Disorders of consciousness and emotional sphere in the elderly and senile age. Diseases of the elderly: causes, signs and prevention
Schizophrenia in the elderly, how to recognize the disease in time
The soul, like the body, is subject to change. Especially these changes become noticeable in old age. This is a period when a turning point occurs in a person’s consciousness, it is necessary to find a foothold not in the outside world, but in oneself.
Mental disorders that occur at this age are to a large extent a reaction of the human psyche to physiological changes in the body and to changes in the environment.
Schizophrenia is one of the most serious mental disorders in the elderly!
How to recognize the first symptoms of schizophrenia in old age in order to seek medical help in time and start timely treatment.
You should pay attention to the following factors:
- Rave;
- Confusion, which is a disorder of formal thinking;
- Inappropriate behavior (laughter for no reason, tears, inappropriate clothing);
- Affect (complete absence or dullness of reactions);
- Alogia (absence or lack of speech);
- Social dysfunction (interpersonal contacts and self-care are kept to a minimum).
If all of the above symptoms are present for more than a month, then schizophrenia is diagnosed.
Types of schizophrenia
Hebephrenic schizophrenia
It is characterized by the presence in the behavior of childishness, foolishness. Sick people are shy, prefer.
The disease is characterized by the following features:
- capriciousness;
- foolishness;
- childishness;
- grimacing;
- hallucinations;
- delirium;
- sharp mood swings;
It differs from infantilism by the groundlessness of actions, obscene behavior, and brutality. Patients completely cease to be interested in what previously attracted them, they cannot even perform simple work.
The disease is diagnosed after observing such signs for at least 2-3 months. The prognosis is unfavorable, with time the disintegration of the personality develops.
paranoid
The main clinical picture is delirium.
In people of senile age, this is the delusion of persecution, attempt on life, theft, infringement of rights by neighbors, and so on. Hallucinations, both auditory and visual, are very common.
The main manifestation of senile delirium is the affirmation of the negative attitude of the people around them, namely, that all the people around them began to treat them badly, they want to take the apartment, poison, rob.
paranoid schizophrenia is the most common form of the disease among the elderly
Such statements should alert loved ones, since a person not only suffers himself, but also poses a serious danger to those around him.
The prognosis of the disease is unfavorable, with advanced stages of the disease, personality degradation occurs.
Catatonic
A combination of mental and musculoskeletal disorders, while the phases of stupor and excitation alternate. With the onset of a catatonic stupor, the patient takes a certain position for a long time.
There is a lack of speech and reaction to external stimuli, delirium, hallucinations. In this state, the patient can be from several hours to several days. A characteristic feature of this form is negativism.
A person ignores any extraneous requests, does everything on the contrary, refuses to eat. The disease manifests itself periodically, between attacks light intervals are possible.
*Learn about other mental disorders in the article:
Residual or residual
A chronic protracted form of the disease, in which there are no obvious signs of an acute schizophrenic disease, but deviations in behavior from accepted norms of behavior indicate the presence of the disease.
Patients present with the following symptoms:
- decrease in activity;
- emotional activity;
- self care.
Speech is inexpressive and meager, self-service skills are lost, interest in married life, communication with loved ones is lost, indifference to children and relatives appears.
With a long course of the disease, patients can no longer do without outside help, so special commissions establish a disability group for them.
Plain or classic
It is characterized by subtle but progressive eccentricities and changes in the behavior of the patient.
This form of schizophrenia is characterized by such symptoms of schizophrenic diseases as isolation, focus on oneself and on the structure of one's body, and lack of emotions.
Video: How to recognize schizophrenia
A sick person becomes indifferent to his fate, the fate of people close to him. He withdraws completely into himself, he has crazy ideas. The disease develops slowly and imperceptibly, which delays the moment of seeking medical attention and worsens the prognosis.
Treatment of schizophrenia
Treatment of all forms of schizophrenia is predominantly symptomatic and social. Antipsychotics are widely used in combination with other drugs.
Drug treatment is carried out simultaneously with the provision of psychological and social support to the patient.
In the acute phase of the disease, the patient should be admitted to the hospital. Methods of treatment and doses of drugs are selected by the attending physician individually for each patient, based on the symptoms of mental disorders.
Preparations
Tranquilizers: Seduxen, Phenazepam, Moditen-depot, as well as Haloperidol-decanoate.
Antipsychotics: Risperidone and Olanzapine, Triftazin, Haloperidol, Aminazina, Stelazin, Sonapax, Tizercin, Haloperidol, Etaperazine, Frenolon.
Nootropics: Racetam, Antirecatam, Nootropil (Piracetam), Oxiracetam.
It should be taken into account that the doses of drugs prescribed to the elderly should be reduced compared to younger patients. This is due to physiological changes in the body of older people.
Treatment of schizophrenia is impossible without psychotherapy. At the first stage, treatment takes place individually, then group and family form of therapy is carried out.
The method of psychotherapy allows the patient to understand his illness, to understand what he feels and does. Various trainings, group conversations help the patient improve relationships with others.
The purpose of family psychotherapy is to explain to the relatives of the patient the symptoms of the disease, the need for long-term treatment. Relatives should know all the factors that can worsen the patient's condition, strive to harmonize family relations.
Attention: Do not self-medicate - at the first signs of the disease, consult a doctor!
Conclusion
Modern medicine, unfortunately, cannot completely cure such a disease as senile schizophrenia. But, if you are attentive to your elderly parents, you will be able to notice the first alarming bells.
It can be sleep disturbance, grumpiness, irritability, unreasonable fears, sudden mood swings, alienation, isolation, suspicion.
Adequate treatment started on time will help reduce the frequency of relapses and hospitalizations, help reduce the rate of destruction of human life and family relationships.
6.9. Mental illnesses in the elderly and senile age
It is well known that the incidence of mental illness increases with age. As early as 1912, the Austrian psychiatrist Stillmeier expressed his firm conviction that dementia awaits every person who has lived for quite a long time. The Swiss psychiatrist E. Bleuler (creator of the doctrine of schizophrenia) was of the same opinion, who stated that symptoms similar to the clinical picture of senile dementia (senile dementia) can be discovered in every person who has reached his normal end of life through senile debility. Russian psychiatrist P. Kovalevsky considered senile dementia to be the natural end of human life. According to WHO (1986), dementias are statistically significantly detected in 5% of the population aged 65 years and in 20% of those over 80 years of age.
According to the US National Institute of Mental Health, at least 15% of people over 65 need mental health care. Currently, 1.5 million people are in psychiatric hospitals, and by the beginning of the 21st century, their number will increase to 3-3.5 million people, if appropriate measures are not taken to protect against such diseases of senile age as dementia and other intellectual and mnestic diseases. violations. The opinion is expressed that already now the problem of dementia in old people is one of the most urgent problems of public health and social security.
