Vascular psychosis symptoms. Special forms of psychoses of late age. vascular disorders. Treatment at the Echinacea Clinic

Differential diagnosis of vascular psychoses

Stages and types of vascular mental disorders

Principles of therapy, prevention and social and labor rehabilitation of patients

In a number of countries, including Russia, there is an increase in the number of patients suffering. They are sometimes referred to in the medical literature as the "disease of the age".

Vascular psychoses are a consequence of impaired functioning of the vessels of the brain and the vascular system as a whole. What are the causes, symptoms and treatment options for the disease?

Plasmin-induced proteolysis and the role of aprobain analogues, lysine and synthetic lysine. Reducing the risk of cardiovascular disease with the use of nutritional supplements. Cardiovascular diseases are among the most common diseases today. They can cause death or disability. In particular, these diseases are well developed countries, due to the stress and unhealthy lifestyle of their inhabitants. That is why some diseases, such as hypertension, are called diseases of civilization.

Diseases of the heart and circulatory system can have many different causes called risk factors. This includes high blood pressure, smoking, overweight and obesity, diabetes, and high blood fat levels. It also depends on the sedentary lifestyle, age and genetics. It is also known that diseases often affect men. If there is a person with many factors at the same time, he has a high risk of developing cardiovascular disease and heart disease. The most common cardiovascular disease is atherosclerosis, heart attack heart disease, the disease occurs when external stimuli are too strong, or act too long, reducing the body's adaptability.

The primary characteristic of the disease

Vascular psychosis can develop in several forms:

1. acute form. It is characterized by a state of "confusion" of consciousness. The psychotic state occurs intermittently and lasts for several hours. Most often, the attack occurs at night, and during the daytime the patient has a clear mind.
2. Subacute forms a. A complicated variety in which the psychosis lasts longer. It may be accompanied, and may, with a clear consciousness of the patient, be characterized by intermediate syndromes. This form is characterized by disorders that are complicated by the so-called delusions of "small scale" and verbal hallucinatory experiences.

From the point of view of the origin of mental abnormalities caused by vascular dysfunction, there are:

Continue vocabulary of biological coronary artery, heart failure, heart block and inflammation, cardiac arrhythmias, and high or low blood pressure. Varicose veins of the legs, aneurysms, myocardial disease or congenital heart disease, pericarditis, phlebitis, pulmonary embolism, angina pectoris may also occur. The list of diseases is very long, and most of them are dangerous to the health and even life of the patient.

The heart to function smoothly, it requires a proper supply of oxygen and nutrients. It cannot use the blood that flows through the atrium chamber, but there is a special network of blood vessels that are wrapped around the heart. They are called coronary arteries because of the shape of the crown that surrounds the myocardium. Ischemic heart disease called coronary heart failure occurs when the heart's need is not met. This is usually due to a decrease in the light of one of the arteries due to atherosclerosis.

• syndromes at the stage of inception, in a pseudoneurotic form, - such disorders usually appear if vascular disease is at the initial stage of development;
• : neurological-psychiatric disorder associated with a certain stage in the development of vascular disease;
• other syndromes caused by external factors(exogenous):, and others.

Causes and mechanisms of the disorder

The main reason for the development of this form of psychosis are diseases associated with a violation in the work of the vascular system of the human body.

Initially, the disease may not have any symptoms. Later, along with the procedure to reduce the cross section of the artery, there is pain in the region of the heart. This is the so-called angina pectoris, behind the bridge, and there are even several times a day. They usually last for a few minutes or longer and the medication or pain will stop at rest. Sometimes accompanied by a feeling of suffocation and weakness. This can lead to infarction or infarction fragment necrosis if there is a sudden occlusion of the artery and the heart The heart is a muscular organ whose work allows blood circulation.

Among the diseases that most often provoke psychosis of vascular origin, they call:

• hypertension;
• thromboangiitis;
• endarteritis.

What leads to mental disorders in the case of these deviations and diseases? What is the sequence of processes that determine the mechanisms of the appearance and course of the disease? To date, there is no exact answer to this question. It is not clear why only certain vascular diseases and brain damage lead to mental disorders.

S. acts as a supply pump, moving the blood vessels. More biological vocabulary does not receive blood. Therefore, if the pain lasts longer and the urgent need to take medication and go to the doctor. A particularly high risk of coronary heart disease affects people who smoke, have high blood pressure, already have diabetes, and have a lot of fat in their blood. In Poland, it was a heart attack and coronary heart disease are the cause of many deaths. About a hundred thousand people, mostly men, are affected every year, and almost half of them die within a year.

We can only talk about the following causal relationships:

1. Sharp jumps in blood pressure can lead to changes in the structures of the brain, which leads to the appearance of acute or subacute psychosis. Its main features are confused consciousness and.
2. The progress of psychotic abnormalities of vascular origin is influenced by individual characteristics of the organism, which have developed on the basis of hereditary and acquired properties, as well as general somatic factors.
3. The acute form of the disorder may occur due to lowering blood pressure at night which, in turn, provokes a shortage of blood supply to the brain. The development of deviation contributes to atherosclerotic lesions of the vessels of the heart, various infectious diseases.
4. A mental disorder often occurs during a sharp period, so vascular psychosis is not uncommon after.

Atherosclerosis usually occurs as a result of their aging and often does not cause any symptoms until it begins to produce effects in the organs of the body. Atherosclerosis most often develops in men over forty. The arteries of healthy people are flexible and have strong muscle. Depending on blood pressure, narrowing or dilation of blood vessels occurs. If there is still high blood pressure and cholesterol levels above normal, and the walls of the arteries are damaged, fat can be deposited in these areas. Then the arterial wall stiffens and blood circulation is difficult.

Features of the clinical picture

In this type of disorder, non-psychotic symptoms intertwined with disorders of an organic nature are combined with symptoms of a psychopathological type. The latter have vaguely expressed features of the neurological appearance.

Symptoms due to which it is possible to diagnose vascular psychosis at the initial stage of development:

The process deepens until, finally, a situation arises when the body does not have enough blood. This is already a disease of atherosclerosis, which can lead to heart attack and coronary artery disease. If a person wears a sedentary lifestyle, the blood supply to the body is not the best. When it comes to high cholesterol, cigarette smoking, diabetes, hypertension and kidney failure - atherosclerosis disease is high. Therefore, it is recommended to give up smoking and an active lifestyle.

High blood pressure cannot cause discomfort. Sometimes it is necessary to examine the pressure so that in the event of an anomaly, treatment can be initiated, because the consequences can be dangerous. The risk of developing hypertension increases with various diseases, such as kidney, gland or heart, but also high blood pressure can be caused by medications. In the vast majority of people, it is difficult to tell the exact cause of high blood pressure. Factors that increase the risk of the disease include smoking, being overweight, eating too much salt, drinking too much, and not being physically active.

Symptoms characteristic of mental disorders occur much later and are manifested by delirium, hallucinations, and a schizophrenic picture.

