Signs of a disturbed psyche. Symptoms of mental illness in women

The weaker sex is more susceptible to mental illnesses. Emotional involvement in social life and natural sensitivity increase the risk of developing diseases. They need to be diagnosed in time in order to begin proper treatment and return life to normal.

Mental illnesses at different age periods of a woman’s life

For each age period (girl, young woman, woman), a group of the most likely mental illnesses has been identified. At these critical stages of development for the psyche, situations occur that most often provoke development.

Girls are less susceptible to mental illnesses than boys, however, they are not immune from the development of school phobias and attention deficit. They are at increased risk of developing anxiety and learning disorders.

Young girls in 2% of cases may become victims of premenstrual dysphoria after the first episode of bleeding during the menstrual period. After puberty, it is believed that girls are 2 times more likely to develop depression than boys.

Women who are included in the group of patients with mental disorders do not undergo drug treatment when planning. In this way they provoke relapses. After childbirth, there is a high probability of signs of depression appearing, which, however, can go away without drug treatment.

A small percentage of women do develop psychotic disorders, the treatment of which is complicated by the limited number of approved medications. For each individual situation, the degree of benefit and risk of drug treatment during breastfeeding is determined.

Women from 35 to 45 years of age are at risk of developing anxiety disorders, they are susceptible to mood changes, and are not immune from the onset of schizophrenia. Decreased sexual function can occur due to taking antidepressants.

Menopause changes the usual course of a woman’s life, her social role and relationships with loved ones. They switch from caring for their children to looking after their parents. This period is associated with depressive moods and disorders, but the connection between the phenomena has not been officially proven.

In old age, women are susceptible to the development of dementia and complications of somatic pathologies with mental disorders. This is due to their life expectancy; the risk of developing dementia (acquired dementia) increases in proportion to the number of years lived. Elderly women who take a lot and suffer from somatic diseases are more prone to insanity than others.

Those over 60 should pay attention to the symptoms of paraphrenia (a severe form of delusional syndrome); they are at greatest risk. Emotional involvement in the lives of others and loved ones at an advanced age, when many have completed their life’s journey, can cause mental disorders.

Dividing a woman’s existence into periods allows doctors to single out the only correct one from a variety of diseases with similar symptoms.

Signs of mental disorders in girls

IN childhood The development of the nervous system occurs continuously, but unevenly. However, 70% of the peak of mental development occurs during this period; the personality of the future adult is formed. It is important to have the symptoms of certain diseases diagnosed by a specialist in a timely manner.
Signs:

• Decreased appetite. Occurs with sudden changes in diet and forced food intake.
• Increased activity. Characterized by sudden forms of motor excitement (bouncing, monotonous running, shouting)
• Hostility. It is expressed in the child’s confidence in the negative attitude towards him of those around him and loved ones, which is not confirmed by facts. It seems to such a child that everyone laughs at him and despises him. On the other hand, he himself will show groundless hatred and aggression, or even fear towards his family. He becomes rude in everyday interactions with relatives.
• Painful perception of physical disability (dysmorphophobia). The child chooses a minor or apparent flaw in appearance and tries with all his might to disguise or eliminate it, even turning to adults with a request for plastic surgery.
• Game activity. It comes down to monotonous and primitive manipulation of objects not intended for play (cups, shoes, bottles); the nature of such a game does not change over time.
• Morbid obsession with health. Excessive attention to one’s physical condition, complaints about fictitious ones.
• Repeated movements of the word. They are involuntary or obsessive, for example, the desire to touch an object, rub your hands, or tap.
• Mood disturbance. The state of melancholy and meaninglessness of what is happening does not leave the child. He becomes whiny and irritable, his mood does not improve for a long time.

• Nervous state. Change from hyperactivity to lethargy and passivity and back. Bright light and loud and unexpected sounds are difficult to tolerate. The child cannot strain his attention for a long time, which is why he experiences difficulties with his studies. He may experience visions of animals, scary-looking people, or hear voices.
• Disorders in the form of repeated spasms or convulsions. The child may freeze for a few seconds, turning pale or rolling his eyes. An attack may manifest itself in shaking of the shoulders, arms, or less often, similar to squats. Systematic walking and talking in your sleep at the same time.
• Disturbances in daily behavior. Excitability coupled with aggression, expressed in a tendency to violence, conflict and rudeness. Unstable attention due to lack of discipline and motor disinhibition.
• A pronounced desire to cause harm and subsequent pleasure from it. The desire for hedonism, increased suggestibility, a tendency to leave home. Negative thinking along with vindictiveness and bitterness against the backdrop of a general tendency towards cruelty.
• A painful and abnormal habit. Biting nails, pulling out hair from the scalp and at the same time reducing psychological stress.
• Obsessive fears. Daytime forms are accompanied by facial redness, increased sweating and palpitations. At night, they manifest themselves in screaming and crying from frightening dreams and motor restlessness; in such a situation, the child may not recognize loved ones and brush someone off.
• Impaired reading, writing and counting skills. In the first case, children have difficulty relating the appearance of a letter to its sound or have difficulty recognizing images of vowels or consonants. With dysgraphia (writing disorder), it is difficult for them to write what they say out loud.

These signs are not always a direct consequence of the development of a mental illness, but require qualified diagnosis.

Symptoms of diseases characteristic of adolescence

Adolescent girls are characterized by anorexia nervosa and bulimia, premenstrual dysphoria and depressive states.

Anorexia, frolicking due to nervousness, includes:

• Denial of the existing problem
• Painful and obsessive feeling excess weight in its apparent absence
• Eating food standing or in small pieces
• Disturbed regime
• Fear of gaining excess weight
• Depressed mood
• Anger and unreasonable resentment
• Passion for cooking, preparing meals for the family without personal participation in the meal
• Avoiding shared meals, minimal interaction with loved ones, spending long periods in the bathroom or exercising outside the home.

Anorexia also causes physical problems. Due to weight loss, problems with the menstrual cycle begin, arrhythmia appears, and constant weakness and muscle pain are felt. How you treat yourself depends on the amount of weight lost versus gained. A person with anorexia nervosa tends to biasedly assess his condition until the point of no return is reached.

Signs of bulimia nervosa:

• The amount of food consumed at a time exceeds the norm for a person of a certain build. Pieces of food are not chewed, but quickly swallowed.
• After eating, a person deliberately tries to induce vomiting to empty the stomach.
• Behavior is dominated by mood swings, closedness and unsociability.
• A person feels helpless and lonely.
• General malaise and lack of energy, frequent illnesses, upset digestion.
• Destroyed tooth enamel– a consequence of frequent vomiting, which contains gastric juice.
• Enlarged salivary glands on the cheeks.
• Denying the existence of a problem.

Signs of premenstrual dysphoria:

• The disease is typical for girls developing premenstrual syndrome. It, in turn, is expressed in depression, gloomy mood, unpleasant physical sensations and an uncomfortable psychological state, tearfulness, disruption of the usual sleep and eating patterns.
• Dysphoria occurs 5 days before the start of menstruation and ends on the first day. During this period, the girl is completely unfocused, cannot concentrate on anything, and is overcome by fatigue. The diagnosis is made if the symptoms are pronounced and bother the woman.

Most adolescent diseases develop due to nervous disorders and characteristics of puberty.

Postpartum mental disorders

In the field of medicine, there are 3 negative psychological states of a woman in labor:

• Neurotic. There is an exacerbation of mental problems that were present when the child was pregnant. This disease is accompanied by a depressed state, nervous exhaustion.
• Traumatic neurosis. Appears after a long and difficult birth; subsequent pregnancies are accompanied by fear and anxiety.
• Melancholy with delusional ideas. The woman feels guilty, may not recognize loved ones and may see hallucinations. This disease is a prerequisite for the development of manic-depressive psychosis.

