Manic-depressive psychosis: symptoms and treatment
Manic-depressive psychosis( MDP) refers to severe mental illness, occurring with a consistent change of the two phases of the disease - manic and depressive.Between them there is a period of mental "normality"( light interval).Contents:
Causes of manic-depressive psychosis
The onset of the development of the disease can be traced most often at the age of 25-30 years.Relative to common mental illness, the TIR level is about 10-15%.There are 0.7 to 0.86 cases per 1,000 of the population.Among women, pathology is 2-3 times more common than in males
Note: causes the onset of manic-depressive psychosis, which is still under study.There is a clear pattern of disease transmission by inheritance.
The period of severe clinical manifestations of pathology is preceded by personality traits - , the cyclotimous accentuation of .Suspicion, anxiety, stress and a number of diseases( infectious, internal) can serve as a trigger mechanism for the development of symptoms and complaints of manic-depressive psychosis.
The mechanism of development of the disease is explained by the result of neuropsychiatric breakdowns with the formation of foci in the cortex of the cerebral hemispheres, as well as problems in the structures of thalamic brain formations.A disturbance in the regulation of norepinephrine-serotonin reactions is caused by the deficiency of these substances.
Violations of the nervous system in the TIR was handled by V.P.Protopopov.
How manic-depressive psychosis manifests
Symptoms of manic-depressive psychosis depend on the phase of the disease.The disease can manifest itself in a manic and depressive form.
Symptoms of the manic phase
The manic phase can proceed in the classical version and with some features.
In the most typical cases, it is accompanied by the following symptoms:
- inadequately pleasurable, exalted and improved mood;
- sharply accelerated, unproductive thinking;
- inadequate behavior, activity, mobility, manifestations of motor excitement.
The beginning of this phase with manic-depressive psychosis looks like a normal burst of energy.The patients are active, they talk a lot, try to do many things at the same time.Their mood is upbeat, overly optimistic.The memory becomes aggravated.Patients say a lot and remember.In all the events that occur, they see an exceptional positive, even where there is none.
Excitation gradually increases.Reduces the time allocated for sleep, patients do not feel fatigue.
Gradually thinking becomes superficial, people suffering from psychosis can not focus their attention on the main thing, they are constantly distracted, they jump from topic to topic.In their conversation, unfinished sentences and phrases are marked - "language outstrips thoughts".Patients have to constantly return to the unspoken topic.
The faces of the patients turn pink, the facial expressions are unnecessarily animated, active gesticulations are observed with their hands.There is a looseness, elevated and inadequate humor, suffering manic-depressive psychosis loudly talking, shouting, noisy breathing.
Activity is unproductive.Patients simultaneously "grab" for a large number of cases, but none of them are brought to a logical end, they are constantly distracted.Super mobility is often combined with singing, dancing movements, jumping.
In this phase of manic-depressive psychosis, patients seek active communication, intervene in all matters, give advice and teach others, criticize.They show a marked reassessment of their skills, knowledge and capabilities, which are sometimes completely absent.At the same time, self-criticism is sharply reduced.
Sexual and food instincts are strengthened.Patients are constantly hungry, sexual motives clearly appear in their behavior.Against this background, they easily and naturally lead a lot of acquaintances.Women begin to use a lot of cosmetics to attract attention to themselves.
In some atypical cases, the manic phase of psychosis proceeds from:
- an unproductive mania - in which there are no active actions and thinking is not accelerating;
- solar mania - behavior is dominated by a superheavy mood;
- angry mania - in the forefront is angry, irritable, dissatisfied with others;
- manic stupor - a manifestation of fun, accelerated thinking combined with motor passivity.
Symptoms of the depressive phase
In the depressive phase, there are three main features:
- morbidly oppressed mood;
- sharply slowed down the pace of thinking;
- motor retardation until complete immobilization.
The initial symptoms of this phase of manic-depressive psychosis are accompanied by sleep disturbances, frequent night awakenings, inability to sleep.Appetite gradually decreases, develops a state of weakness, constipation, pain in the chest.The mood is constantly depressed, the patient's face is apathetic, sad.There is a depressive state.All present, past and future appear in black and hopeless tones.Some patients with manic-depressive psychosis have ideas of self-incrimination, patients try to hide in inaccessible places, experience painful experiences.The pace of thinking sharply slows down, the circle of interests narrows, the symptoms of "mental chewing gum" appear, patients repeat the same ideas, in which self-deprecating thoughts stand out.Sufferers of manic-depressive psychosis begin to recall all their actions and give them ideas of inferiority.Some people consider themselves unworthy of eating, sleeping, respecting.They think that doctors are wasting their time on them, unreasonably prescribe medication to them, as unworthy of treatment.
