home Analyzes Psychoses in children. Schizophrenic psychoses in children and adolescents - definition, classification

Psychoses in children. Schizophrenic psychoses in children and adolescents - definition, classification

Rarely occurs before puberty. There is no doubt, however, that already in children up to school age and at junior schoolchildren periodic endogenous mood disorders are observed, in most cases short-term, taking the form of whims, quirks of disobedience, school failure. They are usually viewed as reactive phenomena or as a result of somatic ailments. As Pieper notes, constitutional depressive predisposition and mood lability are also observed outside the hereditary circular circle.

A short phase course is also characteristic of pubertal cyclothymia. It's amazing how, in the space of a few hours, a manic-expansive naughty and obnoxious tomboy turns into a depressed and contrite sinner. The role of encephalopathy in the occurrence, form and course of psychotic episodes in childhood and during puberty is often difficult to determine.

Features of circular psychoses of childhood up to adolescence - in addition to the brevity of individual phases - are a relatively more frequent (than in adults) change of manic and depressive episodes and some atypicality of the clinical picture, which again reflects phase features. So, for example, in the foreground there may be impulsive states and traits of anxious-suffering aggressiveness, foolish behavior reminiscent of hebephrenia, and various mechanisms of obsession. Oneroid-delirious or close to amental pictures were also reported. Experiences of change or alienation and their pubertal-negative form of expression, hallucinatory and paranoid edge symptoms can make it difficult to differentiate from juvenile schizophrenia, since at this age mixed pictures are generally quite common.

Primary mood disorders in children sometimes develop into a schizophrenic process. Of the 6 catamnestic cases of early mania studied, in two a transition to schizophrenia was subsequently discovered, and in one, at the age of 32, chronic hypomania was discovered.

Schizophrenia. Since certain psychoses, distinguished by specific heredity and coinciding with each other in a number of signs of their clinical picture and course, were combined into the concept of schizophrenia, attempts began to detect the early forms of these diseases and connect them with the previously described forms of “simple early dementia of normal children." If previously doubts were expressed about the possibility of schizophrenic psychoses in childhood, now no one disputes this, although there is no unity in the clinical definition of this concept.

Currently, the diagnosis of childhood schizophrenia is made in Europe almost always in the case of an endogenous change in the psyche, which, from the point of view of symptoms and course dynamics, can to a certain extent be distinguished from other psychoses. Some authors base this diagnosis on the presence of progressive affective devastation. In the USA, the diagnosis of schizophrenia is often abused (which has already been criticized by American authors themselves), extending the concept of schizophrenia to massive behavioral disorders, neurotic developments or severe criminal acts in childhood. In one New York hospital, 10% of all children there were diagnosed with schizophrenia.

Disease frequency. According to Blurer (these data certainly need to be revised in the light of more modern nosological concepts), in 4% of patients schizophrenia begins before the 15th year, and in 1% - before the 1st year of life.

The distribution by age groups is as follows: infantile (up to 10 years of age), prepubertal (10-14 years) and adolescent (14-18 years).

Symptomatology. In the foreground is the loss of contact with the outside world (autism), sometimes while maintaining a peculiar affective attitude towards individuals and things. This also includes affective disorders: a change in the basic mood towards anxious distrust, lability of mood or emotional dullness, inadequacy of affects and regression of the forms of their expression up to the appearance of phylogenetically preformed norms of behavior. Paroxysmal states of anxiety are often observed, the content of which is associated with experiences of cosmic catastrophes (“the sun is falling from the sky”) or with strange somatic fears (10-year-old patient: “my navel is bursting, my artery is rupturing,” etc.). The feeling of change is generally projected mainly into the somatic sphere. In the motor area, general disharmony is observed (sluggishness, angularity), sometimes cataleptic phenomena or rhythmic stereotypies. In the area of speech, there is either increased talkativeness, verbigeration, echo symptoms (echolalia, phonographism), verbal pretentiousness, etc., or mutism. Children may also exhibit all those features of writing and drawing that are characteristic of adults with schizophrenia.

Delusional ideas are rare in early forms of schizophrenia (Mishaux explains this by the weak ability of children to form concepts and the mental instability of this age). There are, however, unsystematized delusional constructions. In prepubertal and juvenile schizophrenia, hallucinations (in different areas of the senses) are common, but in the infantile form they are an exception. The closer clinically childhood psychosis is to adult schizophrenia, the more likely it is that we are dealing with exogenous psychosis. The onset of the disease is often accompanied by phobic or obsessive-neurotic symptoms. Pubertal processes leave a strong imprint on the content and course of psychosis.

Early schizophrenia is characterized by a deep disturbance of the experience of both one’s personality and the surrounding world, disintegration and regression of the age-related psyche, often defined as dementia of early childhood.

The premorbid personality of children with schizophrenia is in many cases characterized by poor communication, timidity, childish seriousness, a tendency to solitude, and similar predominantly schizoid traits. Bakwin reports early onset sensory hypersensitivity (for example, to the color red), Kamp notes premature sensory development and premature motor maturity.

Etiology. Hereditary factors are also critically important for the onset of early schizophrenia. Bender found a homologous disease of one of the parents in 40% of cases, and of both parents in 10%, which is consistent with our observations. However, according to Bender, for childhood schizophrenia to manifest itself, the assistance of exogenous factors (brain damage, mental trauma) is necessary. Many Anglo-American authors often pointed to early mental trauma as a cause of childhood schizophrenia. However, the parents of children with schizophrenia, as far as our experience allows us to judge, are not at all people of the cold, emotionally dull type with soulless, dry educational principles, as Cameron and Starr claim. Corroz's research shows that the mental "climate" is not of decisive importance in the occurrence of childhood psychoses, not to mention the fact that such a profound change in the psyche (significant loss of contact with reality, deep dissociation of the age-related psyche and massive regression phenomena in a schizophrenic child) is psychogenetic cannot be understood. To declare infantile schizophrenia simply an extremely phase-specific form of rebellion against educational oppression means to give a strained and one-sided interpretation of clinical and empirical facts.

The development of painful phenomena is clearly favored by processes and changes in forms in different phases. Outbreaks of psychosis following some (nonspecific) somatic illness are surprisingly common, as has been noted by other researchers. In children with schizophrenia, a significant increase in copper in the blood serum was found.

Flow. Based on the longitudinal studies of Bender et al., the following predictive rules can be formulated. The earlier the disease manifests itself, the worse the prognosis; this applies to both the tendency to remission and the depth of the personality defect. Differences in the course of the disease in both sexes have not been established (however, according to our own observations, early forms of schizophrenia in boys were observed 3 times more often than in girls). Mild clinical forms of schizophrenia with a relatively favorable prognosis also occur up to 10 years of age in the form of autochthonous mood disorders, childhood nervousness, pseudoneurotic states or short-term, anxiously paranoid colored episodes. Significant premorbid personality abnormalities worsen the prognosis. Of our 23 patients with acute onset psychosis, a favorable outcome was found in 17, and out of 27 with a slowly progressive onset - only 7. The symptoms of the initial phase also allow us to draw some prognostic conclusions. Weakening of contact, inadequacy or dullness of affect, abnormalities of volitional functions and motor skills, as well as massive behavioral disturbances were more often observed in cases with an unfavorable outcome than in cases with social or complete remission. Although an outbreak of the disease before the 10th year of life is considered a bad omen, early schizophrenia can still give a relatively favorable outcome. Thus, a follow-up examination of 51 children showed that in 47% of cases there was social or complete remission (although in the vast majority these were children from 11 to 14 years old).

