Somatic diseases of nervous origin. Chronic somatic diseases list

From Greek. "Soma" - the body, respectively, somatic personality disorders are associated with diseases of the bodily sphere. The close relationship between mental and somatic disorders can be traced quite clearly. This condition occurs as a result of disorders of nervous activity that cause symptoms of diseases of various organs in the absence of pathology in them.

Mental disorders in which diseases occur internal organs called "somatization".

It is difficult to recognize somatization, often in this condition the patient complains of pain in the body, but as a result of the examination, the causes of the symptoms are absent.

Many somatic disorders are symptoms of diseases that require the attention of a specialist. The most common of them are sleep disturbance, appetite, pain, and sexual dysfunction.

Sleep disturbance

One of the first signs and most common in mental disorders is insomnia. It may differ in character in various mental disorders.

Insomnia may be associated with internal experiences. In this case, a person cannot fall asleep, trying to mentally find a way out of the situation. In the morning, a person feels tired and irritable. Such a violation is observed in neuroses.

Neurasthenia is accompanied by the sensitivity of sleep: a person is asleep, but the slightest sound awakens him, after which he falls asleep with difficulty.

For people suffering from depression, sleep does not bring rest, since such a person not only finds it difficult to fall asleep, but he is also annoyed by the onset of the morning. With depression, the beginning of a new day gives rise to painful thoughts and feelings. A patient suffering from such a syndrome can spend the whole day in bed, lie down without closing his eyes.

After you stop taking certain drugs or alcohol, you may experience withdrawal syndrome accompanied by insomnia.

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Disorders of sexual functions

There are several types of sexual dysfunctions. Decreased or excessively elevated sexual attraction, violation of orgasm, pain during sexual intercourse.

These manifestations lead psychological factors, among them such as low self-esteem, prolonged abstinence, lack of a permanent partner, unconscious disgust, fear. Often the cause of such disorders are alcohol, drugs.

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Pain that occurs

Among scientists studying psychosomatics, there is an opinion that a patient with a somatic disorder complains of pain in the organ that he considers the most important.

Depression is often accompanied by pain in the heart muscle, which can be accompanied by fears and worries. Such painful sensations are easily removed with sedatives: valerian, valocordin, validol; taking nitroglycerin in such cases does not help.

A headache that is psychogenic in nature can occur due to tension in the muscles of the neck. Self-hypnosis or hysteria also lead to headaches.

Some stressful situations cause severe pain in the back of the head, the patient feels pain radiating to the shoulders. Such states are characteristic of anxious and suspicious persons. Constant stay in a stressful situation entails such an unpleasant syndrome.

Hysteria can be accompanied by various headaches. At the same time, a person may feel squeezing pain, piercing or bursting, usually aggravated in the evening.

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Appetite disorder

Such disorders may look like a lack of appetite or, conversely, an excessive feeling of hunger. Often they are caused by stress, depression.

Many neuroses are accompanied by a decrease in appetite. Some diseases can manifest themselves in a complex in one person. For example, anorexia nervosa and bulimia. In the case of anorexia nervosa, a person may refuse food, sometimes feel disgust for it, but the body's need for food remains. Bulimia is characterized by uncontrolled consumption of large amounts of food and can cause obesity, but there are cases when bulimia leads to weight loss. This happens when the patient, feeling hostility to himself due to neurosis, begins to take laxatives, cause a gag reflex.

In most cases, patients with eating disorders are treated in a hospital setting. In combination with psychotherapy, food intake by patients is strictly controlled.

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Masked depression and hypochondria

In addition to such common disorders, masked depression occurs. It is characterized by severe diseases of the internal organs associated with the experiences of the patient. People who are able to withstand stressful situations and express external calmness are susceptible to such a disorder, however, pathological processes occur in the body that has received a dose of stress.

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Diseases caused by somatic disorders

The basis of psychosomatic personality disorders is the reaction of the body to conflict experiences that cause disruption of the internal organs.

Psychosomatic disorders lead to the appearance of symptoms of many diseases, the appearance of which is influenced by individual predisposition. Somatic diseases include the following diseases, the so-called golden seven:

1. Neurodermatitis - often occurs due to depression, the disease is characterized by the appearance of skin imperfections, severe itching, nervousness.
2. peptic ulcer stomach and duodenal ulcer - one of the causes of this disease is increased nervousness. Overexertion leads to an increase in acidity and, as a result, to the appearance of an ulcer.
3. Bronchial asthma - attacks can be triggered by a strong experience, stress, affecting the heart, causes an asthma attack.
4. Rheumatoid arthritis - an immune pulse can be obtained as a result of mental disorders, nervous strain, which is why the symptoms of joint disease appear.
5. Ulcerative colitis - stress and nervous disorders are one of the causes of the disease.
6. Essential hypertension is the main risk group prone to this disease - people engaged in mental work also occur as a result of an overload of higher nervous activity. In addition, people who are constantly in a state of stress are often susceptible to it.

Recently, somatic disorders include coronary heart disease, obesity, diabetes mellitus, and somatophoric behavioral disorders.

Basically, the symptoms caused by somatic personality disorders are repetitive, accompanied by depression, sleep disturbance, and anxiety. They lead to problems in family relationships, in addition, with such symptoms, unnecessary treatment may be prescribed. For a correct diagnosis in this case, a consultation with a psychiatrist is necessary.

The content of the article

General and clinical characteristics

Somatogenic mental illness is a collective group of mental disorders resulting from somatic non-communicable diseases. These include mental disorders in cardiovascular, gastrointestinal, renal, endocrine, metabolic and other diseases. Mental disorders of vascular origin (with hypertension, arterial hypotension and atherosclerosis) are traditionally distinguished into an independent group.

Classification of somatogenic mental disorders

1. Borderline non-psychotic disorders:
a) asthenic, neurosis-like states caused by somatic noncommunicable diseases(code 300.94), metabolic disorders, growth and nutrition (300.95);
b) non-psychotic depressive disorders due to somatic non-communicable diseases (311.4), metabolic, growth and nutrition disorders (311.5), other and unspecified organic diseases of the brain (311.89 and 311.9);
c) neurosis- and psychopath-like disorders due to somatogenic organic lesions of the brain (310.88 and 310.89).
2. Psychotic states that have developed as a result of functional or organic damage to the brain:
a) acute psychoses (298.9 and 293.08) - asthenic confusion, delirious, amentiviy and other syndromes of clouding of consciousness;
b) subacute protracted psychoses (298.9 and 293.18) - paranoid, depressive-paranoid, anxiety-paranoid, hallucinatory-paranoid, catatonic and other syndromes;
c) chronic psychosis (294) - Korsakov's syndrome (294.08), hallucinatory-paranoid, senestopatho-hypochondriac, verbal hallucinosis, etc. (294.8).
3. Defect-organic states:
a) simple psychoorganic syndrome (310.08 and 310.18);
b) Korsakov's syndrome (294.08);
c) dementia (294.18).
Somatic diseases acquire independent significance in the occurrence of a mental disorder, in relation to which they are an exogenous factor. The mechanisms of brain hypoxia, intoxication, metabolic disorders, neuroreflex, immune, autoimmune reactions. On the other hand, as B. A. Tselibeev (1972) noted, somatogenic psychoses cannot be understood only as the result of a somatic disease. In their development, a predisposition to a psychopathological type of response plays a role, psychological features personality, psychogenic influences.
The problem of somatogenic mental pathology is becoming increasingly greater value due to growth cardiovascular pathology. The pathomorphism of mental illness is manifested by the so-called somatization, the predominance of non-psychotic disorders over psychotic, "bodily" symptoms over psychopathological. Patients with sluggish, "erased" forms of psychosis sometimes end up in general somatic hospitals, and severe forms of somatic diseases are often unrecognized due to the fact that the subjective manifestations of the disease "cover" the objective somatic symptoms.
Mental disorders are observed in acute short-term, protracted and chronic somatic diseases. They manifest themselves in the form of non-psychotic (asthenic, astheno-denpressive, astheno-dysthymic, astheno-hypochondriac, anxiety-phobic, hysteroform), psychotic (delirious, delirious-amental, oneiric, twilight, catatonic, hallucinatory-iaranoid), defective organic (psycho-organic syndrome and dementia) states .
According to V. A. Romasenko and K. A. Skvortsov (1961), B. A. Tselibeev (1972), A. K. Dobzhanskaya (1973), the exogenous nature of mental disorders of nonspecific tin is usually observed in the acute course of somatic illness. In cases of its chronic course with diffuse brain damage of a toxic-anoxic nature, more often than with infections, there is a tendency to endoformity of psychopathological symptoms.