The WHO defines dementia as: “Acquired global impairment of higher cortical brain functions, including memory, problem solving, exercise of learned perceptual-motor skills, proper use of social skills, all aspects of speech, communication, and control of emotional responses, in the absence of gross impairment of consciousness. ".
The International Classification of Diseases - 9 defines dementia as “syndromes with impaired orientation, memory, understanding, intelligence and judgment. To these main features one can add: superficiality and incontinence of affects or longer mood disturbances, a decrease in ethical requirements, an aggravation of personal characteristics, a decrease in the ability to make independent decisions.
The American Classification of Mental Illness identifies five criteria for dementia:
loss of intellectual abilities, which leads to frustration in the social and professional spheres;
memory impairment;
disorder of abstract thinking, evaluation and other higher functions or personality changes;
the presence of a clear consciousness;
the presence of organic causes.
In the elderly and senile age, dementias are divided into:
primary - the result of atrophic-degenerative processes in the brain of unknown origin;
Secondary dementias are dementias whose causes are known.
Primary dementias (senile dementia, Alzheimer's disease, Pick's disease, Parkinson's disease)
Common to all types of atrophic-degenerative dementia of senile age is a characteristic gradual and imperceptible onset, chronically progressive course, irreversibility of the atrophic process, manifested in the terminal stage of the disease in the form of total or global dementia.
In recent years, more and more researchers do not distinguish between senile dementia and Alzheimer's dementia (disease), named after the German psychiatrist who first described this type of dementing disease, believing that this is the same disease, regardless of the age of onset - elderly or senile . These psychiatrists distinguish senile dementia of the Alzheimer's type with onset at 50-65 years of age (early onset) and senile dementia of the Alzheimer's type with onset after 70 years of age (late onset) and briefly designate SDTA. This point of view is supported mainly by pathological and anatomical changes in the brain, which are the same for two types of dementia - senile plaques, neurofibrillary nodes, amyloidosis, gliosis, senile hydrocephalus.
There are more and more reports in the gerontopsychological literature that the spread of ADTA is becoming an epidemic. Annually, this category of patients in the United States spends from 24 to 48 million dollars. It is estimated that by the year 2000 the number of patients with SDTA will double. The prevalence and malignancy of the course of Alzheimer's dementia can only be compared with cancer. In the United States, this dementia is the fourth leading cause of death in the elderly and senile.
Usually the onset of the disease occurs at 45-60 years, and 1/4 of all cases are older than 65 years. Women get sick 3-5 times more often than men.
SDTA has a stereotype of the development of progressive dementia in parallel with the development of cerebral focal symptoms. Memory disorders occupy a central place in the process of disintegration of mental activity: complete amnestic disorientation gradually develops, autopsychic disorientation, reaching the degree of non-recognition of one's own image in the mirror (mirror symptom). The loss of automated habits is obligatory: patients forget the most familiar actions, how to dress, undress, cook, wash, etc. These disorders of praxis (movement) reach complete apraxia, any directed action becomes impossible, such an automated action as gait is disturbed.
Speech disorders are manifested in amnestic and sensory aphasia, in the end, speech consists of individual logoclones, echololia, iterations, for example, “yes-yes-yes”, “but-but-but”, “ta-ta-ta”, etc. P. Reading (alexia), writing (agrophia), counting (acalculia), spatial cognition (agnosia) are deeply disturbed, there is an “aphato-apraktoagnostic” type of dementia. In the terminal stage, mental and physical insanity sets in: grasping and sucking automatisms, violent crying and laughter, epileptiform seizures, and various neurological syndromes appear.
It should be noted that the feeling of illness, the awareness of one's own mental incompetence persists for a very long period of illness. Difficulties in diagnosis usually occur only in the early stages of the disease, when depressive disorders come to the fore.
Despite the attitudes of modern psychiatrists to confuse senile dementia (simple form) and Alzheimer's disease, the stereotype of true senile dementia is very different from the latter. The onset of the disease usually occurs between 65 and 70 years of age. Women get sick twice as often as men.
Usually, the disease begins with the leveling of individual personality traits and with the development of the so-called “senile psychopathization of the personality”, which manifests itself in coarsening, blanching of characterological features, the development of egocentrism, greed, hoarding, moral and ethical licentiousness, vagrancy. A feature of this psychopathic debut is that patients become unbearable in the family, cruelty to close relatives appears, at the same time they become gullible and easily fall under the influence of various kinds of adventurers, who often bring them to various kinds of judicial offenses. Memory disorders develop according to the law established by the French psychologist Ribot; recently acquired knowledge is forgotten, which eventually reaches a complete amnestic disorientation. In the future, patients forget all the acquired knowledge, including those acquired in the distant past. The most characteristic sign of senile dementia is living in the past, i.e. the behavior of patients fully corresponds to the ideas of patients about their own personality: they are small children, lisp, play, or think that they are getting married, going to a ball, etc. Another characteristic feature is confabulation, i.e. replacement of memory lapses with memories from life in the past. At this stage of the disease, the sullen-gloomy affect is replaced by a complacent-euphoric one. In patients with senile dementia, speech expressiveness is preserved for a very long time, but the grammatical structure of speech gradually disintegrates, the connection between thinking and speech is destroyed, empty and non-communicative talkativeness of senile patients is observed.
Neurological symptoms are relatively poor and appear at the very late stages of the disease: amnestic aphasia, mild praxis disorders, epileptiform seizures, senile tremor.
Dementia due to Pick's disease. There is still no reliable information about the prevalence of Pick's disease, but nevertheless, all researchers note that this is the rarest form of atrophic-degenerative dementia. Women get sick more often than men.
The peculiarity of peak dementia lies in the fact that, unlike other degenerative dementias in old age, profound personality changes and a weakening of the most complex types of intellectual activity come to the fore in the clinical picture. At the same time, the mnestic apparatus itself (attention, memory, sensory cognition) remains little affected. There are two options for changing personality:
The 1st variant is characterized by a disorder of drives, a tendency to sexual hyperactivity, which often leads to delinquency, the gradual disappearance of moral and ethical attitudes, accompanied by euphoric-expansive affect with a complete absence of self-criticism;
The 2nd variant is characterized by apathy, spontaneity, weakness, increasing indifference, inaction and affective dullness; at the same time, impoverishment of speech, thinking, and motor skills progress very quickly.
These two options depend on the localization of the atrophic process: the temporal or frontal parts of the brain.
The central place in the clinical picture is occupied by often recurring monotonous and monotonous stereotypes of behavior, gestures, facial expressions, speech - a symptom of a gramophone record. Memory disorders appear rather late, and elementary orientation is preserved even in severely demented patients. Although Pick's disease has been extensively described in the psychiatric literature, it is very difficult to diagnose in hospitals, and is particularly difficult to distinguish early from schizophrenia, brain tumors, and progressive paralysis. Some authors generally believe that the diagnosis can be confirmed or established only after the death of the patient. It must be said that, in general, Pick's disease remains a mystery that is waiting for its solution.
