"Involutional paranoids. Mental disorders of late age (V.R. Piotrovskaya)

A disease such as involutional psychosis affects people in old age. This ailment includes depression, melancholy. The reasons for the appearance of involutional psychosis are also unclear. But, as a rule, this disease is provoked by endocrine disorders of the body and external factors that cause psychological trauma.

What are the signs of the disease?

The concept of "involutional psychosis" appeared at the beginning of the last century. E. Krepelin introduced it. Involutional psychosis is understood as a complex of human mental disorders that occurs at the age of 45-60 years. In patients suffering from this disease, persecution mania is observed. They also begin to think that they are being harmed in some way.

These obsessive thoughts are accompanied by delirium. Involutional psychosis occurs in two forms. The first type is melancholy. The second type is the involutional paranoid. Now let's deal with each type separately.

Melancholy

Involutionary melancholy develops slowly. Although there are exceptions. Usually they occur in those people who have experienced mental trauma associated with external factors. In this case, the disease will progress rapidly. This condition is of two types: ordinary age-related melancholia and malignant depression. The latter is called as Kraepelin's disease. Involutional psychosis is a human condition associated with the usual age-related melancholy, accompanied by anxiety.

Experiences can arise for any reason, for example, concern for yourself, loved ones, about money or health, and so on. As the disease progresses, anxiety turns into depression. A feature of the state is the absence of any one reason for experiencing. That is, a person begins to worry about everything and for nothing in particular. Moreover, these experiences are vague. The state of anxiety and depression intensifies in the evening and at night. There are factors that can trigger an exacerbation. For example, cleaning or the desire of relatives to get rid of unnecessary things. Or the arrival of a new stranger in the house. These factors can cause anxiety and worries of an elderly person.

Kraepelin's disease, or involutional paranoid

Emil Kraepelin is the founder of the classification of human mental illness. His entire medical activity was directed towards the study and ordering of such disorders. Kraepelin tried to unite certain people. So that it is easier to understand them. Microbiology has made it possible to understand the causes of certain mental disorders. Kraepelin was engaged in research and observation of patients with disorders.

He kept his own card index, recorded and studied the history of people's diseases. Analyzing the symptoms and course of diseases, he classified them into groups. His works have been published and published. In them, Kraepelin divided the mental changes of people into groups to make it easier to understand the causes and development of diseases. For example, he singled out psychoses with a cyclic and periodic course, as well as progressive dementia, and despite the fact that his work was first published at the end of the 19th century, scientists and physicians still use them in their work.

Signs of illness

What are the signs of psychosis? Kraepelin's disease is a condition of a person with incessant states of anxiety. At the same time, the patient has problems with sleep, speech is disturbed and absent-mindedness occurs, concentration of attention worsens. This disease is not very common. People over the age of 65 are at risk. This age period is characterized by a decrease in the efficiency of neurons in the brain. This property of the body leads to the susceptibility of various anxiety states and the appearance of depression.

Brain training is an excellent prevention of mental illness

To avoid this situation, older people are advised to train their brains. Give him a load. It is necessary to do this, because as a result of such training, new neural connections will be formed that will ensure the normal functioning of the human body without any disturbances and the occurrence of depressive states. The signs of psychosis will also go away. A great way to improve performance are various crosswords or scanwords. Unraveling them makes the brain work, which is excellent therapy. Also, a positive effect is achieved when studying poems.

age paranoid

This disease is due to the fact that an aged person begins to show aggression and inadequate mood towards close relatives or just acquaintances. Often this condition is accompanied by delirium and chaotic thoughts of the patient.

Age psychosis. Symptoms and treatment of paranoid

The main symptom of this condition is that a person does not leave the thought of causing him any harm. Namely, it seems that relatives want to enter his house or apartment in order to take possession of any personal belongings. These conditions usually occur in people over 60 years of age. They are called presenile psychoses. People who suffer from such a disease can convince strangers that they are right and find allies for themselves. Indeed, from the outside it may seem that relatives have an interest in the property of an elderly person. Relatives in this situation are advised not to leave everything as it is. Often close people attribute everything to age and do not pay attention to the behavior of the patient. In fact, presenile psychosis can be cured. Therefore, if such symptoms are found in a close relative, it is necessary to consult a specialist. It should be said that if timely medical care is not provided to a person suffering from this ailment, then his condition may be aggravated by hallucinations.

The patient may begin to feel that someone is walking around his apartment, or that the neighbors are plotting some kind of action against him, he may even begin to hear their conversations behind the wall. There are also cases when an elderly person is sure that he is given poisoned food or drinks. It must be remembered that they are involutionary and are of a psychic nature. That is, physically a person can be absolutely healthy. If such a disorder arose at the age of 60-65 years, then the patient can still lead a quite active lifestyle, take care of himself. But at the same time, his mental state needs treatment. There are external signs of a person's inner feelings about harming him. Namely, the patient may lose weight, his hair may begin to fall out, and problems with sleep may appear. If these symptoms are noticed, this means that the man (or woman) is unwell and needs help.

If an elderly person complains that they want to poison him or take possession of his property, but in reality no one is making such attempts, you should carefully consider him and provide medical assistance. If you take all the necessary measures to treat this disease at an early stage, then there is a high probability of a complete recovery.

How should this type of psychosis be treated?

First of all, you need to trust a specialist. It is necessary to explain in the correct form to an elderly person that he should see a doctor. The psychotherapist will assess the general condition of the patient and prescribe the necessary treatment, taking into account age characteristics. You should know that when a person is at a respectable age, not all medicines are shown to him.

He may have to refuse to take any medications and drink only those that will not harm the work of other organs and body systems. The basis of the treatment of involutional psychosis is the use of certain drugs. Their dosage is determined by the doctor, taking into account the age of the patient. The doctor also prescribes antidepressants. They are needed in order to remove the state of anxiety in a person. Antidepressants can also be replaced with antipsychotics. They also help to eliminate the state of anxiety in the patient. If the patient's condition is accompanied by delirium, then neuroleptic drugs with a psychotropic effect are prescribed to him.

The purpose of these drugs is to make a person have clarity of consciousness. Together with taking medications, conversations between the doctor and the patient have a positive effect. This type of therapy helps the patient to establish normal communication skills and return to society in a healthy state.

Prevention

Preventive means of the development of this disease are measures aimed at improving the body. You do not need to give yourself a lot of time to relax, you should lead a healthy lifestyle. Namely, observe the regime, eat right, give up bad habits and so on.

