How to treat mental disorders in women. The most terrible mental illnesses: list, why they are dangerous, symptoms, treatment correction and consequences

Neurosis, the symptoms of which may seem quite harmless at first, always manifests itself against the background of serious emotional experiences. It is the treatment of the cause of the formation of a neurotic state that can finally relieve the patient from multiple disorders various systems: cardiovascular, nervous and even digestive.

Early symptoms of mental illness

In almost any person, a mild mental disorder under “favorable” conditions can develop into serious illness. Therefore, it is especially important to know the symptoms of mental illness at an early stage in order to identify the beginnings of a possible mental illness. The main symptoms of mental disorders can be divided into:

• physical (for example, sleep disorders);
• emotional (sadness, fear, anxiety);
• cognitive (fuzzy thinking, memory impairment);
• behavioral (aggression, substance abuse);
• perceptual (hallucinations).

Signs of mental illness manifest differently in different genders.

Signs of mental disorders in men

It is impossible to single out any special list of psychiatric diseases that would be relevant only for men. Men face common mental illnesses, but the male psyche reacts in a special way.

So, common symptoms of mental disorder in men are:

• aggression;
• delirium of jealousy;
• delusions of grandeur (violation of adequate assessment of oneself, as well as others).

At the same time, it is difficult to say what signs of a mental disorder can be visually clearly assessed. In men, the presence of deviations manifests itself in negligence and carelessness (unshaven, poor personal hygiene, untidiness in clothing). As for the behavioral signs of the presence of the disease in men, one can note an aggressive reaction to any minor reason, sharp changes moods, whining, complaints for no real reason.

Signs of mental disorders in women

Women's mental disorders also have their own specifics. List of mental illnesses common in women:

• anxiety and depressive disorder;
• affective insanity;
• anorexia and bulimia, gluttony;
• suicidal disorders;
• hysterical states and borderline states.

Separately, the list of mental illnesses can include disorders that occur in pregnant women: manic anxiety about losing the fetus, fear of death (excessive vigilance), and so on.

Mental disorders during pregnancy often cause complications due to the patient’s refusal to take medications. In women with mental disorders, signs of depression and severe apathy are often observed longer and more pronounced after childbirth. IN in rare cases A woman’s postpartum condition can result in a chronic mental disorder that will require medical supervision and the use of strong medications.

Conclusion

Thus, psychiatry is not only a science that can tell what mental illness happen, but also the most important branch of medicine, capable of diagnosing mental illnesses, finding out what exactly caused a particular mental illness person. Psychiatry not only gives us a list of mental illnesses, but also develops and implements technologies to solve the problems of a person who has become a hostage to his own psyche.

Mental disorders are invisible to the naked eye, and therefore very insidious. They significantly complicate a person’s life when he does not even suspect there is a problem. Experts who study this aspect of the boundless human essence claim that many of us have mental disorders, but does this mean that every second inhabitant of our planet needs treatment? How to understand that a person is truly sick and needs qualified help? You will receive answers to these and many other questions by reading the subsequent sections of the article.

What is a mental disorder

The concept of “mental disorder” covers a wide range of deviations of a person’s mental state from the norm. The problems with internal health in question should not be perceived as a negative manifestation of the negative side of the human personality. Like any physical illness, a mental disorder is a disruption of the processes and mechanisms of perception of reality, which creates certain difficulties. People faced with such problems do not adapt well to real life conditions and do not always correctly interpret what is happening.

Symptoms and signs of mental disorders

Characteristic manifestations of mental deviation include disturbances in behavior/mood/thinking that go beyond generally accepted cultural norms and beliefs. As a rule, all symptoms are dictated by a depressed state of mind. In this case, a person loses the ability to fully perform habitual social functions. The general spectrum of symptoms can be divided into several groups:

• physical – pain in various parts of the body, insomnia;
• cognitive – difficulties in clear thinking, memory impairment, unjustified pathological beliefs;
• perceptual - states in which the patient notices phenomena that other people do not notice (sounds, movement of objects, etc.);
• emotional – sudden feeling of anxiety, sadness, fear;
• behavioral – unjustified aggression, inability to perform basic self-care activities, abuse of psychoactive drugs.

Main causes of diseases in women and men

The etiology aspect of this category of diseases has not been fully studied, so modern medicine cannot clearly describe the mechanisms that cause mental disorders. Nevertheless, a number of reasons can be identified, the connection of which with mental disorders has been scientifically proven:

• stressful life conditions;
• difficult family circumstances;
• brain diseases;
• hereditary factors;
• genetic predisposition;
• medical problems.

In addition, experts identify a number of special cases that represent specific deviations, conditions or incidents against the background of which serious mental disorders develop. The factors that will be discussed are often found in Everyday life, and therefore can lead to a deterioration in people’s mental health in the most unexpected situations.

Alcoholism

Systematic abuse of alcoholic beverages often leads to mental disorders in humans. The body of a person suffering from chronic alcoholism constantly contains a large amount of breakdown products ethyl alcohol, which cause serious changes in thinking, behavior and mood. In this regard, dangerous mental disorders arise, including:

1. Psychosis. Mental disorder due to impairment metabolic processes in the brain. The toxic effect of ethyl alcohol overshadows the patient’s judgment, but the consequences appear only a few days after stopping use. A person is overcome by a feeling of fear or even a mania of persecution. In addition, the patient may have all sorts of obsessions related to the fact that someone wants to cause him physical or moral harm.
2. Delirium tremens. A common post-alcohol mental disorder that occurs due to profound disturbances in metabolic processes in all organs and systems of the human body. Delirium tremens manifests itself in sleep disorders and seizures. The listed phenomena, as a rule, appear 70-90 hours after stopping alcohol consumption. The patient exhibits sudden changes moods from carefree fun to terrible anxiety.
3. Rave. A mental disorder called delusion is expressed in the patient’s appearance of unshakable judgments and conclusions that do not correspond objective reality. In a state of delirium, a person's sleep is disturbed and photophobia appears. The boundaries between sleep and reality become blurred, and the patient begins to confuse one with the other.
4. Hallucinations are vivid ideas, pathologically brought to the level of perception of real-life objects. The patient begins to feel as if the people and objects around him are swaying, rotating, or even falling. The sense of the passage of time is distorted.

Brain injuries

When receiving mechanical brain injuries, a person can develop a whole range of serious mental disorders. As a result of damage nerve centers are launched complex processes, leading to clouding of consciousness. After such cases, the following disorders/conditions/diseases often occur:

1. Twilight states. Celebrated, as a rule, in the evening hours. The victim becomes drowsy and becomes delirious. In some cases, a person may plunge into a state similar to stupor. The patient’s consciousness is filled with all sorts of pictures of excitement, which can cause appropriate reactions: from psychomotor disorder to brutal affect.
2. Delirium. Serious disorder mental disorder, in which a person experiences visual hallucinations. For example, a person injured in a car accident can see moving vehicles, groups of people and other objects associated with the roadway. Mental disorders plunge the patient into a state of fear or anxiety.
3. Oneiroid. A rare form of mental disorder in which the nerve centers of the brain are damaged. Expressed in immobility and slight drowsiness. For some time, the patient may become chaotically excited, and then freeze again without moving.