Diagnosis of the disease

At an early stage, when there are symptoms of a neurotic nature, vascular psychosis is diagnosed based on signs of hypertension, arteriosclerotic stigmas, and slight transformations in the fundus.

More Biological Dictionary and high noise levels in the immediate vicinity. Long-term high blood pressure can lead to stroke, heart and kidney disease, and damage to the eyes and blood vessels. To prevent this, take your blood pressure off. They can help reduce the amount of salt intake, active lifestyle - sports and take care of peaceful sleep.

Low blood pressure also cannot give you symptoms, and until they occur, you cannot speak of an illness. If you become ill, low blood pressure should be treated. They can be weak, especially with a change in body position, dizziness, heart rhythm disturbances. Since the cause of too low pressure is considered a mental problem - exhaustion. Also exposing the body to heat, loss of large amounts of blood and fluids, heart disease and vascular disease. It also happens that low blood pressure is the result of infectious diseases or drugs, as well as neurological diseases and long-term diseases that require lying.

More difficult to diagnose. It is not easy to distinguish from. Characteristic features of dementia are random deviations and flickering of the main signs in vascular disorders.

With dementia associated with age, the symptoms will only increase and no periods of stabilization can be expected. In addition, the onset of vascular psychosis is more acute and may be accompanied by increased confusion.

Low blood pressure is less dangerous, except for symptoms that reduce the comfort of your life. To prevent this disease, you must sleep, do not take a very hot bath, lead an active life and do not start the day very intensely. Varicose veins are uneven extracorporeal veins that sometimes appear on the skin. These visible swellings, usually in the lower extremities, are the main symptoms of varicose veins. Sometimes these are painful changes. Veins have valves Broken flat or pocket structures occurring in the heart, blood vessels, and lymphatics.

Treatment options

Treatment is best started with therapy for the underlying vascular disease that caused the psychosis.

Be sure to be prescribed psychotropic drugs. Their choice is determined by the type of mental disorder. At the first stage of treatment, they are prescribed:, Rudotel and others. Of the usually prescribed Propazine (norm of this drug varies 25-75 mg / day), Rispolept in the form of drops.

Read more The biological dictionary and their abnormal work can cause Blood of the blood. Symbol of sacrifice, purification, martyrdom, initiation, family, kinship. More The dictionary of literary symbols does not flow properly, and the vessels are stretched and shaped like hoses. Causes of varicose veins include genetic factors as well as being inactive during a massive body and being overweight. This condition is mainly associated with those who work at the booth. Preventing varicose veins comes down to a diet rich in fiber, maintaining a normal weight, and leading an active life.

If the patient has it, then atypical ones are prescribed, such as Remeron, and others.

Treatment is not limited to the use of specialized tools. The patient should take vitamins, restorative drugs, drugs designed to affect the higher mental functions of the brain (,).

The patient will have to give up smoking, alcohol, avoid overwork and emotional outbursts.

It is also recommended to avoid long stays and raise your legs as often as possible. Aneurysms are the arteries of the arteries at the site of injury. With age, the risk of developing the disease and the most common cause of aneurysm is atherosclerosis and hypertension. What diseases will cause depends on the location of the aneurysm. In the case of cerebral aneurysms, headaches are observed. Often, patients also complain of a persistent cough and chest pain, similar to the symptoms of a myocardial infarction. There is also arterial thrombosis.

The cause of the disease is the weakness of the arterial muscles, which may be congenital or due to inflammation, as well as damage to the walls as a result of atherosclerosis. Prevention of aneurysm is limited to maintaining normal blood pressure and preventing atherosclerosis.

There is no cure for vascular psychosis or dementia. A person has no chance to recover completely, but you can try to raise the standard of living to the highest possible level.

Preventive measures

Prevention of mental disorders associated with impaired functioning of the vascular system will contribute to:

• timely diagnosed vascular disease;
• the establishment of a constant and orderly regime of the day;
• prevention of excessive loads;
• quitting smoking, alcohol and other bad habits;
• proper, balanced, dietary nutrition;
• abandoning a sedentary lifestyle;
• physiotherapy exercises;
• constant monitoring of blood pressure and taking measures to normalize it, even with minor deviations from the norm.

The disorder never goes away without a trace. Modern medicine is not able to completely cure it, you can only take drugs that improve the blood supply to the brain, drugs that help strengthen memory, but in any case, you won’t be able to completely get rid of all the symptoms. At one time or another they will reappear.

Angina pectoris usually presents as a feeling of constriction in the chest, accompanied by pain and shortness of breath. The pain may radiate to the neck, jaw or arm, as well as the back. These are severe and dull pains that most often occur during intense exercise and last for several minutes, and after rest they resolve spontaneously. Angina is caused by narrowed arteries that supply blood to the heart muscle. Therefore, when the heart draws more blood during exercise, it does not receive the right amount of oxygen and nutrients.

Vascular diseases are divided into groups.

inflammatory processes.

This group includes primary (systemic allergic) and secondary vasculitis. This category also includes such vascular diseases as aortitis, thrombophlebitis and phlebitis.

Atherosclerosis.

Embolism, thrombosis and thromboembolism are mostly "therapeutic" and "surgical" pathologies.

Smoking and being overweight increase the risk of the disease. Diabetic and hypertensive patients are also at risk. Angioedema affects high levels of cholesterol and uric acid in the blood and a less active lifestyle. You cannot prevent angina. With the help of appropriate medicines and arterial surgery, patients can enjoy life without suffering for many years. To reduce the symptoms of the disease, you should stop smoking, take care of normal weight, normal blood cholesterol levels.

Also, vascular diseases include various types of ischemia (including extremities), diabetic macroangiopathy, pregangrene, and others.

According to classical anatomy, a superficial and deep vein system is distinguished. Communication between them is carried out by means of thin-walled vessels (perforating veins). Their defeat affects the formation. The main feature of this vascular apparatus is the presence of a valve system that provides unidirectional blood flow.

You should also live an active life, avoid stress and fatigue, temperature changes, and eat a lightly digestible diet. A heart attack causes pain like angina pectoris. It is difficult to take a breath, to feel a dull pain emanating from the heart to the neck. lower jaw of the back or arm. There is also the fear of death, compresses the chest, cold sweat heals, and the pulse suddenly increases. It also happens that the symptoms are relieved by vomiting that is not accompanied by pain. Symptoms of pain, however, do not disappear, as in sore throats, after a few minutes, after taking medication or resting.

Recently, much attention has been paid to venous pathology. In particular, great importance is attached to its genetic character. Moreover, in many cases, it is not the vascular diseases themselves that are inherited, but only hereditary anomalies in the structure of the walls of the vessels. In this case, congenital inferiority can manifest itself in insufficient equipment with valves or in the form of their anatomical underdevelopment. Provoking factors for the formation of these pathological changes are hormonal disorders, physical overload.

