Psychosis: causes, symptoms, treatment. Psychosis and concomitant mental disorders in women How psychosis is expressed in humans

Psychosis is a mental abnormality that can be explained as “loss of contact with reality.” People suffering from psychosis are called psychotics. Psychotics may experience some personality changes and thought disorders. Depending on the severity of the psychosis, there may be strange behavior, difficulty communicating and functioning in daily life. The diagnosis of psychosis (as a sign of a psychiatric disorder) is made by excluding all other possible diagnoses. Thus, a recurrent episode of illness will not be considered a symptom of a psychiatric disorder until other known possible causes of psychosis have been ruled out. Before diagnosing a psychiatric illness, medical and biological laboratory testing must be performed to rule out possible central nervous system diseases, diseases and injuries to other organs, and the use of psychoactive substances, toxins, and prescription drugs as the cause of psychosis. In medical training settings, psychosis is often compared to fever because both diseases have many causes that are not immediately obvious. The term "psychosis" has many meanings, from relatively standard deviations from the norm to the complex unconscious manifestations of schizophrenia and bipolar I disorder. When properly diagnosed as a psychiatric disorder (ruling out other causes using biological and laboratory testing), psychosis includes symptoms such as hallucinations, delusions, sometimes violence, and a lack of understanding of the motives of one’s behavior. Psychosis also denotes a significant deviation from normal behavior (negative symptoms), and most often various types of hallucinations or delusions, especially in relationships between the individual and others, such as grandiosity and pronoia/paranoia. Excessive dopaminergic signaling is thought to be associated with positive symptoms of psychosis (especially in schizophrenia). However, this hypothesis has not been conclusively confirmed. Disturbances in the dopaminergic system are thought to be responsible for abnormalities in the perception or assessment of the significance of environmental stimuli. There are many antipsychotic drugs that target the dopamine system; however, a meta-analysis of placebo-controlled studies of these drugs showed no significant difference between the effects of the drugs and placebo, or at best a moderate effect size. Thus, it can be concluded that the pathophysiology of psychosis is much more complex than previously thought.

Signs and symptoms

In psychosis, one or more of the following symptoms are observed: hallucinations, delusions, catatonia, thought disorders. There are also disorders associated with socialization.

Hallucinations

Hallucinations are the sensory perception of something in the absence of an external stimulus. Hallucinations are different from illusions (perceptual disturbances), which are false perceptions of external stimuli. Hallucinations can occur in any sense and take almost any form, including simple sensations (light, color, taste, smell) and complex sensations such as seeing and interacting with fully formed animals and people, hearing voices, and complex tactile sensations. Auditory hallucinations, especially hearing voices, are the most common type of hallucination and a common symptom of psychosis. Voices can speak about or to a person, and the speakers can be different people with different personalities. Auditory hallucinations of a derogatory, commanding nature or hallucinations that absorb all a person’s attention can be especially painful. However, the experience of hearing voices is not always negative. One study found that most people who hear voices do not need mental health care. The Hearing Voices Movement was founded to support people experiencing auditory hallucinations, regardless of whether they have a mental disorder.

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Catatonia

Catatonia is an extremely strong emotion in which the perception of reality is greatly impaired. There are two main manifestations of catatonic behavior. The classic illustration of catatonia is waking with no movement or interaction with the outside world. This type of catatonia is represented by the so-called. waxy flexibility (a condition when a person, when his limbs are moved by another person, maintains a position, even if it is uncomfortable and strange). Another type of catatonia is associated with more pronounced external manifestations of extreme anxiety. It involves excessive and mindless movements, as well as intense preoccupation with something that interferes with normal perception of reality. An example is behavior associated with quickly walking in circles and being completely immersed in one's own thoughts, not noticing anything around (not focusing on things that are appropriate to the situation), which was not typical for the person before the onset of symptoms. With both types of catatonia, the person does not react at all to the external world around him. It is important to distinguish between catatonic agitation and bipolar mania (although some patients may experience both).

Thought disorders

Thought disorders are associated with impairments in conscious thought and their classification is largely based on the effect that these disorders have on speech and writing. Patients with thought disorders demonstrate weakened associations, connections, and organization of semantic content in speech and writing. In severe forms, speech becomes incoherent.

Causes

Many causes of schizophrenia are also causes of psychosis.

Psychiatric disorders

In terms of diagnosis, organic disorders were considered to be disorders caused by physical disease in the brain, and functional disorders were disorders associated with the functioning of the brain in the absence of physical disease (mainly psychological or psychiatric diseases). The materialist view of the Mind-Body dichotomy suggests that mental illness is caused by physical processes; according to this theory, the difference between brain and mind, and thus between organic and functional diseases, is fictitious. Minor physical abnormalities have been found in diseases originally thought to be functional, such as schizophrenia. DSM-IV-TR does not differentiate between functional and organic disorders, but instead lists traditional psychotic disorders, general health psychosis, and substance abuse psychosis. The primary psychiatric causes of psychosis are:

Schizophrenia and schizophreniform disorder

Affective disorders (mood disorders), including depression, severe depression or mania in bipolar disorder (manic depression). People experiencing a psychotic episode in the context of depression may suffer from delusions of persecution or self-blame, and people experiencing a psychotic episode in the context of mania may develop delusions of grandeur.

Schizoaffective disorder, including symptoms of both schizophrenia and mood disorders

Brief psychotic disorder, or brief/transient psychotic disorder

Delusional disorder (persistent delusional disorder)

Chronic hallucinatory psychosis

Psychotic symptoms may also occur with:

Schizotypal disorder

Certain personality disorders during stress (including paranoid personality disorder, schizoid personality disorder, and borderline personality disorder)

• Methamphetamine

  Methamphetamine causes psychosis in 26-46% of regular users. Some users develop long-term psychosis that lasts for more than six months. Individuals suffering from brief methamphetamine psychosis may experience a relapse of methamphetamine psychosis years after use, as a result of a stressful event such as prolonged insomnia or binge drinking. With long-term methamphetamine abuse and a history of methamphetamine psychosis, there is an increased risk of relapse into methamphetamine psychosis within a week of restarting methamphetamine use.

  Medications

  Using or stopping a large number of medications can trigger the development of psychotic symptoms. Substances that can induce psychosis in experimental settings and/or in large numbers of people include amphetamine and other sympathomimetics, dopamine agonists, ketamine, corticosteroids (often along with mood changes), and some anticonvulsants such as vigabatrin. Stimulants that can cause psychosis include lisdexamfetamine.

  Other

  A 2014 study found no risk of developing psychosis as a result of childhood abuse.

  Pathophysiology

  The first image of the brain of a person suffering from psychosis was obtained back in 1935 using the technique of pneumoencephalography (a painful and no longer used procedure in which cerebrospinal fluid is pumped out of the space around the brain and air is pumped in its place, allowing for a clearer image of the structure brain on x-ray). The main function of the brain is to collect information coming from the senses (about pain, hunger, etc.) and from the outside world, interpret this information into a coherent picture of the world, and implement an adequate response. Information from the senses goes to the primary sensory areas of the brain. Here it is processed and sent to secondary areas, in which this information is already interpreted. Spontaneous activity in the primary sensory areas can cause hallucinations, which the secondary areas perceive as information coming from the outside world. For example, a brain scan of a person who claims to hear voices may show activation of the primary auditory complex or areas of the brain involved in speech perception and understanding. The paracortex collects interpreted information from the secondary cortex and creates a coherent picture of the world from it. A study of structural changes in the brain in people with psychosis showed significant reductions in gray matter in the temporal lobe, inferior frontal gyrus and anterior cingulate cortex bilaterally in people before and after the onset of psychosis. These and similar studies have led to controversy over whether psychosis causes excitotoxic brain damage and whether potentially harmful changes in the brain are associated with the duration of the psychotic episode. Recent studies have shown no, but research is still being done. Research using sensory deprivation techniques has shown that brain function is dependent on signals from the outside world. When there is no balance between spontaneous brain activity and information from the senses, loss of contact with reality and psychosis may occur. A similar phenomenon in older people, when deterioration of vision, hearing and memory makes a person unnaturally suspicious of the surrounding space, is called paranoia. On the other hand, loss of contact with reality can also be observed if the spontaneous activity of the cerebral cortex increases, disturbing the balance with information from the senses. The 5-HT2A receptor plays an important role in this process, as psychedelics that activate this receptor can cause hallucinations. The main symptom of psychosis, however, is not hallucinations, but the inability to distinguish external from internal stimuli. Close relatives of psychotics may also hear voices, but they may recognize the unreality of these hallucinations and ignore them, not allowing them to interfere with their lives; thus, such people will not be diagnosed with psychosis. Traditionally, psychosis has been associated with the neurotransmitter dopamine. Specifically, the dopamine hypothesis of psychosis states that psychosis causes an excessive increase in dopamine activity in the brain, especially in the mesolimbic pathway. This theory is supported by the following facts. First, drugs that block the dopamine D2 receptor (antipsychotics) cause a decrease in psychotic symptoms, and second, drugs that increase dopamine activity (amphetamines and cocaine), on the contrary, increase psychosis in some people. Recently, however, there is growing evidence that psychosis may be influenced by possible disruption of the excitatory neurotransmitter glutamate, in particular with respect to NMDA receptor activity. This theory is supported by the fact that dissociative NMDA receptor antagonists such as ketamine, phencyclidine, and dextromethorphan (in large overdoses) cause significantly more rapid onset of psychosis than dopaminergic stimulants, even at “normal” recreational dosages. Symptoms of dissociative intoxication also have more in common with symptoms of schizophrenia, including negative psychotic symptoms, than amphetamine psychosis. Dissociative-induced psychosis is more severe and predictable than amphetamine psychosis, which is usually only seen with overdose, long-term use, or insomnia, which itself can precipitate psychosis. New antipsychotic drugs that target glutamate and its receptors are currently being tested. The relationship between dopamine and psychosis is believed to be complex. While the dopamine D2 receptor suppresses the activity of adenylate cyclase, the D1 receptor, on the contrary, increases it. When taking drugs that block D2 receptors, the blocked dopamine moves to D1 receptors. Increased adenylate cyclase activity does not immediately affect gene expression in the nerve cell, so it takes a week or two for the effects of antipsychotics to manifest themselves. Moreover, newer and equally effective antipsychotic drugs block slightly less dopamine in the brain than older drugs, blocking 5-HT2A receptors as well, so perhaps the “dopamine hypothesis” is too simplistic. Soyka and colleagues found that in alcoholic psychosis, normal functioning of the dopaminergic system is observed. Zoldan et al reported that ondansetron, a 5-HT3 receptor antagonist, is moderately effective in the treatment of levodopa-induced psychosis in parkinsonians. Psychiatrist David Healy has criticized pharmaceutical companies promoting biological theories of mental illness that justify the benefits of pharmaceutical treatments while ignoring the social and developmental factors that have a major influence on the etiology of psychosis. Some theories suggest that many symptoms of psychosis represent a problem with internally generated thoughts and experiences. For example, hallucinations associated with the perception of voices may arise as a result of speech generated within the person's consciousness, which is mistakenly perceived as speech coming from an external source. It has been suggested that in bipolar disorder there may be increased activity in the left hemisphere of the brain, while in schizophrenia there is increased activity in the right hemisphere. Increased activation of the right hemisphere of the brain is also observed in people who believe in paranormal phenomena and in people who have certain mystical experiences. Creative people also show a similar pattern of brain activation. Some researchers argue that this is not in any way proof that paranormal, mystical or creative experiences are themselves symptoms of a mental disorder, since it is still unclear why some experiences of this kind are perceived as positive and others as negative.