Note: sometimes has to transfer such patients to forced meals.
Most patients experience muscle weakness, heaviness in the whole body, they move with great difficulty.
With a more compensated form of manic-depressive psychosis, patients self-seek for the dirtiest work.Gradually, the idea of self-blame leads some patients to thoughts of suicide, which they can fully embody in reality.
Depression is most pronounced in the morning, before dawn.By the evening the intensity of her symptoms decreases.Patients mostly sit in discreet places, lie on beds, like to lie under the bed, because they consider themselves unworthy to be in a normal position.The contact is reluctant, responds monotonously, with a slowdown, without superfluous words.
On the faces of the imprint of deep sorrow with a characteristic wrinkle on the forehead.The corners of the mouth are lowered, the eyes are dim, slow-moving.
Asthenic depression - in patients with this type of manic-depressive psychosis, the ideas of their own soullessness toward their relatives dominate, they consider themselves unworthy of parents, husbands, wives, etc.
Virtually all patients in the depressive phase experience a triad of Protopopov - heart palpitations, constipation, dilated pupils.
Symptoms of disorders with manic-depressive psychosis from the internal organs of :
- high blood pressure;
- dry skin and mucous membranes;
- lack of appetite;
- in women with a monthly cycle disorder.
In some cases, the MDP manifests itself as the dominant complaint of persistent pain, discomfort in the body.Patients describe the most diverse complaints from almost all organs and parts of the body.
Note: part of the patients tries to mitigate complaints by resorting to alcohol.
The depressive phase can last 5-6 months.Patients during this period are inoperable.
Cyclotemia is an easy form of manic-depressive psychosis
Allocate both a separate form of the disease and a lightweight version of the TIR.
Cyclotomy proceeds with phases:
- hypomaniacality - the presence of optimistic mood, energetic state, active activity.Patients can work a lot without fatigue, little rest and sleep, their behavior is fairly orderly;
- subdepression - a state with a worsening mood, a decline in all physical and mental functions, a craving for alcohol that goes right after the end of this phase.
How does theflow
? There are three forms of the disease course:
- circular - periodic alternation of manic and depression phases with a light interval( intermission);
- alternating - one phase immediately changes to another without a light gap;
- single-pole - in a row there are the same phases of depression or mania.
Note: usually lasts for 3-5 months, and light intervals can last several months or years.
Manic-depressive psychosis at different periods of life
In children, the onset of the disease can go unnoticed, especially if the manic phase predominates.Juvenile patients look super-mobility, fun, playful, which does not immediately indicate the unhealthy features in their behavior against the background of their peers.
In the case of the depressive phase, children are passive and constantly tired, complain about their health.With these problems they quickly get to the doctor.
In adolescence, the symptoms of cheekiness, coarseness in relationships dominate in the manic phase, and the disinhibition of instincts is observed.
One of the characteristics of manic-depressive psychosis in childhood and adolescence is the short duration of the phases( an average of 10-15 days).With age, their duration increases.
Treatment of manic-depressive psychosis
Treatment measures are constructed depending on the phase of the disease.The expressed clinical symptomatology and presence of complaints demand treatment of manic-depressive psychosis in a hospital.Because, being depressed, patients can harm their health or commit suicide.
The difficulty of psychotherapeutic work is that patients in the depression phase practically do not go into contact.An important point of treatment during this period is the correctness of the selection of antidepressants .The group of these drugs is diverse and the doctor appoints them, guided by their own experience.Usually it is a question of tricyclic antidepressants.
With dominance in the status of inhibition, antidepressants with the properties of analeptics are selected.Anxious depression requires the use of drugs with a pronounced soothing effect.
In the absence of appetite, treatment of manic-depressive psychosis is supplemented with restorative medications
Neuroleptics with marked sedative properties are prescribed to the manic phase.
In the case of cyclothymia, it is preferable to use softer tranquilizers and neuroleptics in small dosages.
Please note: most recently in all phases of the treatment of MDP prescribed preparations of lithium salts, at present this method is not used by all physicians.
After exiting the pathological phases, patients must be included as early as possible in various activities, it is very important to preserve socialization.
With relatives of patients, explanatory work is conducted on the need to create a normal psychological climate home;A patient with symptoms of manic-depressive psychosis at light intervals should not feel unhealthy.
It should be noted that, in comparison with other mental illnesses, patients with manic-depressive psychosis retain their intelligence, performance without degradation.
Interesting ! From the legal point of view, the crime committed during the TIR aggravation phase is considered not to be liable to criminal liability, and in the intermission phase it is punishable.Naturally, in any condition, those suffering from psychosis are not eligible for service in the army.In severe cases, disability is prescribed.
Alexander Lotin, medical reviewer