Psychiatric condition. Types of mental disorders in women
When observing signs of mental illness, you should pay attention to the patient’s appearance: how he is dressed, whether his clothing style matches his age, gender, season, whether he takes care of his appearance and hairstyle.
If this is a woman - does she use cosmetics, jewelry and how does she use it - excessively or in moderation, discreetly or loudly, pretentiously. The facial expression - sad, angry, enthusiastic, wary - and the expression of the eyes - dull, matte, “glowing”, joyful, “sparkling” can tell a lot. Every emotion, every state of mind has its own external expression with numerous shades and transitions, you just need to be able to discern them. You need to pay attention to the patient’s posture and gait, demeanor, and the position in which he stands, sits and lies.
You should also pay attention to how a mentally ill person reacts to contact with: benevolently, obsequiously, dismissively, arrogantly, aggressively, negatively. He bursts into the room, without an invitation sits down on a chair, lounging, crossing his legs, sets the doctor the conditions under which he agrees to be treated, or, upon entering the office, modestly shifts from foot to foot. Seeing the doctor, he jumps out of bed and runs along the corridor to greet him, or turns to the wall during a round. Answers the doctor's questions in detail, trying not to miss the smallest detail, or answers in monosyllables, reluctantly.
Several observation techniques can be distinguished. Observation during a conversation with a mentally ill person. It allows us to note the characteristics of the patient’s response to the doctor’s questions, his reaction to the disease, to the fact of hospitalization. Observation in an artificially created situation, for example, in a situation of “free choice of actions”, when the doctor, sitting in front of the patient, does not ask him anything, giving the patient the opportunity to ask questions, make complaints, express his thoughts, and move freely around the office. Observation in a natural situation, when the patient does not know that he is being observed. This type of observation is used in a psychiatric hospital, and not only the doctor, but also nurses and orderlies must be proficient in it. It is acceptable when visiting a patient at home, or in occupational therapy workshops.
By observing the patient's condition and the signs of his mental illness, it is possible, for example, to distinguish an epileptic seizure from a hysterical one, pathological intoxication from simple intoxication. It should be noted that in child psychiatry, observation is sometimes the only method of identifying mental pathology, since in a child, due to the rudimentary nature of mental disorders, their lack of awareness and verbalization, questioning does not always lead to obtaining the necessary information.
By observing a mentally ill person for a certain time, paying attention, say, to the severity of catatonic symptoms, signs of delirium, a mask of depression, the doctor can guess the nature of the dynamics painful condition and evaluate the effectiveness of the therapy.
If a mentally ill person with a severe chronic illness, previously unkempt, comes to an appointment in clean and neat clothes, then one might think that the process social adaptation in this case it goes well.
Emphasizing the importance of the observation method for diagnosing mental illness, we will give brief signs of mental illness as examples.
Hallucinations
The behavior of a mentally ill person during hallucinations depends on the nature of the hallucinatory experiences: visual, auditory, olfactory, gustatory, tactile, true, false, as well as on the severity of their manifestation. With visual hallucinations, it seems that the patient is peering into something. He can point to the location of hallucinatory images, discuss with those present the details of visual deceptions, and comment on them. The presence of visual hallucinations can be indicated by an attentive, gaze the patient in a certain direction, where there are no real objects, as well as his lively facial expressions, permeated with surprise and curiosity. If the hallucinations are pleasant to the patient, facial expressions of pleasure are visible on his face; if they are frightening, facial expressions of horror and fear are visible.
If a mentally ill person has auditory hallucinations, then he listens, puts his hand to his ear to hear better, asks those around him to talk more quietly, or, on the contrary, plugs his ears and covers his head with a blanket. He may mutter something and, out of connection with the situation, utter phrases that have the nature of questions and answers. He can, “hearing” the call, go to open the door or pick up the phone.
With olfactory hallucinations, the patient senses non-existent odors, plugs his nose or sniffs, makes a scandal with his neighbors, believing that they are letting gases into his room, or, in order to get rid of odors, exchanges an apartment.
A patient with taste hallucinations, feeling persistent, bad taste, often spits, rinses his mouth with water, interpreting them as manifestations of a gastrointestinal tract disease, and often seeks help from a therapist. With olfactory and gustatory hallucinations, refusal to eat is typical.
Tactile hallucinations may be indicated by scratching the skin.
With true hallucinations, the mentally ill person is emotional, his behavior is largely determined by hallucinatory experiences, and he often discusses their content with others. With pseudohallucinations, the patient’s behavior is more monotonous, monotonous, the facial expression is hypomimic, detached, thoughtful, the patient seems to be immersed in himself, in his thoughts, and is reluctant to talk about his experiences.
In acute hallucinosis, the patient is uncritical of hallucinatory experiences and, without hesitation, follows the orders of the “voices.” With chronic hallucinosis, a critical attitude may appear and with it the ability to control one’s actions. For example, a patient, feeling a deterioration in his condition, comes to see him.
Rave
The appearance and behavior of a mentally ill person with delusional experiences is determined by the plot of the delusion. A patient with delusions of jealousy behaves suspiciously towards the object of jealousy, watches him, records the time of his leaving and coming from home, arranges checks and interrogations.
A patient with delusions of invention tries to implement his inventions, writes letters to various authorities on which the recognition of his ideas depends, abandons his main work, and does not allow the thought that his inventions are absurd or are plagiarism.
Delusions of persecution make the patient wary and suspicious. The patient hides from his “persecutors”, hides, and sometimes attacks in defense.
Patients with hypochondriacal delusions are often encountered in the practice of internists. They persistently seek medical and surgical interventions in connection with the existing, in their opinion, incurable disease. Patients with dysmorphomania syndrome are encountered in the practice of dentists and require the correction of one or another imaginary defect in the facial area or the elimination of the disease that is supposedly the cause of bad breath.
Manic state
Manic excitement is characterized by a desire for activity. The patient is constantly busy with something. He takes part in cleaning the premises, recites poems, sings songs, organizes “amateur artistic activities,” and helps the orderlies feed a weakened patient. His energy is inexhaustible, his mood is upbeat and joyful. He interferes in all matters, takes on any work, but does not complete it, switching to new types of activities.
Depression
With depression, the face and eyes acquire a characteristic expression of sadness and grief. A deep fold cuts through the forehead (Melancholic Delta), the corners of the mouth are lowered, the pupils are dilated. Head down. The patient usually sits on the edge of a chair or bed in a bent position.
Catatonic agitation
Catatonic arousal can have the character of a confused-pathetic excitement with pretentiousness, mannerism, negativism (meaningless resistance: they give him food - he turns away; when he tries to take the food away, he grabs it). The patient’s movements do not constitute a complete, meaningful action, but acquire the character of motor automatisms, stereotypies, become impulsive, and incomprehensible to others. Unmotivated laughter, echolalia, echopraxia, yactation, aimless running in circles (manege running), and monotonous jumping are often observed.
Hebephrenic arousal
Hebephrenic arousal is manifested by the following symptoms: pronounced motor restlessness with elements of euphoria and foolishness, crude clownism. Patients take unusual poses, meaninglessly grimace, make faces, imitate others, somersault, expose themselves, sometimes their movements resemble the movements of animals. At the height of impulsive excitement, they can show senseless rage: they scatter food, violently resist attempts to feed them or give them medicine.
Catatonic stupor
Signs of catatonic stupor - a mentally ill person becomes silent (mutism), immobilized. His muscle tone increases. You can find such manifestations of catatonic stupor as symptoms of a cogwheel, proboscis, waxy flexibility, embryo, air cushion. The skin becomes greasy.
The article was prepared and edited by: surgeonThis chapter provides an overview of mental health disorders commonly encountered in women, including their epidemiology, diagnosis, and treatment approach (Table 28-1). Mental disorders are very common. The monthly incidence among American adults exceeds 15%. The lifetime incidence is 32%. Most often, women experience major depression, seasonal affective disorder, manic-depressive psychosis, eating disorders, panic disorders, phobias, generalized anxiety states, somatized mental disorders, pain conditions, borderline and hysterical disorders and suicide attempts.
In addition to the fact that anxiety and depressive disorders are much more common in women, they are more resistant to drug therapy. However, most studies and clinical trials are conducted on men and then extrapolate the results to women, despite differences in metabolism, drug sensitivity, and side effects. Such generalizations lead to the fact that 75% of psychotropic drugs are prescribed to women, and they are also more likely to experience serious side effects.
All doctors should be aware of the symptoms of mental disorders, first aid for them and available methods maintaining mental health. Unfortunately, many cases of mental illness remain undiagnosed and untreated or undertreated. Only a small part of them reaches a psychiatrist. Most patients are seen by other specialists, so only 50% of mental disorders are recognized during initial treatment. Most patients present somatic complaints and do not focus on psycho-emotional symptoms, which again reduces the frequency of diagnosis of this pathology by non-psychiatrists. In particular, affective disorders are very common in patients with chronic diseases. The incidence of mental illness in patients of general practitioners is twice as high as in the general population, and even higher in seriously ill hospitalized patients and frequently seeking medical help. Neurological disorders such as stroke, Parkinson's disease and Meniere's syndrome are associated with mental disorders.
Untreated major depression can worsen the prognosis of somatic diseases and increase the amount of medical care required. Depression can intensify and increase the number of somatic complaints, lower the pain threshold, and increase functional disability. A study of frequent health care users found depression in 50% of them. Only those who experienced a decrease in depressive symptoms during the one-year follow-up showed an improvement in functional activity. Symptoms of depression (low mood, hopelessness, lack of satisfaction in life, fatigue, impaired concentration and memory) interfere with the motivation to seek medical help. Timely diagnosis and treatment of depression in chronic patients helps improve prognosis and increase the effectiveness of therapy.
The socio-economic cost of mental illness is very high. About 60% of suicide cases are caused by affective disorders alone, and 95% are combined with diagnostic criteria for mental illness. Costs associated with treatment, mortality, and disability due to clinically diagnosed depression are estimated to be more than $43 billion per year in the United States. Since more than half of people with mood disorders are either untreated or undertreated, this figure is much lower than the total cost of depression to society. Mortality and disability in this undertreated population, the majority of whom are women, are particularly dismal because 70 to 90% of patients with depression respond to antidepressant therapy.
