Disease of the psyche symptoms. Types of psychological disorders and their signs

Our psyche is a rather delicate and complex system. Experts classify it as a form of active reflection by a person of objective reality, which arises during the interaction of an individual with the outside world and regulates his behavior and activities. Quite often, doctors have to deal with pathological deviations from the normal state, which they call mental disorders. There are many mental disorders, but some are more common. Let's talk about what constitutes a violation of the human psyche in a little more detail, discuss the symptoms, treatment, types and causes of such health problems.

Causes of mental disorders

Mental disorders can be explained by a variety of factors, which in general can be divided into exogenous and endogenous. The first are factors of external influence, for example, the intake of dangerous toxic substances, viral ailments and traumatic injuries. And internal causes are represented by chromosomal mutations, hereditary and genetic ailments, as well as mental development disorders.

An individual's resistance to mental disorders is determined by both specific physical characteristics and the general development of the psyche. After all, different subjects react differently to mental anguish and all sorts of problems.

Typical causes of mental disorders include neuroses, neurasthenia, depressive conditions, aggressive exposure to chemical or toxic elements, as well as traumatic head injuries and a hereditary factor.

Mental Disorder - Symptoms

There are a number of different symptoms that can occur with mental health problems. They are most often manifested by psychological discomfort and impaired activity in various fields. Patients with such problems have different symptoms of a physical and emotional nature, and cognitive and perceptual disorders can also occur. For example, a person may feel unhappy or superhappy regardless of the seriousness of the events that have occurred, and he may also experience failures in the construction of logical relationships.

Classical manifestations of mental disorders are considered excessive fatigue, rapid and unexpected mood swings, insufficiently adequate reaction to events, spatio-temporal disorientation. Also, specialists are faced with impaired perception in their patients, they may lack an adequate attitude to their own state, abnormal reactions (or lack of adequate reactions), fright, confusion (sometimes hallucinations) are observed. Quite a common symptom of mental disorders is anxiety, sleep problems, falling asleep and awakening.

Sometimes mental health problems are accompanied by the appearance of obsessions, persecution mania and various phobias. Such violations often lead to the development of depressive states, which can be interrupted by violent emotional outbursts aimed at fulfilling some incredible plans.

Many mental disorders are accompanied by disorders of self-awareness, which make themselves felt by confusion, depersonalization and derealization. In people with such problems, memory often weakens (and sometimes it is completely absent), paramnesia and disturbances in the thought process are observed.

Delirium is considered a frequent companion of mental disorders, which can be both primary and sensual and affective.

Sometimes mental disorders are manifested by problems with food intake - overeating, which can cause obesity, or, conversely, refusal to eat. Alcohol abuse is common. Many patients with these problems suffer from sexual dysfunction. They also often look sloppy and may even refuse hygiene procedures.

Types of mental disorders

There are quite a few classifications of mental disorders. We will consider just one of them. It includes conditions provoked by various organic diseases of the brain - injuries, strokes and systemic diseases.

Doctors also treat persistent or drug-resistant patients separately.

In addition, disorders of psychological development (debuting in early childhood) and disorders of activity, concentration of attention and hyperkinetic disorders (usually recorded in children or adolescents) can be distinguished.

Mental Disorder - Treatment

Therapy of problems of this kind is carried out under the supervision of a psychotherapist and other narrow specialists, while the doctor takes into account not only the diagnosis, but also the patient's condition and other existing health disorders.

So quite often experts use sedatives that have a pronounced sedative effect. Tranquilizers can also be used, they effectively reduce anxiety and relieve emotional tension. They also lower muscle tone and have a mild hypnotic effect. The most common tranquilizers are Chlordiazepoxide, and.

Also, mental disorders are treated with the use of antipsychotics. These drugs are considered the most popular for such diseases, they are good at reducing mental agitation, reducing psychomotor activity, lowering aggressiveness and suppressing emotional tension. Popular drugs in this group are Propazin, Pimozide, and Flupentixol.

Antidepressants are used to treat patients with complete depression of thought and feeling, with severe depressed mood. Such drugs are able to increase the pain threshold, improve mood, relieve apathy and lethargy, they normalize sleep and appetite well, and also increase mental activity. Qualified psychotherapists often use Pyritinol and as antidepressants.

Another treatment for mental disorders can be carried out with the help of normotimics, which are designed to regulate inappropriate manifestations of emotions, and have anticonvulsant efficacy. These medications are often used for bipolar disorder. These include, etc.

The safest drugs for the treatment of mental disorders are nootropics, which have a positive effect on cognitive processes, enhance memory and increase the resistance of the nervous system to the effects of various stresses. Drugs of choice usually become, and Aminalon.

In addition, corrective psychotherapy is indicated for patients with mental disorders. They will benefit from hypnotics, suggestions, and sometimes NLP methods. An important role is played by mastering the technique of autogenous training, in addition, you cannot do without the support of relatives.

Psychiatric disorder - alternative treatment

Traditional medicine experts say that some medications based on herbs and improvised means may well contribute to the elimination of mental disorders. But you can use them only after agreement with the doctor.

So traditional medicines can be an excellent alternative to some sedative medicines. For example, to eliminate nervous excitement, irritability and insomnia, healers are advised to mix three parts of crushed valerian root, the same amount of peppermint leaves and four parts of clover. Brew a tablespoon of such raw materials with a glass of only boiled water. Insist the medicine for twenty minutes, then strain, and squeeze the plant materials. Take the ready-made infusion in half a glass twice a day and immediately before bedtime.

Also, with irritability of the nervous system, insomnia and nervous excitement, you can mix two parts of valerian roots with three parts of chamomile flowers and three parts of caraway seeds. Brew and take such a remedy in the same way as in the previous recipe.

To cope with insomnia, you can use a simple infusion based on hops. Pour a couple of tablespoons of the crushed cones of this plant with half a liter of cool, pre-boiled water. Insist for five to seven hours, then strain and drink a tablespoon three times to four times a day.

Oregano is also an excellent sedative. Brew a couple of tablespoons of this herb with half a liter of boiling water. Insist for half an hour, then strain and take half a glass three or four times a day just before a meal. This medication is great at relieving sleep problems.

Some traditional medicines can be used to treat depression. So a good effect is given by taking a medicine based on chicory root. Brew twenty grams of such crushed raw materials with a glass of boiling water. Boil the product over low heat for ten minutes, then strain. Take the ready-made broth in a tablespoon five to six times a day.

If your depression is accompanied by severe loss of energy, prepare a rosemary-based medicine. Brew twenty grams of crushed leaves of such a plant with one glass of boiling water and boil over a fire of minimum power for fifteen to twenty minutes. Cool the finished medicine, then strain. Apply it in half a teaspoon half an hour before a meal.

An infusion based on common knotweed also gives a wonderful effect in depression. Brew a couple of tablespoons of this herb with half a liter of boiling water. Insist for half an hour, then strain. Take in small portions throughout the day.

Mental disorders are quite serious conditions that require close attention and adequate correction under the supervision of specialists. The feasibility of using folk remedies is also worth discussing with your doctor.

"Crazy people live behind a high fence, and idiots walk the street in droves"
Unlucky, directed by Francis Weber

We live in a time when tantrums and lingering have become commonplace for many. Each of us is familiar with the state when loved ones behave inappropriately or we ourselves suffer from insomnia, twisting the same obsessive thought in our head all night. But these are the signs of a pre-psychotic state: anxiety, insomnia, unwillingness to live, hysterics, attacks on others, attempted suicide and sudden mood swings. In order to identify abnormalities in the psyche, it is necessary to observe a person in a hospital for 30 days, and in some cases, in order to diagnose schizophrenia, a patient must be examined within 6 months.

Mental illness is not only schizophrenia, it also includes neuroses, psychosis, mania, panic attacks, paranoia, dementia and bipolar disorder. In turn, each mental deviation is subdivided into several more types. It is considered that if situations that cause acute stress reactions in people: hysteria, crying, attack, nervous tremors and other aggressive actions directed at others or at oneself, are episodic and pass after a while, then they do not interfere with life and are not deviation from the norm.

However, it often happens that after the examination, the doctor does not mental disorders in a patient does not reveal, and after a while he commits a brutal planned murder or harms his health or those around him. This is a clear deviation in the psyche and in order not to become a victim of such a patient, it is very important to have some idea of ​​how the signs of mental abnormalities appear and how to behave when communicating or even living with them.

Nowadays, many people are forced to live together or along the neighborhood with alcoholics, drug addicts, neurasthenics and elderly parents with dementia. If you delve into the intricacies of their daily life, you can easily come to the conclusion that there are simply no absolutely mentally healthy people, but only under-examined ones.

Permanent scandals, accusations, threats, assault, unwillingness to live and even attempts at suicide are the first signs that the psyche of the participants in such conflicts is out of order. If such behavior of a person is repeated from time to time and begins to influence the personal life of other people, then we are talking about a mental illness and requires examination by a specialist.

Deviations in psyche first of all, they are manifested in the fact that a person's perception of the world changes and his attitude towards the people around him changes. Unlike healthy people, people with mental deviations strive to satisfy only their physical and physiological needs, they do not care how their inappropriate behavior will affect the health and mood of others. They are cunning and considerate, selfish and hypocritical, emotionless and resourceful.

It's very hard to know when close the person shows you excessive anger, aggression and unfounded accusations against you. Few are able to remain calm and accept the inappropriate behavior of a loved one associated with mental disorders. In most cases, people think that a person is mocking him and try to apply "educational measures" in the form of moral teachings, demands and proofs of innocence.

With time mental illness progress and can combine delusional, hallucinatory and emotional disorders. Manifestations of visual, auditory and delusional hallucinations are manifested in the following:
- a person talks to himself, laughs for no apparent reason.
- cannot concentrate on the topic of conversation, always has a preoccupied and anxious look.
- hears extraneous voices and sees someone that you cannot perceive.
- is hostile to family members, especially to those who serve him. In the later stages of the development of mental illness, the patient becomes aggressive, attacks others, deliberately breaks dishes, furniture and other objects.
- tells stories of implausible or questionable content about yourself and loved ones.
- fears for his life, refuses to eat, accusing loved ones of trying to poison him.
- writes statements to the police and letters to various organizations with complaints about relatives, neighbors and just acquaintances.
- hides money and things, quickly forgets where he put them and accuses others of stealing.
- does not wash or shave for a long time, there is sloppiness and untidiness in behavior and appearance.

Knowing the general signs mental disorders, it is very important to understand that mental illness brings suffering, first of all, to the patient himself, and only then to his relatives and society. Therefore, it is completely wrong to prove to the patient that he is behaving immorally, to accuse or reproach him that he does not love you and worsens your life. Of course, a mentally ill person is a trouble in the family. However, he must be treated like a sick person, and react to their inappropriate behavior with understanding.

It is forbidden argue with the patient, trying to prove to him that his accusations against you are wrong. Listen carefully, calm him down and offer help. Do not try to clarify the details of his delusional accusations and statements, do not ask him questions that can aggravate those with mental disorders. Any mental illness requires attention from loved ones, and treatment by specialists. It should not arouse criticism and accusations of selfishness towards a sick person.

Alas, from the development of mental disorders no one is insured. This is especially true for those who have a hereditary predisposition to the disease or are caring for elderly parents with dementia. Set an example of treating them well to your children so that they do not repeat the mistakes of their parents.

The weaker sex is more susceptible to mental ailments. Emotional social involvement and natural sensitivity increase the risk of developing diseases. They need to be diagnosed on time in order to start the correct treatment and return life to its usual course.

Mental illness at different age periods of a woman's life

For each age period (girl, girl, woman), a group of the most probable mental illnesses is determined. At these critical stages of development for the psyche, situations occur that most often provoke development.

Girls are less susceptible to mental illness than boys, but they are not immune to the appearance of school phobias and attention deficit disorder. They are at increased risk of developing anxiety and learning disorders.

Young girls in 2% of cases may be victims of premenstrual dysphoria after the first case of bleeding during the menstrual period. After puberty, it is believed that girls are 2 times more likely to develop depression than boys.

