A characteristic sign of manic-depressive illness is. Manic-depressive psychosis: causes

Manic depressive psychosis(bipolar affective disorder) is a mental illness manifested by manic and depressive episodes. Treatment of manic-depressive psychosis depends on the phase of the disease (depressive or manic).

Some drugs are used to eliminate existing symptoms (for example, antidepressants, antipsychotics). Other drugs (normalizers) are prescribed to normalize the condition, reduce mood swings and other symptoms of the disease.

Treatment of the depressive phase

Antidepressants are used to treat depressive attacks of manic-depressive psychosis. The choice of drug depends on the severity of signs of depression, as well as the presence of additional symptoms.

Antidepressants – special group drugs, these are not antibiotics or viral agents, to obtain the desired effect, you need to take them for a long time and regularly. As a rule, the duration of taking such drugs is several months. Only the doctor decides which antidepressant, in what dose and for how long it should be taken.

When accompanied by severe melancholy, tricyclic antidepressants (amitriptyline, imipramine) are prescribed.

For treatment, tricyclic antidepressants are used or in combination with antipsychotics that have an anti-anxiety effect (tisercin, chlorprothixene).

Tricyclic antidepressants, despite their pronounced effect, have many side effects, so for milder types of depression it is better to choose antidepressants from other groups that are safer and less toxic (paroxetine, sertraline, fluvoxamine, moclobemide).

At the beginning of therapy, the doses of antidepressants are higher, and after the patient’s condition improves, they switch to maintenance therapy - reduce the dose of the drug. Under no circumstances should you suddenly stop taking the drug, as this may lead to a return of symptoms of depression.

If drug treatment for depression is ineffective, electroconvulsive therapy may be used. It can be prescribed to patients with severe depression, combined with refusal to eat and rapid loss of body weight against this background, falling into a stuporous state, as well as in the presence of persistent suicidal thoughts and tendencies.

Therapy for the manic phase

To treat manic states, a combination of antipsychotics with lithium salts (lithium carbonate, lithium hydroxybutyrate) is used. The effect of using lithium salts occurs after 7-10 days, therefore, to achieve a faster effect, treatment begins with antipsychotics, gradually adding lithium preparations.

For severe symptoms of mania, accompanied by agitation, the antipsychotic chlorpromazine is used, and subsequently switched to haloperidol and clozapine.

Use of mood stabilizers

IN Lately For the treatment of both depressive and manic manifestations of manic-depressive psychosis, mood stabilizers - drugs that stabilize mood - began to be used. This group of drugs includes carbamazepine, lamotrigine, convulex, finlepsin. They can be used in combination with antidepressants.

Moreover, long-term use of mood stabilizers significantly reduces the frequency of attacks of depression and mania in patients with manic-depressive psychosis, and even if such attacks occur, they are much milder, the symptoms of the disease are less pronounced. That is why, to prevent exacerbations, patients with manic-depressive psychosis are prescribed mood stabilizers.

Also, the use of drugs that normalize mood is indicated for patients suffering. The severity of mood swings, rash actions, and reluctance to work while taking these drugs will be significantly lower.

Features of treatment of the disease in children and adolescents

To treat depressive conditions in children and adolescents, antidepressants with an inhibitory, calming effect (fluvoxamine, mianserin) are used. If the child needs to be activated, then nootropics (piracetam, glycine), eglonyl, pyrazidol are used.

To treat manic states in children, neuroleptics such as risperidone, sonapax, neuleptil in combination with lithium salts can be used.

To prevent exacerbation of manic-depressive psychosis in children, Finlepsin and Convulex are used.

Psychotherapy

Psychotherapy is carried out only for depressive episodes of manic-depressive psychosis. Psychotherapy must be combined with drug treatment. Both individual and group psychotherapy can be performed. Group psychotherapy not only helps eliminate the symptoms of bipolar personality disorder, but helps a person realize that his illness is not unique; other people can also suffer from manic-depressive psychosis and are successfully treated for this disease. Group psychotherapy can be carried out only after removal acute symptoms diseases.

Psychotherapeutic treatment is especially important for patients in adolescence, because it is at this age that a system of interpersonal values ​​is created and a model of human social behavior is formed.

AFFECTIVE INSANITY[French maniacal, from Greek, mania madness, mental illness, Lat. depressio depression; Greek, psyche soul + -osis; syn.: manic-melancholic psychosis, intermittent psychosis, cyclophrenia, circular psychosis] - a disease that occurs in the form of depressive and manic phases, separated by intermissions, i.e., states with the complete disappearance of mental disorders and with the preservation of premorbid personality traits.

Information on the prevalence of M.-d. items are heterogeneous; this has a lot to do with those diagnostic criteria, which are used to determine its boundaries.

Frequency of M.-d. among mental illnesses, according to various clinics, ranges from 3% to 18%. Depression is more common in women, while mania and bipolar psychosis are more common in men.

Story

The formation of the concept of “manic-depressive psychosis” is associated with the names of the French. psychiatrists. A type of affective psychosis - circular insanity was described by J. Falre (1851), insanity in a double form - by Baillarger (J. G. F. Baillarger, 1854). They combined manic and depressive states into one wedge, a complex, establishing general patterns in their development and course. Subsequently, K. Kahlbaum (1882) and V. Magnan (1890, 1895) studied paroxysmal affective psychoses, comparing them with continuous forms course of mental illness. The authors created a wedge, a basis for further study of psychoses and their classification by E. Kraepelin (1899, 1913) according to the nozol principle.

Modern idea of ​​M.-d. n. as an independent nozole, a form was created by E. Kraepelin at the end of the 19th - beginning of the 20th century. (he was the first to use this term) and contrasted it with another nosole, a form he identified - early dementia, characterized by a progressive course and outcome in dementia. However, in the group M.-d. items turned out to be included and some atypical wedges, forms.

With the further development of the doctrine of M.-d. etc., then the number of forms related to it increased with the inclusion of atypical ones, then it decreased and a number of “marginal” intermediate psychoses became an independent disease, not associated with M.-d. n. They tried to explain the origin of atypical forms either by the development of psychosis in a special, not characteristic of M.-d. n. constitutional background, or a mixture of hereditary inclinations of M.-d. n. and schizophrenia (see).

Since the mid-20th century, on the one hand, there has been a certain pathomorphosis of the wedge, manifestations of M.-d. p., namely, an increasing number of erased, masked forms of the disease are developing, and on the other hand, the number of depression with somatic disorders in combination with reactive components is increasing. Appearance large number affective psychoses of late age significantly increased the interest of psychiatrists in the study of M.-d. n. in the age aspect.

Clinical picture

At the clinic M.-D. There is a general predominance of depressive states (up to 80%). The age of onset of the disease is most often after 30 years, although the first manifestations can occur even in children and adolescents. The manifestation of the disease in a single phase occurs in 12 - 70%, the disease with repeated phases - in 9 - 27% of cases. Average duration phases 3-18 months. The manic phase can be 2-3 times shorter than the depressive phase. More often M.-d. p. begins with the depressive phase (in 60-80% of cases). Often, long before the first pronounced phase, subdepressive disorders (see Depressive syndromes) or hypomania (see Manic syndromes) appear. The duration of these states varies - from several hours to several months; they arise either spontaneously or are associated with some additional factors ( mental trauma, infection, hormonal changes).

