Psychopathology in infectious diseases. Mental disorders in infectious brain lesions

Psychoses, the main cause of the occurrence and development of which are infections, and the psychopathological picture is determined by typical reactions of an exogenous type, are called infectious.

Reactions of the exogenous type include the following syndromes: asthenic, delirious, Korsakovsky, epileptiform agitation (twilight state), catatonia, hallucinosis. This kind of psychopathological symptomatology may accompany common infections(typhoid, malaria, tuberculosis, etc.) or be a clinical expression of an infection with brain localization. With meningitis, the membranes of the brain are predominantly affected, with encephalitis - the substance of the brain itself, with meningoencephalitis a combined lesion is observed. Some common infections may be complicated by encephalitis

261 Chapter 20. Disorders with infectious diseases

(for example, purulent infection, influenza, malaria) or meningitis (for example, tuberculosis).

At the beginning of the 20th century. the concept of exogenous types of reactions by K. Bongeffer appeared, the essence of which was to recognize reactions as similar psychic forms disorders to various exogenous hazards.

Statistical data on the frequency of infectious psychoses in certain regions of the country, given by various authors are characterized by sharp fluctuations (from 0.1 to 20% of patients admitted to psychiatric hospitals), which is associated with differences in the diagnosis of infectious psychoses and unequal assessment of the role of the infectious factor in the occurrence of mental illnesses. To a lesser extent, the ratio of the numbers of infectious psychoses and other mental illnesses depends on the epidemiological characteristics of a particular area in a certain period.

Clinical manifestations

Of the non-psychotic disorders during the period of an infectious disease and during the period of convalescence, asthenic ones are most often observed. Patients get tired quickly and easily, complain of headaches, weakness, and lethargy. Sleep becomes shallow with nightmares. Mood instability is noted (the background mood is often low, patients are prone to sadness, irritability, and quick-tempered). The patients' movements are slow and sluggish.

The most characteristic of acute infectious psychoses are states of upset consciousness and, in particular, stupefaction: delirious or amentive syndrome, less often - twilight stupefaction. Disturbances of consciousness often develop at the height of the temperature reaction; their structure reveals acute sensory delirium in combination with vivid visual and auditory hallucinations. These phenomena disappear after the feverish period has passed.

Infectious psychosis may develop after normalization of body temperature. Upon passing acute period severe infection, amentia syndrome may be observed with the transition to deep asthenia with hyperesthesia and emotional weakness.

Protracted and chronic infectious psychoses are characterized by: amnestic Korsakoff syndrome (with a tendency to

262 Section III. Certain forms of mental illness

gradual recovery of memory disorders), hallucinatory-paranoid, catatonic-hebephrenic syndromes against the background of formally clear consciousness. The last two syndromes are sometimes difficult to distinguish from the symptoms of schizophrenia. Of great importance in the differential diagnostic plan is the identification of personality changes characteristic of schizophrenia (autism, emotional impoverishment of personality, etc.) or infectious psychoses ( emotional lability, memory impairment, etc.). In this case, it is necessary to take into account the complex of all symptoms, as well as serological and other laboratory data important for diagnosis.

In infections associated with direct damage to the brain tissue and its membranes (neurotropic infections: rabies, epidemic tick-borne encephalitis, Japanese mosquito encephalitis, meningitis), the following clinical picture of the acute period is observed: against the background of severe headaches, often vomiting, stiffness of the neck muscles and other neurological symptoms (Kernig's symptom, diplopia, ptosis, speech impairment, paresis, signs of diencephalic syndrome, etc.) develop stupefaction, oneiric (dream-like) stupefaction, motor agitation with delusional and hallucinatory disorders.

With encephalitis, symptoms of psychoorganic syndrome are revealed. There is a decrease in memory and intellectual productivity, inertia mental processes, especially intellectual, the difficulty of switching active attention and its narrowness, as well as emotional-volitional disorders with their excessive lability, incontinence. Psychoorganic syndrome in most cases has a chronic regressive course. Mental disorders in encephalitis are combined with neurological disorders. As a rule, persistent and intense headaches, central and peripheral paralysis and paresis of the limbs, hyperkinetic disorders, speech disorders and cranial nerve function, epileptiform seizures. Body temperature often rises to high readings(39-40°C). Vasovegetative disorders (fluctuations in blood pressure, hyperhidrosis) are noted.

In a chronic course, infectious psychoses, with all the variety of mental disorders, often lead to personality changes of the type of organic syndrome.

263 Chapter 20. Disorders in infectious diseases Etiology and pathogenesis

In infectious psychosis, clinical manifestations are determined by the individual characteristics of the patient to respond to exogenous harm.

The pathogenesis of mental disorders in various infectious diseases is not the same. It is believed that in acute infections there is a pattern toxic encephalopathy with degenerative changes in neurons; at chronic infections Vascular pathology and hemo- and liquorodynamic disorders are of greatest importance.

Treatment

In the presence of an infectious disease, the underlying disease is treated with the addition of detoxification therapy (polyglucin, reopolyglucin), and vitamin therapy. In the presence of acute psychosis with agitation or confusion, the use of tranquilizers is recommended (seduxen intramuscularly 0.01-0.015 g 3-4 times a day), with increasing agitation - haloperidol (0.005-0.01 g intramuscularly 2-3 times a day) .

For amnestic syndrome and other psychoorganic disorders, it is advisable to prescribe nootropil (piracetam) (from 0.4 to 2-4 g per day), aminalon (up to 2-3 g per day), seduxen, grandaxin (up to 0.02-0.025 g per day). day), vitamins.

Chapter 20

^ MENTAL DISORDERS IN INFECTIOUS DISEASES

Psychoses, the main cause of the occurrence and development of which are infections, and the psychopathological picture is determined by typical reactions of an exogenous type, are called infectious.

Reactions of the exogenous type include the following syndromes: asthenic, delirious, Korsakovsky, epileptiform agitation (twilight state), catatonia, hallucinosis. This kind of psychopathological symptomatology can accompany common infections (typhoid, malaria, tuberculosis, etc.) or be a clinical expression of an infection with brain localization. With meningitis, the membranes of the brain are predominantly affected, with encephalitis - the substance of the brain itself, with meningoencephalitis a combined lesion is observed. Some common infections may be complicated by encephalitis

^ 261 Chapter 20. Disorders in infectious diseases

(for example, purulent infection, influenza, malaria) or meningitis (for example, tuberculosis).

At the beginning of the 20th century. the concept of exogenous types of reaction by K. Bongeffer appeared, the essence of which was the recognition of the response of similar mental forms of disorders to various exogenous harms.

Statistical data on the frequency of infectious psychoses in certain regions of the country, cited by various authors, are characterized by sharp fluctuations (from 0.1 to 20% of patients admitted to psychiatric hospitals), which is associated with differences in the diagnosis of infectious psychoses and unequal assessment of the role of the infectious factor in the occurrence of mental disorders. diseases. To a lesser extent, the ratio of the numbers of infectious psychoses and other mental illnesses depends on the epidemiological characteristics of a particular area in a certain period.