Old age is accompanied by the narrowing of the circle of communication. This is due to the fact that people retire, children are busy with their lives, friends also stop maintaining relationships for various reasons. Despite the above factors, you should not withdraw into yourself and be alone with your thoughts. Man is so arranged that he needs to communicate and develop. Therefore, people who are elderly and limited in communication are advised to expand their circle of interests. To do what you have long dreamed of, but did not have enough time. For example, register on social networks, walk, meet and discover something new.

Conclusion

Now you know what psychosis is. Symptoms and treatment are two important topics that we have covered in detail in the article. We hope that the information was useful to you. We wish you good health and long years!

Description:

Involutional (presenile, presenile) psychoses. Mental diseases of late age are divided into involutional functional (reversible) psychoses that do not lead to the development of dementia, and senile organic psychoses that occur against the background of a destructive process in the brain and are accompanied by the development of severe intellectual impairment.

Involutional psychoses include involutional depression (melancholy), involutional paranoid.

Symptoms:

Involutional melancholia - protracted anxious or anxious-delusional, which first arose at an involutionary age. It is observed more often in women aged 50-65 years.

Symptoms and course. The clinical picture of the disease consists of a depressed mood, with anxiety, fear, confusion. Patients are in a state of motor restlessness, fussiness, turning at times into anxious and dreary excitement. They rush about, find no place for themselves, lament, repeat the same words. In this state, suicidal attempts are possible. The condition can be complicated by the addition of auditory illusions: condemnation, reproaches, accusations are heard in the conversation of others. Crazy ideas of self-accusation, condemnation, ruin, impoverishment or hypochondria content join. Hypochondriacal ideas consist in the conviction of patients in the presence of a severe somatic disease (cancer, heart disease, gastrointestinal tract), which is not confirmed by an objective study. In a number of cases, painful fears take extreme forms of denying the functioning of individual organs and entire systems - “blood stops”, “stomach rots”, “intestines have decomposed”, “there is no stool and no urine is excreted”. The feeling of hopelessness and anxious expectation can also manifest itself in a fantastically grandiose form - "everything perishes, a general catastrophe occurs ... everything is from my sinfulness ... the only way out is in fair retribution."

№ 65 Degenerative diseases of the brain in the elderly. Symptoms, medical tactics, prognosis. Differential diagnosis with atherosclerotic dementia and tumors.

Atrophic processes include a number of endogenous organic diseases, the main manifestation of which is dementia - Alzheimer's disease, Pick's disease, Huntington's chorea, Parkinson's disease and some more rare diseases. In most cases, these diseases begin in adulthood and old age without an obvious external cause. The etiology is mostly unclear. For some diseases, the leading role of heredity has been proven. Pathological anatomical examination reveals signs of focal or diffuse atrophy without inflammation or severe vascular insufficiency. Features of the clinical picture depend primarily on the localization of atrophy.

Alzheimer's disease . The disease is based on primary diffuse atrophy of the cerebral cortex with a predominant lesion of the parietal and temporal lobes, as well as distinct changes in the subcortical ganglia. Clinical manifestations depend on the age of onset and the nature of the atrophy.

The picture of the disease is determined by a pronounced impairment of memory and intelligence, a gross disorder of practical skills, personality changes (total dementia). However, unlike other degenerative processes, the disease develops gradually. At the first stages, elements of awareness of the disease (criticism) are observed, and personality disorders are not pronounced (“preservation of the personality core”). Apraxia occurs very quickly - the loss of the ability to perform habitual actions (dressing, cooking, writing, going to the toilet). Often there are speech disorders in the form of dysarthria and logoclonia (repetition of individual syllables). When writing, you can also find repetitions and omissions of syllables and individual letters. The ability to count is usually lost. It is very difficult to comprehend the situation - this leads to disorientation in the new environment. In the initial period, unstable delusional ideas of persecution and short-term bouts of clouding of consciousness can be observed. In the future, focal neurological symptoms often join: oral and grasping automatism, paresis, increased muscle tone, epileptiform seizures. At the same time, the physical condition and activity of patients remain intact for a long time. Only in the later stages are observed a gross disorder of not only mental, but also physiological functions (marasmus) and death from intercurrent causes. The average duration of the disease is 8 years.

Such an early onset of the disease is relatively rare and is referred to as presenile (presenile) dementia Alzheimer's type. Much more often, an active atrophic process begins in old age (70-80 years). This type of disease is called senile dementia. The mental defect in this variant of the disease is more roughly expressed. There is a violation of almost all mental functions: gross disorders of memory, intelligence, disorders of drives (gluttony, hypersexuality) and a complete lack of criticism (total dementia). There is a contradiction between a profound impairment of brain functions and relative somatic well-being. Patients show perseverance, lift and move heavy things. Crazy ideas of material damage, confabulation, depressive, spiteful or, on the contrary, complacent background of mood are characteristic. Memory disorders increase in accordance with Ribot's law. Patients stereotypically recall pictures of childhood (ecmnesia - “shift into the past”). They misrepresent their age. They don’t recognize relatives: they call the daughter a sister, the grandson - the “boss”. Amnesia leads to disorientation. Patients cannot assess the situation, butt into any conversation, make comments, condemn any actions of others, become grouchy. During the day, drowsiness and passivity are often observed.

Senile dementia and Alzheimer's disease are not significantly different. This allowed in the latest classifications to consider these diseases as a single pathology. At the same time, presenile psychosis described by Alzheimer is considered as an atypically early onset variant of the disease. The clinical diagnosis can be confirmed by X-ray computed tomography and MRI (expansion of the ventricular system, thinning of the cortex).

Methods of etiotropic treatment unknown, typical nootropic drugs are ineffective. As replacement therapy, cholinesterase inhibitors (amiridine, physostigmine, aminostigmine) are used, but they are effective only in “mild” dementia, i.e. in the early stages of the disease. In the event of productive psychotic symptoms (delusions, dysphoria, aggression, confusion), small doses of antipsychotics such as haloperidol and sonapax are used. According to general medical indications, symptomatic agents are also used.

Pick's disease. Like typical Alzheimer's atrophy, the disease often begins in presenile age (average age of onset is 54 years). The pathological substrate is isolated atrophy of the cortex, primarily in the frontal, less often in the frontotemporal regions of the brain.