The first pronounced phase can develop a number of years after the initial shallow manifestations of M.-d. n. It often begins with precursors: in case of depression - in the form of disorders of a somatovegetative nature ( discomfort in the body, increased fatigue, general lethargy, malaise, headaches, sleep disorders, appetite, vague fear); at the beginning of mania - in the form of sleep disturbance, general anxiety, agitation, irritability. Most authors distinguish three stages in the development of the phase: initial symptoms with a predominance of shallow affective disorders, the culmination with the greatest depth of disorders, the stage of reverse development. More often the phases develop gradually, less often - acutely.

The depressive phase with a typical manifestation consists of the following main symptoms: 1) depressed mood with a vital “bodily” feeling of melancholy (depressive affect); 2) motor and speech retardation; 3) intellectual inhibition (slow progress of mental processes). According to the mood and the content of the patient’s thoughts, it is depressive in nature. The same applies to overvalued and delusional ideas: ideas of guilt, sinfulness, self-accusation, self-abasement predominate, often leading to suicide; in more severe cases, ideas of condemnation, delusions of enormity and denial appear (see Cotard syndrome).

In depressive states, the nature of melancholy is vital, “bodily” (melancholy is perceived physically, like a “stone”, like heaviness, like pain in the chest, in the heart area or other parts of the body). In this regard, Schneider (K. Schneider) identified two types of depression - depression with a predominance of bodily sensations and depression of the spirit without a vital component, which is manifested by a depressive, gloomy content of thoughts. With increasing severity of the depressive phase, in typical cases, psychomotor retardation can reach a state of depressive stupor (see Stuporous states) with deep ideational inhibition and the absence of daily fluctuations in the state.

Despite significant differences in the manifestation depressive disorders, significantly deviating from the typical depressive triad, all types of depression (agitated, adynamic, depression with depersonalization, obsessions, depressive-paranoid syndrome, etc.) are characterized as somatovegetative disorders (changes in the of cardio-vascular system, trophics, metabolic processes, sleep disorders), and decreased vitality. The depressive phase (less often the manic phase) is characterized by Protopopov's triad - mydriasis, tachycardia, spastic constipation. Certain types of depressive conditions - see Depressive syndromes.

The manic phase in its typical manifestations is the opposite of the depressive phase and consists of the following symptoms: 1) elevated mood (manic affect); 2) motor and speech excitation; 3) intellectual excitement (accelerated course of mental processes).

Unlike depressive disorders, manic syndrome more often develops at a subclinical level and relatively rarely reaches severe manifestations.

According to the elevated mood, the content of the patients’ thoughts is full of optimism; overestimation of personality, ideas of greatness up to delusional ideas of fantastic content prevail. With the increase in manic excitement, thinking loses its direction until it becomes “jumping thoughts” and incoherence, combined with motor frenzy. Certain types of manic states - see Manic syndromes.

Mixed states are characterized by the replacement of some signs of one affective syndrome with signs of another, when signs of mania are included in depression, and signs of depression are included in mania. So, for example, there are depressions with ideational agitation, in which sadness is combined with a rapid flow of thoughts, which, however, have depressive content, psychomotor retardation is shallow or absent altogether. Mixed states include nonproductive mania and mania with psychomotor retardation. Unproductive mania is characterized by the fact that increased mood and well-being are not accompanied by ideational and motor excitation; the patients are cheerful, but not at all active. Mania with psychomotor retardation can reach the so-called degree. manic stupor (see Catatonic syndrome, Stuporous states); in these cases, despite the elevated mood, the patients are silent and deeply inhibited. A number of authors also classify anxiety-agitated depression as a mixed condition, in which psychosis occurs against a background of severe anxiety and motor agitation.

In wedges, in practice, mixed states occur most often during the transition of affective psychosis from one pole to another during the course of the disease in dual phases or with a continuous change of affective states. Mixed states are much less common as isolated psychosis; the latter is more typical for atypical forms of M.-d. P. E. Kraepelin explains the occurrence of mixed states by the uneven, asynchronous replacement of some signs by others during the transition of the state into a syndrome of the opposite affective sign, due to which the signs of the manic and depressive phases simultaneously coexist. However, not all authors recognize the identification of mixed conditions, the manifestation of which they consider within the framework of atypical affective psychoses.

Flow

Approximately 70% of patients have M.-d. p. proceeds in the form of shallow affective phases and only in 30% - with the development of manifest psychosis.

According to various authors, for M.-d. The most typical are periodic and single-phase depressions (48-80% of patients) - the so-called. monopolar type of flow, alternation of manic and depressive states is less common (from 18 to 41.5%) - circular (bipolar) type of flow; A course with the presence of only manic states is extremely rare (from 2 to 9.6%) - a monopolar manic type of course. The appearance of phases is either strictly regular, often confined to certain times of the year, or irregular with a tendency for phases to become more frequent in later life. With a bipolar course, a different combination of affective phases is noted: either in the form of dual phases followed by a light interval, or in the form of an alternating course, when each manic and depressive state is separated by light intervals, or in the form of a circular continuous (continuous) course, when manic and depressive states follow each other without light intervals. However, these types of flow are not strictly constant.

In prognostic terms, bipolar forms of the flow are less favorable than monopolar ones. With pronounced bipolar forms, there is a hereditary burden (up to 80% of patients) with predominantly affective psychoses, an earlier onset of psychosis, a greater number of phases compared to monopolar forms. Often there is a clear tendency to complicate the structure of phases with their atypicalization, while with typical forms of M.-d. etc. phases proceed in the same way, without changing over many years (flow in the form of a “cliché”). For bipolar M.-d. etc. are characterized by circular phenomena between phases (the course of the disease “at the cyclothymic level”) and a less favorable outcome of the disease. With age, in all types of psychosis, there is a tendency to increase the duration of phases and shorten light intervals.

Chron, depression occurs more often in the elderly, less often in adulthood. They are characterized by a long-term (10-15 years or more) course, but the possibility of recovery from these states is not excluded. Most authors believe that hron, depression are uncharacteristic of true, typical forms of M.-d. n. More often they develop with the so-called. marginal forms on heteronomous grounds, i.e. in the presence of hereditary schizophrenia. The premorbid characteristics of these individuals include rigidity, low contact, sensitivity, and irritability. The clinical picture of chronic depression is monotonous (“freezing depression”). Depression, irritability, gloominess, anxiety predominate, and the relevance of experiences is lost. According to W. Klages, these depressions occur with a sharp decrease in vitality, sub-depressive affect, general asthenia and paranoia. Peters and Gluck (U.H. Peters, A. Gluck, 1973) refer to chronic depression as treatment-resistant conditions that arise during the transition of depression to post-depressive personality changes with a decrease in activity, energy capabilities, with the presence of feelings of uncertainty, guilt, isolation, and connect them appearance with thymoleptic therapy. Hron, manias are less common and usually occur at a subclinical level. They appear either after the end of depression or from the very beginning of the disease,

In typical cases, no matter how long the disease lasts, the patient’s personality does not change, maintaining its main features. In the intervals between attacks, health and performance are almost completely restored. A decrease in working capacity may occur in the case of frequent phase changes, especially with a continuous circular flow. With M.-d. n. phases persist throughout life, but in old age their intensity becomes much weaker. In some atypical forms with a more complex wedge, the picture in some cases, after many years of illness, “mental decrepitude” develops in the form of a feeling of inferiority, increased fatigue, loss of initiative, activity, and cheerfulness. However, the essence of the personality, emotional resonance, and previous attitudes are preserved, although without the possibility of their implementation. Chron, affective states, arising after a long course of M.-d. etc., are also considered as an outcome of the disease. Weitbrecht (N. I. Weitbrecht, 1967) notes lethargy, decreased affective resonance, general pessimism, and “woodiness” of affect as residual states. A number of authors consider these changes as manifestations of protracted, erased affective states.