Somatic diseases

Against the background of somatic diseases, the human psyche suffers very, very seriously. Violations appear that are almost impossible to get rid of. Below is a list mental disorders, which medicine considers the most common in somatic disorders:

1. Asthenic neurosis-like state. A mental disorder in which a person exhibits hyperactivity and talkativeness. The patient systematically experiences phobic disorders and often falls into short-term depression. Fears, as a rule, have clear outlines and do not change.
2. Korsakov's syndrome. A disease that is a combination of memory impairment regarding current events, impaired orientation in space/terrain and the appearance of false memories. A serious mental disorder that cannot be treated with known medical methods. The patient constantly forgets about the events that just happened and often repeats the same questions.
3. Dementia. A terrible diagnosis that stands for acquired dementia. This mental disorder often occurs in people aged 50-70 years who have somatic problems. The diagnosis of dementia is given to people with reduced cognitive function. Somatic disorders lead to irreparable abnormalities in the brain. The mental sanity of a person does not suffer. Find out more about how treatment is carried out, what is the life expectancy with this diagnosis.

Epilepsy

Almost all people suffering from epilepsy experience mental disorders. Disorders that occur against the background of this disease can be paroxysmal (single) and permanent (constant). The following cases of mental disorders are encountered in medical practice more often than others:

1. Mental seizures. Medicine identifies several types of this disorder. All of them are expressed in sudden changes in the patient’s mood and behavior. A mental seizure in a person suffering from epilepsy is accompanied by aggressive movements and loud screams.
2. Transitory mental disorder. Long-term deviations of the patient's condition from normal. Transient mental disorder is a prolonged mental attack (described above), aggravated by a state of delirium. It can last from two to three hours to a whole day.
3. Epileptic mood disorders. As a rule, such mental disorders are expressed in the form of dysphoria, which is characterized by a simultaneous combination of anger, melancholy, causeless fear and many other sensations.

Malignant tumors

The development of malignant tumors often leads to changes in a person’s psychological state. As the formations on the brain grow, the pressure increases, causing serious abnormalities. In this state, patients experience unreasonable fears, delusions, melancholy and many other focal symptoms. All this may indicate the presence of the following psychological disorders:

1. Hallucinations. They can be tactile, olfactory, auditory and gustatory. Such abnormalities are usually found in the presence of tumors in the temporal lobes of the brain. Vegetovisceral disorders are often detected along with them.
2. Affective disorders. Such mental disorders in most cases are observed with tumors localized in the right hemisphere. In this regard, attacks of horror, fear and melancholy develop. Emotions caused by a violation of the structure of the brain are displayed on the patient’s face: facial expression and skin color change, the pupils narrow and dilate.
3. Memory disorders. With the appearance of this deviation, signs of Korsakov's syndrome appear. The patient gets confused about the events that just happened, asks the same questions, loses the logic of events, etc. In addition, in this state a person’s mood often changes. Within a few seconds, the patient's emotions can switch from euphoric to dysphoric, and vice versa.

Vascular diseases of the brain

Operational disruptions circulatory system and blood vessels instantly affect a person’s mental state. When diseases associated with an increase or decrease in blood pressure, brain functions deviate from normal. Serious chronic disorders can lead to the development of extremely dangerous mental disorders, including:

1. Vascular dementia. This diagnosis means dementia. According to its symptoms vascular dementia resemble the consequences of some somatic disorders manifested in old age. Creative thought processes in this state almost completely fade away. The person withdraws into himself and loses the desire to maintain contact with anyone.
2. Cerebrovascular psychoses. The genesis of mental disorders of this type is not fully understood. At the same time, medicine confidently names two types of cerebrovascular psychosis: acute and prolonged. The acute form is expressed by episodes of confusion, twilight stupefaction, and delirium. A protracted form of psychosis is characterized by a state of stupefaction.

What are the types of mental disorders?

Mental disorders can occur in people regardless of gender, age and ethnicity. The mechanisms of development of mental illness are not fully understood, so medicine refrains from making specific statements. However, at the moment, the relationship between some mental illnesses and age has been clearly established. Each age has its own common deviations.

In older people

In old age, against the background of diseases such as diabetes, heart/renal failure and bronchial asthma, many mental abnormalities develop. Senile mental illnesses include:

• paranoia;
• dementia;
• Alzheimer's disease;
• marasmus;
• Pick's disease.

Types of mental disorders in adolescents

Adolescent mental illness is often associated with adverse circumstances in the past. Over the past 10 years, the following mental disorders have often been recorded in young people:

• prolonged depression;
• bulimia nervosa;
• anorexia nervosa;
• drankorexia.

Features of diseases in children

IN childhood Serious mental disorders may also occur. The reason for this, as a rule, is problems in the family, incorrect methods of education and conflicts with peers. The list below contains mental disorders that are most often recorded in children:

• autism;
• Down syndrome;
• attention deficit disorder;
• mental retardation;
• developmental delays.

Which doctor should I contact for treatment?

Mental disorders cannot be treated on their own, therefore, if there is the slightest suspicion of mental disorders, an urgent visit to a psychotherapist is required. A conversation between the patient and a specialist will help quickly identify the diagnosis and choose effective tactics treatment. Almost all mental illnesses are treatable if treated early. Remember this and do not delay!

Video about mental health treatment

The video attached below contains a lot of information about modern methods combating mental disorders. The information received will be useful for everyone who is ready to take care of the mental health of their loved ones. Listen to the words of experts to destroy stereotypes about inadequate approaches to combating mental disorders and learn the real medical truth.

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

Clinical manifestations of mental diseases in most cases form entire symptom complexes and syndromes. Thus, a sick person may have very complex combinations of disorders, which need to be assessed to determine accurate diagnosis Only an experienced psychiatrist can.

Classification of mental illnesses

Mental illnesses are very diverse in nature and clinical manifestations. A number of pathologies may be characterized by the same symptoms, which often makes timely diagnosis of the disease difficult. Mental disorders can be short-term or long-term, caused by external and internal factors. Depending on the cause of occurrence, mental disorders are classified into exocogenous and exogenous. However, there are diseases that do not fall into either group.

Group of exocogenic and somatogenic mental diseases

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

Exogenous and somatogenic diseases of the human psyche include:

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

Group of endogenous mental diseases

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

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

Psychogenic disorders and personality pathologies

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

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

Classification of mental illnesses according to ICD 10

In the international classification of psychoses, mental illnesses are divided into several sections:

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

Main symptoms and syndromes

The symptoms of mental illness are so diverse that it is quite difficult to somehow structure their characteristic clinical manifestations. Since mental illnesses negatively affect all or virtually all nervous functions of the human body, all aspects of his life suffer. Patients experience disorders of thinking, attention, memory, mood, depressive and delusional states.