Dementia due to Parkinson's disease. With regard to this type of dementia, some authors believe that it occurs very often and should be regarded as an integral part of parkinsonian pathology. Other authors dispute this fact and write that dementia disorders are not an obligatory symptom of the disease. According to English authors, Parkinson's dementia develops from 11 to 56% of all observations.
The disease belongs to the degenerative-atrophic disorders of the extrapyramidal system that develop in the elderly and senile age. The disease begins at the age of 50-60 slowly and imperceptibly, its course is chronic and is manifested by neurological syndromes. In the early stages of the disease, irritability, affective lability and importunity, disorders in memory, reproduction, lack of criticism against the background of a complacent euphoric mood are noted. Depending on the degree of bradyphrenia (decrease in speech activity, slowness, difficulty in all mental processes, spontaneousness, apathy), there is a relative preservation of mnestic functions and orientation. Depressive and depressive-hypochondriac disorders are observed very often, there are also severe depressive states with suicidal experiences and suicides. Awareness of one's own inferiority persists for a relatively long time.
Most researchers are inclined to the hereditary nature of the disease. In recent years, much attention has been paid to the study of neurotransmitter systems. Decreased activity of the hormones choline acetyltransferase and acetylcholinesterase was found. There are direct dependencies between the degree of their decline and the degree of intellectual decline. Treatment of extrapyramidal symptoms with anticholinergic agents can deepen cognitive (cognitive) impairment, so the treatment of Parkinson's disease requires great attention.
Secondary dementias
The very name of these dementias contains the answer to the question of their etiology (origin). Almost all somatic diseases, especially long-term and chronic ones, cause a decrease in mental activity, a deterioration in mental activity, and, above all, have a negative effect on the cognitive abilities of an old person. The reasons for the development of secondary dementias are the most numerous and varied. Here we can talk about dementia caused by diseases of the respiratory system, cardiovascular diseases as a result of anoxia of the brain (lack of oxygen); dementia due to metabolic disorders (diabetic, renal, hepatic encephalopathy); dementias caused by hyperlipidemia, electrolyte disorders, lack of B vitamins, etc. Most secondary dementias, when diagnosed as the underlying cause of the dementia syndrome, are reversible with proper therapy. It is clear, by itself, that here we are not talking about true dementia, but about pseudo-dementia. It is precisely such psychotic states that, with the correct treatment of a somatic disease, or at least with an improvement in the somatic health of an old person, can completely disappear and cognitive abilities improve markedly.
The most striking expression of secondary dementias is multi-infarct dementia. In the past, any dementia that develops in the elderly and senile age was associated with age-related vascular changes and was diagnosed as “atherosclerotic dementia”, “vascular dementia”, “arteriopathic dementia”. However, studies have shown that progressive damage to the cerebral arteries by sclerosis does not lead to their stenosis and does not cause mental disorders, so the name “cerebral arteriosclerosis” is incorrect and inaccurate. In cases where dementia is due to vascular disease, we are talking about the occurrence of numerous small and large cerebral infarcts in the brain.
Statistical data on the spread of multi-infarct dementia are very contradictory and vary from 8 to 29% of all dementias. Men are affected more often than women. Some authors believe that men have a genetic predisposition to multi-infarct dementia.
This type of dementia is characterized by affective lability, mental asthenia (weakness), focal neurological symptoms, a close connection with hypertension, a gradual, as it were, stepwise decline in intellectual functions.
Dementia due to depression. The common features that characterize dementia and depression often lead to diagnostic difficulties. Quite often, a depressive disorder is part of an organic dementia. Cognitive impairment, in turn, can be part of functional depression. This syndrome, known as depressive pseudodementia, is very dangerous, not only because of the difficulty in diagnosing, but above all because it diverts attention from a real, albeit temporary, deterioration in cognitive abilities. Experience shows that depressive pseudo-dementia is as true as all secondary dementias. The frequency with which depressive pseudodementia appears varies from 1 to 20%.
With proper assessment of the disease and responsible clinical research, depression can always be distinguished from dementia. But even "ideal depressive patients" show a tendency to cognitive dysfunctions. When examining their intelligence quotient (IQ), they show a verbal deficit, while the results of short-term memory prove that patients remember the given material relatively easily, but reproduce it erroneously. Such sick old people are usually inclined to say "I don't know" and look depressed during the study, although their general memory impairment is slight. Conversely, sick old people with organic dementia do not realize their intellectual inferiority. They try in every possible way to deny and hide it, in the past they do not have depressive episodes. In IQ tests, practical results are worse than verbal ones, memorization of new material is difficult, and often impossible at all. These patients would rather answer a question incorrectly than say “I don't know”. During the study, they are not depressed.
Dementia due to drug intoxication
The exact frequency of this kind of dementia in old people is still not established, but it is so often found with incorrectly prescribed or overdosed drugs that the latter are rightfully considered one of the main causes of secondary dementias of the elderly and senile age. This is largely due to reduced pharmacokinetics (elimination of drugs from the body) and increased drug intake in old age. All medicines can cause intoxication. The boundary between therapeutic and toxic dose for most drugs is very minimal. And although any drug has the potential to cause cognitive impairment, there are still a few groups that are especially dangerous in this regard.
Today, almost all doctors widely prescribe tranquilizers, not knowing their effect on the body. It is not uncommon for elderly and old people to take these drugs for many years, become addicted to them, in fact they develop drug addiction. Meanwhile, the effective use of these psychotropic drugs requires a good knowledge of their decay half-life in the human body in order to avoid an accumulative (accumulative) effect.
With prolonged treatment with digitalis preparations, antihypertensive and antiarrhythmic drugs, frequent changes in the intellectual activity of people are noted.
In cases where it is necessary to determine the role of an overdose of a drug in the development of dementia in geriatric patients, it is most advisable to stop this drug in order to monitor the patient's condition for several weeks.
Treatment and prevention of dementia of senile age
The most important task facing the clinician is early recognition of dementia, i.e. early diagnosis. But in practice it is very difficult to do this, often patients come to the attention of geriatric psychiatrists when dementia is in the stage of pronounced clinical manifestations. Most paraclinical studies are unreliable, and often the exact same changes are seen in mentally healthy old people.
Psychological examination makes it possible to determine the degree of dementia, but carries very little information for differential diagnosis. In addition, such a study in old people should be carried out very carefully, since in no age period do the results depend so much on the personality of the researcher as in old people, on the degree of his competence, conscientiousness, patience and, most importantly, on his benevolence towards old patient.
Most of the symptoms that accompany dementia are treatable, such as anxiety, nighttime confusion, psychomotor agitation, paranoid (delusional) and depressive disorders.
The reasons for the old person's anxiety must be identified and eliminated. It is usually up to a psychiatrist to determine the treatment, but in the absence of it and the old person's marked anxiety, it is better to use haloperidol up to 2 mg per day, higher doses can be toxic. The most preferred is sonapax (thioridazine, melleril), which has an anti-stress, sedative and antidepressant effect - up to 50 mg per day. In severe cases, a combination of 1.5 - 2 mg of haloperidol and 15 - 20 mg of sonapax gives a faster therapeutic effect.