  Neurobiology

  In otherwise healthy individuals, exogenous ligands may cause psychotic symptoms. NMDA receptor antagonists, such as ketamine, can cause psychosis similar to schizophrenia. Long-term use of stimulants or high doses can alter the normal functioning of the brain, leading to a state similar to the manic phase of bipolar disorder. NMDA antagonists at subanesthetic doses (doses insufficient to produce anesthetic effects) cause some so-called “negative” symptoms of thought disorders and catatonia at high doses. Psychostimulants, especially in susceptible individuals, can cause “positive” symptoms such as delusions, particularly persecutory delusions.

  Diagnosis

  The diagnosis of psychosis is made only by excluding all other possible diagnoses. A new psychotic episode cannot be considered a symptom of a psychiatric disorder until all other possible causes of psychosis have been excluded. Many doctors miss this step, which leads to mistakes and misdiagnosis. The initial assessment includes obtaining a complete medical history and a physical examination performed by a physician. To rule out psychosis associated with substance abuse, medications, toxins, complications from surgery, or other medical conditions, it is necessary to conduct biological tests on the patient. Delirium should be excluded, which may include visual hallucinations, rapid onset, and fluctuations in consciousness, which indicate other underlying causes of psychosis, including medical conditions. Ruling out possible illnesses associated with psychosis is done using blood tests to measure:

  Level of thyroid-stimulating hormone to exclude the possibility of hypo- or hyperthyroidism,

  Serum levels of essential electrolytes and calcium to rule out metabolic disorders,

  A complete blood count, including erythrocyte sedimentation rate, to rule out the possibility of systemic infection or chronic disease

  Serology to rule out syphilis or HIV infection.

  Other studies:

  Electroencephalogram to rule out epilepsy

  MRI or CT scan of the head to rule out brain lesions.

  Because psychosis can be caused or exacerbated by certain medications, the possibility of substance-induced psychosis should be ruled out, especially if this is the first episode of psychosis. This type of psychosis can be excluded by using:

  Urine analysis

  Complete toxicological screening of blood serum.

  Because some dietary supplements may also cause psychosis or mania but cannot be detected by laboratory tests, the physician should ask family members, partners, or friends about whether the patient has used any dietary supplements. Common mistakes when diagnosing psychosis:

  Delirium cannot be ruled out

  No abnormalities in health status have been identified,

  The medical history and family history of the patient were not obtained,

  Indiscriminate screening

  Missed possibility of toxic psychosis because screening for substance and medication use was not performed

  Family members or others were not asked about the patient's use of dietary supplements,

  Early diagnosis

  The physician was unaware of the initial diagnosis of the primary psychiatric disorder.

  Only after other causes of psychosis have been ruled out can the physician make a psychiatric differential diagnosis using the patient's family history, additional information obtained from the patient and family members or friends. Types of psychosis in psychiatric illnesses can be established using formal rating scales. The Brief Psychiatric Rating Scale (BPRS) has 18 symptoms, such as hostility, suspiciousness, hallucinations, and grandiosity. The scale is completed based on a patient interview and observation of the patient’s behavior over the previous 2–3 days. The patient's family members can also answer questions about the patient's behavior. During the baseline and follow-up period, both positive and negative symptoms of psychosis will be assessed using 30-item scales.

  Preventing psychosis

  Evidence for the effectiveness of early intervention to prevent psychosis has been inconclusive. Although early intervention for people with a psychotic episode may improve short-term outcomes, after five years the benefit of such intervention is no longer noticeable. However, there is evidence that cognitive behavioral therapy can reduce the risk of developing psychosis in vulnerable people, and in 2014 the UK National Institute for Health and Care Excellence recommended the use of preventative cognitive behavioral therapy in people at increased risk of psychosis.

  Treatment

  Treatment for psychosis depends on the specific diagnosis (schizophrenia, bipolar disorder, or substance abuse). The first-line psychiatric treatment for many psychotic illnesses is antipsychotic medications, which can reduce the positive symptoms of psychosis within 7-14 days. Which specific antipsychotic to use depends on the benefits, risks, and price of the drug. It is controversial whether typical or atypical antipsychotics are better, but there is evidence that the most effective drugs are amisulpride, olanzapine, risperidone and clozapine. When used in low to moderate doses, typical antipsychotics have similar rates to atypical antipsychotics in terms of discontinuation rates and risk of symptom relapse. 40–50% of patients have a good response to treatment, 30–40% have a partial response, and 20% are treatment resistant (no satisfactory response after six weeks of use of two or three different antipsychotics). Clozapine is an effective treatment for patients who do not respond well to other medications (treatment-resistant or refractory schizophrenia), but the drug has the potentially serious side effect of agnarulocytosis (leukopenia), a decrease in the number of white blood cells that occurs in less than 4 people. % of people. Most people experience side effects when taking antipsychotics. Typical antipsychotics exhibit more extrapyramidal side effects, and atypical antipsychotics are associated with weight gain, diabetes, and risk of metabolic syndrome; This is most noticeable with olanzapine, while risperidone and quentiapine also cause weight gain. Risperidone has a similar side effect profile to haloperidol.

  Early Intervention

  Early intervention in psychosis should only be undertaken after a physician has determined that diagnosing and treating the patient early in the illness may improve long-term clinical outcome. With this approach, during the critical period (when therapy is most effective), intensive multidisciplinary therapy is used to prevent long-term clinical manifestations of the disease associated with chronic psychosis.

  Story

  The word “psychosis” entered psychiatric literature in 1841 thanks to Karl Friedrich Canstatt, who wrote the work Handbuch der Medizinischen Klinik. He used this word to refer to mental neurosis. At that time, the word “neurosis” meant any disease of the nervous system, and Canstatt referred to the psychological manifestations of brain disease. Another author of the term is Ernst von Feuchtersleben, who described psychosis in 1845 as an alternative name for insanity and mania. The name comes from the Medieval Latin term psychosis, "soul or life, living, coming to life", and from the Greek word ψυχή (psyche), "soul" with the addition of the suffix -ωσις (-osis), in this case meaning "anomaly". The word was also used to refer to a disease associated with mental illness, as opposed to neurosis, which was considered a disease of the nervous system. Thus, psychosis has become the modern equivalent of the outdated word “madness.” In 1891, Julius Koch used the word to mean “psychopathic abnormalities,” which Schneider later borrowed to mean “personality anomalies.” The division of the basic term “psychosis” into manic-depressive disorder (now called bipolar) and dementia praecox (schizophrenia) was carried out by Emil Kraepelin, who tried to unify the various mental disorders known by the 19th century, grouping diseases based on a classification of basic symptoms. Kraepelin used the term "manic-depressive insanity" to describe the full spectrum of mood disorders, in a broader sense than it is used today. According to Kraepelin's classification, the term "manic-depressive insanity" included unipolar clinical depression, bipolar disorder and other mood disorders such as cyclothymia. These disorders are characterized by difficulty controlling mood and psychotic episodes associated with mood changes, with patients often experiencing periods of normal functioning between psychotic episodes even without medication. Schizophrenia is characterized by psychotic episodes not associated with mood swings, with most patients not taking medication showing signs of mood swings between psychotic episodes.