^ Clinical manifestations

Infectious psychosis can develop even after body temperature normalizes. After the acute period of severe infection has passed, amentia syndrome may occur with the transition to deep asthenia with hyperesthesia and emotional weakness.

Protracted and chronic infectious psychoses are characterized by: amnestic Korsakoff syndrome (with a tendency to

^ 262 Section III. Certain forms of mental illness

gradual recovery of memory disorders), hallucinatory-paranoid, catatonic-hebephrenic syndromes against the background of formally clear consciousness. The last two syndromes are sometimes difficult to distinguish from the symptoms of schizophrenia. Of great importance in the differential diagnostic plan is the identification of personality changes characteristic of schizophrenia (autism, emotional impoverishment of personality, etc.) or infectious psychoses (emotional lability, memory impairment, etc.). In this case, it is necessary to take into account the complex of all symptoms, as well as serological and other laboratory data important for diagnosis.

With encephalitis, symptoms of psychoorganic syndrome are revealed. There is a decrease in memory and intellectual productivity, inertia of mental processes, especially intellectual ones, difficulty in switching active attention and its narrowness, as well as emotional-volitional disorders with their excessive lability, incontinence. Psychoorganic syndrome in most cases has a chronic regressive course. Mental disorders in encephalitis are combined with neurological disorders. As a rule, persistent and intense headaches, central and peripheral paralysis and paresis of the limbs, hyperkinetic disorders, speech disorders and cranial nerve function disorders, and epileptiform seizures are observed. Body temperature often rises to high levels (39-40°C). Vasovegetative disorders (fluctuations in blood pressure, hyperhidrosis) are noted.

In a chronic course, infectious psychoses, with all the variety of mental disorders, often lead to personality changes of the type of organic syndrome.

^ 263 Chapter 20. Disorders in infectious diseases Etiology and pathogenesis

In infectious psychosis, clinical manifestations are determined by the individual characteristics of the patient to respond to exogenous harm.

The pathogenesis of mental disorders in various infectious diseases is not the same. It is believed that during acute infections a picture of toxic encephalopathy with degenerative changes in neurons is observed; in chronic infections, vascular pathology and hemo- and liquorodynamic disorders are of greatest importance.

Treatment

For hallucinatory-paranoid syndrome, it is recommended to prescribe antipsychotics.

Psychotic disorders in infectious psychosis in most cases entail exculpation.

In the event of the occurrence of infectious psychoses after the commission of an offense, when the mental state of the subject temporarily deprives him of the opportunity to participate in the investigation and trial, the person is given appropriate treatment, and only after he recovers from psychosis is the question of his sanity resolved.

The forensic psychiatric significance of acute infectious diseases is small, since offenses committed by these patients

^ 264 Section III. Certain forms of mental illness

we are committed extremely rarely. Of great forensic psychiatric significance are cases when a psychoorganic syndrome is formed in patients after prolonged infectious psychoses with consequences of infectious encephalitis and in patients with a protracted chronic course of an infectious disease. If a shallow intellectual decline is detected, a person’s critical attitude to his condition, to the current situation, as well as insignificant changes in the emotional-volitional sphere with a more or less pronounced intellectual defect or predominant neurosis-like and psychopathic changes that do not prevent the subject from being aware of the situation and directing his actions, then a finding of sanity is made.

Prisoners during the period of infectious psychosis are recognized as insane.

Non-mental disorders observed in patients with infectious diseases, most often manifested in the form of asthenic syndrome, do not, as a rule, entail, during a forensic psychiatric examination, an exemption from responsibility for their actions and actions, and the subjects in most cases are recognized as sane.

When conducting an examination in civil proceedings in the presence of psychosis (or certain psychotic disorders), the decision on the issue of legal capacity is usually postponed until the subject recovers from psychosis.

It is not easy to resolve the issue of legal capacity in case of severe asthenic condition, a predominant chronic course, complicated by other associated factors. At the same time, the corresponding personality structure with its characteristics is also taken into account.

^ Mental disorders in AIDS

In the clinical picture of AIDS, mental disorders occupy a special place and, along with other manifestations of this disease, have a certain significance for the diagnosis, tactics of management and treatment of these patients, as well as expert assessment.

Premorbid personality traits of patients with AIDS are often characterized by psychopathic characteristics, among which hysterical traits are most often identified (in the manner of

^ 265 Chapter 20. Disorders in infectious diseases

ity, theatricality of gestures, facial expressions). Various sexual perversions, including homosexuality, are often discovered. There are signs of antisocial behavior.

Often, even during the incubation period (from infection to the first manifestations of AIDS), lasting from several weeks to several years, asthenic signs are revealed: increased fatigue, irritability, sleep disturbances, appetite, decreased mood with a drop in activity. Information about the fact of infection with AIDS by patients is either underestimated and manifested by anosognosia - denial, or is perceived as stress with subsequent depression, ideas of self-blame with suicidal thoughts and tendencies; pronounced reactive psychopathological states manifest themselves mainly in neurotic and psychotic symptoms with an obsessive-anxious picture.

IN initial period AIDS, along with the appearance of somatic manifestations of infection, neurotic symptoms are revealed, a neurasthenic-like syndrome with impaired concentration, difficulty remembering and emotional lability, with a predominance of sadness and anxiety, is more often observed.

At later stages of the development of the disease, amnestic disorders become more pronounced, reminiscent of manifestations of fixation amnesia, memory of the past is more preserved, criticism decreases, overvalued ideas appear with a tendency to overestimate the abilities of one’s personality. Thinking becomes prone to detail. Emotional incontinence appears.

The clinical psychopathological picture is dynamic with periods of temporary improvement mental state, however, with the development of the disease and its progression, there is a tendency for mental disorders to worsen to a pronounced psychoorganic syndrome with a gross manifestation of dementia. Mental disorders are combined with severe general somatic manifestations.

^ Differential diagnosis. The delimitation of mental disorders observed in patients with AIDS from those similar to other mental illnesses proceeds mainly along the path of establishing anamnestic information in diagnosing these diseases - schizophrenia, psychopathy, etc. - in the past and obtaining objective medical information about the action

^ 266 Section III. Certain forms of mental illness

body AIDS, confirmed by laboratory data.

Treatment of the underlying disease is carried out in an infectious diseases hospital with a corresponding impact on psychopathological syndromes.

^ Forensic psychiatric assessment of disorders in AIDS. In the initial period of AIDS, mental disorders, manifested by psychopathic and neurasthenic-like symptoms, do not deprive this person of the opportunity to realize the actual nature and social danger of his actions and to direct them. Therefore, in relation to the acts accused of him, such a person is recognized as sane.

With the development of psychotic disorders or with further progression of the disease with the formation of a severe psychoorganic syndrome and dementia, the person who committed the offense is declared insane in relation to the crime.

Chapter 21

^ MENTAL DISORDERS IN SYPHILIS OF THE BRAIN AND PROGRESSIVE PARALYSIS

Mental disorders as a result of syphilitic brain damage manifest themselves in various stages of the disease and tend to be progressive.