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

Affective syndrome

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

Depression can be called one of the most common mental disorders. Similar conditions characterized by extremely depressed mood, volitional and motor retardation, suppression of natural instincts such as appetite and the need for sleep, self-deprecating and suicidal thoughts. In especially excitable people, depression may be accompanied by outbursts of rage. The opposite sign of a mental disorder can be called euphoria, in which a person becomes carefree and content, while his associative processes do not accelerate.

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

Obsessiveness

Obsessive states are another one common symptom which is accompanied by mental disorders. In psychiatry, such disorders are designated by the term obsessive-compulsive disorder, in which the patient periodically and involuntarily experiences unwanted, but very obsessive ideas and thoughts.

This disorder also includes various unreasonable fears and phobias, constantly repeating meaningless rituals with the help of which the patient tries to relieve anxiety. A number of signs can be identified that distinguish patients suffering from obsessive-compulsive disorder. Firstly, their consciousness remains clear, while obsessions are reproduced against their will. Secondly, the occurrence of obsessive states is closely intertwined with a person’s negative emotions. Thirdly, intellectual abilities are preserved, so the patient realizes the irrationality of his behavior.

Impaired consciousness

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

View	Characteristic
Amnesia	Complete loss of orientation in the surrounding world and loss of idea of ​​one’s own personality. Often accompanied by threatening speech disorders and increased excitability
Delirium	Loss of orientation in the surrounding space and one’s own personality, combined with psychomotor agitation. Delirium often causes menacing auditory and visual hallucinations.
Oneiroid	The patient’s objective perception of the surrounding reality is only partially preserved, interspersed with fantastic experiences. In fact, this state can be described as half-asleep or a fantastic dream
Twilight stupefaction	Deep disorientation and hallucinations are combined with the preservation of the patient’s ability to perform purposeful actions. In this case, the patient may experience outbursts of anger, unmotivated fear, aggression
Outpatient automatism	Automated form of behavior (sleepwalking)
Turning off consciousness	Can be either partial or complete

Perception disorders

Typically, it is perception disorders that are easiest to recognize in mental illness. TO simple disorders Senesthopathy refers to a sudden unpleasant bodily sensation in the absence of an objective pathological process. Seneostapathy is characteristic of many mental diseases, as well as hypochondriacal delirium and depressive syndrome. In addition, with such disorders, the sensitivity of a sick person may be pathologically decreased or increased.

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

Thinking disorders

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

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

Violations of will

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

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

Memory and attention disorders

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

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

Other clinical manifestations

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

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

You can suspect a mental illness in a loved one by characteristic changes in his behavior: he has stopped coping with the simplest everyday tasks and everyday problems, he has begun to express strange or unrealistic ideas, and he is showing anxiety. Changes in your usual daily routine and diet should also be of concern. Signs of the need to seek help will include outbursts of anger and aggression, prolonged depression, thoughts of suicide, alcohol abuse or drug use.

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

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

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

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

Untreated major depression can worsen the prognosis of somatic diseases and increase the amount of medical care required. Depression can intensify and increase the number of somatic complaints, lower the pain threshold, and increase functional disability. A study of frequent health care users found depression in 50% of them. Only those who experienced a decrease in depressive symptoms during the one-year follow-up showed an improvement in functional activity. Symptoms of depression (low mood, hopelessness, lack of satisfaction in life, fatigue, impaired concentration and memory) interfere with the motivation to seek medical help. Timely diagnosis and treatment of depression in chronic patients helps improve prognosis and increase the effectiveness of therapy.

The socio-economic cost of mental illness is very high. About 60% of suicide cases are caused by affective disorders alone, and 95% are combined with diagnostic criteria for mental illness. Costs associated with treatment, mortality, and disability due to clinically diagnosed depression are estimated to be more than $43 billion per year in the United States. Since more than half of people with mood disorders either remain untreated or receive insufficient treatment, this figure is much lower than the total cost that depression costs society. Mortality and disability in this undertreated population, the majority of whom are women, are particularly dismal because 70 to 90% of patients with depression respond to antidepressant therapy.
Table 28-1
Major mental disorders in women

1. Eating disorders

Anorexia nervosa

Bulimia nervosa

Bouts of gluttony
2. Affective disorders

Major Depression

Adjustment disorder with depressed mood

Postpartum affective disorder

Seasonal affective disorder

Affective insanity

Dysthymia
3. Alcohol abuse and alcohol dependence

4. Sexual disorders

Libido disorders

Sexual arousal disorders

Orgastic disorders

Painful sexual disorders:

Vaginismus

Dyspareunia
5. Anxiety disorders

Specific phobias

Social phobia

Agoraphobia

Panic disorders

Generalized anxiety disorders

Obsessive Obsessive Syndrome

Post-traumatic stress
6. Somatoform disorders and false disorders

False disorders:

Simulation

Somatoform disorders:

Somatization

Conversion

Hypochondria

Somatoform pain
7. Schizophrenic disorders

Schizophrenia

Paraphrenia
8. Delirium
Mental illnesses throughout a woman's life

There are specific periods during a woman's life during which she is at increased risk of developing mental illness. Although the main mental disorders—mood and anxiety disorders—can occur at any age, various precipitating conditions are more common during specific age periods. During these critical periods, the clinician should include specific questions to screen for mental disorders by obtaining a history and assessing the patient's mental status.

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

Women are susceptible to mental disorders during and after pregnancy. Women with a history of mental disorders often refuse medication support when planning pregnancy, which increases the risk of relapse. After childbirth, most women experience mood changes. Most experience a short period of “baby blues” depression that does not require treatment. Others develop more severe, disabling symptoms of depression in the postpartum period, and a small number of women develop psychotic disorders. The relative risks of taking drugs during pregnancy and breastfeeding make it difficult to choose treatment; in each case, the question of the benefit-risk ratio of therapy depends on the severity of symptoms.

Middle age is associated with a continued high risk of anxiety and mood disorders, as well as other mental disorders such as schizophrenia. Women may experience impaired sexual function, and if they take antidepressants for mood or anxiety disorders, they are at increased risk of side effects, including decreased sexual function. Although there is no clear evidence that menopause is associated with an increased risk of depression, most women experience major life changes during this period, especially in the family. For most women, their active role in relation to children is replaced by the role of caregivers for aging parents. Caring for elderly parents is almost always carried out by women. Monitoring of the mental status of this group of women is necessary to identify possible impairments in quality of life.