Table 28-1
Major mental disorders in women
1. Eating disorders
Anorexia nervosa
Bulimia nervosa
Bouts of gluttony
2. Affective disorders
Major Depression
Adjustment disorder with depressed mood
Postpartum affective disorder
Seasonal affective disorder
Affective insanity
Dysthymia
3. Alcohol abuse and alcohol dependence
4. Sexual disorders
Libido disorders
Sexual arousal disorders
Orgastic disorders
Painful sexual disorders:
Vaginismus
Dyspareunia
5. Anxiety disorders
Specific phobias
Social phobia
Agoraphobia
Panic disorders
Generalized anxiety disorders
Obsessive Obsessive Syndrome
Post-traumatic stress
6. Somatoform disorders and false disorders
False disorders:
Simulation
Somatoform disorders:
Somatization
Conversion
Hypochondria
Somatoform pain
7. Schizophrenic disorders
Schizophrenia
Paraphrenia
8. Delirium
Mental illnesses throughout a woman's life
There are specific periods during a woman's life during which she is at increased risk of developing mental illness. Although the main mental disorders—mood and anxiety disorders—can occur at any age, various precipitating conditions are more common during specific age periods. During these critical periods, the clinician should include specific questions to screen for mental disorders by obtaining a history and assessing the patient's mental status.
Girls are at increased risk for school phobias, anxiety disorders, attention deficit hyperactivity disorder, and learning disorders. Adolescents are at increased risk for eating disorders. During menarche, 2% of girls develop premenstrual dysphoria. After puberty, the risk of developing depression increases sharply, and in women it is twice as high as in men of the same age. In childhood, on the contrary, the incidence of mental illness in girls is lower or the same as in boys their age.
Women are susceptible to mental disorders during and after pregnancy. Women with a history of mental disorders often refuse medication support when planning pregnancy, which increases the risk of relapse. After childbirth, most women experience mood changes. Most experience a short period of “baby blues” depression that does not require treatment. Others develop more severe, disabling symptoms of depression in the postpartum period, and a small number of women develop psychotic disorders. The relative risks of taking drugs during pregnancy and breastfeeding make it difficult to choose treatment; in each case, the question of the benefit-risk ratio of therapy depends on the severity of symptoms.
Middle age is associated with a continued high risk of anxiety and mood disorders, as well as other mental disorders such as schizophrenia. In women it may be impaired sexual function, and if they take antidepressants for mood or anxiety disorders, they are at increased risk of side effects, including decreased sexual function. Although there is no clear evidence that menopause is associated with an increased risk of depression, most women experience major life changes during this period, especially in the family. For most women, their active role in relation to children is replaced by the role of caregivers for aging parents. Caring for elderly parents is almost always carried out by women. Monitoring of the mental status of this group of women is necessary to identify possible impairments in quality of life.
As women age, the risk of developing dementia and psychiatric complications of physical pathologies such as stroke increases. Because women live longer than men and the risk of developing dementia increases with age, most women develop dementia. Older women with multiple underlying medical conditions and multiple medications are at high risk for delirium. Women are at increased risk of developing paraphrenia, a psychotic disorder that usually occurs after age 60. Due to their long life expectancy and greater involvement in interpersonal relationships, women experience the loss of loved ones more often and more intensely, which also increases the risk of developing mental illness.
Examination of a psychiatric patient
Psychiatry deals with the study of affective, cognitive and behavioral disorders that occur while maintaining consciousness. Psychiatric diagnosis and treatment selection follows the same logic of history taking, examination, differential diagnosis and treatment planning as in other clinical areas. A psychiatric diagnosis must answer four questions:
1) mental illness (what the patient has)
2) temperamental disorders (what the patient is like)
3) behavioral disturbances (what the patient does)
4) disorders that arose in certain life circumstances (what the patient encounters in life)
Mental illness
Examples of mental illnesses are schizophrenia and major depression. They are similar to other nosological forms - they have a discrete onset, course, and clinical symptoms that can be clearly defined as present or absent in each individual patient. Like other nosologies, they are the result of genetic or neurogenic disorders of the organ, in this case the brain. With obvious abnormal symptoms - auditory hallucinations, mania, severe obsessive states - the diagnosis of a mental disorder is easily made. In other cases, distinguish pathological symptoms, such as low mood with major depression, normal feelings of sadness or disappointment caused by life circumstances can be difficult. It is necessary to focus on identifying known stereotypical sets of symptoms characteristic of mental illness, while at the same time remembering the diseases that are most common in women.
Temperament disorders
Understanding the patient's personality increases the effectiveness of treatment. Personal traits such as perfectionism, indecision, impulsiveness are one way or another quantitatively expressed in people, just like physiological ones - height and weight. Unlike mental disorders, they do not have clear characteristics—“symptoms”—as opposed to “normal” values, and individual differences are normal in the population. Psychopathology or functional personality disorders occur when traits become extreme. When temperament leads to impairment in occupational or interpersonal functioning, this is sufficient to qualify it as a possible personality disorder; in this case you need health care and collaboration with a psychiatrist.
Behavioral disorders
Behavioral disorders have a self-reinforcing property. They are characterized by purposeful, irresistible forms of behavior that subordinate all other types of patient activity. Examples of such disorders include eating disorders and abuse. The first goals of treatment are to switch the patient's activity and attention, stop problem behavior and neutralize provoking factors. Provoking factors may be concomitant mental disorders, such as depression or anxiety disorders, illogical thoughts (an anorectic’s opinion that “if I eat more than 800 calories a day, I will become fat”). Group therapy can be effective in treating behavioral disorders. The final stage of treatment is the prevention of relapse, since relapse is normal form course of behavioral disorders.
Patient's life story
Stressors, life circumstances, social circumstances are factors that can modulate the severity of the disease, personality traits and behavior. Various stages of life, including puberty, pregnancy and menopause, may be associated with an increased risk of developing certain diseases. Social conditions and sex role differences may help explain the increased incidence of specific symptom complexes in women. For example, the media's focus on the ideal figure in Western society is a provoking factor in the development of eating disorders in women. Such contradictory female roles in modern Western society, as a “devoted wife”, “madly loving mother” and “successful businesswoman"adds stress. The purpose of collecting a life history is to more accurately select methods of internally oriented psychotherapy and find the “meaning of life.” The treatment process is facilitated when the patient comes to understand herself, clearly separate her past and recognize the priority of the present for the sake of the future.
Thus, the formulation of a psychiatric case should include answers to four questions:
1. Does the patient have a disease with a clear time of onset, a defined etiology and response to pharmacotherapy.
2. What personality traits of the patient influence her interaction with the environment and how.
3. Does the patient have purposeful behavioral disorders?
4. What events in the woman’s life contributed to the formation of her personality, and what conclusions did she draw from them?
Eating disorders
Of all the mental disorders, the only eating disorders that occur almost exclusively in women are anorexia and bulimia. For every 10 women suffering from them, there is only one man. The incidence and incidence of these disorders is increasing. Young white women and girls from the middle and upper classes of Western society have the highest risk of developing anorexia or bulimia, at 4%. However, the incidence of these disorders in other age, racial and socioeconomic groups is also increasing.
As with abuse, eating disorders are conceptualized as behavioral disturbances caused by dysregulation of hunger, satiety, and food absorption. Behavioral disorders associated with anorexia nervosa include restricting food intake, purging manipulations (vomiting, abuse of laxatives and diuretics), exhausting physical activity, and abuse of stimulants. These behavioral reactions are compulsive in nature, supported by a psychological attitude towards food and weight. These thoughts and behaviors dominate all aspects of a woman's life, impairing physical, psychological and social functioning. Just as with abuse, treatment can only be effective if the patient himself wants to change the situation.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), anorexia nervosa includes three criteria: voluntary fasting with refusal to maintain weight greater than 85% of required; psychological attitude with fear of obesity and dissatisfaction with one’s own weight and body shape; endocrine disorders leading to amenorrhea.
Bulimia nervosa is characterized by the same fear of obesity and dissatisfaction with one's own body as anorexia nervosa, accompanied by bouts of binge eating, and then compensatory behavior aimed at maintaining a low body weight. DSM-IV distinguishes anorexia and bulimia primarily on the basis of underweight and amenorrhea rather than weight control behaviors. Compensatory behavior includes periodic fasting, grueling physical exercise, taking laxatives and diuretics, stimulants and inducing vomiting.
Binges of binge eating differ from bulimia nervosa in the absence of compensatory behavior aimed at maintaining body weight, as a result of which such patients develop obesity. Some patients experience a change from one eating disorder to another throughout their lives; Most often, the change goes in the direction from the restrictive type of anorexia nervosa (when behavior is dominated by restriction of food intake and excessive physical activity) towards bulimia nervosa. There is no single cause of eating disorders; they are considered multifactorial. Known risk factors can be divided into genetic, social predisposition and temperamental characteristics.
Studies have shown a higher concordance of identical twins compared to fraternal twins for anorexia. One family study found tenfold increased risk anorexia in female relatives. In contrast, for bulimia, neither familial nor twin studies have identified a genetic predisposition.
Temperamental and personality traits that contribute to the development of eating disorders include introversion, perfectionism, and self-criticism. Patients with anorexia who restrict food intake but do not purify are likely to have predominant anxiety that keeps them from engaging in life-threatening behavior; Those suffering from bulimia exhibit such personality traits as impulsiveness and the search for novelty. Women with bouts of binge eating and subsequent purging may have other types of impulsive behavior, such as abuse, sexual promiscuity, kleptomania, and self-mutilation.