Women who are part of the group of patients with mental disorders do not receive medical treatment when planning. By doing this, they provoke the occurrence of relapses. After childbirth, there is a high likelihood of signs of depression, which, however, can go away without medication.

A small percentage of women do develop psychotic disorders, which are complicated by the limited number of approved drugs. For each individual situation, the degree of benefit and risk of drug treatment during breastfeeding is determined.

Women from 35 to 45 years old are at risk of developing anxiety disorders, they are susceptible to mood changes, and are not immune from the onset of schizophrenia. A decrease in sexual function can happen due to the use of antidepressants.

Menopause changes the way a woman lives, her social role and relationships with loved ones. From caring for their children, they switch to looking after their parents. This period is associated with depressive moods and disorders, however, the connection between the phenomena has not been officially proven.

In old age, women are susceptible to the appearance of dementia and complications of somatic pathologies by mental disorders. This is due to the length of their lives, the risk of developing dementia (acquired dementia) increases in proportion to the number of years lived. Older women who take a lot and suffer from somatic diseases are more prone to insanity than others.

Those over 60 should pay attention to the symptoms of paraphrenia (a severe form of delusional syndrome), they are at the greatest risk. Emotional involvement in the life of others and loved ones at an advanced age, when many complete their life paths, can cause mental disorders.

The division of a woman's existence into periods allows doctors to single out the only true one from the whole variety of diseases with similar symptoms.

Signs of mental health problems in girls

In childhood, the development of the nervous system occurs continuously, but unevenly. However, the peak of mental development by 70% falls on this period, the personality of the future adult is formed. It is important to diagnose the symptoms of certain diseases in time from a specialist.
Signs:

• Decreased appetite. Occurs with sudden changes in diet and forced food intake.
• Increased activity. Differs in sudden forms of motor excitement (bouncing, monotonous running, shouting)
• Hostility. It is expressed in the child's confidence in the negative attitude of those around him and those close to him, which is not confirmed by the facts. It seems to such a child that everyone laughs at him and despises him. On the other hand, he himself will show groundless hatred and aggression, or even fear towards his family. He becomes rude in his daily interactions with relatives.
• Painful perception of a physical disability (body dysmorphic disorder). The child chooses a minor or seeming flaw in appearance and tries with all his might to disguise or eliminate it, even turning to adults with a request for plastic surgery.
• Game activity. It boils down to a monotonous and primitive manipulation of objects not intended for play (cups, shoes, bottles), the nature of such a game does not change over time.
• Painful obsession with health. Excessive attention to your physical condition, complaints about invented.
• Repetitive movements of the word. They are involuntary or obsessive, for example, the desire to touch an object, rub hands, tap.
• Mood disorder. The state of melancholy and meaninglessness of what is happening does not leave the child. He becomes whiny and irritable, his mood does not improve for a long time.

• Nervous state. Change from hyperactivity to lethargy and passivity and vice versa. Bright light and loud and unexpected sounds are hard to tolerate. The child cannot strain his attention for a long time, which is why he has difficulties with learning. He may have visions of animals, frightening-looking people, or voices.
• Disorders in the form of repetitive spasms or seizures. The child may freeze for a few seconds, while turning pale or rolling his eyes. An attack can manifest itself in shuddering of the shoulders, arms, less often, similar to squats. Systematic walking and talking in a dream at the same time.
• Disorders in daily behavior. Excitability coupled with aggression, expressed in a tendency to violence, conflict and rudeness. Unstable attention against the background of a lack of discipline and motor disinhibition.
• A pronounced desire to harm and the subsequent receipt of this pleasure. Desire for hedonism, increased suggestibility, tendency to leave home. Negative thinking coupled with vindictiveness and resentment amid a general tendency towards cruelty.
• Painful abnormal habit. Biting off nails, pulling hair out of the scalp while reducing psychological stress.
• Obsessive fears. Daytime forms are accompanied by facial flushing, increased sweating and palpitations. At night, they are manifested by screaming and crying from frightening dreams and motor restlessness; in such a situation, the child may not recognize loved ones and brush off someone.
• Impaired reading, writing and numeracy skills. In the first case, children find it difficult to correlate the appearance of a letter with a sound, or they hardly recognize images of vowels or consonants. With dysgraphia (writing disorder), it is difficult for them to write what they say out loud.

These signs are not always a direct consequence of the development of mental illness, but require qualified diagnosis.

Symptoms of diseases typical of adolescence

Adolescent girls are characterized by anorexia nervosa and bulimia, premenstrual dysphoria, and depression.

Anorexia, frolicking on nerves, includes:

• Denial of the existing problem
• Painful obsessive feeling of excess weight in the absence of it
• Eating food standing up or in small pieces
• Violated regimen
• Fear of weight gain
• Depressed mood
• Anger and unreasonable resentment
• Passion for cooking, preparing meals for the family without personally participating in the meal
• Avoiding common meals, minimal interaction with loved ones, long periods in the bathroom or playing sports outside the home.

Anorexia also causes physical disturbances. Due to weight loss, problems with the menstrual cycle begin, arrhythmia appears, constant weakness and pain in the muscles are felt. Attitude towards oneself depends on the amount of lost weight to the gained one. A person with anorexia nervosa is prone to biased assessments of their condition up to the point of no return.

Signs of bulimia nervosa:

• The amount of food consumed at a time exceeds the norm for a person of a certain build. The pieces of food are not chewed, but quickly swallowed.
• After eating, the person deliberately tries to induce vomiting in order to empty the stomach.
• The behavior is dominated by mood swings, closeness and lack of communication.
• A person feels his helplessness and loneliness.
• General malaise and lack of energy, frequent illnesses, upset digestion.
• Destroyed tooth enamel is a consequence of frequent vomiting, which contains gastric juice.
• Enlarged salivary glands on the cheeks.
• Denial that there is a problem.

Signs of premenstrual dysphoria:

• The disease is typical for girls who form premenstrual syndrome. It, in turn, is expressed in depression, a gloomy mood, unpleasant physical sensations and an uncomfortable psychological state, tearfulness, disruption of the usual sleep pattern and food intake.
• Dysphoria occurs 5 days before the onset of menstruation, and ends on the first day. During this period, the girl is completely defocused, cannot concentrate on anything, she is overcome by fatigue. The diagnosis is made if the symptoms are pronounced and interfere with the woman.

Most of the diseases of adolescents develop on the basis of nervous disorders and characteristics of puberty.

Postpartum mental disorders

In the field of medicine, there are 3 negative psychological states of a woman in labor:

• Neurotic. There is an exacerbation of mental problems that were still during the bearing of the child. This ailment is accompanied by depression, nervous exhaustion.
• Traumatic neurosis. Appears after a long and difficult childbirth, subsequent pregnancies are accompanied by fear and anxiety.
• Melancholy with delusional ideas. A woman feels a sense of guilt, may not recognize loved ones and see hallucinations. This disease is a prerequisite for the development of manic-depressive psychosis.

Mental disorder can manifest itself in the form of:

• Depression and tearfulness.
• Unreasonable anxiety, feelings of anxiety.
• Irritability and excessive activity.
• Distrust of others and feeling.

• Incoherent speech and decreased or increased appetite.
• Obsession with communication or a desire to isolate themselves from everyone.
• Confusion and lack of concentration.
• Inadequate self-esteem.
• Suicidal or murderous thoughts.

In the first week or after a month, these symptoms will make themselves felt in case of development of postpartum psychosis. Its duration is equal to four months on average.

Middle-aged period. Mental illnesses that develop during the onset of menopause

During menopause, there is a reverse development of the hormonal glands of sexual secretion, this symptom is most pronounced in women in the period from 45 to 50 years. inhibits cell renewal. As a result, those diseases and disorders that were completely absent or were hidden before begin to appear.

Mental illnesses characteristic of the menopause period develop either 2-3 months before the final completion of the menstrual cycle, or even after 5 years. These reactions are temporary in nature, most often they are:

• Mood swings
• Anxiety about the future
• Increased sensitivity

Women at this age are prone to self-criticism and dissatisfaction with themselves, which entails the development of depressive moods and hypochondriacal experiences.

With physical discomfort during menopause associated with hot flushes or fainting, tantrums appear. Serious menopausal disorders only develop in women who initially had such problems

Mental disorders in women in senile and pre-senile periods

Involutionary paranoid. This psychosis, which appears during involution, is accompanied by delusional thoughts combined with uninvited memories of traumatic situations from the past.

Involutionary melancholy is characteristic of women from 50 years of age. The main prerequisite for the appearance of this disease is anxiety-delusional depression. Usually involutionary paranoid appears after a change in lifestyle or stressful situation.

Dementia of late age. The ailment is an acquired dementia that gets worse over time. Based on clinical manifestations, there are:

• Total dementia. In this variant, perception, the level of thinking, the ability to create and solve problems are reduced. The edges of the personality are erased. A person is not able to critically assess himself.
• Lacunar dementia. Memory impairment occurs when the level of cognitive function is maintained. The patient can critically assess himself, the personality remains basically unchanged. This disease manifests itself in syphilis of the brain.
• These diseases are alarming. The mortality rate of patients with dementia after a stroke is several times higher than that of those who escaped this fate and did not become feeble-minded.

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Treatment of mental disorders is divided into medication and complex psychotherapy. For eating disorders that are common in young girls, a combination of these treatments will be effective. However, even if most of the symptoms coincide with the described disorders, it is necessary to consult a psychotherapist or psychiatrist before undertaking any type of treatment.

This chapter provides an overview of common mental health problems in women, including their epidemiology, diagnosis and treatment approach (Table 28-1). Mental disorders are very common. The monthly incidence among American adults is over 15%. The lifetime incidence rate is 32%. Most commonly, women experience major depression, seasonal affective disorders, manic-depressive psychosis, eating disorders, panic disorders, phobias, generalized anxiety disorders, somatized mental disorders, pain conditions, borderline and hysterical disorders, and suicidal attempts.

In addition to the fact that anxiety and depressive disorders are much more common in women, they are more resistant to drug therapy. However, most studies and clinical trials are conducted in men and then extrapolated to women, despite differences in metabolism, drug susceptibility, side effects. Such generalizations lead to the fact that 75% of psychotropic drugs are prescribed to women, and they are also more likely to experience serious side effects.

All doctors should be aware of the symptoms of mental disorders, the first aid for them, and the available methods for maintaining mental health. Unfortunately, many cases of mental illness go undiagnosed and untreated or insufficiently treated. Only a small fraction of them reach the psychiatrist. Most of the patients are followed up by other specialists, so only 50% of mental disorders are recognized at the first visit. Most patients present with somatic complaints and do not focus on psychoemotional symptoms, which again reduces the frequency of diagnosis of this pathology by non-psychiatrists. In particular, mood disorders are very common in patients with chronic diseases. The incidence of mental illness in patients of general practitioners is twice as high as in the population, and even higher in severely ill hospitalized patients and frequent medical carers. Neurological disorders such as stroke, Parkinson's disease and Meniere's syndrome are associated with mental disorders.

Untreated major depression can worsen the prognosis of medical conditions and increase the amount of medical care required. Depression can aggravate and increase the number of somatic complaints, lower the pain threshold, and increase functional disability. A study of patients with frequent medical care found depression in 50% of them. Only those who had a decrease in the severity of symptoms of depression during a year of observation did an improvement in functional activity. Symptoms of depression (low mood, hopelessness, lack of satisfaction from life, fatigue, impaired concentration and memory) interfere with the motivation for seeking care. Early diagnosis and treatment of depression in chronic patients can improve prognosis and therapy.