Mental disorder may manifest itself as:

• Depressed state and tearfulness.
• Unreasonable anxiety, feelings of restlessness.
• Irritability and excessive activity.
• Distrust of others and feeling.

• Slurred speech and decreased or increased appetite.
• Obsessiveness in communication or the desire to isolate yourself from everyone.
• Confusion and lack of concentration.
• Inadequate self-esteem.
• Thoughts about suicide or murder.

In the first week or month, these symptoms will make themselves felt in the event of the development of postpartum psychosis. Its duration is four months on average.

The period of middle age. Mental illnesses that develop during menopause

During menopause, the hormonal glands of sexual secretion reverse development; this symptom is most pronounced in women between 45 and 50 years of age. inhibits cell renewal. As a result, those diseases and disorders that were previously absent completely or occurred latently begin to appear.

Mental illnesses characteristic of the menopause period develop either 2-3 months before the final completion of the menstrual cycle or even after 5 years. These reactions are temporary, most often they are:

• Mood swings
• Anxiety about the future
• Increased sensitivity

Women at this age are prone to self-criticism and dissatisfaction with themselves, which entails the development of depressive moods and hypochondriacal experiences.

With physical discomfort during menopause, associated with flushing or fainting, hysterics appear. Serious disorders during menopause develop only in women who initially had such problems

Mental disorders in women in senile and pre-senile periods

Involutionary paranoid. This psychosis, which appears during involution, is accompanied by delusional thoughts combined with unbidden memories of traumatic situations from the past.

Involutional melancholy is typical for women over 50 years of age. The main prerequisite for the appearance of this disease is anxiety-delusional depression. Typically, involutional paranoid appears after a change in lifestyle or a stressful situation.

Late-life dementia. The disease is an acquired dementia that worsens over time. Based on clinical manifestations, there are:

• Total dementia. In this variant, perception, level of thinking, creativity and problem solving abilities are reduced. The boundaries of personality are erased. A person is not able to critically evaluate himself.
• Lacunar dementia. Memory impairment occurs when the level of cognitive function is maintained. The patient can evaluate himself critically, but the personality basically remains unchanged. This disease manifests itself in syphilis of the brain.
• These diseases are a warning sign. The mortality rate of patients with dementia after a stroke is many times higher than that of those who escaped this fate and did not become dementia.

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Treatment of mental disorders is divided into medications and complex psychotherapy. For eating disorders typical of young girls, a combination of these treatment methods will be effective. However, even if most of the symptoms coincide with the described disorders, before undertaking any type of treatment it is necessary to consult with a psychotherapist or psychiatrist.

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

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

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

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

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

Table 28-1

Major mental disorders in women

1. Eating disorders

Anorexia nervosa

Bulimia nervosa

Bouts of gluttony

2. Affective disorders

Major Depression

Adjustment disorder with depressed mood

Postpartum affective disorder

Seasonal affective disorder

Affective insanity

Dysthymia

3. Alcohol abuse and alcohol dependence

4. Sexual disorders

Libido disorders

Sexual arousal disorders

Orgastic disorders

Painful sexual disorders:

vaginismus

dyspareunia

5. Anxiety disorders

specific phobias

social phobia

agoraphobia

Panic disorders

Generalized anxiety disorders

Syndrome obsessive states

Post-traumatic stress

6. Somatoform disorders and false disorders

False disorders:

simulation

Somatoform disorders:

somatization

conversion

hypochondria

somatoform pain

7. Schizophrenic disorders

Schizophrenia

Paraphrenia

8. Delirium

Mental illnesses throughout a woman's life

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

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

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

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

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

Examination of a psychiatric patient

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

1) mental illness (what the patient has)

2) temperamental disorders (what the patient is like)

3) behavioral disturbances (what the patient does)

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

Mental illness

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

Temperament disorders

Understanding the patient's personality increases the effectiveness of treatment. Are personal traits such as perfectionism, indecisiveness, and impulsiveness somehow quantified in people, as well as physiological ones? height and weight. Unlike mental disorders, do they have no clear characteristics? ?symptoms?, as opposed to?normal? values, and individual differences are normal in the population. Psychopathology or functional personality disorders occur when traits become extreme. When temperament leads to impairment in occupational or interpersonal functioning, this is sufficient to qualify it as a possible personality disorder; in this case, medical assistance and cooperation with a psychiatrist are needed.

Behavioral disorders

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

Patient's life story

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

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

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

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

3. Does the patient have purposeful behavioral disorders?

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

Eating disorders

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

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

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

Bulimia nervosa is characterized by the same fear of obesity and dissatisfaction with one's own body as anorexia nervosa, accompanied by bouts of binge eating, and then compensatory behavior aimed at maintaining low weight bodies. DSM-IV distinguishes anorexia and bulimia primarily on the basis of underweight and amenorrhea rather than weight control behaviors. Compensatory behavior includes periodic fasting, grueling physical exercise, taking laxatives and diuretics, stimulants and inducing vomiting.

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

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

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

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

Other risk factors for developing eating disorders include family conflict, loss of a significant person such as a parent, physical illness, sexual conflict and trauma. Triggers may also include marriage and pregnancy. Do some professions require you to stay slim? from ballerinas and models.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Affective disorders

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

Depression

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

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

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

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

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

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

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

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

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

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

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

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

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

Is the usual therapeutic approach to treatment a combination of pharmacological agents? antidepressants? and psychotherapy. The emergence of a new generation of antidepressants with minimal side effects has increased therapeutic options for patients with depression. Are there 4 main types of antidepressants used: tricyclic antidepressants, SSRIs, MAO inhibitors and others? see table 28-2.

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

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

Seasonal affective disorders

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

Bipolar disorders (manic-depressive psychosis)

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

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

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

Dysthymia

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

Coexisting affective and neurological disorders

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

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

Alcohol abuse

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

Complications associated with alcoholism ( fatty degeneration liver, cirrhosis, hypertension, gastrointestinal bleeding, anemia and digestive disorders), women develop faster and at lower doses of alcohol than men, because women have lower levels of gastric alcohol dehydrogenase than men. Addiction to alcohol, as well as to other substances? opiates, cocaine? women develops after less time of use than men.

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

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

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

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

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

Table 28-3

CAGE Questionnaire

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

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

3. Have you ever felt guilty about drinking alcohol?

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

Sexual disorders

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

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

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

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

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

Anxiety disorders

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

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

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

Sociological theory focuses on traditional gender role stereotypes that prescribe helplessness, dependence, and avoidance of active behavior for women. Young mothers often worry whether they will be able to ensure the safety of their children, not wanting pregnancy, or infertility? All of these conditions can exacerbate anxiety disorders. A large number of expectations and conflict in the roles of a woman - mother, wife, housewife and successful worker - also increase the frequency of anxiety disorders in women.

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

For anxiety disorders, co-occurrence with other psychiatric diagnoses is high, most often? mood disorders, drug addiction, other anxiety disorders and personality disorders. At panic disorders oh, for example, a combination with depression occurs more often than 50%, and with alcohol addiction? at 20-40%. Social phobia is combined with panic disorder in more than 50%.

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

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

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

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

Phobic disorders

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

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

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

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

Panic disorders

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

Generalized anxiety disorder

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

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

Psychotherapeutic techniques used in the treatment of generalized anxiety disorder include cognitive behavioral therapy, supportive therapy, and an internally focused approach that aims to increase the patient's tolerance to anxiety.

Obsessive-compulsive disorder (obsessive-compulsive disorder)

Obsessions (obsessions)? These are anxious, repetitive, imperative thoughts and images. Examples include fear of infection, fear of committing a shameful or aggressive act. The patient always perceives obsessions as abnormal, excessive, irrational and tries to resist them.