  Treatment

  In ancient times, madness was considered the machinations of evil spirits. Archaeologists have discovered skulls with clearly marked sawed-out parts, some dating back to 5000 BC. It is believed that craniotomy was a common treatment for insanity in those days. Written evidence of supernatural causes and treatments for insanity is described in the New Testament. Mark 5:8-13 describes a man who, in modern parlance, had psychotic symptoms. Jesus Christ cured him of his "demon disease" by summoning demons from his soul and throwing them into a herd of pigs. Exorcism is still used in some religious circles as a treatment for psychosis. A study of laboratory patients in psychiatric clinics found that 30 percent of religious patients believed that their illness was caused by the machinations of the devil. Many of the patients have undergone exorcism treatments for insanity, which, although perceived as a positive experience by patients, have no effect on the symptoms of the disease. The results, however, showed a significant worsening of psychosis symptoms in the absence of medical treatment during involuntary forms of exorcism. Hippocrates wrote about natural, not supernatural, causes of disease. In his work on medicine, he presented a comprehensive explanation of health and disease, including insanity and other mental disorders. Hippocrates wrote: “People should know that in the brain, and only in the brain, our pleasures, joys, laughter, jokes, as well as our sorrows, pain, regrets and tears are created. With the help of the brain we think, see, hear and distinguish the beautiful from the ugly, the good from the bad, the pleasant from the unpleasant... The brain is responsible for madness or delirium, instills horror or fear in us... it is the cause of insomnia, unfortunate mistakes, senseless excitement, absent-mindedness and actions that are contrary to the usual." Hippocrates was a proponent of the humoral theory, believing that disease is the result of a shift in the balance of body fluids, such as blood, mucus, black bile and yellow bile. According to this theory, each fluid or "humour" has a fusion effect on temperament and behavior. Symptoms of psychosis, for example, were thought to be associated with excess black and yellow bile. Thus, bloodletting was recommended for the surgical treatment of psychosis or mania. Benjamin Rush, an 18th-century physician, educator, and “founder of American psychiatry,” also recommended bloodletting to his patients as a first-line treatment for psychosis. Although not a supporter of the humoral theory, Rush, however, believed that active cleansing and bloodletting were effective means for correcting disturbances in the body's circulatory systems, which, in his opinion, was the main cause of "madness." Although Rush's treatment methods are considered outdated and wild today, his contributions to psychiatry, namely the biological interpretation of psychiatric phenomena such as psychosis, are considered invaluable. In honor of his achievements, Rush's image appears on the official seal of the American Psychiatric Association. In the early 20th century, treatments for long-term severe psychosis focused primarily on nervous system suppression. Such methods included insulin shock therapy, cardiazol shock therapy, and electroconvulsive therapy. Despite the significant risks, shock therapy was considered a highly effective treatment for psychosis, including schizophrenia. The use of such risky treatments has led to the development of more invasive methods such as psychosurgery. In 1888, Swiss psychiatrist Gottlieb Burckhardt performed the world's first sanctioned medical psychosurgical operation to remove the cerebral cortex. Although some patients showed improvement in symptoms, one patient died and some developed aphasia and/or epilepsy. Burkhardt published his clinical findings in a scientific paper. The work was criticized by the scientific community, and the scientist's academic and surgical ambitions were ignored. In the late 1930s, Egas Moniz came up with a procedure called leucotomy (prefrontal lobotomy), which removed the fibers connecting the frontal lobes to the rest of the brain. Moniz was inspired by a 1935 experiment demonstrated by neuroscientists John Fulton and Carlyle, in which two chimpanzees were subjected to leucotomy and their behavior before and after the operation was compared. Before leucotomy, subjects exhibited typical chimpanzee behavior, including throwing excrement and fighting. After the procedure, both animals became calmer and less cruel to their relatives. During the interview, Morisch asked the scientists if a similar procedure could be performed on humans, a question that stunned Fulton. Moniz went further and began testing this procedure on people suffering from various psychotic disorders, for which he received the 1949 Nobel Prize. In the late 1930s and early 1970s, leucotomy was a common practice and was often performed in nonsterile settings, such as small outpatient clinics or patients' homes. Until the discovery of antipsychotic drugs in the 1950s, psychosurgery remained a common practice. The first clinical trial of antipsychotics (also known as antipsychotics) for the treatment of psychosis was carried out in 1952. Chlorpromazine (brand name Thorazine) was clinically tested and became the first antipsychotic drug approved for the treatment of short-term and chronic psychosis. Although the mechanism of action of the drug was not studied until 1963, chlorpromazine marked the emergence of the class of dopamine antagonists, or first-generation antipsychotics. Despite its high clinical effectiveness in the treatment of psychosis or diseases with psychotic symptoms, the drug had a huge number of side effects, some of which, such as parkinsonian symptoms such as tardive dyskinesia, were particularly serious. The advent of atypical antipsychotics (second-generation antipsychotics) has been associated with the advent of dopamine antagonists with comparable efficacy, but with a different (also serious) side effect profile, including a lower risk of developing parkinsonian symptoms, but an increased risk of developing cardiovascular disease. Atypical antipsychotics remain the first-line treatment for a variety of psychiatric and neurological diseases, including schizophrenia, major depressive disorder, bipolar disorder, anxiety disorders, dementia and some activity spectrum disorders. We know that dopamine is the primary neurotransmitter involved in psychotic symptoms. Thus, blocking dopamine receptors (namely dopamine D2 receptors) and reducing dopaminergic activity is an effective, but very crude way to treat psychosis. New data from pharmacological studies show that a decrease in dopaminergic activity is not associated with a complete eradication of symptoms of psychosis such as hallucinations and delusions, but with a mitigation of the reward mechanisms involved in the development of delusions; thus, connecting or finding meaningful connections between unrelated stimuli or ideas. The author of this study, Shitizh Kapoor, also speaks of the importance of future research: “The presented model is based on incomplete knowledge about dopamine, schizophrenia and antipsychotics—thus, obtaining a complete picture requires the use of all the knowledge and resources available to us.”

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

So what is psychosis?

This is a mental disorder in which reality is so distorted in a person’s mind that this “picture” no longer has anything in common with what other people see. What prevents a person from being objective is constant fear for his life, voices in his head that order him to do something, visions that are no longer available to anyone... These internal prisms change the patient’s behavior. His reactions become completely inadequate: causeless laughter or tears, anxiety or euphoria. Psychosis manifests itself differently in all patients. Some are confident that the special services are hunting for them, others assure others of their superpowers, and still others persistently pursue the object of their love, groundlessly laying claim to it. It is impossible to list all the manifestations of psychosis, but psychiatrists managed to systematize them by combining them into groups.

Psychosis is not just a wrong train of thought. There is no need to think that the sick person is mistaken or cannot keep his nerves under control. There is no point in arguing, much less condemning him. Psychosis is the same disease as diabetes. This is also a metabolic disorder, but only in the brain. You are not afraid of diabetics, you do not judge them for their disease. You sympathize with them. Patients with neurosis deserve the same treatment. By the way, scientists have proven that mentally healthy people commit crimes more often than people with psychosis.

You shouldn't put a mark on a person. Psychosis is not a life sentence. It happens that after a period of illness, which can be quite severe, the psyche is completely restored and problems never arise again. But more often the disease is cyclical. In this case, after a long period of health, an exacerbation occurs: hallucinations and delusional ideas appear. This happens if you do not strictly follow the recommendations of your doctor. In severe cases, the disease becomes chronic, and mental health does not return.

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

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

If you or someone close to you shows signs of psychosis, do not despair. Modern medicine successfully copes with this disease. And the infamous “registration” was replaced by a consultation with a local psychiatrist - advisory and therapeutic assistance. Therefore, the fact of treatment will not ruin your future life. But attempts to cope with the disease on your own can lead to irreparable changes in the psyche and disability.

Causes of psychosis

If the mitochondria do not produce ATP, the pump does not work. As a result, the vital activity of the cell is disrupted. This neuron remains “hungry” and experiences oxygen deficiency, despite the fact that the person eats normally and spends enough time in the fresh air.

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

Factors and pathologies that lead to psychosis

1. Bad heredity.

   There is a group of genes that are passed on from parents to children. These genes control the brain's sensitivity to external influences and signaling substances. For example, the neurotransmitter dopamine, which causes feelings of pleasure. People with a family history are more susceptible to the influence of negative factors than others, be it illness or psychological trauma. Their psychosis develops at an early age, quickly and in severe form.

   If both parents are sick, the child has a 50% chance of developing psychosis. If only one of the parents is sick, then the risk for the child is 25%. If the parents did not suffer from psychosis, then their children may also face the same problem, having received “defective genes” from previous generations.

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

Risk factors for psychosis

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

Manic-depressive psychosis most often affects young, active people. At this age, fateful changes occur that place a heavy burden on the psyche. This means entering a university, finding a job, starting a family.

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

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

Gender factor

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

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

Geographical factor

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

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

Social factor

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

• women who did not marry and did not give birth to a child;
• men who were unable to build a career or achieve success in society;
• people who are not happy with their social status, were unable to demonstrate their inclinations and abilities, and chose a profession that does not suit their interests.

Factor of psychophysiological constitution

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

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

How psychosis manifests itself

Main manifestations of psychosis

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

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

• He suddenly freezes and listens for something;
• Sudden silence mid-sentence;
• Conversation with oneself in the form of replicas to someone else’s phrases;
• Laughter or depression for no apparent reason;
• The person cannot concentrate on a conversation with you and is staring at something.

1. Manifestations of depressive disorders:
   • A person sits in one position for a long time; he has no desire or strength to move or communicate.
   • Pessimistic attitude, the patient is dissatisfied with his past, present, future and the entire environment.
   • To relieve anxiety, a person can eat constantly or, conversely, give up eating completely.
   • Sleep disturbances, early awakenings at 3-4 o'clock. It is at this time that mental suffering is most severe, which can lead to a suicide attempt.
2. Manifestations of manic disorders:
   • The person becomes extremely active, moves a lot, sometimes aimlessly.
   • Unprecedented sociability and verbosity appear, speech becomes fast, emotional, and may be accompanied by grimacing.
   • An optimistic attitude; a person does not see problems or obstacles.
   • The patient makes unrealistic plans and significantly overestimates his strength.
   • The need for sleep decreases, the person sleeps little, but feels alert and rested.
   • The patient may abuse alcohol and engage in promiscuous sex.

Delusion is a thinking disorder that manifests itself in the form of ideas that do not correspond to reality. A distinctive feature of delusion is that you cannot convince a person using logical arguments. In addition, the patient always tells his delusional ideas very emotionally and is firmly convinced that he is right.

Distinctive signs and manifestations of delirium

• Delusion is very different from reality. Incomprehensible, mysterious statements appear in the patient’s speech. They may concern his guilt, doom, or, conversely, greatness.
• The patient's personality always takes center stage. For example, a person not only believes in aliens, but also claims that they arrived specifically to establish contact with him.
• Emotionality. A person talks about his ideas very emotionally and does not accept objections. He does not tolerate arguments about his idea and immediately becomes aggressive.
• Behavior is subordinated to a delusional idea. For example, he may refuse to eat, fearing that they want to poison him.
• Unreasonable defensive actions. A person curtains the windows, installs additional locks, and fears for his life. These are manifestations of delusions of persecution. A person is afraid of special services that monitor him with the help of innovative equipment, aliens, “black” magicians who send damage to him, acquaintances who weave conspiracies around him.
• Delusions related to one's own health (hypochondriacal). The person is convinced that he is seriously ill. He “feels” the symptoms of the disease and insists on numerous repeated examinations. He is angry with doctors who cannot find the cause of his poor health and do not confirm his diagnosis.
• Delirium of damage manifests itself in the belief that ill-wishers spoil or steal things, add poison to food, influence with radiation, or want to take away an apartment.
• Nonsense of invention. A person is confident that he has invented a unique device, a perpetual motion machine, or a method of combating a dangerous disease. He fiercely defends his invention and persistently tries to bring it to life. Since patients are not mentally impaired, their ideas can sound quite convincing.
• Delirium of love and delirium of jealousy. A person concentrates on his emotions, pursues the object of his love. He comes up with reasons for jealousy, finds evidence of betrayal where there is none.
• Nonsense of litigiousness. The patient inundates various authorities and the police with complaints about his neighbors or organizations. Files numerous lawsuits.

1. Lethargy or stupor. A person freezes in one position and remains motionless for a long time (days or weeks). He refuses food and communication.