In case of syphilitic damage to the brain, separate independent clinical forms syphilis of the brain (with primary damage to the membranes and blood vessels of the brain) and progressive paralysis (with primary damage to the substance of the brain - its parenchyma). Both cerebral syphilis and progressive paralysis arise as a result of infection with the pallidum spirochete, but they differ sharply in the time of onset of the disease, in the nature and location pathological process, as well as according to the clinical picture.

Progressive paralysis has recently been extremely rare, although in accordance with the increasing incidence of syphilis at present, an increase in the number of patients with progressive paralysis can be expected in a few years.

^ 267 Chapter 21. Disorders with syphilis of the brain

Mental disorders in brain syphilis

The psychopathological manifestations of cerebral syphilis are very diverse and are determined mainly by the stage of the disease, localization and prevalence of the pathological process.

Mental disorders in syphilis of the brain are similar to psychopathological symptoms in other organic diseases of the brain: encephalitis, meningitis, tumors, vascular diseases. Taking this into account, characteristic characteristics are of great importance in their diagnosis and differentiation from other diseases. neurological symptoms, as well as laboratory results.

The most common psychopathological syndrome of stages I-II of brain syphilis is neurosis-like (syphilitic neurasthenia), in which neurotic, hypochondriacal and depressive disorders. Symptoms such as severe irritability, emotional lability, complaints of headaches, memory impairment, and loss of performance predominate. Lacunar (partial) dementia gradually develops.

Characteristic pupillary disorders are observed (sluggish reaction of the pupils to light), pathology of the cranial nerves is noted, meningeal symptoms, epileptiform seizures. A positive Wasserman reaction in the blood is detected and is inconsistent. - in the cerebrospinal fluid, moderate pleocytosis (cellular shift), positive globulin reactions, pathological curves in the Lange reaction (change in the color of the liquid in the first 3-5 tubes - “syphilitic wave” 11232111000, in 5-7 tubes - “meningitis curve” 003456631100).

For II and III stages Syphilis is characterized by psychoses, which are classified according to the leading syndrome. There are syphilitic psychoses with hallucinatory-delusional, pseudoparalytic (progressive dementia) syndromes and disorders of consciousness of the delirious and twilight types.

Hallucinatory-delusional syndrome in cerebral syphilis often begins with the appearance of auditory hallucinations: the patient hears insults, abuse directed at himself, often cynical sexual reproaches, soon the patient becomes completely uncritical of these disorders, believes that he is being pursued by murderers, thieves, etc. .

^ 268 Section III. Certain forms of mental illness

Against the background of hallucinatory-delusional disorders, episodes of impaired consciousness with speech and motor agitation may be observed.

Hallucinatory-delusional syndrome in cerebral syphilis must be differentiated from the corresponding syndromes of schizophrenia and alcoholic psychosis.

With syphilis of the brain, delusions and hallucinations have an ordinary content, are associated with an emotional component, and develop against the background of an organic change in personality with typical disorders of memory and thinking, while in schizophrenia they are abstract, signs of emotional impoverishment of the personality, and impaired thinking are found. In alcoholic psychosis, alcoholic personality changes occur.

In the syphilitic process, there are always characteristic neurological and somatic signs of this disease, as well as relevant laboratory data.

In pseudoparalytic syndrome against the background of dementia of the organic type (partial, lacunar), which, as it develops, increasingly acquires a global picture (complete, with a disorder of all, including criticism, manifestations of the intellect), a complacent background of mood predominates, patients are euphoric, can express delusional ideas of greatness of fantastic content.

Sometimes epileptiform seizures and strokes occur.

In addition to these important psychotic syndromes, delirious and twilight disorders of consciousness may be observed.

The variety of clinical manifestations, as already indicated, depends on the characteristics of the pathological process, its localization and prevalence, duration from the moment of infection, and the severity syphilitic infection, from the premorbid characteristics of the organism. Pathomorphological (microscopic) examination reveals a predominance of cerebral vascular lesions, predominantly of small caliber.

In the vessels and membranes of the brain, against the background of chronic pathomorphological changes, signs of an inflammatory process are observed. Pathochemical methods reveal disorders of carbohydrate (mucopolysaccharide) metabolism in the brain. Mental disorders are expressed more often in those forms of cerebral syphilis in which there were no gross focal disorders.

The whole variety of pathomorphological (under microscopic examination) changes in the brain can be reduced to

^ 269 Chapter 21. Disorders with syphilis of the brain

syphilitic gummas, which can be multiple of different sizes, a diffuse inflammatory process - meningitis and vascular damage with a picture of obliterating endarteritis.

For syphilis of the brain, specific therapy is carried out. All patients diagnosed with cerebral syphilis are sent for treatment to a psychiatric hospital.

Treatment. The main and most common method of treating cerebral syphilis is penicillin therapy (at least 12,000,000 units per course of treatment). Several courses are offered. At repeat courses It is advisable to prescribe prolonged forms of penicillin - ecmonvocillin 300,000 units intramuscularly 2 times a day.

Antibiotic treatment is combined with iodine and bismuth preparations. Up to 40 g of bioquinol per course. These drugs are used in combination with vitamins, especially group B, and general strengthening treatment is also carried out.

Used to treat patients with mental disorders psychotropic drugs depending on the leading syndrome.

^ Forensic psychiatric examination Due to the variety of clinical manifestations, cerebral syphilis should not be determined by only one diagnosis of the disease; in each case, an expert opinion is made individually, taking into account the specific manifestations of the disease.

In psychotic forms, as well as severe dementia and personality degradation, patients with brain syphilis are insane.

Currently, during forensic psychiatric examinations, patients are most often encountered who, thanks to long-term and thorough treatment of syphilis, have only minor mental disorders. Such persons are critical of their condition and maintain professional knowledge and skills, in connection with which, during a forensic psychiatric examination, they are recognized as sane in relation to the acts they are accused of.

^ Progressive paralysis

Progressive paralysis manifests itself in 1-5% of patients with syphilis after 10-12 years and is characterized by rapidly increasing total dementia, neurological disorders,

^ 270 Section III. Certain forms of mental illness

properties and typical serological reactions in the blood and cerebrospinal fluid.

There are primary, intermediate and final stages diseases.

On initial stage Cerebrasthenic (neurasthenic-like) symptoms appear and actively grow, which, as a rule, are combined with various progressive personality changes, speech, its articulation, tempo are impaired, disorders of desires, critical abilities, etc. arise.

The middle stage is characterized by an increase in total dementia, a coarsening of the personality, a decrease in criticism, comprehension of the environment, a decrease in memory, and complacency. Gradually, all signs of personality changes and decreased intelligence are revealed.

The final stage of progressive paralysis (stage of insanity) is characterized by total collapse mental activity, complete helplessness, physical insanity. Currently, with modern treatment, painful manifestations usually do not reach the stage of insanity.