Autism in early childhood. In 1943, Kanner first described congenital characterological oddities, recognizable already in the first year of life, the central symptom of which is a kind of qualitative change in attitude towards the surrounding world. These autistic children, even in infancy their gaze is directed somewhere into the distance, they do not show any need for emotional contacts, the arrival or departure of loved ones does not make any impression on them, in a word, they live “as if in their own shell.” Subsequently, they amaze with the presence of obsessions and the invariability of their gaming skills, immoderate attachment to individual objects and amazing dexterity in performing certain motor functions (for example, throwing at a target, climbing a tree, etc.). Approximately 1/3 of these children have a general delay in speech development, but the majority begin to speak unusually early. Mindless repetition of names, echolalia, and misuse of pronouns are also common, as are strange impulsive actions and cryptogenic anxiety attacks. According to Kanner's follow-up data, this condition generally remains unchanged. Children with speech delays retain their isolation, while children with normal speech achieve some social adjustment. About 23% of such children subsequently need care. There appears to be no transition to schizophrenic processes.

This disease, previously rarely described and nosologically highly disputed (Kanner observed only 150 cases over 19 years), is now diagnosed very often.

During last decade with an average annual number of about 500 children per year (inpatient and outpatient, but without schizophrenic illnesses), we found “autistic behavior” as the leading symptom in only 23 cases. Of these, in our opinion, “early childhood autism” could be diagnosed in only 10 children, three should be considered autistic psychopaths, and the remaining 10 children had autism only side symptom accompanying dementia or encephalopathy.

Despite the fact that the heredity of autism in early childhood has not been proven and there is no processivity in it, Bender sees this condition as the earliest form of childhood schizophrenia. Other authors explain these states by “emotional blockade” in the very early age, due to the lack of emotional warmth on the part of the mother, the dry pedantry of the father, etc. Still others legitimately question this hypothesis. Be that as it may, the uniqueness of the clinical picture justifies the recognition of nosological independence for early childhood autism.

Treatment endogenous psychoses early childhood. For schizophrenic psychoses, starting from the pre-pubertal and pubertal periods, insulin and electroconvulsive therapy are recommended. In early childhood autism, both of these methods are ineffective, but in short-phase, usually affective psychoses, they can be dispensed with. As for their value in schizophrenia in children, due to differences in nosological criteria and different intensity of treatment, opinions differ. According to observations from the Marburg Clinic. shock treatments, which are indicated in such cases no less than for adults, can shorten the duration of a separate acute attack and perhaps even prevent the danger of relapse and loss of contact. Nevertheless, the proportion of social complete remissions in treated patients turned out to be not much higher than the general statistical one (i.e., in relation to all patients - both treated and untreated).

The possibilities for using psychotherapy for all childhood psychoses are varied. It, like therapeutic pedagogy, should not be abandoned, especially at the beginning of treatment.

Equally important is the therapeutic use of the environment.

As for the newest psychopharmacological agents, it is currently difficult to list all their indications and therapeutic effectiveness. Like all other therapeutic agents, they do not guarantee a complete cure, but have great palliative value.

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The main types of mental disorders that are typical for adults occur in childhood and adolescence. Timely diagnosis in this case is of great importance, since it affects the treatment and further prognosis of the development of severe psychopathology. Mental disorders in school-age children are most often limited to the following categories: schizophrenia, anxiety and social behavior disorders. Also, adolescents often experience psychosomatic disorders that have no organic causes.

Most often in adolescence There are mood disorders (depression), which can have the most dangerous consequences. At this time, his entire existence seems hopeless to the teenager, he sees everything in black tones. A fragile psyche is the cause of suicidal thoughts among young people, and this problem has acquired important medical significance.

In most cases, depression begins with the child’s complaints about his neuropsychic state and subjective feelings. The teenager isolates himself from others and withdraws into himself. He feels inferior, depressed and often aggressive, while his critical attitude towards himself further aggravates his difficult mental state. If the teenager is not provided with medical assistance at this moment, then he may be lost.

Early symptoms of the disease may indicate a problem:

The child's behavior changes for no apparent reason.
Academic performance is deteriorating.
There is also a constant feeling of fatigue.
The child withdraws, withdraws into himself, and can lie idle all day long.
The teenager shows increased aggressiveness, irritability, and tearfulness.
He does not share his experiences, becomes detached, forgetful, ignores requests, is silent all the time, does not devote himself to his affairs and gets irritated if he is asked.
The teenager suffers from bulimia or a complete lack of appetite.

The list goes on, but if a teenager exhibits most of the listed signs, then you should immediately contact a specialist. Childhood mental disorders should be treated by a doctor who specializes in the treatment of adolescent psychopathologies. Treatment for depression most often involves a combination of pharmacological and psychotherapeutic interventions.

Schizophrenia

Timely identification and pharmacotherapy of the initial stage of schizophrenia in childhood and adolescence helps to improve the prognosis in the future. Early signs of this disorder are vague and similar to common problems. adolescence. However, after a few months the picture changes, and the pathology becomes more distinct.

It is believed that schizophrenia always manifests itself as delusions or hallucinations, but in reality, early signs of schizophrenia can be very diverse: from obsessions, anxiety disorders to emotional impoverishment, etc.

Signs of mental disorder in school-aged children and adolescents:

The child's warm feelings towards his parents weaken and his personality changes. Groundless aggression, anger, and irritation arise, although relationships with peers may remain the same.
Initial symptoms can be expressed in the form of loss of former interests and hobbies, while new ones do not appear. Such children may wander aimlessly on the street or laze around the house.
At the same time, lower instincts weaken. Patients lose interest in food. They do not feel hungry and may skip meals. In addition, teenagers become sloppy and forget to change dirty things.

A characteristic sign of pathology is a sharp decline in academic performance and loss of interest in school life, unmotivated aggression and personality change. As the disease progresses, the symptoms become more obvious, and a specialist will be able to easily recognize the signs of schizophrenia.

Psychosomatic disorders

In adolescence, psychosomatic disorders often occur: abdominal or head pain, sleep disorders. These somatic problems are caused by psychological reasons associated with age-related changes in the body.

Stress and nervous tension, caused by school and family troubles, the teenager results in insomnia and poor health. The student has difficulty falling asleep in the evening or wakes up too early in the morning. In addition, he may suffer from nightmares, enuresis or sleepwalking. All of these disorders are indications for seeing a doctor.

Schoolchildren, both girls and boys, often suffer from persistent headaches. In girls this is sometimes associated with certain period menstrual cycle. But mostly they occur without organic causes, as in respiratory diseases, but are caused by psychosomatic disorders.

These painful sensations are caused by an increase in muscle tone, and interfere with the child’s ability to study normally at school and do homework.

Examination of children under 6 years of age

Assessment is more complex than assessing an adult patient. Toddlers lack the language and cognitive capabilities to describe their emotions and sensations. Thus, the doctor should rely mainly only on observation data of the child’s parents and educators.

The first signs of illness in children preschool age:

Nervous and mental disorders after 2 years of age arise due to the fact that the mother limits the child’s independence and overprotects him, continuing breast-feeding grown up baby. Such a child is timid, dependent on his mother, and often lags behind his peers in the development of skills.
At the age of 3 years, mental disorders are expressed in increased fatigue, moodiness, irritability, tearfulness, speech disorders. If you suppress the sociability and activity of a three-year-old child, this can lead to isolation, autism, and future problems in interacting with peers.
Neurotic reactions in 4-year-old children are expressed in protest against the will of adults and hypertrophied stubbornness.
The reason to seek help from a doctor regarding disorders in a 5-year-old child is the occurrence of symptoms such as poor vocabulary, loss of previously acquired skills, refusal of role-playing games and joint activities with peers.

When assessing the mental state of children, we must not forget that they develop within a family framework, and this greatly influences the child’s behavior.

A child with a normal psyche, living in a family of alcoholics and periodically exposed to violence, at first glance may have signs of mental disorders. Fortunately, most childhood mental disorders are mild and respond well to treatment. At severe forms pathology treatment is carried out by a qualified child psychiatrist.