Mental disorders in certain somatic diseases

Mental disorders in heart disease

One of the most frequently diagnosed forms of heart disease is coronary heart disease (CHD). In accordance with the WHO classification, coronary artery disease includes angina pectoris and rest, acute focal myocardial dystrophy, small- and large-focal myocardial infarction. Coronary-cerebral disorders are always combined. In diseases of the heart, cerebral hypoxia is noted, with lesions cerebral vessels detect hypoxic changes in the heart.
Mental disorders resulting from acute heart failure can be expressed by syndromes of disturbed consciousness, most often in the form of deafness and delirium, characterized by instability of hallucinatory experiences.
Mental disorders in myocardial infarction began to be systematically studied in recent decades(I. G. Ravkin, 1957, 1959; L. G. Ursova, 1967, 1969). Depressive conditions, syndromes of disturbed consciousness with psychomotor agitation, euphoria are described. Overvalued formations are often formed. With small-focal myocardial infarction, a pronounced asthenic syndrome develops with tearfulness, general weakness, sometimes nausea, chills, tachycardia, subfebrile temperature body. With a macrofocal infarction with damage to the anterior wall of the left ventricle, anxiety and fear of death arise; with a heart attack rear wall in the left ventricle, euphoria, verbosity, lack of criticism of one's condition with attempts to get out of bed, requests for some kind of work are observed. In the postinfarction state, lethargy, severe fatigue, and hypochondria are noted. A phobic syndrome often develops - expectation of pain, fear of a second heart attack, getting out of bed at a time when doctors recommend an active regimen.
Mental disorders also occur with heart defects, as pointed out by V. M. Banshchikov, I. S. Romanova (1961), G. V. Morozov, M. S. Lebedinsky (1972). With rheumatic heart disease V. V. Kovalev (1974) identified the following types of mental disorders:
1) borderline (asthenic), neurosis-like (neurasthenic-like) with vegetative disorders, cerebrosteic with mild manifestations of organic cerebral insufficiency, euphoric or depressive-dysthymic mood, hysteroform, asthenoinochondriacal states; neurotic reactions of depressive, depressive-hypochondriac and pseudo-euphoric types; pathological personality development (psychopathic);
2) psychotic (cardiogenic psychoses) - acute with delirious or amental symptoms and subacute, protracted (anxious-depressive, depressive-paranoid, hallucinatory-paranoid); 3) encephalopathic c (psychoorganic) - psychoorganic, epileptiform and corsage syndromes. birth defects hearts are often accompanied by signs of psychophysical infantilism, asthenic, neurosis- and psychopathic states, neurotic reactions, intellectual retardation.
Currently, heart operations are widely performed. Surgeons and cardiologists-therapists note the disproportion between objective physical abilities operated patients and relatively low actual indicators of rehabilitation of persons who underwent heart surgery (E. I. Chazov, 1975; N. M. Amosov et al., 1980; C. Bernard, 1968). One of the most significant reasons for this disproportion is the psychological maladjustment of persons who have undergone heart surgery. When examining patients with pathology of the cardiovascular system, it was established that they have pronounced forms personal reactions (G. V. Morozov, M. S. Lebedinsky, 1972; A. M. Wein et al., 1974). N. K. Bogolepov (1938), L. O. Badalyan (1963), V. V. Mikheev (1979) indicate a high frequency of these disorders (70-100%). Changes in the nervous system in heart defects were described by L. O. Badalyan (1973, 1976). Circulatory insufficiency that occurs with heart defects leads to chronic hypoxia of the brain, the occurrence of cerebral and focal neurological symptoms, including convulsive seizures.
Patients operated on for rheumatic heart disease usually complain of headache, dizziness, insomnia, numbness and cold extremities, pain in the heart and behind the sternum, suffocation, fatigue, shortness of breath, aggravated by physical exertion, weakness of convergence, decreased corneal reflexes, hypotension of muscles, decreased periosteal and tendon reflexes, disorders of consciousness, more often in the form of fainting, indicating a violation of blood circulation in the system of vertebral and basilar arteries and in the basin of the internal carotid artery.
Mental disorders that occur after cardiac surgery are the result of not only cerebral vascular disorders but also personal reactions. V. A. Skumin (1978, 1980) singled out a “cardioprosthetic psychopathological syndrome”, which often occurs during mitral valve implantation or multivalve prosthetics. Due to noise phenomena associated with the activity of the artificial valve, disturbances in the receptive fields at the site of its implantation, and disturbances in the rhythm of cardiac activity, the attention of patients is riveted to the work of the heart. They have concerns and fears about a possible “valve break”, its breakdown. The depressed mood intensifies at night, when the noise from the work of artificial valves is heard especially clearly. Only during the day, when the patient is seen nearby by medical personnel, can he fall asleep. develops a negative attitude towards vigorous activity, there is an anxious and depressive background of mood with the possibility of suicidal actions.
In V. Kovalev (1974), in the immediate postoperative period, he noted in patients astheno-dynamic conditions, sensitivity, transient or persistent intellectual-mneetic insufficiency. After operations with somatic complications, acute psychoses with clouding of consciousness often occur (delirious, delirious-amental and delirious-opeiroid syndromes), subacute abortive and protracted psychoses (anxiety-depressive, depressive-hypochondriac, depressive-paranoid syndromes) and epileptiform paroxysms.

Mental disorders in patients with renal pathology

Mental disorders in renal pathology are observed in 20-25% of patients with LNC (V. G. Vogralik, 1948), but not all of them fall into the field of view of psychiatrists (A. G. Naku, G. N. German, 1981). Marked mental disorders that develop after kidney transplantation and hemodialysis. A. G. Naku and G. N. German (1981) identified typical nephrogenic and atypical nephrogenic psychoses with the obligatory presence of an asthenic background. The authors include asthenia, psychotic and non-psychotic forms of disturbed consciousness in the 1st group, endoform and organic psychotic syndromes in the 2nd group (we consider the inclusion of asthenia syndromes and non-psychotic impairment of consciousness in the composition of psychotic states to be erroneous).
Asthenia in renal pathology, as a rule, precedes the diagnosis of kidney damage. There are unpleasant sensations in the body, a “stale head”, especially in the morning, nightmares, difficulty concentrating, a feeling of weakness, depressed mood, somatic neurological manifestations (coated tongue, grayish-pale complexion, instability of blood pressure, chills and profuse sweating along at night, discomfort in the lower back).
The asthenic nephrogenic symptom complex is characterized by a constant complication and an increase in symptoms, up to the state of asthenic confusion, in which patients do not catch changes in the situation, do not notice the objects they need, nearby. With increasing kidney failure asthenic condition may be replaced by amentia. A characteristic feature of nephrogenic asthenia is adynamia with the inability or difficulty to mobilize oneself to perform an action while understanding the need for such mobilization. Patients spend most of their time in bed, which is not always justified by the severity of renal pathology. According to A. G. Naku and G. N. German (1981), the often observed change of astheno-dynamic states by astheno-subdepressive ones is an indicator of improvement in the patient’s somatic state, a sign of “affective activation”, although it goes through a pronounced stage of a depressive state with ideas of self-abasement (uselessness, worthlessness, burdens on the family).
Syndromes of clouded consciousness in the form of delirium and amentia in nephropathies are severe, often patients die. There are two variants of the amental syndrome (A. G. Maku, G. II. German, 1981), reflecting the severity of renal pathology and having prognostic value: hyperkinetic, in which uremic intoxication is not pronounced, and hypokinetic with increasing decompensation of kidney activity, a sharp increase in arterial pressure.
Severe forms of uremia are sometimes accompanied by psychoses of the type of acute delirium and end in death after a period of stunnedness about sharp motor restlessness, fragmentary delusional ideas. When the condition worsens, the productive forms of the frustrated consciousness are replaced by unproductive ones, adynamia and doubt increase.
Psychotic disorders in case of protracted and chronic kidney diseases are manifested complex syndromes observed against the background of asthenia: anxiety-depressive, depressive and hallucinatory-paranoid and catatonic. The increase in uremic toxicosis is accompanied by episodes of psychotic stupefaction, signs of organic damage to the central nervous system, epileptiform paroxysms and intellectual-mnestic disorders.
According to B. A. Lebedev (1979), 33% of the examined patients against the background of severe asthenia have mental reactions of depressive and hysterical types, the rest have an adequate assessment of their condition with a decrease in mood, an understanding of the possible outcome. Asthenia can often prevent the development of neurotic reactions. Sometimes, in cases of slight severity of asthenic symptoms, hysterical reactions occur, which disappear with an increase in the severity of the disease.
Rheoencephalographic examination of patients chronic diseases of the kidneys makes it possible to detect a decrease in vascular tone with a slight decrease in their elasticity and signs of impaired venous flow, which are manifested by an increase in the venous wave (presystolic) at the end of the catacrotic phase and are observed in people who have been suffering from arterial hypertension for a long time. Characterized by instability vascular tone, mainly in the system of vertebral and basilar arteries. In mild forms of kidney disease, there are no pronounced deviations from the norm in pulse blood filling (L. V. Pletneva, 1979).
In the late stages of chronic renal failure and with severe intoxication perform organ replacement surgery and hemodialysis. After kidney transplantation and during dialysis stable suburemia, chronic nephrogenic toxicodishomeostatic encephalopathy is observed (MA Tsivilko et al., 1979). Patients have weakness, sleep disorders, mood depression, sometimes a rapid increase in adynamia, stupor, appear seizures. It is believed that the syndromes of clouded consciousness (delirium, amentia) arise as a result of vascular disorders and postoperative asthenia, and the syndromes of turning off consciousness - as a result of uremic intoxication. In the process of hemodialysis treatment, there are cases of intellectual-mnestic disorders, organic brain damage with a gradual increase in lethargy, loss of interest in the environment. With prolonged use of dialysis, a psychoorganic syndrome develops - "dialysis-uremic dementia", which is characterized by deep asthenia.
Used in kidney transplant large doses hormones, which can lead to autonomic regulation disorders. During acute insufficiency transplant, when azotemia reaches 32.1-33.6 mmol, and hyperkalemia - up to 7.0 meq / l, hemorrhagic phenomena may occur (abundant nose bleed and hemorrhagic rash), paresis, paralysis. An electroencephalographic study reveals persistent desynchronization with an almost complete disappearance of alpha activity and a predominance of slow-wave activity. A rheoencephalographic study reveals pronounced changes in vascular tone: irregularity of waves in shape and size, additional venous waves. Asthenia sharply increases, subcomatose and coma.

Mental disorders in diseases of the digestive tract

Diseases of the digestive system take the second place in the general morbidity of the population, second only to cardiovascular pathology.
Violations of mental functions in the pathology of the digestive tract are more often limited to sharpening of character traits, asthenic syndrome and neurosis-like conditions. Gastritis, peptic ulcer and nonspecific colitis accompanied by exhaustion of mental functions, sensitivity, lability or torpidity of emotional reactions, anger, a tendency to a hypochondriacal interpretation of the disease, carcinophobia. With gastroesophageal reflux, there are neurotic disorders(neurasthenic syndrome and obsessive phenomena), preceding the symptoms of the digestive tract. The statements of patients about the possibility of a malignant neoplasm in them are noted in the framework of overvalued hypochondriacal and paranoid formations. Complaints of memory impairment are associated with attention disorders caused by both fixation on the sensations caused by the underlying disease and depressive mood.
A complication of stomach resection operations for peptic ulcer is dumping syndrome, which should be distinguished from hysterical disorders. Dumping syndrome is understood as vegetative crises that occur paroxysmal as hypo- or hyperglycemic ones immediately after a meal or after 20-30 minutes, sometimes 1-2 hours.
Hyperglycemic crises appear after ingestion of hot food containing easily digestible carbohydrates. Suddenly there is a headache with dizziness, tinnitus, less often - vomiting, drowsiness, tremor. “Black dots”, “flies” before the eyes, disorders of the body scheme, instability, unsteadiness of objects may appear. They end with profuse urination, drowsiness. At the height of the attack, the level of sugar and blood pressure rise.
Hypoglycemic crises occur outside the meal: weakness, sweating, headache, dizziness appear. After eating, they quickly stop. During a crisis, blood sugar levels drop and blood pressure drops. Possible disorders of consciousness at the height of the crisis. Sometimes crises develop in the morning hours after sleep (RE Galperina, 1969). In the absence of timely therapeutic correction, hysterical fixation of this condition is not excluded.