Already at the initial stage, the leading disorders in the clinic of the disease are gross disorders of personality and thinking, criticism is completely absent (total dementia), the assessment of the situation is disturbed, and disorders of the will and inclinations are noted. Automated skills (counting, writing, professional stamps) persist for quite a long time. Patients can read the text, but its comprehension is grossly impaired. Memory disorders appear much later than personality changes, and are not as severe as in Alzheimer's disease and vascular dementia. Behavior is often characterized by passivity, aspontaneity. With the predominance of damage to the preorbital parts of the cortex, rudeness, foul language, and hypersexuality are observed. Speech activity is reduced, characteristic "standing symptoms" - constant repetition of the same turns, judgments, stereotyped performance of a rather complex sequence of actions. The physical condition remains good for a long time, only in the later stages there are violations of physiological functions, which are the cause of death of patients. The average duration of the disease is 6 years.

Pathological picture differs from Alzheimer's localization of atrophy. Symmetrical local atrophy of the upper cortex prevails without twisted neurofibrils in neurons (Alzheimer's tangles) characteristic of Alzheimer's disease and a sharp increase in the number of senile (amyloid) plaques. Swollen neurons contain argyrophilic Pick bodies; glia growth is also noted.

Signs of atrophy can be detected with computed tomography and MRI in the form of expansion of the ventricles (especially the anterior horns), increased furrows and external hydrocephalus (mainly in the anterior regions of the brain).

There are no effective treatments. Symptomatic agents for behavior correction (neuroleptics) are prescribed.

Huntington's chorea - a hereditary disease transmitted in an autosomal dominant manner (the pathological gene is located on the short arm of chromosome 4). The average age at the time of the onset of the disease is 43-44 years, but often long before the manifestation of the disease, signs of neurological dysfunction and personality pathology are noted. Only in "/ 3 patients mental disorders appear simultaneously with neurological disorders or precede them. More often, hyperkinesis comes to the fore. Dementia grows not so catastrophically, working capacity is maintained for a long time. Automated actions are performed by patients well, but due to the inability to navigate in a new situation and of a sharp decrease in attention, labor efficiency decreases. At a remote stage (and not in all patients), complacency, euphoria, and spontaneity develop. The duration of the disease is on average 12-15 years, but in "/ 3 cases there is a long life expectancy. Antipsychotics (haloperidol) and methyldopa are used to treat hyperkinesis, but their effect is only temporary.

Parkinson's disease starts at age 50-60. Degeneration primarily captures substantia nigra. Leading is neurological symptoms, tremor, akinesia, hypertonicity and muscle rigidity, and an intellectual defect is expressed only in 30-40% of patients. Suspicion, irritability, a tendency to repetition, importunity (akairiya) are characteristic. There are also memory impairments, a decrease in the level of judgments. For treatment, M-anticholinergics, levodopa, vitamin B 6 are used.

A fairly large percentage of older people are prone to such an unpleasant disease as involutional presenile psychosis.

This is a mental illness, which is characterized by such deviations as the constant presence of depressive states, the appearance, delusions of damage, as well.

These symptoms can develop both separately from each other and simultaneously. Usually the depth and nature of the symptoms directly depends on the age of the person. For example, among people under the age of 65 who suffer from mental illness, about 5% suffer from involutional psychosis. With increasing age, senile psychosis occurs more and more often reaches 10%.

The disease develops gradually, rather slowly, but in some cases it may appear quite unexpectedly. As a rule, this is accompanied by strong emotional upheavals experienced by the individual, mental trauma, or some kind of somatic condition.

Initially, everything may look just like an excessive concern for one's health or the health of loved ones, and experiences develop for a variety of reasons. Over time, seemingly insignificant symptoms develop into full-fledged depression, delirium and.

More often the disease is observed among women.

Differences from senile psychosis

Do not confuse involutional psychosis with. In the first case, the main causes of the disease are mainly internal factors:

• character type;
• suspiciousness;
• serious mental shocks for various reasons.

Senile psychosis (or, as it is also called, senile) develops for completely different reasons: it can be physical inactivity, disruption of the organs of perception, poor poor-quality nutrition, sleep problems.

In addition, senile psychosis can be quite irregular - at one time its symptoms increase significantly, and at another they almost completely disappear. If we talk about involutionary psychosis, then it is characterized by a more uniform stable development.

Factors provocateurs

Despite the fact that doctors and specialists highlight some important factors that are believed to be capable of provoking the development of involutional psychosis, in fact, the etiology of this disease is actually unknown.

Usually, doctors can only state the presence of a disease by its specific symptoms and take therapeutic measures, but it is very, very difficult to predict the development of disorders or prevent it in advance.

Possible provoking causes include:

1. Bad heredity. If someone in the family had similar deviations, then the likelihood that the episode will repeat increases.
2. Prolonged stay in a difficult, tense emotional environment, this includes family scandals, a heavy work rhythm, and so on.
3. Strong nervous and mental shocks as a result of any traumatic event. Again, the personality of the individual himself and his heredity are also very important here. For one person, an event will not cause a special reaction, but for another it can become a trigger for the development of mental illness.

Who is at risk

The greatest danger of presenile and senile psychoses is for the elderly, and especially for women. Cases of the disease have been recorded in people from about 45 years of age.

Most often, a complex of violations is observed at the age of 50-60 years. If in the patient's life there are constant nervous shocks and depressive states, and relations with family and loved ones leave much to be desired, then the likelihood of mental illness increases many times over.

Complex clinical picture

Presenile psychosis is characterized by the following main signs and symptoms:

1. Old people are observed , illusions and auditory deceptions. This is manifested by the fact that the patient claims that he hears the whisper of people who are preparing a vile conspiracy against him, noise behind the wall, which is not actually observed, the sound of steps even in an empty apartment.
2. Complaints about non-existent, far-fetched problems. For example, a patient may claim that his stomach or liver hurts, because his food was poisoned by ill-wishers who are pursuing him. The so-called delirium of damage develops.
3. characteristic of senile psychosis sudden change in appearance. If suddenly an elderly person suddenly and quickly became decrepit, lost a lot of weight, then this most likely indicates serious problems in his mental state.

Also, presenile mental disorders are characterized by symptoms of Kraepelin's disease associated with the presence. This is most often expressed in:

In medicine, it is customary to distinguish three main forms of presenile psychosis:

• involutional;
• delirium of damage
• involutionary melancholy.

Let us analyze in more detail their features and main differences.

Paranoid Manifestations and Delusions of Damage

An involutionary paranoid is characterized by the fact that the patient is prone to various, in which he completely perversely, incorrectly, and often very aggressively considers his relationship with his own close people, friends, family members, any acquaintances. The old man may develop persistent obsessive delusions that capture his thoughts and prevent him from concentrating on something else.