In common parlance, young mothers refer to childhood tantrums and growth crises as “child psychosis.” From a medical point of view, everything is much more complicated and serious: psychosis in children is rare, making a diagnosis is not so easy, but at the same time, this disease requires mandatory treatment and observation.
Childhood psychosis is not heart-rending screams and wallowing on the floor, which happen to almost every child. A psychotic disorder has a specific clinical picture, and in order to make a correct diagnosis in childhood, consultation with more than one specialist is usually necessary.

One of the main indicators of a person’s clouding of reason is most often his speech. In psychosis, a person is not able to think coherently, and the flow of his speech clearly demonstrates the confusion and chaotic nature of the sick consciousness.
Is it possible to definitely diagnose psychogenicity in a child under three years of age who has not yet attended kindergarten, and who can’t really speak? Often this is difficult for a larger number of medical experts. In this case, psychosis in a child can be noticed only by his behavior. It will also be difficult to determine when and for what reason the psyche was so seriously damaged.
The subject of dispute between doctors is also clouding of reason that affects children in pre-adolescence. Medicine has classified childhood and adult psychotic disorders, but most doctors believe that even in pre-adolescence, the psyche can suffer to the point of psychogenicity. Clinical picture at the same time has different symptoms, separating adolescent psychosis, with a number of its differences, from a similar pathology in early or adult periods of life.
It is important to distinguish pathology from other mental disorders at an early age, such as neuroses and hysteria. With many similar symptoms, it is psychosis in children that leads to the destruction of adequate consciousness and the loss of a real picture of the world.

Symptoms of childhood psychosis

Psychosis in children manifests itself in different ways, symptoms vary different forms pathologies are heterogeneous. However, most often it appears specific set signs such as:

Hallucinations. The child sees objects, creatures, events that do not exist in reality. Hears voices, smells, experiences tactile sensations of false origin.
Rave. The patient's consciousness is confused, which is clearly manifested in his speech. There is no meaning, coherence, or consistency in it.
Inappropriate behavior, for example, inappropriate fun, uncontrollable pranks. The child suddenly, out of the blue, becomes extremely irritable, begins to break toys, things, and hurts animals.
Aggression, anger. When visiting school or kindergarten, he speaks rudely and angrily with other children, is capable of calling names or hitting, and is often aggressive with adults. He reacts to insignificant reasons with sharp irritation.
Appetite is unstable: from strong greed for food to complete refusal of it.
Stupor. He freezes in one position for a long time, the position of his body and facial expressions do not change, his gaze freezes, his face expresses suffering, and does not react to external stimuli.
Abrupt change of state. Stupor is suddenly replaced by extreme excitability, high motor activity, combined with an aggressive attitude towards others.
Affects. Euphoria, fear, frequent attacks melancholy, resentment, tears up to hysterical sobs.
Doesn't sleep well at night, but constantly wants to sleep during the day. Headaches, high fatigue without external causes.
A fever-like condition (in combination with symptoms of impaired consciousness). The child has cold skin heavy sweating, lips are dry, pupils are dilated.

Signs of destruction of consciousness should immediately cause alarm among parents. child in acute stage illness cannot attend school or kindergarten and requires urgent hospitalization.

But is it possible to an ordinary person without medical education, how to distinguish children's games and fantasies from hallucinations and delusions? After all, a little boy, while playing, imagines himself as a knight saving the princess from an evil dragon. Remember that in the case of psychopathy, a number of symptoms will be noticeable that indicate clouding of reason. So a mentally ill person will actually see an evil monster and behave accordingly - show strong fear, aggression and other signs of a distorted perception of the world.

In children, symptoms of psychosis range from age characteristics. By the age of one year, such a child may have partial or complete absence manifestations of emotions characteristic of infancy. At 2, 4, even at 6 months, the baby does not smile, does not “cry”. Compared to healthy 8-9 month old babies, the patient stands out in that he does not recognize his family, does not show interest in the world around him, and may experience obsessive, monotonous movements.

At two years of age, a child susceptible to psychotic disorder will exhibit noticeable developmental delays. In a 3-year-old child, an inadequate perception of reality will be more obvious.

In children younger age distinguish atypical childhood psychosis. Its symptoms are similar to autism (one of its varieties even has a similar name - “infantile psychosis”). It can occur even in intellectually developed children (although it still occurs more often in mentally retarded people).

The sick person will have poor contact with people and demonstrate delayed speech development. It may be characterized by obsessive identical movements or uncontrolled repetition of other people's words (echolalia). When attending kindergarten, such children do not fit into the general group, since they do not understand those around them and have difficulty adapting to the slightest changes.

Causes of pathology

Physiological causes of psychotic disorders at an early age include:

Dysfunctions thyroid gland.
Consequences of hormonal imbalance, puberty.
High temperature caused by other diseases.
Side effects from chemotherapy and medications.
Meningitis.
Alcohol taken by a pregnant woman (fetal alcoholism in utero) or while breastfeeding.
Genetic inheritance.

Teenagers often experience mental breakdowns as a result of being in a stressful situation. Death can be a serious psychological trauma for them. loved one, conflict situations in the family or with friends, sudden changes in life circumstances.

Psychosis that occurs against the background of psychological trauma in a teenager, like similar manifestations of the disease in adults, may not last long and disappears with the elimination of the stress factor.
But it is worth remembering that the tendency to psychotic disorders can be inherited, and then the course of the disease can be more severe. Sometimes dysfunction of consciousness reaches disability, persisting throughout life.

A psychologist talks about how parental behavior can trigger the development of psychosis in a child.

Variety of forms of the disease

Depending on many factors, the disease can occur in different ways:

quickly and rapidly, with a vivid manifestation of symptoms;
long, but with sharp periodic bursts;
quickly, but with unexpressed symptoms;
Symptoms develop over a long period and appear faintly and sluggishly.

Depending on the age of the patients, early (before adolescence) and late (in adolescents) forms of the pathology are also distinguished.

Psychotic conditions caused by external temporary factors are usually easier to diagnose and treat. The acute phase passes when the provoking problems stop, although for full recovery an exhausted psyche always requires additional time.

In case of a long stay of a person in a traumatic situation or brain damage caused by biochemical abnormalities (both congenital and provoked by taking medicines, diseases and other factors) acute psychotic disorder develops into chronic. Prolonged confusion of mind is extremely dangerous for little man. From dysfunction brain activity suffers intellectual development, the child cannot adapt to society, communicate with peers, or do his favorite things.

Drug treatment and a corrective psychotherapeutic course for severe forms of mental illness are mandatory. Particularly dangerous acute psychosis when all the symptoms manifest themselves very strongly and vividly, and the increase in pathological processes are underway rapidly.

Diagnosis of the disease

It is better to carry out a detailed diagnosis of mental disorders in a hospital under the constant supervision of doctors. To prescribe effective therapy, it is necessary to clearly determine the cause of the psychotic reaction.

In addition to a psychiatrist, an otolaryngologist, a neurologist, a psychologist, and a speech therapist must take part in the examination. In addition to a general examination of the body, the child also undergoes special testing mental development(for example, a computer or written test for the level of development of thinking in accordance with the age group, speech coherence, tests in pictures, etc.).

Therapy and prevention of psychotic disorders at an early age

Young patients are prescribed a course of medications in combination with psychological correction sessions.

The symptoms manifested and the treatment prescribed to the child are directly related, since drugs are needed only in cases where the disease has led to biochemical disorders in the body. “Heavy” forms of psychotropic medications, such as tranquilizers, are prescribed only in the presence of aggressive conditions.

In cases where the illness is protracted and not episodic, it is necessary to treat the young patient under the constant supervision of a psychiatrist.

The corrective effect of psychotherapy is especially noticeable when an emotional breakdown occurred as a result of the stress experienced. Then, by eliminating the factor that caused the onset of the disease and working with the internal attitudes and reactions of the little patient, the psychologist helps him cope with stress and develop adequate reactions to negative events in life.
Parents need to help their son or daughter follow the rules of a healthy life.