Obsessive actions (compulsions)? This is a repetitive behavior such as hand washing, counting, and fiddling with objects. Could these be mental actions? counting to yourself, repeating words, praying. The patient feels it necessary to perform these rituals in order to relieve anxiety caused by obsessions, or to comply with some irrational rules supposedly preventing some danger. Obsessions and compulsions interfere with the patient's normal behavior, occupying most of her time.

The incidence of obsessive-compulsive disorders is the same in both sexes, but in women they begin later (at the age of 26-35 years), can occur at the beginning of an episode of major depression, but persist after its end. Is this the course of the disorder? combined with depression? responds better to therapy. Obsessions related to food and weight are more common in women. In one study, 12% of women with obsessive-compulsive disorder had a history of anorexia nervosa. Neurological disorders associated with obsessive-compulsive disorder include Tourette's syndrome (60% associated with obsessive-compulsive disorder), temporal lobe epilepsy, and post-encephalitis condition.

Treatment for this syndrome is quite effective and is based on a combination of cognitive behavioral therapy and pharmacological treatment. Serotonergic antidepressants are the drugs of choice (clomipramine, fluoxetine, sertraline, fluvoxamine). Should the doses be higher than those used for depression in particular? fluoxetine? 80-100 mg per day. All drugs are started in minimal doses and gradually increased every 7-10 days until a clinical response is obtained. To achieve the maximum therapeutic effect, 8-16 weeks of treatment are most often needed.

Post-traumatic stress disorder

Post-traumatic stress disorder develops after situations that can be traumatic for many people, which is why it is underdiagnosed. Such situations can be war, threat to life, rape, etc. The patient constantly returns her thoughts to the traumatic event and at the same time tries to avoid reminders of it. Personality traits, life stresses, genetic predisposition, and a family history of mental disorders explain why some people develop PTSD and some do not, under the same triggering conditions. Research shows that women are more susceptible to developing this syndrome. Biological theories of the pathogenesis of post-traumatic stress disorder include dysfunction of the limbic system, dysregulation of the catecholamine and opiate systems. In women, symptoms worsen during the luteal phase of the menstrual cycle.

Treatment for PTSD includes medication and psychotherapy. The drugs of choice are imipramine or SSRIs. Psychotherapy involves gradually coming into contact with stimuli that remind you of a traumatic event in order to overcome your attitude towards it.

Anxiety disorders are more common in women than in men. Women rarely seek treatment for fear of being labeled "mentally ill". When women do seek help, they often present only associated somatic symptoms, which worsens the diagnosis and quality of mental health care. Although anxiety disorders are treatable, they are often treated undiagnosed. chronic course and can seriously impair function. Future research will help explain sex differences in the incidence of anxiety disorders.

Somatoform and false disorders

Somatization as a psychiatric phenomenon? it is an expression of psychological distress in the form of somatic disorders. This is a common occurrence in many mental disorders. False disorders and malingering are suspected in the presence of unexplained symptoms that do not fit the picture of somatic and neurological disorders. The motivation for feigning illness is the individual's need to play the role of the patient. Could this intention be completely unconscious? as in conversion disorders, and fully conscious? like in a simulation. Getting used to the role of the patient leads to increased attention from family members and doctors and reduces the patient's responsibility.

Most studies confirm the high incidence of this group of disorders in women. This may be due to differences in the upbringing of the sexes and varying degrees of tolerance to physical discomfort.

False disorders and malingering

False disorders? conscious production of symptoms of mental illness in order to maintain the role of the patient. An example would be administering a dose of insulin to induce a hypoglycemic coma and hospitalization. During simulation, the patient’s goal is not to feel sick, but to achieve other practical results (avoiding arrest, obtaining the status of an insane person).

Somatoform disorders

There are four types of somatoform disorders: somatization, conversion, hypochondriasis and pain. With all of these disorders, there are physical symptoms that cannot be explained from the perspective of existing somatic diseases. Most often, the mechanism for the development of these symptoms is unconscious (unlike false disorders). These symptoms must be severe enough to impair the patient's social, emotional, occupational, or physical functioning and be associated with active seeking of medical help. Because these patients self-diagnose, one of the initial difficulties of treatment is their acceptance of the fact of a mental disorder. Only acceptance of a real diagnosis helps to achieve cooperation with the patient and her compliance with treatment recommendations. The next step is to determine the connection between exacerbations of symptoms and life stressors, depression or anxiety, and explain this connection to the patient. Illustrative example? exacerbation of peptic ulcer from stress? helps patients connect their complaints to their current psychological state. Treatment of co-occurring depression or anxiety is important.

Somatization disorder

Somatization disorder usually includes a variety of somatic symptoms affecting many organs and systems, has a chronic course and begins before the age of 30 years. DSM-IV diagnostic criteria require the presence of at least four pain symptoms, two gastrointestinal, one sexual and one pseudoneurological, none of which are fully explained by physical and laboratory examinations. Patients often present strange and inconsistent combinations of complaints. In women, such disorders are 5 times more common than in men, and the frequency is inversely proportional to educational level and social class. Combination with other mental disorders, especially affective and anxiety disorders, occurs in 50%, and its diagnosis is very important for selecting therapy.

A prerequisite for successful therapy is the choice of one attending physician who coordinates treatment tactics, since such patients often turn to many doctors. Psychotherapy, both individual and group, often helps patients reframe their condition.

Ovarian hormones and the nervous system

Hormones play an important role in the manifestation of many neurological conditions. Sometimes endocrine disorders are caused by an underlying neurological diagnosis, such as an abnormal insulin response to a glucose load in muscular dystrophy. In other cases, on the contrary, are neurological disorders caused by endocrine pathology? for example, peripheral neuropathy with diabetes mellitus. In other endocrine disorders, such as primary hypothyroidism, Cushing's disease, and Addison's disease, neurological dysfunction may be less noticeable and manifest as impairment in cognition or personality traits. All these conditions are expressed equally often in men and women. In women, cyclical changes in ovarian hormone levels have specific effects that are discussed in this chapter.

To better understand the subject, the anatomy, physiology of the ovaries, the pathogenesis of puberty and the physiological effects of ovarian hormones are first discussed. There are various genetic conditions that affect the process of sexual development and maturation. In addition to the fact that they can have a direct effect on neurological status, they also change it by influencing cyclic hormonal changes. The differential diagnosis of delayed sexual development is considered.

Clinically, congenital or acquired changes in certain brain structures can have a significant impact on sexual and neurodevelopment. Can damage to the central nervous system, such as tumors, interfere with sexual development or the menstrual cycle? depending on the age at which they develop.

Anatomy, embryology and physiology

Cells of the ventromedial and arcuate nuclei and the preoptic zone of the hypothalamus are responsible for the production of GnRH. This hormone controls the release of the anterior pituitary hormones: FSH and LH (gonadotropins). Cyclic changes in FSH and LH levels regulate the ovarian cycle, which includes follicular development, ovulation, and maturation of the corpus luteum. These stages are associated with varying degrees of production of estrogens, progesterone and testosterone, which in turn have multiple effects on various organs and according to the principle feedback? on the hypothalamus and cortical areas associated with the regulation of ovarian function. In the first three months of life, GnRH causes a marked response in the production of LH and FSH, which then decreases and recovers closer to the age of menarche. This early LH surge is associated with the peak of oocyte replication. Many researchers consider these facts to be related, since in the future there is practically no production of new oocytes. However, the exact role of FSH and LH in the regulation of oocyte production has not been determined. Just before puberty, GnRH release increases sharply during sleep. This fact and the rise in LH and FSH levels are considered markers of approaching puberty.