Mental disorders in cancer

The clinical picture of neoplasms of the brain is determined by their localization. With the growth of the tumor, cerebral symptoms become more prominent. Almost all types of psychopathological syndromes are observed, including asthenic, psychoorganic, paranoid, hallucinatory-paranoid (A. S. Shmaryan, 1949; I. Ya. Razdolsky, 1954; A. L. Abashev-Konstantinovsky, 1973). Sometimes a brain tumor is detected in a section of deceased persons treated for schizophrenia, epilepsy.
With malignant neoplasms of extracranial localization, V. A. Romasenko and K. A. Skvortsov (1961) noted the dependence of mental disorders on the stage of the course of cancer. In the initial period, sharpening of the characterological traits of patients, neurotic reactions, and asthenic phenomena are observed. In the extended phase, astheno-depressive states, anosognosias are most often noted. With cancer of the internal organs in the manifest and predominantly terminal stages, states of “silent delirium” are observed with adynamia, episodes of delirious and oneiric experiences, followed by deafness or bouts of arousal with fragmentary delusional statements; delirious-amental states; paranoid states with delusions of relationship, poisoning, damage; depressive states with depersonalization phenomena, senestopathies; reactive hysterical psychoses. Characterized by instability, dynamism, frequent change of psychotic syndromes. IN terminal stage the oppression of consciousness gradually increases (stupor, stupor, coma).

Mental disorders of the postpartum period

There are four groups of psychoses arising in connection with childbirth:
1) generic;
2) actually postpartum;
3) lactation period psychoses;
4) endogenous psychoses provoked by childbirth.
Mental pathology of the postpartum period does not represent an independent nosological form. Common to the entire group of psychoses is the situation in which they occur.
Birth psychoses are psychogenic reactions that develop, as a rule, in nulliparous women. They are caused by the fear of waiting for pain, an unknown, frightening event. At the first signs of incipient labor, some women in labor may develop a neurotic or psychotic reaction, in which, against the background of a narrowed consciousness, hysterical crying, laughter, screaming, sometimes fugiform reactions, and less often hysterical mutism appear. Women in labor refuse to follow the instructions offered by medical personnel. The duration of the reactions is from several minutes to 0.5 hours, sometimes longer.
Postpartum psychoses are conventionally divided into postpartum and lactation psychoses proper.
Actually postpartum psychosis develop during the first 1-6 weeks after childbirth, often in the maternity hospital. The reasons for their occurrence: toxicosis of the second half of pregnancy, difficult childbirth with massive tissue trauma, retained placenta, bleeding, endometritis, mastitis, etc. The decisive role in their appearance belongs to a generic infection, the predisposing moment is toxicosis of the second half of pregnancy. At the same time, psychoses are observed, the occurrence of which cannot be explained by postpartum infection. The main reasons for their development are traumatization of the birth canal, intoxication, neuroreflex and psychotraumatic factors in their totality. Actually postpartum psychoses are more often observed in nulliparous women. The number of sick women who gave birth to boys is almost 2 times more than women who gave birth to girls.
Psychopathological symptoms are characterized by an acute onset, occur after 2-3 weeks, and sometimes 2-3 days after childbirth against the background of elevated body temperature. Women in childbirth are restless, gradually their actions become erratic, speech contact is lost. Amenia develops, which in severe cases passes into a soporous state.
Amentia in postpartum psychosis is characterized by mild dynamics throughout the entire period of the disease. The exit from the amental state is critical, followed by lacunar amnesia. Prolonged asthenic conditions are not observed, as is the case with lactation psychoses.
The catatonic (katatono-oneiric) form is less common. A feature of postpartum catatonia is the weak severity and instability of symptoms, its combination with oneiric disorders of consciousness. With postpartum catatonia, there is no pattern of increasing stiffness, as with endogenous catatonia, there is no active negativism. Characterized by instability of catatonic symptoms, episodic oneiroid experiences, their alternation with states of stupor. With the weakening of catatonic phenomena, patients begin to eat, answer questions. After recovery, they are critical of the experience.
Depressive-paranoid syndrome develops against the background of unsharply pronounced stupor. It is characterized by "matte" depression. If the stupor intensifies, the depression is smoothed out, the patients are indifferent, do not answer questions. Ideas of self-accusation are connected with the failure of patients during this period. Quite often find the phenomena of mental anesthesia.
Differential diagnosis of postpartum and endogenous depression is based on the presence of changes in its depth during postpartum depression depending on the state of consciousness, worsening of depression by night. In such patients, in a delusional interpretation of their insolvency, the somatic component sounds more, while in endogenous depression, low self-esteem concerns personal qualities.
Psychoses during lactation occur 6-8 weeks after birth. They occur about twice as often as postpartum psychosis itself. This can be explained by the trend towards rejuvenation of marriages and the psychological immaturity of the mother, the lack of experience in caring for children - younger brothers and sisters. The factors preceding the onset of lactational psychosis include shortening of hours of rest in connection with caring for a child and deprivation of night sleep (K. V. Mikhailova, 1978), emotional overstrain, lactation with irregular meals and rest, leading to rapid weight loss.
The disease begins with impaired attention, fixative amnesia. Young mothers do not have time to do everything necessary due to the lack of composure. At first, they try to “make up time” by reducing rest hours, “put things in order” at night, do not go to bed, and start washing children's clothes. Patients forget where they put this or that thing, they look for it for a long time, breaking the rhythm of work and putting things in order with difficulty. Difficulty comprehending the situation quickly grows, confusion appears. The purposefulness of behavior is gradually lost, fear, the affect of bewilderment, fragmentary interpretive delirium develop.
In addition, there are changes in the state during the day: during the day, patients are more collected, and therefore it seems that the state returns to pre-painful. However, with each passing day, periods of improvement are reduced, anxiety and lack of concentration are growing, and fear for the life and well-being of the child is increasing. An amental syndrome or stunning develops, the depth of which is also variable. The exit from the amental state is protracted, accompanied by frequent relapses. The amental syndrome is sometimes replaced by a short period of a catatonic-oneiric state. There is a tendency to increase the depth of disorders of consciousness when trying to maintain lactation, which is often asked by the patient's relatives.
An astheno-depressive form of psychosis is often observed: general weakness, emaciation, deterioration of skin turgor; patients become depressed, express fears for the life of the child, ideas of low value. The way out of depression is protracted: in patients for a long time there is a feeling of instability in their condition, weakness, anxiety are noted that the disease may return.

Endocrine diseases

Violation of the hormonal function of one of the glands usually causes a change in the state of other endocrine organs. The functional relationship between the nervous and endocrine systems underlies mental disorders. Currently, there is a special section of clinical psychiatry - psychoendocrinology.
Endocrine disorders in adults, as a rule, are accompanied by the development of non-psychotic syndromes (asthenic, neurosis- and psychopathic) with paroxysmal vegetative disorders, and with an increase in the pathological process - psychotic states: syndromes of clouded consciousness, affective and paranoid psychoses. With congenital forms of endocrinopathy or their occurrence in early childhood, the formation of a psychoorganic neuroendocrine syndrome is clearly visible. If an endocrine disease appears in adult women or in adolescence, then they often have personal reactions associated with changes in somatic condition and appearance.
On early stages of all endocrine diseases and with their relatively benign course, the gradual development of a psychoendocrine syndrome (endocrine psychosyndrome, according to M. Bleuler, 1948), its transition with the progression of the disease into a psycho-organic (amnestic-organic) syndrome and the occurrence of acute or prolonged psychoses against the background of these syndromes are noted ( D. D. Orlovskaya, 1983).
Most often, asthenic syndrome appears, which is observed in all forms of endocrine pathology and is included in the structure of the psychoendocrine syndrome. It is one of the earliest and most persistent manifestations of endocrine dysfunction. In cases of acquired endocrine pathology, asthenic phenomena may long precede the detection of gland dysfunction.
"Endocrine" asthenia is characterized by a feeling of pronounced physical weakness and weakness, accompanied by a myasthenic component. At the same time, the urges to activity that persist in other forms of asthenic conditions are leveled. Asthenic syndrome very soon acquires the features of an apatoabulic state with impaired motivation. Such a transformation of the syndrome usually serves as the first signs of the formation of a psychoorganic neuroendocrine syndrome, an indicator of the progression of the pathological process.
Neurosis-like changes are usually accompanied by manifestations of asthenia. Neurastheno-like, hysteroform, anxiety-phobic, astheno-depressive, depressive-hypochondriac, asthenic-abulic states are observed. They are persistent. In patients, mental activity decreases, drives change, and mood lability is noted.
Neuroendocrine syndrome in typical cases is manifested by a "triad" of changes - in the sphere of thinking, emotions and will. As a result of the destruction of higher regulatory mechanisms, there is a disinhibition of drives: sexual promiscuity, a tendency to vagrancy, theft, and aggression are observed. Decrease in intelligence can reach the degree of organic dementia. Often there are epileptiform paroxysms, mainly in the form of convulsive seizures.
Acute psychoses with impaired consciousness: asthenic confusion, delirious, delirious-amental, oneiroid, twilight, acute paranoid states - occur in the acute course of an endocrine disease, for example, with thyrotoxicosis, as well as as a result of acute exposure to additional external harmful factors (intoxication, infection, mental trauma) and in the postoperative period (after thyroidectomy, etc.).
Among psychoses with a protracted and recurrent course, depressive-paranoid, hallucinatory-paranoid, senestopatho-hypochondriac states and verbal hallucinosis syndrome are most often detected. They are observed at infectious lesion system hypothalamus - pituitary gland, after removal of the ovaries. In the clinical picture of psychosis, elements of the Kandinsky-Clerambault syndrome are often found: the phenomena of ideational, sensory or motor automatism, verbal pseudohallucinations, delusional ideas of influence. Features of mental disorders depend on the defeat of a certain link in the neuroendocrine system.
Itsenko-Kushnga disease occurs as a result of damage to the hypothalamus-pituitary-adrenal cortex system and is manifested by obesity, gonadal hypoplasia, hirsutism, severe asthenia, depressive, senestopatho-hypochondriac or hallucinatory-paranoid states, epileptiform seizures, decreased intellectual-mnestic functions, Korsakov's syndrome. After radiotherapy and adrenalectomy, acute psychoses with clouding of consciousness can develop.
In patients with acromegaly resulting from damage to the anterior pituitary gland - eosinophilic adenoma or proliferation of eosinophilic cells, there is increased excitability, malice, anger, a tendency to solitude, a narrowing of the circle of interests, depressive reactions, dysphoria, sometimes psychoses with impaired consciousness, usually occurring after additional external influences. Adiposogenital dystrophy develops as a result of hypoplasia of the posterior pituitary gland. The characteristic somatic signs include obesity, the appearance of circular ridges around the neck (“necklace”).
If the disease begins at an early age, there is an underdevelopment of the genital organs and secondary sexual characteristics. AK Dobzhanskaya (1973) noted that in primary lesions of the hypothalamic-pituitary system, obesity and mental changes long precede sexual dysfunction. Psychopathological manifestations depend on the etiology (tumor, traumatic injury, inflammatory process) and the severity of the pathological process. In the initial period and with a mildly pronounced dynamics, the symptoms for a long time manifest themselves as asthenic syndrome. In the future, epileptiform seizures, personality changes of the epileptoid type (pedantry, stinginess, sweetness), acute and prolonged psychoses, including the endoform type, apatoabulic syndrome, and organic dementia are often observed.
Cerebral-pituitary insufficiency (Symonds' disease and Shien's syndrome) is manifested by severe weight loss, underdevelopment of the genital organs, astheno-adynamic, depressive, hallucinatory-paranoid syndromes, and intellectual and mnestic disorders.
In diseases of the thyroid gland, either its hyperfunction (Graves' disease, thyrotoxicosis) or hypofunction (myxedema) is noted. The cause of the disease can be tumors, infections, intoxications. Basedow's disease characterized by a triad of such somatic signs as goiter, bulging eyes and tachycardia. At the onset of the disease, neurosis-like disorders are noted:
irritability, fearfulness, anxiety, or high spirits. In a severe course of the disease, delirious states, acute paranoid, agitated depression, depressive-hypochondriacal syndrome may develop. In differential diagnosis, one should take into account the presence of somato-neurological signs of thyrotoxicosis, including exophthalmos, Moebius's symptom (weak convergence), Graefe's symptom (lagging upper eyelid from the iris when looking down - there is a white strip of sclera). Myxedema is characterized by bradypsychia, a decrease in intelligence. The congenital form of myxedema is cretinism, which used to be often endemic in areas where there is not enough iodine in drinking water.
At Addison's disease(insufficient function of the adrenal cortex), there are phenomena of irritable weakness, intolerance to external stimuli, increased exhaustion with an increase in adynamia and monotonous depression, sometimes delirious states occur. Diabetes mellitus is often accompanied by non-psychotic and psychotic mental disorders, including delirious, which are characterized by the presence of vivid visual hallucinations.