Depending on the dominant psychopathological syndrome, the most common forms progressive paralysis: dementia - progressive dementia without delirium and psychomotor agitation; depressive - depressed mood with delusions of self-blame and persecution; expansive - with phenomena of euphoria, confabulations, delusions of grandeur with a grandiose overestimation of the patient himself.

The earliest and most typical is the Argyll-Robertson symptom - the lack of reaction of the pupils to light while their reaction to convergence and accommodation is preserved. Along with this, uneven pupils, ptosis (manifested in the inability to raise the eyelid), poor, sedentary facial expressions, a voice with a nasal tint, impaired articulation (tongue twisters), writing, and gait are impaired.

Specific serological reactions: the Wassermann reaction in the blood and cerebrospinal fluid is always positive (usually already at a dilution of 2:10). There is an increase in the number of cells in the cerebrospinal fluid (pleocytosis), positive globulin reactions (Nonne-Appelt, Pandey, Weichbrodt reactions), colloid reactions (Lange reaction) in the cerebrospinal fluid with a change in the color of the tubes like a paralytic curve.

^ 271 Chapter 21. Disorders with syphilis of the brain

Patient A., 59 years old.

From medical history: heredity of mental illnesses is not burdened. He did not lag behind his peers in growth and development. By nature, he was distinguished by his sociability, desire for leadership, and was proactive. I entered school at the age of 8. He studied well, his abilities in learning and music were noted. In 1941 he graduated from 10th grade and went to the front. After demobilization in 1945, he graduated from a circus school, then worked as an aerialist in a circus for 25 years and traveled abroad. For 25 years he was in a close relationship with one woman, was very attached to her, and had a hard time experiencing her death. Had casual sex. There is no exact information about the time of infection with syphilis.

At 52, his character changed noticeably. He began to treat his mother coldly, although he had previously been very attached to her, became selfish, irritable, noted frequent headaches, increased fatigue, and slept poorly at night. A year before hospitalization (58 years old), he went on a business trip, where he quarreled with his colleagues, after which he was admitted to the hospital. No details available. Returned from a business trip ahead of schedule. He was lethargic, tearful, looked changed, and lost weight. The speech was slurred, at times he gave the impression of a drunken person, and later the speech disorders intensified. Couldn't read. He began to complain of constant headaches and severe sweating. It was difficult to remember the events of the current day with relative preservation of memory for events that took place in the past. The disease progressed. He became very complacent and whiny. He asked ridiculous questions and did not always understand the meaning of the questions asked. Didn't answer to the point. On the street he was mistaken for a drunk. He took other people's things for which he had no use. I didn’t recognize my loved ones and became sloppy. Immediately before hospitalization, he left the apartment. After a fight on the street, he was taken to the police; during arrest, he resisted the police and gave the impression of being drunk. I didn’t recognize my sister, I didn’t understand where I was. He claimed that he was an outstanding commander. In this condition he was hospitalized in a psychiatric hospital.

Mental state: the patient is sloppy, has an unsteady gait, staggers, is fussy, and constantly whispers something. He understands that he is in the hospital. Names the year correctly, but cannot name the month or date. Speech is loud and dysarthric. Without waiting to be addressed, he speaks spontaneously, is verbose and voluble. Vocabulary is somewhat limited. Speech is ungrammatical. On

^ 272 Section III. Certain forms of mental illness

Answers questions generally correctly, but not immediately and only if it is possible to attract his attention. Cannot read the text given to him. He writes his last name with great difficulty and with mistakes. He says he is an outstanding commander. He says that he fought in China, America and Japan. He asks the doctor to bring his documents. Let's distract. He remembers well the events that took place in the past. Doesn't remember recent events well. There is instability of affect, which changes depending on the content of what is expressed. Sometimes he is complacently euphoric, sometimes sad and tearful. During his stay in the clinic, states of motor excitement were noted: he was fussy, looking for someone. Disorientation in place and time was noted during these episodes. There is no critical attitude towards one’s condition. Indifferent to his fate.

Neurological state: the pupils are uneven, the reaction to light is sluggish. There is a weakening of convergence and smoothness of the right nasolabial fold. When the eyes are closed, there is trembling of the eyelids. Knee reflexes are increased. Staggers in Romberg's pose.

Laboratory data: The Wasserman reaction in the blood is positive (4+). Cerebrospinal fluid: Nonne-Appeld, Pandi, Weichbrodt reactions are positive, Wasserman - 4+. Cytosis 35/3. Protein 9.9 g/l. Lange reaction - 777766432211.

Diagnosis: progressive paralysis, expansive form.

The conclusion of the forensic psychiatric expert commission declared insane.

Evidence of the syphilic etiology of progressive paralysis is provided by both clinical and laboratory data. Pale spirochetes were first discovered in the brains of patients with progressive paralysis by X. Nogushi in 1913. However, as already indicated, only 1-1.5% of those sick with syphilis become ill with this disease. For progressive paralysis to occur, in addition to the presence of pale spirochetes in the body, a number of additional pathogenic factors are required, the significance of which is still unclear. It is generally accepted that among external unfavorable factors, a large role belongs to alcohol, traumatic brain injuries and other factors that weaken the body’s resistance to infections. However, all these arguments are not confirmed.

With progressive paralysis there is primary lesion both ectodermal tissue (nervous parenchyma) and

^ 273 Chapter 21. Disorders with syphilis of the brain

mesoderm (inflammatory processes in the pia mater and blood vessels). In this way, progressive paralysis differs from syphilis of the brain, which affects only the mesoderm.

Typical morphological characteristics progressive paralysis are a decrease in brain weight, pronounced atrophy of the gyri, opacification (fibrosis) and thickening of the meninges (leptomeningitis), external and internal hydrocele of the brain, ependymitis of the fourth ventricle of the brain.

Characteristic damage to the cortex of the frontal lobes of the brain.

There are pronounced dystrophic changes in nerve cells (wrinkling, atrophy, devastation of the cortex with changes in its architectonics).

With special staining, spirochetes can be seen in the brain itself. In severe forms or exacerbation of the process, colonies of spirochetes and dramatically changed myelin fibers are found. So-called inflammatory foci, glial nodules, consisting of glial cells, are formed.

Thus, morphologically progressive paralysis can be qualified as chronic leptomeningeal encephalitis.

Treatment. Conventional methods of specific treatment for progressive paralysis are ineffective if they are not combined with activities aimed at activating protective forces body. Thus, the main principles that should be followed are: 1) the massiveness of specific therapy; 2) its combination with methods that increase general and immunological reactivity. In 1917, V. Jauregg proposed a method of treating patients with progressive paralysis from malaria. Subsequently, over many decades, vaccinations tertian malaria preceded the first course of specific treatment. After 5-10 attacks, malaria was stopped with quinine. Currently, when malaria has been eliminated in our country, pyrotherapy is used. High temperature cause intramuscular injection sulfozin (a sterile 1-2% solution of purified sulfur in peach, olive or vaseline oil) or pyrogenal, for a course of treatment of 10-12 injections with a temperature reaction of at least 39°C. In the future they carry out specific therapy nicillin in combination with bioquinol.