As women age, the risk of developing dementia and psychiatric complications of physical pathologies such as stroke increases. Because women live longer than men and the risk of developing dementia increases with age, most women develop dementia. Older women with multiple underlying medical conditions and multiple medications are at high risk for delirium. Women are at increased risk of developing paraphrenia, a psychotic disorder that usually occurs after age 60. Due to their long life expectancy and greater involvement in interpersonal relationships, women experience the loss of loved ones more often and more intensely, which also increases the risk of developing mental illness.
Examination of a psychiatric patient

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

1) mental illness (what the patient has)

2) temperamental disorders (what the patient is like)

3) behavioral disturbances (what the patient does)

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

Examples of mental illnesses are schizophrenia and major depression. They are similar to other nosological forms - they have a discrete onset, course, and clinical symptoms that can be clearly defined as present or absent in each individual patient. Like other nosologies, they are the result of genetic or neurogenic disorders of the organ, in this case the brain. For obvious abnormal symptoms - auditory hallucinations, mania, severe obsessive states - the diagnosis of a mental disorder is easy to make. In other cases, it can be difficult to distinguish pathological symptoms, such as the low mood of major depression, from normal feelings of sadness or disappointment caused by life circumstances. It is necessary to focus on identifying known stereotypical sets of symptoms characteristic of mental illness, while at the same time remembering the diseases that are most common in women.
Temperament disorders

Understanding the patient's personality increases the effectiveness of treatment. Personal traits such as perfectionism, indecision, impulsiveness are one way or another quantitatively expressed in people, just like physiological ones - height and weight. Unlike mental disorders, they do not have clear characteristics—“symptoms”—as opposed to “normal” values, and individual differences are normal in the population. Psychopathology or functional personality disorders occur when traits become extreme. When temperament leads to impairment in occupational or interpersonal functioning, this is sufficient to qualify it as a possible personality disorder; in this case, medical assistance and cooperation with a psychiatrist are needed.
Behavioral disorders

Behavioral disorders have a self-reinforcing property. They are characterized by purposeful, irresistible forms of behavior that subordinate all other types of patient activity. Examples of such disorders include eating disorders and abuse. The first goals of treatment are to switch the patient's activity and attention, stop problem behavior and neutralize provoking factors. Provoking factors may be concomitant mental disorders, such as depression or anxiety disorders, illogical thoughts (an anorectic’s opinion that “if I eat more than 800 calories a day, I will become fat”). Group therapy can be effective in treating behavioral disorders. The final stage of treatment is relapse prevention, since relapse is a normal course of behavioral disorders.
Patient's life story

Stressors, life circumstances, social circumstances are factors that can modulate the severity of the disease, personality traits and behavior. Various stages of life, including puberty, pregnancy and menopause, may be associated with an increased risk of developing certain diseases. Social conditions and sex role differences may help explain the increased incidence of specific symptom complexes in women. For example, the media's focus on the ideal figure in Western society is a provoking factor in the development of eating disorders in women. Contradictory female roles in modern Western society such as “devoted wife,” “doting mother,” and “successful businesswoman” add to the stress. The purpose of collecting a life history is to more accurately select methods of internally oriented psychotherapy and find the “meaning of life.” The treatment process is facilitated when the patient comes to understand herself, clearly separate her past and recognize the priority of the present for the sake of the future.

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

1. Does the patient have a disease with a clear time of onset, a defined etiology and response to pharmacotherapy.

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

3. Does the patient have purposeful behavioral disorders?

4. What events in the woman’s life contributed to the formation of her personality, and what conclusions did she draw from them?
Eating disorders

Of all the mental disorders, the only eating disorders that occur almost exclusively in women are anorexia and bulimia. For every 10 women suffering from them, there is only one man. The incidence and incidence of these disorders is increasing. Young white women and girls from the middle and upper classes of Western society have the highest risk of developing anorexia or bulimia, at 4%. However, the incidence of these disorders in other age, racial and socioeconomic groups is also increasing.

As with abuse, eating disorders are conceptualized as behavioral disturbances caused by dysregulation of hunger, satiety, and food absorption. Behavioral disorders associated with anorexia nervosa include restricting food intake, purging manipulations (vomiting, abuse of laxatives and diuretics), exhausting physical activity, and abuse of stimulants. These behavioral reactions are compulsive in nature, supported by a psychological attitude towards food and weight. These thoughts and behaviors dominate all aspects of a woman's life, impairing physical, psychological and social functioning. Just as with abuse, treatment can only be effective if the patient himself wants to change the situation.

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

Bulimia nervosa is characterized by the same fear of obesity and body dissatisfaction as anorexia nervosa, accompanied by bouts of gluttony, and then compensatory behavior aimed at maintaining low body weight. DSM-IV distinguishes anorexia and bulimia primarily on the basis of underweight and amenorrhea rather than weight control behaviors. Compensatory behavior includes intermittent fasting, strenuous exercise, taking laxatives and diuretics, stimulants, and inducing vomiting.

Binges of binge eating differ from bulimia nervosa in the absence of compensatory behavior aimed at maintaining body weight, as a result of which such patients develop obesity. Some patients experience a change from one eating disorder to another throughout their lives; Most often, the change goes in the direction from the restrictive type of anorexia nervosa (when behavior is dominated by restriction of food intake and excessive physical activity) towards bulimia nervosa. There is no single cause of eating disorders; they are considered multifactorial. Known risk factors can be divided into genetic, social predisposition and temperamental characteristics.

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

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

Social conditions that contribute to the development of eating disorders are associated with the widespread idealization of a slender androgynous figure and underweight in modern Western society. Most young women engage in restrictive dieting, a behavior that increases the risk of developing eating disorders. Women compare their appearance with each other, as well as with the generally accepted ideal of beauty and strive to be like it. This pressure is especially pronounced in adolescents and young women, since endocrine changes during puberty increase the content of adipose tissue in a woman’s body by 50%, and the adolescent psyche simultaneously overcomes problems such as identity formation, separation from parents and puberty. The incidence of eating disorders in young women has increased over the past few decades in parallel with the increased media emphasis on thinness as a symbol of female success.

Other risk factors for developing eating disorders include family conflict, loss significant person such as parenthood, physical illness, sexual conflict and trauma. Triggers may also include marriage and pregnancy. Some professions require maintaining slimness - for ballerinas and models.

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

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

Patients with anorexia who resort to purging procedures are at high risk of serious complications. Anorexia has the highest mortality rate of any mental illness, with more than 20% of anorectics dying after age 33. Death usually occurs due to physiological complications of fasting or due to suicide. In bulimia nervosa, death is often a consequence of arrhythmia caused by hypokalemia or suicide.

Psychological signs of eating disorders are regarded as secondary to the main mental diagnosis or concomitant. Symptoms of depression and obsessive neurosis may be associated with fasting: low mood, constant thoughts about food, decreased concentration, ritual behavior, decreased libido, social isolation. In bulimia nervosa, feelings of shame and the desire to hide binge eating and purging behaviors lead to increased social isolation, self-critical thoughts, and demoralization.

Most patients with eating disorders have an increased risk of other mental disorders, the most common being major depression, anxiety disorders, abuse, and personality disorders. Concomitant major depression or dysthymia was observed in 50-75% of patients with anorexia and in 24-88% of patients with bulimia. Obsessive neuroses occurred in 26% of anorectics during their lifetime.

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

Treatment of eating disorders occurs in several stages, starting with assessing the severity of the pathology, identifying concomitant mental diagnoses and establishing motivation for change. Consultation with a nutritionist and psychotherapist specializing in the treatment of patients with eating disorders is necessary. It is necessary to understand that first of all it is necessary to stop pathological behavior, and only after it is brought under control, it will be possible to prescribe treatment aimed at internal processes. A parallel can be drawn with the primacy of abstinence in the treatment of abuse, when therapy carried out simultaneously with continued alcohol intake does not bring results.