Treatment, prevention and social and labor rehabilitation of patients with somatogenic disorders

Treatment of patients with somatogenic mental disorders is carried out, as a rule, in specialized somatic medical institutions. Hospitalization of such patients in psychiatric hospitals in most cases is not advisable, with the exception of patients with acute and prolonged psychosis. The psychiatrist in such cases often acts as a consultant, rather than the attending physician. The therapy is complex. According to indications, psychotropic drugs are used.
Correction of non-psychotic disorders is carried out against the background of the main somatic therapy with the help of sleeping pills, tranquilizers, antidepressants; prescribe psychostimulants of plant and animal origin: tinctures of ginseng, magnolia vine, aralia, eleutherococcus extract, pantocrine. It should be borne in mind that many antispasmodic vasodilators and antihypertensives - clonidine (hemiton), daukarin, dibazol, carbocromen (intecordin), cinnarizine (stugeron), raunatin, reserpine - have a slight sedative effect, and tranquilizers amizil, oxylidine, sibazon (diazepam, relanium ), nozepam (oxazepam), chlozepid (chlordiazepoxide), phenazepam - antispasmodic and hypotensive. Therefore, when using them together, it is necessary to be careful about the dosage, to monitor the state of the cardiovascular system.
Acute psychoses usually indicate a high degree of intoxication, impaired cerebral circulation, and clouding of consciousness indicates a severe course of the process. Psychomotor agitation leads to further exhaustion of the nervous system and can cause a sharp deterioration in the general condition. V. V. Kovalev (1974), A. G. Naku, G. N. German (1981), D. D. Orlovskaya (1983) recommend prescribing chlorpromazine, thioridazine (sonapax), alimemazine (teralen) and other neuroleptics to patients , which do not have a pronounced extrapyramidal effect, in small or medium doses orally, intramuscularly and intravenously under the control of blood pressure. In some cases, it is possible to stop acute psychosis with the help of intramuscular or intravenous administration of tranquilizers (seduxen, relanium). With prolonged forms of somatogenic psychosis, tranquilizers, antidepressants, psychostimulants, neuroleptics and anticonvulsants are used. Some drugs are poorly tolerated, especially from the group of antipsychotics, so it is necessary to individually select doses, gradually increase them, replace one drug with another if complications appear or there is no positive effect.
With defective organic symptoms, it is recommended to prescribe vitamins, sedatives or psychostimulants, amipalone, piracetam.

In schizophrenia, despite the relatively frequent complaints of patients about their poor somatic condition, psychopathological symptoms acute psychosis: delirium and hallucinations, psychomotor agitation usually come to the fore in the clinical picture of the disease.

At the stage of formation of remission, traditionally, attention is paid to the remnants of productive symptoms, signs negative manifestations and neurocognitive deficit. Somewhat more often they talk about somatic pathology within the framework of hypochondriacal symptoms, "", its residual form.

The somatic syndrome usually does not dominate even in the initial states. It is not observed where it is not possible to detect a noticeable movement of psychopathological symptoms. (Goldenberg S.I., Gofshtein M.K., 1940).

At the same time, among patients with schizophrenia, regardless of whether they take psychotropic drugs or not, more often than in the general population, there are symptoms of somatic diseases: cardiovascular disorders, obesity, type 2 diabetes mellitus and some oncological pathology.

Absolutely comorbid schizophrenia somatic diseases

1. Lipid metabolism disorders
2. Diseases of the cardiovascular system

Relatively comorbid schizophrenia, somatic and infectious diseases

1. Osteoporosis
2. Dental diseases
3. Inflammation of the lungs and chronic bronchitis
4. Hyperprolactinemia
5. Thyroid diseases
6. Diabetes
7. Metabolic syndrome (hyperlipedemia)
8. Polydipsia
9. Skin pigmentation
10. Tuberculosis
11. Hepatitis B
12. Hepatitis C
13. Acquired immunodeficiency syndrome (AIDS)

Somatic diseases rarely seen in schizophrenia

• Rheumatoid arthritis
• Bronchial asthma
• Peptic ulcer of the duodenum
• Prostate cancer

Mortality in schizophrenia is twice that of the general population. This fact is clearly noticeable at the age of 20 - 40 years. The average life expectancy of a patient with schizophrenia is 20% shorter than that of a person who does not suffer from this pathology.

Somato-neurological causes of death in patients with schizophrenia

1. Diseases of the endocrine system (diabetes mellitus)
2. Vascular diseases of the brain
3. Heart diseases
4. Seizures
5. Cancers (especially throat cancer)
6. Respiratory diseases (pneumonia)

Among the somatic causes of death, cardiovascular diseases and cancer are recorded in 60% of cases. Recall that according to some authors, suicides and accidents are often recorded among unnatural causes of death in schizophrenia.

Schizophrenia significantly reduces the quality of life and the ability to adapt patients with somatic pathology, complicates it and the outcome, increases the risk of mortality. Inadequate behavior of patients, anosognosia, refusal to take medications contribute to the appearance of somatic diseases (Smulevich A.B., 2007).

Within the framework of “psychotic abnormal behavior in illness” (Pilovs-ki L., 1994), in the presence of a comorbid pathology of schizophrenia with somatic pathology, one can speak of “hypergnosic and hypognosic nosogenic reactions” (Smulevich A.B., 2007). “Hypergnosic reactions” are divided into hypochondriacal (“coenostopathic”, variants of overvalued hypochondria with a kind of “cult of the disease”), depressive and “paranoid” (delusions of a “different” illness, sensitive, paranoia of invention). "Hypoanosognosic nosogenic reactions" include: pathological denial of the disease, "euphoria with pseudodementia", "paranoid reactions with delusions of the attributed disease".

In the presence of overvalued hypochondria in the clinical picture of the disease, heteronomous "bodily sensations" (Glatzel J.) are observed in the form of senestopathies and "bodily fantasies".

Depressive reactions, which occur in almost half of patients with schizophrenia, acquire an atypical character and transform into prolonged hypochondriacal depression.

In the delusion of a “different” disease, patients are convinced that they are not being treated for the disease that they actually suffer from; in the delusion of invention, patients develop strange methods of treatment on their own; doctors, being “in collusion with enemies”, attribute a non-existent disease in order to exclude them from active life and the struggle for justice. The most severe nosogenic reactions include hyponosognosia with features of pathological denial of the disease: patients refuse hospitalization even in the presence of a life-threatening situation, show signs of inadequate euphoria (Smulevich A.B., 2007).

Many patients with schizophrenia suffering from comorbid somatic pathology often do not come into view at all. So, according to A.B. Smulevich (2007), only a third of such patients at least once turned to a psychiatrist and only 20% received specialized care in a neuropsychiatric dispensary. At the same time, speaking of these figures, one cannot exclude the overdiagnosis of schizophrenia, since other mental disorders are traditionally referred to as “sluggish” and “latent” schizophrenia in Russian psychiatry.

Enough full review, the current state of the problem of the relationship between somatic diseases and schizophrenia, is presented in the monograph by S. Leucht et al. (2007).

Appearance

Patients with schizophrenia are most often untidy, reduced nutrition in case of negative attitude to antipsychotic therapy and elevated when taking them.

The skin tends to be pale, there is lethargy and relaxation of the muscles.

With persistent hallucinations that have existed for years, boils and traces of acne are often found on the skin of patients.

They wrote that the fifth finger of the hand of a patient with schizophrenia seemed to be bent inward, and the third toe was longer than the second. However, no significant correlations of these external structural features of the skull and limbs with the symptoms of schizophrenia were found.

