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Psycology » Psychiatry and psychotherapy » Late-onset psychosis » Presenile (involution) psychoses


Psychosis later age: - presenile (involution) psychoses atrophic brain diseases: - Senile dementia of Alzheimer's type - Alzheimer's Disease - Pick's disease - Parkinson's disease and Huntington's chorea borderline disorders in later life

A significant increase in life expectancy in many developed countries now gives rise to the phenomenon of "aging" of the population of the planet. In this regard, a growing interest in the scientific study of the features of aging, biological and psychological, as well as psychopathological aspects of this problem, which puts certain challenges geriatrics, gerontology, and old age psychiatry.

Ancestor of gerontology as a science called prominent Russian scientist II Mechnikov, and problems gerontopsychiatry productively studied in SG Zhislina (1963), A.B. Snezhnevsky (1936), EY Sternberg (1983), NF Shakhmatova (1984) and others for a substantial share of psychosis elderly celebrated in most countries. In respect of such nosological divided into functional psychoses (involutional, presenile psychosis) and organic (atrophic, degenerative processes of old age, Alzheimer's disease, Pick's disease).

Presenile (involutional) psychosis

Involutional psychosis usually develop between the ages of 50-60 years, more often in women. According to clinical features of isolated late (involutional) depression, paranoia and geriatric hallucinosis late age. Later depression (involutional melancholia) frequency twice the amount of depression in young and middle age. In old age depression occur in 4-5% of the number of patients admitted to psychiatric hospitals. After 65 years, as the data in most studies, severe depression occurs in approximately 10% of individuals. This percentage, of course, even higher in nursing homes, special boarding for older people. Has been a significant increase in suicide attempts and completed suicide in old age compared to similar that of the young.

Involutional depression clinic

The initial stage of the disease is most often seen painting protracted subdepressive state with complaints of lethargy, various unpleasant sensations in the body (local hypochondria), sometimes excessive irritability, dissatisfaction with external circumstances, inherently indifferent. Subsequently, the detected signs of anxiety, which is varying in intensity tends to increase. Patients with marked concern for the health of loved ones, a sense of foreboding of something that can happen to children, grandchildren, close friends, foreboding any other possible problems. It all added up to a picture of anxious depression with restlessness, agitation, insomnia. Next, the picture of depressive delusions with ideas of guilt, condemnation, death. The slightest misdemeanor life that occurred with such patients in the past, are magnified in their minds and grow into the idea of ​​monstrous guilt to the community so that patients expect fair and brutal retribution for their sins. They are full of fear, despair, confusion. Many of them appear hypochondriacal delusions character with a picture of megalomania - they feel that their body is rotting, they do not have bones, viscera - nothing, including a world in which they lived (the idea of ​​the death of the world). This kind of crazy ideas in the structure of involutional melancholia was first described by French psychiatrist J. Kotar as nihilistic delusions, which is considered by many psychiatrists pathognomonic for involutional melancholia at the height of its development.

Despite the depressed mood in these patients no motor inhibition, they are restless, fidgety, agitated. Noteworthy somatic condition with involutional melancholia with signs of senility (deep wrinkles, gray hair, falling Masa body even when not disturbed appetite).

Features mental status necessitate differential diagnosis with depressive phase of affective psychosis, as in the case of its occurrence in the elderly can be observed similar symptoms. The main distinguishing feature is the presence of involutional melancholia constant anxiety, not boredom, lack of motor inhibition and, most importantly, the development of delirium Kotar, not peculiar to patients with unipolar depressive psychosis. Furthermore, especially in premorbid involutional depression other than affective psychosis, as predominate characteristics of rigidity and not synthons.

The first case of Cotard's syndrome was described in 1880 by J. Kothari along with J. Falre. It was about Mademoiselle X., who developed a peculiar symptom hypochondriacal delusional content. Disorder began with sensations cod crunch in the back, smack in the head. Then came the idea of ​​self-incrimination with the suicide attempt, the patient said she was condemned by God to eternal torment. Next - the development of ideas of negation: it has no nerves, stomach, blood vessels, it still had only skin and bones, skin, just the bag covers the bone. Then this nonsense denial began to spread on abstract concepts: it has no soul, no God and there is generally neither God nor the devil. She will live forever, can not die a natural death, it can only burn. The patient attempted self-immolation. Such acute illness lasting several months, then there is a weakening of melancholy, but mostly nonsense remained unchanged. Noted decrease in pain sensitivity, the patient was at times aggressive.

In the classical description, J. Kotar in a few lines reproduced the patient's condition and course of the disease, which begins with senestopatii, then appear the idea of ​​self-blame and condemnation, then goes to the dissemination of ideas denial of nihilistic, hypochondriacal to abstract, metaphysical concepts: no God, no devil. Develops delusions of immortality: it can not die a natural death.

J. Kotar described cases aged between 43 and 63 years. This syndrome is very firmly entrenched in response presenile depression in which the first place anxiously longing without express braking with Cotard syndrome.

The second feature - the presence of verbal affective illusions of false recognition in the form of positive and negative double, as well as delusions and staging elements metabolic delirium.

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