Treatment by a general psychiatrist is less desirable from the point of view of maintaining treatment motivation; treatment in special inpatient institutions such as sanatoriums is more effective - the mortality rate for patients in such institutions is lower. Group therapy and strict monitoring of eating and restroom use by medical staff in these institutions minimize the likelihood of relapse.

Several classes of psychopharmacological agents are used in patients with eating disorders. Double-blind, placebo-controlled studies have proven the effectiveness of a wide range of antidepressants in reducing the frequency of binge eating and subsequent purging episodes in bulimia nervosa. Imipramine, desipramine, trazodone and fluoxetine reduce the frequency of such attacks, regardless of the presence or absence of concomitant depression. When using fluoxetine, the most effective dose is higher than that usually used to treat depression - 60 mg. Monoamine oxidase (MAO) inhibitors and buproprion are relatively contraindicated because dietary restrictions must be followed when using MAO inhibitors, and the risk of heart attack increases with buproprion for bulimia. In general, treatment for bulimia should include trying tricyclic antidepressants or selective inhibitors serotonin reuptake therapy (SSRI) along with psychotherapy.

For anorexia nervosa, no medications aimed at increasing body weight have been proven effective in controlled studies. Unless the patient is severely depressed or obvious signs obsessive-compulsive disorder neurosis, most clinicians recommend monitoring the mental status of patients during remission rather than prescribing medications while weight has not yet been gained. Most symptoms of depression, ritualistic behavior, and obsessions disappear when the weight approaches normal. When deciding to prescribe antidepressants, low-dose SSRIs are the safest choice, given the high potential risk of cardiac arrhythmia and hypotension with tricyclic antidepressants, as well as the generally higher risk of drug side effects in underweight people. A recent double-blind, placebo-controlled study of the effectiveness of fluoxetine in anorexia nervosa found that the drug may be useful in preventing weight loss after weight loss has been achieved.

There are few studies examining the levels of neurotransmitters and neuropeptides in sick and recovered patients with eating disorders, but their results show dysfunction of the serotonin, noradrenergic and opiate systems of the central nervous system. Studies of feeding behavior in animal models show similar results.

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

Data from human studies are inconsistent, and it remains unclear whether abnormalities in neurotransmitter levels in patients with eating disorders are associated with this condition, whether they appear in response to fasting and bouts of binge eating and purging, or whether they precede the mental disorder and are a personality trait of the susceptible person. patient's disorder.

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

The long-term prognosis for bulimia is unknown. Episodic relapses are most likely. A decrease in the severity of bulimic symptoms is observed in 70% of patients during a short period of observation after treatment with drugs in combination with psychotherapy. As with anorexia, the severity of symptoms in bulimia affects the prognosis. Among patients with severe bulimia, 33% had no results after three years.

Eating disorders are a complex mental disorder that most often affects women. Their frequency of occurrence in Western society is growing, and they are associated with high morbidity. The use of psychotherapeutic, educational and pharmacological techniques in treatment can improve the prognosis. Although specific help may not be needed at the first stage, failure of treatment requires early referral to a psychiatrist. Further research is needed to clarify the reasons for the predominance of women among patients, to assess the actual risk factors and to develop effective treatment.
Affective disorders

Mood disorders are mental illnesses whose main symptoms are mood changes. Everyone experiences mood swings in their lives, but few experience their extreme expressions—affective disorders. Depression and mania are the two main mood disorders seen in mood disorders. These diseases include major depression, manic-depressive psychosis, dysthymia, adaptation disorder with depressive mood. Features of hormonal status can serve as risk factors for the development of affective disorders during a woman’s life; exacerbations are associated with menstruation and pregnancy.
Depression

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

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

The diagnosis of major depression is based on a history and mental status examination. Main symptoms include low mood and anhedonia – loss of desire and ability to enjoy normal life activities. In addition to depression and anhedonia lasting at least two weeks, episodes of major depression are characterized by the presence of at least four of the following neurovegetative symptoms: significant weight loss or gain, insomnia, or increased drowsiness, psychomotor retardation or alertness, fatigue and loss of strength, reduced ability to concentrate and make decisions. In addition, many people suffer from increased self-criticism with feelings of hopelessness, excessive guilt, suicidal thoughts, and a feeling of being a burden to their loved ones and friends.

Symptoms lasting more than two weeks help differentiate an episode of major depression from a short-term adjustment disorder with low mood. Adjustment disorder is reactive depression, in which depressive symptoms are a reaction to an obvious stress factor, are limited in quantity and can be treated with minimal therapy. This does not mean that an episode of major depression cannot be triggered by a stressful event or cannot be treated. An episode of major depression differs from an adaptation disorder in the severity and duration of symptoms.

Some groups, particularly the elderly, often do not experience classic symptoms of depression such as low mood, leading to an underestimation of the incidence of depression in such groups. There is also evidence that in some ethnic groups depression is expressed more by somatic symptoms than by classical symptoms. In older women, complaints of feelings of social insignificance and a range of characteristic somatic complaints should be taken seriously, as they may require antidepressant medication. Although some laboratory tests, such as the dexamethasone test, have been proposed for diagnosis, they are not specific. The diagnosis of major depression remains clinical and is made after a careful history and mental status assessment.

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

Pregnant women experience a full range of affective symptoms both during pregnancy and after childbirth. The incidence of major depression (about 10%) is the same as non-pregnant women. In addition, pregnant women may experience less severe symptoms depression, mania, periods of psychosis with hallucinations. The use of medications during pregnancy is used both during exacerbation of a mental condition and to prevent relapses. Interrupting medications during pregnancy in women with pre-existing mental disorders results in a sharp increase in the risk of exacerbations. To decide on drug treatment, the risk of potential harm to the fetus from the drugs must be weighed against the risk to both the fetus and mother of recurrence of the disease.

In a recent review, Altshuler et al described current therapeutic recommendations for the treatment of various psychiatric disorders during pregnancy. In general, medications should be avoided if possible during the first trimester due to the risk of teratogenicity. However, if symptoms are severe, treatment with antidepressants or mood stabilizers may be necessary. Initial studies with fluoxetine have shown that SSRIs are relatively safe, but reliable data on the in utero effects of these new drugs are not yet available. The use of tricyclic antidepressants does not lead to a high risk of congenital anomalies. Electroconvulsive therapy is another relatively safe method treatment of severe depression during pregnancy. Taking lithium drugs in the first trimester increases the risk of congenital pathologies of the cardiovascular system. Antiepileptic drugs and benzodiazepines are also associated with an increased risk of congenital anomalies and should be avoided whenever possible. In each case, it is necessary to evaluate all indications and risks individually, depending on the severity of the symptoms. To compare the risk of untreated mental illness with the risk of pharmacological complications for the mother and fetus, consultation with a psychiatrist is necessary.

Many women experience mood disorders after childbirth. Symptom severity ranges from “baby blues” to severe major depression or psychotic episodes. For most women, these mood changes occur in the first six months after childbirth; at the end of this period, all signs of dysphoria disappear on their own. However, for some women, depressive symptoms persist for many months or years. In a study of 119 women after their first birth, half of the women treated with medication after childbirth experienced a relapse within the next three years. Early recognition of symptoms and adequate treatment is necessary for both mother and child, as depression can affect the mother's ability to adequately care for the child. However, treatment of nursing mothers with antidepressants requires caution and a comparative assessment of risks.