There was also a decrease in facial expression of the upper part of the face, dissociation of the top and bottom of the face with productive symptoms, asymmetry of the right and left halves of the face - with negative ones.

Patients smile unusually, turning their faces away, and making the smile strained. All these are somatic disorders, manifested in the appearance of patients with schizophrenia.

Cardiovascular disorders

In schizophrenia, there are somatic disorders such as disorders of the cardiovascular system. They can manifest themselves in painful sensations in the region of the heart, a decrease or instability of blood pressure, some symptoms of a fall in cardiac activity, its insufficiency: increased heart rate, pallor of the skin, acrocyanosis, fainting.

Some researchers wrote that in patients with schizophrenia, the cardiovascular system was initially underdeveloped, the borders of the heart were somewhat reduced, and the heart sounds were deaf. M.D. Pyatov (1966) spoke of "congenital hypoplasia of the heart and great vessels".

In schizophrenia, the difference in blood pressure in the temporal arteries or the arteries of the bottom of the eye and forearm, as well as the dissociation of the reaction of these vessels to emotional and pharmacological stimuli, was noted. Changes in blood pressure were found: its asymmetry between the right and left sides, hypotension, less often hypertension, often dissociation of pressure in the vessels of the brain with the presence of partial cerebral hypertension, especially in catatonia.

Patients with schizophrenia are prone to tachycardia, which is probably the result of arousal or increased activity of the adrenergic system.

These observations partly agreed with data on the insufficiency or, more precisely, the perversion of the reaction of the adrenal system of patients to psychogenic and pharmacological stimuli.

In recent years, many psychiatrists have begun to talk about the relatively high risk of death in patients with schizophrenia due to cardiovascular pathology (Broun S. et al., 2000; Osby U. et al., 2000).

A number of antipsychotics negatively affect the activity of the heart, disrupting the conduction of the heart muscle, prolonging the QTc interval, causing ventricular arrhythmia and increase blood clotting. The ability of some of them, for example, clozapine, to cause myocarditis is well known.

An important factor in the prevention of cardiovascular disease in schizophrenia, many psychiatrists consider between the patient and the attending physician.

Hypertonic disease

According to Canadian scientists, the proportion of people with hypertension in schizophrenia is 13.7%, in many respects similar data were obtained in an epidemiological study of patients in the general medical network, conducted by domestic researchers (Kozyrev V.N., 2002; Smulevich A.B. et al., 2005).

In other studies, it was found that 34.1% of patients with schizophrenia have a diagnosis of hypertension (Dixon L. et al., 1999). However, earlier M.D. Pyatov (1966) in his study showed that the combination of schizophrenia with hypertension is rare and amounts to only 2.65%. A similar point of view is shared by H. Schwalb (1975) and T. Steinert et al. (1996), who believe that cases of vascular hypertension in schizophrenia are relatively rare. According to some authors, hypotension in schizophrenia is due to the effect of antipsychotics, many of which affect alpha and muscarinic receptors.

Probably, this spread of statistics reflects the same old question about the boundaries of schizophrenia and its diagnostic criteria. According to A.B. Smulevich et al. (2005), the difference in data regarding the prevalence of arterial hypertension is due to the contingent that falls into the field of view of researchers.

It should be borne in mind that such well-known risk factors for the occurrence of diseases of the cardiovascular system, such as smoking, diabetes, a sedentary lifestyle, impaired fat metabolism, are quite common in patients with schizophrenia, which undoubtedly contributes to the development of this pathology.

In patients with schizophrenia treated in psychiatric hospitals, arterial hypertension is more malignant, and on an outpatient basis, its course is easier.

We support the point of view of those authors who consider the combination of hypertension with schizophrenia to be a relatively rare occurrence. In our opinion, this is to some extent due to the psychosomatic nature of hypertension, which, for reasons that are not entirely clear, is not so typical of schizophrenia, nor in terms of hereditary predisposition, nor in terms of the pathogenesis of the disease. However, in this case, we again turn to the topic of the boundaries of schizophrenia and its differences from affective disorders.

If there is a combination of schizophrenia and hypertension, then the dynamics of the schizophrenic process, the course of hypertension and the expected outcome of the disease are often unpredictable.

According to some authors, the schizophrenic process here acquires a clearly more favorable course, with the mitigation of the main psychopathological symptoms, with the possibility of long-term remissions, especially in those cases where hypertension joins a long-standing process. A different picture is observed when schizophrenia and hypertension began almost simultaneously or when the latter preceded the former. Here, the course of schizophrenia acquires a noticeably accelerated course, and its symptoms become pronounced. (Bathshchikov V.M., Nevzorova T.A., 1962).

Atherosclerosis

When schizophrenia is combined with a cardiovascular disease such as atherosclerosis, mental illness predominates. Against the background of atherosclerosis, there is an introduction of age-related themes of delirium, a kind of poverty of the delusional system. Disorders of perception become less legible, their individual affiliation is lost, and the phenomena of mental automatism are simplified.

The influence of the vascular factor is reflected in an increase in excitability, irritability, and a tendency to affective outbursts. The low mood is accompanied by weakness, tearfulness, dull headaches, superficiality due to rapid exhaustion. The instability of emotions is combined with impulsiveness. The symptoms of the defect appear against an asthenic background, there is a surprising combination of inactivity with an inability to mobilize and fussy hyperactivity. Cynicism and emotional coldness are combined with the appearance of exaggerated courtesy and condescension (Valeeva A.M., 2000).

The most pronounced effect of vascular pathology is noticeable in periodically relapsing schizophrenia.

signs vascular disease manifest themselves brighter during bouts of psychosis than in the period of remission. Identified memory impairment, short-term episodes of delirium. With the addition of vascular pathology, schizophrenia attacks become protracted, and the quality of remissions deteriorates. When symptoms of vascular disorders can be interpreted in a delusional way. Patients claim that dizziness, headaches, pains in the heart arise as a result of exposure (Morozova VD, 2000).

Cardiac ischemia

In accordance with the results of domestic researchers (Neznanov N.G. et al., 1995; Smulevich A.B. et al., 2005), a significant impact on the development of coronary heart disease, along with a number of traditional factors (hyperlipedemia, smoking and other risks ), have features of the course of schizophrenia and its clinical manifestations. However, according to R. Filik et al. (2006), although angina is more common in schizophrenia than in the general population, these differences are not statistically significant.

According to O.V. Ryzhkova (1999), in patients with schizophrenia, relatively high mortality from coronary heart disease, due to the unfavorable dynamics of this pathology. The latter is usually associated with hyperlipidemia, which occurs in 18-51% of cases in schizophrenia (Bellinier T. et al., 2001). In patients with schizophrenia, men with coronary heart disease, the risk of death increases by almost 4 times (Smulevich A.B., 2007).

People with schizophrenia have an increased risk of developing thrombosis, a thromboembolic lesion of the venous system, usually manifested in the form of deep vein thrombosis of the lower leg or pulmonary thrombosis. Thromboembolic disease of arterial vessels can lead to the development of stroke and heart attack.

endocrine disorders

In schizophrenia, changes in the endocrine system, starting from the first stages of the study of this mental disorder, have always been in the focus of attention.

At one time I.V. Lysakovsky (1925) found in schizophrenia microscopic changes in the tissues of the thyroid gland, adrenal glands, pituitary gland and gonads. According to V.S. Beletsky (1926), in 70% of cases with schizophrenia, depletion of the adrenal cortex in lipoids is detected, and at the same time, a decrease in their concentration in the brain tissues can be recorded.

V.P. Osipov (1931), V.P. Protopopov (1946) attributed schizophrenia to "pluriglandular psychoses", believing that patients with schizophrenia have a congenital inferiority of the endocrine system.

In 1932, R. Gjessing put forward a hypothesis, according to which in patients with schizophrenia there is a relationship between the violation of basic metabolism and nitrogen balance and the state of the functional activity of the thyroid gland. Somewhat later, M. Reiss et al. (1958) came to the conclusion that in patients with schizophrenia, the sensitivity of organs to the effects of thyroid hormones is significantly reduced. At the same time, the brain tissue of patients with schizophrenia showed reduced sensitivity to thyroid-stimulating hormones of the pituitary gland.

M. Bleuler (1954) did a lot for the endocrinology of schizophrenia. His monograph "Endocrinological Psychiatry" at one time gained wide popularity among psychiatrists. The author conducted a parallel study endocrine disorders with psychosis and other mental disorders. M. Bleuler paid special attention to the dynamics of endocrine disorders in schizophrenia, the dependence of their severity on premorbid personality traits, the state of the affective sphere of patients and the nature of drives.

In the second half of the twentieth century, most researchers of schizophrenia were inclined to deny the importance of hormonal disorders in the genesis of this mental disorder. An important argument for this was the numerous statistical data showing that severe endocrine diseases are not necessarily accompanied by severe mental disorders.

According to I.A. Polishchuk (1963), endocrine disorders in inpatients with schizophrenia in the 60s were detected only in 1.1% of cases, in outpatient practice they were found in 50% of patients suffering from this disease (Skanavi E.E., 1964).

A.I. Belkin (1960) put forward a hypothesis about the pronounced effect of thyroid dysfunction on the clinical picture and the course of schizophrenia. The author believed that if its manifestation is accompanied by symptoms of thyrotoxicosis, then the course of the disease will be more favorable. In hypothyroidism, the clinical picture of schizophrenia was distinguished by the severity of psychopathological symptoms and noticeable personality disorders.

A.G. Androsov (1970) singled out three types of syndromes in schizophrenia: hypogenitalism, diencephalic-endocrine and pluriglandular disorders. At the same time, emphasizing that in the last two cases, the course of schizophrenia becomes more malignant. Against the background of hypogenitalism, schizophrenia also proceeded more unfavorably and was characterized by severe disorders of the autonomic nervous system.

A large number of researchers of endocrine disorders occurring in schizophrenia believed that an important role in their genesis is played by a violation of the functional activity of the diencephalic structures of the brain (Grashchenkov N.I., 1957; Orlovskaya D.D., 1966; Belkin A.I., 1973, and etc.).

Numerous studies have shown that most of the parameters of the activity of various endocrine organs in schizophrenia are important to evaluate in dynamics, and also useload tests, allowing to identify the insufficiency of the functional activity of a particular department of the hormonal system. Moreover, stimuli when testing the activity of endocrine organs should be adequate as physiological activators. endocrine glands, preferably simultaneously and differently influencing them according to the mechanism of its effect.