Social conditions that contribute to the development of eating disorders are associated with the widespread idealization of a slender androgynous figure and underweight in modern Western society. Most young women engage in restrictive dieting, a behavior that increases the risk of developing eating disorders. Women compare their appearance to each other, as well as to the generally accepted ideal of beauty and strive to be like it. This pressure is especially pronounced in adolescents and young women, since endocrine changes during puberty increase the content of adipose tissue in a woman’s body by 50%, and the adolescent psyche simultaneously overcomes problems such as identity formation, separation from parents and puberty. The incidence of eating disorders in young women has increased over the past few decades in parallel with the increased media emphasis on thinness as a symbol of female success.
Other risk factors for developing eating disorders include family conflict, loss of a significant person such as a parent, physical illness, sexual conflict and trauma. Triggers may also include marriage and pregnancy. Some professions require maintaining slimness - for ballerinas and models.
It is important to distinguish primary factors risks that trigger the pathological process, from those that support an existing behavior disorder. Eating disorders periodically cease to depend on the etiological factor that triggered them. Supporting factors include the development of pathological eating habits and voluntary fasting. Patients with anorexia begin by maintaining a diet. They are often encouraged by their initial weight loss, receiving compliments on their appearance and self-discipline. Over time, thoughts and behavior related to nutrition become the dominant and subjective goal, the only one that relieves anxiety. Patients resort to more and more often and become more intensely immersed in these thoughts and behavior to maintain their mood, just as alcoholics increase the dose of alcohol to relieve stress and transfer other methods of relaxation to drinking alcohol.
Eating disorders are often underdiagnosed. Patients hide symptoms associated with feelings of shame, internal conflict, and fear of condemnation. Physiological signs Eating disorders may be noticed on examination. In addition to reduced body weight, fasting can lead to bradycardia, hypotension, chronic constipation, delayed gastric emptying, osteoporosis, disorders menstrual cycle. Cleansing procedures lead to electrolyte imbalances, dental problems, hypertrophy of the parotid salivary glands and dyspeptic disorders. Hyponatremia can lead to a heart attack. If there are such complaints, the clinician should conduct a standard interview, including finding out the minimum and maximum weight of the patient during adult life, brief history eating habits, such as counting calories and grams of fat in the diet. Further questioning may reveal the presence of bouts of binge eating and the frequency of resorting to compensatory measures to restore weight. It is also necessary to find out whether the patient herself, her friends and family members believe that she has an eating disorder - and whether this bothers her.
Patients with anorexia who resort to purging procedures are at high risk of serious complications. Anorexia has the highest mortality rate of any mental illness, with more than 20% of anorectics dying after age 33. Death usually occurs due to physiological complications of fasting or due to suicide. In bulimia nervosa, death is often a consequence of arrhythmia caused by hypokalemia or suicide.
Psychological signs of eating disorders are regarded as secondary to the main mental diagnosis or concomitant. Symptoms of depression and obsessive neurosis may be associated with fasting: low mood, constant thoughts about food, decreased concentration, ritual behavior, decreased libido, social isolation. In bulimia nervosa, feelings of shame and the desire to hide binge eating and purging behaviors lead to increased social isolation, self-critical thoughts, and demoralization.
Most patients with eating disorders have an increased risk of other mental disorders, the most common being major depression, anxiety disorders, abuse, and personality disorders. Concomitant major depression or dysthymia was observed in 50-75% of patients with anorexia and in 24-88% of patients with bulimia. Obsessive neuroses occurred in 26% of anorectics during their lifetime.
Patients with eating disorders are characterized by social isolation, communication difficulties, problems in intimate life And professional activity.
Treatment of eating disorders occurs in several stages, starting with assessing the severity of the pathology, identifying concomitant mental diagnoses and establishing motivation for change. Consultation with a nutritionist and psychotherapist specializing in the treatment of patients with eating disorders is necessary. It is necessary to understand that first of all it is necessary to stop pathological behavior, and only after it is brought under control, it will be possible to prescribe treatment aimed at internal processes. A parallel can be drawn with the primacy of abstinence in the treatment of abuse, when therapy carried out simultaneously with continued alcohol intake does not bring results.
Treatment by a general psychiatrist is less desirable from the point of view of maintaining treatment motivation; treatment in special inpatient institutions such as sanatoriums is more effective - the mortality rate for patients in such institutions is lower. Group therapy and strict monitoring of eating and restroom use by medical staff in these institutions minimize the likelihood of relapse.
Several classes of psychopharmacological agents are used in patients with eating disorders. Double-blind, placebo-controlled studies have proven the effectiveness of a wide range of antidepressants in reducing the frequency of binge eating and subsequent purging episodes in bulimia nervosa. Imipramine, desipramine, trazodone and fluoxetine reduce the frequency of such attacks, regardless of the presence or absence of concomitant depression. When using fluoxetine, the most effective dose is higher than that usually used to treat depression - 60 mg. Monoamine oxidase (MAO) inhibitors and buproprion are relatively contraindicated because dietary restrictions must be followed when using MAO inhibitors, and the risk of heart attack increases with buproprion for bulimia. In general, treatment for bulimia should include trying tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs) along with psychotherapy.
For anorexia nervosa, no medications aimed at increasing body weight have been proven effective in controlled studies. Unless the patient has severe depression or obvious signs of obsessive-compulsive disorder, most clinicians recommend monitoring the mental status of patients during remission rather than prescribing medications while the weight has not yet been gained. Most symptoms of depression, ritualistic behavior, and obsessions disappear when the weight approaches normal. When deciding to prescribe antidepressants, low-dose SSRIs are the safest choice, given the high potential risk of cardiac arrhythmia and hypotension with tricyclic antidepressants, as well as the generally higher risk of drug side effects in underweight people. A recent double-blind, placebo-controlled study of the effectiveness of fluoxetine in anorexia nervosa found that the drug may be useful in preventing weight loss after weight loss has been achieved.
There are few studies examining the levels of neurotransmitters and neuropeptides in sick and recovered patients with eating disorders, but their results show dysfunction of the serotonin, noradrenergic and opiate systems of the central nervous system. Studies of feeding behavior in animal models show similar results.
The effectiveness of serotonergic and noradrenergic antidepressants in bulimia also supports the physiology of this disorder.
Data from human studies are inconsistent, and it remains unclear whether abnormalities in neurotransmitter levels in patients with eating disorders are associated with this condition, whether they appear in response to fasting and bouts of binge eating and purging, or whether they precede the mental disorder and are a personality trait of the susceptible person. patient's disorder.
Studies of the effectiveness of treatment for anorexia nervosa show that among hospitalized patients, after 4 years of follow-up, 44% had a good result with the restoration of normal body weight and menstrual cycle; 28% had temporary results, 24% did not, and 4% died. Unfavorable prognostic factors are the course of anorexia with bouts of binge eating and purging, low minimum weight and ineffectiveness of therapy in the past. More than 40% of anorectics develop bulimic behavior over time.
The long-term prognosis for bulimia is unknown. Episodic relapses are most likely. A decrease in the severity of bulimic symptoms is observed in 70% of patients during a short period of observation after treatment with drugs in combination with psychotherapy. As with anorexia, the severity of symptoms in bulimia affects the prognosis. Among patients with severe bulimia, 33% had no results after three years.
Eating disorders are a complex mental disorder that most often affects women. Their frequency of occurrence in Western society is growing, and they are associated with high morbidity. The use of psychotherapeutic, educational and pharmacological techniques in treatment can improve the prognosis. Although specific help may not be needed at the first stage, failure of treatment requires early referral to a psychiatrist. Further research is needed to clarify the reasons for the predominance of women among patients, to assess the actual risk factors and to develop effective treatment.
Affective disorders
Mood disorders are mental illnesses whose main symptoms are mood changes. Everyone experiences mood swings in their lives, but few experience their extreme expressions—affective disorders. Depression and mania are the two main mood disorders seen in mood disorders. These diseases include major depression, manic-depressive psychosis, dysthymia, adaptation disorder with depressive mood. Features of hormonal status can serve as risk factors for the development of affective disorders during a woman’s life; exacerbations are associated with menstruation and pregnancy.
Depression
Depression is one of the most common mental disorders and is more common in women. Most studies estimate the incidence of depression in women to be twice that of men. This pattern may be partly explained by the fact that women are better able to remember past bouts of depression. Diagnosis of this condition is complicated by the wide range of symptoms and the lack of specific signs or laboratory tests.
When diagnosing, it is quite difficult to distinguish between short-term periods of sad mood associated with life circumstances and depression as a mental disorder. The key to differential diagnosis is recognizing typical symptoms and monitoring their dynamics. A person without mental disorders usually does not have disturbances in self-esteem, suicidal thoughts, feelings of hopelessness, or neurovegetative symptoms such as sleep disturbances, appetite disturbances, or lack of vital energy for weeks and months.
The diagnosis of major depression is based on a history and mental status examination. Main symptoms include low mood and anhedonia – loss of desire and ability to enjoy normal life activities. In addition to depression and anhedonia lasting at least two weeks, episodes of major depression are characterized by the presence of at least four of the following neurovegetative symptoms: significant weight loss or gain, insomnia or increased sleepiness, psychomotor retardation or alertness, fatigue and loss of energy, decreased ability to concentrate attention and decision making. In addition, many people suffer from increased self-criticism with feelings of hopelessness, excessive guilt, suicidal thoughts, and a feeling of being a burden to their loved ones and friends.
Symptoms lasting more than two weeks help differentiate an episode of major depression from a short-term adjustment disorder with low mood. Adjustment disorder is reactive depression, in which depressive symptoms are a reaction to an obvious stress factor, are limited in quantity and can be treated with minimal therapy. This does not mean that an episode of major depression cannot be triggered by a stressful event or cannot be treated. An episode of major depression differs from an adaptation disorder in the severity and duration of symptoms.
Some groups, particularly the elderly, often do not experience classic symptoms of depression such as low mood, leading to an underestimation of the incidence of depression in such groups. There is also evidence that in some ethnic groups depression is expressed more by somatic signs than by classical symptoms. In older women, complaints of feelings of social insignificance and a range of characteristic somatic complaints should be taken seriously, as they may require antidepressant medication. Although some diagnostic laboratory tests, for example, the dexamethasone test, they are not specific. The diagnosis of major depression remains clinical and is made after a careful history and mental status assessment.