The socio-economic cost of mental illness is very high. About 60% of suicidal cases are caused only by mood disorders, and 95% are combined with diagnostic criteria for mental illness. The costs of treatment, death, and disability due to clinically diagnosed depression are estimated at more than $ 43 billion in the United States annually. Since more than half of people with mood disorders either go untreated or receive insufficient treatment, this figure is much lower than the total cost of depression to society. Mortality and disability in this under-treated population, most of which are women, is particularly disheartening, as 70 to 90% of depressed patients respond to antidepressant therapy.
Table 28-1
Major mental disorders in women

1. Eating disorders

Anorexia nervosa

Bulimia nervosa

Gluttony attacks
2. Mood disorders

Major depression

Adjustment disorder with depressed mood

Postpartum affective disorder

Seasonal affective disorder

Affective insanity

Dysthymia
3. Alcohol abuse and alcohol dependence

4. Sexual disorders

Libido disorders

Sexual arousal disorders

Orgastic disorders

Painful sexual disorders:

Vaginismus

Dyspareunia
5. Anxiety disorders

Specific phobias

Social phobia

Agoraphobia

Panic disorder

Generalized Anxiety Disorders

Obsessive compulsive disorder

Post-traumatic stress
6. Somatoform disorders and false disorders

False Disorders:

Simulation

Somatoform disorders:

Somatization

Conversion

Hypochondria

Somatoform pain
7. Schizophrenic disorders

Schizophrenia

Paraphrenia
8. Delirium
Mental illness during a woman's life

During a woman's life, there are specific periods during which she is at increased risk of developing mental illness. Although the major mental disorders — mood and anxiety disorders — can occur at any age, different provoking conditions are more common during specific age periods. During these critical periods, the clinician should include specific questions to identify psychiatric disorders by taking a history and examining the patient's mental status.

Girls are at increased risk of school phobias, anxiety disorders, attention deficit hyperactivity disorder, and learning disorders. Adolescents are at increased risk of eating disorders. During menarche, 2% of girls develop premenstrual dysphoria. After puberty, the risk of developing depression increases dramatically, and in women it is twice that of men of the same age. In contrast, in childhood, girls have less or the same incidence of mental illness as boys of their age.

Women are prone to mental health problems during and after pregnancy. Women with a history of mental illness often refuse medication when planning a pregnancy, which increases the risk of recurrence. Most women experience mood swings after childbirth. Most have a short period of "baby blues" depression that does not require treatment. Others develop more severe, disabling symptoms of depression in the postpartum period, and a small number of women develop psychotic disorders. The relative risk of taking drugs during pregnancy and lactation makes the choice of treatment difficult, in each case the question of the relationship between the benefits and risks of therapy depends on the severity of the symptoms.

The middle age period is associated with continued high risk of anxiety and mood disorders, as well as other psychiatric disorders such as schizophrenia. Women may have sexual dysfunction, and if they take antidepressants for mood or anxiety disorders, they are at increased risk of side effects, including decreased sexual function. Although there is no clear evidence that menopause is associated with an increased risk of depression, most women experience major life changes during this period, especially in the family. For most women, their active role in relation to children is replaced by the role of caregivers for elderly parents. Elderly parents are almost always cared for by women. It is necessary to monitor the mental status of this group of women to identify possible violations of the quality of life.

As women age, the risk of developing dementia and psychiatric complications of medical conditions such as stroke increases. Because women have a longer life expectancy than men, and the risk of developing dementia increases with age, most women develop dementia. Older women with multiple medical conditions and high drug intake are at high risk of delirium. Women are at increased risk of developing paraphrenia, a psychotic disorder that usually occurs after age 60. Due to the long life expectancy and high involvement in interpersonal relationships, women more often and more experience the loss of loved ones, which also increases the risk of developing mental illness.
Examination of a psychiatric patient

Psychiatry deals with the study of affective, cognitive and behavioral disorders that occur while maintaining consciousness. Psychiatric diagnosis and treatment selection follow the same logics of history, examination, differential diagnosis and treatment planning as in other clinical branches. A psychiatric diagnosis must answer four queries:

1) mental illness (what the patient has)

2) temperamental disorder (what the patient is)

3) behavioral disturbances (what the patient does)

4) disorders that have arisen in certain life circumstances (which the patient encounters in life)
Mental illness

Examples of mental illness include schizophrenia and major depression. They are similar to other nosological forms - they have a discrete onset, course, clinical symptoms that can be clearly defined as present or absent in each individual patient. Like other nosologies, they are the result of genetic or neurogenic disorders in the functioning of an organ, in this case, the brain. With obvious abnormal symptoms - auditory hallucinations, manias, severe obsessions - the diagnosis of a mental disorder is easy. In other cases, it can be difficult to distinguish pathological symptoms, such as low mood in major depression, from normal feelings of sadness or frustration caused by life's circumstances. It is necessary to focus on identifying known stereotypical symptom complexes characteristic of mental illness, while at the same time remembering the diseases most common in women.
Disorders of temperament

Understanding the patient's personality improves the effectiveness of treatment. Personal traits such as perfectionism, indecision, impulsivity are quantitatively expressed in people in one way or another, as well as physiological ones - height and weight. Unlike mental disorders, they do not have clear characteristics - “symptoms” versus “normal” meanings, and individual differences are normal in the population. Psychopathology or functional disorders of the personality occur when traits take on the character of extremes. When temperament leads to impaired professional or interpersonal functioning, this is sufficient to qualify it as a possible personality disorder; in this case, you need medical help and cooperation with a psychiatrist.
Behavior disorders

Conduct disorders are self-reinforcing. They are characterized by purposeful, irresistible forms of behavior that dominate all other types of patient activity. Eating disorders and abuse are examples of such disorders. The first goals of treatment are to switch the patient's activity and attention, to stop problematic behavior and to neutralize provoking factors. The provoking factors can be comorbid mental disorders such as depression or anxiety disorders, illogical thoughts (anorectics' opinion that “if I eat more than 800 calories a day, I will become fat”). Group therapy can be effective in treating conduct disorders. The final stage of treatment is relapse prevention, since relapse is a normal course of behavioral disorders.
Patient's life story

Stressors, life circumstances, social circumstances are factors that can modulate the severity of the disease, personality traits and behavior. Various life periods, including puberty, pregnancy, and menopause, may be associated with an increased risk of certain diseases. Social conditions and gender role differences may help explain the increased frequency of specific symptom complexes in women. For example, the focus of the media on the ideal figure in Western society is a provoking factor in the development of eating disorders in women. Such contradictory female roles in modern Western society as “devoted wife,” “madly loving mother,” and “successful businesswoman” add stress. The purpose of collecting an anamnesis of life is a more accurate selection of methods of internally oriented psychotherapy, finding the "meaning of life." The healing process is facilitated when the patient comes to understanding herself, clearly separating her past and recognizing the priority of the present for the future.

Thus, a psychiatric case statement should include answers to four questions:

1. Does the patient have a disease with a clear onset time, a certain etiology and response to pharmacotherapy.

2. What personality traits of the patient influence her interaction with the environment and how.

3. Does the patient have targeted conduct disorders?

4. What events in a woman's life contributed to the formation of her personality, and what conclusions did she draw from them.
Eating disorders

Of all psychiatric disorders, only eating disorders occur almost exclusively in women: anorexia and bulimia. For every 10 women suffering from them, there is only one man. The incidence and incidence of these disorders is increasing. Young white women and girls from the middle and upper classes of Western society have the highest risk of developing anorexia or bulimia - 4%. However, the incidence of these disorders in other age, racial and socioeconomic groups is also increasing.

As with abuse, eating disorders are formulated as behavioral disorders caused by dysregulation of hunger, satiety, and food absorption. Behavioral disorders associated with anorexia nervosa include restricting food intake, cleansing manipulations (vomiting, abuse of laxatives and diuretics), exhausting physical activity, and abuse of stimulants. These behavioral responses are obsessive, supported by psychological attitudes about food and weight. These thoughts and behaviors dominate all aspects of a woman's life, disrupting physical, psychological and social functions. As with abuse, treatment can only be effective if the patient wants to change the situation.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), anorexia nervosa includes three criteria: voluntary fasting with refusal to maintain more than 85% weight; psychological attitude with fear of obesity and dissatisfaction with their own weight and body shape; endocrine disorders leading to amenorrhea.

Bulimia nervosa is characterized by the same fear of obesity and dissatisfaction with one's own body as in anorexia nervosa, accompanied by bouts of binge eating, and then compensatory behavior aimed at maintaining a low body weight. The DSM-IV distinguishes anorexia and bulimia primarily in terms of underweight and amenorrhea, rather than the behavior that controls weight. Compensatory behavior includes intermittent fasting, grueling exercise, laxatives, diuretics, stimulants, and vomiting.

Binge eating disorders differ from bulimia nervosa in the absence of compensatory behavior aimed at maintaining body weight, as a result of which these patients develop obesity. In some patients, there is a change from one eating disorder to another over the course of their lives; most often, the change goes in the direction from the restrictive type of anorexia nervosa (when the behavior is dominated by restriction of food intake and excessive exercise) towards bulimia nervosa. There is no single cause of eating disorders; they are considered multifactorial. The known risk factors can be divided into genetic, social and temperamental dispositions.

Studies have shown a higher concordance of identical twins compared to fraternal twins for anorexia. One family study found a tenfold increased risk of anorexia in female relatives. In contrast, for bulimia, neither familial nor twin studies have shown an inherited predisposition.

Temperament and personality traits that contribute to the development of eating disorders include introversion, perfectionism, and self-criticism. Patients with anorexia who have limited food intake but are not involved in cleansing procedures are likely to be predominantly anxious, holding them back from life-threatening behavior; those suffering from bulimia have personality traits such as impulsiveness, the search for novelty. Women with bouts of binge eating and subsequent cleansing may have other impulsive behaviors such as abuse, sexual promiscuity, kleptomania, and auto-harm.

The social conditions conducive to the development of eating disorders are associated with the common idealization in modern Western society of a slim androgynous, underweight figure. Most young women eat restrictive diets, behaviors that increase their risk of developing eating disorders. Women compare their appearance with each other, as well as with the generally accepted ideal of beauty, and strive to be like it. This pressure is especially pronounced in adolescents and young women, since endocrine changes during puberty increase the content of adipose tissue in a woman's body by 50%, and the psyche of adolescents simultaneously overcomes such problems as the formation of personality, separation from parents and puberty. The incidence of eating disorders in young women has increased over the past few decades, in parallel with the increasing media focus on slimness as a symbol of women's success.

Other risk factors for developing eating disorders are family conflict, the loss of a significant other such as a parent, physical illness, sexual conflict, and trauma. Marriage and pregnancy can also be triggers. Some professions require the maintenance of harmony - for ballerinas and models.

It is important to distinguish between the primary risk factors that trigger the pathological process and those that support the pre-existing conduct disorder. Eating disorders periodically cease to depend on the etiological factor that triggered them. Supportive factors include the development of abnormal eating habits and voluntary fasting. Patients with anorexia begin by maintaining a diet. They are often encouraged by their initial weight loss, receiving compliments for their looks and self-discipline. Over time, thoughts and behaviors associated with eating become dominant and subjective goals, the only one to relieve anxiety. Patients resort to more and more intensively immersed in these thoughts and behavior to maintain their mood, as alcoholics increase the dose of alcohol to relieve stress and convert other methods of discharge into alcohol intake.

Eating disorders are often underdiagnosed. Patients hide symptoms associated with a sense of shame, internal conflict, fear of judgment. Physiological signs of eating disorders can be seen on examination. In addition to reduced body weight, fasting can lead to bradycardia, hypotension, chronic constipation, delayed gastric emptying, osteoporosis, and menstrual irregularities. Cleansing procedures lead to electrolyte imbalances, dental problems, hypertrophy of the parotid salivary glands and dyspeptic disorders. Hyponatremia can lead to heart attack. If such complaints are present, the clinician should conduct a routine survey that includes the patient's minimum and maximum body weights during adulthood, a brief history of dietary habits such as calories and grams of dietary fat. Further interrogation may reveal the presence of seizures of binge eating, the frequency of resorting to compensatory measures to restore weight. It is also necessary to find out if the patient herself, her friends and family members think she is suffering from an eating disorder - and if this bothers her.