Very often, patients with involutional paranoid develop the so-called delirium of damage - it seems to them that the people around them, in particular family members, want to do them any harm, rob, injure, and the like. Since the circle of communication of such patients is usually very narrow and limited to the same family, their fears to an outsider can sometimes even seem convincing. In fact, there is a delirium of damage.

Features of melancholy

Involutional melancholia can be divided into two subcategories: malignant (Kraepelin's disease) and senile. The symptoms of both increase rather slowly, over a long period of time.

Of course, any psychological trauma can significantly accelerate their development. Senile involutionary melancholy is accompanied by constant: the patient is depressed, he expresses unreasonable worries about the health of both himself and his loved ones, often he can worry about his material well-being, for some reason believing that he is in danger of trouble.

Very often, the negative mood of the individual intensifies closer to the dark time of the day. Even the slightest change in the environment, social circle or home (for example, the apartment was cleaned) can cause bouts of anxious depression and anxiety.

It is anxiety depression that is the main characteristic of presenile psychosis.

Kraepelin's disease (malignant involutional melancholia) is characterized by such an important difference as the presence of constant anxiety.

It is very difficult for the patient to concentrate, to speak coherently and clearly, to fall asleep normally. Melancholia occurs in people after 65 years of age, when brain neurons significantly reduce their activity. It is during this period that the individual is most susceptible to a variety of mental disorders.

How can you suspect from the outside?

Many symptoms of mental illness can only be identified by a doctor, in order for an ordinary person, for example, a relative of a patient, to understand that his relative has involutional psychosis, you need to know the characteristic signs of this deviation:

These manifestations will help to understand that a person is developing a mental illness and consult a doctor in a timely manner.

In the event of suspicious symptoms, it is imperative to consult a doctor for a diagnosis. This is the only way to unambiguously confirm or refute your suspicions.

The doctor will examine the patient, ask him a series of leading questions that will help him clearly understand what problem he is dealing with.

Therapy Methods

One of the main principles of the treatment of involutional psychosis is the principle of "do no harm". It is necessary to find such an approach to treatment in order to exclude further aggravation and development of disorders, not to give rise to even greater distrust on the part of the patient.

If the development of the chronic form of the disease is not allowed, then this can already be considered in some way a considerable victory for psychosis.

Medications play a major role in the treatment process. The number of items and dosages are strictly limited, since usually you have to deal with older people who simply cannot bear the large amount of medication they take.

Pyrazidol, Tianeptine, Ludoimil, and many others are actively used. The main requirement for drugs is that they must have a minimum of possible side effects.

Often prescribed with a sedative effect. They help to suppress feelings of anxiety, relieve the excitation of the nervous system, and fall asleep normally.

A sedative is best for people with Kraepelin's disease. As for involutional melancholia, neuroleptics with a psychotic effect play the main role here. They help to cope with delirium, overcome a variety of hallucinations, including auditory ones.

Separately, it is worth mentioning the importance of friendly conversations and psychotherapy sessions. This measure helps the patient to become more calm, balanced, at least a little out of the anxious state.

Consequences and possible prevention

Over time, a person increasingly loses touch with the real world, lives with fictitious and far-fetched anxieties, can significantly spoil relations with those around him and those close to him, become a very unpleasant and strong burden for them.

Reason gradually leaves such a person and he ceases to adequately perceive the world around him, which can ultimately end in complete incapacity.

With adequate supportive care, in most cases a person will be able to live a normal normal life, but should always be treated with extreme caution. No quarrels and worries should concern him. The patient should be enveloped in an exceptionally positive atmosphere and unobtrusive care.

As for the issue of disease prevention, it boils down to attempts to delay the very process of aging of the body and the destruction of the nervous system.

This is achieved by quite standard methods: proper moderate nutrition, physical activity and physical education in a reasonable amount, constant mental work, which helps the brain neurons to be active and build new connections, thereby significantly slowing down.

It is very important that older people be enveloped in an atmosphere of well-being, order and peace. They should not worry, especially for serious reasons, otherwise depression and stress will cause mental breakdowns of one kind or another. It is also very important to get enough sleep and follow the daily routine.

In general, involutional psychosis is a rather dangerous and unpleasant disease that can lie in wait for every elderly person; when symptoms appear, you need to see a doctor in time and start treatment. This in many cases helps to maintain human health and return it to normal.