In childhood, the incidence of depression in boys and girls is the same. Differences become noticeable during puberty. Angola and Worthman consider the cause of these differences to be hormonal and conclude that hormonal changes may be a trigger mechanism for a depressive episode. Beginning at menarche, women are at increased risk of developing premenstrual dysphoria. This mood disorder is characterized by symptoms of major depression, including anxiety and mood lability, occurring in last week menstrual cycle and stopping in the first days of the follicular phase. Although premenstrual emotional lability occurs in 20-30% of women, it severe forms are quite rare - in 3-5% of the female population. A recent multicenter, randomized, placebo-controlled trial of sertraline 5–150 mg demonstrated significant improvement in symptoms with treatment. 62% of women in the study group and 34% in the placebo group responded to treatment. Fluoxetine at a dose of 20-60 mg per day also reduces the severity of premenstrual disorders in more than 50% of women, according to a multicenter placebo-controlled study. In women with major depression, as well as with manic-depressive psychosis, mental disorders worsen in the premenstrual period - it is unclear whether this is an exacerbation of one condition or the overlap of two (major mental disorder and premenstrual dysphoria).
Pregnant women experience a full range of affective symptoms both during pregnancy and after childbirth. The incidence of major depression (about 10%) is the same as in non-pregnant women. In addition, pregnant women may experience less severe symptoms of depression, mania, and periods of psychosis with hallucinations. The use of medications during pregnancy is used both during exacerbation of a mental condition and to prevent relapses. Interrupting medications during pregnancy in women with pre-existing mental disorders results in sharp increase risk of exacerbations. To make a decision about drug treatment, it is necessary to compare the risk potential harm drugs for the fetus with a risk for both the fetus and the mother of recurrence of the disease.
In a recent review, Altshuler et al described current therapeutic recommendations for the treatment of various psychiatric disorders during pregnancy. In general, medications should be avoided if possible during the first trimester due to the risk of teratogenicity. However, if symptoms are severe, treatment with antidepressants or mood stabilizers may be necessary. Initial studies with fluoxetine have shown that SSRIs are relatively safe, but reliable data on the in utero effects of these new drugs are not yet available. The use of tricyclic antidepressants does not lead to a high risk congenital anomalies. Electroconvulsive therapy is another relatively safe method treatment of severe depression during pregnancy. Taking lithium drugs in the first trimester increases the risk of congenital pathologies of the cardiovascular system. Antiepileptic drugs and benzodiazepines are also associated with an increased risk of congenital anomalies and should be avoided whenever possible. In each case, it is necessary to evaluate all indications and risks individually, depending on the severity of the symptoms. To compare the risk of untreated mental illness and the risk pharmacological complications For mother and fetus, consultation with a psychiatrist is necessary.
Many women experience mood disorders after childbirth. The severity of symptoms ranges from “baby blues” to severe major depression or psychotic episodes. For most women, these mood changes occur in the first six months after childbirth; at the end of this period, all signs of dysphoria disappear on their own. However, for some women, depressive symptoms persist for many months or years. In a study of 119 women after their first birth, half of the women treated with medication after childbirth experienced a relapse within the next three years. Early recognition of symptoms and adequate treatment is necessary for both mother and child, as depression can affect the mother's ability to adequately care for the child. However, treatment of nursing mothers with antidepressants requires caution and a comparative assessment of risks.
Mood changes during menopause have been known for a long time. Recent studies, however, have not confirmed the existence of a clear link between menopause and mood disorders. In a review of this issue, Schmidt and Rubinow found very little published research suggesting this relationship exists.
Mood changes associated with hormonal changes during menopause may improve with HRT. For most women, HRT is the first stage of treatment before psychotherapy and antidepressants. If symptoms are severe, it is indicated initial treatment antidepressants.
Due to the long life expectancy of women compared to men, most women outlive their spouses, which is a stressful factor in older age. At this age, monitoring is necessary to detect symptoms of severe depression. Taking an anamnesis and examining the mental status of older women should include screening for somatic symptoms and identifying feelings of uselessness and a burden to loved ones, because depression in the elderly is not characterized by decreased mood as a primary complaint. Treatment of depression in the elderly is often complicated by low tolerance to antidepressants, so they must be prescribed in a minimum dose, which can then be gradually increased. SSRIs are not recommended at this age due to their anticholinergic side effects of sedation and orthostasis. When a patient takes several medicines drug monitoring in the blood is necessary due to the mutual influence on metabolism.
There is no single cause of depression. The main demographic risk factor is belonging to female. Analysis of population data shows that the risk of developing major depression is increased among those who are divorced, single, and unemployed. The role of psychological causes is being actively studied, but so far no consensus has been reached on this issue. Family studies have demonstrated an increased incidence of affective disorders in the proband's immediate relatives. Twin studies also support the idea of a genetic predisposition in some patients. Especially strong hereditary predisposition plays a role in the genesis of manic-depressive psychosis and major depression. The probable cause is disruption of the functioning of the serotonergic and noradrenergic systems.
The usual therapeutic approach to treatment is a combination of pharmacological agents - antidepressants - and psychotherapy. The emergence of a new generation of antidepressants with minimum quantity side effects has increased therapeutic options for patients with depression. There are 4 main types of antidepressants used: tricyclic antidepressants, SSRIs, MAO inhibitors and others - see table. 28-2.
A key principle in the use of antidepressants is the adequate duration of their use - a minimum of 6-8 weeks for each drug at a therapeutic dose. Unfortunately, many patients stop taking antidepressants before the effect develops because they do not see improvement in the first week. When taking tricyclic antidepressants, drug monitoring can help confirm that sufficient therapeutic blood levels have been achieved. For SSRIs this method is less useful, their therapeutic level varies greatly. If the patient does not take full course antidepressant and continues to experience symptoms of major depression, you must begin a new course of treatment with a different class of drug.
All patients receiving antidepressant treatment should be monitored for the development of symptoms of mania. Although it's enough rare complication taking antidepressants, it still happens, especially if there is a family or personal history of manic-depressive psychosis. Symptoms of mania include decreased need for sleep, feeling increased energy, agitation. Before prescribing therapy, patients must carefully collect anamnesis in order to identify symptoms of mania or hypomania, and if they are present or with a family history of manic-depressive psychosis, consultation with a psychiatrist will help select therapy with mood stabilizers - lithium, valproic acid, possibly in combination with antidepressants.
Seasonal affective disorders
For some people, the course of depression is seasonal, worsening in winter time. The severity of clinical symptoms varies widely. For moderate symptoms, irradiation with full-spectrum non-ultraviolet light (fluorescent lamps - 10 thousand lux) for 15-30 minutes every morning during the winter months is sufficient. If symptoms meet the criteria for major depression, antidepressant treatment should be added to light therapy.
Bipolar disorders (manic-depressive psychosis)
The main difference between this disease and major depression is the presence of both episodes of depression and mania. The criteria for depressive episodes are the same as for major depression. Manic episodes are characterized by bouts of elevated, irritable, or aggressive mood that last at least a week. These mood changes are accompanied by the following symptoms: increased self-esteem, decreased need for sleep, loud and rapid speech, racing thoughts, agitation, flashes of ideas. Such an increase in vital energy is usually accompanied by excessive behavior aimed at obtaining pleasure: spending large sums of money, drug addiction, promiscuity and hypersexuality, risky business projects.
There are several types of manic-depressive disorder: the first type is the classic form, type 2 includes alternating episodes of depression and hypomania. Episodes of hypomania are milder than classic mania, with the same symptoms, but not disrupting the patient's social life. Other forms of bipolar disorder include rapid mood swings and mixed states, when the patient has signs of both mania and depression.
First-line medications for treating all forms of bipolar disorder are mood stabilizers such as lithium and valproate. The initial dose of lithium is 300 mg once or twice daily, then adjusted to maintain blood levels of 0.8 to 1.0 mEq/L for bipolar first disorder. The level of valproate in the blood that is effective for the treatment of these diseases has not been precisely established; one can focus on the level recommended for the treatment of epilepsy: 50-150 mcg/ml. Some patients require a combination of mood stabilizers and antidepressants to treat symptoms of depression. A combination of mood stabilizers and low-dose antipsychotics is used to control symptoms of acute mania.
Dysthymia
Dysthymia is a chronic depressive condition that lasts at least two years, with symptoms less severe than those of major depression. The severity and number of symptoms are not sufficient to meet criteria for major depression, but they do impair social functioning. Symptoms typically include appetite disturbances, decreased energy, poor concentration, sleep disturbances, and feelings of hopelessness. Studies conducted in different countries indicate a high prevalence of dysthymia in women. Although there are few reports on treatment for this disorder, there is evidence that SSRIs such as fluoxetine and sertraline may be used. Some patients may experience episodes of major depression due to dysthymia.
Coexisting affective and neurological disorders
There is much evidence of associations between neurological disorders and mood disorders, more often with depression than with bipolar disorders. Episodes of major depression are common in Huntington's chorea, Parkinson's and Alzheimer's diseases. 40% of patients with parkinsonism experience episodes of depression – half have major depression, half have dysthymia. In a study of 221 patients with multiple sclerosis, 35% were diagnosed with major depression. Some studies have demonstrated an association between left frontal lobe stroke and major depression. Patients with AIDS develop both depression and mania.
Neurological patients with features that meet the criteria for mood disorders should be prescribed medications, since drug treatment of mental disorders improves the prognosis of the underlying neurological diagnosis. If the clinical picture does not meet the criteria for affective disorders, psychotherapy is sufficient to help the patient cope with difficulties. The combination of several diseases increases the number of prescribed drugs and sensitivity to them, and therefore the risk of delirium. In patients receiving multiple medications, antidepressants should be started at a low dose and increased gradually while monitoring for possible symptoms of delirium.