Anorexic patients undergoing cleansing procedures are at high risk of serious complications. Anorexia has the highest mortality rate of any mental illness - more than 20% of anorectics die after age 33. Death usually occurs due to physiological complications of fasting or due to suicide. In bulimia nervosa, death is often the result of hypokalemic arrhythmias or suicide.

Psychological signs of eating disorders are regarded as secondary to or concomitant with the underlying psychiatric diagnosis. Symptoms of depression and obsessive-compulsive neurosis may be associated with fasting: low mood, constant thoughts about food, decreased concentration, ritual behavior, decreased libido, social isolation. In bulimia nervosa, feelings of shame and a desire to hide bouts of binge eating and cleansing procedures lead to increased social isolation, self-critical thoughts, and demoralization.

Most patients with eating disorders are at increased risk of other mental disorders, most often major depression, anxiety disorders, abuse, and personality disorders. Concomitant major depression or dysthymia was observed in 50-75% of patients with anorexia and in 24-88% of patients with bulimia. Obsessive-compulsive neuroses were encountered throughout life in 26% of anorectics.

Patients with eating disorders are characterized by social isolation, communication difficulties, problems in intimate life and professional activity.

Treatment of eating disorders occurs in several stages, starting with assessing the severity of the pathology, identifying associated mental diagnoses and establishing the motivation for change. Consultation with a dietitian and psychotherapist specialized in treating patients with eating disorders is required. It is necessary to understand that first of all it is necessary to stop pathological behavior, and only after it is taken under control, it will be possible to prescribe treatment aimed at internal processes. A parallel can be drawn with the primacy of abstinence in the treatment of abuse, when therapy concurrently with continued alcohol intake is ineffective.

Treatment by a general psychiatrist is less desirable from the point of view of maintaining the motivation of treatment; treatment in special inpatient institutions such as sanatoriums is more effective - the mortality rate in patients of such institutions is lower. Group therapy and tight monitoring of food intake and latrine use by nursing staff at these facilities minimizes the likelihood of relapse.

Several classes of psychopharmacological agents are used in patients with eating disorders. Double-blind, placebo-controlled studies have shown the effectiveness of a wide range of antidepressants in reducing the frequency of binge eating and subsequent cleansing treatments for bulimia nervosa. Imipramine, desipramine, trazodone, and fluoxetine reduce the frequency of these attacks, regardless of the presence or absence of concomitant depression. With fluoxetine, a more effective dose is 60 mg than is usually used in the treatment of depression. Monoamine oxidase (MAO) inhibitors and buproprion are relatively contraindicated, since dietary restrictions must be observed when using MAO inhibitors, and against the background of buproprion with bulimia, the risk of heart attack increases. In general, treatment for bulimia should include attempting to use tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs) in conjunction with psychotherapy.

For anorexia nervosa, no weight-gain medication has been shown to be effective in controlled trials. Unless the patient has severe depression or obvious signs of obsessive-compulsive disorder, most clinicians recommend monitoring the mental status of patients during remission rather than prescribing medications while the weight is not yet gained. Most of the symptoms of depression, ritual behavior, and obsessions disappear when the weight approaches normal. Low-dose SSRIs are the safest choice when deciding to prescribe antidepressants, given the high potential risk of cardiac arrhythmias and hypotension with tricyclic antidepressants, and the overall higher risk of drug side effects in underweight people. A recent double-blind, placebo-controlled study of the efficacy of fluoxetine in anorexia nervosa showed that the drug may be useful in preventing weight loss after reaching normal levels.

There are few studies examining the levels of neurotransmitters and neuropeptides in patients and recovered patients with eating disorders, but their results show dysfunction of the serotonin, noradrenergic and opiate systems of the central nervous system. Studies of feeding behavior in animal models give the same results.

The efficacy of serotonergic and noradrenergic antidepressants in bulimia also supports the physiology of this disorder.

Evidence from human studies is inconsistent, and it remains unclear whether disturbances in neurotransmitter levels in patients with eating disorders are associated with the condition, appear in response to fasting and bouts of binge eating and purging, or precede mental impairment and are personality traits of a susceptible person. upset patient.

Studies of the effectiveness of the treatment of anorexia nervosa show that among hospitalized patients, after 4 years of follow-up, 44% had a good result with the restoration of normal body weight and menstrual cycle; 28% had a temporary result, 24% did not and 4% died. Unfavorable prognostic factors are the variant of the course of anorexia with bouts of binge eating and purging, low minimum weight and ineffectiveness of therapy in the past. More than 40% of anorectics develop bulimic behavior over time.

The long-term prognosis for bulimia is unknown. Episodic relapses are more likely to occur. A decrease in the severity of bulimic symptoms is observed in 70% of patients with a short follow-up period after treatment with drugs in combination with psychotherapy. As with anorexia, the severity of symptoms in bulimia affects prognosis. Among patients with severe bulimia, 33% had no results after three years.

Eating disorders are a complex mental disorder that most commonly affects women. The frequency of their occurrence in Western society is growing, they are combined with high morbidity. The use of psychotherapeutic, educational and pharmacological techniques in treatment can improve the prognosis. Although the initial stage may not require specific assistance, treatment failure requires early psychiatric consultation. Further research is needed to clarify the reasons for the predominance of women among patients, to assess the real risk factors and to develop an effective treatment.
Affective disorders

Mood disorders are mental illnesses in which mood changes are the main symptom. Everyone experiences mood swings in their lives, but their extreme expressions - affective disorders - are experienced by a few. Depression and mania are two of the main mood disorders seen in mood disorders. These diseases include major depression, manic-depressive psychosis, dysthymia, and impaired adaptation with a depressed mood. Features of hormonal status can serve as risk factors for the development of affective disorders during a woman's life, exacerbations are associated with menstruation and pregnancy.
Depression

Depression is one of the most common mental disorders and is more common in women. Most studies estimate the incidence of depression in women is twice as high as in men. This pattern may in part be explained by the fact that women have a better memory of past episodes of depression. Diagnosis of this condition is complicated by a wide range of symptoms and the absence of specific signs or laboratory tests.

When diagnosing, it is difficult to distinguish between short-term periods of sad mood associated with life circumstances and depression as a mental disorder. The key to differential diagnosis is to recognize typical symptoms and monitor their dynamics. A person without mental disabilities usually does not have self-esteem disorders, suicidal thoughts, feelings of hopelessness, neurovegetative symptoms such as sleep disturbances, appetite, lack of vital energy for weeks and months.

Diagnosis of major depression is based on a history and mental status assessment. The main symptoms include low mood and anhedonia - a loss of desire and the ability to enjoy normal life activities. In addition to depression and anhedonia lasting for at least two weeks, episodes of major depression are characterized by the presence of at least four of the following neurovegetative symptoms: significant weight loss or gain, insomnia or increased sleepiness, psychomotor retardation or revitalization, fatigue and loss of energy, decreased ability to concentrate attention and decision making. In addition, many people suffer from increased self-criticism with feelings of hopelessness, excessive guilt, suicidal thoughts, feeling like a burden for their loved ones and friends.

Symptoms lasting more than two weeks help distinguish an episode of major depression from a short-term adjustment disorder with low mood. Adjustment disorder is reactive depression in which depressive symptoms are a response to an overt stress factor, are limited in number, and respond to minimal therapy. This does not mean that an episode of major depression cannot be triggered by a stressful event or cannot be treated. An episode of major depression differs from a disorder in adaptation in the severity and duration of symptoms.

In some groups, in particular in the elderly, the classic symptoms of depression, such as decreased mood, are often not observed, which leads to an underestimation of the frequency of depression in such groups. There is also evidence that in some ethnic groups depression is more pronounced somatic symptoms than classical symptoms. In older women, complaints of a sense of social uselessness and a set of characteristic somatic complaints must be taken seriously, since they may require antidepressant medication. Although some laboratory tests have been suggested for diagnosis, such as the dexamethasone test, they are not specific. The diagnosis of major depression remains clinical and is made after careful history and mental status assessments.

In childhood, the incidence of depression in boys and girls is the same. The differences become noticeable in puberty. Angola and Worthman consider the cause of these differences to be hormonal and conclude that hormonal changes may be a trigger mechanism for a depressive episode. Beginning with menarche, women are at increased risk of developing premenstrual dysphoria. This mood disorder is characterized by symptoms of major depression, including anxiety and mood lability, that occur in the last week of the menstrual cycle and end in the early days of the follicular phase. Although premenstrual emotional lability occurs in 20-30% of women, its severe forms are quite rare - in 3-5% of the female population. A recent multicenter, randomized, placebo-controlled trial of sertraline 5-150 mg showed significant improvement in symptoms with treatment. 62% of women in the study group and 34% in the placebo group responded to treatment. Fluoxetine at a dose of 20-60 mg per day also reduces the severity of premenstrual disorders in more than 50% of women, according to a multicenter, placebo-controlled study. In women with major depression, as well as with manic-depressive psychosis, mental disorders are exacerbated during the premenstrual period - it is unclear whether this is an exacerbation of one condition or an overlap of two (the underlying mental disorder and premenstrual dysphoria).

In pregnant women, the entire spectrum of affective symptoms is observed both during pregnancy and after childbirth. The incidence of major depression (about 10%) is the same as in non-pregnant women. In addition, pregnant women may experience less severe symptoms of depression, mania, and periods of psychosis with hallucinations. The use of medications during pregnancy is used both during an exacerbation of a mental state and for the prevention of relapses. Interruption of medication during pregnancy in women with preexisting mental health problems dramatically increases the risk of exacerbations. To make a decision about drug treatment, it is necessary to compare the risk of potential harm of drugs to the fetus with the risk to both the fetus and the mother of recurrence of the disease.

In a recent review, Altshuler et al described existing therapeutic guidelines for treating various mental health problems during pregnancy. In general, medication should be avoided if possible during the first trimester due to the risk of teratogenicity. However, if symptoms are severe, treatment with antidepressants or mood stabilizers may be necessary. Initial studies of the use of fluoxetine showed that SSRIs are relatively safe, but reliable data on the intrauterine effects of these new drugs are not yet available. The use of tricyclic antidepressants does not lead to a high risk of congenital anomalies. Electroconvulsive therapy is another relatively safe treatment for severe depression during pregnancy. Taking lithium preparations in the first trimester increases the risk of congenital cardiovascular diseases. Antiepileptic drugs and benzodiazepines are also associated with an increased risk of congenital anomalies and should be avoided if possible. In each case, it is necessary to assess all indications and risks individually, depending on the severity of the symptoms. Psychiatric consultation is needed to compare the risk of untreated mental illness and the risk of pharmacological complications for the mother and fetus.

Many women experience mood disturbances after childbirth. The severity of symptoms ranges from “baby blues” to severe major depression or psychotic episodes. In most women, these mood changes occur in the first six months after childbirth, at the end of this period all signs of dysphoria disappear on their own. However, in some women, depressive symptoms persist for months or years. In a study of 119 women after the first birth, half of the women who received medication after childbirth relapsed within the next three years. Early identification of symptoms and adequate treatment is necessary for both the mother and the baby, as depression can affect a mother's ability to adequately care for her baby. However, antidepressant treatment for nursing mothers requires caution and comparative risk assessment.

Mood changes during menopause have been known for a long time. Recent studies, however, have not confirmed a clear link between menopause and mood disorders. In a review of this issue, Schmidt and Rubinow found very few published research findings to support this relationship.

Mood changes associated with hormonal changes during menopause can resolve with HRT. For most women, HRT is the first stage of treatment before psychotherapy and antidepressants. If symptoms are severe, initial antidepressant treatment is indicated.

Due to the longer life expectancy of women compared to men, most women worry about their spouses, which is a stressful factor in older age. At this age, monitoring is necessary to detect symptoms of severe depression. Anamnesis and mental status research in older women should include screening for somatic symptoms and identifying feelings of unnecessaryness, a personal burden for loved ones, because depression in the elderly is uncommon for depression as a primary complaint. Treatment of depression in the elderly is often complicated by low tolerance to antidepressants, so they must be prescribed at a minimum dose, which can then be gradually increased. SSRIs are undesirable at this age due to their anticholinergic side effects of sedation and orthostasis. When a patient is taking several drugs, drug monitoring in the blood is necessary due to the mutual influence on metabolism.