The use of various stress tests in schizophrenia is justified due to the fact that transient, rudimentary and polymorphic disorders of the functional activity of the endocrine glands usually dominate in schizophrenia.

An analysis was made of the hormonal parameters of the sympathetic-adrenal system (adrenaline and norepinephrine) and the apparatus associated with insulin metabolism.

As you know, one of the catecholamines - adrenaline - reflects the state of the adrenal - hormonal link; the other - norepinephrine - sympathetic - transmission. Estimation of the level of insulin in this case makes it possible to obtain information about the function of the apparatus of the pancreatic islet that produces insulin (Genes G., 1970).

Research results of V.M. Morkovkina and A.V. Kartelishcheva (1988) showed that the endogenous concentration of adrenaline in the blood during acute attack schizophrenia in percentage terms differs little from the norm, but the content of norepinephrine increases markedly.

In patients with schizophrenia, a decrease in the blood content of adrenaline was noted, in contrast to its increase in healthy individuals one hour after insulin injection. At the same time, there was a lack of decrease in indicators in patients, which is usual for the control group of healthy individuals, by the end of the study against the background of glucose administration. The dynamics of the content of norepinephrine in the blood in schizophrenia differed very sharply from the norm, and the nature of the curve had a qualitative discrepancy with the control at the end of the test. There was a decrease of 50% in indicators instead of their usual stabilization.

Based on the data obtained, the researchers concluded that in the blood of patients with schizophrenia during an acute episode of psychosis, there is an increase in the activity of the sympathetic - adrenal system.

The authors proposed to use this test for differential from bipolar affective disorder, since they assumed that schizophrenia is characterized by an increase in the level of noradrenaline in the blood, and adrenaline is characteristic of bipolar affective disorder. With both psychoses, the totality of adrenaline and noradrenaline values ​​turned out to be above the norm.

In general, in patients with bipolar affective disorder, the total activity of the sympathetic-adrenal system is higher than in schizophrenia. The adrenaline / norepinephrine ratio at the same time provides an opportunity to assess the nature of the balance between the activity of the adrenal and sympathetic departments of the neuroendocrine system (Knyazev Yu.A. et al., 1972).

In schizophrenia, there is a pronounced shift in the activity of the sympathetic-adrenal system towards the sympathetic link, which indicates the presence in the acute phase of the disease of dissociation between mediators of the nervous system and hormones. The degree of dissociation decreases towards the end of the stress test, when violations are detected carbohydrate metabolism: decreased glucose utilization, combination of hyperglycogenosynthesis with hyperglycolysis.

Many researchers of hormonal activity in schizophrenia noted the existence of a relationship between the level of 17-ketosteroids and the mental state of patients with schizophrenia, the higher the level of these hormones, the more pronounced the excitation of patients.

Most often, in schizophrenia, such “through” manifestations of endocrine system dysfunction as hirsutism, obesity, and infantilism are detected.

According to G.M. Rudenko (1969), obesity and hirsutism can be detected in various forms of schizophrenia, especially at the stage of the manifest period of the disease.

Diseases of the endocrine system in schizophrenia

• Hyperprolactinemia
• Diabetes
• hirsutism
• Obesity
• Infantilism

The syndrome of infantilism manifests itself in schizophrenia usually under the age of 15 years, obesity syndrome - at the age of 16-20 years, and hirsutism in patients with distinct affective disorders who fell ill after 20-25 years.

Recent data indicate a high prevalence of diabetes mellitus in patients with schizophrenia. Information is provided on a threefold excess of the occurrence of this pathology in patients with schizophrenia compared with the corresponding indicators in the general population. Even more often, 42-65% of patients with schizophrenia are diagnosed with hyperprolactinemia, which may partly be due to the use of psychotropic drugs. Hyperprolactinemia, in turn, leads to the development of hypogonadism in men, persistent galactorrhea, amenorrhea in women, and contributes to the formation of endometrial, breast and prostate cancer (Drobizhev M.Yu., et al., 2006).

Schizophrenia in patients with pathology of the endocrine system is often characterized, as well as the relative frequency of its occurrence. atypical manifestations. In the clinical picture of the disease, hypothalamic disorders, senesto-hypochondriac symptoms are noted (Orlovskaya D.D., 1974).

Recent studies of the hormonal background in schizophrenia have shown correlations between blood levels of testosterone, gonadotropins, prolactin and the severity of negative symptoms in men with schizophrenia (Akhondzadeh S., 2006).

Studies by J. Kulkarni and A. De Castella (2002) revealed the dependence of the level of psychotic symptoms on the estrogenic background. The authors also noted that the dynamics of psychosis is more favorable in combination therapy with antipsychotics and estrogens.

Schizophrenia is often combined with severe osteoporosis. Some researchers associate this phenomenon with hypoestrogenism, but the final mechanism of osteoporosis in schizophrenia should be recognized as unclear.

Gastrointestinal disorders

Many psychiatrists have drawn attention to the frequent combination of schizophrenia, especially including catatonic symptoms, with gastrointestinal disorders.

It was noted that patients in this case complain of pain in the region of one or another segment of the gastrointestinal tract, often with pain radiating to other organs of the abdominal and thoracic cavities.

Psychiatrists noted in patients with schizophrenia complaints of nausea, intolerance to a particular type of food, discomfort in the mouth.

Among doctors, it is well known that patients with schizophrenia, along with complaints of pain, also often note peculiar sensations in the gastrointestinal tract, reminiscent of the descriptions of senestopathy: “tension”, “contraction”, “burning”, “heaviness”, “cold” and others

Some domestic psychiatrists noted the “spasm phenomenon” of the intestine in schizophrenia, drawing an analogy with the symptoms of catatonia and considering this spasm as a somatic manifestation of the latter (Goldenberg S.I., Gofshtein M.K., 1940).

In our practice, we have noticed that gastrointestinal disorders in schizophrenia are often combined with generalized symptoms of dysfunction of the autonomic nervous system. Sweating, dizziness, fainting, chilliness are typical complaints of such patients. In the clinical picture of patients prone to gastrointestinal disorders, various vasomotor disorders are also recorded in the form of acrocyanosis, blanching and coldness of the extremities.

At the same time, with a history of schizophrenia, sometimes before the onset of psychosis, liver diseases and gastrointestinal disorders may be noted, indicating the presence of toxicosis.

Comparatively often, patients with sluggish schizophrenia complain of pain of a different nature in the stomach or intestines. Clinicians often suspect peptic ulcer of the stomach and duodenum. In some cases, patients are diagnosed with "cholecystitis", "hepatitis", "duodenitis". However, almost always this diagnosis is accompanied by a diagnosis concerning one or another degree of severity of dysfunction of the autonomic nervous system.

The group of patients with schizophrenia who complain of pain in the intestinal region often resembles those patients who have mild hemorrhagic disorders.

The focus of attention of many researchers in the early and mid-twentieth century was the study of intestinal diseases in schizophrenia, it was assumed that the latter play an important role in the etiology of this mental disorder. In the 1970s, interest in this topic revived in connection with the hypothesis of the involvement of gluten in the pathogenesis of schizophrenia. Based on this hypothesis, a diet therapy was proposed, specially designed for patients with schizophrenia, providing for the restriction of cereals and milk (Dochan F., Grasberg J., 1973). However, later studies aimed at detecting antibodies to reticulin in patients with schizophrenia refuted the hypothesis of the etiological significance of intestinal disorders in the genesis of schizophrenia (Lambert M. et al., 1989). At the same time, there are statements in the literature that a gluten-free diet significantly improves the mental state of young children with autism and that children with schizophrenia are prone to various diseases intestines (Perisic V. et al., 1990).

According to H. Ewald et al. (2001) in patients with schizophrenia, cases of appendicitis are slightly less common than in the general population, which, according to the authors, is associated with a number of factors, including a genetic predisposition to these diseases, features of antipsychotic therapy, and lifestyle of patients.

Peptic ulcer in schizophrenia is relatively rare and, according to some authors, is recorded in only 2.69% of cases, which is almost 5 times higher than the prevalence of peptic ulcer in the general population (Heinterhuber H., Lochenegg L., 1975). It has been suggested that the low activity of the hypothalamus in schizophrenia to some extent excludes the influence of stress on the formation of gastric and duodenal ulcers. In our opinion, the presence of a certain antagonism between the predisposition to certain psychosomatic diseases, for example, to bronchial asthma or peptic ulcer, and the etiopathogenesis of schizophrenia cannot be ruled out here either. It should be noted that earlier some authors cited statistical information indicating approximately the same prevalence of peptic ulcer in schizophrenia and among the population of the general population (Hussar A., ​​1968).

Respiratory diseases

According to many clinicians, respiratory diseases are relatively common in schizophrenia and are one of the reasons for the shorter life expectancy of patients.

Among patients suffering from schizophrenia, the fact of a high prevalence of pulmonary tuberculosis is known (Ozeretskovsky D.S., 1962).

In the presence of tuberculosis in patients suffering from schizophrenia, the dynamics of the condition of patients depends on exacerbations of these diseases, as a rule, increasing the rate of increase in symptoms (Orudzhev Ya.S., Zubova E.Yu., 2000).

In our practice, we rarely met among patients with schizophrenia people suffering from bronchial asthma. Probably a classic psychosomatic illness, which is bronchial asthma, has a different genetic background than schizophrenia.

In patients with schizophrenia, risk factors for the development of bronchopulmonary pathology, in particular, smoking, are identified. In addition, the neuronal connection between the brain centers of respiration, fear and the autonomic nervous system explains the occurrence of complex disorders. respiratory system And mental sphere. Abnormal breathing reflexively affects behavioral disorders, reveals a relationship with disorders of the central nervous system function. Hyperventilation is often accompanied painful sensations and senestopathies, anxiety and restlessness. Hypoxia enhances the severity of cognitive impairment.

Schizophrenia often complicates the treatment of respiratory diseases. In patients with a long course of the disease, reactivity may be reduced, which leads to mild symptoms of pneumonia, and immunodeficiency states contribute to its unfavorable course. All of the above requires special attention doctor to the state of the respiratory system of a patient with schizophrenia.