The causes of a heart attack are improper delivery of oxygen to the heart muscle and nutrients or a blood clot. In Poland, about 300,000 people die every year, mostly men. A higher risk of heart attack affects people who smoke, have high blood pressure, diabetes, and high fat levels. To prevent a heart attack, take care of the right weight, stop smoking and lead an active lifestyle. You must treat hypertension and lower blood cholesterol levels, as well as avoid stress and tension, temperature changes.

The most common manifestations of pathologies include:

Quickly there is a feeling of fatigue in the limbs after exercise;

feeling of numbness or tingling;

Constant swelling of the legs;

Non-healing for a long period

As a result of disorders of the capillary function, pathologies of the veins also develop. Due to the pressure in them, the walls of small vessels change. The capillaries become bulging and swollen. Thus, a vascular network is formed on the legs.

There are many reasons for the development of such a pathological condition. Experts call excessive load on the legs as the main provoking factor.

In addition, diseases of the liver and intestines, and a violation of blood circulation lead to a breakdown in capillary function. During pregnancy, it is very important to monitor your weight, otherwise excess weight can also cause the development of pathology.

Quite a lot of people create this problem for themselves by abusing alcohol, smoking, exposure to the sun, taking hormonal drugs.

It should be noted that the appearance of the vascular network is characteristic not only for the lower extremities. As a result, rosacea may develop. Vascular network on the face occurs in people with increased skin sensitivity. It is they who are more susceptible to temperature fluctuations, as well as the adverse effects of individual cosmetic preparations.

The first symptoms of rosacea are regularly occurring burning and itching. Later, irritation develops, usually in the forehead, nose, or chin. As the disease progresses, the symptoms become more pronounced and occur more frequently. In the next phase of the disease, intense redness develops on the skin and the formation

If early signs of vascular disease occur, in order to prevent undesirable consequences, it is necessary to consult a specialist.

Psychopathological manifestations in the form of acute psychoses can occur at any stage of the vascular process, even in a state of dementia. F. Stern (1930) described "arteriosclerotic states of confusion". Such psychoses are characterized by a number of common clinical features. First of all, the syndromes of stupefaction arising in the structure of these psychoses as reactions of an exogenous type are distinguished by atypicality, the lack of expression of all their components, and syndromal incompleteness. The manifestations of acute vascular psychoses do not always correspond to the most typical pictures of delirium, and others, which makes it possible to reasonably qualify them as states of "confusion" (M. Bleiler, 1966). Another property of vascular psychoses can be considered that acute psychotic episodes are quite often short-term, occur episodically, last no more than a few hours. As a rule, such an episode unfolds at night, and during the day, patients can be in a clear mind, without psychotic disorders. A common property of vascular psychoses is also their recurrence, sometimes repeated. First of all, this applies to the nocturnal states of confusion. The course of acute vascular psychoses differs from the course of another etiology, such as alcoholic delirium, acute traumatic psychosis. So, in the dynamics of delirium tremens, an increase in the severity of the disease is most often expressed by a deepening of the delirious syndrome itself (the transition of “professional delirium” into mushing), and in acute vascular psychoses, various syndromes of altered consciousness can replace each other (after the delirious syndrome, amental, etc. .).

In the subacute course of vascular psychoses with a more protracted course, in addition to the syndromes of clouding of consciousness, there may occur not accompanied by a disorder of consciousness, but also reversible syndromes, which X. Wick called "transitional" or "intermediate". Compared with symptomatic psychoses, such protracted and more complex forms of the course of vascular psychoses are much more common. E.Ya. Sternberg emphasizes that with vascular psychoses, almost all types of intermediate syndromes can occur, preceding the syndromes of clouded consciousness: neurotic, affective (asthenic, depressive, anxiety-depressive), hallucinatory-delusional (schizoform), as well as organic circle syndromes (adynamic, apathetic abulic, euphoric, expansive-confabulatory, amnestic, Korsakov-like).

Depressive conditions occur, taking into account different data, in 5 - 20% of all cases. At the same time, along with the phenomena of melancholy, grouchiness, pronounced tearfulness, hypochondria (“tearful depression”, “aching depression”) are almost constantly observed. With each new recurring episode of depression, an organic defect with the formation of dementia becomes more and more obvious. Depressive episodes are just as often accompanied by anxiety, unaccountable fear, they often precede acute cerebrovascular accident.

Paranoid (schizoform) psychoses are characterized by acute sensual delusions with ideas of relationship, persecution, poisoning, exposure. Such psychoses are usually short-term and usually occur in the initial stages of cerebral atherosclerosis with signs of arterial hypertension. For the later stages of cerebral atherosclerosis, acute hallucinatory-paranoid states are characteristic. Hallucinations in such cases are of a stage nature, visual deceptions often occur (and, and).

The most difficult to recognize are protracted endoform psychoses of vascular origin. In addition to the constitutional genetic predisposition, an important role in the development of protracted vascular psychoses is played by special properties of the organic process. As a rule, protracted endoform psychoses develop in vascular processes that manifest quite late (at the age of 60-70 years), proceeding with slow progression and without gross focal disorders. Such patients with a picture of delusional psychosis are not characterized by the usual initial asthenic manifestations of the vascular process, the sharpening of personality traits is more common.

Clinically, the most substantiated is the allocation of protracted flax psychoses in men, mainly in the form of delusions of jealousy. It is characterized by a small development of the topic, poorly systematized. At the same time, the predominance of sexual details with a large exposure of this plot can be considered a distinctive feature. Typical themes in the descriptions of patients are cheating wife with young people, young family members of the patient himself, including his son, son-in-law. The delusions of jealousy are usually combined with ideas of damage (the wife feeds rival lovers better, gives them the patient's favorite things, etc.). The mood is tearfully depressed with outbursts of irritability, malice and aggressiveness. Such organic stigmatization is more pronounced with deep psycho-organic changes.

The definition of vascular psychoses includes psychoses, which are based on vascular diseases of the brain (hypertension, thrombosis, and others). These psychoses have an acute and subacute form, occurring with the presence of a transitional syndrome and clouded consciousness, as well as chronic manifestations of psychoses of an affective or hallucinatory-paranoid type.

Mental disorders, in the formation of which pathologies of the vascular system are involved, cause a variety of symptoms, which is explained by different diseases.

It is impossible to say exactly how these psychoses have spread.

The reflection of clinical diversity and the possible difference in mental disorders, taking into account their origin, is presented in the following classification of mental disorders, which are based on vascular disorders: syndromes in the initial, neurosis-like, pseudo-neurosthenic form; various types of vascular dementia; exogenous, delusional, affective, hallucinatory and other types of syndromes.

The special isolation of the syndrome in its initial form with vascular genesis is justified by the frequency of its occurrence, as well as by the fact that in most cases the presence of vascular pathology, this particular syndrome, may be the only manifestation of the clinical picture of the disease for its entire period. Under such circumstances, the progress of the disease is not observed, but rather stabilizes precisely at this stage of manifestation.