There is no single cause of depression. The main demographic risk factor is female. Analysis of population data shows that the risk of developing major depression is increased in divorced, single and unemployed. The role of psychological causes is being actively studied, but so far no consensus has been reached on this issue. Family studies have demonstrated an increased incidence of affective disorders in the closest relatives of the proband. Twin studies also support the idea of ​​genetic predisposition in some patients. Especially strongly hereditary predisposition plays a role in the genesis of manic-depressive psychosis and major depression. The probable cause is a dysfunction of the serotonergic and noradrenergic systems.

The usual therapeutic approach to treatment is a combination of pharmacological agents - antidepressants - and psychotherapy. The advent of a new generation of antidepressants with minimal side effects has increased the therapeutic options for depressed patients. There are 4 main types of antidepressants used: tricyclic antidepressants, SSRIs, MAO inhibitors and others - see table. 28-2.

The key principle for the use of antidepressants is to take them appropriately - at least 6-8 weeks for each drug in a therapeutic dose. Unfortunately, many patients stop taking antidepressants before the effects develop because they see no improvement in the first week. When taking tricyclic antidepressants, drug monitoring can help confirm that sufficient therapeutic blood levels have been achieved. For SSRIs, this method is less useful, their therapeutic level varies greatly. If the patient has not taken the full course of the antidepressant and continues to experience symptoms of major depression, a new course of treatment with a different class of drug should be initiated.

All patients receiving antidepressant treatment should be monitored for the development of symptoms of mania. Although this is a rare complication of antidepressant medication, it does happen, especially if you have a family or personal history of manic-depressive psychosis. Symptoms of mania include decreased need for sleep, increased energy, and agitation. Before prescribing therapy, patients must carefully collect anamnesis in order to identify symptoms of mania or hypomania, and if they are present or with a family history of manic-depressive psychosis, a psychiatric consultation will help to choose therapy with mood stabilizers - lithium, valproic acid, possibly in combination with antidepressants.
Seasonal affective disorders

For some people, the course of depression is seasonal, exacerbating in the winter. The severity of clinical symptoms varies widely. With moderate severity of symptoms, exposure to full-spectrum non-UV light (fluorescent lamps - 10 thousand lux) for 15-30 minutes every morning during the winter months is sufficient. If symptoms meet the criteria for major depression, antidepressant treatment should be added to light therapy.
Bipolar Disorders (Manic Depressive Psychosis)

The main difference between this disease and major depression is the presence of both episodes of depression and mania. The criteria for depressive episodes are the same as for major depression. Manic episodes are characterized by bouts of elevated, irritable, or aggressive mood lasting at least a week. These mood changes are accompanied by the following symptoms: increased self-esteem, decreased need for sleep, loud and fast speech, jumping thoughts, agitation, flashes of ideas. Such an increase in vital energy is usually accompanied by excessive behavior aimed at obtaining pleasure: spending large sums of money, drug addiction, promiscuity and hypersexuality, risky business projects.

There are several types of manic-depressive disorder: the first type is the classic form, the second type includes a change in episodes of depression and hypomania. Episodes of hypomania are milder than classical mania, with the same symptoms, but not disrupting the patient's social life. Other forms of bipolar disorder include mood swings and mixed conditions, where the patient has signs of both mania and depression at the same time.

The first line drugs for all forms of bipolar disorder are mood stabilizers such as lithium and valproate. The initial dose of lithium is 300 mg once or twice a day, then adjusted to maintain a blood level of 0.8-1.0 mEq / L for bipolar I disorder. The level of valproate in the blood, which is effective for the treatment of these diseases, is not precisely established; one can focus on the level recommended for the treatment of epilepsy: 50-150 μg / ml. In some patients, a combination of mood stabilizers with antidepressants is needed to treat symptoms of depression. A combination of mood stabilizers with low-dose antipsychotics is used to control the symptoms of acute mania.
Dysthymia

Dysthymia is a chronic depressive condition lasting at least two years, with symptoms that are less severe than major depression. The severity and number of symptoms are not sufficient to meet the criteria for major depression, but they impair social functioning. Symptoms commonly include appetite disturbances, decreased energy, poor concentration, sleep disturbances, and feelings of hopelessness. Studies conducted in different countries claim a high prevalence of dysthymia in women. Although there are few reports of therapy for this disorder, there is evidence that SSRIs such as fluoxetine and sertraline may be used. Some patients with dysthymia may experience episodes of major depression.
Coexisting affective and neurological disorders

There is ample evidence of associations between neurological disorders and mood disorders, more often with depression than with bipolar disorder. Episodes of major depression are common in Huntington's chorea, Parkinson's, and Alzheimer's. Episodes of depression occur in 40% of patients with parkinsonism - half have major depression and half have dysthymia. In a study of 221 patients with multiple sclerosis, 35% were diagnosed with major depression. Several studies have shown a link between left frontal lobe stroke and major depression. AIDS patients develop both depression and mania.

Neurological patients with features that meet the criteria for affective disorder should be treated with drugs because drug treatment for mental disorders improves the prognosis of the underlying neurological diagnosis. If the clinical picture does not meet the criteria for affective disorders, psychotherapy is sufficient to help the patient cope with the difficulties. The combination of several diseases increases the number of prescribed drugs and the sensitivity to them, and therefore the risk of delirium. In patients receiving large amounts of drugs, antidepressants should be started at a low dose and increased gradually, monitoring for possible symptoms of delirium.
Alcohol abuse

Alcohol is the most frequently abused substance in the United States, with 6% of the adult female population having a serious alcohol problem. Although alcohol abuse is lower in women than in men, alcohol dependence and alcohol-related morbidity and mortality are significantly higher in women. Research on alcoholism is focused on the male population, and the validity of extrapolating this data to the female population is questionable. For diagnosis, they usually use questionnaires that identify problems with the law and employment, which are much less common in women. Women are more likely to drink alone and are less likely to fall into fits of rage while intoxicated. One of the main risk factors for the development of alcoholism in a woman is the partner of an alcoholic patient who persuades her to drink drinking and does not allow her to seek help. In women, the signs of alcoholism are more pronounced than in men, but doctors determine it in women less often. All this allows us to consider the official frequency of occurrence of alcoholism in women underestimated.

Complications associated with alcoholism (fatty liver disease, cirrhosis, hypertension, gastrointestinal bleeding, anemia and digestive disorders) develop faster in women and with lower alcohol intake than men, since women have a lower level of gastric alcohol dehydrogenase. The dependence on alcohol, as well as on other substances - opiates, cocaine - in women develops after a shorter time of intake than in men.

There is evidence that the incidence of alcoholism and related medical problems is increasing in women born after 1950. During the phases of the menstrual cycle, changes in alcohol metabolism in the body are not observed, however, women who drink are more likely to experience menstrual irregularities and infertility. During pregnancy, there is usually a complication such as fetal alcohol syndrome. The incidence of cirrhosis increases dramatically after menopause, and alcoholism increases the risk of alcoholism in older women.

Women with alcoholism are at increased risk of associated psychiatric diagnoses, especially drug addiction, mood disorders, bulimia nervosa, anxiety, and psychosexual disorders. Depression occurs in 19% of women who are alcoholics and 7% of women who do not abuse alcohol. Although alcohol brings temporary relaxation, it exacerbates the course of mental disorders in susceptible people. It takes several weeks of withdrawal to achieve remission. Women with a family history of paternal alcoholism, anxiety disorder, and premenstrual syndrome drink more during the second phase of their cycle, possibly in an attempt to relieve symptoms of anxiety and depression. Women who are alcoholics are at high risk of suicide attempts.

Women usually seek salvation from alcoholism in a roundabout way, turning to psychoanalysts or general practitioners with complaints of family problems, physical or emotional complaints. They rarely go to alcohol treatment centers. Alcoholic patients need a special approach due to their frequent inadequacy and reduced feelings of shame.

Although it is almost impossible to ask such patients directly about the amount of alcohol consumed, screening for alcohol abuse should not be limited to indirect signs such as anemia, elevated liver enzymes and triglycerides. The question “have you ever had alcohol problems” and the CAGE questionnaire (Table 28-3) provide rapid screening with a sensitivity of more than 80% for more than two positive responses. Support, explanation, and discussion with the doctor, psychologist, and Alcoholics Anonymous help the patient adhere to the treatment. In the period of withdrawal, it is possible to prescribe diazepam at a starting dose of 10-20 mg with a gradual increase of 5 mg every 3 days. Follow-up visits should be at least twice a week, they assess the severity of symptoms of withdrawal symptoms (sweating, tachycardia, hypertension, tremor) and adjust the dose of the drug.

Although alcohol abuse is less common in women than in men, its harm to women, given the associated morbidity and mortality, is significantly higher. New research is needed to clarify the pathophysiology and psychopathology of the sexual characteristics of the course of the disease.
Table 28-3
CAGE questionnaire

1. Have you ever felt that you need to drink less?

2. Have people ever bothered you with their criticism of your alcohol intake?

3. Have you ever felt guilty about drinking alcohol?

4. Has it ever happened that alcohol was the only remedy that helps to become cheerful in the morning (open your eyes)
Sexual Disorders

Sexual dysfunctions have three successive stages: disorders of desire, arousal and orgasm. The DSM-IV considers sexual pain disorder as the fourth category of sexual dysfunction. Desire disorders are further subdivided into decreased sexual desire and perversion. Painful sexual disorders include vaginismus and dyspareunia. Clinically, women often have a combination of several sexual dysfunctions.

The role of sex hormones and menstrual irregularities in the regulation of sexual desire remains unclear. Most researchers assume that endogenous fluctuations in estrogen and progesterone do not significantly affect sexual desire in women of reproductive age. However, there is clear evidence of a decrease in desire in women with surgical menopause, which can be restored by the administration of estradiol or testosterone. Studies of the relationship between arousal and orgasm with cyclical fluctuations in hormones do not provide unambiguous conclusions. There was a clear correlation between the plasma level of oxytocin and the psychophysiological value of orgasm.

In postmenopausal women, the number of sexual problems increases: a decrease in vaginal lubrication, atrophic vaginitis, a decrease in blood supply, which are effectively solved with the help of estrogen replacement therapy. Testosterone supplementation helps increase sexual desire, although there is no clear evidence of the supportive effect of androgens on blood flow.

Psychological factors, communication problems play a much more important role in the development of sexual disorders in women than organic dysfunction.

Special attention should be paid to the influence of medications taken by psychiatric patients on all phases of sexual function. Antidepressants and antipsychotic drugs are the two main classes of drugs associated with these side effects. When using SSRIs, anorgasmia is observed. Despite clinical reports on the effectiveness of cyproheptadine addition or on interrupting the main drug for the weekend, a more acceptable solution for now is changing the class of antidepressant to another, with less severity of side effects in this area, most often to buproprion and nefazodone. In addition to the side effects of psychopharmacological drugs, a chronic mental disorder itself can lead to a decrease in sexual interest, as well as physical illnesses accompanied by chronic pain, low self-esteem, changes in appearance, and fatigue. A history of depression may be the cause of decreased sexual desire. In such cases, sexual dysfunction occurs during the onset of the mood disorder, but does not go away after the episode ends.
Anxiety Disorders

Anxiety is a normal adaptive emotion that develops in response to a threat. It works as a signal to activate behavior and minimize physical and psychological vulnerability. Reducing anxiety is achieved either by overcoming or avoiding a provoking situation. Pathological anxiety states differ from normal anxiety in the severity and chronicity of the disorder, provoking stimuli, or an adaptive behavioral response.

Anxiety disorders are widespread, with a monthly incidence of 10% among women. The average age at development of anxiety disorders is adolescence and adolescence. Many patients never seek help for this or turn to non-psychiatrists with complaints of somatic symptoms associated with anxiety. Medication overuse or withdrawal, use of caffeine, weight loss drugs, pseudoephedrine can exacerbate anxiety disorder. Medical examination should include a thorough history taking, routine laboratory tests, ECG, urine toxicological analysis. Some types of neurological pathology are accompanied by anxiety disorders: movement disorders, brain tumors, impaired blood supply to the brain, migraine, epilepsy. Somatic diseases accompanied by anxiety disorders: cardiovascular, thyrotoxicosis, systemic lupus erythematosus.