Alcohol abuse
Alcohol is the most commonly abused substance in the United States, with 6% of the adult female population having a serious drinking problem. Although the rate of alcohol abuse is lower in women than in men, alcohol dependence and alcohol-related morbidity and mortality are significantly higher in women. Alcoholism studies have focused on the male population; the validity of extrapolating their data to the female population is questionable. For diagnosis, questionnaires are usually used that identify problems with the law and employment, which are much less common among women. Women are more likely to drink alone and are less likely to have drunken rages. One of the main risk factors for the development of alcoholism in a woman is a partner with alcoholism, who inclines her to drinking buddies and does not allow her to seek help. In women, signs of alcoholism are more pronounced than in men, but doctors identify it in women less often. All this allows us to consider the official incidence of alcoholism in women to be underestimated.
Complications associated with alcoholism ( fatty degeneration liver, cirrhosis, hypertension, gastrointestinal bleeding, anemia and digestive disorders), women develop faster and at lower doses of alcohol than men, because women have lower levels of gastric alcohol dehydrogenase than men. Dependence on alcohol, as well as on other substances - opiates, cocaine - in women develops after a shorter period of use than in men.
There is evidence that the incidence of alcoholism and related medical problems increases in women born after 1950. During the phases of the menstrual cycle, no changes in the metabolism of alcohol in the body are observed, but women who drink are more likely to experience irregular menstrual cycles and infertility. During pregnancy, a common complication is alcohol syndrome fetus The incidence of cirrhosis increases sharply after menopause, and alcoholism increases the risk of alcoholism in older women.
Women with alcoholism are at increased risk for comorbid psychiatric diagnoses, especially drug addiction, mood disorders, bulimia nervosa, anxiety and psychosexual disorders. Depression occurs in 19% of women alcoholics and 7% of women who do not abuse alcohol. Although alcohol brings temporary relaxation, it exacerbates mental disorders in susceptible people. Several weeks of abstinence are required to achieve remission. Women with a paternal family history of alcoholism, anxiety disorder, and premenstrual syndrome drink more in the second phase of the cycle, possibly in an attempt to reduce symptoms of anxiety and depression. Alcoholic women are at high risk of suicide attempts.
Women usually seek salvation from alcoholism in a roundabout way, turning to psychoanalysts or general practitioners with complaints about family problems, physical or emotional complaints. They rarely go to alcoholism treatment centers. Alcoholic patients require a special approach due to their frequent inadequacy and reduced sense of shame.
Although asking these patients directly about the amount of alcohol they drink is practically impossible, screening for alcohol abuse should not be limited to indirect signs such as anemia, elevated liver enzymes and triglycerides. The question “have you ever had a problem with alcohol” and the CAGE questionnaire (Table 28-3) provide a rapid screening with a sensitivity of more than 80% for more than two positive answers. Support, explanation and discussion with the doctor, psychologist and members of Alcoholics Anonymous helps the patient adhere to treatment. During the abstinence period, it is possible to prescribe diazepam at a starting dose of 10-20 mg with a gradual increase by 5 mg every 3 days. Control visits should be at least twice a week, at which the severity of signs of withdrawal syndrome (sweating, tachycardia, hypertension, tremor) is assessed and the dose of the drug is adjusted.
Although alcohol abuse is less common in women than in men, its harm to women in terms of associated morbidity and mortality is significantly greater. New research is needed to elucidate the pathophysiology and psychopathology of sexual characteristics of the course of the disease.
Table 28-3
CAGE Questionnaire
1. Have you ever felt like you need to drink less?
2. Has it ever happened that people bothered you with their criticism of your alcohol intake?
3. Have you ever felt guilty about drinking alcohol?
4. Has it ever happened that alcohol was the only remedy that helped you become cheerful in the morning (open your eyes)
Sexual disorders
Sexual dysfunctions have three successive stages: disturbances of desire, arousal and orgasm. DSM-IV considers painful sexual disorders to be the fourth category of sexual dysfunction. Desire disorders are further divided into decreased sexual desire and perversions. Painful sexual disorders include vaginismus and dyspareunia. Clinically, women often have a combination of several sexual dysfunctions.
The role of sex hormones and menstrual cycle disorders in the regulation sexual desire remains unclear. Most researchers suggest that endogenous fluctuations in estrogen and progesterone do not have a significant effect on sexual desire in women of reproductive age. However, there is clear evidence of decreased desire in women with surgical menopause, which can be restored by the administration of estradiol or testosterone. Research on the relationship between arousal and orgasm and cyclic fluctuations in hormones does not provide clear conclusions. A clear correlation has been observed between the plasma level of oxytocin and the psychophysiological magnitude of orgasm.
In postmenopausal women, the number of sexual problems: decreased vaginal lubrication, atrophic vaginitis, decreased blood supply, which are effectively resolved with estrogen replacement therapy. Supplementation with testosterone helps increase sexual desire, although there is no clear evidence for the supportive effects of androgens on blood flow.
Psychological factors and communication problems play a much more important role important role in the development of sexual disorders in women than organic dysfunction.
The influence of medications taken by psychiatric patients on all phases of sexual function deserves special attention. Antidepressants and antipsychotic drugs are the two main classes of drugs associated with these side effects. Anorgasmia has been observed with the use of SSRIs. Despite clinical reports of the effectiveness of adding cyproheptadine or interrupting the main drug for the weekend, a more acceptable solution for now is to change the class of antidepressant to another one with fewer side effects in this area, most often to buproprion and nefazodone. In addition to the side effects of psychopharmacological drugs, a chronic mental disorder itself can lead to a decrease in sexual interest, as well as physical illnesses accompanied by chronic pain, low self-esteem, changes in appearance, fatigue. A history of depression may be a cause of decreased sexual desire. In such cases, sexual dysfunction occurs during the onset of the affective disorder, but does not subside after the end of the episode.
Anxiety disorders
Anxiety is a normal adaptive emotion that develops in response to threat. It works as a signal to activate behavior and minimize physical and psychological vulnerability. Reducing anxiety is achieved either by overcoming or avoiding the provoking situation. Pathological anxiety states differ from normal anxiety in the degree of severity and chronicity of the disorder, provoking stimuli, or adaptive behavioral response.
Anxiety disorders are widespread, with a monthly incidence of 10% among women. Average age development of anxiety disorders – teenage years and youth. Many patients never seek help for this issue or turn to non-psychiatrists with complaints about somatic symptoms related to anxiety. Excessive use of medications or their withdrawal, use of caffeine, weight loss drugs, pseudoephedrine can worsen anxiety disorders. The medical examination should include a thorough medical history, routine laboratory tests, ECG, and urine toxicology test. Some types of neurological pathology are accompanied by anxiety disorders: movement disorders, brain tumors, cerebral blood supply disorders, migraine, epilepsy. Somatic diseases accompanied by anxiety disorders: cardiovascular, thyrotoxicosis, systemic lupus erythematosus.
Anxiety disorders are divided into 5 main groups: phobias, panic disorders, generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. With the exception of obsessive-compulsive disorder, which is equally common in men and women, anxiety disorders are more common in women. In women, specific phobias and agoraphobia are three times more common, panic with agoraphobia is 1.5 times more common, generalized anxiety disorder is 2 times more common, and post-traumatic stress syndrome is 2 times more common. The reasons for the predominance of anxiety disorders in the female population are unknown; hormonal and sociological theories have been proposed.
Sociological theory focuses on traditional gender role stereotypes that prescribe helplessness, dependence, and avoidance of active behavior for women. Young mothers often worry about whether they can keep their children safe, about not wanting to become pregnant, about infertility—all of these conditions can exacerbate anxiety disorders. A large number of expectations and conflict in the roles of a woman - mother, wife, housewife and successful worker - also increase the frequency of anxiety disorders in women.
Hormonal fluctuations exacerbate anxiety in the premenstrual period, during pregnancy and after childbirth. Progesterone metabolites function as partial GABA agonists and possible modulators of the serotonergic system. Alpha-2 receptor binding also changes throughout the menstrual cycle.
For anxiety disorders, comorbidity with other psychiatric diagnoses is high, most often mood disorders, drug dependence, other anxiety disorders, and personality disorders. At panic disorders ah, for example, a combination with depression occurs more often than 50%, and with alcohol addiction– in 20-40%. Social phobia is combined with panic disorder in more than 50%.
The general principle of treating anxiety disorders is the combination of pharmacotherapy with psychotherapy - the effectiveness of such a combination is higher than using these methods in isolation from each other. Drug treatment affects three main neurotransmitter systems: noradrenergic, serotonergic and GABAergic. The following classes of drugs are effective: antidepressants, benzodiazepines, beta blockers.
All medications should be started at low doses and then gradually increased by doubling every 2-3 days or less frequently to minimize side effects. Patients with anxiety disorders are very sensitive to side effects, so gradually increasing the dose increases compliance with therapy. Patients should be explained that most antidepressants take 8 to 12 weeks to take effect, be told about the main side effects, be encouraged to continue taking the drug for the required amount of time, and explain that some of the side effects will subside over time. The choice of antidepressant depends on the patient’s set of complaints and its side effects. For example, patients with insomnia may be better off starting with a more sedating antidepressant such as imipramine. If effective, treatment should be continued for 6 months to a year.
At the beginning of treatment, before the effect of antidepressants develops, the addition of benzodiazepines is useful to sharply reduce symptoms. Long-term use of benzodiazepines should be avoided due to the risk of dependence, tolerance, and withdrawal symptoms. When prescribing benzodiazepines, it is necessary to warn the patient about their side effects, the risks associated with them long-term use and the need to consider them only as a temporary measure. Taking clonazepam 0.5 mg twice daily or lorazepam 0.5 mg four times daily for a limited period of 4–6 weeks may improve initial compliance with antidepressant treatment. When taking benzodiazepines for longer than 6 weeks, discontinuation should occur gradually to reduce anxiety associated with possible withdrawal symptoms.