Influences that increase the tone of the noradrenergic system increase the release of GnRH, and activation of the opiate system? slows down. GnRH-secreting cells are also influenced by levels of dopamine, serotonin, GABA, ACTH, vasopressin, substance P, and neurotensin. Although there are higher cortical regions that directly influence the GnRH-producing areas of the hypothalamus, the amygdala has the most pronounced influence. Located in the anterior limbic system of the temporal lobe, the amygdala has reciprocal relationships with many areas of the neocortex and with the hypothalamus. The amygdala nucleus has two sections, the fibers from which run as part of various brain pathways. Fibers from the corticomedial region are part of the stria terminalis, and from the basolateral? as part of the ventral amygdalofugal tract. Both of these pathways have connections with areas of the hypothalamus containing cells that produce GnRH. Studies with stimulation and disruption of the amygdala and pathways have revealed a clear response in LH and FSH levels. Stimulation of the corticomedial nucleus stimulated ovulation and uterine contractions. Stimulation of the basolateral nucleus blocked sexual behavior in females during ovulation. Destruction of the sria terminalis blocked ovulation. Disruption of the ventral amygdalofugal tract had no effect, but bilateral damage to the basolateral nucleus also blocked ovulation.

GnRH is released into the portal system of the hypothalamus and enters the anterior pituitary gland, where it affects gonadotrophic cells, which occupy 10% of the adenohypophysis. They usually secrete both gonadotropic hormones, but among them there are subtypes that secrete only LH or only FSH. GnRH secretion occurs in a circhoral pulsatile rhythm. Answer? release of LH and FSH? develops quickly, in the same pulse mode. The half-lives of these hormones are different: for LH it is 30 minutes, for FSH? about 3 o'clock. That. When measuring hormone levels in peripheral blood, FSH is less variable than LH. LH regulates the production of testosterone in the theca cells of the ovaries, which, in turn, is converted into estrogens in granulosa cells. LH also helps maintain the corpus luteum. FSH stimulates follicular cells and controls aromatase levels, influencing the synthesis of estradiol (Fig. 4-1). Immediately before the onset of puberty, pulsed release of GnRH causes a predominant stimulation of FSH production, with virtually no effect on LH levels. The sensitivity of LH to stimulation increases after menarche. During the reproductive period, the LH pulse is more stable than FSH. At the onset of menopause, the LH response begins to decline until postmenopause, when both FSH and LH levels are elevated, but FSH predominates.

In the ovaries, sex hormones are synthesized from LDL cholesterol circulating in the blood under the influence of FSH and LH: estrogens, progesterone and testosterone (Fig. 4-1). Are all ovarian cells, except the egg itself, capable of synthesizing estradiol? main ovarian estrogen. Does LH regulate the first stage? conversion of cholesterol to pregnenolone, and FSH? the final conversion of testosterone to estradiol. Estradiol, when accumulated in sufficient quantities, has a positive feedback effect on the hypothalamus, stimulating the release of GnRH and causing an increase in the pulse amplitude of LH and, to a lesser extent, FSH. The pulsation of gonadotropins reaches its maximum amplitude during ovulation. After ovulation, FSH levels decrease, which leads to a decrease in FSH-dependent estradiol production and, consequently, estradiol-dependent LH secretion. The corpus luteum develops, leading to an increase in the levels of progesterone and estradiol, synthesized by theca and granulosa cells of the corpus luteum.

Estrogens? hormones that have many peripheral effects. They are necessary for secondary puberty: the maturation of the vagina, uterus, fallopian tubes, stroma and ducts of the mammary glands. They stimulate endometrial growth during the menstrual cycle. They are also important for the growth of long bones and the closure of growth plates. They have an important influence on the distribution of subcutaneous fat and the level of HDL in the blood. Estrogens reduce the reabsorption of calcium from bones and stimulate the blood coagulation system.

In the brain, estrogens act both as a trophic factor and as a neurotransmitter. The density of their receptors is greatest in the preoptic area of ​​the hypothalamus, but there is also some quantity in the amygdala, CA1 and CA3 areas of the hippocampus, cingulate gyrus, locus coeruleus, raphe nuclei and central gray matter. In many areas of the brain, the number of estrogen receptors changes throughout the menstrual cycle, in some? specifically in the limbic system? their level depends on the serum level. Estrogens activate the formation of new synapses, in particular the NMDA transmitter system, as well as the reaction of the formation of new dendrites. Both of these processes are further enhanced in the presence of progesterone. The reverse processes do not depend on an isolated decrease in estrogen levels, but only on its decrease in the presence of progesterone. Without progesterone, a decrease in estrogen does not trigger reverse processes. That. the effects of estrogen are enhanced in non-ovulating women who do not have sufficient level progesterone in the luteal phase.

Estrogens exert their influence at the level of neurotransmitters (cholinergic system) by activating acetylcholinesterase (AChE). They also increase the number of serotonin receptors and the level of serotonin synthesis, which causes its fluctuations during the cycle. In human and animal studies, increasing estrogen levels improve fine motor skills but reduce spatial orientation abilities. With an initially reduced level of estrogen in women, its increase improves verbal short-term memory.

In animals treated with estrogens, resistance to convulsions provoked by electric shock decreases, and the threshold of sensitivity to convulsive drugs decreases. Local application of estrogen itself provokes spontaneous convulsions. In animals with structural but non-epileptic lesions, estrogens can also provoke seizures. In humans, intravenous administration of estrogens can activate epileptic activity. During periods of higher estrogen concentrations, an increase in the basal EEG amplitude is observed compared to periods of minimal concentration. Progesterone has the opposite effect on epileptic activity, increasing the threshold for seizure activity.

Disorders with a genetic predisposition

Genetic disorders can disrupt the normal process of puberty. They can directly cause the same neurological disorders that also depend on hormone levels throughout the menstrual cycle.

Turner syndrome? an example of a chromosomal deletion. One out of every 5000 live born girls has a karyotype of 45, XO, i.e. deletion of one X chromosome. This mutation is associated with many somatic developmental abnormalities, such as coarctation of the aorta, delayed puberty due to high FSH levels, and gonadal dysgenesis. If it is necessary to replenish the level of sex hormones, hormone replacement therapy is possible. It has recently been discovered that some patients with Turner syndrome have a partial deletion in the long or short arm of the X chromosome, or mosaicism, i.e. In some cells of the body the karyotype is normal, while in others there is a complete or partial deletion of the X chromosome. In these cases, although the process of sexual development may proceed normally, patients may present some somatic features of the disease, such as short stature, wing-shaped cervical folds. There are other cases where there is gonadal dysgenesis, but there are no somatic signs, and development occurs normally until the development of secondary sexual characteristics.

Another disorder with a genetic predisposition and varying clinical manifestations is congenital adrenal hyperplasia. This autosomal recessive anomaly has 6 clinical forms and occurs in both men and women. In three of these forms only the adrenal glands are affected, in the rest? adrenal glands and ovaries. In all 6 variants, women have virilization, which can delay puberty. There is a high incidence of PCOS in this disorder.

Another genetic disorder is P450 aromatase deficiency syndrome. With him it happens partial violation placental conversion of circulating steroids to estradiol, which leads to increased levels of circulating androgens. This causes the effect of masculinization of the fetus, in particular the female fetus. Although this effect tends to reverse after childbirth, it remains unclear how prenatal exposure to high levels of androgens might influence future neurodevelopment in women, especially given all the varied influences these hormones have on neurogenesis.

Structural and physiological disorders

Structural brain abnormalities may affect sexual development or the cyclical pattern of female sex hormone secretion. If damage occurs before puberty, disruption is more likely to occur. Otherwise, the damage can change the nature of hormonal secretion, causing the development of conditions such as PCOS, hypothalamic hypogonadism, and premature menopause.

Damage leading to menstrual irregularities can be localized in the pituitary gland (intrasellar localization) or hypothalamus (suprasellar). Extrasellar localization of damage is also possible, for example, increased intracranial pressure and its influence on both the hypothalamus and pituitary gland.