Anxiety disorders are classified into 5 main groups: phobias, panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress syndrome. With the exception of obsessive-compulsive disorder, which occurs equally frequently in men and women, anxiety disorders are more common in women. Specific phobias and agoraphobia are three times more common in women, panic with agoraphobia is 1.5 times more common, generalized anxiety disorder is 2 times more common, and post-traumatic stress syndrome is 2 times more common. The reasons for the prevalence of anxiety disorders in the female population are unknown; hormonal and sociological theories have been proposed.

Sociological theory focuses on traditional gender-role stereotypes that prescribe a woman to be helpless, addicted, and avoid active behavior. Young mothers are often worried about whether they will be able to keep their babies safe, unwillingness to become pregnant, and infertility - all of these conditions can exacerbate anxiety disorders. High expectations and conflicting roles as a mother, wife, housewife, and successful worker also increase the incidence of anxiety disorders in women.

Hormonal fluctuations exacerbate anxiety conditions in the premenstrual period, during pregnancy and after childbirth. Progesterone metabolites function as partial GABA agonists and potential modulators of the serotonergic system. Alpha-2 receptor binding also changes throughout the menstrual cycle.

For anxiety disorders, the combination with other psychiatric diagnoses is high, most often - mood disorders, drug dependence, other anxiety disorders and personality disorders. In panic disorder, for example, a combination with depression occurs more often than 50%, and with alcohol dependence - in 20-40%. Social phobia is associated with panic disorder in more than 50%.

The general principle of the treatment of anxiety disorders is the combination of pharmacotherapy with psychotherapy - the effectiveness of this combination is higher than the use of these methods in isolation. Drug treatment affects three main neurotransmitter systems: noradrenergic, serotonergic, and GABAergic. The following classes of drugs are effective: antidepressants, benzodiazepines, beta-blockers.

All drugs should be started at low doses and then gradually doubled every 2-3 days or less to minimize side effects. Patients with anxiety disorders are very sensitive to side effects, so a gradual increase in dose increases compliance with therapy. Patients need to be explained that most antidepressants are effective after 8-12 weeks, talk about the main side effects, help to continue the drug for the required amount of time, and explain that some of the side effects go away over time. The choice of an antidepressant depends on the patient's complaints and side effects. For example, people with insomnia are better off starting with more sedative antidepressants such as imipramine. If effective, treatment should be continued for 6 months to a year.

At the beginning of treatment, before the development of the effect of antidepressants, the addition of benzodiazepines is useful, which can dramatically reduce the symptoms. Long-term use of benzodiazepines should be avoided due to the risk of dependence, tolerance, and withdrawal. When prescribing benzodiazepines, it is necessary to warn the patient about their side effects, the risk associated with their long-term use and the need to consider them only as a temporary measure. Clonazepam 0.5 mg twice daily or lorazepam 0.5 mg four times daily for a limited period of 4–6 weeks may improve initial compliance with antidepressant treatment. For benzodiazepines for longer than 6 weeks, discontinuation should be gradual to reduce the anxiety associated with possible withdrawal.

In pregnant women, anxiolytics should be used with caution, the safest drugs in this case are tricyclic antidepressants. Benzodiazepines can cause hypotension, respiratory distress syndrome, and low Apgar scores in newborns. Clonazepam has minimal potential teratogenic effect; this drug can be used with caution in pregnant women with severe anxiety disorders. The first step should be to attempt non-pharmacological treatments - cognitive (learning) and psychotherapy.
Phobic disorders

There are three types of phobic disorders: specific phobias, social phobia, and agoraphobia. In all cases, in a provoking situation, anxiety arises and a panic attack may develop.

Specific phobias are irrational fears of specific situations or objects that cause them to avoid. Examples include fear of heights, fear of flying, fear of spiders. They usually appear at the age of less than 25 years, in women, fear of animals develops first. These women rarely seek treatment because many phobias do not interfere with their normal lives and their stimuli (such as snakes) are easy to avoid. However, in some cases, such as fear of flying, phobias can interfere with a career, in which case treatment is indicated. Simple phobias can be easily dealt with with psychotherapeutic techniques and systemic desensitization. Additionally, a single dose of 0.5 or 1 mg lorazepam before flight helps to reduce this specific fear.

Social phobia (fear of society) is the fear of a situation in which a person is available for the close attention of other people. Avoiding provocative situations in this phobia severely limits working conditions and social function. Although social phobia is more common in women, it is easier for them to avoid a provocative situation and do housework, therefore, in the clinical practice of psychiatrists and psychotherapists, men with social phobia are more common. Disorders of motor activity and epilepsy can be combined with social phobia. In a study of patients with Parkinson's disease, the presence of social phobia was revealed in 17%. Pharmacological treatment of social phobia is based on the use of beta-blockers: propranolol at a dose of 20-40 mg one hour before the alarming presentation or atenolol at a dose of 50-100 mg per day. These drugs block the activation of the autonomic nervous system due to anxiety. Antidepressants, including tricyclic drugs, SSRIs, MAO blockers, can also be used - at the same doses as used in the treatment of depression. The preferred combination of pharmacotherapy with psychotherapy: short-term use of benzodiazepines or low-dose clonazepam or lorazepam in combination with cognitive therapy and systematic desensitization.

Agoraphobia - fear and avoidance of crowded places. Often combined with panic attacks. In this case, it is very difficult to avoid provoking situations. As with social phobia, agoraphobia is more common in women, but men seek help more often because its symptoms interfere with their personal and social lives. Treatment for agoraphobia consists of systemic desensitization and cognitive psychotherapy. Antidepressants are also effective because of their high association with panic disorder and major depression.
Panic disorder

A panic attack is a sudden attack of severe fear and discomfort, lasting several minutes, passing gradually and including at least 4 symptoms: chest discomfort, sweating, tremors, hot flashes, shortness of breath, paresthesia, weakness, dizziness, palpitations, nausea, frustration stool, fear of death, loss of self-control. Panic attacks can occur with any anxiety disorder. They are unexpected and accompanied by a constant fear of anticipating new attacks, which changes behavior and directs it to minimize the risk of new attacks. Panic attacks also occur in many conditions of intoxication and certain diseases such as emphysema. In the absence of therapy, the course of panic disorder becomes chronic, but treatment is effective, and the combination of pharmacotherapy with cognitive-behavioral psychotherapy causes a dramatic improvement in most patients. Antidepressants, especially tricyclic drugs, SSRIs and MAO inhibitors, at doses comparable to those used to treat depression are the treatment of choice (Table 28-2). Imipramine or nortriptyline is started at a low dose of 10-25 mg per day and increased by 25 mg every three days to minimize the severity of side effects and enhance compliance. Blood levels of nortriptyline should be maintained between 50 and 150 ng / ml. Fluoxetine, fluvoxamine, tranylcypromine, or phenelzine may also be used.
Generalized anxiety disorder

DSM-IV defines generalized anxiety disorder as persistent, profuse, poorly controlled anxiety associated with daily activities such as work, school, which interferes with life and is not limited to the symptoms of other anxiety disorders. There are at least three of the following symptoms: fatigue, poor concentration, irritability, sleep disturbances, anxiety, and muscle tension.

Treatment includes medication and psychotherapy. Buspirone is the first-line treatment for generalized anxiety disorder. The initial dose is 5 mg twice a day, it is gradually increased over several weeks to 10-15 mg twice a day. An alternative is imipramine or an SSRI (sertraline) (see Table 28-2). Short-term use of long-acting benzodiazepines, such as clonazepam, can help manage symptoms in the first 4–8 weeks, before the main treatment takes effect.

Psychotherapeutic techniques used in the treatment of generalized anxiety disorder include cognitive behavioral therapy, supportive therapy, and an internally focused approach that aims to increase the patient's anxiety tolerance.
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The disease manifests itself in a sharp change in the patient's behavior, the loss of an adequate attitude towards life and others, in the absence of a desire to perceive the existing reality. At the same time, mental disorders interfere with the awareness of the presence of these very problems, a person cannot eliminate them on his own.

Due to the emotional component, hormonal explosions and exposure to stress, psychoses and other mental disorders are twice as common in women as in men (7 versus 3%, respectively).

What are the reasons and who is most at risk?

The main reasons for the development of psychosis in females are as follows:

• pregnancy and childbirth;
• menopause;
• diseases of various organs and systems;
• infectious diseases;
• alcohol poisoning or drug abuse;
• prolonged chronic stress;
• mental illness of various types;
• depressive conditions.

One of the main reasons is increased emotional excitability or the presence of a similar disease in a woman's family, mother, sister, that is, a genetic component.

Who is at risk

The root cause of the onset of psychosis is often alcohol abuse and subsequent intoxication of the body. In most cases, men are most susceptible to alcoholism, therefore, the female sex suffers from alcoholic psychosis much less often and tolerates it faster and easier.

But there is also a reason that is specific to women only, which increases the risk of the disease. This is pregnancy and childbirth. The physical factors of the onset of psychosis in this case include toxicosis, vitamin deficiency, a decrease in the tone of all body systems, various diseases or complications due to difficult gestation and childbirth.

Psychological include - fear, anxiety, increased emotional sensitivity, unwillingness to become a mother. At the same time, postpartum mental disorder occurs more often than during pregnancy.

Features of behavior

A woman with mental disorders is characterized by such changes in behavior and life (and the symptoms are noticeable only from the outside, the patient herself does not know that she is sick):

• lack of resistance to stress, which often leads to tantrums or scandals;
• the desire to isolate themselves from communication with colleagues, friends and even loved ones;
• there is a craving for something unreal, supernatural, interest in magical practices, shamanism, religion and similar trends;
• the appearance of various fears, phobias;
• decreased concentration, retarded mental activity;
• loss of strength, apathy, unwillingness to show any activity;
• a sharp change in mood for no apparent reason;
• sleep disturbances, can manifest itself as excessive drowsiness and insomnia;
• decrease or complete lack of desire to eat.

Varieties of mental abnormalities

Psychoses can be conditionally divided into two large groups:

1. Organic. In such cases, psychosis is a consequence of a physical illness, a secondary disorder after disturbances in the work of the central nervous and cardiovascular systems.
2. Functional. Such violations are initially due to the psychosocial factor and the presence of a predisposition to their occurrence. These include affective disorders, disorders of the process of thinking and perception. Among others, the most common: manic - depressive psychosis, schizophrenia, paranoia, paranoid.

Separately, postpartum psychosis can be distinguished, it appears in 1 - 3% of women in the first months after the birth of a child, in contrast to the more common postpartum depression, psychotic deviation does not go away on its own and requires treatment under the qualified supervision of specialists.

• decreased appetite and rapid weight loss;
• constant anxiety, sudden mood swings;
• the desire for isolation, refusal to communicate;
• violation of the level of self-esteem;
• thoughts of committing suicide.

Symptoms appear on an individual basis, with some within a day after childbirth, others within a month.

A mental breakdown can be accompanied by various conditions that provoke disruptions in the work of the whole body of a woman.

Violation of the diet, activity and rest, emotional tension, taking medications. These factors "hit" the nervous, cardiovascular, respiratory, digestive and endocrine systems. The manifestation of concomitant diseases is individual.

Who should you contact for help?

Self-medication in this case is contraindicated. You should also not contact familiar doctors of various specialties, psychologists, or traditional healers. Treatment should be carried out only by a public or private doctor - a highly qualified psychotherapist!

The specialist will examine the patient, send him for additional tests and, based on their results, prescribe treatment and the necessary medications.

Treatment can take place in a hospital with the participation of medical staff, or at home. When treating at home, a mandatory safety measure will be taking care of the baby with the least intervention of the mother (in the event of a postpartum mental breakdown). The nanny or relatives should take over these concerns until the patient's symptoms disappear.