The most severe symptom of dementia is vagrancy, which is the most difficult to treat. The reasons for this behavior of demented old people have not yet been studied. In such cases, constant monitoring of patients at home is necessary. Sometimes you have to fix the patient, for example, tie him to a chair, to an armchair, to a bed. If it is impossible to keep a demented old person at home, he should be hospitalized in a psychiatric hospital or placed in a special boarding school for patients with chronic mental illness.
Currently, various psychostimulants, in particular, nootropil, paracetam, cavinton, etc., are widely used to treat intellectual-mnestic disorders in old age. These drugs have a positive effect only in vascular lesions with hypoxia and in the early stages of dementia. In the late stages of primary dementia and multi-infarct dementia, they are contraindicated.
Primary prevention of dementias consists in the removal from factors that enhance or change the processes of physiological aging, i.e. they are common to all medicine.
Secondary prevention means early detection and proper treatment.
However, for most dementias, especially for primary ones, i.e. atrophic-degenerative, important is the so-called tertiary prevention- relief and reduction of the consequences of the disease. This type of prevention consists primarily in the formation of a positive attitude towards an old person with dementia manifestations and the use of various methods of treatment.
Now most of the dementia old people live at home, and relatives take care of them. As a result, families face many problems. These people experience great difficulties and emotional stress. Depression and neurotic states of varying severity are described in relatives who need psychiatric help. One of the reasons is the lack of the most elementary knowledge in servicing a demented old person and a correct understanding of his mental behavior and intellectual and memory impairments.
Another reason is that out-of-hospital psychiatric care does not meet the needs and requirements of the population. Only in some countries there is a system for the training of qualified personnel in geriatric psychiatric care.
Functional mental disorders in the elderly and old people
These mental disorders are characterized by the absence of signs of dementia; intellectual-mnestic functions are preserved in old people. Mental disorders of this register usually begin at a young or mature age, and with them patients live to the elderly, senile age, and even to the very advanced age. These are the so-called endogenous psychoses - schizophrenia, manic-depressive psychosis, various psychoneuroses. However, there are also mental disorders that first occur in the elderly and senile age.
The most common in old age are depressive disorders, it is believed that they accompany aging. Georgian psychiatrist A. Zurabashvili wrote that depression is the most common anthropotypical form of human reaction, and as a universal human motive, it becomes more frequent with increasing age. It is estimated that 15-20% of all old people have depressive disorders that require psychiatric monitoring and treatment. The famous Soviet geriatric psychiatrist N.F. Shakhmatov found that the ratio of depressive symptoms in the elderly (60-64 years) and in the senile (80 years and older) is 1:3.3. Another no less famous geriatric psychiatrist E.Ya. Sternberg, on the contrary, believed that the highest percentage of depression is observed in people aged 60 - 69 years - 32.2%, while after 70 years these disorders are found only in 8.8%. However, English psychiatrists found that the decrease in identified depressions with age is not due to their true decrease, but to the fact that the presence of depression in old age is either not noticed at all or is assessed as an age norm. Many old people consider depression to be a normal component of old age and therefore do not seek help, and doctors share this opinion and do not diagnose depression. It would not be an exaggeration to say that such an opinion exists in relation to almost all mental disorders in old age, “all ailments are from old age, and not from illness.” This view is extremely dangerous in improving medical care for the very old.
Causes great concern and high frequency of suicides (suicides) in old age. The propensity to commit suicide is also increasing: over the age of 70, their number is three times higher than suicides committed between the ages of 20 and 30 years. Among the causes of death in people over 65 years of age, suicide ranks 17th. 11% of Americans aged 65 and over commit suicide. The American psychiatrist Shamoin believes that suicide is possible in all old people, and not just in depressed patients. In his opinion, every patient of senile age should be examined regarding passive and active ideas about suicide. Persons with active thoughts or ideas of suicide and definite plans for their implementation should be treated immediately in conditions that preclude its completion.
Regardless of the nature, depressive syndromes in old age are characterized by general patterns and features that greatly complicate their diagnosis.
So, at the age of 50-65 years, the presence of anxiety, internal restlessness, fear, anxious excitement, diffuse paranoidity, i.e. unformed delusions, ideas of self-blame, anxious fears, hypochondriacal experiences.
Depressions of the actual senile age - 70 years and more - are characterized by other features: apathy, discontent, irritation, a feeling of undeserved resentment. These senile depressions are not accompanied by depressive self-esteem and depressive evaluation of the past. Usually, with a gloomy pessimistic assessment of the present, social status, health and financial situation, the past is presented in a positive light. With age, ideas of self-accusation, self-deprecation and a sense of moral guilt are less and less observed, and somatic complaints, hypochondriacal fears, and ideas of material insolvency are more often expressed. As a rule, such old people accuse relatives or persons serving them of insufficient attention, lack of sympathy, and neglect.
In old age, mania is also observed - up to 10%. Most often, angry mania is found: gloominess, irritability, hostility and even aggressiveness against the background of high mood. Often this condition occurs in the form of carelessness, indifference, carelessness and is difficult to separate from dementia.
Of particular interest are paranoid psychoses with a picture of small-scale delusions of persecution of the so-called small scale, which is completely exhausted by everyday topics. Such old people believe that people close to them do all sorts of dirty tricks in order to get rid of the presence of an old person in a family or in a communal apartment. They find confirmation of “moral oppression” in the most harmless actions, words, and behavior of others. The intellect remains unaffected, although such paranoid psychoses usually occur in illiterate, low-intellectual old people, but very well adapted to ordinary everyday life. Antipsychotics can temporarily mitigate the severity of the psychotic state, but a complete cure is not observed.
In old age, symptomatic acute psychoses are observed, which are characterized by a violation of consciousness, the presence of hallucinatory or illusory disorders, broken speech, a violation of the sleep formula - they sleep during the day and stay awake at night, psychomotor agitation, disorientation and often profound memory impairment. As a rule, such psychoses occur acutely, they are distinguished by “flickering, fluctuation”, i.e. inconstancy of the clinical picture during the day. The presence of an etiological factor is mandatory - this is usually any somatic, neurological, infectious disease.
These psychoses have various names, but in domestic psychiatry it is more customary to call them states of mental confusion. Interestingly, they are rarely found directly in psychiatric hospitals, only 5-7%, while in neurological departments - up to 40%, in therapeutic and surgical departments - from 14 to 30%.
There is evidence that these conditions are 2 times more likely to be found in people over 75 years of age. Some authors believe that they are found in men and women with the same frequency, others believe that they are found in men twice as often as in women. Treatment should primarily be aimed at the underlying somatic disease and relief of psychomotor agitation.
In the terminal stage, so-called quiet, immobilized states of mental confusion are often found.
