Psychopathology in infectious diseases. Mental disorders in infectious lesions of the brain

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

The reactions of the exogenous type include the following syndromes: asthenic, delirious, Korsakovsky, epileptiform excitation (twilight state), catatonia, hallucinosis. Such psychopathological symptoms may accompany common infections (typhus, malaria, tuberculosis, etc.) or be a clinical expression of an infection with cerebral localization. With meningitis, predominantly the membranes of the brain are affected, with encephalitis, the substance of the brain itself, with meningoencephalitis, a combined lesion is observed. Some common infections may be complicated by encephalitis

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(eg, pyogenic infection, influenza, malaria) or meningitis (eg, tuberculosis).

At the beginning of the XX century. the concept of exogenous types of reactions of K. Bongeffer appeared, the essence of which was to recognize the response of similar mental forms of disorders to various exogenous hazards.

Statistical data on the frequency of infectious psychoses in certain regions of the country, cited by various authors, differ in 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 an unequal assessment of the role of an infectious factor in the occurrence of mental disorders. diseases. To a lesser extent, the ratio of the number 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 quickly and easily get tired, complain of headaches, weakness, lethargy. Sleep becomes shallow with nightmares. Mood instability is noted (often the background of mood is reduced, patients are prone to melancholy, irritable, quick-tempered). The movements of patients are slow, sluggish.

The most characteristic for acute infectious psychoses are states of disturbed consciousness and, in particular, its clouding: delirious or amental syndrome, less often - twilight clouding of consciousness. Disturbances of consciousness often develop at the height of the temperature reaction, in their structure acute sensory delirium is found in combination with vivid visual and auditory hallucinations. These phenomena after the passage of the febrile period pass.

Infectious psychosis can also develop after normalization of body temperature. After the acute period of severe infection has passed, an amental syndrome can be observed with a 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. Separate forms of mental illness

gradual recovery of memory disorders), hallucinatory-paranoid, catatonic-gebephrenic syndromes against the background of a 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 statement of personality changes characteristic of schizophrenia (autism, emotional impoverishment of the 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, Japanese mosquito encephalitis, meningitis), the following clinical picture of the acute period is observed: against the background of severe headaches, often vomiting, stiff neck muscles and other neurological symptoms (Kernig's symptom, diplopia, ptosis, speech disorder, paresis, signs of diencephalic syndrome, etc.) develop stupor, oneiroid (dream-like) confusion, motor excitation with delusional and hallucinatory disorders.

With encephalitis, symptoms of a 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. The psychoorganic syndrome in most cases has a chronic regressive course. Mental disorders in encephalitis are combined with neurological disorders. As a rule, there are persistent and intense headaches, central and peripheral paralysis and paresis of the extremities, 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 the chronic course, infectious psychoses, with all the variety of mental disorders, often lead to personality changes according to the type of organic syndrome.

263 Chapter 20. Disorders in infectious diseases Etiology and pathogenesis

With infectious psychosis, the clinical manifestations are due to the individual characteristics of the sick person to respond to exogenous harmfulness.

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

Treatment

In the presence of an infectious disease, the underlying disease is treated with the addition of detoxification therapy (polyglucin, rheopolyglucin), vitamin therapy. In the presence of acute psychosis with excitation or clouding of consciousness, the use of tranquilizers is recommended (seduxen intramuscularly at 0.01-0.015 g 3-4 times a day), with an increase in excitation - haloperidol (0.005-0.01 g intramuscularly 2-3 times a day) .

With 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). days), vitamins.

Chapter 20

^ MENTAL DISORDERS IN INFECTIOUS DISEASES

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(eg, pyogenic infection, influenza, malaria) or meningitis (eg, tuberculosis).

^ Clinical manifestations

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

^ 262 Section III. Separate forms of mental illness

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

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

With infectious psychosis, the clinical manifestations are due to the individual characteristics of the sick person to respond to exogenous harmfulness.

Treatment

With hallucinatory-paranoid syndrome, the appointment of neuroleptics is recommended.

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 the trial, the person is given appropriate treatment, and only after he has recovered from the psychosis is the question of his sanity resolved.

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

^ 264 Section III. Separate forms of mental illness

we are extremely rare. Of great forensic psychiatric importance are cases when a psychoorganic syndrome forms in patients after protracted infectious psychoses with the consequences of infectious encephalitis and in patients with a protracted chronic course of an infectious disease. If there is a shallow intellectual decline, a critical attitude of the person to his state, to the current situation, as well as the insignificance of 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 judgment of sanity is made.