Signs and symptoms of vascular psychosis

Vascular psychoses in their initial manifestations are recorded as a syndrome in a pseudo-neurasthenic form. By this is meant a non-psychotic type of symptoms with certain inclusions of pathologies of an organic nature. Against this background, the symptoms of a psychopathological type are closely intertwined with mild stigmas of a neurological type. The patient complains of the presence of noise or ringing in the ears, the onset of which occurs suddenly and disappears just as quickly. in the occipital region like constriction and comes on in the morning.

A characteristic symptom is a feeling of numbness in the cheeks, chin, nose and twitching of the facial muscles. Psychosis takes place against the background of a disturbed sleep pattern, the duration of which decreases to 3 hours without the possibility of falling asleep again and is superficial. The patient acquires sensitivity to any stimulus and may experience episodic dizziness, balance failures while walking. He has an instability of the emotional plan, forgetfulness, excessive tearfulness, instability of attention, and rapid fatigue.

The patient is aware of his pain and his negative changes. They are expressed in slow motor skills of reactions and speech, a tendency to reasonable edification, difficulty in remembering new events and information, and a violation in the exact dating of what is happening. There is constant instability of the emotional sphere and incontinence of affect (capriciousness, tearfulness, anxious fears about health, relatives). Perhaps the development of hypochondria.

Reactive states and neurotic-like disorders have the ability to develop when transient somatic disorders occur. At the same time, reactions of a depressive type, symptoms of hypochondria, fear of imminent death, helplessness and dependence are constantly present. Such symptoms of the initial stage in vascular pathologies make it possible for the manifestation of personality changes with manifestations of a psychopathic type, a certain rigidity in the psyche. There is a subordination of psychopathization to the age factor.

Differential Diagnosis

The initial period of the process of vascular pathology has signs that resemble neurasthenic and neuropathic diseases. When diagnosing, the doctor relies on the somatics of arteriosclerotic sigmas or the symptoms of hypertension (reveals changes in the fundus, determines scattered microsymptoms of the neurological type).

The greatest difficulty is the delimitation of senile dementia from vascular dementia. In this variant, the flickering of symptomatic signs of vascular processes with periods of recovery, alternating with sharp changes in mental functions, is considered to be a distinctive feature, and senile dementia is constantly progressing without visible periods of stabilization. Also, vascular disorders have an acute manifestation at the onset of the disease with the presence of a nocturnal increase in undulation of consciousness.

Treatment of vascular psychosis

The basis of therapeutic measures in the treatment of vascular psychosis is to eliminate the underlying disease of a somatic nature. The doctor prescribes psychotropic medications depending on the prevalence of certain mental disorders. At the beginning of treatment, sedative tranquilizers are used (atarax, rudotel, and others).

In small doses, it is possible to prescribe antipsychotics (rispolept, propazin, haloperidol). Anxiety-depressive disorders require the use of atypical antidepressants to avoid confusion with amitriptyline.

Expert editor: Mochalov Pavel Alexandrovich| MD general practitioner

Education: Moscow Medical Institute. I. M. Sechenov, specialty - "Medicine" in 1991, in 1993 "Occupational diseases", in 1996 "Therapy".

These psychoses have an acute and subacute form, occurring with the presence of a transitional syndrome and clouded consciousness, as well as chronic manifestations of psychoses of an affective or hallucinatory-paranoid type.

Mental disorders, in the formation of which pathologies of the vascular system are involved, cause a variety of symptoms, which is explained by different diseases.

It is impossible to say exactly how these psychoses have spread.

The reflection of clinical diversity and the possible difference in mental disorders, taking into account their origin, is presented in the following classification of mental disorders, which are based on vascular disorders: syndromes in the initial, neurosis-like, pseudo-neurosthenic form; various types of vascular dementia; exogenous, delusional, affective, hallucinatory and other types of syndromes.

The special isolation of the syndrome in its initial form with vascular genesis is justified by the frequency of its occurrence, as well as by the fact that in most cases the presence of vascular pathology, this particular syndrome, may be the only manifestation of the clinical picture of the disease for its entire period. Under such circumstances, the progress of the disease is not observed, but rather stabilizes precisely at this stage of manifestation.

Signs and symptoms of vascular psychosis

Vascular psychoses in their initial manifestations are recorded as a syndrome in a pseudo-neurasthenic form. By this is meant a non-psychotic type of symptoms with certain inclusions of pathologies of an organic nature. Against this background, the symptoms of a psychopathological type are closely intertwined with mild stigmas of a neurological type. The patient complains of the presence of noise or ringing in the ears, the onset of which occurs suddenly and disappears just as quickly. The headache in the occipital region is like a constriction and comes on in the morning.

A characteristic symptom is a feeling of numbness in the cheeks, chin, nose and twitching of the facial muscles. Psychosis takes place against the background of a disturbed sleep pattern, the duration of which decreases to 3 hours without the possibility of falling asleep again and is superficial. The patient acquires sensitivity to any stimulus and may experience episodic dizziness, balance failures while walking. He has an instability of the emotional plan, forgetfulness, excessive tearfulness, instability of attention, and rapid fatigue.

The patient is aware of his pain and his negative changes. They are expressed in slow motor skills of reactions and speech, a tendency to reasonable edification, difficulty in remembering new events and information, and a violation in the exact dating of what is happening. There is constant instability of the emotional sphere and incontinence of affect (capriciousness, tearfulness, anxious fears about health, relatives). Perhaps the development of hypochondria.

Reactive states and neurotic-like disorders have the ability to develop when transient somatic disorders occur. At the same time, reactions of a depressive type, symptoms of hypochondria, fear of imminent death, helplessness and dependence are constantly present. Such symptoms of the initial stage in vascular pathologies make it possible for the manifestation of personality changes with manifestations of a psychopathic type, a certain rigidity in the psyche. There is a subordination of psychopathization to the age factor.

Found a mistake in the text? Select it and a few more words, press Ctrl + Enter

Differential Diagnosis

The initial period of the process of vascular pathology has signs that resemble neurasthenic and neuropathic diseases. When diagnosing, the doctor relies on the somatics of arteriosclerotic sigmas or the symptoms of hypertension (reveals changes in the fundus, determines scattered microsymptoms of the neurological type).

The greatest difficulty is the delimitation of senile dementia from vascular dementia. In this variant, the flickering of symptomatic signs of vascular processes with periods of recovery, alternating with sharp changes in mental functions, is considered to be a distinctive feature, and senile dementia is constantly progressing without visible periods of stabilization. Also, vascular disorders have an acute manifestation at the onset of the disease with the presence of a nocturnal increase in undulation of consciousness.

Treatment of vascular psychosis

The basis of therapeutic measures in the treatment of vascular psychosis is to eliminate the underlying disease of a somatic nature. The doctor prescribes psychotropic medications depending on the prevalence of certain mental disorders. At the beginning of treatment, sedative tranquilizers are used (atarax, rudotel, and others).