The child needs a measured daily routine, the absence of strong shocks and surprises.
It is unacceptable to show rudeness and physical violence to children, and measures of reward and punishment must be clear to them.
A friendly and positive atmosphere in the family, love and patience between all its members help the patient quickly return to normal life.
If stressful situation was associated with a visit educational institution, that is, it makes sense to change school or kindergarten.

All this is extremely important for the final and sustainable recovery of the little patient’s psyche.

The question arises whether children who have suffered a temporary clouding of reason can hope for complete cure and full adult life? Will they be able to grow into adequate members of society, create their own families, and have children? Fortunately, yes. With timely medical care and quality therapy, many cases of early psychogenic disease are completely cured.

Psychosis– a mental illness in which a person cannot adequately perceive the surrounding reality and respond to it appropriately. Psychoses are very diverse in their manifestations. They accompany many diseases, such as schizophrenia, senile dementia, " delirium tremens"or may be an independent pathology.

So what is psychosis?

This is a mental disorder in which reality is so distorted in a person’s mind that this “picture” no longer has anything in common with what other people see. What prevents a person from being objective is constant fear for his life, voices in his head that order him to do something, visions that are no longer available to anyone... These internal prisms change the patient’s behavior. His reactions become completely inadequate: causeless laughter or tears, anxiety or euphoria. Psychosis manifests itself differently in all patients. Some are confident that the special services are hunting for them, others assure others of their superpowers, and still others persistently pursue the object of their love, groundlessly laying claim to it. It is impossible to list all the manifestations of psychosis, but psychiatrists managed to systematize them by combining them into groups.

Psychosis is not just a wrong train of thought. There is no need to think that the sick person is mistaken or cannot keep his nerves under control. There is no point in arguing, much less condemning him. Psychosis is the same disease as diabetes. This is also a metabolic disorder, but only in the brain. You are not afraid of diabetics, you do not judge them for their disease. You sympathize with them. Patients with neurosis deserve the same treatment. By the way, scientists have proven that mentally healthy people commit crimes more often than people with psychosis.

You shouldn't put a mark on a person. Psychosis is not a life sentence. It happens that after a period of illness, which can be quite severe, the psyche is completely restored and problems never arise again. But more often the disease is cyclical. In this case, after a long period of health, an exacerbation occurs: hallucinations and delusional ideas appear. This happens if you do not strictly follow the recommendations of your doctor. In severe cases, the disease takes chronic nature, and mental health never returns.

Psychosis is a fairly common problem. According to statistics, 15% of patients in mental hospitals are patients with psychosis. And 3-5% of the total population suffer from psychosis caused by various diseases: asthma, cerebral atherosclerosis, etc. But there are still thousands of people whose psychosis is associated with external reasons– taking drugs, alcohol, medicines. To date, doctors cannot calculate the exact number of patients with psychosis.

Psychosis affects both children and adults, men and women. But some forms of the disease predominantly affect women. Thus, women suffer from manic-depressive syndrome 3-4 times more often. Psychoses most often occur during menstruation, menopause and after childbirth. This suggests that mental illness associated with fluctuations in hormone levels in the female body.

If you or someone close to you shows signs of psychosis, do not despair. Modern medicine successfully copes with this disease. And the infamous “registration” was replaced by a consultation with a local psychiatrist - advisory and therapeutic assistance. Therefore, the fact of treatment will not ruin your future life. But attempts to cope with the disease on your own can lead to irreparable changes in the psyche and disability.

Causes of psychosis

The mechanism of psychosis. Psychosis is based on dysfunction of brain cells (neurons). Inside the cell there are components - mitochondria, which ensure cellular respiration and give it energy for activity in the form of ATP molecules. These compounds act as an electrical current for a special sodium-potassium pump. It pumps into the neuron the chemical elements necessary for its operation: potassium, sodium, calcium.

If the mitochondria do not produce ATP, the pump does not work. As a result, the vital activity of the cell is disrupted. This neuron remains “hungry” and experiences oxygen deficiency, despite the fact that the person eats normally and spends enough time in the fresh air.

Neurons in which the chemical balance is disturbed cannot form and transmit nerve impulses. They disrupt the functioning of the entire central nervous system, leading to the development of psychosis. Depending on which parts of the brain are more affected, the manifestations of the disease depend. For example, lesions in the subcortical emotional centers lead to manic-depressive psychosis.

Factors and pathologies that lead to psychosis

Psychiatrists believe that psychosis does not occur in “one fine moment” after suffering a nervous shock. Every stressful situation undermines the brain and prepares the ground for the emergence of psychosis. Each time the person's reaction becomes a little stronger and more emotional, until psychosis develops.

Risk factors for psychosis

Age factor

Different psychoses manifest themselves at different periods of a person’s life. For example, in adolescence, when a hormonal explosion occurs, the likelihood of schizophrenia is high.

Manic-depressive psychosis most often affects young, active people. At this age, fateful changes occur that place a heavy burden on the psyche. This means entering a university, finding a job, starting a family.

During maturity, syphilitic psychoses occur. Since changes in the psyche begin 10-15 years after infection with syphilis.

In old age, the appearance of psychosis is associated with menopause in women, age-related changes in blood vessels and nerve cells. Poor circulation and destruction of nervous tissue leads to senile psychosis.

Gender factor

The number of men and women suffering from psychosis is approximately the same. But some types of psychosis may affect more than one sex. For example, manic-depressive (bipolar) psychosis develops 3 times more often in women than in men. And unipolar psychosis (attacks of depression without a period of excitement) has the same tendency: there are 2 times more female representatives among patients. This statistics is explained by the fact that the female body more often experiences hormonal surges, which affect the functioning of the nervous system.

In men, psychosis due to chronic alcoholism, syphilitic and traumatic psychosis are more common. These “male” forms of psychosis are not related to the level of hormones, but to the social role and behavioral characteristics of the stronger sex. But early cases of psychosis in Alzheimer's disease in men are associated with genetic characteristics.

Geographical factor

It has been noticed that mental illnesses, including psychosis, more often affect residents of large cities. And those who live in small populated areas and in rural areas take less risk. The fact is that life in big cities is fast paced and full of stress.

Illumination, average temperature and day length have little effect on the prevalence of diseases. However, some scientists note that people born in the northern hemisphere during the winter months are more prone to psychosis. The mechanism of disease development in this case is not clear.

Social factor

Psychosis often appears in people who have failed to realize themselves socially:

women who did not marry and did not give birth to a child;
men who were unable to build a career or achieve success in society;
people who are not happy with their social status, were unable to demonstrate their inclinations and abilities, and chose a profession that does not suit their interests.

In such a situation, a person is constantly under pressure negative emotions, and this prolonged stress depletes the strength of the nervous system.

Factor of psychophysiological constitution

Hippocrates described 4 types of temperament. He divided all people into melancholic, choleric, phlegmatic and sanguine. The first two types of temperament are considered unstable and therefore more prone to the development of psychosis.

Kretschmer identified the main types of psychophysiological constitution: schizoid, cycloid, epileptoid and hysteroid. Each of these types is equally at risk of developing psychosis, but depending on the psychophysiological constitution, the manifestations will differ. For example, the cycloid type is prone to manic-depressive psychosis, and the hysteroid type more often than others develops hysteroid psychosis and has a high tendency to attempt suicide.

How psychosis manifests itself

The manifestations of psychosis are very diverse, since the disease causes disturbances in behavior, thinking, and emotions. It is especially important for patients and their relatives to know how the disease begins and what happens during an exacerbation in order to begin treatment in a timely manner. You may notice unusual behavior, refusal to eat, strange statements, or an overly emotional reaction to what is happening. The opposite situation also happens, a person ceases to be interested in the world, nothing touches him, he is indifferent to everything, does not show any emotions, moves and talks little.

