of circulating androgens. This causes the effect of masculinization of the fetus, in particular the female fetus. Although this effect tends to reverse after delivery, it remains unclear how intrauterine exposure to high levels of androgens may influence the development of the nervous system in women in the future, especially given all the various influences that these hormones have on neurogenesis.

Structural and physiological disorders

Structural disorders of the brain can affect sexual development or the cyclic nature of the secretion of female sex hormones. If the damage occurs before puberty, it is more likely to be disrupted. Otherwise, damage can change the nature of hormonal secretion, causing the development of conditions such as PCOS, hypothalamic hypogonadism, premature menopause.

Damage leading to menstrual irregularities can be localized in the pituitary gland (intrasellar localization) or hypothalamus (suprasellar). Extrasellar localization of damage is also possible, for example, an increase in intracranial pressure and its effect on both the hypothalamus and the pituitary gland.

Intrasellar lesions can be localized in cells that produce adenohypophysis hormones. These hormones (eg growth hormone) may affect gonadotropin function directly, or the size of the lesions may cause a decrease in gonadotrophs. In these cases, the levels of gonadotropins decrease, but the GnRH level remains normal. With suprasellar lesions, the production of hypothalamic releasing factors and a secondary decrease in gonadotropin levels are reduced. In addition to endocrine disorders, suprasellar pathology more often than intrasellar cause neurological symptoms: disturbances in appetite, rhythms of sleep and wakefulness, mood, vision and memory.

Partial epilepsy

Epilepsy is quite common in adults, especially with the localization of the focus in the temporal lobe of the cortex. Women experience a peak incidence of epilepsy around the time of menopause. On fig. Figures 4-2 show three different patterns of epilepsy according to the phases of the menstrual cycle. The two most easily recognizable patterns? this is an exacerbation of seizures in the middle of the cycle, during normal ovulation (first) and immediately before and after menstruation (second). The third pattern is observed in women with anovulatory cycles, they develop seizures throughout the "cycle", the duration of which can vary significantly. As noted earlier, estradiol has a proconvulsant effect, but progesterone? anticonvulsant. The main factor determining the pattern of seizures is the ratio of concentrations of estradiol and progesterone. With anovulation, there is a relative predominance of estradiol.

For its part, the presence of focal, with a focus in the temporal lobe of the cerebral cortex, epilepsy, can affect the normal menstrual cycle. Almond nucleus? the structure related to the temporal lobe is in a reciprocal relationship with the hypothalamic structures that affect the secretion of gonadotropins. In our study of 50 women with clinical and electroencephalographic signs of an epileptic focus in the temporal lobe, 19 had significant disorders of the reproductive system. 10 out of 19 had PCOS, 6? hypergonadotropic hypogonadism, in 2? premature menopause, 1? hyperprolactinemia. In humans, there is an advantage of the right temporal lobe over the left in the influence of epileptic foci on the production of gonadotropins. Women with left-sided lesions had more LH peaks during the 8-hour follow-up period compared to controls. All of these women had PCOS. In women with hypergonadotropic hypogonadism, there was a significant decrease in LH peaks during the 8-hour follow-up period compared with controls, and the focus of epilepsy was more often observed in the right temporal lobe (Fig. 4-3).

Menopause can influence the course of epilepsy. In obese women, due to aromatase activity in adipose tissue, adrenal androgens are converted to estradiol. Therefore, obese women may not experience the classic menopausal symptoms of estrogen deficiency. Due to ovarian hypofunction, progesterone deficiency occurs, which leads to a predominance of estrogen levels over progesterone. The same situation can develop in women with normal weight while taking HRT. In both cases, there is an increase in convulsive activity due to the uncompensated influence of estrogens. With an increase in the frequency of seizures, combined estrogen-progestin HRT should be prescribed continuously.

Pregnancy can have a significant impact on seizure activity through the production of endogenous hormones and their effect on the metabolism of anticonvulsants.

Nowadays, mental deviations are found in almost every second person. Not always the disease has bright clinical manifestations. However, some deviations cannot be neglected. The concept of the norm has a wide range, but inaction, with obvious signs of illness, only exacerbates the situation.