Intrasellar damage can be localized in cells that produce hormones of the adenohypophysis. These hormones (eg growth hormone) may affect gonadotropin function directly or the size of the lesions may cause a decrease in the number of gonadotrophs. In these cases, gonadotropin levels decrease, but GnRH levels remain normal. With suprasellar injuries, the production of hypothalamic releasing factors and a secondary decrease in gonadotropin levels decrease. In addition to endocrine disorders, suprasellar pathologies more often than intrasellar pathologies cause neurological symptoms: disturbances in appetite, sleep and wakefulness rhythms, mood, vision and memory.

Partial epilepsy

Epilepsy is quite common in adults, especially with localization of the focus in the temporal lobe of the cortex. Women experience a peak incidence of epilepsy during menopause. In Fig. Figure 4-2 shows three different patterns of epilepsy according to the phases of the menstrual cycle. The two most easily recognized patterns? this is an exacerbation of attacks in the middle of the cycle, with normal ovulation(first) and immediately before and after menstruation (second). The third pattern is observed in women with anovulatory cycles, in which attacks develop throughout the entire “cycle,” the duration of which can vary significantly. As noted earlier, estradiol has a proconvulsant effect, but progesterone? anticonvulsant. The main factor determining the pattern of attacks is the ratio of estradiol and progesterone concentrations. During anovulation, there is a relative predominance of estradiol.

For its part, the presence of focal epilepsy, with a focus in the temporal lobe of the cerebral cortex, can affect the normal menstrual cycle. Amygdala nucleus? the structure belonging to the temporal lobe is in a reciprocal relationship with hypothalamic structures that influence the secretion of gonadotropins. In our study of 50 women with clinical and electroencephalographic signs of an epileptic focus in the temporal lobe, significant disorders were found in 19 reproductive system. 10 out of 19 had PCOS, 6? hypergonadotropic hypogonadism, in 2? premature menopause, 1? hyperprolactinemia. In humans, there is an advantage of the right temporal lobe over the left in the influence of epileptic foci on the production of gonadotropins. Women with left-sided lesions had more LH peaks during the 8-hour observation period compared with controls. All of these women had PCOS. In women with hypergonadotropic hypogonadism, there was a significant reduction in LH peaks during the 8-hour observation period compared with controls, and the focus of epilepsy was more often observed in the right temporal lobe (Fig. 4-3).

Menopause may influence the course of epilepsy. In obese women, adrenal androgens are converted to estradiol due to aromatase activity in adipose tissue. Therefore, obese women may experience virtually no symptoms of estrogen deficiency that are classic for menopause. Due to ovarian hypofunction, progesterone deficiency occurs, which leads to a predominance of estrogen levels over progesterone. The same situation can develop in women with normal weight while taking HRT. In both cases, there is an increase in seizure activity due to the uncompensated influence of estrogens. When the frequency of attacks increases, combined estrogen-progestin HRT should be prescribed in a continuous mode.

Pregnancy can have a significant impact on seizure activity due to the production of endogenous hormones and their effect on the metabolism of anticonvulsants.

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According to the presumption of mental health, a person does not have to prove that he is not sick. Especially if his symptoms of mental illness are not pronounced, do not appear systematically, and in general he is quite stable. But there are a number of signs of mental disorders that provide sufficient grounds for a psychiatric examination.

Signs of neuropsychiatric disorders: symptoms of impaired perception

The first group of mental illnesses includes symptoms of impaired perception

Senestopathies- this is a breakthrough of signals from internal organs, muscles into consciousness. These symptoms of mental disorders manifest themselves in the form of painful, unpleasant, often migrating sensations in the head, chest, abdomen, and limbs. This is when it twists, hurts, overflows, burns somewhere inside, and the doctors say that nothing can hurt. In many cases, they are manifestations of hidden depression and neuroses.

Illusions- this is a distorted perception of really existing objects and things of the surrounding world. They are divided into auditory, tactile, gustatory, olfactory and visual.

An example of a visual illusion would be a bush by the road, mistaken for an animal; the lace on a curtain folds into the shape of a face.

An example of auditory illusions is falling drops of water, the noise from which is mistaken for a conversation, or the sound of train wheels is mistaken for music.

Illusions as signs of mental illness often occur in infectious patients, with chronic poisoning and intoxication, and at the beginning of the development of delirium tremens. But they are also observed in healthy people. This can happen in cases where the perception of the environment is unclear (darkness, noisy room) or the person is in a state of emotional stress.

Example of a physical illusion: a spoon dipped into a glass of water seems to be broken.

In addition, there are psychosensory disorders when the perception of signs of objects and one’s own body is disrupted. They appear larger or smaller, further or closer than they actually are, proportions are distorted, quantity, lighting, color change.

How to understand that a person has a mental disorder: hallucinations

Hallucinations are imaginary perceptions that do not have an external object as their source. They can be elementary (knock, noise, rumble, color spots) and complex (voices, music, pictures, objects, people).

How to understand that a person has a mental disorder, and what hallucinations are there? These imaginary perceptions are divided into auditory, visual, gustatory, tactile and olfactory. They can have a “made” character or seem real, real.

Auditory (verbal) hallucinations are characterized by the fact that the patient hears individual words, phrases, songs, and music. Sometimes the words are threatening or commanding in nature, and then it can be difficult to disobey them.

Visual hallucinations can be represented by figures, objects, or entire pictures or films.

Tactile hallucinations are felt as foreign objects touching the body, like insects or snakes crawling on or inside the body.

Taste hallucinations are represented by the feeling that the patient has bitten off something.

Olfactory - the sensation of a non-existent odor, most often unpleasant.

Hallucinations are nonspecific, occur in a wide variety of diseases and, like delusions, are signs of psychosis. They are found in schizophrenia, intoxication, delirium tremens (delirium tremens), organic (vascular, tumor) diseases of the brain, and senile psychoses.

The presence of these signs of mental illness in a person can be judged by his behavior. He gets irritated, scolds, laughs, cries, talks to himself, and responds to an imaginary attack with a defensive reaction.

A symptom of mental illness is impaired thinking

The second group of signs of mental illness are symptoms of thinking disorders.

The patient's pace of thinking may change. It can speed up so much that the patient does not have time to express his thoughts and experiences in words. When speaking, he misses words and entire phrases. A similar condition is observed more often in a state of mania during manic-depressive psychosis. The state of slow thinking is characterized by inhibition of patients; they answer in monosyllables, with long pauses between words. These symptoms of mental illness are characteristic of dementia, deafness.

Sometimes they talk about the viscosity of thinking. In this condition the patient is very detailed. If he is asked to talk about something, he gets stuck for a long time on minor details and has difficulty getting to the most important part of the story. It is extremely difficult to listen to such people. The viscosity of thinking reflects its rigidity; occurs in organic brain lesions, epilepsy.

Thinking disorders also include the so-called reasoning - a tendency to empty ranting and philosophizing.

The fragmentation of thinking is manifested in the fact that individual phrases are not connected with each other; The phrases of such patients are completely impossible to understand.

Reasoning and fragmented thinking are more common in schizophrenia.

Symptoms of neuropsychiatric diseases such as disorders of the content of thinking can be divided into obsessive, overvalued and delusional ideas.

Obsessive states include conditions that occur in patients against their will; patients evaluate them critically and try to resist them.

For example, obsessive doubts are constant uncertainty about the correctness of the actions and actions taken. This haunting unknown exists in defiance of reason and logic. Patients check 10 times whether the appliances are turned off, whether the doors are closed, etc.

Intrusive memories are intrusive memories of an unnecessary, often unpleasant fact or event.

Obsessive abstract thoughts - constantly scrolling through various abstract concepts in the head, operating with numbers.