Care for older people with mental disabilities
Epidemiological studies show that 5% of people over 65 years of age, 20% of those aged 80 years and 30% of those aged 90 years and older suffer from irreversible dementia, but 55 to 75% of them live at home, a fairly large percentage of old people with mental disorders of a different nature are in nursing homes, which are intended for mentally healthy old people. Only a small part of mentally ill old people are under the supervision of psychiatrists, are registered in neuropsychiatric dispensaries. It is well known how difficult it is sometimes to hospitalize an old person aged 75 years and older in a psychiatric hospital, even in the presence of acute psychosis. Therefore, it is impossible to overestimate the role of the family in providing medical and social care for mentally ill old people. At the same time, one cannot remain silent about the problems that exist in such families.
According to Yu. Danilov, family conflicts in terms of frequency rank first among other traumatic situations in the elderly and senile age. He draws attention to the fact that the mental illness of an old family member usually leads to a stressful situation for both the sick old person and his family members. “The usual idea that there is one patient in the family often does not correspond to reality. In fact, as a rule, we are talking about mental decompensation of almost all family members. Developing opportunistic circumstances are complicated by the misunderstanding and attitude of relatives towards the patient.”
Investigating the possibilities and results of out-of-hospital detention of mentally ill senile and childhood patients, the English psychiatrists J. Honig and M. Hamilton found that objectively caring for old people is physically much more difficult for the family. But the main thing is that relatives are less willing to endure this burden, caring for an old person. The need for constant care for children with mental disorders is much easier to bear.
Many geriatric psychiatrists note that relatives of mentally ill old people often experience a fear of them that is much greater than with the most severe somatic diseases. It is fear that underlies the rejection of a mentally ill old person. But along with such observations, there are more optimistic views on the attitude of surrounding people towards old people. Thus, the American gerontologist M. Miller notes that relatives resort to medical care only in case of a somatic illness of an old person; the family voluntarily takes on all the burdens of caring for a mentally ill old man. Many geriatric psychiatrists write that there is a need to inform the poorly educated contingents of the population about mental disorders in old people and the proper organization of care for them. Good treatment, timely treatment of mental disorders and somatic diseases improve mental activity and adaptive capabilities of even severely demented patients of senile age. The opinion is expressed in the literature that the “tolerant” attitude of society towards the mental illness of old people is the result of a decrease in the social activity of the elderly, a decrease in the level of social requirements for them. A number of psychiatrists believe that the main components of the population's tolerance for mentally ill old people are a general ignorance of specific mental disorders and a low level of social requirements.
English psychiatrists L. Harris and J. Sanford pay special attention to the fact that material security, socio-economic status are not only important for maintaining mental health in old age, but these factors have a decisive influence on the tolerance of relatives to mental disorders in old people .
According to the English gerontologist E. Brody, old people with dementia can only live at home if they have close relatives who care for them. The author emphasizes that caring for such old people is so difficult mentally and physically that usually only a very close person can perform these duties. An interesting interpretation by some geriatric psychiatrists is the overprotection that unmarried and childless daughters show towards their elderly sick parents. According to these scholars, this overprotectiveness is nothing more than a feeling of guilt due to a suppressed desire to be free from these worries.
There are acute forms of senile psychoses, manifested by states of clouding of consciousness, and chronic ones - in the form of depressive, paranoid, hallucinatory, hallucinatory-paranoid and paraphrenic states.
Acute forms of senile psychoses are observed most often. Patients suffering from them are found both in psychiatric and somatic hospitals. The occurrence of their psychosis is usually associated with a somatic disease, so such psychoses are often referred to as somatogenic psychoses of late age.
The cause of senile psychosis is often acute and chronic respiratory diseases, heart failure, hypovitaminosis, diseases of the genitourinary system, as well as surgical interventions, i.e., acute forms of senile psychosis are symptomatic psychoses.
Causes of senile psychosis:
In some cases, the cause of senile psychosis can be hypodynamia, sleep disturbances, malnutrition, sensory isolation (decreased vision, hearing). Since the detection of a somatic disease in the elderly is often difficult, its treatment in many cases is too late. Therefore, mortality in this group of patients is high and reaches 50%. For the most part, psychosis occurs acutely, in some cases its development is preceded by a prodromal period lasting one or several days, in the form of episodes of fuzzy orientation in the environment, the appearance of helplessness in self-service, increased fatigue, as well as sleep disorders and lack of appetite.Common forms of clouding of consciousness are delirium, stunned consciousness and amnesia. Their common feature, especially delirium and amnesia, is the fragmentation of the clinical picture, in which motor excitation predominates. Often during psychosis, there is a change from one form of clouding of consciousness to another, for example, delirium to amentia or stunning. Clearly defined clinical pictures are much less common, more often it is delirium or stunning.
The difficulty of clearly qualifying the state of clouding of consciousness in senile psychoses led to their designation by the term "senile confusion". The more fragmented the clinical picture of senile psychoses, the more severe the somatic disease or the previous manifestations of the psychoorganic syndrome.
Usually, the clinical features of states of clouding of consciousness in senile psychoses are in the presence of age-related (so-called senile) features - motor excitation, which is devoid of coordinated sequential actions and is more often characterized by fussiness and randomness.
In the delusional statements of patients, ideas of damage and impoverishment predominate; a few and static hallucinations and illusions are noted, as well as an unsharply expressed affect of anxiety, fear, confusion. In all cases, the appearance of mental disorders is accompanied by a deterioration in the somatic condition. Psychosis lasts from several days to 2-3 weeks, rarely longer. The disease can proceed both continuously and in the form of repeated exacerbations. During the recovery period, patients constantly have adynamic asthenia and passing or persistent manifestations of the psychoorganic syndrome.
Forms and symptoms of senile psychosis:
Chronic forms of senile psychosis, occurring in the form of depressive states, are observed more often in women. In the mildest cases, subdepressive states occur, characterized by lethargy, adynamia; patients usually complain of a feeling of emptiness; the present seems insignificant, the future is devoid of any prospects. In some cases, there is a feeling of disgust for life. Constantly there are hypochondriacal statements, usually associated with certain existing somatic diseases. Often these are “silent” depressions with a small number of complaints about their state of mind.Sometimes only an unexpected suicide allows a retrospective to correctly assess the existing statements and the mental disorders hidden behind them. In chronic senile psychoses, severe depressions with anxiety, delusions of self-accusation, agitation up to the development of Cotard's syndrome are possible. Previously, such conditions were attributed to the late version of involutional melancholia. In modern conditions, the number of pronounced depressive psychoses has sharply decreased; this circumstance, apparently, is associated with the pathomorphosis of mental illness. Despite the duration of the disease (up to 12-17 years or more), memory disorders are determined by shallow dysmnestic disorders.