Mental illness in adults, children: list and description

Sometimes, different ailments have the same symptoms, but in most cases, diseases can be divided and classified. Major mental illnesses - a list and description of deviations may attract the attention of loved ones, but only an experienced psychiatrist can establish the final diagnosis. He will also prescribe treatment based on the symptoms, coupled with clinical studies. The sooner the patient seeks help, the greater the chance of successful treatment. We need to discard stereotypes, and not be afraid to face the truth. Now mental illness is not a sentence, and most of them are successfully treated if the patient turns to the doctors for help in time. Most often, the patient himself is not aware of his condition, and this mission should be undertaken by his relatives. The list and description of mental illnesses is for informational purposes only. Perhaps your knowledge will save the lives of those who are dear to you, or dispel your worries.

Agoraphobia with panic disorder

Agoraphobia, in one way or another, accounts for about 50% of all anxiety disorders. If initially the disorder meant only the fear of open space, now the fear of fear has been added to this. That's right, a panic attack overtakes in an environment where there is a high probability of falling, getting lost, getting lost, etc., and fear will not cope with this. Agoraphobia expresses non-specific symptoms, that is, increased heart rate, sweating can also occur with other disorders. All the symptoms of agoraphobia are exclusively subjective signs experienced by the patient himself.

Alcoholic dementia

Ethyl alcohol, with constant use, acts as a toxin that destroys the brain functions responsible for human behavior and emotions. Unfortunately, only alcoholic dementia can be tracked, its symptoms can be identified, but treatment will not restore lost brain functions. You can slow down alcohol dementia, but you can't heal a person completely. Symptoms of alcoholic dementia include slurred speech, memory loss, sensory loss, and lack of logic.

Allotriophagy

Some are surprised when children or pregnant women combine incompatible foods, or, in general, eat something inedible. Most often, this is the lack of certain trace elements and vitamins in the body. This is not a disease, and is usually “treated” by taking a vitamin complex. With allotriophagy, people eat what is basically not edible: glass, dirt, hair, iron, and this is a mental disorder, the causes of which are not only a lack of vitamins. Most often, this is a shock, plus beriberi, and, as a rule, treatment also needs to be approached comprehensively.

Anorexia

In our time of craze for gloss, the mortality rate from anorexia is 20%. An obsessive fear of getting fat makes you refuse to eat, up to complete exhaustion. If you recognize the first signs of anorexia, a difficult situation can be avoided and measures can be taken in time. The first symptoms of anorexia:
Table setting turns into a ritual, with calorie counting, fine cutting, and spreading/smearing food on a plate. All life and interests are focused only on food, calories, and weighing five times a day.

Autism

Autism - what is this disease, and how can it be treated? Only half of the children diagnosed with autism have functional brain disorders. Children with autism think differently than normal children. They understand everything, but cannot express their emotions due to the disruption of social interaction. Ordinary children grow up and copy the behavior of adults, their gestures, facial expressions, and so learn to communicate, but with autism, non-verbal communication is impossible. do not strive for loneliness, they simply do not know how to establish contact themselves. With due attention and special training, this can be somewhat corrected.

Delirium tremens

Delirium tremens refers to psychosis, against the background of prolonged use of alcohol. Signs of delirium tremens are represented by a very wide range of symptoms. Hallucinations - visual, tactile and auditory, delirium, rapid mood swings from blissful to aggressive. To date, the mechanism of brain damage is not fully understood, as well as there is no complete cure for this disorder.

Alzheimer's disease

Many types of mental disorders are incurable, and Alzheimer's disease is one of them. The first signs of Alzheimer's disease in men are non-specific, and it is not immediately evident. After all, all men forget birthdays, important dates, and this does not surprise anyone. In Alzheimer's disease, short-term memory is the first to suffer, and a person literally forgets today. Aggression, irritability appear, and this is also attributed to a manifestation of character, thereby missing the moment when it was possible to slow down the course of the disease and prevent too rapid dementia.

Pick's disease

Niemann Pick disease in children is exclusively hereditary, and is divided according to severity into several categories, according to mutations in a certain pair of chromosomes. The classic category "A" is a sentence for a child, and death occurs by the age of five. Symptoms of Niemann Pick disease appear in the first two weeks of a child's life. Lack of appetite, vomiting, clouding of the cornea of ​​​​the eye and enlarged internal organs, due to which the child's stomach becomes disproportionately large. Damage to the central nervous system and metabolism leads to death. Categories "B", "C", and "D" are not so dangerous, since the central nervous system is not affected so rapidly, this process can be slowed down.

bulimia

Bulimia - what kind of disease is it, and should it be treated? In fact, bulimia is not just a mental disorder. A person does not control his feeling of hunger and eats literally everything. At the same time, the feeling of guilt makes the patient take a lot of laxatives, emetics, and miracle remedies for weight loss. Obsession with your weight is just the tip of the iceberg. Bulimia occurs due to functional disorders of the central nervous system, with pituitary disorders, with brain tumors, the initial stage of diabetes, and bulimia is only a symptom of these diseases.