Mood changes during menopause have been known for a long time. Recent studies, however, have not confirmed the existence of a clear link between menopause and mood disorders. In a review of this issue, Schmidt and Rubinow found very little published research suggesting this relationship exists.

Mood changes associated with hormonal changes in menopause, may disappear when taking HRT. For most women, HRT is the first stage of treatment before psychotherapy and antidepressants. If symptoms are severe, initial treatment with antidepressants is indicated.

Due to the long life expectancy of women compared to men, most women outlive their spouses, which is a stressful factor in older age. At this age, monitoring is necessary to detect symptoms of severe depression. Taking an anamnesis and examining the mental status of older women should include screening for somatic symptoms and identifying feelings of uselessness and a burden to loved ones, because depression in the elderly is not characterized by decreased mood as a primary complaint. Treatment of depression in the elderly is often complicated by low tolerance to antidepressants, so they must be prescribed in a minimum dose, which can then be gradually increased. SSRIs are not recommended at this age due to their anticholinergic side effects of sedation and orthostasis. When a patient takes several medications, drug monitoring in the blood is necessary due to the mutual influence on metabolism.

There is no single cause of depression. The main demographic risk factor is being female. Analysis of population data shows that the risk of developing major depression is increased among those who are divorced, single, and unemployed. The role of psychological causes is being actively studied, but so far no consensus has been reached on this issue. Family studies have demonstrated an increased incidence of affective disorders in the proband's immediate relatives. Twin studies also support the idea of ​​a genetic predisposition in some patients. Hereditary predisposition plays a particularly strong role in the genesis of manic-depressive psychosis and major depression. The probable cause is disruption of the functioning of the serotonergic and noradrenergic systems.

Ordinary therapeutic approach Treatment is a combination of pharmacological agents - antidepressants - and psychotherapy. The emergence of a new generation of antidepressants with minimal side effects has increased therapeutic options for patients with depression. There are 4 main types of antidepressants used: tricyclic antidepressants, SSRIs, MAO inhibitors and others - see table. 28-2.

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

All patients receiving antidepressant treatment should be monitored for the development of symptoms of mania. Although this is a fairly rare complication of taking antidepressants, it does happen, especially if there is a family or personal history of manic-depressive psychosis. Symptoms of mania include decreased need for sleep, feelings of increased energy, and agitation. Before prescribing therapy, patients must carefully collect anamnesis in order to identify symptoms of mania or hypomania, and if they are present or with a family history of manic-depressive psychosis, consultation with a psychiatrist will help select therapy with mood stabilizers - lithium, valproic acid, possibly in combination with antidepressants.
Seasonal affective disorders

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

The main difference between this disease and major depression is the presence of both episodes of depression and mania. The criteria for depressive episodes are the same as for major depression. Manic episodes are characterized by bouts of elevated, irritable, or aggressive mood that last at least a week. These mood changes are accompanied by the following symptoms: increased self-esteem, decreased need for sleep, loud and rapid speech, racing thoughts, agitation, flashes of ideas. Such an increase in vital energy is usually accompanied by excessive behavior aimed at obtaining pleasure: spending large sums of money, drug addiction, promiscuity and hypersexuality, risky business projects.

There are several types of manic-depressive disorder: the first type is the classic form, type 2 includes alternating episodes of depression and hypomania. Episodes of hypomania are milder than classic mania, with the same symptoms, but not disrupting the patient's social life. Other forms of bipolar disorder include rapid mood swings and mixed states, when the patient has signs of both mania and depression.

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

Dysthymia is a chronic depressive condition that lasts at least two years, with symptoms less severe than those of major depression. The severity and number of symptoms are not sufficient to meet criteria for major depression, but they do impair social functioning. Symptoms typically include appetite disturbances, decreased energy, poor concentration, sleep disturbances, and feelings of hopelessness. Research conducted in different countries, claim a high prevalence of dysthymia in women. Although there are few reports on treatment for this disorder, there is evidence that SSRIs such as fluoxetine and sertraline may be used. Some patients may experience episodes of major depression due to dysthymia.
Coexisting affective and neurological disorders

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

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

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

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

There is evidence that the incidence of alcoholism and related medical problems increases in women born after 1950. During the phases of the menstrual cycle, no changes in the metabolism of alcohol in the body are observed, but women who drink are more likely to experience irregular menstrual cycles and infertility. During pregnancy, a common complication is fetal alcohol syndrome. The incidence of cirrhosis increases sharply after menopause, and alcoholism increases the risk of alcoholism in older women.

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

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

Although it is practically impossible to directly ask such patients about the amount of alcohol they are taking, screening for alcohol abuse should not be limited to indirect signs, such as anemia, increased levels of liver enzymes and triglycerides. The question “have you ever had a problem with alcohol” and the CAGE questionnaire (Table 28-3) provide a rapid screening with a sensitivity of more than 80% for more than two positive answers. Support, explanation and discussion with the doctor, psychologist and members of Alcoholics Anonymous helps the patient adhere to treatment. During the abstinence period, it is possible to prescribe diazepam at a starting dose of 10-20 mg with a gradual increase by 5 mg every 3 days. Control visits should be at least twice a week, at which the severity of signs of withdrawal syndrome (sweating, tachycardia, hypertension, tremor) is assessed and the dose of the drug is adjusted.

Although alcohol abuse is less common in women than in men, its harm to women in terms of associated morbidity and mortality is significantly greater. New research is needed to elucidate the pathophysiology and psychopathology of sexual characteristics of the course of the disease.
Table 28-3
CAGE Questionnaire

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

2. Has it ever happened that people bothered you with their criticism of your alcohol intake?

3. Have you ever felt guilty about drinking alcohol?

4. Has it ever happened that alcohol was the only remedy that helped you become cheerful in the morning (open your eyes)
Sexual disorders

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

The role of sex hormones and menstrual cycle disorders in the regulation sexual desire remains unclear. Most researchers suggest that endogenous fluctuations in estrogen and progesterone do not have a significant effect on sexual desire in women reproductive age. However, there is clear evidence of decreased desire in women with surgical menopause, which can be restored by the administration of estradiol or testosterone. Research on the relationship between arousal and orgasm and cyclic fluctuations in hormones does not provide clear conclusions. A clear correlation has been observed between the plasma level of oxytocin and the psychophysiological magnitude of orgasm.

In postmenopausal women, the number of sexual problems increases: decreased vaginal lubrication, atrophic vaginitis, decreased blood supply, which are effectively addressed with estrogen replacement therapy. Supplementation with testosterone helps increase sexual desire, although there is no clear evidence for the supportive effects of androgens on blood flow.