Anxiolytics should be used with caution in pregnant women; the safest drugs in this case are tricyclic antidepressants. Benzodiazepines can lead to hypotension, respiratory distress syndrome and low Apgar scores in newborns. A minimal potential teratogenic effect was observed with clonazepam; this drug can be used with caution in pregnant women with severe anxiety disorders. The first step should be to try non-pharmacological treatment - cognitive (education) and psychotherapy.
Phobic disorders
There are three types of phobic disorders: specific phobias, social phobia and agoraphobia. In all cases, in a provoking situation, anxiety arises and a panic attack may develop.
Specific phobias are irrational fears of specific situations or objects that cause them to be avoided. Examples include fear of heights, fear of flying, fear of spiders. They usually appear before the age of 25; women develop a fear of animals first. Such women rarely seek treatment because many phobias do not interfere with normal life and their stimuli (such as snakes) are easy to avoid. However, in some cases, for example with a fear of flying, phobias can interfere with a career, in which case treatment is indicated. Simple phobias are quite easy to cope with psychotherapeutic techniques and systemic desensitization. Additionally, a single dose of 0.5 or 1 mg of lorazepam before flight helps reduce this specific fear.
Social phobia (fear of society) is the fear of a situation in which a person is exposed to the close attention of other people. Avoidance of provoking situations with this phobia sharply limits working conditions and social function. Although social phobia is more common in women, it is easier for them to avoid provoking situations and do housework, so in the clinical practice of psychiatrists and psychotherapists, men with social phobia are more often encountered. Movement disorders and epilepsy can be combined with social phobia. In a study of patients with Parkinson's disease, the presence of social phobia was detected in 17%. Pharmacological treatment of social phobia is based on the use of beta blockers: propranolol at a dose of 20-40 mg one hour before the alarm presentation or atenolol at a dose of 50-100 mg per day. These drugs block the activation of the autonomic nervous system due to anxiety. Antidepressants, including tricyclics, SSRIs, MAO blockers, can also be used - in the same doses as for the treatment of depression. A combination of pharmacotherapy with psychotherapy is preferable: short-term use of benzodiazepines or low doses of clonazepam or lorazepam in combination with cognitive therapy and systematic desensitization.
Agoraphobia is fear and avoidance of crowded places. Often combined with panic attacks. In this case, it is very difficult to avoid provoking situations. As with social phobia, agoraphobia is more common in women, but men are more likely to seek help because its symptoms interfere with their personal and social life. Treatment of agoraphobia consists of systemic desensitization and cognitive psychotherapy. Due to the high compatibility with panic disorders and major depression, antidepressants are also effective.
Panic disorders
A panic attack is sudden attack strong fear and discomfort, lasting several minutes, passing gradually and including at least 4 symptoms: chest discomfort, sweating, trembling, hot flash, shortness of breath, paresthesia, weakness, dizziness, palpitations, nausea, bowel disorders, fear of death, loss of control yourself. Panic attacks can occur with any anxiety disorder. They are unexpected and accompanied constant fear expectations of new attacks, which changes behavior and directs it to minimize the risk of new attacks. Panic attacks also occur with many states of intoxication and some diseases, such as emphysema. In the absence of therapy, the course of panic disorder becomes chronic, but treatment is effective, and the combination of pharmacotherapy with cognitive behavioral psychotherapy causes dramatic improvement in most patients. Antidepressants, especially tricyclics, SSRIs, and MAO inhibitors, in doses comparable to those used to treat depression, are the treatment of choice (Table 28-2). Imipramine or nortriptyline is started at a low dose of 10-25 mg per day and increased by 25 mg every three days to minimize side effects and increase compliance. Nortriptyline blood levels should be maintained between 50 and 150 ng/ml. Fluoxetine, fluvoxamine, tranylcypromine or phenelzine may also be used.
Generalized anxiety disorder
DSM-IV defines generalized anxiety disorder as persistent, severe, poorly controlled anxiety associated with daily activities such as work, school, that interferes with daily life and is not limited to symptoms of other anxiety disorders. There are at least three of the following symptoms: fatigue, poor concentration, irritability, sleep disturbances, anxiety, muscle tension.
Treatment includes medications and psychotherapy. The first-line drug for the treatment of generalized anxiety disorder is buspirone. The initial dose is 5 mg twice a day, gradually increasing it over several weeks to 10-15 mg twice a day. An alternative is imipramine or an SSRI (sertraline) (see Table 28-2). Short-term use of a long-acting benzodiazepine, such as clonazepam, may help control symptoms in the first 4 to 8 weeks before the main treatment takes effect.
Psychotherapeutic techniques used in the treatment of generalized anxiety disorder include cognitive behavioral therapy, supportive therapy and an internally oriented approach, which is aimed at increasing the patient’s tolerance to anxiety.
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Mental disorders- in a broad sense, these are diseases of the soul, meaning a state mental activity, different from healthy. Their opposite is mental health. Individuals who have the ability to adapt to daily changes living conditions and resolve everyday problems are generally considered mentally healthy individuals. When this ability is limited, the subject does not master the current tasks of professional activity or the intimate-personal sphere, and is also unable to achieve the designated tasks, plans, and goals. In a situation of this kind, one may suspect the presence of a mental abnormality. Thus, neuropsychiatric disorders are a group of disorders that affect the nervous system and behavioral response of an individual. The described pathologies may appear due to abnormalities in metabolic processes in the brain.
Causes of mental disorders
Neuropsychiatric diseases and disorders due to the numerous factors that provoke them are incredibly diverse. Disorders of mental activity, whatever their etiology, are always predetermined by deviations in the functioning of the brain. All causes are divided into two subgroups: exogenous factors and endogenous. The first include external influence, for example, the use of toxic substances, viral diseases, injuries, to the second - immanent causes, including chromosomal mutations, hereditary and genetic diseases, disorder mental development.
Resistance to mental disorders depends on specific physical characteristics and the general development of their psyche. Different subjects have different reactions to mental anguish and problems.
Typical causes of mental functioning deviations are identified: neuroses, depressive states, exposure to chemical or toxic substances, head injuries, heredity.
Anxiety is considered the first step leading to exhaustion of the nervous system. People often tend to imagine in their imagination various negative developments of events, which in reality never materialize, but provoke unnecessary unnecessary anxiety. Such anxiety gradually escalates and, as the critical situation increases, can transform into a more serious disorder, which leads to a deviation in the individual’s mental perception and to impaired functioning. various structures internal organs.
Neurasthenia is a response to prolonged exposure to traumatic situations. It is accompanied by increased fatigue and mental exhaustion against the background of hyperexcitability and constant attention to trifles. At the same time, excitability and grumpiness are protective means against the final failure of the nervous system. Individuals who are characterized by an increased sense of responsibility, high anxiety, who do not get enough sleep, and who are burdened with many problems are more prone to neurasthenic conditions.
As a result of a serious traumatic event, which the subject does not try to resist, hysterical neurosis occurs. The individual simply “escapes” into such a state, forcing himself to feel all the “charm” of the experience. This condition can last from two to three minutes to several years. Moreover, the longer the period of life it affects, the more pronounced the mental disorder of personality will be. Only by changing the individual's attitude towards own illness and attacks, it is possible to achieve a cure for this condition.
In addition, people with mental disorders are susceptible to weakened memory or its complete absence, paramnesia, and impaired thinking.
Delirium is also a frequent accompaniment of mental disorders. It can be primary (intellectual), sensory (imaginative) and affective. Primary delusion initially appears as the only sign of mental disorder. Sensual delirium manifests itself in a violation of not only rational knowledge, but also sensory one. Affective delusions always occur together with emotional deviations and are characterized by imagery. They also distinguish overvalued ideas, which mainly appear as a result of real-life circumstances, but subsequently occupy a meaning that does not correspond to their place in consciousness.
Signs of a mental disorder
Knowing the signs and characteristics of mental disorders, it is easier to prevent their development or identify them early stage the occurrence of a deviation rather than treating an advanced form.
TO obvious signs mental disorders include:
- the appearance of hallucinations (auditory or visual), expressed in conversations with oneself, in answers to interrogative statements of a non-existent person;
- causeless laughter;
— difficulty concentrating when completing a task or a thematic discussion;
- changes in the individual’s behavioral response towards relatives, often sharp hostility arises;
- speech may contain phrases with delusional content (for example, “it’s all my fault”), in addition, it becomes slow or fast, uneven, intermittent, confusing and very difficult to perceive.
People with mental disorders often try to protect themselves, and therefore they lock all the doors in the house, curtain the windows, carefully check every piece of food, or completely refuse to eat.
You can also highlight signs of mental abnormality observed in females:
- overeating leading to obesity or refusal to eat;
- alcohol abuse;
- sexual dysfunction;
- depression;
- fast fatiguability.
In the male part of the population, signs and characteristics of mental disorders can also be identified. Statistics say that the stronger sex suffers from mental disorders much more often than women. In addition, male patients are characterized by more aggressive behavior. So, common signs include:
- sloppiness appearance;
- there is sloppiness in appearance;
- can be avoided for a long time hygiene procedures(do not wash or shave);
- rapid mood changes;
— emotional and behavioral deviations in childhood;
- Personality disorders.
More often, mental illnesses and disorders arise in childhood and adolescence. Approximately 16 percent of children and adolescents have mental health problems. The main difficulties that children face can be divided into three categories:
- mental development disorder - children, in comparison with their peers, lag behind in the formation of various skills, and therefore experience difficulties of an emotional and behavioral nature;
- emotional defects associated with severely damaged feelings and affects;
— expansive pathologies of behavior, which are expressed in the deviation of the baby’s behavioral reactions from social principles or manifestations of hyperactivity.
Neuropsychiatric disorders
Modern express rhythm of life forces people to adapt to different environmental conditions, sacrifice sleep, time, and energy in order to get everything done. There is no way a person can do everything. The price to pay for constant haste is health. The functioning of systems and the coordinated work of all organs is directly dependent on the normal activity of the nervous system. Impacts external conditions Negative environments can cause mental illness.