Hallucinosis

The causes of hallucinosis syndrome occur against the background of encephalitis, epilepsy, traumatic brain injury, hemorrhage, or tumors. With full lucid consciousness, the patient may experience visual hallucinations, auditory, tactile, or olfactory. A person can see the world around him in a somewhat distorted form, and the faces of the interlocutors can be presented as cartoon characters, or as geometric shapes. The acute form of hallucinosis can last up to two weeks, but you should not relax if the hallucinations have passed. Without identifying the causes of hallucinations, and appropriate treatment, the disease may return.

dementia

Senile is a consequence of Alzheimer's disease, and is often referred to by the people as "old man's insanity." The stages of development of dementia can be divided into several periods. At the first stage, memory lapses are observed, and sometimes the patient forgets where he went and what he did a minute ago.

The next stage is the loss of orientation in space and time. The patient can get lost even in his room. Further, hallucinations, delusions, and sleep disturbances follow. In some cases, dementia proceeds very quickly, and the patient completely loses the ability to reason, speak and serve himself within two to three months. With proper care, supportive care, the prognosis of life expectancy after the onset of dementia is from 3 to 15 years, depending on the causes of dementia, patient care, and individual characteristics of the organism.

Depersonalization

Depersonalization syndrome is characterized by a loss of connection with oneself. The patient cannot perceive himself, his actions, words, as his own, and looks at himself from the outside. In some cases, this is a defensive reaction of the psyche to a shock, when you need to evaluate your actions from the outside without emotions. If this disorder does not go away within two weeks, treatment is prescribed based on the severity of the disease.

Depression

It is impossible to answer unequivocally whether it is a disease or not. This is an affective disorder, that is, a mood disorder, but it affects the quality of life, and can lead to disability. A pessimistic attitude triggers other mechanisms that destroy the body. Another option is also possible, when depression is a symptom of other diseases of the endocrine system or pathology of the central nervous system.

dissociative fugue

Dissociative fugue is an acute mental disorder that occurs against a background of stress. The patient leaves his home, moves to a new place, and everything connected with his personality: name, surname, age, profession, etc., is erased from his memory. At the same time, the memory of the books read, of some experience, but not related to his personality, is preserved. A dissociative fugue can last from two weeks to many years. Memory may return suddenly, but if this does not happen, you should seek qualified help from a psychotherapist. Under hypnosis, as a rule, the cause of the shock is found, and the memory returns.

Stuttering

Stuttering is a violation of the tempo-rhythmic organization of speech, expressed by spasms of the speech apparatus, as a rule, stuttering occurs in physically and psychologically weak people who are too dependent on someone else's opinion. The area of ​​the brain responsible for speech is adjacent to the area responsible for emotions. Violations occurring in one area are inevitably reflected in another.

gambling addiction

Gambling is considered a disease of the weak. This is a personality disorder, and treatment is complicated by the fact that there is no cure for gambling. Against the background of loneliness, infantilism, greed, or laziness, addiction to the game develops. The quality of treatment for gambling addiction depends solely on the desire of the patient himself, and consists in constant self-discipline.

Idiocy

Idiocy is classified in the ICD as profound mental retardation. The general characteristics of personality and behavior are correlated with the level of development of a three-year-old child. Patients with idiocy are practically incapable of learning and live exclusively by instinct. Typically, patients have an IQ of around 20, and treatment consists of patient care.

Imbecility

In the International Classification of Diseases, imbecility has been replaced by the term "mental retardation". Impairment of intellectual development in the degree of imbecility represents the average level of mental retardation. Congenital imbecility is a consequence of intrauterine infection or defects in the formation of the fetus. The level of development of the imbecile corresponds to the development of a child of 6-9 years. They are moderately trainable, but the imbecile's independent living is impossible.