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

The influence of medications taken by psychiatric patients on all phases of sexual function deserves special attention. Antidepressants and antipsychotic drugs are the two main classes of medications associated with these side effects. Anorgasmia has been observed with the use of SSRIs. Despite clinical reports of the effectiveness of adding cyproheptadine or interrupting the main drug for the weekend, a more acceptable solution for now is to change the class of antidepressant to another one with fewer side effects in this area, most often to buproprion and nefazodone. In addition to the side effects of psychopharmacological drugs, a chronic mental disorder itself can lead to a decrease in sexual interest, as well as physical illnesses accompanied by chronic pain, low self-esteem, changes in appearance, and fatigue. A history of depression may be a cause of decreased sexual desire. In such cases, sexual dysfunction occurs during the onset of the affective disorder, but does not subside after the end of the episode.
Anxiety disorders

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

Anxiety disorders are widespread, with a monthly incidence of 10% among women. The average age for the development of anxiety disorders is adolescence and young adulthood. Many patients never seek help for this issue or consult non-psychiatrists complaining of somatic symptoms associated with anxiety. Excessive use of medications or their withdrawal, use of caffeine, weight loss drugs, pseudoephedrine can worsen anxiety disorders. The medical examination should include a thorough medical history, routine laboratory tests, ECG, and urine toxicology test. Some types of neurological pathology are accompanied by anxiety disorders: movement disorders, brain tumors, cerebral blood supply disorders, migraine, epilepsy. Somatic diseases accompanied by anxiety disorders: cardiovascular, thyrotoxicosis, systemic lupus erythematosus.

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

Sociological theory focuses on traditional gender role stereotypes that prescribe helplessness, dependence, and avoidance of active behavior for women. Young mothers often worry about whether they can keep their children safe, about not wanting to become pregnant, about infertility—all of these conditions can exacerbate anxiety disorders. A large number of expectations and conflict in the roles of a woman - mother, wife, housewife and successful worker - also increase the frequency of anxiety disorders in women.

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

For anxiety disorders, comorbidity with other psychiatric diagnoses is high, most often mood disorders, drug dependence, other anxiety disorders, and personality disorders. At panic disorders ah, for example, a combination with depression occurs more often than 50%, and with alcohol dependence – in 20-40%. Social phobia is combined with panic disorder in more than 50%.

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

All medications should be started at low doses and then gradually increased by doubling every 2-3 days or less frequently to minimize side effects. Patients with anxiety disorders are very sensitive to side effects, so gradually increasing the dose increases compliance with therapy. Patients should be explained that most antidepressants take 8 to 12 weeks to take effect, be told about the main side effects, be encouraged to continue taking the drug for the required amount of time, and explain that some of the side effects will subside over time. The choice of antidepressant depends on the patient’s set of complaints and its side effects. For example, patients with insomnia may be better off starting with a more sedating antidepressant such as imipramine. If effective, treatment should be continued for 6 months to a year.

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

Anxiolytics should be used with caution in pregnant women, most safe drugs in this case - tricyclic antidepressants. Benzodiazepines may cause hypotension, respiratory distress, and low Apgar scores in neonates. A minimal potential teratogenic effect was observed with clonazepam; this drug can be used with caution in pregnant women with severe anxiety disorders. The first step should be to try non-pharmacological treatment - cognitive (education) and psychotherapy.
Phobic disorders

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

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

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

Agoraphobia is fear and avoidance of crowded places. Often combined with panic attacks. In this case, it is very difficult to avoid provoking situations. As with social phobia, agoraphobia is more common in women, but men are more likely to seek help because its symptoms interfere with their personal and social lives. Treatment of agoraphobia consists of systemic desensitization and cognitive psychotherapy. Due to the high compatibility with panic disorders and major depression, antidepressants are also effective.
Panic disorders

A panic attack is a sudden attack strong fear and discomfort, lasting several minutes, passing gradually and including at least 4 symptoms: chest discomfort, sweating, trembling, hot flash, shortness of breath, paresthesia, weakness, dizziness, palpitations, nausea, bowel disorders, fear of death, loss of control yourself. Panic attacks can occur with any anxiety disorder. They are unexpected and are accompanied by constant fear of expecting new attacks, which changes behavior and directs it towards minimizing the risk of new attacks. Panic attacks also occur with many states of intoxication and some diseases, such as emphysema. In the absence of therapy, the course of panic disorder becomes chronic, but treatment is effective, and the combination of pharmacotherapy with cognitive behavioral psychotherapy causes dramatic improvement in most patients. Antidepressants, especially tricyclics, SSRIs, and MAO inhibitors, in doses comparable to those used to treat depression, are the treatment of choice (Table 28-2). Imipramine or nortriptyline is started at a low dose of 10-25 mg per day and increased by 25 mg every three days to minimize side effects and increase compliance. Nortriptyline blood levels should be maintained between 50 and 150 ng/ml. Fluoxetine, fluvoxamine, tranylcypromine or phenelzine may also be used.
Generalized anxiety disorder

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

Treatment includes medications and psychotherapy. The first-line drug for the treatment of generalized anxiety disorder is buspirone. The initial dose is 5 mg twice a day, gradually increasing it over several weeks to 10-15 mg twice a day. An alternative is imipramine or an SSRI (sertraline) (see Table 28-2). Short-term use of a long-acting benzodiazepine, such as clonazepam, may help control symptoms in the first 4 to 8 weeks before the main treatment takes effect.

Psychotherapeutic techniques used in the treatment of generalized anxiety disorder include cognitive behavioral therapy, supportive therapy and an internally oriented approach, which is aimed at increasing the patient’s tolerance to anxiety.
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Each of us is familiar with the state of anxiety, each of us has experienced difficulty sleeping, each of us has experienced periods of depressed mood. Many are familiar with such phenomena as childhood fears; many were “attached” to some obsessive melody, which for some time it was impossible to get rid of. All of the above conditions occur both normally and in pathology. However, normally they appear sporadically, not for long and, in general, do not interfere with life.

If the condition drags on ( formal criterion is a period of more than 2 weeks), if it begins to impair performance or simply interferes with leading a normal lifestyle, it is better to consult a doctor so as not to miss the onset of a disease, possibly a serious one: it does not necessarily begin with severe mental disorders. Most people, for example, think that schizophrenia is necessarily a severe psychosis.

In fact, almost always schizophrenia (even its most severe forms) begins gradually, with subtle changes in mood, character, and interests. Thus, a previously lively, sociable and affectionate teenager becomes withdrawn, alienated and hostile towards his family. Or a young man who was previously mainly interested in football begins to spend almost days reading books, thinking about the essence of the universe. Or the girl begins to be upset about her appearance, claiming that she is too fat or that she has ugly legs. Such disorders can last for several months or even several years, and only then a more severe condition develops.

Of course, any of the changes described do not necessarily indicate schizophrenia or any mental illness at all. Character changes in adolescence everyone, and this causes parents all known difficulties. Almost all teenagers are upset about their appearance, and many begin to have “philosophical” questions.

In the vast majority of cases, all these changes have nothing to do with schizophrenia. But it happens that they do. It is useful to remember that this may be the case. If the phenomena " adolescence“are expressed very strongly, if they create much more difficulties than in other families, it makes sense to consult a psychiatrist. And this is absolutely necessary if the matter is not limited to changes in character, but they are joined by other, more distinct painful phenomena, for example, depression or obsession.