Treatment usually consists of a complex, which includes:

• medications, usually antipsychotics, antidepressants, mood stabilizers;
• psychotherapy - regular sessions with a psychotherapist and family psychologist;
• social adaptation.

The patient is far from immediately able to realize, to accept her condition to the end. Relatives and friends must be patient to help the woman return to her normal life.

The consequences of the absence of therapy are extremely unfavorable. The patient loses touch with reality, her behavior becomes inadequate and dangerous not only for her own life and health, but also for those around her.

The person is suicidal, can become a victim or cause of violence.

How to prevent mental breakdown?

Preventive measures include:

• regular monitoring of your health;
• treatment of diseases that can cause mental disorders;
• strengthening the immune system;
• physical activity;
• active social life;
• quitting smoking, alcohol, drugs;
• reducing stress and fatigue in daily life;
• thorough, versatile preparation for pregnancy and childbirth;
• preparation for climacteric changes in the body.

Prevention should be a priority, especially in those women who are prone to emotional breakdown or have an inherited predisposition to psychotic disorders.

This section was created to take care of those who need a qualified specialist, without disturbing the usual rhythm of their own life.

Symptoms of Mental Disorders

The article provides an overview of the symptoms and syndromes of mental disorders, including the features of their manifestation in children, adolescents, the elderly, men and women. Some of the methods and means used in traditional and alternative medicine for the treatment of such diseases are mentioned.

Causes of emotional illness

Pathological changes in the psyche can lead to:

• infectious diseases affecting the brain directly or as a result of secondary infection;
• exposure to chemicals - drugs, food ingredients, alcohol, drugs, industrial poisons;
• endocrine system damage;
• traumatic brain injury, oncology, structural anomalies and other pathologies of the brain;
• burdened heredity, etc.

Syndromes and signs

Asthenic syndrome

This painful condition, also called asthenia, neuropsychic weakness or chronic fatigue syndrome, is manifested by increased fatigue and exhaustion. In patients, there is a weakening or complete loss of the ability to any prolonged physical and mental stress.

The development of asthenic syndrome can lead to:

• prolonged physical, emotional or intellectual stress;
• some diseases of internal organs;
• intoxication;
• infections;
• nervous and mental illness;
• improper organization of work, rest and nutrition.

Asthenic syndrome can be observed both at the initial stage of the development of a disease of internal organs, and occur after an acute illness.

Asthenia often accompanies a chronic disease, being one of its manifestations.

Chronic fatigue syndrome often manifests itself in people with an unbalanced or weak type of higher nervous activity.

The following signs indicate the presence of asthenia:

• irritable weakness;
• predominance of low mood;
• sleep disturbances;
• intolerance to bright light, noise and strong odors;
• headache;
• dependence on the weather.

The manifestations of neuropsychic weakness are determined by the underlying disease. For example, with atherosclerosis, pronounced memory impairments are observed, with hypertension - painful sensations in the region of the heart and headaches.

Obsession

The term "obsession" (obsession, obsession) is used to denote a set of symptoms associated with recurrent obsessive unwanted thoughts, ideas, ideas.

An individual fixating on such thoughts, as a rule, causing negative emotions or a stressful state, finds it difficult to get rid of them. This syndrome can manifest itself in the form of obsessive fears, thoughts and images, the desire to get rid of which often leads to the performance of special "rituals" - copulsions.

Psychiatrists have identified several hallmarks of obsessive-compulsive disorder:

1. Obsessive thoughts are reproduced by consciousness voluntarily (against the will of a person), while the consciousness remains clear. The patient tries to fight the obsession.
2. Obsessions are alien to thinking, there is no visible connection between obsessive thoughts and the content of thinking.
3. Obsession is closely related to emotions, often of a depressive nature, anxiety.
4. Obsessions are not reflected in intellectual abilities.
5. The patient is aware of the unnaturalness of obsessive thoughts, retains a critical attitude towards them.

Affective syndrome

Affective syndromes are symptom complexes of mental disorders that are closely associated with mood disorders.

There are two groups of affective syndromes:

1. With a predominance of manic (elevated) mood
2. With a predominance of depressive (low) mood.

In the clinical picture of affective syndromes, the leading role belongs to disorders of the emotional sphere - from small fluctuations in mood to quite pronounced disorders (affects).

By nature, all affects are divided into sthenic, which proceed with a predominance of excitement (delight, joy), and asthenic, which proceed with a predominance of inhibition (melancholy, fear, sadness, despair).

Affective syndromes are observed in many diseases: with circular psychosis and schizophrenia, they are the only manifestations of the disease, with progressive paralysis, syphilis, brain tumors, vascular psychosis - its initial manifestations.

Affective syndromes are disorders such as depression, dysphoria, euphoria, mania.

Depression is a fairly common mental disorder that requires special attention, since 50% of people who commit suicide attempts have signs of this mental disorder.

Characteristic features of depression:

• low mood;
• pessimistic attitude towards reality, negative judgments;
• motor and volitional inhibition;
• oppression of instinctive activity (loss of appetite or, conversely, a tendency to overeat, decreased sexual desire);
• concentration of attention on painful experiences and difficulty in concentrating;
• decreased self-esteem.

Dysphoria, or mood disorders, which are characterized by a maliciously melancholy, intense affect with irritability reaching outbursts of anger and aggression, are characteristic of excitable psychopaths and alcoholics.

Dysphoria is common in epilepsy and organic diseases of the central nervous system.

Euphoria, or high spirits with a touch of carelessness, contentment, not accompanied by an acceleration of associative processes, is found in the clinic of atherosclerosis, progressive paralysis, and brain injury.

Mania

A psychopathological syndrome characterized by a triad of symptoms:

• unmotivated elevated mood,
• acceleration of thinking and speech,
• motor excitement.

There are signs that do not appear in all cases of manic syndrome:

• increased instinctive activity (increased appetite, sexual desire, self-protective tendencies),
• instability of attention and overestimation of oneself as a person, sometimes reaching delusional ideas of greatness.

A similar condition can occur with schizophrenia, intoxication, infections, trauma, brain damage and other diseases.

Senestopathy

The term "senestopathy" is defined as a sudden onset of painful, extremely unpleasant bodily sensation.

This sensation devoid of objectivity arises in the place of localization, although there is no objective pathological process in it.

Senestopathies are common symptoms of mental disorders, as well as structural components of depressive syndrome, hypochondriacal delirium, and mental automatism syndrome.

Hypochondriac syndrome

Hypochondria (hypochondriacal disorder) is a condition characterized by constant anxiety due to the possibility of getting sick, complaints, anxiety about one's well-being, the perception of ordinary sensations as abnormal, assumptions about the presence, in addition to the underlying disease, of any additional one.

Most often, concerns arise about the heart, gastrointestinal tract, genitals and brain. Pathological attention can lead to certain malfunctions in the body.

Some peculiarities inherent in the personality have the development of hypochondria: suspiciousness, anxiety, depression.

Illusion

Illusions are distorted perceptions in which a real-life object or phenomenon is not recognized, and instead a different image is perceived.

There are the following types of illusions:

1. Physical, including optical, acoustic
2. Physiological;
3. Affective;
4. Verbal, etc.

Metamorphoses (organic), physical and physiological illusions can occur in people whose mental health is beyond doubt. A patient with optical illusions can perceive a raincoat hanging on a hanger as a lurking killer, spots on bed linen seem to him to be bugs, a belt on the back of a chair is like a snake.

In case of acoustic illusions, the patient in an overheard conversation distinguishes threats against him, the remarks of passers-by perceives as accusations and insults addressed to him.

Most often, illusions are observed in infectious and intoxication diseases, but they can occur in other painful conditions.

Fear, fatigue, anxiety, exhaustion, and distortion of perception due to poor lighting, noise, hearing loss and visual acuity predispose to the emergence of illusions.

Hallucination

An image that appears in consciousness without a stimulus is called a hallucination. In other words, this is a mistake, an error in the perception of the senses, when a person sees, hears, feels something that does not really exist.

Conditions under which hallucinations occur:

• severe fatigue
• the use of certain psychotropic substances,
• the presence of mental (schizophrenia) and neurological diseases.

Distinguish between true, functional and other types of hallucinations. True hallucinations are usually classified according to analyzers: visual, acoustic, tactile, gustatory, olfactory, somatic, motor, vestibular, complex.

Delusional disorders

A delusional disorder is a condition characterized by the presence of delusion - a disorder of thinking, accompanied by the emergence of reasoning, ideas and conclusions that are far from reality.

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There are three groups of delusional states, united by a common content:

1. Persecution delirium. This group includes beliefs that the patient is being persecuted, they want to poison (delirium of poisoning), his property is spoiled and stolen (delusion of damage), the sexual partner is changing (delusion of jealousy), everything around is set up, an experiment is being conducted on him (delusion of staging).
2. Delusions of greatness in all varieties (delusions of wealth, inventions, reformism, origin, love). Sometimes a patient with a mental disorder in the form of religious delusion may call himself a prophet.
3. Depressive delusions. The main content of delusional states is self-blame, self-abasement and sinfulness. This group includes hypochondriacal and nihilistic delusions, Cotard's syndrome.

Catatonic syndromes

Catatonic syndrome belongs to a group of psychopathological syndromes, the main clinical manifestation of which is movement disorders.

The structure of this syndrome is:

1. Catatonic excitement (pathetic, impulsive, silent).
2. Catatonic stupor (cataleptic, negativistic, stupor with torpor).

Depending on the form of arousal, the patient may experience moderate or pronounced motor and speech activity.

Extreme arousal - chaotic, meaningless actions of an aggressive nature, causing severe damage to oneself and others.

The state of catatonic stupor is characterized by motor retardation, silence. The patient can be in a constrained state for a long time - up to several months.

Diseases in which manifestations of catatonic syndromes are possible: schizophrenia, infectious, organic and other psychoses.

Clouding of consciousness

Twilight disorder (clouding) of consciousness is one of the types of impairment of consciousness that occurs suddenly and is manifested by the patient's inability to navigate in the world around him.

At the same time, the ability to perform habitual actions remains unchanged, speech and motor excitement, the affects of fear, anger and melancholy are observed.

Acute delusions of persecution and predominantly visual hallucinations of a frightening nature may occur. Delusional ideas of persecution and greatness become the determining factors for the behavior of the patient, who can commit destructive, aggressive actions.

For the twilight clouding of consciousness, amnesia is characteristic - complete forgetting of the period of the disorder. This condition is observed in epilepsy and organic lesions of the cerebral hemispheres. Less common in traumatic brain injury and hysteria.

Dementia

The term "dementia" is used to denote the irreversible impoverishment of mental activity with the loss or decrease of the knowledge and skills acquired before the onset of this state, and the inability to acquire new ones. Dementia occurs as a result of past illnesses.

According to the severity, they are distinguished:

1. Complete (total), which has arisen with progressive paralysis, Pick's disease.
2. Partial dementia (with vascular diseases of the central nervous system, the consequences of traumatic brain injury, chronic alcoholism).

With complete dementia, there are profound disturbances in criticism, memory, judgments, unproductive thinking, the disappearance of the patient's previously inherent individual character traits, as well as a careless mood.

With partial dementia, there is a moderate decrease in criticism, memory, judgments. Lowered mood with irritability, tearfulness, fatigue prevails.

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Symptoms of a mental disorder

Among women. The risk of developing mental disorders during the premenstrual period, during and after pregnancy, during middle age and aging is increased. Eating disorders, affective disorders, including postpartum, depression.

In men. Mental disorders are more common than in women. Traumatic and alcoholic psychoses.

In children. One of the most common disorders is attention deficit disorder. Symptoms are problems with prolonged concentration, hyperactivity, impaired control over impulses.

In adolescents. Eating disorders are common. School phobias, hyperactivity syndrome, anxiety disorders are observed.

In the elderly. Mental illnesses are diagnosed more often than in young and middle-aged people. Symptoms of dementia, depression, psychogenic neurotic disorders.