Hypochondria

It manifests itself in an obsessive search for diseases in oneself. The patient carefully listens to his body and looks for symptoms that confirm the presence of the disease. Most often, such patients complain of tingling, numbness of the extremities and other non-specific symptoms, requiring doctors to accurately diagnose. Sometimes, patients with hypochondria are so sure of their serious illness that the body, under the influence of the psyche, fails and really gets sick.

Hysteria

The signs of hysteria are quite violent, and, as a rule, women suffer from this personality disorder. With a hysteroid disorder, there is a strong manifestation of emotions, and some theatricality, and pretense. A person seeks to attract attention, arouse pity, achieve something. Some consider it just whims, but, as a rule, such a disorder is quite serious, since a person cannot control his emotions. Such patients need psychocorrection, since hysterics are aware of their behavior, and suffer from incontinence no less than their loved ones.

Kleptomania

This psychological disorder refers to the disorder of drives. The exact nature has not been studied, however, it is noted that kleptomania is a concomitant disease with other psychopathic disorders. Sometimes kleptomania manifests itself as a result of pregnancy or in adolescents, with a hormonal transformation of the body. The craving for theft in kleptomania does not aim to get rich. The patient is looking for only thrills from the very fact of committing an illegal act.

Cretinism

Types of cretinism are divided into endemic and sporadic. As a rule, sporadic cretinism is caused by a deficiency of thyroid hormones during embryonic development. Endemic cretinism is caused by a lack of iodine and selenium in the mother's diet during pregnancy. In the case of cretinism, early treatment is of the utmost importance. If, with congenital cretinism, therapy is started at 2-4 weeks of a child's life, the degree of his development will not lag behind the level of his peers.

"Culture shock

Many do not take culture shock and its consequences seriously, however, the state of a person with culture shock should be of concern. Often people experience culture shock when moving to another country. At first a person is happy, he likes different food, different songs, but soon he encounters the deepest differences in deeper layers. Everything that he used to consider normal and ordinary goes against his worldview in a new country. Depending on the characteristics of the person and the motives for moving, there are three ways to resolve the conflict:

1. Assimilation. Complete acceptance of a foreign culture and dissolution in it, sometimes in an exaggerated form. One's own culture is belittled, criticized, and the new one is considered more developed and ideal.

2. Ghettoization. That is, creating your own world inside a foreign country. This is a separate residence, and the restriction of external contacts with the local population.

3. Moderate assimilation. In this case, the individual will keep in his home everything that was accepted in his homeland, but at work and in society he tries to acquire a different culture and observes the customs generally accepted in this society.

Persecution mania

Mania of persecution - in a word, one can characterize the real disorder as spy mania, or persecution. Persecution mania can develop against the background of schizophrenia, and manifests itself in excessive suspicion. The patient is convinced that he is an object of surveillance by special services, and suspects everyone, even his relatives, of espionage. This schizophrenic disorder is difficult to treat, since it is impossible to convince the patient that the doctor is not an employee of the special services, but the pill is a medicine.

Misanthropy

A form of personality disorder characterized by hostility towards people, up to hatred. What is misanthropy, and how to recognize a misanthrope? Misanthrope opposes himself to society, its weaknesses and imperfections. To justify his hatred, a misanthrope often raises his philosophy to a kind of cult. A stereotype has been created that a misanthrope is an absolutely closed hermit, but this is not always the case. The misanthrope carefully selects whom to let into his personal space and who can be his equal. In a severe form, the misanthrope hates all of humanity as a whole and may call for massacres and wars.

Monomania

Monomania is a psychosis, expressed in focusing on one thought, with full preservation of reason. In today's psychiatry, the term "monomania" is considered obsolete, and too general. Currently, there are "pyromania", "kleptomania" and so on. Each of these psychoses has its own roots, and treatment is prescribed based on the severity of the disorder.

obsessive states

Obsessive-compulsive disorder, or obsessive-compulsive disorder, is characterized by the inability to get rid of annoying thoughts or actions. As a rule, OCD suffers from individuals with a high level of intelligence, with a high level of social responsibility. Obsessive-compulsive disorder manifests itself in endless thinking about unnecessary things. How many cells are on the companion's jacket, how old is the tree, why the bus has round headlights, etc.