Erased forms

Cyclothymia. K. Kalbaum (1889), Yu. V. Kannabikh (1914) and S. A. Sukhanov (1907) consider cyclothymia as a milder version of the course of M.-d. n. Cyclothymia belongs to M.-d. item is proven not only by its wedge, similarity, but also the same with M.-d. n. hereditary burden of psychoses and personality anomalies, as well as similar constitutional premorbid personality characteristics.

This form of the disease is much more common (about 2.5 times) than the expressed forms of M.-d. n. Patients with cyclothymia do not always come to the attention of psychiatrists and, therefore, do not receive appropriate treatment. In this regard, the danger of suicidal tendencies increases sharply. Affective phases in cyclothymia do not reach psychotic states, but occur at a subclinical level, often maintaining performance throughout the entire course of the disease. Phases resemble initial stages development of affective disorders in M.-d. n. According to statistical data, in cases of cyclothymia, monopolar forms predominate in the form of periodic depressions, and bipolar circular forms are much less common.

Hidden (larved) depression(syn.: masked depression, missed depression, latent depression, depression without depression, somatized depression, autonomic depression, depressive equivalents, affective equivalents, etc.) more often refers to M.-d. etc., revealing a close connection with cyclothymia. Hidden depression is very widespread, but diagnosing it is difficult, because in these conditions somatovegetative disorders predominate, and mild affective disorders mask their depressive nature. Patients with such disorders constantly and unsuccessfully turn to doctors. In some cases, only a few years later the depressive nature of the disorder is recognized and appropriate treatment is carried out. The danger of such conditions due to the possibility of suicidal tendencies is even greater than with cyclothymia (2/3 of patients attempt suicide). The percentage of larval depression among other types of depression, according to various authors, ranges from 10 to 75%. The increase in the number of diagnosed depressions is associated not only with an improvement in their diagnosis, but also with the transition of obvious depressive forms into masked ones under the influence of treatment.

Wedge, the picture of larval depression is characterized by an abundance of somatic disorders and a poverty of affective ones, as a result of which the disease can take the form of any somatic disease, in which there is a need not only for conservative treatment, but also for surgical intervention. Somatic disorders may mimic appendicitis, cholelithiasis or kidney stones, cardiovascular and other diseases. Patients may complain of periodic headaches, they have skin lesions (psoriasis, neurodermatitis), uncertain senestopathy (see), a number of autonomic disorders, pain in various parts of the body. Neurol, disorders in the form of radiculitis, neuralgia may occur. At the same time, however, it is important not to miss a true somatic illness, which may accompany hidden depression. Somatic disorders are combined with somatovegetative phenomena characteristic of endogenous depression (sleep disturbances, loss of weight, loss of appetite, constipation), which are sometimes accompanied by vital components of depression (in the form of a feeling of heaviness, “mental” pain in the chest), daily fluctuations in condition. General depression and depression complement these conditions. The nature of the affect, according to a number of authors, is different - from anxious-sad to sluggish-apathetic.

All classifications of larval depressions are based on the nature of somatic disorders.

T. A. Nevzorova and Yu. Z. Drobyshev (1962) distinguish cardiac and gastrological syndromes, intestinal dyskinesia syndrome and diencephalic syndrome. Lopez Ibor (J. Lopez-Ibor, 1972) distinguishes depression with a predominance of: 1) pain and paresthesia; 2) attacks of dizziness; 3) psychosomatic disorders; 4) attacks with lack of appetite, etc.

The fact that these forms belong to latent depression is confirmed by the frequency of occurrence of all these disorders, their reversibility, the absence of an organic basis, the presence, although erased, of depressive affect with daily fluctuations, and the positive therapeutic effect of the use of antidepressants. Possibility of alternation hidden depressions with true depressive states during the course of the disease, the presence of heredity aggravated by affective psychoses once again emphasizes their belonging to endogenous forms of M.-d. P.

Early recognition and treatment improves the prognosis of larval depression.

Endoreactive dysthymia was originally described by Weitbrecht as an independent wedge, a form of affective psychoses, the peculiarity of which is the combination of somatogenic-psychogenic factors with endogenous affective ones.

As etiological factor in endoreactive dysthymia, somatogeny plays a significant role in the form of long-term somatic distress in combination with psychogenic factors. There is no history of manic states, but depressive disorders are common. Wedge, the picture of depression is characterized by a gloomy-irritable or tearful-dysphoric mood background, the absence of ideas of guilt and depressive delirium, and an abundance of astheno-hypochondriacal disorders. However, depression has vital components in the form of a feeling of heaviness, “mental” pain in the chest; There is a tendency towards a protracted course within one attack. Hereditary burden of M.-d. n. weak; in the premorbid, sensitive, irritable, gloomy personalities predominate.

Depression of exhaustion. Kielholz exhaustion depressions are close to endoreactive dysthymia, but they differ in the more pronounced psychoreactive nature of the disease. In the genetic works of J. Angst, doubts are expressed regarding the independence of the so-called part. reactive and neurotic depressions and there is a tendency to attribute them to endogenous affective diseases, i.e., to varieties of M.-d. P.

Age characteristics

Due to the general aging of the population, depression in old age is becoming increasingly important. Features of late-life depression include the absence of pronounced ideomotor inhibition, anxiety, fears, agitation, anxious verbalization, the predominance not of depressive ideas, but of ideas of attitude and diffuse paranoidity, and a tendency to anxious-hypochondriacal fears. In old age, lethargy, resigned humility, submission to fate (sometimes referred to as dull depression) or dissatisfaction, irritability, and increased resentment predominate.

According to E. Ya. Sternberg (1970), the wedge, the picture of depression in late age is largely due to general biol. features of the aging process, changes in a person’s social status in old age. There is a “reduction, shredding” of late-life depression, there is no depressive self-esteem and no revaluation of the past. Concerns for health and fear of possible financial instability prevail. With age, the wedge and psychopathol often smooth out, the differences between depressions of various nosols, forms due to the complication of depression, the increase in their atypia in M.-d. with the appearance of features similar to depression in schizophrenia (presence of paranoid disorders, atypia of the affective triad). With M.-d. age-related features of depression will be more pronounced the later the first manifest phase develops. The duration of depression and the depth of disorders increase with age. However, in old age, the duration of depression in some cases becomes shorter, the depth of the disorder decreases, depression loses its severity, the statements of patients are monotonous, and affect is smoothed out. The periodic type of course predominates (in 54.6% of patients). One-time depression is much less common (in 27.3% of patients), and even less common is a circular course (in 18.1% of patients). The duration of depressive states ranges from 6 months. up to 3 years or more.