In small doses, it is possible to prescribe antipsychotics (rispolept, propazin, haloperidol). Anxiety-depressive disorders require the use of atypical antidepressants to avoid confusion with amitriptyline.

Psychosis is a pronounced form of disorders that have a mental type. The companions of psychosis are delusional states, sudden changes in mood, hallucinations, states of arousal, uncontrollable or depressive behavior, a violation of the thought process and a complete lack of the ability to critically assess one's condition.

This mental illness has hereditary-constitutional origins. It is transmitted genetically, but only to those who have the right qualities of an anatomical and physiological nature, that is, a suitable cyclothymic constitution. To date, a connection has been established between this disease and the disordered one.

Intoxication through alcohol is a pathological condition that occurs when ethanol acts on the central nervous system and is accompanied by depression of the central nervous system. Alcoholic psychosis is a mental disorder caused by chronic alcohol intoxication.

It is worth distinguishing between two concepts - signs and symptoms of the disease, since they will differ in the context of this mental disorder. Signs are understood as only 4 areas of brain activity that have disorders. They are also called.

Women's depression is not just a bad mood. Now it is fashionable to designate with this word any bouts of melancholy and apathy. In fact, depression refers to a disease, with varying degrees of severity and its own symptoms. In time for this state of man.

The information on the site is intended for familiarization and does not call for self-treatment, a doctor's consultation is required!

Vascular psychoses - Disorders of mental activity at a later age

Blood vessels occupy a somewhat special position in the human body. On the one hand, they are a direct part of a special cardiovascular system that provides blood supply to the body, on the other hand, they are so morphologically and functionally intimately connected with those important organs that they vascularize (heart, kidneys, brain) that they form a single whole with them. . The blood vessels of the brain are involved in the pathological process in various diseases - infectious, traumatic and others, but in such cases they do not talk about the actual vascular lesions of the brain. Actually vascular pathology (atherosclerosis, hypertension, thromboangiitis obliterans), affecting various internal organs, can secondarily affect brain activity and cause various mental disorders. In such cases, it is more correct to speak of somatogenic (or symptomatic), rather than vascular psychoses. The pathology of the cerebral vessels themselves and the disorders of cerebral circulation caused by it can be the direct cause of mental disorders, in such cases one should speak of vascular psychoses proper. Above, the expediency of distinguishing vascular psychoses both from the group of “psychoses of various genesis in old age” and from the group of “involutional psychoses” proper has already been substantiated. Vascular psychoses in their genesis and clinical manifestations occupy, as it were, an intermediate position between these two groups of mental disorders in people at a later age.

The main forms of cerebrovascular pathology most frequently encountered in clinical practice are atherosclerosis and hypertension. Although both of these forms have much in common both in genesis and in clinical manifestations, and in many clinical cases we meet with their combination, it is still necessary and possible, in our opinion, to distinguish between atherosclerotic and hypertensive disorders of mental activity. In view of the fact that we recently published a special monograph on the clinical features of mental disorders caused by hypertension, we will mainly touch on the issue of atherosclerotic psychoses and their combination with hypertensive psychoses and only to the extent necessary for a more complete understanding. psychiatric aspect of gerontology and geriatrics. A more detailed presentation of the clinic and pathogenesis of mental disorders in cerebral atherosclerosis, those interested in this problem can be found in the relevant chapters of well-known psychiatric manuals (German, edited by Bumke, article by Stern-1930; American, edited by Arrieti, article by Ferrara-1959), and also in recently published special monographs and thematic collections by V. M. Banshchikov (1967), Yu. E. Rakhalsky (1965), Quandt (1959) and others.

There are various groupings of mental disorders caused (mainly) by chronic cerebral atherosclerosis. Despite the differences between the individual groups, all authors distinguish the following three groups of mental disorders: 1) neurosis-like (pseudo-neurotic) states; 2) dementia states; and 3) psychotic states.

If the cerebral atherosclerotic process is complicated by a stroke, then various types of disturbed consciousness arise, after which certain local psychopathological phenomena (aphatic, agnostic, apractical) can be detected. With late "vascular epilepsy" there are twilight states of consciousness.

Atherosclerotic neurosis-like states and dementia are defined as “basic or universal” (Yu. E. Rakhalsky) or as “obligate” (Quandt) manifestations; psychotic states are considered as "individual", "optional", "accessory" forms of manifestation of the disease. One or another of the mentioned psychopathological syndromes and symptom complexes can occur in patients with cerebral atherosclerosis in combination or in succession at various stages of the pathological vascular process, characterizing its stage, pace, development and localization, on the one hand, individual biological and socio-psychological characteristics the patient - on the other.

Without dwelling on the description of the features of mental disorders caused by cerebral atherosclerosis, since they have been described many times and are well known to psychiatrists, we will pay attention to the differential diagnostic criteria for distinguishing between vascular, presenile and senile disorders of mental activity. This will allow a better understanding of both the "general" and "special" in these disorders of mental activity, characteristic of the involutionary segment of human ontogenesis.

It has already been mentioned above that in vascular and actually presenile and senile disorders of mental activity, both “functional”, reversible, “ademental” psychotic states (depressive, paranoid, hallucinatory) and progressive, slightly reversible states of dementia are observed. For these two groups, we will conduct differential diagnostics.

It is known that the initial period of many organic diseases of the brain is characterized by symptom complexes similar to neurotic ones, especially neurasthenia. However, in these cases we are not talking about true neurosis, but about pseudo-neurosis, pseudo-neurasthenia, a neurosis-like state. Essentially, in such cases, there is cerebral asthenia due to insufficiency of cerebral circulation. The clinical symptoms of these conditions are well known to all. Difficulties in distinguishing pseudo-neurotic states from true neuroses are exacerbated by the fact that the decompensation of neuropsychic activity that occurs in a patient with cerebral atherosclerosis is often due to life difficulties, conflict situations, psycho-traumatic circumstances (there is an impression of a reactive genesis of the disease), although these circumstances themselves are a difficult situation. largely due to vascular disease of the brain. To this it should be added that often pseudo-neurotic symptoms are complicated by secondary psychogenic reactions to their disease and the patient's life situation that has changed in connection with this. But, despite all this, a thorough analysis of all clinical symptoms and laboratory data, and in particular the dynamics of the process, allows us to correctly determine the nature of the disease and delimit the initial stage of an atherosclerotic disorder of mental activity from a true neurosis. At the same time, it should not be overlooked (as already shown above) that reactive neurotic states are often observed at a later age. The so-called "climacteric neurosis", as well as the early stages of some involutional (presenile) psychoses, should also be distinguished from both true neuroses and the "neurasthenic" stage of cerebral atherosclerosis. With "climacteric neurosis" and the early stages of involutional psychoses, we are talking mainly about "functional" (but not psychogenic) disorders of nervous activity, without pronounced symptoms of loss and without the transition of the process into an organic one, while in cerebral atherosclerosis there is a progressive debilitating process that at the initial stages of the disease manifests itself in the form of a pseudoneurotic picture. The difference in personal reactions in vascular and involutional psychoses has already been pointed out above.