The second version of the disorder is obsessive actions, or rechecking actions. The most common impact is related to cleanliness and order. The patient endlessly washes everything, folds and washes again, to the point of exhaustion. The syndrome of persistent states is difficult to treat, even with the use of complex therapy.

narcissistic personality disorder

The signs of narcissistic personality disorder are easy to recognize. prone to overestimated self-esteem, confident in their own ideality and perceive any criticism as envy. This is a behavioral personality disorder, and it's not as harmless as it might seem. Narcissistic personalities are confident in their own permissiveness and are entitled to something more than everyone else. Without a twinge of conscience, they can destroy other people's dreams and plans, because for them it does not matter.

Neurosis

Is obsessive-compulsive disorder a mental illness or not, and how difficult is it to diagnose the disorder? Most often, the disease is diagnosed on the basis of patient complaints, and psychological testing, MRI and CT of the brain. Often, neuroses are a symptom of a brain tumor, aneurysm, or previous infections.

Oligophrenia

This is a form of mental retardation in which the patient does not develop mentally. Oligophrenia is caused by intrauterine infections, defects in genes, or hypoxia during childbirth. The treatment of oligophrenia consists in the social adaptation of patients, and teaching the simplest self-service skills. For such patients, there are special kindergartens, schools, but it is rarely possible to achieve development more than the level of a ten-year-old child.

Panic attacks

A fairly common disorder, however, the causes of the disease are unknown. Most often, doctors in the diagnosis write VVD, since the symptoms are very similar. There are three categories of panic attacks:

1. Spontaneous panic attack. Fear, increased sweating and palpitations occur without any reason. If such attacks occur regularly, somatic diseases should be ruled out, and only after that you should be referred to a psychotherapist.

2. Situational panic attack. Many people have phobias. Someone is afraid to ride in an elevator, others are afraid of airplanes. Many psychologists successfully cope with such fears, and you should not delay visiting a doctor.

3. Panic attack when taking drugs or alcohol. In this situation, biochemical stimulation is on the face, and the psychologist in this case will only help get rid of the addiction, if any.

Paranoia

Paranoia is a heightened sense of reality. Patients with paranoia can build the most complex logical chains and solve the most intricate tasks, thanks to their non-standard logic. - a chronic disorder characterized by periods of calm and violent crises. During such periods, the treatment of the patient is especially difficult, since paranoid ideas can be expressed in persecution mania, megalomania, and other ideas where the patient considers doctors enemies or they are unworthy of treating him.

Pyromania

Pyromania is a mental disorder characterized by a morbid passion for watching fire. Only such contemplation can bring joy, satisfaction and calm to the patient. Pyromania is considered a type of OCD, due to the inability to resist the urge to set something on fire. Pyromaniacs rarely plan a fire in advance. This is spontaneous lust, which does not give material gain or profit, and the patient feels relieved after the arson has been committed.

Psychoses

They are classified according to their origin. Organic psychosis occurs against the background of brain damage due to infectious diseases (meningitis, encephalitis, syphilis, etc.)

1. Functional psychosis - with a physically intact brain, paranoid deviations occur.

2. Intoxication. The cause of intoxication psychosis is the abuse of alcohol, drug-containing drugs, and poisons. Under the influence of toxins, nerve fibers are affected, which leads to irreversible consequences and complicated psychoses.

3. Reactive. Psychosis, panic attacks, hysteria, and increased emotional excitability often occur after psychological trauma.

4. Traumatic. Due to traumatic brain injuries, psychosis can manifest itself in the form of hallucinations, unreasonable fears, and obsessive-compulsive states.

Self-damaging behavior "Patomimia"

Self-harmful behavior in adolescents is expressed in self-hatred, and self-infliction of pain as a punishment for their weakness. During adolescence, children are not always able to show their love, hate, or fear, and self-aggression helps to cope with this problem. Often, pathomimia is accompanied by alcoholism, drug addiction, or dangerous sports.

seasonal depression

Conduct disorder is expressed in apathy, depression, increased fatigue, and a general decrease in vital energy. All these are signs of seasonal depression, which affects mainly women. The causes of seasonal depression lie in the reduction of daylight hours. If the breakdown, drowsiness and melancholy began from the end of autumn and last until the very spring - this is seasonal depression. The production of serotonin and melatonin, hormones responsible for mood, is affected by the presence of bright sunlight, and if it is not there, the necessary hormones fall into a “hibernation”.

Sexual perversions

The psychology of sexual perversion changes from year to year. Separate sexual inclinations do not correspond to modern standards of morality and generally accepted behavior. In different times and in different cultures, their understanding of the norm. What can be considered a sexual perversion today:

Fetishism. The object of sexual attraction is clothing or an inanimate object.
Egsbizionism. Sexual satisfaction is achieved only in public, by demonstrating one's genitals.
Voyeurism. Does not require direct participation in sexual intercourse, and is content with spying on the sexual intercourse of others.