Prisoners in 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 entail, as a rule, during a forensic psychiatric examination, exemption from responsibility for committed acts and actions, and the subjects in most cases are recognized as sane.

When conducting an examination in a civil process in the presence of psychosis (or individual 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 capacity in severe asthenic condition, the prevailing chronic course, complicated by other concomitant factors. At the same time, the corresponding structure of the personality with its features 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, are of particular importance for the diagnosis, tactics of managing and treating these patients, as well as for expert assessment.

Premorbid personality traits of AIDS patients are often characterized by psychopathic features, among which hysterical traits are most often detected (with

^ 265 Chapter 20

ness, theatricality of gestures, facial expressions). Often, various sexual perversions are found, including homosexuality. There are signs of antisocial behavior.

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

In the initial period of AIDS, along with the appearance of somatic manifestations of the infection, neurotic symptoms are detected, a neurasthenic syndrome is more often observed with impaired concentration, memory difficulties and emotional lability, with a predominance of melancholy and anxiety.

At later stages of the development of the disease, amnestic disorders become more pronounced, resembling manifestations of fixative amnesia, memory for 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 characterized by dynamism with periods of temporary improvement in the mental state, however, with the development of the disease and its progression, with a tendency to worsen mental disorders 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 AIDS patients 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. Separate forms of mental illness

AIDS disease, confirmed by laboratory data.

The underlying disease is being treated in an infectious diseases hospital with a corresponding effect on psychopathological syndromes.

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

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

Chapter 21

^ MENTAL DISORDERS IN SYPHILIS OF THE BRAIN AND PROGRESSIVE PARALYSIS

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

In case of syphilitic damage to the brain, individual independent clinical forms of syphilis of the brain (with primary damage to the meninges and vessels of the brain) and progressive paralysis (with primary damage to the substance of the brain - its parenchyma) are isolated, based on the localization and the period that has elapsed since the onset of the disease with syphilis. Both syphilis of the brain and progressive paralysis result from infection with a pale spirochete, but they differ sharply in the time of onset of the disease, in the nature and localization of the pathological process, and also in the clinical picture.

Progressive paralysis has recently been extremely rare, although in line with the increase in the incidence of syphilis at the present time, one can assume an increase in the number of patients with progressive paralysis in a few years.

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Mental disorders in syphilis of the brain

Psychopathological manifestations of brain syphilis are very diverse and are mainly due to the stage of the disease, localization and prevalence of the pathological process.

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

The most common psychopathological syndrome of stage I-II of brain syphilis is neurosis-like (syphilitic neurasthenia), in which neurotic, hypochondriacal and depressive disorders are observed. Symptoms such as severe irritability, emotional lability, complaints of headaches, memory impairment, and a drop in working capacity predominate. Gradually formed lacunar (partial) dementia.

There are characteristic pupillary disorders (lethargy of the pupils' reaction to light), pathology of the cranial nerves, meningeal symptoms, epileptiform seizures. A positive Wasserman reaction in the blood and unstable are detected. - in the cerebrospinal fluid, moderate pleocytosis (cell shift), positive globulin reactions, pathological curves in the Lange reaction (liquid color change in the first 3-5 tubes - "syphilitic tooth" 11232111000, in 5-7 tubes - "meningitis curve" 003456631100).

Stages II and III of syphilis are characterized by psychoses, which are classified according to the leading syndrome. There are syphilitic psychoses with hallucinatory-delusional, pseudo-paralytic (progressive dementia) syndromes and disorders of consciousness according to delirious and twilight types.

The hallucinatory-delusional syndrome with syphilis of the brain often begins with the appearance of auditory hallucinations: the patient hears insults, abuse addressed to him, often cynical sexual reproaches, soon the patient becomes completely uncritical to these disorders, believes that he is being pursued by murderers, thieves, etc. .

^ 268 Section III. Separate forms of mental illness

Against the background of hallucinatory-delusional disorders, episodes of disturbed consciousness with speech and motor excitation can be observed.

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

With syphilis of the brain, delusions and hallucinations have a mundane content, are associated with an emotional component, 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, impaired thinking are found. In alcoholic psychosis, alcoholic personality changes take place.

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

With pseudo-paralytic syndrome against the background of dementia of the organic type (partial, lacunar), which, with development, increasingly acquires a picture of a global one (complete, with a breakdown of all, including criticism, manifestations of the intellect), a benevolent background of mood prevails, patients are euphoric, can express delusional ideas of greatness of fantastic content.