Vascular psychosis as an acute complication in cerebrovascular diseases

In a number of countries, including Russia, there is an increase in the number of patients suffering from cerebrovascular diseases. They are sometimes referred to in the medical literature as the "disease of the age".

Vascular psychoses are a consequence of impaired functioning of the vessels of the brain and the vascular system as a whole. What are the causes, symptoms and treatment options for the disease?

The primary characteristic of the disease

Vascular include psychoses that have developed as a result of atherosclerosis, stroke, hypotension, hypertension, thrombosis or other diseases of the cerebral vessels.

Vascular psychosis can develop in several forms:

1. Sharp form. It is characterized by a state of "confusion" of consciousness. The psychotic state occurs intermittently and lasts for several hours. Most often, the attack occurs at night, and during the daytime the patient has a clear mind.
2. Subacute form. A complicated variety in which the psychosis lasts longer. It may be accompanied by a clouding of consciousness, or, with a clear consciousness of the patient, it may be characterized by intermediate syndromes. This form is characterized by disorders that are complicated by the so-called delusions of "small scale" and verbal hallucinatory experiences.

From the point of view of the origin of mental abnormalities caused by vascular dysfunction, there are:

• syndromes at the stage of origin, in a pseudo-neurotic form - such disorders usually appear if vascular disease is at the initial stage of development;
• vascular dementia: a neurological-psychiatric disorder associated with a certain stage in the development of vascular disease;
• other syndromes caused by external factors (exogenous): delusional disorders, hallucinations, and others.

Causes and mechanisms of the disorder

The main reason for the development of this form of psychosis are diseases associated with a violation in the work of the vascular system of the human body.

Among the diseases that most often provoke psychosis of vascular origin are:

What leads to mental disorders in the case of these deviations and diseases? What is the sequence of processes that determine the mechanisms of the appearance and course of the disease? To date, there is no exact answer to this question. It is not clear why only certain vascular diseases and brain damage lead to mental disorders.

We can only talk about the following causal relationships:

1. Sharp jumps in blood pressure can lead to changes in the structures of the brain, which leads to the appearance of acute or subacute psychosis. Its main features are confused consciousness and hallucinations.
2. The progress of psychotic deviations of vascular genesis is influenced by the individual characteristics of the organism, which have developed on the basis of hereditary and acquired properties, as well as general somatic factors.
3. The acute form of the disorder can occur due to a decrease in blood pressure at night, which, in turn, provokes a shortage of blood supply to the brain. The development of deviation contributes to atherosclerotic lesions of the vessels of the heart, various infectious diseases.
4. A mental disorder often occurs during a period of a sharp violation of the blood circulation of the brain, so vascular psychosis is not uncommon after a stroke.

Features of the clinical picture

In this type of disorder, non-psychotic symptoms intertwined with disorders of an organic nature are combined with symptoms of a psychopathological type. The latter have vaguely expressed features of the neurological appearance.

Symptoms due to which it is possible to diagnose vascular psychosis at the initial stage of development:

• sudden onset and then quickly disappearing tinnitus;
• pain in the back of the head may appear in the morning;
• numbness of the lower part of the face (cheeks, chin), arbitrary contraction of the muscles of the face;
• non-periodic dizziness, uncoordinated movements when walking;
• sleep disorder: the patient is able to sleep for only 3 hours, and when he wakes up, he cannot fall asleep again;
• unstable emotional background: a constant desire to cry, forgetfulness, fatigue, inattention;
• reaction and speech slow down;
• the appearance of hypochondria is not ruled out.

Symptoms characteristic of mental disorders occur much later and are manifested by delirium, hallucinations, and a schizophrenic picture.

Diagnosis of the disease

At an early stage, when there are symptoms of a neurotic nature, vascular psychosis is diagnosed based on signs of hypertension, arteriosclerotic stigmas, transformations in the fundus, and slightly pronounced neurotic abnormalities.

It is more difficult to diagnose vascular dementia. It is not easy to distinguish it from senile dementia. Characteristic features of dementia are random deviations and flickering of the main signs in vascular disorders.

With dementia associated with age, the symptoms will only increase and no periods of stabilization can be expected. In addition, the onset of vascular psychosis is more acute and may be accompanied by increased confusion.

Treatment options

Treatment is best started with therapy for the underlying vascular disease that caused the psychosis.

Be sure to be prescribed psychotropic drugs. Their choice is determined by the type of mental disorder. At the first stage of treatment, tranquilizers are prescribed: Atarax, Phenazepam, Rudotel and others. Of the antipsychotics, Propazine is usually prescribed (the rate of this drug varies in mg / day), Rispolept in the form of drops.

If the patient has an anxiety-depressive syndrome, then atypical antidepressants such as Remeron, Cipramil and others are prescribed.

Treatment is not limited to the use of specialized tools. The patient should take vitamins, restorative drugs, drugs designed to affect the higher mental functions of the brain (Mexidol, Piracetam).

The patient will have to give up smoking, alcohol, avoid overwork and emotional outbursts.

There is no cure for vascular psychosis or dementia. A person has no chance to recover completely, but you can try to raise the standard of living to the highest possible level.

Preventive measures

Prevention of mental disorders associated with impaired functioning of the vascular system will contribute to:

• timely diagnosed vascular disease;
• the establishment of a constant and orderly regime of the day;
• prevention of excessive loads;
• quitting smoking, alcohol and other bad habits;
• proper, balanced, dietary nutrition;
• abandoning a sedentary lifestyle;
• physiotherapy exercises;
• constant monitoring of blood pressure and taking measures to normalize it, even with minor deviations from the norm.

The disorder never goes away without a trace. Modern medicine is not able to completely cure it, you can only take drugs that improve the blood supply to the brain, drugs that help strengthen memory, but in any case, you won’t be able to completely get rid of all the symptoms. At one time or another they will reappear.

This section was created to take care of those who need a qualified specialist, without disturbing the usual rhythm of their own lives.

Special forms of psychoses of late age. Vascular disorders

Special forms of psychosis of late age

This is a polyetiological group of mental illnesses that develop in connection with endogenous-organic, exogenous, symptomatic and vascular determinants, similar in their manifestations to exogenous types of reactions. In modern taxonomy of mental disorders, they occupy a different place, in the ICD-10 they are coded under the headings G06.0–G06.9. There are acute psychoses and chronic hallucinoses.

Acute psychoses

The prevalence among mental illnesses of late age ranges from 4 to 20%. In typical cases, they are manifested by evening-night states of confused consciousness without a clear syndromic outline. Episodes of confusion can be repeated many times. There may also be delirious states, as well as hallucinosis, especially visual. Psychotic states sometimes acquire a chronic character. It happens that psychotic states are limited to pictures of amnestic disorientation and a temporary increase in nocturnal restlessness.