Manic states in late life occupy a relatively small place. As age-related manifestations, the predominance of fussiness over the true desire for activity, unproductivity, and monotonous activity are noted; The behavior of patients sometimes has a silly connotation. Some patients easily develop irritability, anger, litigious behavior, and a general paranoid mood. A transition to chronic or protracted manic states is possible. In cases of earlier onset of the disease, age-related features of mania are less noticeable.

In childhood, the appearance of M.-d. It is observed very rarely (affective disorders of other origins are more common). The phases themselves and the entire course of psychosis are characterized by a number of features: short phases with a bipolar type of course predominate, hypochondriacal disorders, fear, phenomena of depersonalization, obsession, and massive autonomic disorders are noted. Nissen (G. Nissen, 1971) among depressive disorders notes the presence in children of such symptoms as impaired contact, anxiety, lethargy, uncertainty, aggressiveness, insomnia, and mutism. Other authors point to a feeling of fatigue, decreased academic performance, self-blame, psychosomatic disorders, and suicidal thoughts. G.K. Ushakov, N.M. Iovchuk note the possibility of changes in depressive symptoms during the course of the disease. Very often, depression in children is masked with a predominance of somatovegetative disorders.

IN puberty depression acquires even more typical features. They occur more often than in childhood, often occur at a subclinical level and are the initial, initial period of M.-d. with the development of the psychotic affective phase in adulthood. In adolescents, depressive states approach the wedge pattern of depression in adults, but are characterized by great lability. The feeling of guilt with reflection can be expressed quite clearly. Suicidal tendencies and attempts are common.

Manic phases in childhood are also extremely atypical. Psychomotor agitation and a state of excitement predominate, which initially manifests itself as an increase in play activity, while as the severity of the phase increases, the excitement reaches a state of frenzy. In adolescence, in manic states, the ideational component of mania is more clearly revealed in the form of acceleration of thought processes and a tendency to rhyme. During the pubertal period, manic states either approach cyclothymic disorders, occurring at a shallow subclinical level, or acquire a number of features due to the disinhibition of drives (for example, alcohol abuse, sexual excesses). In some cases, the behavior has traits of foolishness. Severe manic states during puberty, especially if psychosis began with them, can raise a number of doubts about whether this psychosis belongs to M.-d. n. Catamnesis studies often confirm the validity of these doubts. Typically, such psychosis turns out to be a manifestation of schizophrenia.

Etiology and pathogenesis

Etiology M.-d. p. is not clear. Most authors classify it as an endogenous disease. Significant importance in the development of M.-d. n. has a hereditary-constitutional factor. Frequency of M.-d. n. among families of probands (see) compared to the general population is increased. The number of patients in descending generations has increased compared to ascending ones: if in the general population the proportion of patients with M.-d. n. accounts for 0.4%, then for the parents of the proband - from 7 to 23%, and for the children of the proband - up to 33%. The twin method clearly revealed the importance of heredity: according to F. J. Kallmann, burdened heredity among brothers and sisters was detected in 18% of those examined, among fraternal twins - in 23%, among identical twins - in 92%, i.e. it is significant degree of consanguinity. In families where M.-d. occurs. n., there is an increase in the number of cycloid constitutional-premorbid individuals with cyclothyme-like mood swings (in the population there are 0.7%, and in parents of patients - 14.5%, in brothers and sisters - 12.9%, in fraternal twins - 30% , in identical ones - 37%). In families where there are patients with M.-d. etc., in addition to affective heredity, patients with schizophrenia are also identified, the number of which increases in descending generations. However, heredity is only one of the factors shaping the development of psychosis. Great importance is given to a cyclothymic constitution, a special temperament favorable to the development of the disease. The cyclothymic constitution is characterized by fluctuations in mood, activity and somatic functions. E. Kretschmer (1921) and E. Bleuler (1925) noted the existence of a correlation of the disease with body structure and character. So, for example, the cycloid constitution is characterized by a picnic physique and an open, sociable character. Development of M.-d. etc. from another heteronomous constitutional basis, for example, schizoid, contributes to the emergence of “atypical”, more severe forms currents of M.-d. P.

The age factor, gender, endocrine influences, etc. have a certain pathogenetic significance in the formation of psychosis. It is known that women get sick more often than men (approximately 70% of women and 30% of men). In women, the development of psychosis often coincides with menstruation, childbirth, the period of involution, etc.

A certain pathoplastic or provoking significance in the development of M.-d. n. have external factors. Infections, intoxications, and traumatic situations can cause the development of the phase. However, more often it is not possible to establish the reason for the development of psychosis. In these cases, manic and depressive phases arise and recur with surprising consistency, often repeating themselves in a cliché fashion and appearing to coincide with certain seasons.

Attempts to identify pathogenetic and pathophysiol mechanisms of M.-d. etc. have been done for many years. V.P. Osipov believed that the basis of affective disorders is a violation of the tone of the sympathoadrenal system. The administration of adrenaline slows down the course of associative processes in patients with manic states, increases depression, and reduces manic agitation. V.P. Protopopov (1961) associated the origin of the main symptoms with the pathology of the thalamo-hypothalamic region, with a violation of the regulation of central mechanisms. I.P. Pavlov believed that under M.-D. n. the dynamic relationships between the cortex and subcortex are disrupted due to the inhibitory state of the higher parts of the nervous system, and the circularity of disorders is associated with the weakness of the nervous processes of both internal inhibition and excitation.

Research in. n. have shown that in hypomanic patients new conditioned connections arise easily, but the development of inhibitory reactions is difficult. At the height of excitation, protective inhibition occurs, spreading throughout the entire second signaling system.

Japanese authors Suwa and Yamashita (N. Suwa, J. Yamashita, 1972) drew attention to the circadian rhythms of function, the state of the adrenal cortex during depression and their connection with the rhythms of the hypothalamus and limbic system.

Increasing importance is being attached to genetic factors in the development of affective psychoses and to those biochemical mechanisms that determine the pathogenesis of the disease. The work is carried out in three main directions: studying disorders of mono-amine metabolism, steroid hormone metabolism, studying shifts in water metabolism and electrolyte metabolism. However, according to M.E. Vartanyan, 1970, the last two directions reflect nonspecific changes in the body of patients associated with stressful situation, while disorders of monoamine metabolism are associated with the mechanisms of occurrence of affective disorders. A number of researchers have discovered the function, insufficiency of brain norepinephrine in depression and its increased activity in mania. In this regard, metabolic disorders of “central” catecholamines (see) become of particular importance.

Diagnosis

The diagnosis is made on the basis of repeated affective phases in a wedge, a picture of the disease characterized by a predominantly affective structure, the presence of light intervals during which patients are practically healthy, and the absence of personality degradation.

Differential diagnosis is made between affective attacks of periodic schizophrenia (see) and reactive depression. In contrast to reactive depression in M.-d. with a reactive onset, the psychogenic situation is reflected in the patient’s experiences only at the beginning of the phase or is not reflected at all in the content of the experiences, and subsequently the disease flows according to the patterns characteristic of M.-d. P.

Affective disorders have been described in toxic-infectious diseases, for example, manic states in typhus, intoxication with quinine and sp. Unlike M.-d. These disorders are temporary, closely related to the underlying disease and are only one of its symptoms (see Intoxication psychoses).