Paranoid states (psychosis):
Paranoid states, or psychoses, are manifested by chronic paranoid interpretive delusions that spread to people in the immediate environment (relatives, neighbors) - the so-called delusions of small scope. Patients usually talk about being harassed, wanting to get rid of them, deliberately spoiling their products, personal belongings, or simply robbing them. More often, they believe that by “bullying” others want to hasten their death or “survive” from the apartment. Much less often are statements that they are trying to destroy them, for example, to poison them. At the onset of the disease, delusional behavior is often observed, which is usually expressed in the use of all kinds of devices that prevent entry into the patient's room, less often in complaints sent to various government agencies, and in a change of residence. The disease continues for many years with a gradual reduction in delusional disorders. Social adaptation of such patients usually suffers a little. Lonely patients fully serve themselves, maintain family and friendly ties with former acquaintances.hallucinatory states:
Hallucinatory states, or hallucinosis, manifest mainly in old age. Allocate verbal and visual hallucinosis (Bonnet hallucinosis), in which other psychopathological disorders are absent or occur in a rudimentary or transient form. The disease is combined with severe or complete blindness or deafness. With senile psychosis, other hallucinoses are also possible, for example, tactile.Verbal hallucinosis Bonnet appears in patients whose average age is about 70 years. At the onset of the disease, acoasms and phonemes may occur. At the height of the development of psychosis, polyvocal hallucinosis is observed, characterized by true verbal hallucinations. Their content is dominated by abuse, threats, insults, less often orders. The intensity of hallucinosis is subject to fluctuations. With an influx of hallucinations, a critical attitude towards them is lost for a while, the patient develops anxiety and motor restlessness. The rest of the time, painful disorders are perceived critically. Hallucinosis intensifies in the evening and at night. The course of the disease is protracted, long-term. A few years after the onset of the disease, dysmnestic disorders can be detected.
Visual hallucinosis Bonnet occurs in patients whose average age is about 80 years. It appears acutely and often develops according to certain patterns. At first, separate planar visual hallucinations are noted, then their number increases; they become stage-like. In the future, hallucinations become voluminous. At the height of the development of hallucinosis, true visual hallucinations appear, multiple mobile, often colored natural sizes or reduced (Lilliputian), projected outside. Their content is people, animals, pictures of everyday life or nature.
At the same time, patients are interested spectators of ongoing events. They understand. that they are in a painful state, correctly assess the visible, while often engaging in a conversation with hallucinatory images or performing actions in accordance with the content of the visible, for example, setting the table to feed relatives seen. With an influx of visual hallucinations, for example, the appearance of hallucinatory images approaching the sick or crowding them, anxiety or fear arises for a short time, attempts to drive away the visions. During this period, the critical attitude towards hallucinations decreases or disappears. The complication of visual hallucinosis is also possible due to the short-term appearance of individual tactile, olfactory or verbal hallucinations. Hallucinosis has a chronic course, increasing or decreasing. Over time, its gradual reduction occurs, memory disorders of the dysmnesic type become more distinct.
Hallucinatory-paranoid state:
Hallucinatory-paranoid states appear more often after 60 years in the form of psychopathic disorders, lasting for many years, in some cases up to 10-15 years. The complication of the clinical picture occurs due to the paranoid delusions of damage and robbery (delusions of a small scale), which can be joined by unsystematized ideas of poisoning and persecution, which also extend to people in the immediate environment. The clinical picture changes mainly at the age of 70-80 years, as a result of the development of polivocal verbal hallucinosis, similar in manifestations to Bonnet's verbal hallucinosis. Hallucinosis can be combined with individual ideational automatisms - mental voices, a sense of openness, echo thoughts.Thus, the clinical picture of psychosis takes on a pronounced schizophrenic-like character. Hallucinosis quickly acquires a fantastic content (i.e., a picture of a fantastic hallucinatory paraphrenia develops), then the hallucinations are gradually replaced by delusional confabulations; the clinical picture resembles senile paraphrenia. In the future, some patients develop ecmnestic confabulations (a shift of the situation into the past), in others, paraphrenic-confabulatory disorders predominate until death, dysmnesia is possible without the development of total dementia. The appearance of pronounced memory disorders occurs slowly, often mnestic disorders occur 12-17 years after the onset of overt symptoms of the disease.
Senile paraphrenia (senile confabulosis):
Another type of paraphrenic condition is senile paraphrenia (senile confabulosis). Among these patients, persons aged 70 years and older predominate. The clinical picture is characterized by multiple confabulations, the content of which refers to the past. Patients talk about their participation in unusual or significant events in social life, about acquaintances with high-ranking people, and relationships that are usually erotic in nature.These statements are distinguished by figurativeness and clarity. Patients have an increased euphoric affect, overestimation of their own personality, up to delusional ideas of grandeur. In a number of cases, confabulations of fantastic content are combined with confabulations reflecting everyday events of a past life. Usually the content of confabulation does not change; they seem to take the form of a cliché. This applies to both the main theme and its details. It is not possible to change the content of confabulatory statements with the help of appropriate questions or direct suggestion. Psychosis can exist unchanged for 3-4 years, while there are no noticeable memory impairments.
In most cases, after the development of overt confabulosis and its stable existence, a gradual reduction of paraphrenic disorders occurs; at the same time, slowly increasing changes in memory are detected, which for a number of years are predominantly dysmnestic in nature.
Signs of senile psychosis:
Most chronic senile psychoses have the following common features: limitation of clinical manifestations to one range of disorders, preferably one syndrome (for example, depressive or paranoid); the severity of psychopathological disorders, which makes it possible to clearly qualify the psychosis that has arisen; long-term existence of productive disorders (delusions, hallucinations, etc.) and only their gradual reduction; a combination for a long period of productive disorders with sufficient preservation of intelligence, in particular memory; memory disorders are more often limited to dysmnestic disorders (for example, in such patients, affective memory is retained for a long time - memories associated with emotional influences).In those cases when psychosis is accompanied by a vascular disease, usually manifested by arterial hypertension, it is detected mainly after 60 years of age and proceeds in most patients benignly (without strokes), is not accompanied by asthenia, patients retain, despite psychosis, significant activity, they, like as a rule, there is no slowness of movements, which is characteristic of patients with vascular diseases of the brain.