There is a large group of symptoms of neuropsychiatric disorders such as. These are fears of getting sick: alienophobia (fear of going crazy), cancerophobia (fear cancer), cardiophobia (fear of heart disease), vertigophobia (fear of fainting), mysophobia (fear of pollution, which can lead to infectious disease); fears of space: agoraphobia (fear of open space), claustrophobia (closed space), acrophobia (fear of heights); social phobias: lalophobia (fear of speaking, speaking in front of listeners, fear of incorrect pronunciation of words, stuttering), mythophobia (fear of telling a lie), ereitophobia (fear of blushing), gynecophobia (fear of communicating with women) and androphobia (with men). There are also zoophobia (fear of animals), triskaidekaphobia (fear of the number “13”), phobophobia (fear of fear) and many others.

Obsessive ideas can be observed in obsessive-compulsive disorder and schizophrenia.

With overvalued ideas, logically based beliefs arise that are based on real events, associated with personality traits, and extremely emotionally charged. They encourage a person to engage in narrowly focused activities, which often leads to maladjustment. Criticism remains for highly valuable ideas, and there is the possibility of their correction.

How to identify a mental disorder: symptoms of delirium

A mental disorder can be identified as a harbinger of impending instability by the presence of delusions in a person.

According to the mechanism of development, delirium is divided into chronically developing (systematized) and acutely emerging (not systematized).

Delusional ideas are understood as false judgments arising from mental illness that do not correspond to reality. These judgments cannot be corrected, there is no criticism of them, and they completely take over the consciousness of patients, change their activities and maladapt in relation to society.

Systematized delirium of interpretation develops slowly, gradually and is accompanied by general change personality. Delusional ideas and judgments are carefully justified by the patient, who provides a consistent chain of evidence that has subjective logic. But the facts that the patient cites to support his ideas are interpreted by him one-sidedly, abstractly and biasedly. This kind of nonsense is persistent.

One of the symptoms of a mental personality disorder is relational delusion. The patient believes that all the facts and events surrounding him are related to him. If two people are talking somewhere, it’s definitely about him. If there is a fork or knife on the table, then this has a direct relation to it, it was done with some purpose or intent.

How else do mental disorders manifest themselves in humans? One of the options is delusions of jealousy. The patient believes that his partner is cheating on him. He finds a lot of facts to support this: she was late at work for 30 minutes, put on a yellow dress; brushed my teeth and didn't throw out the trash.

Delusions of harm are more common in elderly patients with senile dementia. They always feel like they are being robbed, their things, valuables and money are being taken away. Patients constantly hide what they have, and then forget about it and cannot find what is hidden, since their memory, as a rule, is impaired. Even while in the hospital, they hide everything they can from possible thieves and robbers.

Hypochondriacal delirium. Patients suffering from this type of delusion constantly talk about their imaginary illness. Their “stomach is rotting,” their heart “hasn’t worked for a long time,” “worms are in their heads,” and “the tumor is growing by leaps and bounds.”

Delusions of persecution are characterized by the fact that the patient thinks that he is being watched by people and organizations sent by enemies. He claims that he is being watched through the window day and night, being followed on the street, and listening devices have been installed in his apartment. Sometimes such people, when traveling on buses, constantly change trains to hide from their “enemies,” go to another city, remove wallpaper from the walls, and cut electrical wires.

With delusions of influence, patients believe that they are being affected by “special rays”, “psychotropic weapons”, hypnosis, radio waves, specially created machines in order to destroy them, force them to obey, cause them unpleasant thoughts and sensations. This also includes delusions of obsession.

Delusions of grandeur are perhaps the most pleasant. Patients consider themselves rich people, having wagons of money and barrels of gold; They often imagine themselves to be great strategists and generals who have conquered the world. Occurs with progressive paralysis (with syphilis), dementia.

There is delirium of self-blame and self-abasement, when patients blame themselves for the sins they allegedly committed: murder, theft, and causing “terrible harm” to the world.

Delusions, like hallucinations, are a sign of psychosis. Occurs in schizophrenia, epilepsy, organic brain diseases, and alcoholism.

Main clinical symptoms of mental personality disorder: disturbance of emotions

The third group of main symptoms of mental illness includes signs of emotional disturbance.

Emotions reflect a person’s attitude towards reality and himself. The human body is closely connected with the environment, and it is constantly affected by internal and external stimuli. The nature of this influence and our emotional reaction determine our mood. Remember? If we can’t change the situation, let’s change our attitude towards it. Emotions can be controlled both through thoughts (formulas of suggestion, meditation) and through the external bodily reflection of emotions (gestures, facial expressions, laughter, tears).

Emotions are divided into positive, negative, ambiguous and uncertain (they arise when something new appears and should quickly turn into positive or negative).

A violent manifestation of emotions (sadness, joy, anger) is called affect.

Affect can be pathological if it occurs against the background of a darkened consciousness. It is at this moment that a person can commit serious crimes, since his actions at this moment are not controlled by the central nervous system.

Emotions are divided into positive (not in the sense of “good”, but in the sense of newly appeared ones) - these are hypothymic, hyperthymic, parathymic - and negative (lost).

Hypotymia- decreased mood. It manifests itself in the form of melancholy, anxiety, confusion and fear.

Yearning- this is a state with a predominance of sadness and depression; this is the suppression of all mental processes. Everything around is seen only in dark colors. Movements are usually slow, and a feeling of hopelessness is expressed. Often, life seems to have no meaning. High risk of suicide. Melancholy can be a manifestation of neuroses, manic-depressive psychosis.

Anxiety- this is an emotional state characterized by internal anxiety, constraint and tension localized in the chest; accompanied by a premonition and expectation of impending disaster.

Fear- a state the content of which is fear for one’s well-being or life. It can be unconscious, when patients are afraid, without knowing what, and are in anticipation that something terrible might happen to them. Some want to run away somewhere, others are depressed and freeze in place.

Fear can have certainty. In this case, the person knows what he is afraid of (some people, cars, animals, etc.).

Confusion- a changeable emotional state with feelings of bewilderment and futility.

Hypothymic states are not specific and occur in a variety of conditions.

Hyperthymia - high mood. Manifests itself in the form of euphoria, complacency, anger and ecstasy.

Euphoria- a feeling of causeless joy, fun, happiness with an increased desire for activity. Occurs with drug or alcohol intoxication, manic-depressive psychosis.

Ecstasy- this is a state of highest elation, exaltation. Occurs in epilepsy, schizophrenia.

Complacency- a state of contentment, carelessness, without the desire for activity. Characteristic for senile dementia, atrophic processes of the brain.

Anger- the highest degree of irritability, malice with a tendency to aggressive and destructive actions. The combination of anger and sadness is called dysphoria. It is characteristic of epilepsy.

All of the above emotions are also found in everyday life in healthy people: it’s all about their quantity, intensity and impact on human behavior.

Parathymia (the main symptoms of mental disorders of emotions) include ambivalence and emotional inadequacy.

Ambivalence- this is a duality of attitude towards something, a duality of experience, when one object evokes two opposing feelings in a person at the same time.

Emotional inadequacy- discrepancy between the emotional reaction and the occasion that caused it. For example, joyful laughter at the news of the death of a loved one.

How to recognize a mental disorder: emotional dullness

How can you recognize a mental disorder in a person by observing his emotional state?

Negative emotional disorders include emotional dullness. This symptom can be expressed to varying degrees. With more mild degree patients simply become more indifferent to the world around them, and treat loved ones, relatives, and acquaintances coldly. Their emotions are somehow smoothed out and appear very unclear.

With more pronounced emotional dullness, the patient becomes apathetic to everything that happens, everything becomes indifferent to him, and “paralysis of emotions” occurs.

The patient is absolutely inactive and strives for solitude. Clinical symptoms of mental disorders such as parathymia and emotional dullness are most often found in schizophrenia.

Regulation emotional states associated with the work of deep brain structures (thalamus, hypothalamus, hippocampus, etc.), which are responsible for the functioning of internal organs (gastrointestinal tract, lungs, of cardio-vascular system), for the cellular and biochemical composition of blood. If a person is not aware of emotions, they are able to “record” in the muscles, creating muscle disorders, or “freeze” inside, manifesting themselves as psychosomatic diseases(colic, neurodermatitis, etc.).