^ 274 Section III. Certain forms of mental illness

Forensic psychiatric examination. In forensic psychiatric practice, when examining patients with untreated progressive paralysis, there are practically no difficulties in deciding the issue of sanity.

In psychotic states, profound dementia, subjects suffering from progressive paralysis are recognized as insane, and when considering cases in civil proceedings - incompetent and in need of guardianship; transactions concluded by them are declared invalid.

Even diagnostics in initial stage Progressive paralysis causes the patient's insanity, since already at this stage progressive personality changes occur, critical abilities are impaired, drive disorders and other significant mental disorders are noted.

Certain difficulties arise in the forensic psychiatric assessment of therapeutic remission of progressive paralysis. Persons who, as a result of treatment, have achieved a stable and long-term (at least 4-5 years) improvement in their mental state, equating to practical recovery, may be considered sane.

Convicts with suspected progressive paralysis are sent for a forensic psychiatric examination. If progressive paralysis is detected, they are released from further serving their sentence in accordance with Art. 433 U PC of the Russian Federation. Such a person, by a court decision, may be sent to a psychiatric hospital for compulsory treatment.

^ Chapter 22

ALCOHOLISM

The steady increase in the incidence of alcoholism in many countries of the world, economic and social damage, and the medical consequences of alcohol dependence contribute to the deterioration of the health of the population and indicate that this disease is one of the most important socio-biological problems of our time (G.V. Morozov, 1978-2000; N. N. Ivanets, 1990-2000, etc.).

Alcoholism and the severe social and medical consequences associated with it reflect an increasingly worsening situation

^ 275 Chapter 22. Alcoholism

drink existing all over the world and in our country (N. N. Ivanets, 1995).

One of the most tragic components of this situation is violent mortality as a result of auto-aggressive and aggressive actions, poisoning and accidents, as well as the significance of manifestations of alcoholism in mortality, alcohol-associated somatic pathology, road traffic accidents, domestic and industrial alcoholism.

Alcoholism in the social sense is the steady consumption of alcoholic beverages, which has bad influence on health, life, work and welfare of society. Alcoholism in the medical sense is a chronic disease that occurs as a result of frequent, excessive consumption of alcoholic beverages and a painful addiction to them.

Alcoholism is characterized by a progressive course and a combination of mental and somatic disorders, such as pathological craving for alcohol, withdrawal syndrome, changes in the pattern of intoxication and tolerance to alcohol, development characteristic changes personality, toxic encephalopathy syndrome. From a certain stage of the disease, psychopathological manifestations are combined with neuritis and diseases of the internal organs (cardiovascular diseases, diseases of the gastrointestinal tract).

The first descriptions of alcohol abuse date back to ancient times and are presented in surviving written monuments. Even in the works of Aristotle it was indicated that drunkenness is a disease.

When defining alcoholism, S.S. Korsakov in 1901 distinguished between the concepts of “alcoholism” and “drunkenness.” He examined the clinical picture of alcoholism in dynamics.

Foreign authors focused primarily on the socio-ethical aspects of the problem of alcoholism and considered alcoholics as individuals who, as a result of drinking alcohol, cause harm to themselves, their family members and society as a whole.

According to the definition of alcoholism, this WHO, those suffering from alcoholism include those persons whose addiction to it has led to severe mental disorders or caused both mental and somatic disorders, changed relationships with the team and caused damage

^ 276 Section III. Certain forms of mental illness

public and material interests of these persons. This definition lacks a detailed medical interpretation and does not fully reflect the clinical picture typical of alcoholism.

Many modern authors consider it incorrect to use the term “chronic alcoholism,” which was also pointed out by experts from the UN Committee on Alcoholism in 1955. In their opinion, the term “alcoholism” includes only that condition that is regarded as chronic. In this regard, it is correct to use the term “alcoholism” without adding “chronic”, since this goes without saying.

Alcoholism is a disease resulting from alcohol abuse in such doses and with such frequency that it leads to loss of efficiency at work, disruption of family relationships and public life and to physical and mental health disorders.

Alcoholism differs from everyday drunkenness in clearly defined and biologically determined signs, although everyday drunkenness always precedes alcoholism. Domestic drunkenness, habitual alcohol abuse is always a violation by a person of social and ethical rules. As a result, in the prevention of drunkenness crucial have administrative, legal and educational measures. Unlike drunkenness, alcoholism is a disease that always requires the use of active medical measures and a set of treatment and rehabilitation measures.

The incidence rate of neuroinfections is about one case per 1 thousand. About a fifth of patients with consequences of neuroinfections are hospitalized in psychiatric hospitals annually, and of patients with infectious psychoses - about 80%. Mortality in the latter group reaches 4–6%.

There is an opinion that some are caused by viral infections

Mental disorders due to viral infections

These diseases constitute the predominant part of neuroinfections, since most viruses are highly neurotropic. Viruses can persist, i.e. remain asymptomatic in the body for some time. For “slow infection” a long period The disease is asymptomatic and only then manifests itself and slowly progresses. Discovery of slow viruses at the end of the twentieth century. had important and for psychiatry: the clinical picture of such diseases is often determined precisely by mental disorders. Slow viruses are also associated with the development of some forms of dementia. In slow infections, mainly degenerative changes in the central nervous system and mild inflammatory reactions are observed against the background of immune deficiency (AIDS, subacute sclerosing panencephalitis, progressive multifocal leukoencephaly).

In the last 20 years, prion diseases in which prion protein has been detected have begun to be distinguished from the group of slow infections. These are, for example, Creutzfeldt-Jakob disease, kuru, Gerstmann-Straussler-Scheinker syndrome, fatal familial insomnia. With viral diseases, in some cases several different viruses are simultaneously affected - these are “virus-associated” forms of diseases. Viral encephalitis is divided into primary and secondary. Primary ones are caused by the first meeting with a new virus. Secondary ones are associated with the activation of a persistent virus. Hereditary immune deficiency plays a decisive role in the development of viral encephalitis. Along with diffuse encephalitis, especially viral encephalitis, local lesions are often observed. So, with Economo's encephalitis this is a lesion of subcortical structures (hence the picture of parkinsonism), with rabies - neurons of the hippocampal peduncles and Purkinje cells of the cerebellum, with poliomyelitis - the anterior horns spinal cord, with herpetic encephalitis - lower sections temporal lobes with symptoms of a brain tumor of the same location.

1. Tick-borne (spring-summer) encephalitis. This seasonal disease caused by an arbovirus. Infection occurs through a tick bite and through nutrition. Noted diffuse lesion gray matter of the brain of an inflammatory and dystrophic nature; Vascular changes also occur. The acute period of the disease manifests itself in three variants: encephalitic, encephalomyelitis and poliomyelitis. The last two options differ from the first in the greater severity of neurological symptoms. In areas of tick-borne encephalitis, tick-borne systemic borreliosis, or Lyme disease (caused by a special pathogen), is also common.