With many organic diseases brain, affective syndromes may occur with a tendency to recur (with progressive paralysis, encephalitis, epilepsy, brain injury). Unlike M.-d. n. with progressive paralysis (see), manic syndrome occurs against the background of dementia and other signs characteristic of this disease: patients are foolish, unproductive, erotic, the background mood is elated and complacent. Ideas of greatness of absurd content predominate. Affective disorders are characteristic of epilepsy (see). Unlike M.-d. etc. with epilepsy in depression, a dysphoric shade predominates with anger and intensity of affect, explosiveness, or a state with gloomy gloominess, depression; in manic states, patients are also easily excitable, irritable, and angry.

In other organic psychoses, for example, traumatic, in contrast to M.-d. n. affective syndromes occur against the background of psychoorganic syndrome (see). Patients in a state of depression exhibit many asthenic features with general lethargy, weakness, emotional lability, in some cases they have a dysphoric connotation.

Treatment

A wide arsenal of psychopharmaceuticals, drugs with a different spectrum of action makes it possible to treat affective disorders of various structures. For depression with a predominance of psychomotor retardation without a pronounced affect of melancholy, as well as for adynamic depression with a decrease in volitional and mental activity, drugs with a stimulating effect are indicated, activating impulses and reducing inhibition (nuredal). For depression with a predominant feeling of melancholy, vital components, motor and intellectual retardation, drugs with a wide spectrum of action, thymoleptic drugs (melipramine), are most effective. For anxious depression, depression with irritability, tearfulness and grumpiness without severe psychomotor retardation, drugs with a sedative-thymoleptic or sedative tranquilizing effect (amitriptyline, melleril, chlorprothixene, tizercin) are indicated. For some types of anxious depression, drips are effective. intravenous administration drugs such as seduxen, teralen. Anxious patients are not recommended to be prescribed antidepressants with a psychostimulant effect, since they cause not only a sharp increase in anxiety, depressive agitation with suicidal tendencies, but also an exacerbation of psychosis in general with the appearance of new symptoms in the form of delusions and hallucinations.

For difficult depressive syndromes, for example, depressive-paranoid with Cotard's delusion, a combination of antidepressants with antipsychotics is necessary. Almost all antidepressants (see) have side effects. As a result of drug intoxication, a transition from depression to a manic state or the development of delirious or amentia-like disorder of consciousness is possible. When increasing intraocular pressure the use of amitriptyline is contraindicated. Despite the widespread use of psychotropic drugs, electroconvulsive therapy is still important, especially for long-term, protracted forms of depression that are resistant to drug effects. In the treatment of manic states, neuroleptics (aminazine, stelazine, haloperidol, magentil), as well as large doses of lithium salts (up to 1 g and above) are widely used under the control of the patient’s somatic condition and the level of lithium salts in the blood serum.

Preventive therapy with lithium salts is increasingly used both clinically and in outpatient setting. Lithium salts have the ability not only to influence affective disorders during the phase, but also to prevent or delay the appearance of a new attack and relieve its intensity.

Forecast

The prognosis for life is favorable. However, given the presence of suicidal tendencies, it is necessary to very carefully monitor the condition of patients, especially during minor depressive attacks, when patients are treated on an outpatient basis. Each attack ends with the patient practically recovering; work capacity does not suffer after the end of the attack.

Patients easily adapt socially. In cases of a continuous course, with a continuous change of manic and depressive states, patients are forced to leave work.

Bibliography: Avrutsky G. Ya., Gurovich I. Ya. and Gromova V. V. Pharmacotherapy of mental illnesses, M., 1974, bibliogr.; Akopova I. L. Psychoses and character anomalies in families of patients with manic-depressive psychosis, Zhurn, neuropath, and psychiat., vol. 72, JV" 4, p. 554, 1972, bibliogr.; Anufriev A.K. Hidden endogenous depression , ibid., vol. 78, no. 6, p. 857, LЪ 9, p. 1342, 1978, bibliogr.; Depression. Issues of clinical practice, psychopathology, therapy, p. 109, M.-Basel, 1970; Efimenko V.L. Depression in old age, L., 1975, bibliogr.; Kannabikh Yu. V. Cyclothymia, its symptomatology and course, M., 1914, bibliogr.; Treatment of depressive states with Ludiomil, ed. E. A. Babayan and V. M. Shamanina, b. m., 1973; Lomachenkov A. S. On the issue of diagnosis and prognosis of manic-depressive psychosis in children and adolescents, Proceedings Leningr, pediatrician, med. Institute, t. 57, p. 97, 1971; New drugs in the treatment of mental and nervous diseases, ed. O. A. Balunova and Yu. L. Nullera, L., 1974, bibliogr.; Protopopov V.P. Selected works, Kyiv, 1961; Sternberg E. Ya. Gerontological psychiatry, M., 1977, bibliogr.; Angst J. Zur Atiologie und Nosologie endogener dep-ressiver Psychosen, B.u.a., 1966, Bibliogr.; B a i 1 1 a r g e r, De la folie k double forme, Ann. Med. Psych., t. 6, p. 369, 1854; Brat-fos O. a. Haug J. O. The course of manic-depressive psychosis, Acta psychiat, scand., v. 44, p. 89, 1968; Falk W. Die Larvierte Depression in der taglichen Praxis, in the book: Die Larvierte Depression, hrsg. v. P. Kielholz, S. 246, Bern u. a., 1973; F a 1 r e t J. P. M£moire sur la folie circulare, Bull. Acad. Med. (Paris), t. 19, p. 382, 1853 -1854; F r i e d m a n M. J. a. S t o 1 k J.M. Depression, hypertension, and serum dopamine-(3-hydroxylase activity, Psychosom. Med., v. 40, p. 107, 1978; Glatzel G. u. Lungershau-sen E. Zur Frage der Residualsyndrome nach thymoleptisch behandelten cyclothy-men Depressionen , Arch. Psychiat. Nervenkr., Bd 210, S. 437, 1968; Kielholz P. Wirkungsspektren der Psyeho-pharmaka und Depressionsdiagnostik, in the book: Pharmakopsychiat. u. Psychopath., hrsg. v. H. Kranz u. K. Heinrich, S. 106, Stuttgart, 1967, Bibliogr.; K 1 ages W. Zur Struktur der chronischen endogenen Depressionen, in the book: Problematik, Therapie u. Rehabilitation der chron. endogen. Psychosen, hrsg. v. Fr. Panse, S. 256, Stuttgart, 1967, Bibliogr.; K r a i n e s S. H. Mental depression and their treatment, N. Y., 1957; Lehrbuch der speziellen Kinder- und Jugend-psychiatrie, hrsg. v. H. Harbauer u. a., S. 415, B., 1976; L e s s e S. The multivariant masks of depression, Amer. J. Psychiat., v. 124, suppl., p. 35, 1968; LOpez-I b o r J. J. Masked depressions, Brit. J. Psychiat., v. 120, p. 245, 1972, bibliogr.; Mitsuda H. The concept of “atypical psychoses” from the aspect of clinical genetics, Acta psychiat, scand. , v. 41, p. 372, 1965; Nissen G. Depressive Syndrome im Kindes- und Jugendalter, B.- N. Y., 1971; Schneider K. Klinische Psychopathologie, Stuttgart, 1959; S m e r a 1-d i E., Negri F. a. M e 1 i with a A. M. A. genetic study of affective disorders, Acta psychiat, scand., v. 56, p. 382, 1977; S u-wa N.a. Yamashita I. Psychophysiological studies of emotion and mental disorders, Sapporo, 1972; W e i t b-r e c h t H. I. Die chronische Depression, Wien. Z. Nervenheilk., Bd 24, S. 265, 1967.