What are the other main signs of mental disorders: memory impairment

What other signs of mental disorders are described in modern psychiatry?

The fourth group of signs of mental disorders includes symptoms of impaired memory.

Memory disorders are considered the loss or decrease in the ability to remember, retain and reproduce information and individual events. They are divided into two types: amnesia (lack of memory) and paramnesia (memory deceptions).

Amnesia can be of different types. With retrograde amnesia (loss of memory of the days, months and years preceding the present illness), the patient may not remember not only some life events (partial retrograde amnesia), but also the entire chain of events, including his first and last name (systemic retrograde amnesia). Congrade amnesia is the loss from memory of only the disease or injury itself; anterograde - events subsequent to the disease.

There are also concepts of fixation and reproductive amnesia. In the first case, the patient is deprived of the ability to remember current events; in the second case, he cannot reproduce in his memory the necessary information needed at the moment.

Progressive amnesia is a gradual decay of memory from new, recently acquired knowledge to old. The events of distant childhood are most clearly preserved in memory, while the events of recent years fall out of memory completely (“fell into childhood”).

Paramnesia is divided into false memories and memory distortion. The first includes fictitious events, facts and cases that take the place of events that have completely fallen out of memory. The second is the transfer of past events to the present time in place of the disappeared ones.

Memory disorders are characteristic of systematic psychoses, epilepsy, brain injuries, and organic diseases of the central nervous system.

How to determine a mental disorder in a person: a violation of volitional activity

You can identify a mental disorder as a reason to consult a psychiatrist based on the symptoms of a disorder of volitional activity - this is the fifth group of signs of a mental illness.

Will- this is a psychological activity aimed at achieving a goal and overcoming the obstacles that arise.

Volitional disorders can manifest themselves as a weakening of volitional activity (hypobulia) or its complete absence (abulia), perversion of volitional acts (parabulia).

Hypobulia- reduction in the intensity and quantity of all impulses to activity. Individual instincts may be suppressed: food (, loss of appetite); sexual (decreased libido - sexual desire); defensive (lack of defensive actions in response to an external threat).

As a transient phenomenon, it occurs in neuroses and depression; more persistent ones occur in some types of organic brain damage, schizophrenia, and dementia.

How else can you recognize a mental illness based on its characteristic signs? A sharp increase in appetite, even to the point of gluttony, is called bulimia, and is often found in mental retardation, dementia, and hypothalamic syndrome. With these same diseases, some forms of psychopathy and manic-depressive psychosis, hypersexuality occurs (satiriasis in men and nymphomania in women).

There are also many perverted drives and instincts. For example, dromomania - a pathological attraction to vagrancy, pathological gambling - to games, suicidomania - to suicide, shopaholism - to shopping; This also includes paraphilias-perversions of sexual desire (sadism, masochism, fetishism, exhibitionism, etc.).

Paraphilias occur in psychopathy, schizophrenia and addictive behavior diseases.

How mental disorders manifest themselves: symptoms of attention disorders

How else do mental illnesses manifest in humans? The sixth group of main signs of mental disorders includes symptoms of attention impairment.

Attention is direction mental activity on the phenomena of the surrounding world and on the processes occurring in the body.

There are passive and active attention.

Passive (indicative) attention is based on a person’s indicative reaction to signals. Active (voluntary) attention comes down to focusing a person on solving a problem, achieving a goal.

Attention disorders are manifested by absent-mindedness, exhaustion, distractibility and stiffness.

Distracted (unstable) attention manifests itself in the inability to concentrate on a certain form activities.

Attention Fatigue manifests itself in an increasing weakening of the intensity of the ability to concentrate during work. As a result, passion for work becomes impossible and productivity drops.

Distractibility- this is a painful mobility of attention, when the change of activity is too fast and unreasonable, as a result of which its productivity sharply decreases.

Stiffness of attention- painful fixation, difficulty switching from one object to another.

Attention disorders almost always occur in mental illness.

How to identify a mental disorder in a person is described in psychiatric textbooks, but many special examinations must be carried out to make a diagnosis.

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Stressful situations sometimes cause an inappropriate reaction in a person. Prolonged depression and neuroses are often difficult to differentiate from manifestations of mental illness. Signs of schizophrenia in women have complex symptoms. It is impossible to make a correct diagnosis without qualified help from a psychiatrist, a comprehensive examination, and special tests. What is schizophrenia and what are the signs of its manifestation?

The first symptoms of schizophrenia in women

Disdainful attitude towards mental disorders in modern society – negative factor. By demanding to isolate such people, we forget that mental illnesses are often hereditary, caused by a simple set of genes. Social adaptation and early treatment can minimize the manifestations of the disorder. The support of loved ones is especially important for women.

Schizophrenia – incurable disease, causing disturbances in logical thinking processes and suppression of emotional functions. Most ordinary people often associate it with “split personality,” which is absolutely wrong. Clinical DNA studies have identified a group of “damaged” genes that make it more likely to develop the disease. According to data, every hundredth person on the planet suffers from it. How to define schizophrenia and what are its signs?

The difference in the course of this mental disorder in women lies in the late period of manifestation of the initial symptoms. If in adult men the disease begins to progress by the age of 18, then in girls early signs make themselves felt by the age of 23-25. Much less common are isolated cases of childhood schizophrenia and senile dementia. In women, early signs are classified into:

1. Positive. Accompanied by sudden mood swings, visions or delusions, disturbing, obsessive thoughts. Women become nervous and may cry or laugh for no reason.
2. Negative symptoms schizophrenia. Problems in communicating with society, persistent apathy towards events, reluctance to take care of oneself, loss of interest in work and hobbies are distinctive features of the initial stage of the disease in women.

Main signs of schizophrenia

Teenage schizophrenia manifests itself in girls with outbursts of aggression, isolation, or the perception of the absence of fans as the “end of the world.” Some scientists call colored dreams one of the prerequisites for mental disorders, noting that people suffering from mental disorders tend to “view” pictures. How does schizophrenia manifest in women at different stages of the disease? Doctors identify 7 signs of schizophrenia in women:

1. Crazy thoughts and alien voices.
2. Constant repetition of words, often meaningless.
3. A feeling of interference in life from the outside.
4. Lack of interest in success and career growth.
5. Closedness, sloppy appearance.
6. Cognitive signs - a violation of the associative series, a “breakdown” of the cause-effect chain, difficulty in perceiving incoming new information.
7. Mood swings, depression, suicidal tendencies.

Sluggish

Signs of a mental disorder in women that occurs in a latent form are distinguished by the absence of an aggressive state and safety for others. Often, latent schizophrenia does not develop into more severe and dangerous forms. It is characterized by inappropriate behavior of a paroxysmal form: unreasonable jealousy, decreased interest in everyday issues, loss of relationships with children.

Paranoid

Persecution mania is a frequent “guest” in mental disorders. The following signs will help recognize the syndrome of paranoid schizophrenia in women:

1. Denial of reality, a comfortable feeling inside the “own” world.
2. Constant visions, images created by one’s own imagination.
3. Voices that patients hear.
4. Mild speech dysfunction, confusion of words, illogical statements.

Senile

Age-related disease has its own characteristics. In old age, the signs of schizophrenia, manifested by unusual, strange behavior, are considered to be:

1. Partial memory loss.
2. Forgetfulness of current events against the backdrop of an excellent memory of a time long past.
3. Insomnia.
4. Delusional events that do not actually happen: petty theft, bodily harm by relatives.
5. Decreased intelligence, disruption of cause-and-effect functions.