Pedophilia. Painful longing to satisfy one's sexual passion with pre-pubescent children.
Sadomasochism. Sexual satisfaction is possible only in the case of causing or receiving physical pain or humiliation.

Senestopathy

Senestopathy is in psychology one of the symptoms of hypochondria or depressive delirium. The patient feels pain, burning, tingling, for no particular reason. In a severe form of senestopathy, the patient complains of freezing of the brain, itching of the heart, and itching in the liver. Diagnosis of senestopathy begins with a complete medical examination to exclude somatics and nonspecific symptoms of diseases of the internal organs.

negative twin syndrome

The delusional negative twin syndrome is also known as Capgras syndrome. In psychiatry, they have not decided whether to consider this an independent disease or a symptom. A patient with the negative twin syndrome is sure that one of his relatives, or himself, has been replaced. All negative actions (crashed the car, stole a candy bar in the supermarket), all this is attributed to the double. Of the possible causes of this syndrome, the destruction of the connection between visual perception and emotional is called, due to defects in the fusiform gyrus.

irritable bowel syndrome

Irritable bowel syndrome with constipation is expressed in bloating, flatulence, and impaired defecation. The most common cause of IBS is stress. Approximately 2/3 of all TCS sufferers are women, and more than half of them suffer from mental disorders. Treatment for TCS is systemic and includes medication to treat constipation, flatulence, or diarrhea, and antidepressants to relieve anxiety or depression.

chronic fatigue syndrome

Already reaching epidemic proportions. This is especially noticeable in large cities, where the rhythm of life is more rapid and the mental burden on a person is enormous. The symptoms of the disorder are quite variable and home treatment is possible if this is the initial form of the disease. Frequent headaches, sleepiness throughout the day, fatigue even after vacations or weekends, food allergies, memory loss and inability to concentrate are all symptoms of CFS.

Burnout Syndrome

The syndrome of emotional burnout in medical workers occurs after 2-4 years of work. The work of doctors is associated with constant stress, often doctors feel dissatisfied with themselves, the patient, or feel helpless. After a certain time, they are overtaken by emotional exhaustion, expressed in indifference to someone else's pain, cynicism, or outright aggression. Doctors are taught to treat other people, but they don't know how to deal with their own problem.

Vascular dementia

It is provoked by a violation of blood circulation in the brain, and is a progressive disease. Those who have high blood pressure, blood sugar, or someone from close relatives suffered from vascular dementia should be attentive to their health. How long they live with such a diagnosis depends on the severity of the brain damage, and on how carefully loved ones care for the patient. On average, after diagnosis, the life of the patient is 5-6 years, subject to appropriate treatment and care.

Stress and adjustment disorder

Stress and impaired behavioral adaptation are quite persistent. Violation of behavioral adaptation usually manifests itself within three months, after the stress itself. As a rule, this is a strong shock, the loss of a loved one, a catastrophe, violence, etc. A behavioral adaptation disorder is expressed in violation of the moral rules accepted in society, senseless vandalism, and actions that endanger one's life or others.
Without appropriate treatment, stress disorder can last up to three years.

Suicidal behavior

As a rule, adolescents have not yet fully formed the idea of ​​​​death. Frequent suicide attempts are caused by the desire to relax, take revenge, get away from problems. They do not want to die forever, but only temporarily. Nevertheless, these attempts may be successful. To prevent suicidal behavior in adolescents, prevention should be carried out. Trusting relationships in the family, learning to cope with stress and resolve conflict situations - this greatly reduces the risk of suicidal ideation.

Madness

Insanity is an outdated concept for the definition of a whole complex of mental disorders. Most often, the term madness is used in painting, in literature, along with another term - "madness". By definition, insanity or insanity can be temporary, caused by pain, passion, possession, and is mostly treated with prayer or magic.

Tapophilia

Tapophilia manifests itself in attraction to the cemetery and funeral rituals. The reasons for tapophilia mainly lie in the cultural and aesthetic interest in monuments, in rites and rituals. Some old necropolises are more like museums, and the atmosphere of the cemetery pacifies and reconciles with life. Tapophiles are not interested in dead bodies, or thoughts about death, and show only cultural and historical interest. As a general rule, taphophylia does not require treatment unless visiting cemeteries develops into compulsive behavior with OCD.