Sometimes there are epileptiform seizures, strokes.

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

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

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

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

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

With syphilis of the brain, specific therapy is carried out. All patients who have syphilis of the brain are sent for treatment to a psychiatric hospital.

Treatment. The main and most common treatment for syphilis of the brain is penicillin therapy (at least 12,000,000 units for a course of treatment). Conduct several courses. With repeated courses, it is advisable to prescribe prolonged forms of penicillin - ekmonvocillin 300,000 IU intramuscularly 2 times a day.

Antibiotic treatment is combined with iodine and bismuth preparations. For a course up to 40 g of biyoquinol. These drugs are used in combination with vitamins, especially group B, and general restorative treatment is also carried out.

For the treatment of patients with mental disorders, psychotropic drugs are used, depending on the leading syndrome.

^ Forensic psychiatric examination syphilis of the brain due to the variety of clinical manifestations should not be determined by only one diagnosis of the disease, in each case an expert opinion is issued 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, when conducting a forensic psychiatric examination, patients are most often encountered who, due to long-term and thorough treatment of syphilis, have only minor mental disorders. Such persons are critical of their condition, retain professional knowledge and skills, and therefore, during a forensic psychiatric examination, they are recognized as sane in relation to the acts incriminated to them.

^ 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. Separate forms of mental illness

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

There are initial, middle and final stages of the disease.

At the initial stage, cerebrasthenic (neurasthenic-like) symptoms appear and actively increase, which, as a rule, is combined with various progressive personality changes, speech, its articulation, tempo are disturbed, disorders of drives, critical abilities, etc.

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

The final stage of progressive paralysis (the stage of insanity) is characterized by a total breakdown of mental activity, complete helplessness, and 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 of progressive paralysis are distinguished: dementia - progressive dementia without delirium and psychomotor agitation; depressive - depressed mood with delusions of self-accusation and persecution; expansive - with phenomena of euphoria, confabulations, delusions of grandeur with a grandiose reassessment of the patient himself.

The earliest and most typical symptom of Argyle-Robertson is the absence of pupillary reaction 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, articulation is disturbed (tongue twisters fail), writing, gait.

Specific serological reactions: the Wasserman reaction in the blood and in the cerebrospinal fluid is always positive (as a rule, 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), colloidal reactions (Lange reaction) in the cerebrospinal fluid with a change in the color of the test tubes according to the type of paralytic curve.

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Patient A., 59 years old.

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

At 52, his character changed markedly. 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 did not sleep well at night. A year before the hospitalization (58 years old), he went on a business trip, where he quarreled with colleagues, after which he was hospitalized. Detailed information is not available. Returned from a business trip ahead of schedule. He was lethargic, whiny, looked changed, lost weight. His 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, severe sweating. With difficulty, he recalled the events of the current day, with the relative preservation of memory for events that took place in the past. The disease progressed. He became very benevolent and whiny. He asked ridiculous questions, did not always understand the meaning of the questions being asked. Answered not to the point. On the street they took him for a drunk. He took other people's things that he did not find use for. He did not recognize his relatives, he became sloppy. Immediately before the stationing, he left the apartment. After a fight on the street, he was taken to the police, during the arrest he resisted the police, gave the impression of being drunk. He did not recognize his sister, did not understand where he was. He claimed to be an outstanding commander. In this state, he was hospitalized in a psychiatric hospital.

Mental condition: the patient is untidy, gait is uncertain, staggers, fussy, constantly whispers something. He understands that he is in the hospital. Names the year correctly, but cannot name the month and date. Speech is loud and dysarthric. Without waiting for an appeal to him, he speaks spontaneously, verbose and long-winded. Vocabulary is somewhat limited. Speech is grammatical. On the

^ 272 Section III. Separate forms of mental illness

questions are generally answered correctly, but not immediately and only if it is possible to attract his attention. Cannot read the text offered to him. He writes his last name with great difficulty and with errors. He says that he is an outstanding commander. He says that he fought in China, America and Japan. He asks the doctor to bring his documents. We distract. He recalls well the events that took place in the past. Recent events are poorly remembered. The instability of the affect is noted, which changes depending on the content of the utterance. Now complacently euphoric, then sad and tearful. During his stay in the clinic, states of motor excitation were noted: he was fussy, he was looking for someone. During these episodes, there was disorientation in place and time. There is no critical attitude to one's condition. He is indifferent to his fate.

neurological condition: pupils are uneven, the reaction to light is sluggish. There is a weakening of convergence, smoothness of the right nasolabial fold. When the eyes are closed, there is a trembling of the eyelids. Patella reflexes are increased. He staggers in the Romberg pose.