In psychiatry, the age from 45 to 60 years old was considered to be presenile, and more than 60 years old - senile. At a symposium on gerontology in 1963, the following age periodization was adopted: 45-59 years old - middle age, 60-74 years old - elderly, 75-90 years old - senile.
People of presenile and senile age often feel worse, mood, self-esteem is disturbed, there is a feeling of insecurity, dissatisfaction with oneself, anxiety, fears of loneliness, helplessness, death, which leads to gloom, irritability, pessimism.
Most often in presenile and senile age, the following mental disorders are observed:
1) non-psychotic disorders (neurosis- and psychopath-like);
2) presenile, or presenile, psychoses (melancholia, paranoid, Alzheimer's disease and Pick's disease);
3) senile, or senile, psychoses (senile dementia).
In the "International Statistical Classification of Diseases, Injuries and Causes of Death of the 9th Revision", mental disorders of presenile and senile age are represented by the following groups (we give them together with codes):
1. Non-psychotic involutional disorders:
300.96 - neurosis-like states caused by menopause.
300.97 - neurosis-like states due to involution.
301.96 - psychopathic states caused by menopause.
301.97 - psychopathic states due to involution.
311.6 - non-psychotic depressive disorders caused by menopause.
311.7 - non-psychotic depressive disorders due to involution.
2. "Adement" involutional (presenile) psychoses:
296.13 - involutionary melancholy.
297.21 - involutional paranoid.
298.95 - psychosis due to menopause.
298.96 - psychoses due to involution.
3. Senile and presenile organic psychotic states:
290.0 - senile dementia, simple type.
290.1 ​​- presenile dementia (290.11 - early senile dementia; 290.12 - dementia in Alzheimer's disease and Pick's disease).
290.2 - senile dementia of a depressive or paranoid type (290.21 - senile depression; 290.22 - senile delirium of damage, hallucinatory-delusional psychosis, senile paranoid).
290.3 - senile dementia, complicated by the phenomena of acute confusion.
290.8 Other senile and presenile organic psychotic states.
290.9 - unspecified senile and presenile organic psychotic states.
The problem of nosological independence of involutionary mental pathology and especially "ademental", so-called functional, psychoses of presenile age is complex and raises a number of controversial issues. N. F. Shakhmatov (1980), for example, considers it quite reasonable to single out nosologically independent late psychoses due to the fact that they are characterized not only by age-related features, but also by age-related endocrine restructuring. At the same time, E. Ya. Sternberg (1977) came to the conclusion that the allocation of an independent group of involutional psychoses based on the characteristics of their clinical picture is methodologically insufficiently substantiated and in most cases one should talk about the late detection of endogenous (schizophrenia, manic-depressive psychosis) and organic psychoses.
According to a number of researchers (N. E. Bacherikov, 1980; P. G. Smetannikov, 1980; N. F. Shakhmatov, 1980; E. A. Shcherbina, 1981; S. M. Plotnikov, 1984), currently available data on the features of the clinical picture and the pathogenesis of psychoses make it possible to talk about the nosological independence of the "functional" and dementia forms of involutional psychoses. In favor of the nosological independence of presenile psychoses, the originality of their clinical picture, the patterns of the course, testify.
It has been established that approximately 30% of patients with presenile psychoses are characterized by a hereditary burden of involutional and other psychoses and psychopathy (with paranoid variants - in 40% of cases). Premorbid personality traits in most cases are anxious and suspicious and asthenic traits with a tendency to long-term fixation of negative emotions (in 73.2% of patients with a depressive picture) or hypoparanoic and sthenic features (in 59.1% of patients with presenile paranoid). The onset of psychosis is often preceded by signs of a pathological menopause, age-related somatic and mental changes, conflict situations at home and at work, and somatic diseases.
Thus, the psychotic state is the result of the interaction of biological, individual psychological and socio-psychological age factors. The clinical picture of the psychotic state is characterized at first by mood swings and anxiety in patients, arising from very specific life situations - past or current. Only later is one of the variants of a depressive or paranoid syndrome formed with typical and persistent symptoms.
However, the question of the nosological essence, etiology and pathogenesis of non-psychotic, psychotic and defective organic mental disorders, which are currently classified as presenile and senile, is not finally resolved. Apparently, this is a group of diseases that occupy, as it were. an intermediate position between exogenous and endogenous and based on hereditary and acquired predisposition, age-related neuroendocrine restructuring. The onset of psychopathological conditions, including rapidly developing dementia, is often associated with the sudden onset of personally significant psychological and social problems, with an exacerbation of somatic disease and trauma.

Non-psychotic mental disorders

Psychopathological manifestations during menopause and involution in most cases are represented by neurosis- and psychopath-like states, as well as non-psychotic variants of the depressive syndrome.
According to the data of E. M. Vikhlyaeva, D. D. Orlovskaya (1979), the following syndromes are most often observed at this age: neurasthenic-like, obsessive-phobic, depressive-hypochondriac, astheno-depressive, asthenosenestopathic.
Mental disorders during menopause usually develop against the background of asthenia. Patients complain of a decrease in working capacity, activity, mental and physical fatigue that is unusual for them. This is often regarded by patients as a manifestation of laziness and looseness, a loss of the ability to control themselves, to which they react painfully. Some patients develop irritability and anger, a feeling of internal tension in the foyer of exhaustion. Rest somewhat improves the condition, but there is no complete reduction of asthenia phenomena.
In the clinical picture during the menopause, there are unpleasant sensations in the internal organs, parasthesia and the form of a flush of heat, burning sensations, numbness, crawling, cooling. Often there are unpleasant sensations in the vulva, usually in the form of itching. Senestoiatia occurs less frequently, patients experience painful sensations of “softness of the bones”, “blood transfusion in the heart”, and numbness of the head that are difficult to describe in words.
Mood changes are usually observed - anxiety, emotional vulnerability, resentment. These disorders predominate in non-psychotic forms of depressive syndrome (anxious-depressive, depressive-hypochondriac). An important role in the appearance of depressive mood is played by violations of sexual desire, more often in the direction of its decrease.
With depressive-hypochondriac syndrome, along with mood disorders, patients have thoughts about the presence of diseases of internal organs, which doctors allegedly do not recognize. Such patients persistently demand consultations, consultations and calm down for a short time after their fears are not confirmed during the next examination.
Obsessive-phobic states are manifested in patients with obsessive fears for their health or the health of their loved ones, obsessive memories of unpleasant episodes from their own lives. Psychopathic disorders that occur during menopause can be considered as an exacerbation of previously inherent character traits. Most often, a hysteroform syndrome occurs: patients have emotional lability, capriciousness, they are dissatisfied with the supposedly insufficient attention to them by their relatives, they require increased attention to themselves, their well-being and health. There is a tendency to exaggerate the existing unpleasant sensations, theatricality, demonstrative behavior. These patients at a young age are distinguished by liveliness of emotions, brightness of perception, sociability, they like to be in sight. Sometimes during menopause, such premorbid features as mental rigidity, pedantry in the performance of official and family duties are sharpened.
Neurosis and psychopathic disorders in women usually develop at the age of 40-50 years and often coincide with menopause. Their duration is from several months to 10 years (average 3-5 years). In most patients, further reduction of neurosis- and psychopathic disorders occurs, in some they take a protracted character, in some cases they transform into a picture of non-resenile psychoses - involutional melancholia or paranoid.