Manic

Sudden outbreaks of violent activity and their alternation with periods of complete fatigue are a reason to be wary. Manic mental health disorder in women is characterized by:

• Sudden mood swings.
• The world is seen either in pink or black colors.
• Impetuosity of action, sudden “illumination” of an idea.
• Fear of persecution and mania of universal conspiracies.
• Obsession with certain actions or rituals.

Alcoholic

In women, constant drinking of alcoholic beverages quickly causes addiction, which can eventually lead to alcoholic schizophrenia. Its signs are:

1. Anxious state.
2. Tactile improbable sensations.
3. Visions, colloquially called “squirrel visions.”
4. Aggression.
5. Increased body temperature.

Neurosis-like

This type of disease has best forecasts restoration of mental health. Signs that are easily eliminated with proper treatment are:

1. Dissatisfaction with one's appearance, taking the form of ugliness.
2. Obsessive fears, feelings of loneliness.
3. Aggressive or withdrawn state.
4. Tantrums with playing “to the public”, pretentious tricks and theatricality.

Causes

Schizophrenia is transmitted through the female line with a probability of inheritance of up to 14%. Being a carrier of the “wrong” gene, a woman may not suffer from the disease, passing it on to future generations. Modern medicine and psychiatry are not able to accurately indicate the factors that lead to mental disorder. Collectively the reasons are:

1. Heredity. A woman who has received a damaged gene as a “gift” can become schizophrenic as a child or at a later age. Childhood schizophrenia often leads to degradation and developmental cessation.
2. Infectious or viral diseases suffered by the mother during pregnancy. They cause functional disorders in the baby's brain.
3. Disorders of the functions of neurotransmitters responsible for the interaction of the brain and various human systems. They begin to appear in teenagers during hormonal changes.
4. Upbringing. Abandoned, unwanted children or toddlers growing up in families where one or both parents suffer from mental disorders sometimes show signs of schizophrenia.
5. Long-term stressful situations, neuroses. Loneliness, constant pressure at work, misunderstanding on the part of loved ones lead a woman to obsessive thoughts.
6. Bad habits. Any drugs or alcohol destroy brain neurons. As a result, women develop signs of acquired schizophrenia.

Video: how schizophrenia manifests itself

Classic signs of schizophrenia in women are often accompanied by neurotic attacks, an outburst of emotions or aggression. Manic persecution, desire for litigiousness, apathy in life, emotional poverty in relationships with loved ones “tear” women out of their usual social circle. The earlier schizophrenia is treated, the greater the chances of long periods of remission. Find out what the external signs of schizophrenia are in women by watching the video.

Typical signs of a mental disorder are changes in behavior and disturbances in thinking that go beyond existing norms and traditions. Basically, these signs are associated with the complete or partial insanity of a person and make a person incapable of performing social functions.

Such disorders can occur in men and women at any age, regardless of nationality.

The pathogenesis of many mental disorders is not completely clear, but scientists have come to the conclusion that their formation is influenced by a combination of social, psychological and biological factors.

The person who feels early symptoms disease, I’m worried about how to understand that you have a mental disorder? In this case, you should take a test that includes many points and get an opinion from a professional psychotherapist. Questions must be answered as honestly and openly as possible.

As the disease progresses, symptoms appear that are noticeable, if not to the patient himself, then to his loved ones. The main signs of a mental disorder are:

• emotional symptoms();
• physical symptoms (pain, insomnia);
• behavioral symptoms (medication abuse, aggression);
• perceptual symptoms (hallucinations);
• cognitive symptoms (memory loss, inability to formulate thoughts).

If the first symptoms of the disease are persistent and interfere with normal activities, it is recommended to undergo diagnostics. There are borderline mental states of the individual, which are present in many mental and somatic diseases or ordinary fatigue.

Asthenia

Asthenic syndrome is manifested by nervous exhaustion, fatigue, and low performance. The female psyche is more vulnerable and therefore such disorders are more typical for the weaker sex. They experience increased emotionality, tearfulness and mood lability.

The male psyche reacts to asthenic syndrome outbursts of irritation, loss of self-control over trifles. With asthenia, severe headaches, lethargy and disturbances in night sleep are also possible.

Obsessions

This is a condition in which an adult persistently has various fears or doubts. He cannot get rid of these thoughts, despite recognizing the problem. A patient with mental pathology can spend hours checking and counting something, and if he is distracted at the time of the ritual, start counting again. This category also includes claustrophobia, agoraphobia, fear of heights and others.

Depression

This painful condition for any person is characterized by a persistent decrease in mood, depression, depression. The disease can be detected by early stage, in this case the condition can be quickly normalized.

Severe cases of depression are often accompanied by suicidal thoughts and require hospital treatment.

The following are considered characteristic:

• feelings of guilt, sinfulness;
• feeling of hopelessness;
• sleep disorders.

The condition may be accompanied by heart rhythm disturbances, increased sweating, pressure surges, loss of appetite, weight loss, and diarrheal disorders. Mild forms of the disease respond well to treatment, but if severe depression occurs, the patient needs to see a doctor.

Mania

This neuropsychiatric disorder is characterized by sleep disturbances: usually adults with this disorder can sleep 4-6 hours and feel alert. In the initial stage (hypomania), a person notices an increase in vitality, increased performance, and creative enthusiasm. The patient sleeps little, but works a lot and is very optimistic.

If hypomania progresses and turns into mania, then these symptoms are accompanied by a change in personality and an inability to concentrate. Patients are fussy, talk a lot, while constantly changing their posture and gesticulating energetically.

Typical symptoms of mania in adults are increased appetite, increased libido, and challenging behavior. A good mood can suddenly give way to irritation. As a rule, with mania, sanity is lost, and patients do not understand that their condition is pathological.

Hallucinations

This is an acute mental disorder in which the patient touches, sees or hears things that do not really exist. Hallucinations may occur due to alcohol consumption or the progression of mental illness.

Hallucinations are:

• auditory (voices);
• tactile (itching, pain, burning);
• visual (visions);
• taste;
• olfactory (smells), etc.

However, a situation is also possible when a sick person feels several of them at the same time. Imperative hallucinations are dangerous when “voices” in the patient’s head order him to perform certain actions (sometimes to kill himself or someone else). Such conditions are an indication for pharmacotherapy and constant monitoring.

Delusional disorders

These disorders are a sign of psychosis. Delusional beliefs do not correspond to reality, but it is not possible to convince the patient of this. Erroneous ideas are extremely important to the patient and affect all his actions.

Nonsense has varied content:

• fear of persecution, damage, poisoning, material damage, etc.;
• conviction of one's own greatness, divine origin, various kinds of invention;
• ideas of self-blame and self-denial;
• ideas of a love or erotic nature.

Often the appearance of delusional ideas is preceded by depersonalization and derealization.

Catatonic syndromes

These are conditions in which motor disorders come to the fore: complete or partial inhibition or, conversely, excitation. With catatonic stupor, the patient is completely immobilized, silent, and the muscles are toned. The patient freezes in an unusual, often awkward and uncomfortable position.

For catatonic excitement, repetition of any movements with exclamations is typical. Catatonic syndromes are observed both with darkened and clear consciousness. In the first case, this indicates a possible favorable outcome of the disease, and in the second, the severity of the patient’s condition.

Blackout

IN unconscious the perception of reality is distorted, interaction with society is disrupted.

There are several types of this condition. They are united by common symptoms:

• Disorientation in space and time, depersonalization.
• Detachment from the environment.
• Loss of ability to logically comprehend a situation. Sometimes incoherent thoughts.
• Memory loss.

Each of these signs sometimes occurs in an adult, but their combination may indicate confusion. They usually go away when clarity of consciousness is restored.

Dementia

With this disorder, the ability to learn and apply knowledge is reduced or lost, and adaptation to the outside world is disrupted. There are congenital (oligophrenia) and acquired forms of decreased intelligence, which occur in older people or patients with progressive forms of mental disorders.