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

Diagnosis: progressive paralysis, expansive form.

By the conclusion of the forensic psychiatric expert commission, he was declared insane.

Proof of the syphilitic etiology of progressive paralysis is both clinical and laboratory data. For the first time, pale spirochetes were found in the brain of patients with progressive paralysis of X. Nogushi in 1913. However, as already mentioned, only 1-1.5% of those with syphilis fall ill with this disease. For the occurrence of progressive paralysis, 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 the external adverse factors, alcohol, traumatic brain injuries and other factors that weaken the body's resistance to infections play a large role. However, all these arguments have not been confirmed.

With progressive paralysis, there is a primary lesion of both the ectodermal tissue (nerve parenchyma) and

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mesoderm (inflammatory processes in the pia mater and vessels). This progressive paralysis differs from syphilis of the brain, in which only the mesoderm is affected.

Typical morphological signs of progressive paralysis are a decrease in brain mass, pronounced atrophy of the gyri, clouding (fibrosis) and thickening of the meninges (leptomeningitis), external and internal dropsy of the brain, ependymitis of the IV ventricle of the brain.

Characterized by damage to the cortex of the frontal lobes of the brain.

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

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

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

Treatment. The usual methods of specific treatment of progressive paralysis are ineffective if they are not combined with measures aimed at activating the body's defenses. Thus, the main principles to be followed are: 1) massiveness of specific therapy; 2) its combination with methods that increase the overall and immunological reactivity. In 1917, V. Jauregg proposed a method for treating patients with progressive paralysis from malaria. Subsequently, for many decades, inoculations of three-day malaria preceded the first course of specific treatment. After 5-10 attacks, malaria was stopped with quinine. At present, when malaria has been eliminated in our country, pyrotherapy is used. High temperature is caused by intramuscular injection of sulfozine (sterile 1-2% solution of purified sulfur in yersik, olive or vaseline oil) or pyrogenal, for a course of treatment of 10-12 injections with a temperature response of at least 39 ° C. In the future, specific therapy is carried out with nicillin in combination with biyoquinol.

^ 274 Section III. Separate forms of mental illness

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

In psychotic states, profound dementia, subjects suffering from progressive paralysis are recognized as insane, and when considering cases in a civil process - incompetent, in need of guardianship; transactions entered into by them are invalidated.

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

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

Convicts with suspicion of progressive paralysis are sent for a forensic psychiatric examination. If progressive paralysis is detected, they are exempted from further serving their sentence in accordance with Art. 433 of the RF PC. 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, the medical consequences of alcohol addiction 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 and others).

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

^ 275 Chapter 22. Alcoholism

pyu existing throughout the world and in our country (N. N. Ivanets, 1995).

One of the most tragic components of this situation is violent death as a result of auto-aggressive and aggressive actions, poisoning and accidents, as well as the significance of alcoholism manifestations 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 a harmful effect on the health, life, work and welfare of society. Alcoholism in the medical sense is a chronic disease that occurs as a result of frequent, immoderate 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 a pathological craving for alcohol, withdrawal symptoms (drunk) syndrome, a change in the picture of intoxication and alcohol tolerance, the development of characteristic personality changes, and the syndrome of toxic encephalopathy. From a certain stage of the disease, psychopathological manifestations are combined with neuritis and diseases of internal organs (cardiovascular diseases, diseases of the gastrointestinal tract).

The first descriptions of alcohol abuse date back to ancient times and are presented in the surviving written monuments. Even in the writings 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". The clinical picture of alcoholism was considered by him in dynamics.

Foreign authors focused mainly on the social and 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 WHO definition of alcoholism, those suffering from alcoholism are those 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. Separate forms of mental illness

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

Many modern authors consider the use of the term “chronic alcoholism” to be incorrect, which was also pointed out by the experts of the UN Committee on Alcoholism Problems in 1955. According to them, the term “alcoholism” includes only the condition that is regarded as chronic. In this regard, the correct use of the term "alcoholism" without the addition of "chronic", as it goes without saying.

Alcoholism is a disease resulting from the abuse of alcohol in such doses and with such frequency that they lead to loss of efficiency in work, disruption of family relationships and social life, and physical and mental health disorders.

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

The incidence rate of neuroinfections is about one case per 1,000. Approximately one fifth of patients with the consequences of neuroinfection are annually hospitalized in psychiatric hospitals, and about 80% of patients with infectious psychoses. Mortality in the latter group reaches 4-6%.