With the encephalitic variant of encephalitis, headaches, nausea, vomiting, and dizziness are observed at the onset of the disease. On the second day, the temperature and general toxic phenomena increase: hyperemia of the face, pharynx, mucous membranes, catarrhal phenomena in the trachea and bronchi. Meningeal symptoms appear. Lethargy, irritability, affective lability, and hyperesthesia are expressed. In severe cases, stupor or coma develops.

As stupor decreases, delirium, fear, and psychomotor agitation may occur. During the period of convalescence and in the long-term period, cerebroasthenia, neurosis-like, and, less commonly, mnestic-intellectual disorders, and often epileptic seizures. Of the neurological disorders, the main ones are flaccid atrophic paralysis of the muscles of the neck and shoulder girdle, often with bulbar phenomena. Spastic mono- and hemiparesis occur less frequently. It could also be Kozhevnikov epilepsy. With timely initiation of treatment, improvement occurs by 7–10 days: mental and neurological disorders are undergoing reverse development. With bulbar disorders, 1/5 of patients die.

Progressive forms of the disease are caused by persistence of the virus. They occur both asymptomatically and subacutely. In the first case, a protracted asthenoneurotic syndrome is detected with fixation of attention on the disease. At late stages of the disease, hallucinatory-paranoid psychoses have been described. More often, residual psychopathic, paroxysmal, and other disorders are identified.

Treatment: antibiotics wide range actions, anticholinesterase drugs, vitamins, symptomatic remedies; in the acute period is carried out in infectious diseases hospital. Prevention: vaccination.

2. Japanese encephalitis. Caused by the Japanese (mosquito) encephalitis virus. In the USSR after 1940, only sporadic cases of Far East. The acute stage of the disease is characterized by confusion and motor agitation. Psychosis develops after the temperature normalizes. Sometimes mental disorders precede the appearance of neurological, cerebral and focal disorders. At late stages of the disease there may be hallucinatory-delusional and catatonic disorders, diffuse organic symptoms (Lukomsky, 1948). Organic dementia rarely develops.

3. Vilyuisky encephalitis. It has been established that localized encephalomyelitis occurs with dys- and atrophic changes brain parenchyma; changes in the perivascular spaces and meninges are detected. The acute period of the disease resembles the flu. More typical chronic stage encephalitis; dementia, speech disorders and spastic paresis gradually develop. A psychotic form of encephalitis is also distinguished (Tazlova, 1974). In this case, various psychotic disorders are observed (from obsessions to amentia), and a psychoorganic syndrome is gradually formed. It is important that there is a possibility of reverse development of the latter.

4. Epidemic encephalitis, or lethargic encephalitis Economo. Caused by a special virus that is transmitted by droplets and by contact. The acute stage of the disease begins 4–15 days after infection. Against the background of cerebral and general toxic manifestations, delirium, other psychotic syndromes and agitation are often observed. At the same time, various hyperkinesis and symptoms of impaired cranial innervation are detected. Delirium is gradually replaced by a disturbance of consciousness (domnolence), from which patients cannot be brought out. In the chronic form of the disease against the background of parkinsonism and other extrapyramidal disorders, mental disorders such as pathology of drives, bradyphrenia, hallucinations, delusions, depression, metamorphopsia and many others are detected. etc.

At late stages of the disease, the phenomena of parkinsonism dominate. Specific treatment does not exist. IN acute stage diseases recommend convalescent serum, detoxification, corticosteroids, ACTH. For postencephalitic parkinsonism, artane, cyclodol, etc. are prescribed. Psychotropic drugs are used according to indications and with great caution (risk of increased extrapyramidal symptoms!).

5. Rabies. Sporadic disease. Carriers of the rabies virus are dogs, and less commonly cats, badgers, foxes and other animals. The prodromal period of the disease begins 2–10 weeks or later after infection. Mood decreases, irritability, dysphoria, short episodes of darkness appear with hallucinations, but more often illusions. There is fear and anxiety. Paresthesia and pain sometimes occur at the site of the bite, radiating to adjacent areas of the body. Reflexes, muscle tone, and temperature increase. The patients' condition worsens, headaches, tachycardia, shortness of breath occur, and sweating and salivation increase.

The stage of arousal is dominated by mental disorders: agitation, aggression, impulsivity and disturbances of consciousness (stupefaction, delirium, confusion). Hyperkinesis of smooth muscles is typical - spasms of the larynx and pharynx with breathing and swallowing disorders, shortness of breath. General cerebral disorders develop with general hyperesthesia. A characteristic fear of drinking water is hydrophobia. An increase in hyperkinesis and increased spasm are replaced by paralysis, convulsive seizures, severe speech disorders, and phenomena of decerebrate rigidity. Central violations vital functions lead patients to death. Persons vaccinated against rabies with a hysterical character may develop conversion disorders resembling symptoms of rabies (paresis, paralysis, swallowing disorders, etc.).

6. Herpetic encephalitis. Caused by viruses herpes simplex types 1 and 2. The first of them more often leads to brain damage. In this case, cerebral edema occurs, pinpoint hemorrhages, foci of necrosis and signs of degeneration and swelling of neurons appear. Encephalitis is widespread and very often accompanied by mental disorders. The latter can occur already at the onset of the disease and precede the development of neurological symptoms. In typical cases, the onset of the disease is characterized by fever, moderate intoxication, and catarrhal symptoms in the upper respiratory tract. A few days later, a new rise in temperature follows. Developing cerebral symptoms: headaches, vomiting, meningeal symptoms, seizures.

Consciousness is stunned, even to the point of coma. The state of stupor is at times interrupted by delirium with agitation and hyperkinesis. At the height of the disease, coma develops, neurological disorders increase (hemiparesis, hyperkinesis, muscle hypertension, pyramidal signs, decerebrate rigidity, etc.). Survivors of prolonged coma may develop apallic syndrome and akinetic mutism. The recovery stage lasts up to two years or more. Against the backdrop of gradual recovery mental functions sometimes Klüver-Bussy syndrome is detected: agnosia, tendency to put objects in the mouth, hypermetamorphosis, hypersexuality, loss of shame and fear, dementia, bulimia; akinetic mutism, affective fluctuations, and vegetative crises are not uncommon.

In people who have undergone surgery for bilateral removal of the temporal lobes of the brain, it was first described by Tertien in 1955. In the long-term period of the disease, residual symptoms of encephalopathy with asthenic, psychopathic and convulsive manifestations are observed. There are known cases of bipolar affective and schizophrenia-like disorders. Complete recovery is observed in 30% of patients. Schizophrenia-like disorders can also be observed in early stages course of the disease. Sometimes conditions similar to febrile schizophrenia occur. When treated with neuroleptics, some patients develop mutism, catatonic stupor, and then amentia, leading to death. In diagnosing the disease, laboratory tests are important, indicating an increase in antibody titers to the herpes virus. Treatment: Vidarabine, acyclovir (Zovirax), corticosteroids are prescribed, with great caution - psychotropic drugs for symptomatic therapy. If untreated, mortality can reach 50–100%.