Presenile psychoses

Involutionary melancholy

Involutional melancholia usually develops gradually, its initial period is an average of 2-3 months. Patients complain of weakness, fatigue, lethargy, and these phenomena do not disappear after rest. Attention is focused on unpleasant sensations in the internal organs, mood decreases. If the disease begins during menopause, then vegetative disorders intensify. With a later onset of psychosis, autonomic symptoms are less pronounced. In the initial period of the disease, asthenovegetative, senestopathic, phobic, hypochondriacal, hystero-like and dysthymic syndromes are usually observed (V. N. Ilyina, 1980). Harbingers of mental disorders are most often sleep disorders, indecision, fatigue, excessive suspiciousness, obsession, which are often provoked by a change in the usual living conditions: retirement, a psychotraumatic situation in the family, fear of the imaginary severity of deterioration in somatic health, etc. Against this background, sometimes there are thoughts about the unfair treatment of others, a tendency to exaggerate the severity of one's suffering. In some patients, the onset of psychosis is acute after a trauma or somatic illness.
In the non-psychotic stage of involutional melancholy, patients do not complain of a dreary mood, they tend to explain the decrease in mood by poor general health or unpleasant events, and describe their feelings vividly and figuratively. Some patients have a suspicion that they have become ill with a serious somatic illness, but the degree of conviction is subject to fluctuations - they can, at least temporarily, be convinced of the groundlessness of fears.
According to V. L. Efimenko (1975), at the height of psychosis, anxiety and anxiety-depressive, depressive-hypochondriac and astheno-depressive syndromes are most often observed, most rarely melancholic.
The most pronounced disorders in the emotional sphere are anxiety and melancholy. Anxiety is usually accompanied by motor restlessness, especially in the initial stage of psychosis. It sometimes intensifies when the situation changes, for example, during hospitalization. Longing does not prevail in the picture of the disease. Anxious and melancholy mood is often accompanied by fear. Irritability, anger, weakness, emotional lability, that is, symptoms more characteristic of cerebral atherosclerosis, can be observed at the height of psychosis and in patients with presepile depression. Characterized by the sound of premorbid emotional features, sharpening of personality traits, introversion of emotional experiences with outwardly active interest in family and other circumstances.
Patients with presenile depression at the height of the disease state may have obsessive, overvalued, delusional and paranoid ideas, reminiscent of being stuck in certain psychotraumatic situations. Unlike reactive psychoses, these ideas are saturated not so much with the content of real mental trauma as with delusional formations, which are a kind of development of a psychotraumatic situation that has long since passed. For example, a delusional belief in the death or arrest of loved ones, as a rule, reflects fears about situations that were observed in a past life, then lost their relevance and resurfaced in experiences when psychosis occurred.
In patients with presenile depression, delusional ideas of self-accusation, persecution, poisoning, hypochondriacal (sometimes reaching the degree of Kotard's hypochondriacal delusions) are noted. The future is presented as sick in a gloomy light, they expect disaster, misfortune, prepare for this by distributing their property among loved ones.
At agitated depression patients become fussy, groan, make a lot of non-purposeful movements, make various requests and complaints to others. In rare cases, motor inhibition is observed, sometimes reaching a substupor. Sometimes anxiety, fear, a delusional assessment of what is happening lead to an illusory interpretation of the words of others, some people experience bodily or fragmentary verbal hallucinations, usually unstable and with a partial critical assessment.
Often in the clinical picture of involutional melancholia, asthenia occurs, which manifests itself in the complaints and behavior of patients, is confirmed by experimental psychological studies. In recent years, due to pathomorphosis, the clinic of involutional melancholia has changed towards the predominance of less severe forms, more often in the form of neurosis-like and hypopsychotic symptoms (N. F. Shakhmatov, 1980; V. N. Ilyina, 1980).

Involutional paranoid

In involutional paranoid paranoid syndrome is leading in the form of interpretive delusions of persecution of a “small scale”, paranoid ideas of damage, jealousy, poisoning, attitude and influence. Delusional ideas are characterized by a gradual development and, as a rule, an association with premorbid personality traits. The onset of a mental illness is usually preceded by prolonged overwork caused by family or domestic circumstances, somatic problems, but the massiveness of the psychotraumatic situation and the severity of somatic diseases that occur in patients with presenile depression are not noted. Delusion is not of a generalizing, ideological nature, does not completely fence off the patient from the usual concerns and interests, does not radically change the social and ethical attitudes of the individual.
Often, before the onset of delirium, there is an increase in suspicion in relation to everyday phenomena, there is, as it were, an exacerbation of sensitivity to various noises, sounds, unusual phrases spoken by someone around. Delusions develop slowly, first ideas of relation and interpretation appear, then persecution. The delusional plot is ordinary, petty, concrete, not prone to growth. Therefore, at first, the statements of patients do not raise doubts about their authenticity or they are explained by the peculiarities of character and relationships in the family, apartment, at work. Subsequently, the patients' complaints become more and more ridiculous, they begin to stubbornly assert that relatives, acquaintances, neighbors, employees get into their room, spoil things, steal objects, clothes, jewelry, food. They "notice" suspicious spots on a tablecloth or blanket, "puffs" of threads on clothes, they say that the table or chairs are not in their places. Unpleasant sensations in the internal organs of the patients are explained by the fact that someone planted poison in the writing. This is confirmed by the appearance or intensification of pain if one of the "ill-wishers" is nearby.
Systematized, small-scale, with specific content, delusional ideas of persecution, poisoning, jealousy and damage are usually emotionally saturated, accompanied by a violent expression of claims against the "persecutors". The behavior of patients is active, they are not limited only to requests or exhortations to ill-wishers, they complain about them at their place of work or to the police, and, not finding support there, sometimes they themselves make an attempt to deal with them.
Crazy ideas are often accompanied by illusions and hallucinations: patients "hear" a suspicious noise behind the wall, unintelligible voices, threats against themselves in the conversation of imaginary enemies, feel an unpleasant smell or taste of food.
In addition to the typical paranoid syndrome, depressive-paranoid, hallucinatory-paranoid psychoses are observed in presenile delusional psychoses. and paraphrenic syndromes (R. G. Ilesheva, 1980; 10. E. Rakhalsky, 1980; E. A. Shcherbina, 1981).
Patients with depressive-paranoid syndrome usually complain of a bad mood, express ideas of damage and poisoning, claim that they are allegedly accused of immoral behavior and various crimes, try to "rehabilitate", to prove their innocence. They are restless, annoyingly complaining to others that they are undeservedly suspected, willingly talk about their fears, expecting sympathy from the interlocutor.
Hallucinatory-paranoid syndrome is rare and is characterized by delusions of persecution and guilt, accompanied by auditory hallucinations, the intensification of which causes fear and anxiety and often leads to acts of auto-aggression.
In paraphrenic syndrome, delusions of greatness of a fantastic nature, accompanied by senestonatia, paresthesias and hallucinations, join the ideas of persecution.
The course of presenile psychoses is often monotonous and prolonged - from several months to several years. E. Ya. Sternberg (1979) considered their course without remission to be characteristic of presenile psychoses. According to other authors (EA Shcherbina, 1981), many patients with presenile psychosis suffer 2-3 attacks of the disease. Most researchers agree that presenile psychoses, especially depressive forms, are characterized by either single protracted states or an undulating, remitting course with the subsequent disappearance of psychotic manifestations.

Dementia of presenile age

Dementias that occur in people of presenile age are characterized by a slow onset, progression, the development of total dementia with the collapse of higher cortical functions (speech, writing, reading, praxis), the addition of subcortical disorders that are caused by atrophic processes.