Diagnosis of senile psychosis:
The diagnosis of senile psychosis is established on the basis of the clinical picture. Depressive states in senile psychoses are differentiated from depressions in manic-depressive psychosis that arose at a late age. Paranoid psychoses are distinguished from late manifesting schizophrenia and paranoid states in the debut of senile dementia. Verbal hallucinosis Bonnet should be differentiated from similar conditions, occasionally occurring in vascular and atrophic diseases of the brain, as well as in schizophrenia; visual hallucinosis Bonnet - with a delirious state, noted in acute forms of senile psychosis. Senile paraphrenia should be distinguished from presbyophrenia, which is characterized by signs of progressive amnesia.Treatment of senile psychoses:
Treatment is carried out taking into account the physical condition of patients. Of the psychotropic drugs (it must be remembered that aging causes a change in the reaction of patients to their action), in depressive states, amitriptyline, azafen, pyrazidol, melipramine are used. In some cases, two drugs are used simultaneously, for example, melipramine and amitriptyline. For other senile psychoses, propazine, stelazin (triftazin), haloperidol, sonapax, and teralen are indicated. In the treatment of all forms of senile psychosis with psychotropic drugs, correctors (cyclodol, etc.) are recommended. Side effects are more often manifested by tremor and oral hyperkinesia, which easily take a chronic course and are difficult to treat. In all cases, strict control over the somatic condition of patients is necessary.Forecast:
The prognosis for acute forms of senile psychosis is favorable in case of timely treatment and short duration of the state of clouding of consciousness. A long-term stupefaction of consciousness entails the development of a persistent and in some cases progressive psycho-organic syndrome. The prognosis of chronic forms of senile psychosis in relation to recovery is usually unfavorable. Therapeutic remission is possible in depressive conditions, Bonnet's visual hallucinosis, and in other forms, a weakening of productive disorders. Patients with a paranoid state usually refuse treatment; the best adaptive capabilities, despite the presence of delirium, are noted in them.The aging process is accompanied by changes in the human psyche. In the article, we will consider senile mental illnesses, learn how to prevent the appearance of deviations in the elderly using folk methods. Let's get acquainted with preventive methods that preserve clarity of mind and sobriety of memory.
Body aging
Such a physiological process is not a disease or a sentence. It is accompanied by changes in the human body. It makes no sense to label the age at which such changes occur, because the body of each person is individual and perceives everything that happens to him in his own way. Many manage to maintain clarity of mind, good memory and physical activity until the end of their days.
Violation in the psyche provokes retirement, the death of loved ones and acquaintances, a feeling of abandonment and insolvency, and illness. This and much more changes life stereotypes, provokes the emergence of chronic depression, which leads to more serious diseases.
Deviations in old age are difficult to characterize, because the mental state of a person depends on many factors. The occurrence of the disorder is provoked by negative thoughts, constant stress and anxiety. Prolonged stress affects the emotional and physical state of a person. The nervous system becomes vulnerable, hence neuroses and deviations.
Diseases of old age
Age-related changes are often accompanied by chronic diseases. Over the years, they become aggravated, gradually undermining health, affecting the mental state of a person. It is becoming increasingly difficult to resist external circumstances. Older people react more painfully to unforeseen situations.
Common diseases of old age:
- Damage to blood vessels leads to atherosclerosis.
- Psychosis and depression are frequent companions of the elderly.
- Alzheimer's and Parkinson's diseases.
- Dementia or dementia.
- The loss of calcium provokes the appearance of osteoporosis.
- Diuresis is a disease that provokes urinary incontinence, frequent urges.
- epileptic seizures.
Changes in the brain of the elderly
According to scientists, old age is a disease that can be treated. Most diseases appear in the human body at a young age. Brain aging provokes the awakening of chronic diseases and the emergence of new ailments.
senile depression
Causes of depression in old age:
- Unresolved issues.
- genetic predisposition.
- Changes in the neurological and hormonal sphere.
- response to negative events.
- Side effect of taking medications.
- Bad habits.
Symptoms are: depression, bad mood, accompanied by tears and negative thoughts, loss of appetite, sleep disturbance, and so on. In some cases, depression causes dementia, accompanied by apathy, poor memory, confusion of thoughts, disruption of physiological processes.
If depression does not go away within 2 weeks, seek help from a specialist. Modern medicine offers a wide range of drugs for the treatment of depression at any age. Start treatment in a timely manner, this will increase the chances of recovery.
Women are more prone to mental illness than men.
Dementia
Dementia includes senile destruction of the psyche. Older people deny the presence of mental disorders. Even relatives are in no hurry to realize the problem, justifying the illogical behavior of a close elderly person with advanced age. People are mistaken when they say that insanity is a manifestation of character.
- Causes of dementia:
- Senile dementia occurs as a result of age-related changes.
- Bad habits.
- Game addiction.
- The use of carbohydrates in large quantities.
- Lack of useful elements in the body.
- Thyroid disorders.
False dementia is treatable, while true dementia leading to Alzheimer's disease requires specialist supervision and constant monitoring of the patient's behavior.
Paranoia
Psychosis, accompanied by unthinkable ideas. An elderly person with such a diagnosis suffers himself and involuntarily makes others suffer. The paranoid is suspicious, irritable, prone to exaggeration, does not trust close people, accuses them of all sins.
Only a psychotherapist will make the correct diagnosis and prescribe the appropriate treatment.
Parkinson's disease
This is a disease of the brain, manifested by impaired coordination of movements, trembling of the hands, chin, legs, stiffness, slow action, and a frozen look.
Unreasonable fear, insomnia, confusion, reduced intellectual function appear.
Causes of Parkinson's disease:
- body aging;
- genetic predisposition,
- bad ecology,
- lack of vitamin D
- oncological diseases.
Early diagnosis allows you to remain active for a long time, to remain a professionally active person. Ignoring the disease leads to its progression.
The disease is also called "trembling paralysis", it often manifests itself in people over 70 years old.
Alzheimer's disease
Symptoms of the disease of the central nervous system are extensive. It flows differently for everyone. The loss of short-term memory, ill-considered actions, mental disorders are alarming, gradually a person becomes helpless.
At the last stage, the patient completely relies on the help of others, he is not able to take care of himself on his own. His health noticeably worsens, hallucinations appear, memory loss, inability to move independently, and in some cases convulsions.
Factors affecting the development of the disease:
- Improper diet, consumption of alcoholic beverages, sausages.
- Passion for salt, white sugar, flour products.
- Low brain and physical activity.
- Low level of education.
- Lack of oxygen.
- Obesity.
- Incomplete sleep.
The disease is considered incurable, although there are drugs that improve the patient's condition, albeit not for long. Recently, more and more older people are faced with such a diagnosis.
Treatment of the psyche with folk remedies
Alternative methods are effective only in combination with therapy prescribed by a doctor.
The use of herbal preparations is advisable in the initial stages of the development of senile psychoses.
Fighting senile insomnia
Ingredients:
- Dry leaves and flowers of hawthorn - 2 tablespoons.
- Water - 500 ml.
How to cook: Pour boiling water over dry grass, leave to infuse for 2 hours. Strain.
How to use: Take 3 times a day, 50 ml.
Result: Soothes, relieves senile neurosis, promotes sound sleep.
For senile dementia
Ingredients:
- Nettle - 200 g.
- Cognac - 500 ml.
How to cook: Fill the nettle with cognac. Leave for a day. Remove for 5 days in a dark place.
How to use: Take the tincture twice a day before meals, a teaspoonful.
Recipe: Prevention of mental disorders.
With aggressive behavior
Ingredients:
- Melissa.
- Motherwort.
- Blueberry leaves.
- Chamomile.
- Mint.
- Water - 700 ml.
How to cook: Take herbs, 10 g each, pour boiling water.
How to use: Cooled infusion (200 ml) take before bedtime.
Result: Soothes, restores clarity to thoughts.