There is an opinion that some are caused precisely by viral infections.

Mental disorders in viral infections

These diseases make up the predominant part of neuroinfections, since most viruses are highly neurotropic. Viruses can persist, i.e., remain in the body asymptomatically for some time. With a “slow infection”, the disease is asymptomatic for a long period, and only then it manifests itself and slowly progresses. Discovery of slow viruses at the end of the 20th century. was also important for psychiatry: the clinical picture of such diseases is often determined precisely by mental disorders. The development of some forms of dementia is also associated with slow viruses. With slow infections, there are mainly degenerative changes in the central nervous system and mild inflammatory reactions against the background of immune deficiency (AIDS, subacute sclerosing panencephalitis, progressive multifocal leukoencephaly).

In the last 20 years, prion diseases, in which a prion protein has been found, have been isolated from the group of slow infections. These are, for example, Creutzfeldt-Jakob disease, kuru, Gerstmann-Straussler-Scheinker syndrome, fatal familial insomnia. In viral diseases, in some cases, several different viruses act simultaneously - these are “virus-associated” forms of diseases. Viral encephalitis is divided into primary and secondary. Primary due to 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, 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 hippocampus legs and Purkinje cells of the cerebellum, with poliomyelitis - the anterior horns of the spinal cord, with herpetic encephalitis - the lower parts of the temporal lobes with symptoms of a brain tumor of the same localization.

1. Tick-borne (spring-summer) encephalitis. This is a seasonal disease caused by an arbovirus. Infection occurs when bitten by a tick and through the alimentary route. There is a diffuse lesion of the 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 variants differ from the first one in the greater severity of neurological symptoms. In the foci of tick-borne encephalitis, tick-borne systemic borreliosis, or Lyme disease (caused by a specific 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 effects increase: flushing of the face, throat, mucous membranes, catarrhal phenomena in the trachea and bronchi. Meningeal symptoms appear. Lethargy, irritability, affective lability, hyperesthesia are expressed. In severe cases, stupor or coma develops.

With a decrease in stupor, there may be delirium, fear, psychomotor agitation. During the period of convalescence and in the long term, cerebrosthenia, neurosis-like, less often mnestic-intellectual disorders, and often epileptic seizures, may occur. 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. Maybe Kozhevnikovskaya epilepsy. With the timely start of treatment, improvement occurs by the 7–10th day: mental and neurological disorders undergo a reverse development. With bulbar disorders, 1/5 of patients die.

Progressive forms of the disease are due to the persistence of the virus. They are both asymptomatic and subacute. In the first case, a protracted asthenoneurotic syndrome with fixation of attention to the disease is revealed. At the remote stages of the disease, hallucinatory-paranoid psychoses are described. Residual psychopathic, paroxysmal, and other disorders are more often detected.

Treatment: broad-spectrum antibiotics, anticholinesterase drugs, vitamins, symptomatic agents; in the acute period is carried out in the infectious diseases hospital. Prevention: vaccination.

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

3.Vilyuisky encephalitis. It has been established that nested encephalomyelitis occurs with dis- and atrophic changes in the brain parenchyma; changes in the perivascular spaces and membranes of the brain are revealed. The acute period of the disease resembles the flu. The chronic stage of encephalitis is more typical; dementia, speech disorders and spastic paresis gradually develop. There is also a psychotic form of encephalitis (Tazlova, 1974). At the same time, various psychotic disorders are observed (from obsessions to amentia), a psychoorganic syndrome is gradually formed. It is important that there is a possibility of reverse development of the latter.

4. Epidemic encephalitis, or Ekonomo lethargic encephalitis. It is caused by a special virus that is transmitted by drop and 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 craniocerebral innervation are detected. Gradually, delirium is replaced by a violation of consciousness (somnolence), from which patients cannot be removed. In the chronic form of the disease against the background of parkinsonism and other extrapyramidal disorders, such mental disorders as pathology of drives, bradyphrenia, hallucinations, delirium, depression, metamorphopsia, and many others are revealed. others

At the remote stages of the course of the disease, the phenomena of parkinsonism dominate. There is no specific treatment. In the acute stage of the disease, convalescent serum, detoxification, corticosteroids, ACTH are recommended. With postencephalitic parkinsonism, artan, cyclodol, etc. are prescribed. Psychotropic drugs are used according to indications and with great care (danger of exacerbating extrapyramidal symptoms!).