Anxiety

Anxiety in psychology is unmotivated fear, or fear for minor reasons. There is a “useful anxiety” in a person’s life, which is a protective mechanism. Anxiety is the result of an analysis of the situation, and a forecast of the consequences, how real the danger is. In the case of neurotic anxiety, a person cannot explain the reasons for his fear.

Trichotillomania

What is trichotillomania and is it a mental disorder? Of course, trichotillomania belongs to the OCD group and is aimed at pulling out one's hair. Sometimes hair is pulled out unconsciously, and the patient can eat personal hair, which leads to gastrointestinal problems. As a rule, trichotillomania is a reaction to stress. The patient feels a burning sensation in the hair follicle on the head, on the face, body, and after pulling out, the patient feels calm. Sometimes patients with trichotillomania become recluses, as they are embarrassed by their appearance, and they are ashamed of their behavior. Recent studies have revealed that patients with trichotillomania have damage in a particular gene. If these studies are confirmed, the treatment of trichotillomania will be more successful.

hikikomori

To fully study such a phenomenon as hikikomori is quite difficult. Basically, hikikomori deliberately isolate themselves from the outside world, and even from members of their family. They do not work, and do not leave the limits of their room, except for an urgent need. They maintain contact with the world via the Internet, and can even work remotely, but they exclude communication and meetings in real life. It is not uncommon for hikikomori to suffer from autism spectrum disorder, social phobia, and anxiety disorder. In countries with an underdeveloped economy, hikikomori is practically not found.

Phobia

A phobia in psychiatry is fear, or excessive anxiety. As a rule, phobias are classified as mental disorders that do not require clinical research and psychocorrection will do better. The exception is already rooted phobias that get out of control of a person, disrupting his normal life.

Schizoid personality disorder

Diagnosis - schizoid personality disorder is based on the signs characteristic of this disorder.
In schizoid personality disorder, the individual is characterized by emotional coldness, indifference, unwillingness to socialize, and a tendency to retire.
Such people prefer to contemplate their inner world and do not share their experiences with loved ones, and are also indifferent to their appearance and how society reacts to it.

Schizophrenia

On the question: is it a congenital or acquired disease, there is no consensus. Presumably, for the appearance of schizophrenia, several factors must come together, such as genetic predisposition, living conditions, and socio-psychological environment. It is impossible to say that schizophrenia is an exclusively hereditary disease.

selective mutism

Selective mutism in children aged 3-9 years is manifested in selective verbality. As a rule, at this age, children go to kindergarten, school and find themselves in new conditions for themselves. Shy children experience difficulties in socialization, and this is reflected in their speech and behavior. At home they may talk incessantly, but at school they won't utter a single sound. Selective mutism is classified as a behavioral disorder, and psychotherapy is indicated.

Encoprese

Sometimes parents ask the question: "Encopresis - what is it, and is it a mental disorder?" With encopresis, the child cannot control his feces. He can "go big" in his pants, and not even understand what's wrong. If such a phenomenon is observed more than once a month, and lasts at least six months, the child needs a comprehensive examination, including a psychiatrist. During potty training, parents expect the child to get used to it the first time, and scold the child when he forgets about it. Then the child has a fear of both the potty and defecation, which can be expressed in encopresis on the part of the psyche, and a host of diseases of the gastrointestinal tract.

Enuresis

As a rule, it disappears by the age of five, and special treatment is not required here. It is only necessary to observe the regime of the day, do not drink a lot of liquid at night, and be sure to empty the bladder before going to bed. Enuresis can also be caused by neurosis against the background of stressful situations, and psychotraumatic factors for the child should be excluded.

Of great concern is enuresis in adolescents and adults. Sometimes in such cases there is an anomaly in the development of the bladder, and, alas, there is no treatment for this, except for the use of an enuretic alarm clock.

Often, mental disorders are perceived as a person’s character and they blame him for what, in fact, he is not guilty. The inability to live in society, the inability to adapt to everyone is condemned, and the person, it turns out, is alone with his misfortune. The list of the most common ailments does not cover even a hundredth of mental disorders, and in each case, symptoms and behavior may vary. If you are concerned about the condition of a loved one, do not let the situation take its course. If the problem interferes with life, then it must be solved together with a specialist.

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