2. Motor excitement. Movements become fast, jerky, and often aimless. Facial expressions are very emotional, the conversation is accompanied by grimaces. Can mimic other people's speech and imitate animal sounds. Sometimes a person is unable to perform simple tasks because he loses control of his movements.

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

Convince the person to seek help from a psychiatrist. Explain that the doctor will prescribe medications that will help you calm down and make it easier to endure stressful situations.
Types of psychoses

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

Manic psychosis

Depressive psychosis

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

1. Pathologically low mood

   Thoughts are centered around your personality, your mistakes and your shortcomings. Concentrating on one’s own negative sides gives rise to the belief that everything was bad in the past, the present cannot please anyone, and in the future everything will be even worse than now. On this basis, a person with depressive psychosis can commit suicide.

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

   A sick person experiences causeless melancholy, it presses and oppresses. It is noteworthy that he can practically show with his finger where the unpleasant sensations are concentrated, where the “soul hurts.” Therefore, this condition even received a name - pre-cardiac melancholy.

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

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

2. Mental retardation

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

   As a result of a deficiency of neurotransmitters, memory, reaction, and thinking deteriorate. A person gets tired quickly, doesn’t want to do anything, nothing interests him, doesn’t surprise or make him happy. You can often hear them say, “I envy other people. They can work, relax, have fun. It’s a pity that I can’t do that.”

   The patient always looks gloomy and sad. The gaze is dull, unblinking, the corners of the mouth are downcast, avoids communication, tries to retire. He reacts slowly to calls, answers in monosyllables, reluctantly, in a monotonous voice.

3. Physical inhibition

   Depressive psychosis physically changes a person. Appetite drops and the patient quickly loses weight. Therefore, weight gain during depression indicates that the patient is getting better.

   A person’s movements become extremely slow: a slow, uncertain gait, hunched shoulders, a lowered head. The patient feels a loss of strength. Any physical activity causes the condition to worsen.

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

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

   Basic rules for communicating with patients with psychosis

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

   Psychological treatments for psychosis

   In psychosis, psychological methods successfully complement drug treatment. A psychotherapist can help a patient:
   • reduce symptoms of psychosis;
   • avoid recurrent attacks;
   • increase self-esteem;
   • learn to adequately perceive the surrounding reality, correctly assess the situation, your condition and react accordingly, correct behavioral errors;
   • eliminate the causes of psychosis;
   • increase the effectiveness of drug treatment.
   Remember, psychological methods of treating psychosis are used only after the acute symptoms of psychosis have been relieved.

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

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

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

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

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

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

   Psychoeducation– this is the education of the patient and his family members. The psychotherapist talks about psychosis, the characteristics of this disease, the conditions for recovery, motivates to take medications and lead a healthy lifestyle. Tells relatives how to behave correctly with the patient. If you disagree with something or have questions, be sure to ask them in the time designated for discussion. It is very important for the success of treatment that you have no doubts.

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

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

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

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

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

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

   Family therapy – group therapy, during which a specialist conducts sessions with family members where the person with psychosis lives. Therapy is aimed at eliminating conflicts in the family, which can cause exacerbations of the disease. The doctor will talk about the peculiarities of the course of psychosis and the correct models of behavior in crisis situations. Therapy is aimed at preventing relapses and ensuring that all family members can live comfortably together.

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

   Specific setting of goals and achievement of simple goals gives the patient confidence that he again becomes the master of his life.

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

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

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

   Drug treatment of psychosis

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

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

   Treatment of manic psychosis

   Group of drugs	Mechanism of treated action	Representatives	How is it prescribed?
   Antipsychotic drugs (neuroleptics)	Used for all forms of psychosis. Block dopamine-sensitive receptors. This substance is a neurotransmitter that promotes the transfer of excitation between brain cells. Thanks to the action of neuroleptics, it is possible to reduce the severity of delusions, hallucinations and thought disorders.	Solian (effective for negative disorders: lack of emotions, withdrawal from communication)	In the acute period, 400-800 mg/day is prescribed, with a maximum of 1200 mg/day. Take regardless of meals. Maintenance dose 50-300 mg/day.
   		Zeldox	40-80 mg 2 times a day. The dose is increased over 3 days. The drug is prescribed orally after meals.
   		Fluanxol	The daily dose is 40-150 mg/day, divided into 4 times. The tablets are taken after meals. The drug is also available in the form of an injection solution, which is given once every 2-4 weeks.
   Benzodiazepines	Prescribed for acute manifestations of psychosis together with antipsychotic drugs. They reduce the excitability of nerve cells, have a calming and anticonvulsant effect, relax muscles, eliminate insomnia, and reduce anxiety.	Oxazepam	Take 5-10 mg twice or thrice a day. If necessary, the daily dose can be increased to 60 mg. The drug is taken regardless of food, washed down with a sufficient amount of water. Duration of treatment is 2-4 weeks.
   		Zopiclone	Take 7.5-15 mg 1 time per day half an hour before bedtime, if psychosis is accompanied by insomnia.
   Mood stabilizers (mood stabilizers)	They normalize mood, preventing the onset of manic phases, and make it possible to control emotions.	Actinerval (a derivative of carbamazepine and valproic acid)	The first week, the daily dose is 200–400 mg, divided into 3-4 times. Every 7 days, the dose is increased by 200 mg, bringing it to 1 g. The drug is also discontinued gradually so as not to cause a worsening of the condition.
   		Contemnol (contains lithium carbonate)	Take 1 g per day once in the morning after breakfast, with a sufficient amount of water or milk.
   Anticholinergic drugs (cholinergic blockers)	Necessary to neutralize side effects after taking antipsychotics. Regulates the sensitivity of nerve cells in the brain by blocking the action of the mediator acetylcholine, which ensures the transmission of nerve impulses between cells of the parasympathetic nervous system.	Cyclodol, (Parkopan)	The initial dose is 0.5-1 mg/day. If necessary, it can be gradually increased to 20 mg/day. Frequency of administration: 3-5 times a day, after meals.

   Treatment of depressive psychosis

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

   
   Let us remember that any independent change in dose can have very serious consequences. Reducing the dosage or stopping taking medications causes an exacerbation of psychosis. Increasing the dose increases the risk of side effects and addiction.

   Prevention of psychosis

   What needs to be done to prevent another attack of psychosis?

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

   • Drug therapy– the main point of prevention of psychosis. If you have difficulty taking your medications on a daily basis, talk to your doctor about switching to a depot form of your antipsychotic medications. In this case, it will be possible to give 1 injection every 2-4 weeks.

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

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

     
     

     What is postpartum psychosis?

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

     Manifestations of postpartum psychosis.

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

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

     Causes of postpartum psychosis.

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

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

     Treatment of postpartum psychosis.

     Treatment must be started as soon as possible because the woman’s condition is rapidly deteriorating. If there is a risk of suicide, the woman will be treated in a psychiatric department. While she is taking medications, the baby cannot be breastfed, since most drugs pass into mother's milk. But communication with the child will be useful. Taking care of the baby (provided that the woman herself wants it) helps to normalize the state of the psyche.

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

     For mental and motor agitation and manifestations of manic syndrome, lithium preparations (Lithium Carbonate, Micalite) and antipsychotics (Clozapine, Olanzapine) are needed.

     Psychotherapy for postpartum psychosis is used only after acute manifestations have been eliminated. It is aimed at identifying and resolving conflicts that led to mental disorders.

     What is reactive psychosis?

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

     Mental disorders occur after a strong shock: a disaster, attack by criminals, fire, collapse of plans, career failure, divorce, illness or death of a loved one. In some cases, psychosis can also be triggered by positive events that cause an outburst of emotions.

     Emotionally unstable people, those who have suffered a bruise or concussion, severe infectious diseases, or whose brains have been damaged by alcohol or drug intoxication are especially at risk of developing reactive psychosis. As well as teenagers going through puberty and women going through menopause.

     Manifestations of reactive psychosis.

     Symptoms of psychosis depend on the nature of the injury and the form of the disease. The following forms of reactive psychosis are distinguished:

     • psychogenic depression;
     • psychogenic paranoid;
     • hysterical psychosis;
     • psychogenic stupor.
     Psychogenic depression manifests itself as tearfulness and depression. At the same time, these symptoms may be accompanied by short temper and grumpiness. This form is characterized by the desire to arouse pity and draw attention to one’s problem. Which could end in a demonstrative suicide attempt.

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

     Hysterical psychosis has several forms.

     1. Delusional fantasies – delusional ideas that relate to greatness, wealth, persecution. The patient tells them very theatrically and emotionally. Unlike delusion, a person is not sure of his words, and the essence of the statements changes depending on the situation.
     2. Ganser syndrome patients do not know who they are, where they are, or what year it is. They answer simple questions incorrectly. They perform illogical actions (eating soup with a fork).
     3. Pseudo-dementia – short-term loss of all knowledge and skills. A person cannot answer the simplest questions, show where his ear is, or count his fingers. He is capricious, grimaces, and cannot sit still.
     4. Puerilism syndrome – an adult develops childish speech, childish emotions, and childish movements. It may develop initially or as a complication of pseudodementia.
     5. The "feral" syndrome – human behavior resembles the habits of an animal. Speech gives way to a growl, the patient does not recognize clothes and cutlery, and moves on all fours. This condition, if unfavorable, can replace puerilism.
     Psychogenic stupor– after a traumatic situation, a person loses the ability to move, speak and react to others for some time. The patient may lie in the same position for weeks until he is turned over.

     Treatment of reactive psychosis.

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

     At reactive depression antidepressants are prescribed: Imipramine 150-300 mg per day or Sertraline 50-100 mg once a day after breakfast. Therapy is supplemented with tranquilizers Sibazon 5-15 mg/day or Phenazepam 1-3 mg/day.

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

     Psychotherapy can free a person from excessive fixation on a traumatic situation and develop defense mechanisms. However, it is possible to begin consultations with a psychotherapist only after the acute phase of psychosis has passed and the person has regained the ability to accept the specialist’s arguments.

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

   Russian Academy of Medical Sciences
   RESEARCH CENTER FOR MENTAL HEALTH

   MOSCOW
   2004

   Oleychik I.V. - Candidate of Medical Sciences, Head of the Scientific Information Department of the National Center for Mental Health of the Russian Academy of Medical Sciences, Senior Researcher of the Department for the Study of Endogenous Mental Disorders and Affective States

   2004, Oleychik I.V.
   2004, Scientific Center for Public Health of the Russian Academy of Medical Sciences

   WHAT ARE PSYCHOSES

   The purpose of this brochure is to convey in the most accessible form to all interested people (primarily relatives of patients) modern scientific information about the nature, origin, course and treatment of such serious diseases as psychosis.