Musculoskeletal disorders

Osteoporosis is a bone disease characterized by a decrease in bone density due to a decrease in the content of minerals in it. Osteoporosis usually makes itself felt after menopause. The literature describes cases of so-called secondary osteoporosis, which develops as a result of taking certain medications. Prolactinemia, developed as a result of taking antipsychotics, plays a role in the development of osteoporosis in patients with schizophrenia. It is assumed that as a result of estrogen deficiency in women, osteoporosis can also develop, and hypogonadism is considered a risk factor for this pathology. Decreased testosterone levels lead to osteopenia. Despite the fact that androgens play a role in the development of osteoporosis, the latter is much more common in women than in men.

Some authors believe that osteoporosis partly develops in patients with schizophrenia due to an increase in negative symptoms and a sedentary lifestyle. In addition, in the genesis of osteoporosis, one can assume the influence of polydipsia (impaired electrolyte balance), increased activity of interleukins, frequent use alcohol, smoking and dietary disorders (lack of vitamins).

Oncological diseases

The first studies on the prevalence of cancer among patients with schizophrenia appeared at the beginning of the 20th century. In the 1970s, it was generally accepted that people with schizophrenia were not susceptible to cancer as a somatic disorder.

Recent studies by Israeli scientists have again shown a low incidence of neoplasm, regardless of its location, among patients with schizophrenia (Barac Y. et al., 2005). It has been suggested that even at the genetic level there is an antagonism between schizophrenia and oncological pathology (Grinshpoon A., et.al., 2005).

Later, there were reports that significant differences in the prevalence of cancer among patients with schizophrenia and healthy individuals could not be identified (Dalton S. et al., 2005). Some authors have suggested a higher percentage of oncological diseases in schizophrenia.

In recent years, it seems that some oncological diseases, especially in men (cancer of the prostate or rectum), are really rare in schizophrenia; for other oncological pathologies, the combination with schizophrenia does not differ significantly from the situation that develops on this issue in the general population . The opposite point of view has also been registered; so, in particular, in the presence of smoking in men suffering from schizophrenia, cancer of the larynx is more often recorded, in women, uterine cancer and breast cancer are more often noted (Grinshpoon A. et al., 2001).

Australian scientists noted that in the case of cancer in patients with schizophrenia, the course of oncological disease is extremely unfavorable and the mortality rate is increased here (Lawrence D. et al., 2000).

Among the factors hindering the development of oncological pathology in patients with schizophrenia, the following are noted: early detection of precancerous diseases due to more frequent hospitalizations in a psychiatric clinic, a decrease in the number of carcinogens, less exposure to the sun due to more indoor exposure, the use of phenothiazines, according to some authors preventing the development of cancer. On the contrary, the factors contributing to the occurrence of neoplasms include: reduced sexual activity (breast cancer and cervical cancer), an increase in prolactin levels due to treatment with certain antipsychotics (breast cancer).

An analysis of the literature on the problem of the relationship between oncological diseases and schizophrenia allows us to conclude that, despite the fact that for some types of cancer the probability of its occurrence in schizophrenia is quite small, for others, on the contrary, it is increased. In addition, the unfavorable course of neoplasm when it occurs in patients with schizophrenia, as well as a high mortality rate, seems to be a fairly characteristic feature of the combination of these diseases.

Sexual disorders

Sexual dysfunction in schizophrenia occurs in 50% of men and 30% of women. This somatic pathology may be due to the social influence of the disease, the characteristics of its symptoms, impaired activity of neurotransmitters and the influence of drugs (antidopaminergic, anticholinergic, antiadrenergic, antihistamine effects).

The existence of a large number of factors influencing human sexual activity, including the diverse effects of antipsychotics, is confirmed by the fact that in some patients antipsychotics improve sexual function, comparable to the period when they were already ill, but not yet treated. In other patients, antipsychotics may cause sexual dysfunction, even if there is a fairly good remission of the disease.

In the majority of patients with schizophrenia taking classical antipsychotics, sexual disorders are observed in almost 45% of cases, while in the general population they are recorded in only 17% of people (Smith S. et al., 2002). In the mechanism of development of sexual disorders that have developed in the process, the main role is played by the sedative effect of drugs and an increase in prolactin levels, the latter is especially significant for women with schizophrenia.

D. Aizenberg et al. (1995) conducted a comparative study aimed at identifying sexual dysfunctions in patients with schizophrenia: those who were treated with antipsychotics and those who did not take these drugs, and in this study A control group of individuals who did not suffer from schizophrenia was identified. It turned out that patients with schizophrenia not treated with antipsychotics tended to have a low level of sexual activity, while patients treated with antipsychotics showed mainly erectile dysfunction and orgasm. According to the results of the study, it was suggested that antipsychotics restore sexual desire, but at the same time lead to sexual dysfunctions.

In a study by S. Macdonald et al. (2003) found a correlation between the severity of negative symptoms and sexual disorders in women with schizophrenia.

It is noted that the doctor's attention to sexual problems a patient with schizophrenia noticeably improves compliance with the latter.

In patients with schizophrenia, as a rule, there is a cross-sex accentuation of sex-role behavior: in men, the feminine radical dominates, while in women, on the contrary, the masculine one (Alekseev B.E., Konovalova E.M., 2007).

Gynecological diseases

Women with schizophrenia often present with galactorrhea due to long-term use antipsychotics, especially High prolactin levels inhibit the release of gonadotropin-releasing hormone, which can lead to ovarian dysfunction, manifested by irregular periods and even amenorrhea. At the same time, some authors deny the significant role of prolactin in the genesis of menstrual disorders (Perkins D., 2003).

In schizophrenia, obstetric pathology is often noted: intrauterine growth retardation of the fetus, premature birth, perinatal death, stillbirth, low weight fetus. Children of women with schizophrenia tend to have low Apgar scores. As noted above, in women with schizophrenia, more often than in the general population, such oncological diseases as breast and cervical cancer are recorded. In relation to cancer of the body of the uterus, the literature data are often contradictory.

Diseases of the ENT organs

According to R. Mason, E. Wilton (1995), the relative risk of middle ear diseases in patients with schizophrenia is 1.92. The authors hypothesized that in some cases this pathology may have etiopathogenetic significance in schizophrenia, since there may be involvement in the pathological process of the temporal lobe. In addition, diseases of the middle ear can contribute to the appearance of negative symptoms in schizophrenia, as they increase the isolation of the patient from the external environment, as well as enhance cognitive impairment, in particular, the patient's attention.

In schizophrenia, vestibular disorders are recorded relatively often and are often the cause of constant complaints from people suffering from this disease. In the literature, one can find some statements regarding the role vestibular disorders in the genesis of schizophrenia. However, in the opinion of most authors, such hypotheses do not stand up to serious experimental testing.

Deafness in schizophrenia occurs with the same frequency as in the general population, however, in the presence of this pathology, the clinical picture of the course of a mental disorder often changes, in particular, there is a tendency to develop a paranoid syndrome, which is especially noticeable in elderly patients. According to A. Cooper (1976), the appearance of deafness in adolescence contributes to the unfavorable and may play a role in its pathogenesis.

Dental diseases

Dental diseases in schizophrenia, as part of somatic disorders, are more often observed in those patients who are in psychiatric hospitals for a long time. The more malignant course of schizophrenia, the more pronounced negative symptoms, than older age patients, the more dental diseases manifest themselves. In women and patients with a distinct manifestation of the defect, there are more cases of caries, lack of fillings and more frequent loss of teeth. Patients with schizophrenia rarely monitor oral hygiene.

There are reports in the literature about the negative effect of phenothiazines on diseases of the oral cavity.

Spanish dentists, examining a large group of patients with schizophrenia who received antipsychotics, found in these patients in almost 8% of cases putrefactive dental caries, the absence of any teeth in 17% of patients (Velasco E. et al., 1997). Studies by scientists in India have shown that only 12% of patients with schizophrenia have no signs of caries, 88% need conservative treatment dentist and 16% of patients require complex periodontal therapy (Kenkre A., Spadigam A., 2000). Chinese experts in the examination of patients with schizophrenia revealed cases of caries in 75.3% (Tang W. et al., 2004).

A. Friedlander, S. Marder (2002) believe that patients with schizophrenia receiving antipsychotics are prone to such aversive orofacial effects as xerostomia.

Some authors refer to dental problems diseases of the temporomandibular region and oral dyskinesia. E. Velasco-Ortega et al. (2005) revealed in 32% of patients with schizophrenia evidence of any pathology of the joints of the temporomandibular region. Manifestations of oral dyskinesia, as noted above, are usually a consequence of classical antipsychotic therapy.

Most dentists believe that people with schizophrenia should have regular dental check-ups to prevent and treat oral disease.

Dermatological diseases

Patients with schizophrenia tend to allergic reactions. They usually change immune status and, in particular, an increase in immunoglobulin E. (IgE). At the same time, compared with patients with schizophrenia, persons suffering from affective disorders almost twice demonstrate sufficiently pronounced hypersensitivity (Rybakowski J. et al., 1992).

According to E. Herkert et al. (1972) we can talk about some comorbidity of schizophrenia and tuberous sclerosis, as well as schizophrenia and pellagra, which manifests itself as vitamin B3 deficiency. At the same time, the comorbidity of pellagra and affective disorders manifests itself more clearly. In affective disorders, in the genesis of which, as well as schizophrenia, changes in the metabolism of serotonin in brain tissues play a certain role. There is no doubt that such changes occur due to the imbalance of amino acids, nicotinic acid and tryptophan. Note that with pellagra and with schizphorenia, there is some commonality of symptoms of mental disorders.

Patients with schizophrenia often show signs of skin hyperpigmentation, which some authors explain by long-term use of classical antipsychotics that can increase the concentration of melanin in skin. In the literature, you can also find data indicating the ability of a number of antipsychotics to cause lupus erythematosus (Gallien M. et al., 1975).

Rarely, schizophrenia is associated with rheumatoid arthritis, skin cancer, and malignant melanoma.

The negative correlation between rheumatoid arthritis and schizophrenia may be explained by the anti-inflammatory and analgesic effects of some antipsychotics, as well as by the prostaglandin and estrogen deficiencies often found in individuals with schizophrenia. Some authors suggest that changes in the metabolism of serotonin and tryptophan play a role here. In addition, some variants of hyperprolactinemia may contribute to the suppression of autoimmune reactions that underlie the pathogenesis of rheumatoid arthritis. Probably, the psychosomatic nature of rheumatoid arthritis may be another argument explaining the antagonism of schizophrenia and this disease.