5. Rabies. sporadic disease. The carriers of the rabies virus are dogs, less often cats, badgers, foxes and other animals. The prodromal period of the disease begins 2–10 weeks and later after infection. The mood decreases, irritability, dysphoria, short episodes of stupefaction of the creature with hallucinations appear, but more often - illusions. There is fear and anxiety. At the site of the bite, paresthesia and pain sometimes occur with irradiation to neighboring areas of the body. Increased reflexes, muscle tone, temperature. The patient's condition worsens, headache, tachycardia, shortness of breath occur, sweating and salivation increase.

In the stage of excitation, mental disorders dominate: agitation, aggression, impulsivity and impaired consciousness (stupor, delirium, confusion). Hyperkinesis of smooth muscles is typical - spasms of the larynx and pharynx with respiratory and swallowing disorders, shortness of breath. Cerebral disorders with general hyperesthesia develop. Characteristic is the fear of drinking water - hydrophobia. The increase in hyperkinesis and intensification of spasm are replaced by paralysis, convulsive seizures, gross speech disorders, and signs of decerebrate rigidity. Central violations of vital functions lead patients to death. Individuals vaccinated against rabies with a hysterical character may develop conversion disorders resembling the symptoms of rabies (paresis, paralysis, swallowing disorders, etc.).

6. Herpetic encephalitis. Caused by herpes simplex viruses types 1 and 2. The first of them often leads to brain damage. In this case, cerebral edema occurs, point hemorrhages, foci of necrosis and signs of dystrophy, swelling of neurons appear. Encephalitis is widespread and very often accompanied by mental disorders. The latter may 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, catarrhal phenomena in the upper respiratory tract. A few days later, a new rise in temperature follows. Cerebral symptoms develop: headaches, vomiting, meningeal symptoms, convulsive seizures.

Consciousness is stunned, up to a coma. The stunned state is interrupted at times by delirium with excitement and hyperkinesias. At the height of the disease, coma develops, neurological disorders increase (hemiparesis, hyperkinesis, muscle hypertension, pyramidal signs, decerebrate rigidity, etc.). Survivors after prolonged coma may develop apallic syndrome and akinetic mutism. The recovery phase lasts up to two years or more. Against the background of the gradual restoration of mental functions, the Klüver-Bussy syndrome is sometimes found: agnosia, a tendency to take objects in the mouth, hypermetamorphosis, hypersexuality, loss of shame and fear, dementia, bulimia; akinetic mutism, affective fluctuations, vegetative crises are frequent.

In people who underwent bilateral removal of the temporal lobes of the brain, it was first described by Tertien in 1955. In the late period of the disease, residual symptoms of encephalopathy with asthenic, psychopathic and convulsive manifestations are observed. Cases with bipolar affective and schizophrenia-like disorders are known. Complete recovery is noted in 30% of patients. Schizophrenia-like disorders can also be observed in the early stages of the course of the disease. Sometimes there are conditions similar to febrile schizophrenia. When treated with antipsychotics, some patients develop mutism, catatonic stupor, and then amentia, leading to death. In the diagnosis of 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 care - psychotropic drugs for symptomatic therapy. If left untreated, mortality can reach 50-100%.

7. Influenza encephalitis. Respiratory influenza viruses are airborne; Placental transmission from mother to fetus is also possible. Influenza can be very severe, leading to the development of encephalitis. Neurotoxicosis with hemo- and liquorodynamic phenomena is combined with inflammation in the membranes of the choroid plexuses and the 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, on the 3rd–7th day, motor, sensory disorders, deafening of consciousness, sometimes to coma, appear. Stunning can be replaced by excitement with deceptions of perception, and then - mood swings, dysmnesia, asthenia. In hyperacute forms of encephalitis, cerebral edema and cardiovascular disorders can lead to death. Treatment: antiviral drugs (acyclovir, interferon, rimantadine, arbidol, etc.), diuretics, detoxification agents, symptomatic, including psychotropic drugs. With active treatment, the prognosis is favorable; this does not apply, however, to hyperacute influenza.

Unlike the mentioned viral diseases, which are usually confined to a certain time of the year, there are also those observed in different seasons of the year. These are polyseasonal encephalitis. Let's point out the main ones.

8. Encephalitis with parainfluenza. It is a sporadic, locally flaring disease affecting the upper respiratory tract. However, there may be hemo- and liquorodynamic disorders, 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, illusions. The recovery period is characterized by transient asthenic, vegetative and mnestic disorders. The prognosis is favorable.