Main manifestations of psychosis

Hallucinations. They can be auditory, visual, tactile, gustatory, olfactory. Most often, auditory hallucinations occur. The person thinks he hears voices. They can be in the head, come from the body, or come from outside. The voices are so real that the patient does not even doubt their authenticity. He perceives this phenomenon as a miracle or a gift from above. Voices can be threatening, accusing or commanding. The latter are considered the most dangerous, since a person almost always follows these orders.

You can guess that a person has hallucinations based on the following signs:

He suddenly freezes and listens for something;
Sudden silence mid-sentence;
Conversation with oneself in the form of replicas to someone else’s phrases;
Laughter or depression for no apparent reason;
The person cannot concentrate on a conversation with you and is staring at something.

Affective or mood disorders. They are divided into depressive and manic.

Manifestations of depressive disorders:
- A person sits in one position for a long time; he has no desire or strength to move or communicate.
- Pessimistic attitude, the patient is dissatisfied with his past, present, future and the entire environment.
- To relieve anxiety, a person can eat constantly or, conversely, give up eating completely.
- Sleep disorders early awakenings at 3-4 o'clock. It is at this time that mental suffering is most severe, which can lead to a suicide attempt.
Manifestations of manic disorders:
- The person becomes extremely active, moves a lot, sometimes aimlessly.
- Unprecedented sociability and verbosity appear, speech becomes fast, emotional, and may be accompanied by grimacing.
- An optimistic attitude; a person does not see problems or obstacles.
- The patient makes unrealistic plans and significantly overestimates his strength.
- The need for sleep decreases, the person sleeps little, but feels alert and rested.
- The patient may abuse alcohol and engage in promiscuous sex.

Crazy ideas.

Delusion is a thinking disorder that manifests itself in the form of ideas that do not correspond to reality. A distinctive feature of delusion is that you cannot convince a person using logical arguments. In addition, the patient always tells his delusional ideas very emotionally and is firmly convinced that he is right.

Distinctive signs and manifestations of delirium

Movement disorders. During periods of psychosis, two types of deviations occur.

Lethargy or stupor. A person freezes in one position and remains motionless for a long time (days or weeks). He refuses food and communication.

Motor excitement. Movements become fast, jerky, and often aimless. Facial expressions are very emotional, the conversation is accompanied by grimaces. Can mimic other people's speech and imitate animal sounds. Sometimes a person is unable to perform simple tasks because he loses control of his movements.

Personality characteristics always manifest themselves in symptoms of psychosis. The inclinations, interests, and fears that a healthy person has intensify during illness and become the main purpose of his existence. This fact has long been noticed by doctors and relatives of patients.

What to do if someone close to you has alarming symptoms?

If you notice such manifestations, then talk to the person. Find out what is bothering him and what is the reason for the changes in his behavior. In this case, it is necessary to show maximum tact, avoid reproaches and claims, and not raise your voice. One carelessly spoken word can cause a suicide attempt.

Convince the person to seek help from a psychiatrist. Explain that the doctor will prescribe medications that will help you calm down and make it easier to endure stressful situations.
Types of psychoses

The most common are manic and depressive psychoses - an apparently healthy person suddenly shows signs of depression or significant agitation. Such psychoses are called monopolar - the deviation occurs in one direction. In some cases, the patient may alternately show signs of manic and depressive psychosis. In this case, doctors talk about bipolar disorder - manic disorder. depressive psychosis.

Manic psychosis

Manic psychosis – heavy mental disorder, which causes three characteristic symptoms: high mood, accelerated thinking and speech, noticeable motor activity. Periods of excitement last from 3 months to one and a half years.

Depressive psychosis

Depressive psychosis is a disease of the brain, and psychological manifestations are the external side of the disease. Depression begins slowly, unnoticed by the patient and those around him. As a rule, good, highly moral people fall into depression. They are tormented by a conscience that has grown to pathological proportions. Confidence appears: “I am bad. I'm not doing my job well, I haven't achieved anything. I'm bad at raising children. I'm a bad spouse. Everyone knows how bad I am and they talk about it.” Depressive psychosis lasts from 3 months to a year.

Depressive psychosis is the opposite of manic psychosis. He also has triad of characteristic symptoms

Pathologically low mood
Thoughts are centered around your personality, your mistakes and your shortcomings. Concentrating on one’s own negative sides gives rise to the belief that everything was bad in the past, the present cannot please anyone, and in the future everything will be even worse than now. On this basis, a person with depressive psychosis can commit suicide.
Since a person’s intellect is preserved, he can carefully hide his desire for suicide so that no one disturbs his plans. At the same time, he does not show his depressed state and assures that he is already better. It is not always possible to prevent a suicide attempt at home. Therefore, people with depression who are focused on self-destruction and their own low value are treated in a hospital.
A sick person experiences causeless melancholy, it presses and oppresses. It is noteworthy that he can practically show with his finger where the concentrations are concentrated. discomfort, where “the soul hurts.” Therefore, this condition even received a name - pre-cardiac melancholy.
Depression in psychosis has a distinctive feature: the condition is worst early in the morning, and in the evening it improves. The person explains this by saying that in the evening there are more worries, the whole family gathers and this distracts from sad thoughts. But with depression caused by neurosis, on the contrary, the mood worsens in the evening.
It is characteristic that in the acute period of depressive psychosis, patients do not cry. They say they would like to cry, but there are no tears. Therefore, crying in this case is a sign of improvement. Both patients and their relatives should remember this.
Mental retardation
Mental and metabolic processes in the brain proceed very slowly. This may be due to a lack of neurotransmitters: dopamine, norepinephrine and serotonin. These chemical substances ensure proper signal transmission between brain cells.
As a result of a deficiency of neurotransmitters, memory, reaction, and thinking deteriorate. A person gets tired quickly, doesn’t want to do anything, nothing interests him, doesn’t surprise or make him happy. You can often hear them say, “I envy other people. They can work, relax, have fun. It’s a pity that I can’t do that.”
The patient always looks gloomy and sad. The gaze is dull, unblinking, the corners of the mouth are downcast, avoids communication, tries to retire. He reacts slowly to calls, answers in monosyllables, reluctantly, in a monotonous voice.

Physical inhibition

Depressive psychosis physically changes a person. Appetite drops and the patient quickly loses weight. Therefore, weight gain during depression indicates that the patient is getting better.

A person’s movements become extremely slow: a slow, uncertain gait, hunched shoulders, a lowered head. The patient feels a loss of strength. Any physical activity causes the condition to worsen.

In severe forms of depressive psychosis, a person falls into a stupor. He can sit for a long time without moving, looking at one point. If you try to read notation at this time; “Get yourself together, pull yourself together,” then you will only make the situation worse. A person will have the thought: “I should, but I can’t - that means I’m bad, good for nothing.” He cannot overcome depressive psychosis by force of will, since the production of norepinephrine and serotonin does not depend on our desire. Therefore, the patient needs qualified help and drug treatment.

There are a number of physical signs of depressive psychosis: daily mood swings, early awakenings, weight loss due to poor appetite, menstrual irregularities, dry mouth, constipation, and some people may develop insensitivity to pain. These signs indicate that you need to seek medical help.