In the modern world, the development of many diseases occurs, according to psychologists and scientists, due to psychological trauma, experiences, various negative beliefs and thoughts. Quite often there are situations when there are no physiological prerequisites for the onset of the disease, but the disease progresses. In this case, they begin to talk about somatic disorders. So what is it?

Somatic diseases are bodily diseases, as opposed to mental pathologies. This group includes pathologies that are caused by malfunctions internal systems and organs or external influences that are not related to the mental activity of a person.

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Somatic manifestations lead to the appearance of symptoms of many diseases, the nature of which is influenced by the predisposition of the individual.

Common somatic pathologies include the following diseases:

• Ulcer of the stomach and duodenum. The main cause of this disease is increased nervousness. Overexertion causes an increase in acidity and, as a result, the appearance of an ulcer.
• Neurodermatitis(skin disease) - appears due to depression, the disease is accompanied by skin imperfections, nervousness, severe itching.
• Bronchial asthma- can be caused by strong feelings. Affecting the heart, stress causes an attack of suffocation.
• Ulcerative colitis- Nervous disorders and stress are common causes of the disease.
• Rheumatoid arthritis- most often appears due to mental disorders, nervous strain, resulting in symptoms of joint disease.
• Essential (chronic) hypertension- appears due to overload of nervous activity.

Less commonly, somatic diseases contribute to the development of:

• Diabetes.
• Ischemic myocardial disease.
• Somatoform behavioral disorders.

Causes

The basis of somatic personality disorders is the body's reaction to stressful situations that provoke disturbances in the functioning of internal organs.

The reason for the development of such conditions is emotional stress caused by:

• conflicts;
• increased nervousness;
• anger;
• discontent;
• anxiety;
• fear.

Symptoms

It is rather difficult to recognize somatization, often in such a condition the patient complains of pain in the body, but as a result of the examination, there are no causes for the onset of symptoms. The most common symptoms of somatic diseases are:

Appetite disorder

Such disorders may look like complete absence appetite and increased hunger. Often they are caused by depression, stress. Most neuroses are accompanied by loss of appetite. Some diseases manifest themselves in a complex in one person. For example, bulimia and anorexia.

If the patient suffers anorexia nervosa, then he can refuse food, sometimes feel disgust for it, while the body's need for food will remain. Bulimia is characterized by uncontrolled consumption of large amounts of food and can be a cause of obesity. In some cases, pathology entails weight loss. This happens when a person, feeling hostility towards himself due to neurosis, begins to drink laxatives and induce vomiting.

Sleep disturbance

One of the most common symptoms mental disorders - insomnia. Basically, it appears due to internal experiences. In this case, the patient cannot fall asleep, trying to make the right decision and find a way out of a difficult situation. In the morning, a person wakes up irritable and tired. Insomnia is often observed in neuroses.

Neurasthenia is characterized by the sensitivity of sleep: a person is asleep, but even a small sound wakes him up, after which he cannot fall asleep.

Pain syndrome

With somatic disorders, the patient complains of pain in the organ that is most vulnerable to him.

Depression is often accompanied by unpleasant, stabbing sensations in the heart, which may be accompanied by anxiety and fears.

A headache that is psychogenic in origin may occur due to tension in the muscles of the neck. Hysteria or self-hypnosis also lead to headaches.

Some stressful situations cause severe pain in the back of the head, the patient feels pain radiating to the shoulders. Such conditions often haunt anxious and suspicious people.

Disorders of sexual function

There are several libido disorders. These include: excessively increased or decreased sexual desire, pain during intercourse, lack of orgasm.

Psychological factors lead to such disorders, among them - prolonged abstinence, low self-esteem, lack of a permanent partner, fear, unconscious disgust.

Assessment of risk factors

Most often, somatic diseases develop in adolescence and rarely in those over 30. In most cases, disorders occur in women, and the risk of their occurrence is higher for those who have a family history of a similar pathology, drug or drug addiction, and antisocial personality disorders.

In addition, they are prone to somatic diseases suspicious people and those who are engaged in mental work or are constantly in a state of stress.

How to treat

Treatment of somatic diseases is carried out both on an outpatient basis and in a hospital. Stay in stationary conditions is shown at the stage acute manifestation psychomatosis, followed by a recovery period. Great importance is given to work with the patient, which will facilitate the neuropsychiatric factors in the development of the disease.

Of the drugs, preference is given to those that are needed to treat the disease that has appeared. In parallel with taking medications, psychotherapeutic therapy is performed in order to influence the mechanism of the development of the disease and its provoking factors. To calm down, antidepressants or tranquilizers are prescribed.

Usage folk remedies considered as an adjunct to the main methods of treatment. Most often, the doctor prescribes plant extracts and herbs that will help in the treatment of a certain disease that has arisen (for example, cabbage juice for stomach ulcers, calendula decoction for hypertension).

In children

The most common physical disorder that can create difficulties for a child's emotional, mental, and physical development is neuropathy. This is a severe violation of congenital etiology, that is, that appeared during fetal development or during childbirth.

Causes of neuropathy can be:

• Prolonged toxicosis in the mother.
• Pathological development of pregnancy, which leads to the threat of miscarriage.
• Stress of the expectant mother during the period of expectation of the child.

Signs of childhood neuropathy are:

• Emotional instability- a tendency to anxiety, emotional disorders, irritable weakness, rapid onset of affects.
• Sleep disturbance in the form of night terrors, difficulty falling asleep, refusal to sleep during the day.
• Vegetative dystonia(a disorder of the nervous system that regulates the functioning of internal organs). It is expressed in a variety of disorders in the work of internal organs: dizziness, difficulty breathing, gastrointestinal disorders, nausea, etc. At school and preschool age in children with difficulties in adapting to children's institution somatic reactions are often observed in the form of pressure fluctuations, headaches, vomiting, etc.
• Metabolic disorders, a tendency to allergic reactions with various manifestations, increased sensitivity to infections. Scientists suggest that allergies in boys and reduced appetite are associated with internal tension and emotional dissatisfaction of the mother with family life during the period of bearing a child.
• Minimal brain weakness. It manifests itself in the increased sensitivity of the child to external influences: bright light, noise, stuffiness, travel by transport, weather changes.
• General somatic disorder, decrease in the body's immune forces. The child often suffers from acute respiratory viral infections, acute respiratory infections, gastrointestinal diseases, diseases of the respiratory system, etc. In this case, the disease can begin with a strong emotional experience associated, for example, with separation from loved ones, difficulties in adapting to a preschool institution. In the development of this condition, a significant role is played by the general condition of the mother during pregnancy, especially poor emotional well-being, sleep disturbance, severe overwork.
• Psychomotor disorders(stuttering, tics, involuntary urination during night and daytime sleep). Such disorders most often disappear with age and have only a seasonal dependence, aggravating in autumn and spring.

The first signs of neuropathy are diagnosed already in the first year of a child's life, they appear:

• frequent regurgitation;
• restless sleep;
• temperature fluctuations;
• rolling when crying.

Neuropathy is only a basic pathogenic factor, against which a decrease in the overall activity of the child, including mental activity, may appear. As a result, psychophysical maturation slows down, which negatively affects mental development, adaptation to social realities, personality change (a child can become completely dependent on others, lose interest in life, and so on).

With the timely organization of health-improving, restorative measures, including a favorable psychological atmosphere, over time, the signs of neuropathy decrease and disappear. In case of unfavorable circumstances, pathology becomes the basis for the development of chronic somatic diseases, psycho-organic syndrome.

Actually, we will talk about somatic diseases caused by mental disorders. Such diseases are called psychosomatic. Quite often, the same person has a combination of somatic and mental illness. Such patients are often found in the practice of therapists, cardiologists, gastroenterologists, surgeons, etc.

a brief description of

In the field of general medical practice, those who suffer from mental disorders are found to have high level somatic diseases.

IN therapeutic departments hospitals, affective disorders and adjustment disorders are inherent in young women. Organic mental disorders are characteristic of the elderly. Somatic diseases associated with alcoholism occur in young men. For patients of therapeutic and gynecological clinics, psychological problems are typical.

Mental disorder complicates and slows down the healing process. It is possible that the somatic disease itself is more serious in patients with severe psychopathological symptoms.

What links somatic diseases and mental disorders

• psychological reasons.
• Mental disorders that are manifested by somatic symptoms.
• Psychiatric consequences caused by a somatic disease, manifested by organic and functional disorders.
• Accidentally coinciding in time, mental and somatic illness.
• Mental disorder complicates the somatic condition. (For example: eating disorder, self-harm, alcohol and other substance abuse).

Psychoemotional stress is accompanied by physiological changes in the human body. If it lasts too long or occurs very often, it can lead to pathological somatic disorders. Unfavorable psychological factors can consolidate and aggravate the disease, provoke relapses.

The German psychoanalyst Franz Alexander suggested that there are seven somatic diseases that are caused by mental disorders.

• Bronchial asthma.
• Rheumatoid arthritis.
• Diseases of the gastrointestinal tract (ulcerative colitis).
• Essential arterial hypertension.
• Neurodermatitis (skin disease).
• thyrotoxicosis.
• Peptic ulcer.

Unresolved emotional conflicts, associated with relationships of subordination, according to Alexander, are the cause of asthma. However, there is no convincing evidence for this theory. But there is evidence that the emotions of fear, anger, excitement provoke and complicate the attacks of an already existing disease.

Rheumatoid arthritis associated with anxiety and depression. Restrictions in work and rest, family troubles and problems in the sexual sphere, provoke and support the development of this disease.

Somatic causes ulcerative colitis not identified, therefore, many experts agree with Alexander's psychological theory. clinical experience proven psychological stressors and social problems cause this nasty disease.

When a person experiences short-term emotional stress his blood pressure rises sharply. Prolonged emotional stress leads to sustained hypertension. For men whose work is associated with great responsibility, blood pressure increased.

It is assumed that many skin diseases can also be caused by psychological causes. These diseases include: neurodermatitis, hives, atopic dermatitis, lichen simplex, psoriasis, eczema. People suffering from pronounced skin manifestations, of course, experience awkwardness, self-doubt, which is reflected in their social functioning.

Psychological problems affect the stomach. Peptic ulcers of the stomach and duodenum are observed more often when people are exposed to strong external adverse events, such as during war or natural disasters.

This is far from complete list somatic diseases associated with psychological problems. Yes, and there is no convincing evidence that psychological factors can lead to the occurrence of a somatic disease, but it has been definitely proven that such factors aggravate the course of an already existing disease and can provoke a relapse.