Neurasthenia is a neurosis that arises against the background of psychological trauma or overwork of the body, for example, due to lack of sleep, lack of rest, or prolonged hard work. The neurasthenic state develops in stages. At the first stage, aggressiveness and increased excitability, sleep disturbance, and inability to concentrate on activities are observed. At the second stage, irritability is noted, which is accompanied by fatigue and indifference, decreased appetite, discomfort in the epigastric region. Headaches, slow or increased heart rate, and tearfulness may also occur. The subject at this stage often takes any situation “to heart.” At the third stage, the neurasthenic state turns into an inert form: the patient is dominated by apathy, depression and lethargy.
Obsessive states are a form of neurosis. They are accompanied by anxiety, fears and phobias, and a sense of danger. For example, an individual may worry excessively about the hypothetical loss of some thing or be afraid of contracting a particular illness.
Obsessive-compulsive disorder is accompanied by repetition identical thoughts that have no significance for the individual, performing a series of mandatory manipulations before doing something, the appearance of absurd desires of an obsessive nature. The symptoms are based on a feeling of fear of going against the inner voice, even if its demands are absurd.
Conscientious, fearful individuals who are unsure of their own decisions and subordinate to the opinions of those around them are usually susceptible to such a violation. Obsessive fears are divided into groups, for example, there is a fear of the dark, heights, etc. They are observed in healthy individuals. The reason for their occurrence is associated with a traumatic situation and the simultaneous impact of a specific factor.
You can prevent the occurrence of the described mental disorder by increasing confidence in your own importance, developing independence from others and independence.
Hysterical neurosis is either found in increased emotionality and the individual’s desire to draw attention to himself. Often such a desire is expressed by rather eccentric behavior (deliberately loud laughter, pretentious behavior, tearful hysterics). With hysteria, decreased appetite, increased temperature, weight changes, and nausea may be observed. Since hysteria is considered one of the most complex forms of nervous pathologies, it is treated with the help of psychotherapeutic agents. It occurs as a result of suffering a serious injury. At the same time, the individual does not resist traumatic factors, but “runs away” from them, forcing him to feel painful experiences again.
The result of this is the development of pathological perception. The patient enjoys being in a hysterical state. Therefore, it is quite difficult to bring such patients out of this state. The range of manifestations is characterized by scale: from stamping feet to rolling in convulsions on the floor. The patient tries to benefit from his behavior and manipulates the environment.
The female sex is more prone to hysterical neuroses. To prevent attacks of hysteria, temporary isolation of people suffering from mental disorders is useful. After all, as a rule, for individuals with hysteria, the presence of an audience is important.
There are also severe mental disorders that are chronic and can lead to disability. These include: clinical depression, schizophrenia, bipolar affective disorder, identities, epilepsy.
With clinical depression, patients feel depressed, unable to rejoice, work or conduct usual social activities. Persons with mental disorders caused by clinical depression, are characterized by bad mood, lethargy, loss of usual interests, and lack of energy. Patients are unable to “pull themselves together.” They experience uncertainty, decreased self-esteem, increased feelings of guilt, pessimistic ideas about the future, appetite and sleep disorders, and weight loss. In addition, somatic manifestations may be observed: disturbances in the functioning of the gastrointestinal tract, pain in the heart, head and muscles.
The exact causes of schizophrenia have not been studied for certain. This disease characterized by deviations in mental activity, logic of judgment and perception. Patients are characterized by detachment of thoughts: the individual seems that his worldview was created by someone outsider and stranger. In addition, withdrawal into oneself and personal experiences and isolation from the social environment are characteristic. Often people with mental disorders caused by schizophrenia experience ambivalent feelings. Some forms of the disease are accompanied by catatonic psychosis. The patient may remain motionless for hours, or express motor activity. With schizophrenia, emotional dryness may also be observed even in relation to those closest to you.
Bipolar affective disorder is an endogenous illness that manifests itself in alternating phases of depression and mania. Patients experience either a rise in mood and a general improvement in their condition, or a decline, immersion in the blues and apathy.
Dissociative identity disorder is a mental pathology in which the patient experiences a “division” of personality into one or more component parts that act as separate entities.
Epilepsy is characterized by the occurrence of seizures, which are provoked by the synchronous activity of neurons in a certain area of the brain. The causes of the disease may be hereditary or other factors: viral disease, traumatic brain injury, etc.
Treatment of mental disorders
The picture of treatment for mental functioning deviations is formed based on the medical history, knowledge of the patient’s condition, and the etiology of a particular disease.
Used to treat neurotic conditions sedatives due to their calming effect.
Tranquilizers are mainly prescribed for neurasthenia. Drugs in this group can reduce anxiety and relieve emotional tension. Most of them also reduce muscle tone. Tranquilizers primarily have a hypnotic effect rather than causing changes in perception. Side effects are expressed, as a rule, in a feeling of constant fatigue, increased drowsiness, and difficulties in remembering information. Negative manifestations also include nausea, low blood pressure and decreased libido. The most commonly used are Chlordiazepoxide, Hydroxyzine, and Buspirone.
Neuroleptics are the most popular in the treatment of mental pathologies. Their effect is to reduce mental arousal, reduce psychomotor activity, reduce aggressiveness and suppress emotional tension.
The main side effects of antipsychotics include a negative effect on skeletal muscles and the appearance of abnormalities in dopamine metabolism. The most commonly used antipsychotics include: Propazine, Pimozide, Flupenthixol.
Antidepressants are used in a state of complete depression of thoughts and feelings, and decreased mood. Drugs in this series increase the pain threshold, thereby reducing pain during migraines provoked by mental disorders, improve mood, relieve apathy, lethargy and emotional tension, normalize sleep and appetite, and increase mental activity. The negative effects of these drugs include dizziness, tremors of the limbs, and confusion. The most commonly used antidepressants are Pyritinol and Befol.
Normotimics regulate inappropriate expression of emotions. They are used to prevent disorders that include several syndromes that manifest themselves in stages, for example, with bipolar affective disorder. In addition, the described drugs have an anticonvulsant effect. Side effects include trembling of the limbs, weight gain, disruption of the gastrointestinal tract, and unquenchable thirst, which subsequently leads to polyuria. It is also possible to appear various rashes on the skin surface. The most commonly used are lithium salts, Carbamazepine, Valpromide.
Nootropics are the most harmless among medications that help cure mental pathologies. They have a beneficial effect on cognitive processes, enhance memory, and increase the resistance of the nervous system to the effects of various stressful situations. Sometimes side effects include insomnia, headaches and digestive disorders. The most commonly used are Aminalon, Pantogam, Mexidol.
In addition, hypnotechniques and suggestion are widely used, but are less commonly used. In addition, the support of relatives is important. Therefore, if a loved one suffers from a mental disorder, then you need to understand that he needs understanding, not condemnation.
Women are emotional and sensitive creatures, and therefore are more susceptible to nervous and mental disorders than men. Moreover, for a certain period in the life of the fair half, certain mental disorders are characteristic.
Of course, not for everyone and not always, but the risk exists. The main thing here is to recognize the symptoms in time and start timely treatment. This will help return life to its usual course.
What are the signs of a mental disorder, what is the behavior of women? Let's talk about this today on the Popular About Health website:
Common mental disorders
Representatives of the fairer sex often suffer from mental disorders: depression, eating disorders, seasonal affective and somatization mental disorders.
They often have hysterical attacks of panic, anxiety and fear. Manic-depressive psychosis, various phobias and suicidal attempts may occur.
For each period, critical stage in life, there is a group of the most likely mental disorders. Let's look at them in more detail:
During childhood, girls are much less likely to develop mental health problems than boys of the same age. But even at this stage they are not immune from the occurrence of anxiety states and disorders associated with relationships with peers and learning disabilities.
Young girls are more likely to develop premenstrual dysphoria, which may appear after the first menstrual bleeding. Well, after puberty, girls are twice as likely as boys to suffer from depression.
Young women are susceptible to a variety of mental health problems during pregnancy and after childbirth. They are frightened by the fear of pregnancy and future motherhood, frequent mood swings occur, and depression and other disorders may develop.
Most often, everything goes away soon and no treatment is required. However, some experience more severe symptoms of a psychotic disorder that require immediate treatment.
Women of the so-called middle age are at high risk of developing affective and anxiety states, fears, mood swings and other disorders, including schizophrenia. At this age, sexual function may decrease, especially while taking antidepressants.
During menopause, the risk of severe depression increases. In addition to hormonal changes, which are not in the best possible way affect mental health, many experience changes in personal life and family.
During menopause, women experience severe physical discomfort, which is also associated with hot flashes. They often have tantrums. It should be noted here that this period is experienced most strongly by those women who previously had problems with the nervous system or psyche.
Most older women shift their attention from raising children, who are now adults, to aging parents. Some become, in the literal sense of the word, nurses - they take upon themselves all the care and care for them. Which undoubtedly reduces the quality of life.
As you age, your likelihood of developing dementia, stroke, and related psychiatric complications increases.
In older women, who usually have many somatic pathologies and take a large number of different medications, the risk of delirium increases. After 60 years, they often suffer from a psychotic disorder - paraphrenia.
In addition, elderly and senile women begin to lose loved ones, some even remain completely alone. They experience all this very hard, which cannot but affect their mental state.
How to recognize the problem, what behavior?
There are common characteristic signs of mental disorder in women. They are associated with changes in behavior and attitude towards others. You must understand that often they themselves do not notice anything strange about themselves.
Therefore, loved ones should know the symptoms of disorders in order to provide timely help to a loved one. Here are the most common ones:
Frequent hysterics and scandals, often out of nowhere. This often happens in women who are not resistant to stress.
There is a strong craving for the occult, everything supernatural and unreal - magical and religious rituals, shamanism, etc.
Often overcome by anxieties, fears and phobias.
Concentration decreases, lethargy appears, mental activity is impaired, and there is a lack of activity.
Apathy occurs, loss of strength occurs, frequent shifts moods for no reason.
Sleep is disturbed. This manifests itself in insomnia or excessive sleepiness.
Appetite is disrupted - from bouts of gluttony to complete reluctance to eat.