B. M. Shamanina.

There is a huge variety of diseases that can affect a person. And they affect the most various organs and body systems. Now I would like to talk about what manic psychosis is.

Terminology

First you need to understand what exactly we are talking about. Therefore, you will have to understand the terminology. So, manic psychosis is, first of all, a serious mental disorder, which is mainly accompanied by symptoms such as hallucinations, delusions, and inappropriate behavior.

It is also worth noting that many people know what manic-depressive psychosis is ( this concept more common among the masses, also more often mentioned in various kinds of films and fiction). The manic phase is also accompanied by a depressive state, and its specific symptoms and manifestations are recorded.

About forms of psychosis

Before considering symptoms and manifestations manic psychosis, it should be noted that these indicators depend specifically on the form of the disease. So, in medicine there are two of them:

• Monopolar psychosis. In this case, only the symptoms of manic syndrome appear.
• Bipolar psychosis. In this variant, a depressive state is also added to the manic state.

About the symptoms of unipolar manic psychosis

What are the signs of manic psychosis if the disease is in the monopolar phase? So, initially it should be noted that symptoms mainly appear after 35 years of age. An indicator that always happens and is visible is mania, or manic attacks. It must also be said that this disease is very inconsistent and atypical, which is the main problem. After all, it is very, very difficult to predict its exacerbation.

About a manic attack

As mentioned above, manic psychosis is always accompanied by mania. What exactly is this? In this case, the patient’s activity and initiative increase, his mood is always upbeat, and he is interested in almost everything. Thinking also speeds up, but since a person cannot grasp everything, glitches begin, jumping from one moment to another. At this stage, a person already becomes unproductive. All basic needs also increase: food, intimate relationships. But very little time is allocated for sleep - no more than 3-4 hours per day. During an attack, people want to communicate with everyone and help many people. Because of this, patients often make new acquaintances, and there are often unplanned sexual relations with new comrades. Patients can either leave home themselves or bring new, complete strangers.

It should also be noted that if a patient has a manic psychosis, he tends to overestimate his capabilities. Such people often get involved in politics or social activities. They may also become addicted to alcohol or psychotropic substances. Behavior may be completely uncharacteristic (a person behaves completely differently than in moments of a normal state), next step the patient cannot be predicted.

About behavior in case of unipolar manic psychosis

Patients in the event of a manic attack are not aware of their actions. Behavior may be ridiculous and uncharacteristic. They experience a strong surge of energy, which at this stage does not surprise them at all. The so-called Napoleon complex is often observed, that is, ideas of greatness and high origin arise. At the same time, even despite the increased activity and nervous tension, such people treat others as positively as possible. But sometimes there may be mood swings, outbursts of emotions, which are often accompanied by irritability.

It should also be noted that this stage develops very quickly. It only takes 4-5 days. The duration may vary, but on average it is 2.5-4 months. Coming out this state patient for a couple of weeks.

Manic psychosis without main symptom

In 10% of patients, it happens that manic psychosis passes without mania itself. In this case, the patient experiences an increased reaction rate, as well as motor agitation. In this case, thinking slows down rather than speeds up, but concentration is at an ideal level. Increased activity in this type of manic psychosis is very monotonous. However, the patient does not feel joy. There is also no surge of strength or euphoria. The duration of such psychosis can even reach 1 year.

Differences between mono- and bipolar psychoses

What is the difference between unipolar and bipolar manic-depressive psychosis? First of all, the duration. In the first case, such conditions in the patient may be protracted. That is, the duration of manic psychosis can range from 4 months to 1 year. The process of “entry” and “exit” also differs. In monopolar psychosis they are long-term, gradual, and increasing. With bipolar - rapid. It should also be noted that at the onset of the disease, unipolar psychosis has a seasonal manifestation and occurs mainly in spring or autumn. Later this pattern is lost.

About bipolar manic psychosis

Separately, we also need to consider manic bipolar psychosis. This is another type of this disease. It should be noted that most often another term is used in everyday life, namely “manic-depressive psychosis.” What is it? The peculiarity of this condition is that the patient alternates between attacks of manic and depressive states. Basically, this disease manifests itself around the age of 30. And it most often occurs in those who have had similar diseases in their family.

About the course of this type of psychosis

In most cases (approximately 60-70%), patients have their first attack during the depressive phase of the disease. This often manifests itself as a depressed mood, even suicidal tendencies. When a person copes with this period, a bright streak begins, which doctors call remission. Then, after a certain time, the phase begins again, but it can be both manic and depressive to an equal degree.

Forms of manic-depressive psychosis

It should also be said that manic-depressive psychosis has several forms:

• Bipolar psychosis, when the manic phase predominates.
• Bipolar psychosis, when the depressive phase predominates.
• Bipolar psychosis with an equal predominance of manic and depressive states.
• Circulatory bipolar psychosis.

Psychosis with a predominance of depressive states

If the patient has a predominant depressive phase of manic-depressive psychosis, the following conditions will be characteristic:

• The first attacks will be very acute. Suicidal feelings may predominate in patients.
• Depressive psychosis is seasonal and worsens during periods of vitamin deficiency.
• A person’s mood is always disgusting; there is an emptiness in the soul.
• Motor and mental activity slow down, information is difficult to assimilate.
• Sleep is unstable, intermittent. The patient often wakes up at night.
• There are ideas of self-accusation and the fall. Also, a person is constantly afraid for his health, seeing mortal danger in everything.
• The duration of the period is on average three months, maximum six.

Psychosis with a predominance of manic states

In this case, it is the manic phases that predominate. The disease itself begins with a manic attack, but almost always after this a depressive period occurs. Experts say that a so-called dual phase occurs, followed by remission. In science this is called a cycle. It should also be noted that in this case all the symptoms of monopolar manic psychosis are present.

Clear bipolar psychosis

Bipolar psychosis can also have an equal number of both manic and depressive phases. The duration of such conditions initially takes about 2 months, then their duration increases and can even reach 4-5 months. The patient experiences a couple of phases per year, followed by a very long remission (on average, a couple of years).

Diagnosis of the disease

How is manic-depressive psychosis and schizophrenia recognized? So, doctors define the disease in two main directions:

• First you need to prove the existence of psychosis itself.
• Next, you must definitely decide on its type: is it mono- or bipolar psychosis.

Doctors take one of two evaluation systems as the basis for their definition: the ICD - that is, the world classification of diseases, or the no less widespread DSM - criteria created by the US Psychiatric Association.

It is also important for doctors to identify the presence of certain symptoms in a patient. In this case, they use various specialized questionnaires:

• Mood Disorders Questionnaire - a questionnaire about depressive disorders.
• Young Mania Rating Scale.
• Bipolar Spectrum Diagnostic Scale, that is, an assessment of the bipolar spectrum.
• Beck's scale.