9. Encephalitis in mumps. The disease is transmitted by airborne droplets. More common in children. Usually there is inflammation in the salivary and parotid glands ("mumps"), but it also happens in the brain, testicles, thyroid, pancreas and mammary glands. When the brain is damaged, serous meningitis occurs, less often - meningoencephalitis. To verify the diagnosis, serological and virological studies are required. At the height of the development of meningoencephalitis, cerebral phenomena and disturbances of consciousness, in particular delirium, are noted. There are epileptic seizures with postictal twilight clouding of consciousness. Coma is rare; upon exit from it, psycho-organic phenomena are possible. A disease in early childhood can lead to mental retardation, at an older age - pathocharacterological reactions and psychopathic behavior.

10. Measles encephalitis. It occurs frequently and in different age groups. In the white and gray matter of the brain, multiple hemorrhages, foci of demyelination are found; ganglion cells are damaged. Serous meningitis, encephalitis, meningoencephalitis, encephalomyelitis and encephalopathy occur in 0.1% of patients. There are also polyradical neuritic syndrome, myelitis with para- and tetraparesis, pelvic and trophic disorders, and sensitivity disorders. At the height of the development of encephalitis, clouding of consciousness, agitation, visual deceptions, and aggression are possible. During the recovery period, there is a decrease in attention, memory, thinking, as well as disinhibition of drives and violent phenomena. 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. It occurs mainly in children. The rubella virus is transmitted by airborne droplets and transplacental routes. 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 excitement with fear and aggression are noted, hypomnesia, violent phenomena, bulimia, as well as speech disorders and difficulties in writing and counting are detected a little later. Some of these disorders persist in the residual period. After an illness in early childhood, there may be a delay in mental development.

12. Encephalitis caused by the varicella-zoster virus. In adults, the varicella-zoster virus causes shingles. Encephalitis is relatively mild. Usually, static-coordination disorders 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, seizures, mental retardation, and psychopathic behavior may persist in the residual period.

13. Post-vaccination encephalitis. Develop after 9-12 days when vaccinated against smallpox, usually in children 3-7 years old. In 30–50%, the course is severe, with a fatal outcome. At the height of the development of the disease, disturbances of consciousness up to severe coma are observed. Stupefaction is interspersed with clouding of consciousness, arousal, visual deceptions. Convulsive seizures, paralysis, paresis, hyperkinesis, ataxia, loss of sensitivity, pelvic disorders are frequent. With adequate treatment, there is a complete or partial restoration of mental functions.

As mentioned, slow viral infections have now become relevant.

14.Acquired immunodeficiency syndrome - AIDS is one of them. The human immunodeficiency virus (HIV) causes damage to the immune system, and then various secondary or "opportunistic" infections, as well as malignant tumors, join. HIV is a neurotropic retrovirus that is transmitted through the sexual and syringe routes. Cases of HIV transmission through kidney transplants and bone marrow transplantation have been described.

Proven and "vertical" transmission - from mother to fetus. The incubation period lasts up to five years. AIDS is characterized by 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, emaciation, 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 of herpetic encephalitis, meningitis, etc. The virus is found in astrocytes, macrophages, and cerebrospinal fluid. At the beginning 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, individual crazy ideas. During the period of advanced disorders, dementia is typical. There are also incontinence of affect, regression of behavior with disinhibition of drives. Dementia with Morio-like behavior is characteristic of damage to the frontal cortex; various neurological symptoms (stiffness, hyperkinesis, astasia, etc.) are also observed. A few months later, there is a global disorientation, coma, and then death occurs. Many patients do not live to see dementia. Psychoses with hallucinations, delusions, mania were observed in 0.9% of HIV-infected people.

Psychogenic depressions with suicidal tendencies are very frequent; usually these are reactions to illness and ostracism. Etiotropic treatment is reduced to the appointment of azidothymidine, dideoxycillin, phosphonofomat and other drugs. Genciclovir is also used. Zidovudine (an inhibitor of HIV replication) is recommended for the first 6–12 months. Symptomatic treatment consists in the appointment of nootropics, vasoactive and sedatives, antidepressants, antipsychotics (the latter - for behavior correction). In addition, special programs of social, psychological and psychotherapeutic assistance, therapy of somatic pathology are being implemented.

15. Subacute sclerosing panencephalitis. Its other names are: Van Bogart's leukoencephalitis, Pette-Dering's nodular panencephalitis, encephalitis with Dawson's inclusions. 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 5 and 15 years of age. Its first stage lasts 2-3 months. Irritability, sleep disturbances, anxiety, as well as psychopathic phenomena (leaving home, aimless actions, etc.) are observed.