Not all conditions for which it would be reasonable to seek help in a timely manner are listed here. These are just guidelines that can help you suspect something is wrong and make the right decision.

Is this really a disease?!

Any illness, be it physical or mental, invades our lives unexpectedly, brings suffering, disrupts plans, and disrupts the usual way of life. However, mental disorder burdens both the patient and his loved ones additional problems. If it is customary to share about a physical (somatic) illness with friends and relatives and seek advice on how best to proceed, then in the case of a mental disorder, both the patient and his family members try not to tell anyone anything.

If in case of a physical illness people strive to understand what is happening as quickly as possible and quickly seek help, then in the event of mental disorders the family does not realize for a long time that it is a disease: the most ridiculous, sometimes mystical assumptions are made, and a visit to a specialist is postponed for months or even years.

A mental disorder manifests itself in changes in the perception of the outside world (or perception of oneself in this world), as well as in changes in behavior.

Why is this happening?

Symptoms of physical (somatic) diseases are most often very specific (pain, fever, cough, nausea or vomiting, upset bowel movements or urination, etc.) In such a situation, everyone understands that they need to go to the doctor. And the patient may not have the usual complaints of pain, weakness, malaise, or “usual” symptoms such as fever or lack of appetite. Therefore, the thought of illness does not immediately occur to the patient himself or to his loved ones.

The symptoms of mental illness, especially at the very beginning, are either quite vague or very unclear. In young people they are often similar to character difficulties (“whims”, “whims”, age crisis), and in depression - to fatigue, laziness, lack of will.

Therefore, for a very long time, people around them think that a teenager, for example, was poorly brought up or came under bad influence; that he was overworked or “overtrained”; that a person is “playing the fool” or mocking his family, and first of all the family tries to apply “educational measures” (moral teaching, punishment, demands to “pull yourself together”).

In the event of a gross violation of the patient’s behavior, his relatives have the most incredible assumptions: they have “jinxed” him, “zombified” him, drugged him, etc. Often family members guess that we are talking about a mental disorder, but explain it by overwork, a quarrel with a loved one, fear, etc. They try in every possible way to delay the time of seeking help, waiting for it to “go away on its own.”

But even when it becomes clear to everyone that the matter is much more serious, when the thought of “spoilage” or “evil eye” is behind us, when there is no longer any doubt that a person is sick, there is still a pressing prejudice that mental illness is not at all what that disease, for example heart or stomach. Often this wait lasts from 3 to 5 years. This affects both the course of the disease and the results of treatment; it is known that the earlier treatment is started, the better.

Most people are firmly convinced that diseases of the body (they are also called somatic diseases, because “soma” in Greek means “body”) are an ordinary phenomenon, and mental disorders, diseases of the soul (“psyche” in Greek - soul), - this is something mysterious, mystical and very scary.
We repeat, that this is just a prejudice and that its causes are complexity and "unusuality" of psychopathological symptoms. In other respects, mental and physical illnesses are no different from each other."

Signs that may suggest mental illness:

• Noticeable personality change.
• Inability to cope with problems and daily activities.
• Strange or big ideas.
• Excessive anxiety.
• Long-term decreased mood or apathy.
• Noticeable changes in your usual eating and sleeping patterns.
• Thoughts and conversations about suicide.
• Extreme ups and downs of mood.
• Alcohol or drug abuse.
• Excessive anger, hostility, or inappropriate behavior.

Behavioral disorders- symptoms of the disease, and the patient is as little to blame for them as a patient with the flu is to blame for having a fever. This is a very difficult problem for relatives - to understand and accustom themselves to the fact that the incorrect behavior of a sick person is not a manifestation of malice, bad upbringing or character, that these violations cannot be eliminated or normalized (educational or punitive) measures, that they are eliminated as the condition improves sick.

For relatives, it may be useful information O initial manifestations psychosis or symptoms of an advanced stage of the disease. 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 with your loved one, especially if he is afraid, 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 presence of voices advising or ordering suicide.
• 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.

If you or someone close to you experiences one or more of these warning signs, you should immediately consult a psychiatrist.
A psychiatrist is a doctor who has received a higher medical education and completed a course of specialization in the field of psychiatry, has a license to practice and is constantly improving his professional level.

Questions from relatives about the manifestation of the disease.

I have an adult son - 26 years old. Something has been happening to him lately. I see him strange behavior: stopped going outside, is not interested in anything, doesn’t even watch his favorite videos, refuses to get up in the morning and hardly cares about personal hygiene. This had never happened to him before. I can't find the reason for the changes. Maybe it's a mental illness?

Relatives often ask this question, especially in the very initial stages of the disease. The behavior of a loved one causes anxiety, but it is impossible to accurately determine the reason for the change in behavior. In this situation, significant tension may arise between you and the person close to you.

Watch your loved one. If the resulting behavior disorders are persistent enough and do not disappear when circumstances change, it is likely that their cause may be a mental disorder. If you feel uneasy, try consulting a psychiatrist.
Try not to get into conflict with the person you care about. Instead, try to find productive ways to resolve the situation. Sometimes it can be helpful to start by learning as much as you can about mental illness.

How to convince a patient to seek psychiatric help if he says: “I’m fine, I’m not sick”?

Unfortunately, this situation is not uncommon. We understand that it is extremely painful for relatives to see a family member suffering from an illness, and it is equally difficult to see that he refuses to seek help from a doctor or even from his loved ones to improve his condition.

Try to express your concerns to him in a way that does not seem like criticism, accusations or unnecessary pressure on your part. Sharing your fears and concerns with a trusted friend or doctor first can help you talk calmly with the patient.

Ask your loved one if he is concerned about his condition, and try to discuss with him possible ways to solve the problem. Your main principle should be to involve the patient as much as possible in discussing problems and making appropriate decisions. If it is impossible to discuss anything with the person you care about, try to find support in resolving the difficult situation from other family members, friends or doctors.

Sometimes mental condition the patient deteriorates sharply. You need to know when mental health services provide treatment against the wishes of the patient (involuntary hospitalization, etc.), and in which they don’t do this.

The main purpose of involuntary (forced) hospitalization is to ensure the safety of both the patient in acute condition and the people around him.

Remember that there is no substitute for a trusting relationship with your doctor. You can and should talk to him about the problems facing you first. Do not forget that these problems can be no less difficult for the specialists themselves.

Please explain, does the psychiatric care system provide any mechanism for providing it in the event that a patient needs help, but refuses it?

Yes, in accordance with such a mechanism, such a mechanism is provided. A patient may be admitted and held involuntarily in a mental health facility if the psychiatrist believes that the person has a mental illness and is likely to cause serious physical harm to himself or others if left untreated.

To persuade the patient to voluntary treatment, the following can be advised:

• Choose the right moment to talk to your coachee and try to honestly express your concerns to him.
• Let him know that first of all you are concerned about him and his well-being.
• Consult your relatives and your doctor about what is best for you to do.

If this does not help, seek advice from your doctor, and if necessary, contact emergency psychiatric help.