Not so rarely, the pictures of psychoses are similar to those in senile or vascular dementia: there are signs of nocturnal fussiness with “packing for the road”, with a shift in the situation into the past, with a special fussy businesslike activity. The age theme of delusional statements also draws attention (ideas of damage, robbery, ruin, impoverishment, domestic persecution). It is indicated that sometimes such factors as sensory deprivation (decreased visual acuity, hearing loss), psychogenic disorders (death of a loved one, retirement, etc.), as well as changes in the situation (moving, hospitalization, etc.) . In addition, cardiovascular diseases, respiratory tract infections, bone fractures and other somatogenies play a significant role.

In the treatment of acute psychoses, measures to improve the somatic condition are of primary importance; of psychotropic drugs, Seduxen is most often used intramuscularly or intravenously. Mild neuroleptics in small doses (chlorprothixene, teralen, etc.) can also be shown. Prognosis: in most cases, this is a way out of psychosis, in some cases, apparently, with a defect in the form of an increase in psychoorganic decline. In 27–50%, a lethal outcome is observed.

Chronic hallucinosis

Among mental disorders of late age, they occur with a frequency of 0.1-0.5% (Shakhmatov, 1976). Nosological affiliation is not defined. Manifested by syndromes of hallucinosis (verbal, visual, tactile, olfactory), transient and mixed hallucinosis and the so-called delusional hallucinosis.

1. Verbal hallucinosis. They can be a manifestation of vascular psychosis, schizophrenia, and are also associated with sensory deprivation. In the latter case, they are observed in the deaf and hard of hearing, which is why they are called hallucinosis of the Sh. Bonnet type. Described by E.A. Popov (1956). This psychosis is characterized by mono- or polyvocal true verbal hallucinations, usually unpleasant (scoldling, threats, etc.), rarely - imperative content, aggravated in the evening and at night. Hearing deceptions often seem to grow out of noise in the ears and head, during periods of an influx of hallucinations, anxiety arises, criticism of them is lost. Psychosis continues for years, organic dementia, however, does not occur.

2. Visual hallucinosis. They are manifested by chronic or undulating current visual hallucinosis of Sh. Bonnet. With the influx of hallucinations, criticism of them disappears, there may be behavioral disturbances. Consciousness is not disturbed. The content of "Lilliputian" optical illusions is associated with experiences that are relevant to patients. Sometimes hallucinations of a different modality join. In some cases, hallucinosis develops against the background of a pronounced psycho-organic decrease, probably of vascular origin.

3. Olfactory hallucinosis. Three variants of psychosis have been described. Olfactory hallucinosis Gabek (1965) occurs after 40 years on the background of organic cerebral pathology. Patients consider themselves a source of unpleasant odor, discover ideas of attitude; believe that those around them reject them, are depressed, sometimes make suicidal attempts. Some patients have senestopathies, some tactile deceptions. Shakhmatov's (1972) olfactory hallucinosis is characterized by true olfactory delusions as well as delusions of prejudice and small-scale persecution. Olfactory hallucinosis Sternberg (1977) is manifested by deceptions of smell that occur only in a certain environment (for example, in your room). Sometimes there are also unpleasant tactile and visceral sensations.

In the treatment of hallucinosis, mild antipsychotics (chlorprothixen, sonapax, etc.) are usually used, small doses of haloperidol and atypical antipsychotics (clozapine, risperidone, etc.) can be recommended. Forecast: cases of recovery are rare.

Mental disorders in the pathology of cerebral vessels

Arise as a result of disorders of cerebral circulation in diseases such as atherosclerosis, hypertension, intracranial aneurysms, vasculitis, amyloidosis of cerebral vessels. Significantly more frequent in the second half of life. They make up about a third of all cases of mental pathology in people over 60 years of age. There is no direct dependence of mental disorders on the nature and severity of vascular pathology. Other causes also take an active part in the development of mental disorders: heredity, constitution, somatic diseases, age-related changes in the brain, injuries, etc., and often endogenous mental illnesses. There are three groups of mental disorders of vascular origin: exogenous-organic, endoform and vascular dementia.

Exogenous organic mental disorders

Allocate transient or transient and persistent, chronic, progressive disorders.

1. Transient mental disorders. There are stunned consciousness, confusion, Korsakov's syndrome, euphoric-pseudo-paralytic and apatoabulic states.

Stunned consciousness (various degrees of stunning, stupor and coma) occurs in acute disorders of cerebral circulation (strokes, transient disorders of cerebral hemodynamics, hypertensive crises). The duration and severity of stupor reflect the depth of cerebral hemodynamic impairment.

Confusion is observed in 33–50% of cases of ischemic stroke, in 53–88% of hemorrhagic stroke, and in 27–33% of cases of transient cerebrovascular accident. It manifests itself in various pictures of clouding of consciousness with delirious, oneiric and amental phenomena, existing against the background of slight stupor. In this case, there may be apathy and lethargy, euphoria with complacency or fear and anxiety, as well as the phenomena of ecmnesia. Fluctuations in clouding of consciousness and increased confusion at night are typical. Psychosis can last up to several months. Sometimes states of confusion serve as the main clinical manifestation of cerebrovascular accident, if it is a microstroke or lacunar cerebral infarction. Confusion of consciousness can also occur for other reasons (infections, intoxications, etc.). In the ICD-10, it is encoded with the G5 cipher.

Korsakoff's syndrome in the form of fixation amnesia with confabulations with a high degree of probability indicates a disorder of the blood supply to the hippocampus, especially the right hemisphere, or thalamus. May be largely reversible. In the ICD-10, it is encoded with the code G04. The localization of damage is also indicated by violations of the body scheme and anosognosia.

Relatively rare are euphoric-pseudo-paralytic and apatoabolic states, indicating damage to the orbital and convexitate cortex of the frontal parts of the brain.

2. Persistent mental disorders. There are asthenic conditions and psychoorganic disorders.

Asthenic conditions are observed in the initial stages or after acute disorders of cerebral circulation. Characterized by mental and physical exhaustion, emotional lability with symptoms of weakness, attention deficit with signs of dysmnesia. In addition, sleep disturbances, neurotic formations (hypochondria, phobias, hysterical symptoms) are revealed. Common and complaints of headaches, dizziness, unsteady gait. For the diagnosis, it is important to exclude other causes of these disorders (subdepression, dysthymia, etc.). It should be emphasized that in the absence of a history of indications of acute or transient disorders of cerebral hemodynamics, the diagnosis of vascular cerebrovascular disease is largely hypothetical. According to ICD-10, it is encoded with the code G06.6.