Basic rules for communicating with patients with psychosis

Don't argue or talk back to people if you see signs of manic excitement in them. This can provoke an attack of anger and aggression. As a result, you can completely lose trust and turn the person against you.
If the patient exhibits manic activity and aggression, remain calm, self-confident and friendly. Take him away, isolate him from other people, try to calm him down during the conversation.
80% of suicides are committed by patients with psychosis in the stage of depression. Therefore, be very attentive to your loved ones during this period. Don't leave them alone, especially in the morning. Please contact Special attention for signs warning of a suicide attempt: the patient talks about an irresistible feeling of guilt, about voices ordering him to kill himself, about hopelessness and uselessness, about plans to end his life. Suicide is preceded by a sharp transition from depression to a bright, peaceful mood, putting things in order, and drawing up a will. Don't ignore these signs, even if you think it's just an attempt to attract attention.
Hide all items that could be used to attempt suicide: household chemicals, medicines, weapons, sharp objects.
If possible, eliminate the traumatic situation. Create a calm environment. Try to ensure that the patient is surrounded by close people. Reassure him that he is safe now and that everything is over.
If a person is delusional, do not ask clarifying questions, do not ask about details (What do aliens look like? How many are there?). This may make the situation worse. “Get hold of” any nonsense statement he makes. Develop the conversation in this direction. You can focus on the person's emotions by asking, “I can see you're upset. How can I help you?"
If there are signs that the person has experienced hallucinations, then calmly and confidently ask him what just happened. If he saw or heard something unusual, find out what he thinks and feels about it. To cope with hallucinations, you can listen to loud music on headphones or do something exciting.
If necessary, you can firmly remind about the rules of behavior and ask the patient not to scream. But you shouldn’t make fun of him, argue about hallucinations, or say that it’s impossible to hear voices.
You should not turn to traditional healers and psychics for help. Psychoses are very diverse, and for effective treatment it is necessary to accurately determine the cause of the disease. To do this, it is necessary to use high-tech diagnostic methods. If you waste time on treatment with unconventional methods, acute psychosis will develop. In this case, it will take several times longer to fight the disease, and in the future it will be necessary to constantly take medications.
If you see that a person is relatively calm and in the mood to communicate, try to convince him to see a doctor. Explain that all the symptoms of the disease that bother him can be eliminated with the help of medications prescribed by the doctor.
If your relative flatly refuses to see a psychiatrist, persuade him to see a psychologist or psychotherapist to combat depression. These specialists will help convince the patient that there is nothing wrong with a visit to a psychiatrist.
The most difficult step for loved ones is calling an emergency psychiatric team. But this must be done if a person directly declares his intention to commit suicide, may injure himself or cause harm to other people.

Psychological treatments for psychosis

For psychosis psychological methods successfully complement drug treatment. A psychotherapist can help a patient:

reduce symptoms of psychosis;
avoid recurrent attacks;
increase self-esteem;
learn to adequately perceive the surrounding reality, correctly assess the situation, your condition and react accordingly, correct behavioral errors;
eliminate the causes of psychosis;
increase the effectiveness of drug treatment.

Remember, psychological methods of treating psychosis are used only after it has been possible to remove acute symptoms psychosis.

Psychotherapy eliminates personality disorders that occurred during the period of psychosis, puts thoughts and ideas in order. Working with a psychologist and psychotherapist makes it possible to influence future events and prevent relapse of the disease.

Psychological treatment methods are aimed at restoring mental health and socializing a person after recovery to help him feel comfortable in his family, work team and society. This treatment is called psychosocialization.

Psychological methods that are used to treat psychosis are divided into individual and group. During individual sessions, the psychotherapist replaces the personal core lost during illness. It becomes an external support for the patient, calms him down and helps him correctly assess reality and respond adequately to it.

Group therapy helps you feel like a member of society. A group of people struggling with psychosis is led by a specially trained person who has managed to successfully cope with this problem. This gives patients hope for recovery, helps overcome awkwardness and return to normal life.

Hypnosis, analytical and suggestive (from the Latin Suggestio - suggestion) methods are not used in the treatment of psychosis. When working with altered consciousness, they can lead to further mental disorders.

Good results in the treatment of psychosis are given by: psychoeducation, addiction therapy, cognitive behavior therapy, psychoanalysis, family therapy, occupational therapy, art therapy, as well as psychosocial trainings: social competence training, metacognitive training.

Psychoeducation– this is the education of the patient and his family members. The psychotherapist talks about psychosis, the characteristics of this disease, the conditions for recovery, motivates to take medications and lead a healthy lifestyle. Tells relatives how to behave correctly with the patient. If you disagree with something or have questions, be sure to ask them in the time designated for discussion. It is very important for the success of treatment that you have no doubts.

Classes take place 1-2 times a week. If you visit them regularly, you will develop right attitude to illness and drug treatment. Statistics say that thanks to such conversations, it is possible to reduce the risk of repeated episodes of psychosis by 60-80%.

Addiction therapy necessary for those people who have developed psychosis against the background of alcoholism and drug addiction. Such patients always have an internal conflict. On the one hand, they understand that they should not use drugs, but on the other hand, there is desire return to bad habits.

Classes are conducted in the form of individual conversation. A psychotherapist talks about the connection between drug use and psychosis. He will tell you how to behave to reduce temptation. Addiction therapy helps to create strong motivation to abstain from bad habits.

Cognitive (behavioral) therapy. Cognitive therapy is recognized as one of the best methods of treating psychosis accompanied by depression. The method is based on the fact that erroneous thoughts and fantasies (cognitions) interfere with the normal perception of reality. During the sessions, the doctor will identify these incorrect judgments and the emotions associated with them. It will teach you to be critical of them and not let these thoughts influence your behavior, and will tell you how to look for alternative ways to solve the problem.

To achieve this goal, the Negative Thought Protocol is used. It contains the following columns: negative thoughts, the situation in which they arose, emotions associated with them, facts for and against these thoughts. The course of treatment consists of 15-25 individual sessions and lasts 4-12 months.

Psychoanalysis. Although this technique is not used to treat schizophrenia and affective (emotional) psychoses, its modern “supportive” version is effectively used to treat other forms of the disease. At individual meetings, the patient reveals his inner world to the psychoanalyst and transfers to him feelings directed at other people. During the conversation, the specialist identifies the reasons that led to the development of psychosis (conflicts, psychological trauma) and the defense mechanisms that a person uses to protect himself from such situations. The treatment process takes 3-5 years.

Family therapy – group therapy, during which a specialist conducts sessions with family members where the person with psychosis lives. Therapy is aimed at eliminating conflicts in the family, which can cause exacerbations of the disease. The doctor will talk about the peculiarities of the course of psychosis and the correct models of behavior in crisis situations. Therapy is aimed at preventing relapses and ensuring that all family members can live comfortably together.

Occupational therapy. This type of therapy most often occurs in a group setting. The patient is recommended to attend special classes where he can engage in various activities: cooking, gardening, working with wood, textiles, clay, reading, composing poetry, listening and writing music. Such activities train memory, patience, concentration, and develop Creative skills, help to open up and establish contact with other members of the group.

Specific setting of goals and achievement of simple goals gives the patient confidence that he again becomes the master of his life.

Art therapy – art therapy method based on psychoanalysis. This is a “no words” treatment method that activates self-healing capabilities. The patient creates a picture that expresses his feelings, an image of his inner world. Then a specialist studies it from the point of view of psychoanalysis.

Social competence training. A group lesson in which people learn and practice new forms of behavior so that they can then apply them in Everyday life. For example, how to behave when meeting new people, when applying for a job, or in conflict situations. In subsequent classes, it is customary to discuss the problems that people encountered when implementing them in real situations.

Metacognitive training. Group training sessions that are aimed at correcting thinking errors that lead to delusions: distorted attribution of judgments to people (he doesn’t love me), hasty conclusions (if he doesn’t love me, he wants me dead), depressive way of thinking, inability to empathize , feeling other people's emotions, painful confidence in memory impairment. The training consists of 8 lessons and lasts 4 weeks. At each module, the trainer analyzes thinking errors and helps to form new patterns of thoughts and behavior.

Psychotherapy is widely used for all forms of psychosis. It can help people of all ages, but is especially important for teenagers. During the period when life attitudes and behavioral stereotypes are just being formed, psychotherapy can radically change life for the better.

Drug treatment of psychosis

Drug treatment psychosis is a prerequisite for recovery. Without it, it will not be possible to get out of the trap of the disease, and the condition will only get worse.