   Psychoses (psychotic disorders) are understood as the most striking manifestations of mental illnesses, in which the patient’s mental activity does not correspond to the surrounding reality, the reflection of the real world in the mind is sharply distorted, which manifests itself in behavioral disorders, the appearance of abnormal pathological symptoms and syndromes.

   Most often, psychoses develop within the framework of so-called “endogenous diseases” (Greek. endo- inside,genesis- origin). A variant of the occurrence and course of a mental disorder due to the influence of hereditary (genetic) factors, which include: schizophrenia, schizoaffective psychosis, affective diseases (bipolar and recurrent depressive disorder). The psychoses that develop with them are the most severe and protracted forms of mental suffering.

   The concepts of psychosis and schizophrenia are often equated, which is fundamentally wrong, since psychotic disorders can occur in a number of mental illnesses: Alzheimer's disease, senile dementia, chronic alcoholism, drug addiction, epilepsy, mental retardation, etc.

   A person can suffer a transient psychotic state caused by taking certain medications, drugs, or the so-called psychogenic or “reactive” psychosis that occurs as a result of exposure to severe mental trauma (stressful situation with a danger to life, loss of a loved one, etc.). Often there are so-called infectious (developing as a result of a severe infectious disease), somatogenic (caused by severe somatic pathology, such as myocardial infarction) and intoxication psychoses. The most striking example of the latter is delirium tremens - “delirium tremens”.

   Psychotic disorders are a very common type of pathology. Statistical data in different regions differ from each other, which is associated with different approaches and capabilities for identifying and accounting for these sometimes difficult to diagnose conditions. On average, the frequency of endogenous psychoses is 3-5% of the population.

   Accurate information about the prevalence of exogenous psychoses among the population (Greek. exo- outside, genesis- origin. There is no option for the development of a mental disorder due to the influence of external causes located outside the body, and this is explained by the fact that most of these conditions occur in patients with drug addiction and alcoholism.

   The manifestations of psychosis are truly limitless, which reflects the richness of the human psyche. The main manifestations of psychosis are:

   • hallucinations(depending on the analyzer, auditory, visual, olfactory, gustatory, and tactile are distinguished). Hallucinations can be simple (bells, noise, calls) or complex (speech, scenes). The most common are auditory hallucinations, the so-called “voices,” which a person can hear coming from outside or sounding inside the head, and sometimes the body. In most cases, voices are perceived so clearly that the patient does not have the slightest doubt about their reality. Voices can be threatening, accusing, neutral, imperative (commanding). The latter are rightfully considered the most dangerous, since patients often obey the orders of voices and commit acts that are dangerous to themselves or others.

   crazy ideas- judgments, conclusions that do not correspond to reality, completely take over the patient’s consciousness, and cannot be corrected by dissuading and explaining. The content of delusional ideas can be very diverse, but the most common are: delusions of persecution (patients believe that they are being spied on, they want to kill them, intrigues are woven around them, conspiracies are being organized), delusions of influence (by psychics, aliens, intelligence agencies with the help radiation, radiation, “black” energy, witchcraft, damage), delusions of damage (they add poison, steal or spoil things, want to survive from the apartment), hypochondriacal delusions (the patient is convinced that he is suffering from some kind of disease, often terrible and incurable, stubbornly proves that his internal organs are damaged and requires surgical intervention). There are also delusions of jealousy, invention, greatness, reformism, other origins, love, litigious, etc.

   movement disorders, manifested in the form of inhibition (stupor) or agitation. When stupor occurs, the patient freezes in one position, becomes inactive, stops answering questions, looks at one point, and refuses to eat. Patients in a state of psychomotor agitation, on the contrary, are constantly on the move, talk incessantly, sometimes grimace, mimic, are foolish, aggressive and impulsive (they commit unexpected, unmotivated actions).

   mood disorders manifested by depressive or manic states. Depression is characterized, first of all, by low mood, melancholy, depression, motor and intellectual retardation, disappearance of desires and motivations, decreased energy, a pessimistic assessment of the past, present and future, ideas of self-blame, and thoughts of suicide. A manic state is manifested by unreasonably elevated mood, acceleration of thinking and motor activity, overestimation of one’s own capabilities with the construction of unrealistic, sometimes fantastic plans and projections, disappearance of the need for sleep, disinhibition of drives (abuse of alcohol, drugs, promiscuity).

   All of the above manifestations of psychosis belong to the circle positive disorders, so named because the symptoms that appear during psychosis seem to be added to the pre-morbid state of the patient’s psyche.

   Unfortunately, quite often (though not always) a person who has suffered psychosis, despite the complete disappearance of his symptoms, develops so-called negative disorders, which in some cases lead to even more serious social consequences than the psychotic state itself. Negative disorders are so called because patients experience a change in character, personal properties, and a loss of powerful layers from the psyche that were previously inherent in it. Patients become lethargic, lack initiative, and passive. Often there is a decrease in energy tone, the disappearance of desires, motivations, aspirations, an increase in emotional dullness, isolation from others, a reluctance to communicate and enter into any social contacts. Often their previously inherent responsiveness, sincerity, and sense of tact disappear, and irritability, rudeness, quarrelsomeness, and aggressiveness appear. In addition, patients develop thinking disorders that become unfocused, amorphous, rigid, and meaningless. Often these patients lose their previous work skills and abilities so much that they have to register for disability.

   1. COURSE AND PROGNOSIS OF PSYCHOSES

   The most common type (especially with endogenous diseases) is the periodic type of psychosis with acute attacks of the disease occurring from time to time, both provoked by physical and psychological factors, and spontaneous. It should be noted that there is also a single-attack course, observed more often in adolescence. Patients, having suffered one, sometimes protracted attack, gradually recover from the painful state, restore their ability to work and never come to the attention of a psychiatrist. In some cases, psychoses can become chronic and develop into a continuous course without disappearance of symptoms throughout life.

   In uncomplicated and unadvanced cases, inpatient treatment usually lasts one and a half to two months. This is exactly the period doctors need to fully cope with the symptoms of psychosis and select the optimal supportive therapy. In cases where the symptoms of the disease turn out to be resistant to drugs, several courses of therapy are required, which can delay the hospital stay for up to six months or more. The main thing that the patient’s relatives need to remember is not to rush the doctors, do not insist on an urgent discharge “on receipt”! It takes a certain time to completely stabilize the condition, and by insisting on early discharge, you risk getting an undertreated patient, which is dangerous for both him and you.

   One of the most important factors influencing the prognosis of psychotic disorders is the timeliness of initiation and intensity of active therapy in combination with social and rehabilitation measures.

   1. WHO ARE THEY - THE MINDALLY ILL?

   Over the centuries, a collective image of a mentally ill person has formed in society. Unfortunately, in the minds of many people, he is still an unkempt, unshaven man with a burning gaze and an obvious or secret desire to attack others. They fear the mentally ill because, supposedly, “it is impossible to understand the logic of their actions.” Mental illnesses are considered to be sent down from above, strictly inherited, incurable, contagious, leading to dementia. Many believe that the cause of mental illness is difficult living conditions, prolonged and severe stress, complex family relationships, and lack of sexual contact. Mentally ill people are considered either “weaklings” who simply cannot pull themselves together or, going to the other extreme, sophisticated, dangerous and ruthless maniacs who commit serial and mass murders and sexual violence. It is believed that people suffering from mental disorders do not consider themselves sick and are unable to think about their treatment.

   Unfortunately, the relatives of the patient often internalize the views typical in society and begin to treat the unfortunate person in accordance with the prevailing misconceptions in society. Often, families into which a mentally ill person appears try at all costs to hide their misfortune from others and thereby aggravate it even more, dooming themselves and the patient to isolation from society.

   Mental disorder is a disease like any other. There is no reason to be ashamed that this disease runs in your family. The disease is of biological origin, i.e. occurs as a result of metabolic disorders of a number of substances in the brain. Suffering from a mental disorder is much the same as having diabetes, peptic ulcers, or other chronic illness. Mental illness is not a sign of moral weakness. Mentally ill people cannot eliminate the symptoms of their illness through willpower, just as it is impossible to improve their vision or hearing through willpower. Mental illnesses are not contagious. The disease is not transmitted by airborne droplets or other means of infection, so it is impossible to get psychosis by closely communicating with the patient. According to statistics, cases of aggressive behavior among mentally ill people are less common than among healthy people. The heredity factor in patients with mental illness manifests itself in the same way as in patients with cancer or diabetes mellitus. If two parents are sick, the child gets sick in about 50% of cases; if one parent is sick, the risk is 25%. Most people with mental disorders understand that they are ill and seek treatment, although in the initial stages of the illness it is difficult for a person to accept it. A person's ability to make decisions about his or her own treatment is greatly enhanced if family members are involved and approve and support their decisions. And, of course, we should not forget that many brilliant or famous artists, writers, architects, musicians, and thinkers suffered from serious mental disorders. Despite the serious illness, they managed to enrich the treasury of human culture and knowledge, immortalizing their name with the greatest achievements and discoveries.

   SIGNS OF BEGINNING DISEASE OR EXCERNSATION

   For relatives whose loved ones suffer from one or another mental disorder, information about the initial manifestations of psychosis or symptoms of the advanced stage of the disease may be useful. All the more useful may be recommendations on some rules of behavior and communication with a person in a painful condition. In real life, it is often difficult to immediately understand what is happening to your loved one, especially if he is scared, suspicious, distrustful and does not directly express any complaints. In such cases, only indirect manifestations of mental disorders can be noticed. Psychosis can have a complex structure and combine hallucinatory, delusional and emotional disorders (mood disorders) in various proportions. The following symptoms may appear during the disease, all without exception, or individually.

   Manifestations of auditory and visual hallucinations:

   Conversations with oneself that resemble a conversation or remarks in response to someone else's questions (excluding comments out loud like “Where did I put my glasses?”).

   Laughter for no apparent reason.

   Sudden silence, as if a person is listening to something.

   Alarmed, preoccupied look; inability to concentrate on the topic of conversation or a specific task.

   The impression that your relative sees or hears something that you cannot perceive.