Treatment of this disease

Having figured out what manic-depressive psychosis is, the treatment of this disease is what is also important to talk about. So, initially it should be noted that with this problem, the understanding and support of relatives is very important. After all, it is necessary to prevent suicidal tendencies in the patient. You also need to monitor the person in order to seek doctor’s help in time. What else can loved ones do? The patient needs to devote a lot of time: periodically walk together, arrange days of joint rest, involve him in homework, monitor the intake of medications, as well as provide comfortable living conditions and periodic visits to sanatoriums to maintain general health.

But the most important thing is the drug treatment of manic psychosis. The choice of drug should be completely entrusted to doctors; self-medication in this case is unacceptable. What medications can patients take?

• Normotimics. These are medications that normalize and stabilize the patient’s mood. Examples of drugs: Lithium carbonate, Carbamazepine, Lamotrigine.
• If the patient has depressive psychosis, doctors may also prescribe antidepressants. Examples of drugs: Olanzapine, Sertraline, Aripiprazole.

in modern psychiatry are a very common diagnosis affecting humanity. Their appearance is associated with global cataclysms, personal problems of people, environmental influences and other factors.

People, under the pressure of problems, can fall not only into a depressive state, but also into a manic state.

Etymology of the disease

What manic-depressive psychosis is can be explained in simple words: this is what is commonly called a periodically alternating state of idle and complete depression.

In psychiatry, experts call this a disease that is characterized by the appearance in a person of two periodically alternating polar states that differ in psychosomatic indicators: mania and depression (positive is replaced by negative).

This disease is often referred to in the literature on psychiatry, which also studies MDP, as “ manic depression", or "bipolar disorder".

Types (phases)

Flows in two forms:

– depressive phase,
- manic phase.

Depressive phase is accompanied by the appearance of a depressed pessimistic mood in the sick person, and manic phase bipolar disorder is expressed by an unmotivated cheerful mood.
Between these phases, psychiatrists allocate a time interval - intermission , during which the sick person retains all his personality traits.

Today, according to many experts in the field of psychiatry, manic-depressive psychosis is no longer a separate disease. In its turn bipolar disorder is an alternation of mania and depression, the duration of which can range from one week to 2 years. The intermission separating these phases can be long - from 3 to 7 years - or it can be completely absent.

Causes of the disease

Psychiatrists classify manic-depressive psychosis as autosomal dominant type . Most often, an illness of this nature is hereditary a disease passed from mother to child.

Causes psychosis lies in the disruption of the full activity of emotional centers located in the subcortical region. Malfunctions of the processes of excitation and inhibition occurring in the brain can provoke the appearance of bipolar disorder in a person.

Relationships with others, staying in under stress can also be considered as the causes of manic-depressive psychosis.

Symptoms and signs

Manic-depressive psychosis most often affects women than men. Case statistics: per 1000 healthy people accounts for 7 patients in psychiatric clinics.

In psychiatry, manic depressive psychosis has a number of symptoms manifested in the phases of the disease. In teenagers the signs are the same, sometimes more pronounced.

The manic phase begins in a person with:

– changes in self-perception,
– appearance of vivacity literally out of nowhere,
– tide physical strength and unprecedented energy,
– opening a second wind,
– disappearance of previously oppressive problems.

A sick person who had any diseases before the onset of the phase suddenly miraculously gets rid of them. He begins to remember all the pleasant moments from his life that he lived in the past, and his mind is filled with dreams and optimistic ideas. The manic phase of bipolar disorder displaces all negativity and thoughts associated with it.

If a person has difficulties, he simply does not notice them.
For the patient, the world appears in bright colors, his sense of smell is heightened and taste buds. A person’s speech also changes, it becomes more expressive and louder, he has a vividness of thinking and an improvement in mechanical memory.

The manic phase changes human consciousness so much that the patient tries to see only exclusively positive things in everything, he is satisfied with life, is constantly cheerful, happy and excited. He reacts negatively to outside criticism, but easily takes on any task, expanding the range of his personal interests and acquiring new acquaintances in the course of his activities. Patients who prefer to live an idle and cheerful life, love to visit places of entertainment, and they change sexual partners quite often. This phase is more typical for adolescents and young people with pronounced hypersexuality.

The depressive phase does not proceed so brightly and colorfully. Patients staying in it suddenly develop a melancholy state, which is not motivated by anything, it is accompanied by lethargy motor function and slowness of thought processes. In severe cases, a sick person may fall into a depressive stupor (complete numbness of the body).

People may experience the following: symptoms:

- sad mood
– loss of physical strength,
- emergence of suicidal thoughts,
– a feeling of one’s own unworthiness for others,
– absolute emptiness in the head (lack of thoughts).

Such people, feeling useless for society, not only think about committing suicide, but often they end their mortal existence in this world in exactly this way.

Patients are reluctant to make verbal contact with other people and are extremely reluctant to answer even the simplest questions.

Such people refuse sleep and food. Quite often the victims of this phase are teenagers who have reached the age of 15; in more rare cases, people over 40 years of age suffer from it.

Diagnosis of the disease

A sick person must undergo a full examination, which includes the following: methods, How:
1. electroencephalography;
2. MRI of the brain;
3. radiography.

But it is not only such methods that are used to carry out examinations. The presence of manic-depressive psychosis can be calculated by polls And tests.

In the first case, specialists try to draw up an anamnesis of the disease from the patient’s words and identify a genetic predisposition, and in the second, based on tests, bipolar personality disorder is determined.

A test for bipolar disorder will help an experienced psychiatrist identify the patient’s degree of emotionality, alcohol, drug or other addiction (including gambling addiction), determine the level of attention deficit ratio, anxiety, and so on.

Treatment

Manic-depressive psychosis includes the following treatment:

• Psychotherapy. This treatment is carried out in the form of psychotherapeutic sessions (group, individual, family). This kind of psychological help allows people suffering from manic-depressive psychosis to realize their illness and completely recover from it.

The life of any person consists of joys and sorrows, happiness and misfortune, to which he reacts accordingly - such is our human nature. But if the “emotional swing” is pronounced, that is, there are episodes of euphoria and deep depression appear very clearly, without any reason, and periodically, then we can assume the presence of manic-depressive psychosis (MDP). Currently, it is commonly called bipolar affective disorder (BAD) - this decision was made by the psychiatric community so as not to traumatize patients.

This syndrome is specific mental illness requiring treatment. It is characterized by alternating depressive and manic periods with intermission - completely healthy state, in which the patient feels great and does not have any mental or physical pathologies. It should be noted that there are no personality changes, even if phase changes occur frequently, and he has been suffering from the disorder for quite a long time. This is the uniqueness of this mental illness. At one time such people suffered from it famous personalities, like Beethoven, Vincent Van Gogh, actress Virginia Woolf, which had a strong impact on their work.

According to statistics, almost 1.5% of the world's population is affected by MDP, and among the female half there are four times more cases of the disease than among males.

Types of BAR

There are two types of this syndrome:

1. Bipolar type I. Since in this case the periods of mood changes can be traced very clearly, it is called classic.
2. Bipolar type II. Due to the weak severity of the manic phase, it is more difficult to diagnose, but is much more common than the first. It can be confused with various forms of depressive disorders, including:

• Clinical depression;
• postpartum and other female depression, seasonal, etc.;
• so-called atypical depression with such pronounced symptoms as increased appetite, anxiety, drowsiness;
• melancholy (insomnia, lack of appetite).