7. Influenza encephalitis. Respiratory influenza viruses are transmitted through respiratory droplets; Placental transmission from mother to fetus is also possible. Influenza can be very severe and lead to the development of encephalitis. Neurotoxicosis with hemo- and liquorodynamic phenomena is combined with inflammation in the membranes of the choroidal plexuses and brain parenchyma. Identification of influenza encephalitis is based on the detection of high titers of antibodies to viruses in the blood and cerebrospinal fluid. In the acute stage of the disease, motor, sensory disorders, stunning consciousness, sometimes to the point of coma. Stunning can be replaced by excitement with deceptions of perception, and then by mood swings, dysmnesia, and asthenia. In hyperacute forms of encephalitis, cerebral edema and disturbances in cardiovascular activity can lead to death. Treatment: antiviral drugs(acyclovir, interferon, rimantadine, arbidol, etc.), diuretics, detoxification agents, symptomatic, including psychotropic medications. With active treatment, the prognosis is favorable; this does not apply, however, to hyperacute influenza.

Unlike those mentioned viral diseases, usually confined to a certain time of year, are also observed in different seasons of the year. These are multiseasonal encephalitis. Let us indicate the main ones.

8. Encephalitis with parainfluenza. This is a sporadic disease that occurs in local outbreaks and affects the upper respiratory tract. There may, however, be hemo- and liquorodynamic disturbances, inflammation of the pia mater and ependyma of the ventricles of the brain; in the acute period of the disease, cerebral and meningeal phenomena are observed, symptoms of toxicosis with convulsive seizures, delirium, hallucinations, and illusions. Recovery period characterized by transient asthenic, vegetative and mnestic disorders. The prognosis is favorable.

9.Encephalitis due to mumps. The disease is transmitted by airborne droplets. More common in children. Inflammation is usually observed in the salivary and parotid glands(“mumps”), but also occurs in the brain, testicles, thyroid, pancreas and mammary glands. When the brain is damaged, serous meningitis occurs, and less commonly, meningoencephalitis. To verify the diagnosis, serological and virological research. At the height of the development of meningoencephalitis, general cerebral phenomena and disturbances of consciousness, in particular delirium, are noted. There are epileptic seizures with postictal twilight stupefaction. Coma is rare; upon exiting it, psychoorganic phenomena are possible. Disease in early childhood may cause delay mental development, at an older age - pathocharacterological reactions and psychopathic behavior.

10.Measles encephalitis. It occurs frequently and in different age groups. In white and gray matter multiple hemorrhages and foci of demyelination are found in the brain; There are lesions of ganglion cells. Serous meningitis, encephalitis, meningoencephalitis, encephalomyelitis and encephalopathy occur in 0.1% of patients. There are also polyradicaloneuritic syndrome, myelitis with para- and tetraparesis, pelvic and trophic disorders, sensitivity disorders. At the height of the development of encephalitis, clouding of consciousness, agitation, visual illusions, and aggression are possible. During the recovery period, a decrease in attention, memory, thinking, as well as disinhibition of drives and violent phenomena are observed. If there was a coma in the acute period, hyperkinesis, convulsive and asthenoneurotic syndromes, and behavioral deviations remain in the residual stage. The prognosis is generally favorable.

11.Rubeolar encephalitis. Occurs mainly in children. The rubella virus is transmitted by airborne droplets and transplacentally. In the acute period of the disease, against the background of toxic and cerebral phenomena, there may be coma, stupor, and neurological symptoms. At the exit from the acute state, episodes of agitation with fear and aggression are noted; somewhat later, hypomnesia, violent phenomena, bulimia, as well as speech disorders and difficulties in writing and counting are revealed. Some of these disorders persist in the residual period. After an illness in early childhood, mental development may be delayed.

12. Encephalitis caused by a virus chickenpox. In adults, the varicella zoster virus causes shingles. Encephalitis is relatively mild. Static-coordination disorders usually predominate. Sometimes there are disturbances of consciousness, convulsive seizures, agitation and impulsive actions, as well as neurological symptoms (hemiparesis, etc.). In the future, a decrease in memory and thinking is sometimes detected. Without treatment, convulsive seizures, mental retardation, and psychopathic behavior may persist in the residual period.

13. Post-vaccination encephalitis. They develop after 9–12 days when vaccinated against smallpox, usually in children 3–7 years old. In 30–50% the course is severe, with fatal. At the height of the disease development, disturbances of consciousness up to severe coma are observed. Stupefaction alternates with confusion, agitation, and visual illusions. Frequent seizures, paralysis, paresis, hyperkinesis, ataxia, loss of sensitivity, pelvic disorders. With adequate treatment, complete or partial restoration mental functions.

As mentioned, slow viral infections have now become relevant.

14.These primarily include acquired immunodeficiency syndrome - AIDS. The human immunodeficiency virus (HIV) causes damage to the immune system, and then various secondary or “opportunistic” infections are added, as well as malignant tumors. HIV is a neurotropic retrovirus, transmitted sexually and by syringes. Cases of HIV transmission through kidney transplants and bone marrow transplants have been described.

“Vertical” transmission has also been proven - from mother to fetus. Incubation period lasts up to five years. Characteristic of AIDS are a significant frequency and variety of secondary infections and diseases, such as pneumonia, cryptococcosis, candidiasis, atypical tuberculosis, cytomegaly and herpes, fungi, helminths, tumors (for example, Kaposi's sarcoma), often toxoplasmosis (in 30%), etc. From the very beginning, prolonged fever, anorexia, exhaustion, diarrhea, dyspnea, etc. occur, and all this against the background of severe asthenia. Brain dystrophy with atrophy, sponginess and demyelination is often combined with inflammatory changes as a result herpetic encephalitis, meningitis, etc. The virus is found in astrocytes, macrophages, and cerebrospinal fluid. At the onset of the disease, asthenia, apathy and aspontaneity dominate.

Symptoms of cognitive deficit gradually develop (deterioration of attention, memory, mental productivity, slowness of mental processes). There may be delirious episodes, catatonic manifestations, and isolated delusional ideas. During the period of advanced disorders, dementia is typical. Incontinence of affect and regression of behavior with disinhibition of drives also occur. Dementia with mori-like behavior is characteristic of damage to the frontal cortex; various neurological symptoms are also observed (stiffness, hyperkinesis, astasia, etc.). A few months later, global disorientation, coma, and then death occur. Many patients do not live to develop dementia. Psychoses with hallucinations, delusions, and mania were noted in 0.9% of HIV-infected people.

Very common psychogenic depression with suicidal tendencies; usually these are reactions to illness and ostracism. Etiotropic treatment is reduced to the prescription of azidotimedine, dideoxycilline, phosphonofomate and other drugs. Genciclovir is also used. Zidovudine (an HIV replication inhibitor) is recommended for the first 6–12 months. Symptomatic treatment consists of prescribing nootropics, vasoactive and sedatives, antidepressants, neuroleptics (the latter for behavior correction). In addition, special programs of social, psychological and psychotherapeutic assistance and therapy for somatic pathology are being implemented.