Reasons to immediately contact a specialist are also: confusion in consciousness, forgetfulness, inadequate self-esteem, as well as obsession, or complete reluctance to communicate and, of course, suicidal thoughts or actions.
Treatment of mental disorders is carried out comprehensively and includes drug therapy and psychotherapy. It is also recommended to change the diet in favor of foods rich in vitamins and eliminate alcohol.
You can use infusions of plants that have a calming effect. In particular, healers recommend taking tinctures of valerian, chamomile, mint, St. John's wort, etc.
However, in any case, before doing anything, you must consult with a specialist - a psychotherapist or psychiatrist. Be healthy!
The symptoms and signs of schizophrenia in women should be known in order to promptly begin treatment for this disorder. Although, of course, the diagnosis of the disease and the therapeutic course should not be prescribed independently, but by a qualified doctor.
The development of schizophrenia in women can be assumed based on some symptoms
Schizophrenia, which affects females, is practically no different from the same disorder diagnosed in males.
This is about pathological disorders in the emotional as well as mental sphere, as a result of which certain personality defects are formed.
Researchers cite a genetic factor as the main reason.. In particular, genes were found in sick people that are directly related to the development of the described mental disorder. This does not necessarily mean that a person will develop schizophrenia, but such a danger exists for both him and his children.
- When one parent is schizophrenic, there is a 14 percent chance that the child will develop symptoms.
- If both parents are sick, the risk increases to 46 percent.
Therefore, the doctor always asks the patient whether any of her relatives suffer from mental disorders - schizoaffective, suicidal, dysthymia, and so on.
But you shouldn’t focus on heredity alone. Schizophrenia is sometimes triggered by stress, alcohol and drug abuse, and so on.
Accordingly, the symptoms of schizophrenia in women with signs are very diverse.
Postpartum disorders
Interestingly, the first signs of schizophrenia appear in women after childbirth. They are considered as postpartum psychosis. Of course, childbirth is not the cause, but only the stimulus that triggers the disease.
It is quite possible that the hereditary background of such a woman in labor is heavily burdened. The trigger for postpartum mental changes is hormonal changes, as well as the stress that one has to endure.
It is likely that the disorder could develop in other cases, being caused by other factors.
Schizophrenia may begin to develop after childbirth
Onset of the disease
How does schizophrenia begin in women, at what age and by what first signs can it be identified? Traditionally, this happens to girls between 20 and 25 years old, although it is possible to observe symptoms in children and teenagers. Senile schizophrenic disorder occurs less frequently, but this is not excluded.
Based on a woman's behavior, it can be assumed that she has initial signs schizophrenia:
- obsessive movements;
- psychotic character;
- development of delusional ideas;
- aggressive state;
- irritability;
- weakening of emotions;
- loss of interests.
You can notice the onset of the disease by the patient performing meaningless rituals and other inappropriate actions, obsessive fears. A person’s immersion in pathological experiences does not allow him to pay attention to what is happening around him and what those around him are doing. She does not realize the absurdity of her own actions.
It is important not to confuse schizophrenic illness with any other pathology. For example, hypochondriacal mood can be caused by:
- the same worms migrating throughout the body;
- rotting organs;
- problems with blood vessels and so on.
Suffering from somatoform disorders, people first invent symptoms for themselves (after reading, for example, medical literature or talking with other patients), and then, in reality, begin to feel them.
Such signs of insanity most often indicate a sluggish disorder in women or a psychotic-like nature of the disease. Inappropriate behavior is expressed in loud laughter or crying, mannerisms, and so on.
Sometimes it all starts with a feeling of depersonalization. For example, a woman looks in the mirror and is unable to recognize her image; she says that it is some other person.
Delusional ideas
Schizophrenia can be latent or begins quite acutely. In the latter case, the patient experiences hallucinations, develops delusional ideas, and hears some voices inside her head.
The danger comes from hallucinations that are imperative in nature, when the voices in your head begin to command. It is very difficult for the patient to resist such orders and, accordingly, she becomes dangerous.
How else to recognize the disease? For crazy ideas:
- Delusions of persecution characteristic of paranoid schizophrenia. The woman suddenly begins to feel as if she is constantly being watched and stalked. She can perceive ordinary passers-by as intelligence agents. This is where the fear of being alone and leaving the house arises.
- Unreasonable jealousy- arises despite the fact that there is no factual basis for this. A man may be the most faithful, but a woman suffering from this delusion will, during a period of exacerbation, herself come up with phantom lovers for him, adding to this number all possible acquaintances and strangers, neighbors, and work colleagues.
- Delirium of influence– a characteristic sign of female schizophrenic disorder. The patient sincerely believes that someone controls her behavior and thoughts, influences her with “invisible rays.”
- Delirium of relationships– the patient believes that she is being mocked, she is being discussed.
- Physical disabilities- this type of delirium involves the patient’s feelings associated with the fact that she considers herself ugly and finds some ugly sides in herself. For example, having a small nose, she suddenly begins to consider it too large. Or, having a normal weight, she believes that she is too fat, and therefore does everything possible to get rid of excess weight. No matter what logical arguments you make, you will not be able to dissuade the patient.
Delusions of jealousy make you suspect even an absolutely faithful loved one of cheating
Symptoms and signs of female schizophrenia from the very beginning can be associated with causeless aggression, anger, and negative feelings towards those closest to them. Moreover, emotional splitting is possible, when the patient treats one person with both love and hatred.
Stages of the disease
There are such stages of schizophrenia in women (the distinction is quite arbitrary, but doctors use it):
- initial manifestations– the onset of the disease with some, not yet very pronounced symptoms;
- advanced stage– mental disorder begins to develop, symptoms expand;
- defect– neurosis-like symptoms are replaced by personality changes, disturbances in the thought process, and apathy.
It is not necessary for the disease to proceed according to this pattern every time. Some patients already initially encounter emotional disturbances, and all other symptoms arise subsequently. Sometimes it is possible not to “meet” disorders such as hallucinations and delusions at all.
Signs of schizophrenia in a girl are noticeable in her behavior (although in the case of a secretive form it is more difficult to diagnose the disease): even if the person was previously emotionally active, after the disorder develops, indifference, coldness will appear, and much of what was of interest before will become uninteresting. Another point that should be noted in behavior is the patient staying in one place for a long time without moving, looking in one direction.
Schizophrenia can be suspected by the patient’s untidiness: often even basic rules of hygiene are not followed. She stops cooking, sometimes puts on makeup, but inappropriately, vulgarly, quits studying and/or working, and neglects her family.
If you watch a video of the behavior of a woman with schizophrenia, the corresponding signs become immediately obvious.
What's the worst?
It is personal changes that can safely be called the worst manifestations mental disorders. If you do not understand how to treat this disease in a timely manner, these changes may become irreversible.
The progression of the schizophrenic condition over time leads to loss personal properties and any emotional manifestations. A feeling of apathy remains.
A sick person, as a rule, does not need anything: neither her family members, nor work or hobbies. Accordingly, loved ones suffer from this - especially children who suddenly lost their mother’s love.
The progression of schizophrenia can lead to complete apathy towards everything
The occurrence of catatonic signs is also possible: as already indicated, this is freezing in some position, silence, lack of response to any requests. Or behavior becomes noticeably passive.
That is why it is necessary to begin treatment of the described disease as early as possible and not delay it. At the same time, you cannot do this on your own: both the diagnosis and the therapeutic process must be carried out by qualified doctors.
About treatment
Is there a cure for schizophrenia in women? Can we cure the disease at all? Of course, yes, but the success of therapy largely depends on the type of disease, its stage and the individual characteristics of the patient.
Doctors usually use antipsychotics, antidepressants, nootropics, thymostabilizers and various vitamin complexes.
What exactly to treat? Neuroleptics perform the following functions:
- eliminate hallucinatory experiences;
- get rid of delusional ideas;
- calm aggression;
- free from catatonic manifestations.
In particular, we can recall Tizercin and Aminazine.
What to do about emotional and cognitive signs? To stop them, you will need to use atypical antipsychotics, like Olanzapine or Quetiapine. However, it should be understood that this will not stop the progression of the disorder.
Usually, treatment course lasts quite a long time - at least several months - and involves the following stages:
- active therapy– when acute symptoms are eliminated (takes about a couple of months);
- stabilizing treatment– medication dosages are reduced, it is necessary to consolidate the achieved effect (takes about three months);
- maintenance therapy– helps to avoid relapse of the disease and lasts about six months.
Naturally, along with drug treatment, some psychotherapeutic techniques are used. After relief of acute manifestations, patients need social adaptation.
Age-related disorders
What about symptoms of schizophrenia in older people? In principle, they coincide with the signs of the disorder in young girls.
Older women, as well as those under 30, may suffer from:
- delusional manifestations;
- hallucinations;
- confused speech (suggesting impaired formal thinking);
- inappropriate behavior;
- dulling of reactions;
- social dysfunctions;
- alogy.
Some external signs in adults you can see it even in photos and, even more so, in videos. It is, of course, more difficult to treat senile schizophrenia than in young people due to mental instability and a weakened body in old age.
Latent form
The latent form of schizophrenia (also called latent) involves a minimum of signs and their rather weak level of severity. There are no productive symptoms (such as hallucinations and delusions), but there is emotional cooling, autism and moments of mental splitting.
At first, it is difficult to even understand what kind of schizophrenic disorder is developing - a simple form or a paranoid one. Only a psychotherapist can be responsible for diagnosis. It is likely that he will suggest that the patient undergo a test to determine this disease (he will also be able to recognize the disease based on the collected medical history). But it’s better not to engage in self-diagnosis.
The latent form of schizophrenia may be paranoid
conclusions
The topic of female schizophrenia is of interest to many today. Husbands, for example, check symptoms to see if their wives suffer from a similar disorder. Parents worry about their daughters, in whose behavior they perceive inadequacy, and children suspect the development of such a disease in their elderly mothers.
Anything is possible, but an accurate diagnosis can only be made by a qualified doctor, who will prescribe the appropriate treatment.