Alzheimer's disease

Alzheimer's disease usually begins at the age of 50 to 65 years, the average duration of the disease is 8-9 years. In the initial stage, there are violations of memory, fixation abilities, reproduction. Often there are phenomena of amnestic disorientation in place and time. Memory gaps are sometimes filled with coifabulations. E. Ya. Shternberg (1967) noted that the amnestic syndrome in Alzheimer's disease is not accompanied by a pathological revival of past experience. In patients, intelligence decreases, attention is disturbed early. Already in the initial stage of the disease, signs of the decay of motor skills and speech appear. First of all, the ability to fine and complex movements, mastered in recent years, disappears, which is especially pronounced in the study of constructive finger praxis.
Speech disorders are initially manifested by difficulty in pronouncing words: speech becomes uncertain, patients no longer understand and differentiate the meaning of certain phrases, semantic relationships between words. Counting violations (acalculia) are noted, the ability to understand the number of digits, to compare numbers is lost. Over time, speech, counting, praxis and optical perception disorders increase. The phenomena of amnestic aphasia and memory impairment are aggravated. Patients cannot name objects, but remember their properties and purpose. The optical gnosis is broken. The vocabulary is depleted, nouns fall out of speech, patients skip words, cut off phrases, leave them unfinished. Writing is disturbed - at first arbitrary, and then under dictation: handwriting suffers rudely, patients rearrange and skip letters. Primary alexia appears: at first, patients can still read aloud, but they do not understand what they read, and in the future they no longer recognize the letters. The phenomena of apraxia are aggravated - the ability to perform habitual actions is lost, motor activity decreases.
In the initial stage of Alpheimer's disease, depressive states, fragmentary delusional ideas of loss, short-term episodes of impaired consciousness, psychomotor agitation, and influx of hallucinations often occur. Usually these psychotic states are rudimentary and not persistent. Dementia in Alzheimer's disease is accompanied by focal symptoms: epileptiform seizures, akinetohyperkinetic and extrapyramidal (parkinson-like) symptoms, choreic hyperkinesis. In the initial stage, gross dementia develops, complete disintegration of speech, praxis and recognition is observed, gait is disturbed, muscle tone increases, and grasping automatisms appear. Patients lie in a fetal position, lead a vegetative lifestyle, and their cachexia rapidly increases, despite increased appetite and the absence of diseases of internal organs.
Alzheimer's disease, according to E. Ya. Sternberg, occurs 3-4 times more often than Pick's disease. The author identified a number of features inherent in Alzheimer's disease: the frequency of familial burden of endogenous psychoses or psychopathy, dissociation in the initial stage between memory impairment and the presence of a "facade" of the personality, an early emerging tendency for the development of individual components of the dementia syndrome into focal disorders. Dementia in Alzheimer's disease has the character of aphato- and apractoagnostic.

Pick's disease

The average age of patients at the onset of the disease is 56 years, the average duration of the disease is 6 years. Atrophic changes are expressed mainly in the frontal and temporal lobes of the brain, mainly the upper layers of the cerebral cortex are affected.
The clinic of the initial stage of Pick's disease is determined by the localization of the atrophic process. In cases of damage to the frontal lobes appear aspontaneity, lethargy, inactivity, apathy. Patients become indifferent to themselves, to how they look, stop caring for loved ones, do not cook food. However, when prompted from outside, they can show some activity.
If the atrophic process is localized in the basal part of the frontal lobe, then pseudo-paralytic symptoms are observed: disinhibition, lack of a sense of distance, decreased criticism. With the defeat of the temporal or frontotemporal areas, stereotypes in speech, writing and movements come to the fore. E. Ya. Sternberg (1977) also describes more rare variants of the onset of Pick's disease: asthenic, aphatic, psychotic, amnestic.
Dementia in Pick's disease is manifested initially by a violation of complex forms of intellectual activity - the ability to abstract, generalize and distract. The productivity of thinking, the level of judgments and criticism are reduced. Memory remains slightly impaired for a long time, confabulations usually do not occur. Speech disorders develop - stereotypes and echolalia. Dysarthria and logoclonia characteristic of Alzheimer's disease are usually not observed. With the frontal variant of dementia, speech activity decreases, up to mutism, with temporal dementia, amnesic aphasia occurs. The phenomena of echolalia develop gradually, at first, patients repeat the questions addressed to them with some grammatical changes, rearrangement of words, then they no longer understand the meaning of the speech of others and automatically repeat some of the words or phrases they hear. In the initial stage, “standing turns” in speech are connected in meaning with questions or the general content of the conversation, over time this connection is lost. Stereotypes are added to the letter. Praxis disorders are less typical of Pick's disease, constructive praxis is usually not disturbed, and ideomotor apraxia may be observed.
Psychoses develop less frequently than in Alzheimer's disease, and are manifested by depressive, anxiety-depressive states, an influx of visual hallucinations.
In the terminal stage, dementia is accompanied by somatic insanity.
Differential diagnosis.
Neurastheno- and psychopathic symptoms during menopause may resemble a clinic of neuroses, psychopathy or organic diseases: the consequences of a traumatic brain injury suffered in the past, neuroinfections, and phenomena of a vascular disease of the brain. In favor of the climacteric genesis of these disorders, the connection of their occurrence with the onset of menopause, the combination with endocrine-diencephalic disorders typical for this age period, and the absence of signs of organic pathology of the brain testify. Neurosis is usually observed in younger people.
The clinical picture of involutional melancholia may resemble vascular depression, the depressive phase of manic-depressive psychosis, and reactive depressions. It is often necessary to differentiate between involutional paranoid and vascular psychoses, reactive paranoids, and schizophrenia.
In presenile depression, in contrast to the depressive phase of manic-depressive psychosis, in the clinical picture anxiety comes to the fore, not melancholy, there is no slowdown in ideational and motor acts. In addition, patients with circular depression are uncommunicative, while patients with presenile depression are anxious, intrusive, approaching patients or staff with complaints, looking for sympathy and help. The nature of delusional ideas is also different. If patients with circular depression often express ideas of self-accusation and self-deprecation, they say that they should suffer a “deserved punishment”, then people suffering from presenile depression expect punishment for “sins in the past”, try to justify themselves in the eyes of others, proving their innocence. With circular depression, patients usually feel better in the evening, with presenile depression, asthenia and anxiety increase in the evening, mood worsens. For circular depression, the Protopopov triad is typical (increased heart rate, dilated pupils, a tendency to constipation), indicating sympathicotonia. Presenile depression is accompanied by vagotonia.
For patients with reactive depression, astheno-depressive syndrome is typical, asthenia is more pronounced than in presenile depression. Experiences are associated with mental trauma, anxiety is less pronounced, patients are usually whiny, sometimes motor agitation develops. The severity of painful symptoms increases in connection with the mention of an unfavorable situation and weakens when it is resolved. If reactive depression develops after strong, personally significant psychotraumatic influences, then the appearance of presenile depression is often preceded by prolonged minor experiences associated with family or domestic troubles. The clinical picture of late schizophrenia has a number of features due to age: delusions of small scope with specific content, age-related delusions (jealousy, damage, poisoning) are often noted. Patients with premorbid psychosis in the premorbid period are usually extroverted, emotionally vulnerable, anxious, some hypersocial; Patients with schizophrenia in their youth are distinguished by an unusual, peculiar character, uncommunicativeness. In schizophrenia, there is a dissociation of thought processes, often mental automatism, delirium is polythematic, not associated with real life circumstances.
Patients with presenile paranoid are sociable, tend to attract more sympathizers and helpers to their side. Patients with schizophrenia are characterized by emotional decline. In schizophrenia, delirium develops rapidly and is reduced under the influence of treatment. Presenile delirium develops slowly and is characterized by therapeutic resistance.
Reactive paraioids, unlike presenile ones, develop acutely in connection with mental trauma, which manifests itself as a delusional plot, deactivated after the elimination of mental trauma. In persons suffering from presenile paranoid, the delusional plot only at the beginning of the disease can be associated with mental trauma, and the dynamics of psychopathological symptoms does not depend on the strengthening or weakening of psycho-traumatic effects.
In the differential diagnosis of preseile, senile and vascular dementia, it is necessary to take into account age, the total nature of dementia (in contrast to vascular dementia), typical violations of higher cortical functions: writing, speech, praxis.