Regular consumption of walnuts, dried fruits, buckwheat and sauerkraut improves memory. The development of dementia can be prevented by solving crossword puzzles, leading an active lifestyle, monitoring nutrition, and resisting a depressive mood.
Proper nutrition and adequate sleep
Omega-3 acids have a positive effect on the structure of the brain. They are found in:
- asparagus,
- fish oil,
- red caviar,
- olive oil,
- broccoli.
Include fish in your diet, which improves brain activity and slows down the development of dementia.
You need to go to bed before 11 pm. Sleep duration should be 8 hours. During this time, the brain will rest, restore energy potential. The sleep hormone is called melatonin. You can fill its deficiency with meat and dairy products, eggs, poultry, buckwheat, bananas, walnuts, B vitamins.
Physical activity and mental work
Sport improves brain function and protects it from aging. Jogging, brisk walking, dancing, roller skating, cycling and other types of cardio are considered effective.
Constantly develop, read books every day, learn a new language. Studies have shown that memory does not fail people who read and write a lot by hand. This will preserve the functions of brain activity, but is not a panacea for developing pathologies.
Busy is the best medicine
It is much easier to cope with mental illness if you accept your age and the changes that accompany it. This will help a real assessment of behavior and attitude. Optimism will keep your composure and peace of mind. The wisdom accumulated over the years of life will solve any problems.
Old age is a difficult period of a person's life, when there is a fading not only of his physiological functions, but also serious mental changes.
A person's social circle narrows, health deteriorates, and cognitive abilities weaken.
It is during this period that people are most susceptible to the occurrence of mental illness, a large group of which are senile psychoses.
What is fairy tale therapy for the elderly? Learn about it from ours.
Personality characteristics of older people
According to WHO classification, old age begins in people after 60 years, this age period is divided into: advanced age (60-70, senile (70-90) and the age of the centenarian (after 90 years).
Major mental problems old age:
- Narrowing the circle of communication. The person does not go to work, the children live independently and rarely visit him, many of his friends have already died.
- deficit. In an elderly person, attention, perception. According to one theory, this is due to a decrease in the possibilities of external perception, according to another, due to a lack of use of the intellect. That is, the functions die off as unnecessary.
Main question- how the person himself relates to this period and the ongoing changes. Here, his personal experiences, state of health and social status play a role.
If a person is in demand in society, then it is much easier to survive all the problems. Also, a healthy vigorous person will not feel old age.
The psychological problems of an elderly person are a reflection of social attitudes in old age. It may be positive and negative.
At positive at first glance, guardianship over the elderly, respect for their life experience and wisdom comes out. Negative expressed in a dismissive attitude towards the elderly, the perception of their experience as unnecessary and superfluous.
Psychologists distinguish the following types of people's attitudes towards their old age:
- Regression, or a return to a childish pattern of behavior. Old people require increased attention to themselves, show touchiness, capriciousness.
- Apathy. Old people stop communicating with others, become isolated, withdraw into themselves, and show passivity.
- Desire to participate in community life regardless of age and disease.
Thus, an elderly person will behave in old age in accordance with his life, attitudes, acquired values.
Senile mental illness
With increasing age, the likelihood of mental illness increases. Psychiatrists say that 15% of old people acquire various mental illnesses. Old age is characterized by the following types of diseases:
psychoses
In medicine, psychosis is understood as a gross mental disorder in which behavioral and mental reactions do not correspond to the real state of affairs.
Senile (senile) psychoses first appear after age 65.
They make up about 20% of all cases of mental illness.
The main cause of senile psychosis, doctors call the natural aging of the body.
Provoking factors are:
- Belonging to the female gender. Most of the patients are women.
- Heredity. Most often, psychosis is diagnosed in people whose relatives suffered from mental disorders.
- . Some diseases provoke and aggravate the course of mental illness.
WHO in 1958 developed classification of psychosis based on syndromic principles. There are the following types:
- . These include mania and.
- paraphrenia. The main manifestations are delusions, hallucinations.
- A state of confusion. The disorder is based on confusion.
- Somatogenic psychoses. Develop against the background of somatic diseases, proceed in an acute form.
Symptoms
The clinical picture depends on the type of disease, as well as on the severity of the stage.
Symptoms of the development of acute psychosis:
- disorientation in space;
- motor excitations;
- anxiety;
- hallucinatory states;
- the emergence of crazy ideas.
Acute psychosis lasts from a few days to a month. It directly depends on the severity of the somatic disease.
postoperative psychosis refers to acute mental disorders that occur within a week after surgery. The signs are:
- delirium, hallucinations;
- violation of orientation in space and time;
- confusion;
- motor excitement.
This state can last continuously or be combined with periods of enlightenment.
- lethargy, apathy;
- a sense of the meaninglessness of existence;
- anxiety;
- suicidal moods.
It lasts quite a long time, while the patient retains all cognitive functions.
- delirium directed towards loved ones;
- constant expectation of a dirty trick from others. It seems to the patient that they want to poison him, kill him, rob him, etc.;
- restriction of communication due to fear of being offended.
However, the patient retains self-care and socialization skills.
hallucinosis. In this state, the patient has various hallucinations: verbal, visual tactile. He hears voices, sees non-existent characters, feels touches.
The patient may communicate with these characters or try to get rid of them, for example, build barricades, wash and clean his home.
Paraphrenia. Fantastic confabulations come first. The patient talks about his connections with famous personalities, ascribes non-existent merits to himself. Also characterized by megalomania, high spirits.
Diagnostics
What to do? Consultation required for diagnosis psychiatrist and neurologist.
The psychiatrist conducts special diagnostic tests, prescribes tests. The basis for the diagnosis are:
- Stability occurrence of symptoms. They occur with a certain frequency, do not differ in variety.
For psychoses are not characterized by gross disorders of the intellect, they increase gradually as the disease progresses.
Treatment
Treatment of senile psychosis combines medical and psychotherapeutic methods. The choice depends on the severity of the condition, the type of disorder, the presence of somatic diseases. Patients are prescribed the following groups of drugs:
The doctor selects a combination of drugs according to the type of psychosis.
Also, in parallel, it is necessary to treat a somatic disease, if it appeared cause of the disorder.
Psychotherapy
Psychotherapeutic classes are an excellent tool for the correction of psychosis in the elderly. In combination with drug therapy, they give positive results.
Doctors use mainly group sessions. Old people, being engaged in groups, acquire a new social circle with common interests. A person can start talking openly about his problems, fears, thereby getting rid of them.
Most effective methods of psychotherapy:
Senile psychoses This is a problem not only for the patient himself, but also for his relatives. With timely and correct treatment, the prognosis of senile psychosis is favorable. Even with severe symptoms, it is possible to achieve a stable remission. Chronic psychoses, especially those associated with depression, are more difficult to treat.
Relatives of the patient need to be patient, show care and attention. A mental disorder is a consequence of the aging of the body, so not a single person is immune from it.