15. Subacute sclerosing panencephalitis. Its other names are: Van Bogaert leukoencephalitis, Pette-Döring nodular panencephalitis, Dawson's inclusion encephalitis. The causative agent of the disease is similar to the measles virus. May persist in brain tissue. In the brain of patients, glial nodules, demyelination in subcortical structures, and special nuclear inclusions are found. The disease usually develops between the ages of 5 and 15 years. Its first stage lasts 2–3 months. Irritability, sleep disturbances, anxiety, as well as psychopathic-like phenomena (leaving home, aimless acts, etc.) are observed.

Towards the end of the stage, drowsiness increases. Dysarthria, apraxia, agnosia are detected, memory is lost, and the level of thinking decreases. The second stage is represented by various hyperkinesis, dyskinesia, generalized seizures and peck-type attacks. Dementia is evident. The third stage occurs after 6–7 months and is characterized by hyperthermia, severe breathing and swallowing disorders, as well as violent phenomena (screaming, laughing, crying). In the fourth stage, opisthotonus, decerebrate rigidity, blindness, and flexion contractures occur. Patients live no more than two years. Subacute and especially chronic forms of the disease are less common; the development of dementia occurs against the background of apraxia, dysarthria, hyperkinesis and other neurological symptoms.

16. Progressive multifocal leukoencephalopathy. Develops against the background of other diseases with immunodeficiency. Caused by two strains of papova group viruses. They are present in a latent state in 70% healthy people, being activated when immunity decreases, more often in people over 50 years of age. Degenerative changes and signs of demyelination are found in the brain of patients. The disease is characterized by rapidly developing dementia with aphasia. There may be ataxia, hemiparesis, sensory loss, blindness and seizures. CT scan reveals lesions reduced density brain matter, especially white matter.

A separate group consists of prion diseases.

17. Particularly relevant of these is Creutzfeldt-Jakob disease. Caused by an infectious protein - a prion, it can occur when eating meat from cows, sheep and goats that become carriers of this protein. The disease is rare (one in 1 million people). It manifests itself as rapidly developing dementia, ataxia, and myoclonus. Triphasic waves on the EEG are typical. In the initial stage of the disease there may be euphoria, hallucinations, delirium, and catatonic stupor. Within a year, patients die. Depending on the topic of brain damage, several forms of the disease are distinguished. The classic one is dyskinetic - with dementia, pyramidal and extrapyramidal symptoms.

Kuru or “laughing death” is a now extinct prion disease with dementia, euphoria, violent screams and laughter, leading to death after 2-3 months. It was first identified among the Papuans of New Guinea. Occurring in middle age with a frequency of one case per 10 million people, Gerstmann-Straussler-Scheinker syndrome manifests itself mainly in neurological symptoms. Dementia does not always develop. Fatal familial insomnia is manifested by intractable insomnia, disturbances of attention and memory, disorientation and hallucinations. In addition, hyperthermia, tachycardia and hypertension, hyperhidrosis, ataxia and other neurological symptoms are observed. Like both last forms of the disease, it is associated with a hereditary predisposition.

Mental disorders in infectious diseases

Psychiatry / Mental disorders for infectious diseases

Mental disorders in infectious diseases very different. This is due to the nature of the infectious process, with the characteristics of the response to infection of the central nervous system.

Psychoses resulting from general acute infections, are classified as symptomatic. Mental disorders also occur with so-called intracranial infections, when the infection directly affects the brain. Infectious psychoses are based on a variety of psychopathological phenomena related to the so-called exogenous types of reactions (Bongeffer, 1910): syndromes of impaired consciousness, hallucinosis, asthenic and Korsakoff syndromes.

Psychosis, both in general and in intracranial infections, occurs:

organic damage

So called Transient psychoses - transient and leave no consequences behind.

Delirium- the most common type of response of the central nervous system to infection, especially in children and young people. Delirium may have features depending on the nature of the infection, the age of the patient, and the state of the central nervous system. With infectious delirium, the patient’s consciousness is disturbed, he does not orient himself in his surroundings, against this background, abundant visual illusory and hallucinatory experiences, fears, and ideas of persecution arise. Delirium worsens in the evening. Patients see scenes of fire, death, destruction, terrible disasters. Behavior and speech are determined by hallucinatory-delusional experiences. In the formation of hallucinatory-delusional experiences during infectious delirium, they play an important role painful sensations in various organs (the patient feels as if he is being quartered, his leg is being amputated, he is being shot in the side, etc.). During psychosis, the symptom of a double may arise. It seems to Pain that his double is next to him. As a rule, delirium goes away after a few days, and memories of the experience are partially preserved. In unfavorable cases, infectious delirium occurs with very deep stupefaction, with pronounced agitation, taking on the character of chaotic tossing (sometimes excruciating delirium), and ends in death. Prognostically unfavorable is the preservation of such a state when the temperature drops.

Amentia- the other one is pretty common species response to an infection, in which there is a deep clouding of consciousness with a violation of orientation in the environment and one’s own personality. Usually develops in connection with severe somatic condition. The picture of amentia includes: impaired consciousness, severe psychomotor agitation, hallucinatory experiences. Amentia is characterized by incoherence of thinking (incoherence) and confusion. The excitement is quite monotonous, limited to the confines of the bed. The patient randomly rushes from side to side (yactation), shudders, stretches out, sometimes tries to run somewhere and can rush to the window, experiences fear, and incoherent speech. Such patients require strict supervision and care. They, as a rule, refuse to eat and quickly lose weight. Often, elements of delirium and amentia are mixed in the clinical picture of psychosis.

Much less often, transient psychoses include amnestic disorders in the form of short-term retrograde or anterograde amnesia - for some time, events that preceded the disease or took place after the acute period of the disease disappear from memory. Infectious psychosis is replaced by asthenia, which is defined as emotionally hyperesthetic weakness. This variant of asthenia is characterized by irritability, tearfulness, severe weakness, intolerance to sounds, light, etc.

Protracted (protracted, prolonged) psychoses. A number of common infectious diseases under unfavorable circumstances can acquire a protracted and even chronic course. Mental disorders in patients with chronic infectious diseases usually occur from the very beginning without clouding of consciousness in the form of so-called transitional syndromes. As already mentioned, this form of psychosis is also reversible. They usually end with prolonged asthenia.

The clinical picture of affected infectious psychoses is quite variable. Depression with delusional ideas of relationships, poisoning, i.e. a depressive-delusional state, can be replaced by a manic-euphoric state with elevated mood, talkativeness, importunity, fussiness, overestimation of one’s own capabilities and even ideas of greatness. In the future, ideas of persecution, hypochondriacal delusions, and hallucinatory experiences may appear. Confabulations in transitional psychoses are rare. All psychopathological disorders in protracted psychoses are accompanied by pronounced asthenic syndrome with symptoms of irritable weakness, as well as often depressive-hypochondriacal disorders.

Edited by Professor M.V. Korkina.