There is no single regimen for drug therapy for psychosis. The doctor prescribes medications strictly individually, based on the manifestations of the disease and the characteristics of its course, gender and age of the patient. During treatment, the doctor monitors the patient's condition and, if necessary, increases or decreases the dose to achieve positive effect and not cause side effects.

Treatment of manic psychosis

Group of drugs	Mechanism of treated action	Representatives	How is it prescribed?
Antipsychotic drugs (neuroleptics)	Used for all forms of psychosis. Block dopamine-sensitive receptors. This substance is a neurotransmitter that promotes the transfer of excitation between brain cells. Thanks to the action of neuroleptics, it is possible to reduce the severity of delusions, hallucinations and thought disorders.	Solian (effective for negative disorders: lack of emotions, withdrawal from communication)	In the acute period, 400-800 mg/day is prescribed, with a maximum of 1200 mg/day. Take regardless of meals. Maintenance dose 50-300 mg/day.
		Zeldox	40-80 mg 2 times a day. The dose is increased over 3 days. The drug is prescribed orally after meals.
		Fluanxol	The daily dose is 40-150 mg/day, divided into 4 times. The tablets are taken after meals. The drug is also available in the form of an injection solution, which is given once every 2-4 weeks.
Benzodiazepines	Prescribed for acute manifestations of psychosis together with antipsychotic drugs. They reduce the excitability of nerve cells, have a calming and anticonvulsant effect, relax muscles, eliminate insomnia, and reduce anxiety.	Oxazepam	Take 5-10 mg twice or thrice a day. If necessary, the daily dose can be increased to 60 mg. The drug is taken regardless of food, washed down with a sufficient amount of water. Duration of treatment is 2-4 weeks.
Benzodiazepines		Zopiclone	Take 7.5-15 mg 1 time per day half an hour before bedtime, if psychosis is accompanied by insomnia.
Mood stabilizers (mood stabilizers)	They normalize mood, preventing the onset of manic phases, and make it possible to control emotions.	Actinerval (a derivative of carbamazepine and valproic acid)	The first week, the daily dose is 200–400 mg, divided into 3-4 times. Every 7 days, the dose is increased by 200 mg, bringing it to 1 g. The drug is also discontinued gradually so as not to cause a worsening of the condition.
Mood stabilizers (mood stabilizers)		Contemnol (contains lithium carbonate)	Take 1 g per day once in the morning after breakfast, with a sufficient amount of water or milk.
Anticholinergic drugs (cholinergic blockers)	Necessary to neutralize side effects after taking antipsychotics. Regulates the sensitivity of nerve cells in the brain by blocking the action of the mediator acetylcholine, which ensures the transmission of nerve impulses between cells of the parasympathetic nervous system.	Cyclodol, (Parkopan)	The initial dose is 0.5-1 mg/day. If necessary, it can be gradually increased to 20 mg/day. Frequency of administration: 3-5 times a day, after meals.

Treatment of depressive psychosis

Group of drugs	Mechanism of treated action	Representatives	How is it prescribed?
Antipsychotic drugs	Makes brain cells less sensitive to excess amounts of dopamine, a substance that promotes signal transmission in the brain. The drugs normalize thinking processes, eliminate hallucinations and delusions.	Quentiax	During the first four days of treatment, the dose is increased from 50 to 300 mg. In the future, the daily dose can range from 150 to 750 mg/day. The drug is taken 2 times a day, regardless of meals.
		Eglonil	Tablets and capsules are taken 1-3 times a day, regardless of meals. Daily dose from 50 to 150 mg for 4 weeks. It is not advisable to use the drug after 16 hours so as not to cause insomnia.
		Rispolept Konsta	A suspension is prepared from microgranules and the included solvent, which is injected into the gluteal muscle once every 2 weeks.
		Risperidone	The initial dose is 1 mg 2 times a day. Tablets of 1-2 mg are taken 1-2 times a day.
Benzodiazepines	Prescribed for acute manifestations of depression and severe anxiety. The drugs reduce the excitability of the subcortical structures of the brain, relax muscles, relieve feelings of fear, and calm the nervous system.	Phenazepam	Take 0.25-0.5 mg 2-3 times a day. The maximum daily dose should not exceed 0.01 g. Prescribed in short courses so as not to cause dependence. After improvement occurs, the dosage is gradually reduced.
Benzodiazepines		Lorazepam	Take 1 mg 2-3 times a day. For severe depression, the dose can be gradually increased to 4-6 mg/day. The drug is discontinued gradually due to the risk of seizures.
Normotimics	Medicines designed to normalize mood and prevent periods of depression.	Lithium carbonate	Take orally 3-4 times a day. The initial dose is 0.6-0.9 g/day, gradually the amount of the drug is increased to 1.5-2.1 g. The medicine is taken after meals to reduce the irritant effect on the gastric mucosa.
Antidepressants	Remedies to combat depression. Modern 3rd generation antidepressants reduce the uptake of serotonin by neurons and thereby increase the concentration of this neurotransmitter. They improve mood, relieve anxiety, melancholy, and fear.	Sertraline	Take 50 mg orally, 1 time per day after breakfast or dinner. If there is no effect, the doctor may gradually increase the dose to 200 mg/day.
Antidepressants		Paroxetine	Take 20-40 mg/day in the morning with breakfast. Swallow the tablet without chewing and wash it down with water.
Anticholinergic drugs	Medicines that help eliminate the side effects of taking antipsychotics. Slowness of movements, muscle stiffness, trembling, impaired thinking, increased or absent emotions.	Akineton	2.5-5 mg of the drug is administered intravenously or intramuscularly. In tablets, the initial dose is 1 mg 1-2 times a day, gradually the amount of the drug is increased to 3-16 mg/day. The dose is divided into 3 doses. The tablets are taken during or after meals with liquid.

Let us remember that any independent dose change can have a very severe consequences. Reducing the dosage or stopping taking medications causes an exacerbation of psychosis. Increasing the dose increases the risk of side effects and addiction.

Prevention of psychosis

What needs to be done to prevent another attack of psychosis?

Unfortunately, people who have experienced psychosis are at risk of experiencing a relapse of the disease. A repeated episode of psychosis is a difficult ordeal for both the patient and his relatives. But you can reduce your risk of relapse by 80% if you take the medications prescribed by your doctor.

Drug therapy– the main point of prevention of psychosis. If you have difficulty taking your medications on a daily basis, talk to your doctor about switching to a depot form of your antipsychotic medications. In this case, it will be possible to give 1 injection every 2-4 weeks.
It has been proven that after the first case of psychosis, it is necessary to use drugs for one year. For manic manifestations of psychosis, lithium salts and Finlepsin are prescribed at 600-1200 mg per day. And for depressive psychosis, Carbamazepine 600-1200 mg per day is needed.
Regularly attend individual and group psychotherapy sessions. They will increase your self-confidence and motivation to get better. In addition, the psychotherapist can notice signs of an approaching exacerbation in time, which will help adjust the dosage of medications and prevent a recurrence of the attack.
Follow a daily routine. Train yourself to get up and take food and medications at the same time every day. A daily schedule can help with this. In the evening, plan for tomorrow. Add all necessary things to the list. Mark which ones are important and which ones are unimportant. Such planning will help you not to forget anything, get everything done and be less nervous. When planning, set realistic goals.