If the depressive and manic phases are mild in nature - their manifestations are dim, smoothed out, then such bipolar psychosis is called “cyclotomy”.

According to clinical manifestations, TIRs are divided into types:

• with predominance of the depressive phase;
• with the superiority of the manic period;
• with alternating euphoria and depression, interrupted by periods of intermission;
• the manic phase changes to the depressive phase without intermission.

What Causes Bipolar Disorder

The first signs of manic-depressive syndrome appear in adolescents aged 13-14 years, but it is quite difficult to diagnose it during this period, since this puberty age is characterized by special mental problems. Before the age of 23, when your personality is formed, this is also problematic. But by the age of 25, psychosis is completely formed, and in the period of 30-50 years, its characteristic symptoms and development can already be observed.

There are also difficulties in determining the causes of bipolar disorder. It is believed that it is inherited through genes, and may also be associated with characteristics of the nervous system. That is, it is a congenital disease.

However, there are also such biological “impetuses” to the development of this psychosis:

• oncological diseases;
• head injuries;
• hormonal disorders, imbalance of essential hormones;
• intoxication of the body, including drug use;
• thyroid dysfunction.

MDP can also provoke socio-psychological reasons. For example, a person has experienced a very strong shock, from which he is trying to recover through promiscuous sex, heavy drinking, having fun, or plunging headlong into work, resting only a few hours a day. But after a while the body becomes exhausted and tired, the described manic state is replaced by a depressed, depressed one. This is explained simply: due to nervous overstrain, biochemical processes fail, they negatively affect autonomic system, and this, in turn, affects human behavior.

Those at risk for developing bipolar affective disorder are people whose psyches are mobile, susceptible to outside influence, and unable to adequately interpret life events.

The danger of bipolar disorder is that it gradually makes a person’s mental state worse. If you neglect treatment, this will lead to problems with loved ones, finances, communication, etc. The result is suicidal thoughts, which is fraught with sad consequences.

Symptom groups

Bipolar psychosis, dual by definition, is also defined by two groups of symptoms characteristic of depressive and manic disorders, respectively.

Characteristics of the manic phase:

1. Active gestures, hasty speech with “swallowed” words. With strong passion and the inability to express emotions in words, simply waving your arms occurs.
2. Unsupported optimism, incorrect assessment of the chances of success - investing money in dubious enterprises, participating in the lottery with confidence in a big win, etc.
3. Desire to take risks - commit a robbery or a dangerous stunt for fun, participate in gambling.
4. Overconfidence, ignoring advice and criticism. Disagreement with a certain opinion can cause aggression.
5. Excessive excitement, energy.
6. Severe irritability.

Depressive symptoms are diametrically opposed:

1. Malaise in the physical sense.
2. Complete apathy, sadness, loss of interest in life.
3. Distrust, self-isolation.
4. Sleep disturbances.
5. Slow speech, silence.
6. Loss of appetite or, conversely, gluttony (rare).
7. Decreased self-esteem.
8. The desire to leave life.

A given period can last several months or hourly.

The presence of the above symptoms and their alternation gives reason to believe the presence of manic-depressive psychosis. You must immediately contact a specialist for advice. Treatment of TIR for early stages will help relieve the disorder and prevent complications from developing, prevent suicide, and improve the quality of life.

You should seek medical help if:

• mood changes for no reason;
• sleep duration changes unmotivated;
• appetite suddenly increases or worsens.

As a rule, the patient himself, believing that everything is fine with him, does not go to the doctor. Close people who see it from the outside and who are concerned do it for him. inappropriate behavior relative.

Diagnostics and therapy

As mentioned above, bipolar syndrome is difficult to diagnose due to the consistency of its symptoms with others mental disorders. To achieve this, you have to observe the patient for some time: this makes it possible to make sure that there are manic attacks and depressive manifestations, and they are cyclical.

The following will help identify manic-depressive psychosis:

• testing for emotionality, anxiety, addiction bad habits. The test will also determine the attention deficit coefficient;

• thorough examinations - tomography, lab tests blood, ultrasound. This will determine the presence of physical pathologies, cancerous tumors, disruptions in the endocrine system;
• specially designed questionnaires. The patient and his relatives are asked to answer questions. This way you can understand the history of the disease and genetic predisposition to it.

That is, diagnosing MDP requires an integrated approach. It involves collecting as much information as possible about the patient, as well as analyzing the duration of his behavioral disorders and their severity. It is necessary to observe the patient to ensure that there is no physiological pathologies, drug addiction, etc.

Experts never tire of reminding: timely identification clinical picture and the development of a treatment strategy guarantees a positive result in a short time. The modern techniques available in their arsenal can effectively combat attacks of psychosis, extinguish them, and gradually reduce them to nothing.

Pharmaco- and psychotherapy for manic-depressive psychosis

This psychosis is very difficult to treat, because the doctor is dealing with two opposite conditions at once, which require a completely different approach.

Medicines and doses are selected by a specialist very carefully: the drugs should gently remove the patient from the attack, without putting him into depression after a manic period and vice versa.

The goal of treating bipolar disorder with medications includes the use of antidepressants that reuptake serotonin ( chemical substance, a hormone present in the human body associated with mood and behavior). Prozac is usually used, which has proven its effectiveness in this psychosis.

The lithium salt found in drugs such as contemnol, lithium carbonate, lithium hydroxybutyrate, etc. stabilizes the mood. They are also taken to prevent the recurrence of the disorder, but they should be used with caution by people with hypotension, problems with the kidneys and the gastrointestinal tract.

Lithium is replaced by antiepileptic drugs and tranquilizers: carbamezapine, valproic acid, topiramate. They slow down nerve impulses and prevent mood swings.

Neuroleptics are also very effective in the treatment of bipolar disorder: halapedrol, aminazine, Tarasan, etc.

All the above drugs have sedative effect, that is, among other things, they reduce the reaction to external stimuli, therefore it is not recommended to drive a vehicle while taking them.

Together with drug treatment, psychotherapy is also necessary to manage the patient’s condition, control it and maintain long-term remission. This is possible only after the patient’s mood has stabilized with the help of medications.

Psychotherapeutic sessions can be individual, group or family. The specialist conducting them has the following goals:

• to achieve the patient’s awareness that his condition is not standard in emotional terms;
• develop a strategy for the patient’s behavior for the future if a relapse of any phase of psychosis occurs;
• consolidate the successes achieved in the patient’s ability to control his emotions and his condition in general.

Family psychotherapy involves the presence of the patient and people close to him. During the sessions, cases of bipolar disorder attacks are worked through, and relatives learn how to prevent them.

Group sessions help patients understand the syndrome more deeply, as they bring together people suffering from the same problem. Seeing from the outside the desire of others to find emotional stability, the patient develops strong motivation for treatment.

In the case of rare attacks interspersed with long “healthy” phases, the patient can lead a normal life, work, but at the same time undergo outpatient treatment - undergo preventive therapy, take medications, visit a psychologist.

In particularly severe cases of circular pathology, the patient may be assigned disability (group 1).

If you recognize it in time, you can live a normal life with bipolar disorder, knowing how to manage it. For example, it was diagnosed in actors Catherine Zeta Jones, Jim Carrey, Ben Stiller, which does not prevent them from successfully acting in films, having a family, etc.