Psychoorganic disorders are quite frequent and are the result of a smoothly progressing vascular pathology or acute disorders of the blood supply to the brain. They are characterized by a mild cognitive deficit (passivity of mental processes, dysmnesia, decreased attention) or personality changes (passivity, narrowing of the range of interests, complacency, irritability, a tendency to psychopathic behavior). Older people may show signs of "senile psychopathization" in the form of egocentrism, callousness, stinginess, suspicion, grouchiness. They can go into states of apparent dementia. The diagnosis is made in the presence of neurological signs of vascular pathology, indications of cerebral circulation disorders and CT or MRI data on vascular damage to the brain. In the ICD-10, it is encoded with the code G06.7 and G07.0, respectively.

Vascular dementia most often develops on the basis of atherosclerosis and hypertension due to destructive brain damage, most often heart attacks and diffuse ischemic destruction. It has been established that even single and small infarctions in such areas of the brain as the frontal, upper parietal, lower medial parts of the temporal lobe (including the hippocampus), as well as the thalamus, can lead to dementia.

Less commonly, dementia is associated with laminar necrosis (diffuse neuronal death and gliosis in the cerebral cortex and cerebellum), as well as gliosis or incomplete ischemic necrosis (including sclerosis of the hippocampus). It is second only to Alzheimer's disease in prevalence. Depending on the clinical structure, different types of vascular dementia are distinguished. Dysmnestic dementia (and this is 2/3 of all cases of vascular dementia) characterizes a moderate mnestic-intellectual decline with a slowdown in the pace of mental processes and mild amnestic aphasia.

Lability of clinical manifestations and preservation of critical function are typical. Amnestic dementia (this is 15% of all cases of vascular dementia) is characterized by a predominant decrease in memory for current events, orientation in time and place is disturbed. Confabulations are fragmentary. Patients are usually passive, the mood is mostly benevolent. Pseudo-paralytic dementia (this is 10% of all cases of vascular dementia) is manifested by complacency, a decrease in criticism with a relative preservation of memory. Asemic dementia is relatively rare. It is manifested by pronounced violations of the higher functions of the cortex, primarily aphasia. The mnestic-intellectual decline, aspontaneity and emotional dullness also gradually increase.

Depending on the pathogenesis, there are multi-infarct dementia, dementia with single infarcts, and Binswanger's encephalopathy with a predominantly white matter lesion of the subcortical region. The latter, as it turned out thanks to CT and MRI, is 1/3 of all cases of vascular dementia. It is manifested by various pictures of vascular dementia mentioned above, there may also be epileptic seizures.

Cerebral amyloid angiopathy is a rare primary amyloidosis of the brain, most often in people over 60 years of age. There are hemorrhagic type with multiple recurrent hemorrhages, demento-hemorrhagic type with atypical manifestations of dementia of the Alzheimer's type and dementia type with the gradual development of dementia, similar to Binswanger's encephalopathy, in which the white subcortical substance is also affected. Cerebral "autoimmune" vasculitis: these include panarteritis, systemic lupus erythematosus, "temporal" arteritis. In this case, an isolated brain lesion is possible, especially at the age of 50–80 years. Manifested in the form of confused consciousness and dementia of various types. Angiography is required for accurate diagnosis.

Spontaneous hemorrhages due to rupture of arterial saccular aneurysms. With parenchymal and subarachnoid hemorrhages, as well as as a result of spasm of large arteries and ischemic destruction, various types of dementia develop, excluding asemic. With mixed vascular-atrophic dementia, dementia develops as a result of a frequent combination of ischemic destruction of the brain and Alzheimer's disease. There are other variants of combinations of dementia, their frequency is from 5 to 15% of all cases of dementia. To diagnose vascular dementia, it is necessary to prove the fact of dementia, the presence of vascular damage to the brain and to identify a temporary relationship between them. The prognosis of vascular dementia is often life-threatening.

3. Endoform mental disorders are manifested by symptoms of schizophrenia, delusional psychosis, affective disorders. The significance of the vascular factor in this case is only partial, and often hypothetical. Endoform psychoses can develop in connection with a stroke, transient disorders of cerebral circulation, as well as against a background of psychoorganic disorder and vascular dementia.

Delusional psychoses, acute and subacute, develop immediately after a stroke and last up to several days. As a rule, in this case, elements of confused consciousness are observed: at times, patients do not orient themselves in place, time, situation, after the delirium has passed, its partial amnesia is revealed. This is usually a delusion of perception with fear, aggravated or provoked by a change of scenery to an unfamiliar one for the patient. Protracted and chronic delusional psychoses are usually represented by paranoid, poorly systematized delusions of jealousy, damage, robbery.

It occurs against the background of a psychoorganic disorder in individuals with paranoid and schizoid character traits. Sometimes the origins of delirium lie in post-stroke delirium. Rarely, in addition to delusional psychosis, visual hallucinosis with confabulations. More complex in structure delusional phenomena (with verbal true and pseudohallucinosis, delusions of influence, housing paranoids with olfactory or auditory hallucinosis) usually occur when a vascular lesion of the brain is combined with schizophrenia or delusional disorder. The vascular process plays in such cases the role of a provoking or pathoplastic factor.

Depression is very common in vascular patients. Often these are endogenous or psychogenic depressions, combined with vascular damage to the brain. Actually vascular depressions in the form of hypothymic conditions of varying severity occur either in the first three months after a stroke in the left hemisphere, or two years or more after a stroke in the right hemisphere. In this case, early depressions are accompanied by speech disorders, and in late depressions, cerebral atrophy is detected. Depression in terms of three months to two years is associated, apparently, with a high frequency of psychogenic factors. Patients with post-stroke depression have a higher mortality rate than patients without it.

other psychoses. There are cases of catatonic psychosis in patients with subarachnoid hemorrhage, as well as manic and bipolar affective disorders after a stroke in the right hemisphere.

For the prevention of mental disorders of vascular origin, it is important to control such risk factors as arterial hypertension, coronary heart disease, diabetes mellitus, hyperlipidemia, etc. For secondary prevention, it is advisable to keep systolic blood pressure within 135–150 mm Hg. Art. Regular intake of aspirin at a dose of 325 mg per day for two years after a stroke is also beneficial. With mild and moderate dementia, nootropics (nootropil, encephabol, akatinol, amyridine, cerebrolysin) are indicated in large doses for 4-6 months. In the treatment of patients with confused consciousness, a thorough examination and control of the somatic condition is necessary. In the presence of delirium, hallucinations, agitation, sleep disturbances, mild antipsychotics (dipyridone, sonapax, gemineurin), haloperidol in drops up to 3 mg, leponex 12.5 mg each, and with persistent psychomotor agitation - finlepsin up to 200-400 mg. With severe fear, a single administration of tranquilizers is allowed. In acute delusional psychosis, haloperidol is prescribed, and with intense fear and arousal, chlorpromazine or tizercin is added to it. With depression, the appointment of mianserin, sertralen, citalopram is preferable. Patients with confused consciousness and delusional psychoses need inpatient treatment in the psychosomatic or geriatric psychiatric departments of the hospital.