Towards the end of the stage, drowsiness increases. Dysarthria, apraxia, agnosia are revealed, memory is lost, the level of thinking decreases. The second stage is represented by various hyperkinesias, dyskinesias, generalized seizures and peck-type seizures. Expressed dementia. 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. It develops against the background of other diseases with immunodeficiency. It is caused by two strains of papova viruses. In a latent state, they are present in 70% of healthy people, being activated with a decrease in immunity more often in people over 50 years of age. In the brain of patients, degenerative changes and signs of demyelination are found. The disease is characterized by rapidly developing dementia with aphasia. There may be ataxia, hemiparesis, sensory loss, blindness, and convulsions. A CT scan reveals foci of reduced brain density, especially white matter.

Prion diseases form a separate group.

17. Particularly relevant among them is Creutzfeldt-Jakob disease. It is caused by an infectious protein - a prion, can occur when eating the meat of cows, sheep and goats that have become carriers of this protein. The disease is rare (one in 1 million people). It is manifested by rapidly developing dementia, ataxia, myoclonus. Three-phase waves on EEG are typical. In the initial stage of the disease, there may be euphoria, hallucinations, delirium, catatonic stupor. Patients die within a year. Depending on the topic of brain damage, several forms of the disease are distinguished. Classical 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. First identified in the Papuans of New Guinea. Occurring in middle age with a frequency of one case per 10 million people, Gerstmann-Streussler-Scheinker syndrome is manifested mainly by neurological symptoms. Dementia does not always develop. Fatal familial insomnia is manifested by incurable insomnia, impaired attention and memory, disorientation and hallucinations. In addition, hyperthermia, tachycardia and hypertension, hyperhidrosis, ataxia and other neurological symptoms are observed. Like the last two forms of the disease, it is associated with a hereditary predisposition.

Mental disorders in infectious diseases

Psychiatry / Mental disorders in infectious diseases

Mental disorders in infectious diseases are quite different. This is due to the nature of the infectious process, with the peculiarities of the reaction to infection of the central nervous system.

Psychoses resulting from common acute infections are symptomatic. Mental disorders also occur in 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 disturbed consciousness, hallucinosis, asthenic and Korsakoff syndromes.

Psychosis in both general and intracranial infections proceed:

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 childhood and young age. Delirium may have features that depend on the nature of the infection, the age of the patient, the state of the central nervous system. With infectious delirium, the patient's consciousness is disturbed, he does not orient himself in the environment, against this background there are abundant visual illusory and hallucinatory experiences, fears, ideas of persecution. Delirium worse towards evening. Patients see scenes of fire, death, destruction, terrible disasters. Behavior and speech are caused by hallucinatory-delusional experiences. In the formation of hallucinatory-delusional experiences in infectious delirium, painful sensations in various organs play an important role (it seems to the patient that he is being quartered, his leg is amputated, his side is shot, etc.). In the course of psychosis, a symptom of a doppelgänger may occur. Painfully, it seems that next to him is his double. As a rule, the delirium passes in a few days, and the memories of the experience are partially preserved. In unfavorable cases, infectious delirium proceeds with a very deep stupefaction of consciousness, with a sharply pronounced excitation, which takes on the character of erratic throwing (sometimes exacerbating delirium), and ends lethally. Prognostically unfavorable is the preservation of such a state with a drop in temperature.

amentia- another rather frequent type of response to 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 a severe somatic condition. The picture of amentia includes: a violation of consciousness, a sharp psychomotor agitation, hallucinatory experiences. Amentia is characterized by incoherence of thinking (incoherence) and confusion. Excitation is rather monotonous, limited to the limits of the bed. The patient randomly rushes from side to side (yactation), shudders, stretches out, sometimes tends to run somewhere and can rush to the window, feels fear, speech is incoherent. Such patients need strict supervision and care. They, as a rule, refuse to eat, quickly lose weight. Often in the clinical picture of psychosis, elements of delirium and amentia are mixed.

Much less often, transient psychoses include amnestic disorders in the form of short-term retrograde or anterograde amnesia - events that preceded the disease or took place after the acute period of the disease disappear from memory for some time. 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 proceed from the very beginning without clouding of consciousness in the form of so-called transitional syndromes. As already indicated, this form of psychosis is also reversible. They usually end with prolonged asthenia.

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

Edited by Professor M. V. Korkina.