   The appearance of delirium can be recognized by the following signs:

   Changed behavior towards relatives and friends, the appearance of unreasonable hostility or secrecy.

   Direct statements of implausible or dubious content (for example, about persecution, about one’s own greatness, about one’s irredeemable guilt.)

   Protective actions in the form of curtaining windows, locking doors, obvious manifestations of fear, anxiety, panic.

   Expressing, without obvious grounds, fears for one’s life and well-being, or for the life and health of loved ones.

   Separate, meaningful statements that are incomprehensible to others, adding mystery and special significance to everyday topics.

   Refusal to eat or careful checking of food contents.

   Active litigious activity (for example, letters to the police, various organizations with complaints about neighbors, co-workers, etc.).

   How to respond to the behavior of a person suffering from delusions:

   Do not ask questions that clarify the details of delusional statements and statements.

   Do not argue with the patient, do not try to prove to your relative that his beliefs are wrong. Not only does this not work, but it can also worsen existing disorders.

   If the patient is relatively calm, inclined to communicate and help, listen carefully, reassure him and try to persuade him to see a doctor.

   Suicide Prevention

   In almost all depressive states, thoughts of not wanting to live may arise. But depression accompanied by delusions (for example, guilt, impoverishment, incurable somatic illness) is especially dangerous. At the height of the severity of the condition, these patients almost always have thoughts of suicide and suicidal readiness.

   The following signs warn of the possibility of suicide:

   The patient’s statements about his uselessness, sinfulness, and guilt.

   Hopelessness and pessimism about the future, reluctance to make any plans.

   The patient's conviction that he has a fatal, incurable disease.

   Sudden calming of the patient after a long period of sadness and anxiety. Others may have the false impression that the patient's condition has improved. He puts his affairs in order, for example, writes a will or meets with old friends whom he has not seen for a long time.

   Preventive action:

   Take any conversation about suicide seriously, even if it seems unlikely to you that the patient might try to commit suicide.

   If you get the impression that the patient is already preparing for suicide, do not hesitate to immediately seek professional help.

   Hide dangerous objects (razors, knives, pills, ropes, weapons), carefully close windows and balcony doors.

   YOUR RELATIVE IS ILL

   All members of the family where a mentally ill person appears initially experience confusion, fear, and do not believe what happened. Then the search for help begins. Unfortunately, very often people first turn not to specialized institutions where they can get advice from a qualified psychiatrist, but, at best, to doctors of other specialties, at worst - to healers, psychics, and specialists in the field of alternative medicine. The reason for this is a number of existing stereotypes and misconceptions. Many people have a mistrust of psychiatrists, which is associated with the problem of the so-called “Soviet punitive psychiatry” artificially inflated by the media during the years of perestroika. Most people in our country still associate a consultation with a psychiatrist with various serious consequences: registration at a psychoneurological dispensary, loss of rights (limitation of the ability to drive vehicles, travel abroad, carry weapons), the threat of loss of prestige in the eyes of others, social and professional discredit. Fear of this kind of stigma, or, as they now say, “stigma”, conviction in the purely somatic (for example, neurological) origin of their suffering, confidence in the incurability of mental disorders by the methods of modern medicine and, finally, simply a lack of understanding of the painful nature of their condition force people to people and their relatives categorically refuse any contact with psychiatrists and psychotropic therapy - the only real opportunity to improve their condition. It should be emphasized that after the adoption in 1992 of the new Law of the Russian Federation “On psychiatric care and guarantees of the rights of citizens in its provision,” most of the above fears are unfounded.

   The infamous “registration” was abolished ten years ago, and currently a visit to a psychiatrist does not threaten negative consequences. Nowadays, the concept of “accounting” has been replaced by the concepts of advisory and medical care and dispensary observation. The advisory population includes patients with mild and short-term mental disorders. Help is provided to them if they independently and voluntarily go to the dispensary, at their request and with their consent. Minor patients under the age of 15 are provided with assistance at the request or with the consent of their parents or legal representatives of their rights. The dispensary observation group includes patients suffering from severe, persistent or frequently exacerbating mental disorders. Dispensary observation can be established by a decision of a commission of psychiatrists, regardless of the consent of the person suffering from a mental disorder, and is carried out through regular examinations by doctors of psychoneurological dispensaries (PND). Dispensary observation is terminated upon condition of recovery or significant and persistent improvement in the patient’s condition. As a rule, observation is stopped if there are no exacerbations for five years.

   It should be noted that often when the first signs of mental disorder appear, concerned relatives assume the worst - schizophrenia. Meanwhile, as already mentioned, psychoses have other causes, so each patient requires a thorough examination. Sometimes delay in seeing a doctor is fraught with the most severe consequences (psychotic conditions that develop as a result of a brain tumor, stroke, etc.). To identify the true cause of psychosis, consultation with a qualified psychiatrist using the most complex high-tech methods is necessary. This is also why turning to alternative medicine, which does not have the full arsenal of modern science, can lead to irreparable consequences, in particular, to an unjustified delay in bringing the patient to the first consultation with a psychiatrist. As a result, the patient is often brought to the clinic by ambulance in a state of acute psychosis, or the patient is examined in an advanced stage of mental illness, when time has already been lost and there is a chronic course with the formation of negative disorders that are difficult to treat.

   Patients with psychotic disorders can receive specialized care in the primary care unit at their place of residence, in psychiatric research institutions, in psychiatric and psychotherapeutic care offices at general clinics, in psychiatric offices in departmental clinics.

   The functions of the psychoneurological dispensary include:

   Outpatient consultation of citizens referred by doctors of general clinics or who applied independently (diagnosis, treatment, solution of social issues, examination);

   Referral to a psychiatric hospital;

   Emergency care at home;

   Consultative and clinical observation of patients.

   After examining the patient, the local psychiatrist decides in what conditions to carry out treatment: the patient’s condition requires urgent hospitalization in a hospital or outpatient treatment is sufficient.

   Article 29 of the Law of the Russian Federation “On psychiatric care and guarantees of the rights of citizens during its provision” clearly regulates the grounds for involuntary hospitalization in a psychiatric hospital, namely:

   “A person suffering from a mental disorder may be hospitalized in a psychiatric hospital without his consent or without the consent of his legal representative until a judge’s decision, if his examination or treatment is possible only in an inpatient setting, and the mental disorder is severe and causes:

   a) his immediate danger to himself or others, or

   b) his helplessness, that is, his inability to independently satisfy the basic needs of life, or

   c) significant harm to his health due to a deterioration in his mental state if the person is left without psychiatric help.”

   TREATMENT: BASIC METHODS AND APPROACHES.

   Despite the fact that psychoses are a complex group that includes conditions of various origins, the principles of treatment for them are the same. Throughout the world, drug therapy is considered the most effective and reliable method of treating psychosis. When it is carried out, an unconventional, strictly individual approach is used to each patient, taking into account age, gender, and the presence of other diseases. One of the main tasks of a specialist is to establish fruitful cooperation with the patient. It is necessary to instill in the patient faith in the possibility of recovery, to overcome his prejudice against the “harm” caused by psychotropic drugs, to convey to him his conviction in the effectiveness of treatment, subject to systematic adherence to the prescribed prescriptions. Otherwise, there may be a violation of medical recommendations regarding doses and medication regimen. The relationship between doctor and patient should be built on mutual trust, which is guaranteed by the specialist’s adherence to the principles of non-disclosure of information, medical confidentiality, and anonymity of treatment. The patient, in turn, should not hide from the doctor such important information as the fact of using psychoactive substances (drugs) or alcohol, taking medications used in general medicine, driving a car or operating complex mechanisms. A woman should notify her doctor if she is pregnant or breastfeeding. Often relatives or patients themselves, having carefully studied the annotations for the medications recommended to them, are perplexed, and sometimes even indignant, that the patient was prescribed a drug to treat schizophrenia, while he has a completely different diagnosis. The explanation is that almost all drugs used in psychiatry act nonspecifically, i.e. They help with a wide range of painful conditions (neurotic, affective, psychotic) - it’s all about the prescribed dose and the doctor’s skill in selecting optimal treatment regimens.

   Undoubtedly, taking medications should be combined with social rehabilitation programs and, if necessary, with family psychotherapeutic and psychopedagogical work.

   Social rehabilitation is a complex of programs for teaching patients with mental disorders ways of rational behavior both in a hospital setting and in everyday life. Rehabilitation is aimed at teaching social skills for interacting with other people, skills necessary in everyday life, such as taking into account one’s own T financial finances, cleaning the house, shopping, using society n transport, etc., vocational training, which includes activities T skills necessary to obtain and maintain employment, and training for those patients who want to graduate from high school or college. Auxiliary Psych O Therapy is also often used to help mentally ill people. Psychotherapy helps mentally ill people feel better O treat yourself, especially those who experience a feeling of inadequacy n anxiety due to their illness and to those who seek to deny the presence of the illness. Psychotherapy n O Helps the patient learn ways to solve everyday problems. An important element of social rehabilitation is participation in the work of mutual groups m noy on d hanging out with other people who understand what it means to be crazy And mentally ill. Such groups, led by patients who have undergone hospitalization, allow other patients to experience help in their lives. And mania of their problems, and also expand the possibilities of their participation in recovery b events and society n new life.

   All these methods, when used wisely, can increase the effectiveness of drug therapy, but are not able to completely replace drugs. Unfortunately, science still does not know how to cure mental illnesses once and for all; psychoses often have a tendency to recur, which requires long-term preventive medication.

   NEUROLEPTICS IN THE TREATMENT SYSTEM OF PSYCHOTIC DISEASESESKIH RAWITHBUILDINGS

   The main drugs used to treat psychosis are the so-called neuroleptics or antipsychotics.