Communicate more. You will feel comfortable among people who have overcome psychosis. Communicate in self-help groups or specialized forums.
Exercise daily. Running, swimming, cycling are suitable. It’s very good if you do this in a group of like-minded people, then the classes will bring both benefit and pleasure.
Make a list of the early symptoms of an approaching crisis., the appearance of which must be reported to the attending physician. Pay attention to these signals:
1. Behavior Changes: frequent leaving the house, prolonged listening to music, unreasonable laughter, illogical statements, excessive philosophizing, conversations with people with whom you usually do not want to communicate, fussy movements, squandering, adventurism.
2. Mood changes: irritability, tearfulness, aggressiveness, anxiety, fear.
3. Changes in health: sleep disturbance, lack or increased appetite, increased sweating, weakness, weight loss.
What not to do?
- Don't drink a lot of coffee. It can have a strong stimulating effect on the nervous system. Avoid alcohol and drugs. They have a bad effect on brain function, cause mental and motor agitation, and attacks of aggression.
- Don't overwork yourself. Physical and mental exhaustion can cause severe confusion, inconsistent thinking, and increased responsiveness to external stimuli. These deviations are associated with a violation of the absorption of oxygen and glucose by nerve cells.
- Do not take a steam bath, try to avoid overheating. An increase in body temperature often leads to delirium, which is explained by an increase in the activity of electrical potentials in the brain, an increase in their frequency and amplitude.
- Don't conflict. Try to resolve conflicts constructively to avoid stress. Severe mental stress can become a trigger for a new crisis.
- Don't refuse treatment. During periods of exacerbation, the temptation to refuse to take medications and visit a doctor is especially great. Do not do this, otherwise the disease will become acute and require hospital treatment.
What is postpartum psychosis?
Postpartum psychosis Quite a rare mental illness. It develops in 1-2 women giving birth out of 1000. Signs of psychosis most often appear during the first 4-6 weeks after birth. Unlike postpartum depression, this mental disorder is characterized by delusions, hallucinations, and desires to harm yourself or the baby.
Manifestations of postpartum psychosis.
The first signs of the disease are sudden mood swings, anxiety, severe restlessness, and unreasonable fears. Subsequently, delusions and hallucinations appear. A woman may claim that the child is not hers, that he is stillborn or crippled. Sometimes a young mother develops paranoia, she stops going out for walks and does not allow anyone near the child. In some cases, the disease is accompanied by delusions of grandeur, when a woman is confident in her superpowers. She may hear voices telling her to kill herself or her child.
According to statistics, 5% of women in a state of postpartum psychosis kill themselves, and 4% kill their child. Therefore, it is very important for relatives not to ignore the signs of the disease, but to consult a psychiatrist in a timely manner.
Causes of postpartum psychosis.
The cause of mental disorders can be difficult childbirth, unwanted pregnancy, conflict with the husband, fear that the spouse will love the child more than her. Psychologists believe that psychosis can be caused by a conflict between a woman and her mother. It can also cause brain damage due to injury or infection. A sharp decrease in the level of female hormone estrogen, as well as endorphins, thyroid hormone and cortisol.
In approximately half of cases, postpartum psychosis develops in patients with schizophrenia or manic-depressive syndrome.
Treatment of postpartum psychosis.
Treatment must be started as soon as possible because the woman’s condition is rapidly deteriorating. If there is a risk of suicide, the woman will be treated in a psychiatric department. While she is taking medicines You cannot breastfeed your baby, as most drugs penetrate into the mother's milk. But communication with the child will be useful. Taking care of the baby (provided that the woman herself wants it) helps to normalize the state of the psyche.
If a woman is severely depressed, antidepressants are prescribed. Amitriptyline, Pirlindol are indicated if anxiety and fear predominate. Citalopram and Paroxetine have a stimulating effect. They will help in cases where psychosis is accompanied by stupor - the woman sits motionless and refuses to communicate.
For mental and motor agitation and manifestations of manic syndrome, lithium preparations (Lithium Carbonate, Micalite) and antipsychotics (Clozapine, Olanzapine) are needed.
Psychotherapy for postpartum psychosis is used only after elimination acute manifestations. It is aimed at identifying and resolving conflicts that led to mental disorders.
What is reactive psychosis?
Reactive psychosis or psychogenic shock - a mental disorder that occurs after severe psychological trauma. This form of the disease has three characteristics that distinguish it from other psychoses (Jaspers triad):
1. Psychosis begins after a severe emotional shock that is very significant for this person.
2. Reactive psychosis is reversible. The more time has passed since the injury, the milder symptoms. In most cases, recovery occurs after about a year.
3. Painful experiences and manifestations of psychosis depend on the nature of the trauma. There is a psychologically understandable connection between them.
Causes of reactive psychosis.
Mental disorders occur after a strong shock: a disaster, attack by criminals, fire, collapse of plans, career failure, divorce, illness or death of a loved one. In some cases, psychosis can also be triggered by positive events that cause an outburst of emotions.
Especially at risk of developing reactive psychosis are emotionally unstable people, those who have suffered a bruise or concussion, severe infectious diseases, whose brain has been damaged by alcohol or drug intoxication. As well as teenagers going through puberty and women going through menopause.
Manifestations of reactive psychosis.
Symptoms of psychosis depend on the nature of the injury and the form of the disease. The following forms of reactive psychosis are distinguished:
- psychogenic depression;
- psychogenic paranoid;
- hysterical psychosis;
- psychogenic stupor.
Psychogenic depression manifests itself as tearfulness and depression. At the same time, these symptoms may be accompanied by short temper and grumpiness. This form is characterized by the desire to arouse pity and draw attention to one’s problem. Which could end in a demonstrative suicide attempt.
Psychogenic paranoid accompanied by delusions, auditory hallucinations and motor agitation. The patient feels that he is being persecuted, he fears for his life, is afraid of exposure and is fighting with imaginary enemies. Symptoms depend on the nature of the stressful situation. The person is very excited and commits rash acts. This form of reactive psychosis often occurs on the road, as a result of lack of sleep and alcohol consumption.
Hysterical psychosis has several forms.
1. Delusional fantasies – delusional ideas that relate to greatness, wealth, persecution. The patient tells them very theatrically and emotionally. Unlike delusion, a person is not sure of his words, and the essence of the statements changes depending on the situation.
2. Ganser syndrome patients do not know who they are, where they are, or what year it is. They answer simple questions incorrectly. They perform illogical actions (eating soup with a fork).
3. Pseudo-dementia – short-term loss of all knowledge and skills. A person cannot answer the simplest questions, show where his ear is, or count his fingers. He is capricious, grimaces, and cannot sit still.
4. Puerilism syndrome – an adult develops childish speech, childish emotions, and childish movements. It may develop initially or as a complication of pseudodementia.
5. The "feral" syndrome – human behavior resembles the habits of an animal. Speech gives way to a growl, the patient does not recognize clothes and cutlery, and moves on all fours. This condition, if unfavorable, can replace puerilism.
Psychogenic stupor– after a traumatic situation, a person loses the ability to move, speak and react to others for some time. The patient may lie in the same position for weeks until he is turned over.
Treatment of reactive psychosis.
The most important stage in the treatment of reactive psychosis is the elimination of the traumatic situation. If you manage to do this, then there is a high probability of a quick recovery.
Drug treatment of reactive psychosis depends on the severity of manifestations and characteristics of the psychological state.
At reactive depression antidepressants are prescribed: Imipramine 150-300 mg per day or Sertraline 50-100 mg once a day after breakfast. Therapy is supplemented with tranquilizers Sibazon 5-15 mg/day or Phenazepam 1-3 mg/day.
Psychogenic paranoid treated with antipsychotics: Triftazin or Haloperidol 5-15 mg/day.
For hysterical psychosis, it is necessary to take tranquilizers (Diazepam 5-15 mg/day, Mezapam 20-40 mg/day) and antipsychotics (Alimemazine 40-60 mg/day or Neuleptil 30-40 mg/day).
Psychostimulants, for example Sidnocarb 30-40 mg/day or Ritalin 10-30 mg/day, can bring a person out of a psychogenic stupor.
Psychotherapy can free a person from excessive fixation on a traumatic situation and develop defense mechanisms. However, you can start consulting with a psychotherapist only after acute phase the psychosis has passed, and the person has again gained the ability to perceive the specialist’s arguments.
Remember – psychosis is curable! Self-discipline, regular medication, psychotherapy and help from loved ones guarantee the return of mental health.