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Treatment and prevention

In the treatment of asthenic syndrome, the main efforts are directed at eliminating the cause that led to the disease. General strengthening therapy is carried out, including the intake of vitamins and glucose, proper organization of work and rest, sleep restoration, good nutrition, dosed physical activity, medications are prescribed: nootropics, antidepressants, sedatives, anabolic steroids.

Treatment of obsessive-compulsive disorders is carried out by eliminating the causes traumatizing the patient, as well as by influencing the pathophysiological links in the brain.

Therapy of affective states begins with the establishment of supervision and referral of the patient to a specialist. Depressive patients who are capable of making a suicidal attempt must be hospitalized.

When prescribing drug therapy, the characteristics of the patient's condition are taken into account. For example, with depression, which is a phase of circular psychosis, psychotropic drugs are used, and in the presence of anxiety, combined treatment with antidepressants and antipsychotics is prescribed.

Acute mental disorder in the form of a manic state is an indication for hospitalization, which is necessary to protect others from inappropriate actions of a sick person. Antipsychotics are used to treat these patients.

Since delirium is a symptom of brain damage, pharmacotherapy and biological methods of exposure are used to treat it.

For the treatment of hypochondria, it is recommended to use psychotherapeutic techniques. In cases where psychotherapy is ineffective, measures are taken to reduce the significance of hypochondriacal fears. For most cases of hypochondria, drug therapy is excluded.

Folk remedies

The list of remedies used by traditional healers to treat depression includes:

• pollen
• bananas,
• carrot,
• tinctures of ginseng roots and Manchurian aralia,
• infusions of angelica and bird highlander,
• decoction of peppermint leaves,
• baths with poplar leaves infusion.

The arsenal of traditional medicine contains many tips and recipes to help get rid of sleep disturbances and a number of other symptoms of mental disorders.

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How to identify signs of mental disorder in women in time?

The weaker sex is more susceptible to mental ailments. Emotional social involvement and natural sensitivity increase the risk of developing diseases. They need to be diagnosed on time in order to start the correct treatment and return life to its usual course.

Mental illness at different age periods of a woman's life

For each age period (girl, girl, woman), a group of the most probable mental illnesses is determined. At these critical stages of development for the psyche, situations occur that most often provoke the development of the disorder.

Girls are less susceptible to mental illness than boys, but they are not immune to the appearance of school phobias and attention deficit disorder. They are at increased risk of developing anxiety and learning disorders.

Young girls in 2% of cases may be victims of premenstrual dysphoria after the first case of bleeding during the menstrual period. After puberty, it is believed that girls are 2 times more likely to develop depression than boys.

Women who are part of the group of patients with mental disorders do not undergo drug treatment when planning a pregnancy. By doing this, they provoke the occurrence of relapses. After childbirth, there is a high likelihood of signs of depression, which, however, can go away without medication.

A small percentage of women do develop psychotic disorders, which are complicated by the limited number of approved drugs. For each individual situation, the degree of benefit and risk of drug treatment during breastfeeding is determined.

Women from 35 to 45 years old are at risk of developing anxiety disorders, they are susceptible to mood changes, and are not immune from the onset of schizophrenia. A decrease in sexual function can happen due to the use of antidepressants.

Menopause changes the way a woman lives, her social role and relationships with loved ones. From caring for their children, they switch to looking after their parents. This period is associated with depressive moods and disorders, however, the connection between the phenomena has not been officially proven.

In old age, women are susceptible to the appearance of dementia and complications of somatic pathologies by mental disorders. This is due to the length of their lives, the risk of developing dementia (acquired dementia) increases in proportion to the number of years lived. Older women who take a lot of medications and suffer from somatic illnesses are more prone to insanity than others.

Those over 60 should pay attention to the symptoms of paraphrenia (a severe form of delusional syndrome), they are at the greatest risk. Emotional involvement in the life of others and loved ones at an advanced age, when many complete their life paths, can cause mental disorders.

The division of a woman's existence into periods allows doctors to single out the only true one from the whole variety of diseases with similar symptoms.

Signs of mental health problems in girls

In childhood, the development of the nervous system occurs continuously, but unevenly. However, the peak of mental development by 70% falls on this period, the personality of the future adult is formed. It is important to diagnose the symptoms of certain diseases in time from a specialist.

• Decreased appetite. Occurs with sudden changes in diet and forced food intake.
• Increased activity. Differs in sudden forms of motor excitement (bouncing, monotonous running, shouting)
• Hostility. It is expressed in the child's confidence in the negative attitude of those around him and those close to him, which is not confirmed by the facts. It seems to such a child that everyone laughs at him and despises him. On the other hand, he himself will show groundless hatred and aggression, or even fear towards his family. He becomes rude in his daily interactions with relatives.
• Painful perception of a physical disability (body dysmorphic disorder). The child chooses a minor or seeming flaw in appearance and tries with all his might to disguise or eliminate it, even turning to adults with a request for plastic surgery.
• Game activity. It boils down to a monotonous and primitive manipulation of objects not intended for play (cups, shoes, bottles), the nature of such a game does not change over time.
• Painful obsession with health. Excessive attention to their physical condition, complaints of fictitious diseases.
• Repetitive movements of the word. They are involuntary or obsessive, for example, the desire to touch an object, rub hands, tap.
• Mood disorder. The state of melancholy and meaninglessness of what is happening does not leave the child. He becomes whiny and irritable, his mood does not improve for a long time.

• Nervous state. Change from hyperactivity to lethargy and passivity and vice versa. Bright light and loud and unexpected sounds are hard to tolerate. The child cannot strain his attention for a long time, which is why he has difficulties with learning. He may have visions of animals, frightening-looking people, or voices.
• Disorders in the form of repetitive spasms or seizures. The child may freeze for a few seconds, while turning pale or rolling his eyes. An attack can manifest itself in shuddering of the shoulders, arms, less often legs, similar to squats. Systematic walking and talking in a dream at the same time.
• Disorders in daily behavior. Excitability coupled with aggression, expressed in a tendency to violence, conflict and rudeness. Unstable attention against the background of a lack of discipline and motor disinhibition.
• A pronounced desire to harm and the subsequent receipt of this pleasure. Desire for hedonism, increased suggestibility, tendency to leave home. Negative thinking coupled with vindictiveness and resentment amid a general tendency towards cruelty.
• Painful abnormal habit. Biting off nails, pulling hair out of the scalp while reducing psychological stress.
• Obsessive fears. Daytime forms are accompanied by facial flushing, increased sweating and palpitations. At night, they are manifested by screaming and crying from frightening dreams and motor restlessness; in such a situation, the child may not recognize loved ones and brush off someone.
• Impaired reading, writing and numeracy skills. In the first case, children find it difficult to correlate the appearance of a letter with a sound, or they hardly recognize images of vowels or consonants. With dysgraphia (writing disorder), it is difficult for them to write what they say out loud.

These signs are not always a direct consequence of the development of mental illness, but require qualified diagnosis.

Symptoms of diseases typical of adolescence

Adolescent girls are characterized by anorexia nervosa and bulimia, premenstrual dysphoria, and depression.

Anorexia, frolicking on nerves, includes:

• Denial of the existing problem
• Painful obsessive feeling of excess weight in the absence of it
• Eating food standing up or in small pieces
• Disrupted sleep patterns
• Fear of weight gain
• Depressed mood
• Anger and unreasonable resentment
• Passion for cooking, preparing meals for the family without personally participating in the meal
• Avoiding common meals, minimal interaction with loved ones, long periods in the bathroom or playing sports outside the home.

Anorexia also causes physical disturbances. Due to weight loss, problems with the menstrual cycle begin, arrhythmia appears, constant weakness and pain in the muscles are felt. Attitude towards oneself depends on the amount of lost weight to the gained one. A person with anorexia nervosa is prone to biased assessments of their condition up to the point of no return.

Signs of bulimia nervosa:

• The amount of food consumed at a time exceeds the norm for a person of a certain build. The pieces of food are not chewed, but quickly swallowed.
• After eating, the person deliberately tries to induce vomiting in order to empty the stomach.
• The behavior is dominated by mood swings, closeness and lack of communication.
• A person feels his helplessness and loneliness.
• General malaise and lack of energy, frequent throat ailments, upset digestion.
• Destroyed tooth enamel is a consequence of frequent vomiting, which contains gastric juice.
• Enlarged salivary glands on the cheeks.
• Denial that there is a problem.

Signs of premenstrual dysphoria:

• The disease is typical for girls who form premenstrual syndrome. It, in turn, is expressed in depression, a gloomy mood, unpleasant physical sensations and an uncomfortable psychological state, tearfulness, disruption of the usual sleep pattern and food intake.
• Dysphoria occurs 5 days before the onset of menstruation, and ends on the first day. During this period, the girl is completely defocused, cannot concentrate on anything, she is overcome by fatigue. The diagnosis is made if the symptoms are pronounced and interfere with the woman.

Most of the diseases of adolescents develop on the basis of nervous disorders and characteristics of puberty.

Postpartum mental disorders

In the field of medicine, there are 3 negative psychological states of a woman in labor:

• Neurotic depression. There is an exacerbation of mental problems that were still during the bearing of the child. This ailment is accompanied by depression, nervous exhaustion.
• Traumatic neurosis. Appears after a long and difficult childbirth, subsequent pregnancies are accompanied by fear and anxiety.
• Melancholy with delusional ideas. A woman feels a sense of guilt, may not recognize loved ones and see hallucinations. This disease is a prerequisite for the development of manic-depressive psychosis.

Mental disorder can manifest itself in the form of:

• Depression and tearfulness.
• Unreasonable anxiety, feelings of anxiety.
• Irritability and excessive activity.
• Distrust of others and a sense of fear.

• Incoherent speech and decreased or increased appetite.
• Obsession with communication or a desire to isolate themselves from everyone.
• Confusion and lack of concentration.
• Inadequate self-esteem.
• Suicidal or murderous thoughts.

In the first week or after a month, these symptoms will make themselves felt in case of development of postpartum psychosis. Its duration is equal to four months on average.

Middle-aged period. Mental illnesses that develop during the onset of menopause

During menopause, there is a reverse development of the hormonal glands of sexual secretion, this symptom is most pronounced in women in the period from 45 to 50 years. Climax inhibits cell renewal. As a result, those diseases and disorders that were completely absent or were hidden before begin to appear.

Mental illnesses characteristic of the menopause period develop either 2-3 months before the final completion of the menstrual cycle, or even after 5 years. These reactions are temporary in nature, most often they are:

• Mood swings
• Anxiety about the future
• Increased sensitivity

Women at this age are prone to self-criticism and dissatisfaction with themselves, which entails the development of depressive moods and hypochondriacal experiences.

With physical discomfort during menopause associated with hot flushes or fainting, tantrums appear. Serious menopausal disorders only develop in women who initially had such problems

Mental disorders in women in senile and pre-senile periods

Involutionary paranoid. This psychosis, which appears during involution, is accompanied by delusional thoughts combined with uninvited memories of traumatic situations from the past.

Involutionary melancholy is characteristic of women from 50 years of age. The main prerequisite for the appearance of this disease is anxiety-delusional depression. Usually involutionary paranoid appears after a change in lifestyle or stressful situation.

Dementia of late age. The ailment is an acquired dementia that gets worse over time. Based on clinical manifestations, there are:

• Total dementia. In this variant, perception, the level of thinking, the ability to create and solve problems are reduced. The edges of the personality are erased. A person is not able to critically assess himself.
• Lacunar dementia. Memory impairment occurs when the level of cognitive function is maintained. The patient can critically assess himself, the personality remains basically unchanged. This disease manifests itself in syphilis of the brain.
• These diseases are alarming. The mortality rate of patients with dementia after a stroke is several times higher than that of those who escaped this fate and did not become feeble-minded.

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Treatment of mental disorders is divided into medication and complex psychotherapy. For eating disorders that are common in young girls, a combination of these treatments will be effective. However, even if most of the symptoms coincide with the described disorders, it is necessary to consult a psychotherapist or psychiatrist before undertaking any type of treatment.