   The first chemical compounds that have the property of stopping psychosis were discovered in the middle of the last century. Then, for the first time, psychiatrists had a powerful and effective treatment for psychosis in their hands. Such drugs as aminazine, haloperidol, stelazine and a number of others have proven themselves especially well. They stopped psychomotor agitation well, eliminated hallucinations and delusions. With their help, a huge number of patients were able to return to life and escape from the darkness of psychosis. However, over time, evidence has accumulated that these drugs, later called classical neuroleptics, affect only positive symptoms, often without affecting negative ones. In many cases, the patient was discharged from a psychiatric hospital without delusions or hallucinations, but became passive and inactive, and was unable to return to work. In addition, almost all classical antipsychotics cause so-called extrapyramidal side effects (drug-induced parkinsonism). These effects are manifested by muscle stiffness, tremors and convulsive twitching of the limbs, sometimes there is a hard-tolerable feeling of restlessness, which is why patients are in constant motion, unable to stop for a minute. To reduce these unpleasant phenomena, doctors are forced to prescribe a number of additional drugs, which are also called correctors (cyclodol, parkopan, akineton, etc.). The side effects of classical antipsychotics are not limited to extrapyramidal disorders; in some cases, salivation or dry mouth, urination problems, nausea, constipation, palpitations, a tendency to lower blood pressure and fainting, weight gain, decreased libido, erectile dysfunction and ejaculation may be observed. In women, galactorrhea (discharge from the nipples) and amenorrhea (disappearance of menstruation) are common. It is impossible not to note side effects from the central nervous system: drowsiness, deterioration of memory and concentration, increased fatigue, the possibility of developing the so-called. neuroleptic depression.

   Finally, it should be emphasized that, unfortunately, traditional antipsychotics do not help everyone. There has always been a portion of patients (about 30%) whose psychoses were difficult to treat, despite adequate therapeutic tactics with timely change of drugs of various groups.

   All these reasons explain the fact that patients often voluntarily stop taking medications, which in most cases leads to an exacerbation of the disease and re-hospitalization.

   A real revolution in the treatment of psychotic disorders was the discovery and introduction into clinical practice in the early 90s of a fundamentally new generation of neuroleptics - atypical antipsychotics. The latter differ from classical neuroleptics in their selectivity of neurochemical action. By acting only on certain nerve receptors, these drugs, on the one hand, turned out to be more effective, and on the other, much better tolerated. They were found to cause virtually no extrapyramidal side effects. Currently, several such drugs are already available on the domestic market - rispolept (risperidone), Zyprexa (olanzapine), Seroquel (quetiapine) and azaleptin (leponex), which was previously introduced into clinical practice. The most widely used are Leponex and Rispolept, which are included in the “List of Vital and Essential Medicines”. Both of these drugs are highly effective in various psychotic conditions. However, while Rispolept is more often prescribed by practitioners in the first place, Leponex is justifiably used only in the absence of an effect from previous treatment, which is associated with a number of pharmacological features of this drug, the nature of side effects and specific complications, which, in particular, require regular monitoring general blood test.

   What are the advantages of atypical antipsychotics for lein the acute phase of psychosis?

   The ability to achieve a greater therapeutic effect, including in cases of symptom resistance or patient intolerance to typical antipsychotics.

   The effectiveness of treating negative disorders is significantly greater than that of classical neuroleptics.

   Security, i.e. insignificant severity of both extrapyramidal and other side effects characteristic of classical antipsychotics.

   There is no need to take correctors in most cases with the possibility of monotherapy, i.e. treatment with one drug.

   Acceptability of use in weakened, elderly and somatically burdened patients due to low interaction with somatotropic drugs and low toxicity.

   SUPPORTIVE AND PREVENTIVE TERAFDI

   Among psychotic disorders of various origins, psychoses developing as part of endogenous diseases make up the lion's share. The course of endogenous diseases differs in duration and tendency to relapse. That is why international recommendations regarding the duration of outpatient (maintenance, preventive) treatment clearly stipulate its terms. Thus, patients who have suffered a first attack of psychosis need to take small doses of drugs for one to two years as preventive therapy. If a repeated exacerbation occurs, this period increases to 3-5 years. If the disease shows signs of transition to a continuous course, the period of maintenance therapy is increased indefinitely. That is why among practical psychiatrists there is a justified opinion that in order to treat patients who become ill for the first time (during their first hospitalization, less often outpatient therapy), maximum efforts should be made, and the longest and most complete course of treatment and social rehabilitation should be carried out. All this will pay off handsomely if it is possible to protect the patient from repeated exacerbations and hospitalizations, because after each psychosis negative disorders increase, which are especially difficult to treat.

   Preventing RecAnddivas of psychosis

   Reducing the relapse of mental illness is facilitated by a structured daily lifestyle that has the maximum therapeutic effect and includes regular exercise, reasonable rest, a stable daily routine, a balanced diet, avoidance of drugs and alcohol, and regular use of medications prescribed by a doctor as maintenance therapy.

   Signs of an approaching relapse may include:

   Any significant changes in the patient’s behavior, daily routine or activity (unstable sleep, loss of appetite, appearance of irritability, anxiety, change in social circle, etc.).

   Features of behavior that were observed on the eve of the previous exacerbation of the disease.

   The appearance of strange or unusual judgments, thoughts, perceptions.

   Difficulty doing ordinary, simple tasks.

   Unauthorized termination of maintenance therapy, refusal to visit a psychiatrist.

   If you notice warning signs, take the following measures:

   Notify your doctor and ask him to decide if your therapy needs to be adjusted.

   Eliminate all possible external stressors on the patient.

   Minimize (within reasonable limits) all changes in your daily routine.

   Provide the patient with as calm, safe and predictable an environment as possible.

   To avoid exacerbation, the patient should avoid:

   Premature withdrawal of maintenance therapy.

   Violations of the medication regimen in the form of an unauthorized dosage reduction or irregular intake.

   Emotional turmoil (conflicts in the family and at work).

   Physical overload, including both excessive exercise and overwhelming housework.

   Colds (acute respiratory infections, flu, sore throats, exacerbations of chronic bronchitis, etc.).

   Overheating (solar insolation, prolonged stay in a sauna or steam room).

   Intoxication (food, alcohol, medicinal and other poisoning).

   Changes in climatic conditions during the holidays.

   Advantages of atypical antipsychotics during professionalAndlactic treatment.

   When carrying out maintenance treatment, the advantages of atypical antipsychotics over classical antipsychotics are also revealed. First of all, this is the absence of “behavioral toxicity”, that is, lethargy, drowsiness, inability to do anything for a long time, slurred speech, unsteady gait. Secondly, a simple and convenient dosing regimen, because Almost all new generation drugs can be taken once a day, say at night. Classical antipsychotics, as a rule, require three doses, which is caused by the peculiarities of their pharmacodynamics. In addition, atypical antipsychotics can be taken without regard to meals, which allows the patient to maintain their usual daily routine.

   Of course, it should be noted that atypical antipsychotics are not a panacea, as some advertising publications try to present. Drugs that completely cure serious illnesses such as schizophrenia or bipolar disorder have yet to be discovered. Perhaps the main disadvantage of atypical antipsychotics is their cost. All new drugs are imported from abroad, produced in the USA, Belgium, Great Britain and, naturally, have a high price. Thus, the approximate costs of treatment when using the drug in average dosages for a month are: Zyprexa - $200, Seroquel - $150, Rispolept - $100. True, recently more and more pharmacoeconomic studies have appeared, convincingly proving that the total costs of patient families for the purchase of 3-5, and sometimes more, classical drugs, namely such complex regimens are used for the treatment and prevention of psychotic disorders, are approaching the costs per one atypical antipsychotic (here, as a rule, monotherapy is carried out, or simple combinations with 1-2 more drugs are used). In addition, a drug such as rispolept is already included in the list of drugs provided free of charge in dispensaries, which makes it possible, if not to fully meet the needs of patients, then at least partially to alleviate their financial burden.

   It cannot be said that atypical antipsychotics have no side effects at all, because Hippocrates said that “an absolutely harmless medicine is absolutely useless.” When taking them, there may be an increase in body weight, a decrease in potency, disturbances in the menstrual cycle in women, and an increase in the level of hormones and blood sugar. However, it should be noted that almost all of these adverse events depend on the dosage of the drug, occur when the dose is increased above the recommended one and are not observed when using average therapeutic doses.

   Extreme caution must be exercised when deciding whether to reduce dosages or discontinue an atypical antipsychotic. This question can only be decided by the attending physician. Untimely or abrupt withdrawal of the drug can lead to a sharp deterioration in the patient’s condition, and, as a result, to urgent hospitalization in a psychiatric hospital.

   Thus, from all of the above it follows that psychotic disorders, although they are among the most serious and quickly disabling diseases, do not always fatally lead to severe outcomes. In most cases, provided that psychosis is correctly and timely diagnosed, early and adequate treatment is prescribed, and modern gentle methods of psychopharmacotherapy are used, combined with methods of social rehabilitation and psychocorrection, it is possible not only to quickly relieve acute symptoms, but also to achieve complete restoration of the patient’s social adaptation.

   Psychosis is in which the patient does not have a normal perception of reality, and he cannot react to it in a certain way.

   Often this disease accompanies senile dementia and alcoholic delirium (madness), but it is possible for it to act as an independent pathology.

   Causes

   The function of the nerve cell is impaired due to the fact that mitochondria do not produce ATP. The neuron does not receive proper nutrition, and it does not form or transmit a nerve impulse. Because of this, the activity of the entire central nervous system cannot function normally, which leads to the development of psychosis.

   Manifestations of the disease depend on damage to the structure of the central nervous system.

   Provoking factors :

   1. Genetic burden
      
   2. Head injury.
   3. Severe intoxication from alcoholic beverages, drugs and medications.
   4. Diseases of the nervous system.
   5. Infectious diseases: influenza, mumps, malaria.
   6. Neoplasms of the brain.
   7. Severe attacks of bronchial asthma.
   8. Systemic diseases.
   9. Vitamin deficiency B1 and B3.
   10. Hormonal disorders.
   11. Severe neuro-emotional stress.
   12. Electrolyte imbalance caused by vomiting, diarrhea and crash dieting.

   Classification

   2 main groups of the disease:

   Endogenous psychosis caused by internal factors (disorder of the functioning of the nervous and endocrine systems).

   • Exogenous caused by external factors (infections, intoxication, nervous strain, mental trauma).

   

   Depending on appearance:

   • Spicy: develops instantly.
   • Reactive: formed due to prolonged exposure to mental trauma.

   Besides, on etiology and pathogenesis The following forms of the disease are distinguished:

   • Alcoholic;
   • Amphetamine psychosis;
   • Hypomanic psychosis;
   • Hysterical;
   • Korsakovsky;
   • Senile;
   • Involutionary;
   • Paranoid;
   • Schizoaffective;
   • Postpartum.

   Signs of psychosis

   
   

   As the disease develops, behavioral and emotional reactions change and thinking is impaired.

   The patient is unable to correctly perceive reality and may resist hospitalization and treatment.