Senile psychoses

The disease usually develops in people over 70 years of age. The frequency of senile dementia among mental illnesses of senile age ranges from 12 to 25%. In a clinical and epidemnological examination of patients conducted at the Moscow Psychoneurological Dispensary No. 2, senile dementia was found in 4.3% of them, in the population these patients accounted for 5.4% (E. Ya. Sternberg, 1977).
The development of senile dementia is based on a progressive atrophic process that occurs in the cerebral cortex, mainly in the frontal and temporal lobes. In the etiology of senile dementia, the hereditary factor and the burden of exogenous hazards are of great importance.
Senile dementia develops slowly. In its course, three stages are distinguished: initial, developed dementia and insanity. Initially, character traits are sharpened, up to a kind of “caricaturing” of the personality. Previously thrifty people become greedy, stingy, some increase playfulness, coquetry, inadequate for age. In the past, neat people demand petty-pedantic compliance with sanitary standards from their loved ones, sociable people become annoying. The circle of interests gradually narrows, one's own well-being and material well-being acquire the greatest importance, social and ethical coarsening, egocentrism develop. Patients become grouchy, stubborn, suspicious, insensitive to loved ones and, along with this, easily suggestible. These personality traits often lead to conflicts in the family or with neighbors, and patients do not critically evaluate their behavior. Their sense of shame disappears, instincts are disinhibited. Patients become gluttonous, sexually promiscuous, prone to sexual perversions, which in some cases leads to the commission of socially dangerous acts. Sometimes patients leave home, roam the streets, collect various rubbish.
Patients have impaired memory. In the initial stage of senile dementia, the process of memorization suffers. This leads to amnestic disorientation, which is especially pronounced if patients find themselves in an environment that is unusual for them (moving to a new place of residence, hospitalization in a hospital). They cannot go to their ward, room, toilet. Leaving the entrance of the house, they cannot find their way back on their own. They have difficulty remembering names, dates, names of objects. Gradually, life events fall out of memory in reverse chronological order - progressive amnesia develops. At first, patients forget the names of grandchildren, then children, while some events of their youth are remembered with small details.
In the third stage of senile dementia, patients cannot remember their age, surnames, addresses, completely lose the knowledge acquired in life. Intelligence decreases gradually. Initially, attention suffers, distractibility increases. The ability to generalize is reduced, vocabulary is depleted.
It should be noted that in the initial stage, patients are obese, not satisfied, angry. Over time, the mood becomes complacent, euphoria, carelessness appear. In the stage of insanity, emotional devastation develops. Despite a gross violation of memory and intelligence, patients remain talkative, contact for a long time.
A feature of senile dementia is its total nature: the lack of a critical attitude to the defect of the intellect and one's behavior, the collapse of the "core" of the personality.
In the final stage, patients completely lose their speech, the ability to distinguish between edible and inedible, their self-service skills disappear. Usually at this stage, patients are constantly lying in bed, recovering under themselves. Mental insanity is accompanied by physical insanity: patients lose weight, atrophic changes develop in the internal organs. Death occurs 5-10 years after the onset of the disease.
The confabulatory form of senile dementia (presbyophrenia) is manifested by high spirits, increased motor activity, fussiness and combined with abundant pseudo-reminiscences and confabulations.
With senile delirium, patients are disoriented in place, time, in the mind there is a shift of the situation into the past. Memories are often associated with their profession. Fear and motor excitation in senile delirium are usually not noted.
Against the background of total dementia, hypochondriacal crazy ideas sometimes arise in the form of Kotard's delirium, delirium of stealing, impoverishment. At night, patients are usually awake, walking around the apartment or ward, looking for missing things, looking in the bed of other patients; they are grouchy, unhappy, cursing if they are put to bed. With Kotard's delirium, patients claim that their insides have disappeared, their stomach has disappeared, food falls "right into the stomach", some say that they have died.
In the depressive form of senile dementia, the mood of patients is reduced, they are unsociable, gloomy, gloomy, they have ideas of self-blame.
Differentiate senile dementia and vascular, presenile dementia, brain tumors.
In senile dementia, a decrease in the size of the brain, a decrease in its mass, a thickening of the dura mater are macroscopically detected, microscopically - foci of desolation, growth of senile drusen (stellate glial formations).
Treatment of patients with senile dementia is reduced mainly to the organization of care for them, it is often necessary to use symptomatic, cardiac, vascular drugs. Antipsychotic drugs are prescribed for the relief of psychotic states. In the initial stage of the disease, it is advisable to use nootropic drugs.
If patients with senile dementia commit illegal acts, they are recognized as insane.