   Psychosis in women: symptoms and signs

   

   The following signs are most typical for them::

   • Sleep is disturbed;
   • Mood changes frequently;
   • Appetite worsens;
   • A feeling of threat and anxiety appears;
   • Motor activity sharply decreases;
   • Attentiveness is lost;
   • The woman becomes distrustful and tries to isolate herself from everyone;
   • An interest in religion and magic may suddenly awaken.

   Alcohol psychosis: symptoms and treatment

   This form is characterized by the following features:

   This condition is also called "delirium tremens" . Appears 2-7 days after a person stops drinking alcohol. It can last for several hours or days. Characterized by sudden changes in mood, insomnia and psychomotor agitation.

   First a person feels alarm, appears shiver head and hands. After some time, the consciousness is darkened, frightening hallucinations: appearance of devils, monsters, sensation of touch, creepy voices. There is a complete violation of topographic and temporal orientation. Available somatic disorders and in the form of muscle hypotension, increased sweating, increased body temperature, tachycardia.

   

   As a rule, delirium ends after a long sleep.

   2. Alcoholic hallucinosis

   Most often seen in people over 40 years of age with a total experience of alcoholism of about 10 years . It can develop during withdrawal symptoms or in the last day of a long binge.

   Exists 2 forms of hallucinosis:

   Acute: lasts several hours or weeks. The patient feels anxiety and sleep disturbance. The appearance of auditory and sometimes visual hallucinations is characteristic.

   After a few days, the visions lose their brightness and disappear over time, and the patient loses tension and delusional ideas. The main feature of this form is that the patient does not lose topographical, temporal and personal orientation.

   Protracted: it is typical for it that a person is unable to distinguish hallucinations from reality, and they correspond to an everyday situation. Symptoms are dominated by hallucinations, delusions, or movement disorders.

   3. Alcohol paranoid

   Characteristic of persons with alcoholism for about 12-13 years . Due to insomnia, a person is constantly tormented by anxiety, and it is possible to develop acute delusions of persecution.
   

   Such patients are convinced that they can be poisoned or stabbed to death.
   

   Paranoid happens sharp And protracted. At first form, it appears over several days, less often than weeks, and when second– long lasting and lasts for months.

   A person often looks healthy, but he becomes overly suspicious, does not trust anyone, and fear and anxiety are present all the time. The patient tries to limit his social circle.

   Over time, such people become more and more convinced that they are right, and nonsense becomes extremely implausible . They dangerous for loved ones, however, if a person stops drinking, delusional ideas disappear.

   Treatment

   1. Drug therapy

   • (Aminazine,

     1. Physiotherapy

     The following methods are used:

     • Electrosleep;
     • Spa therapy;
     • Acupuncture;
     • Occupational therapy.

     They help relieve stress, increase performance and improve metabolism.

     1. Electroconvulsive therapy

        The basis is the induction of convulsive seizures due to the action of electric current, affecting the subcortical structures of the brain and the metabolism of the nervous system.

     The success of therapy largely depends on the time at which treatment measures begin: the earlier treatment begins, the higher the likelihood of curing a mental disorder and preventing negative consequences for the individual.

     Video

   Psychosis is a deviation from the normal state of the psyche that has severe symptoms. Often this word is used not in a medical sense, but in an everyday meaning, when we want to describe behavior that does not correspond to the situation, sudden and unexpected manifestations of emotions. The word “psychosis” at the everyday level means behavior that is not adequate to the current moment.

   This everyday definition has much in common with the medical one. Soviet physiologist I.P. Pavlov, familiar to everyone from school through experiments aimed at studying conditioned reflexes, defined this disorder as a mental disorder in which a person’s reactions grossly contradict reality.

   Causes of psychosis

   There can be many reasons for the disorder. This condition can be triggered by the use of alcohol, amphetamines, cocaine and other psychoactive substances. Long-term use of antidepressants can also lead to this disorder. Withdrawal of certain medications (when a person stops taking a medication they are used to) can have the same result.

   The diagnosis of psychosis can be made not only for the above reasons. There are a number of social factors that create favorable conditions for this disorder. Poverty comes first. It has been proven that psychosis is more common in people whose financial situation is low.

   The second factor is violence. The disorder may be triggered by physical abuse, including sexual abuse, experienced in childhood or later in life. Violence can be more than just physical. The disorder can arise as a result of emotional abuse (bullying, boycotting, isolation, etc.).

   Another reason that is common in children is hospitalization. A child may have a hard time being away from home and being in unfamiliar conditions. Hospital treatment can be perceived as violence.

   In addition, psychosis can be triggered by repeated trauma. If a child has experienced violence as a child and experiences it again as an adult, this may become the basis of a mental disorder.

   Types of psychoses

   There are different classifications of this disease. From the point of view of the causes of psychosis, they are divided into endogenous and exogenous. Endogenous in Latin means “generated by internal factors, intraborn.” The causes of such disorders are associated with metabolic disorders in the brain. This type includes bipolar personality disorder and depressive psychosis.

   The next type is exogenous. Translated from Latin it means “generated by external factors.” A striking example is psychosis caused by taking psychoactive drugs (drugs, alcohol). In addition to psychoactive drugs, external factors include psychosocial causes: stressful situations, depression, violence, severe emotional experiences.

   In addition, there are organic psychoses. They occur against the background or as a consequence of somatic diseases, for example, after a heart attack, infectious and other diseases.

   
   

   Stages of psychosis

   The stages of psychosis are called phases. There are 4 main phases: prodromal (initial), untreated psychosis, acute and residual. How long each phase lasts depends on the individual characteristics and predispositions of the person. However, it should be remembered that this disease is long-term. Taking into account all phases (not only acute), its course is measured in years or even decades.

   The prodromal phase is characterized by the appearance of mild symptoms at first, which then become more and more pronounced. By the end of the stage they become completely identifiable. At this stage, the most striking manifestations may occur - hallucinations and delusions. The duration of the phase varies from 2 to 5 years.

   The untreated phase of psychosis begins when symptoms persist and ends when treatment begins.

   In the acute phase, a person may not understand what is happening to him and may not realize that he is sick. At this stage, symptoms appear most clearly. This is delirium, hallucinations, fragmented thinking.

   After the completed course of treatment, the residual phase begins (from the English residue - residue). This stage is characterized by residual symptoms. The residual phase extends for an indefinite period. It can last until the end of the patient's life.

   At the same time, symptoms suppressed by drug treatment may worsen after some time. The period of exacerbation may occur again. The possibility of relapse is the specificity of the residual phase.

   Signs of psychosis

   Psychosis can be recognized at the initial stage of development. To do this, it is necessary to carefully analyze the precursors of the disease. These are subtle manifestations of symptoms that are often confused with signs of puberty, attributed to bad character or unsociability.

   Precursors include: anxiety, irritability, sensitivity, anger. The disease leaves its mark on a person’s thinking: there are problems with memory and building logical connections. Symptoms also manifest themselves in appearance. Such a person can be called neglected, unkempt. A clear sign is a sleep disorder, which is expressed in drowsiness or, conversely, insomnia. The person may lose appetite and become lethargic.

   Manifestations of psychosis in women

   A feature of the female form is the rapid progression of the disease and acute symptoms. Mild manifestations of the disorder are mood swings, which are often attributed to hormonal changes associated with childbirth or menopause.

   The cause of the disease may be schizophrenia, disorders of the thyroid gland, pregnancy, childbirth, menopause, and damage to the nervous system. The disease can develop against the background of postpartum depression. External causes include: alcohol consumption, stress, depression.

   A woman in a state of psychosis behaves excitedly, anxiously or, conversely, is in a state of euphoria. Such states alternate. They are often accompanied by thoughts out loud (the patient talks to herself or to imaginary interlocutors). At the same time, speech is characterized by incoherence and confusion of thoughts. A person may experience visual and auditory hallucinations, which are often described as the presence of a voice that can give orders and direct the person’s actions.

   At the same time, all patients are characterized by a lack of understanding of their condition.

   
   

   Symptoms of psychosis in men

   The specificity of the disease in men is that aggression is added to female symptoms. It is also typical for women, but to a lesser extent.

   Psychoactive substances affect men less than women and are less likely to cause psychosis. This is due to the fact that a man’s body weight is on average greater than a woman’s body weight. Therefore, the toxic effect of alcohol in the case of men is not as dangerous as in the case of women.

   In addition, when drinking alcohol, the adrenal glands begin to produce male hormones. For men, this poses no danger other than sexual arousal. In the case of a woman, this leads to irreversible hormonal changes.

   Therefore, more often the cause of the disease in men is not alcohol, but social factors: problems with employment, low social status, the need to compete and compete with colleagues and business partners. This social pressure creates a feeling of hopelessness.

   All this leads to irritability, gloomy and withdrawn behavior, apathy, and depression. These symptoms often develop into a form of aggression.

   
   

   Treatment of psychosis

   You can find out from a specialist how to get rid of psychosis. You should not engage in self-diagnosis and self-medication. The disease is associated with disturbances in the functioning of the brain, so for an accurate diagnosis it is necessary to do a CT or MRI. However, an experienced psychiatrist can determine the presence of a problem using tests that will show a lack of connection with reality, illogical thinking and other mental disorders.

   Patients are prescribed antidepressants and tranquilizers (sedatives). Such drugs work better in combination with physiotherapeutic procedures, physical therapy, which has a restorative effect and helps the patient relax and unwind.

   Cognitive therapy or psychoanalysis demonstrates high effectiveness in treating the disease. With its help, the doctor determines the cause of the disorder and adjusts the composition of drug treatment.

   
   

   Prevention of psychosis

   Treatment of psychosis at home is impossible. However, there are a number of recommendations that will help you choose the right line of communication with loved ones suffering from this disorder.

   It is necessary to listen to the patient, no matter how crazy his thoughts may seem, but you should not enter into dialogue and try to defend your point of view. You should agree with the patient on everything. This is due to the fact that such a person may not understand what he is saying. During an exacerbation, the dispute can provoke the patient to aggressive actions. In such situations, it is necessary to call an ambulance.

   It should be remembered that psychosis is divided into manic and depressive. In the first case, antidepressants are contraindicated. Therefore, you should not choose treatment on your own. If symptoms are detected, you should immediately consult a doctor.

   Possible consequences of untreated psychosis

   It is impossible to completely cure psychosis. However, treatment of symptoms can provide stable remission, that is, a state without relapse of the disease. If the patient is not helped, the disease will definitely return. In advanced cases, the disease returns in an aggravated form. The extreme manifestation in such cases can be suicide.