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Psycology » Psychiatry and psychotherapy » Affective psychosis » Affective psychosis

  1. Affective psychosis
  2. Manifestations of affective phases: depression
  3. Manifestations of affective phases: mania, cyclothymia, dysthymia
  4. Diagnosis and treatment of affective psychosis

Affective psychosis - endogenous mental illness that is characterized by recurrent and spontaneously occurring affective phases (depression, mania, mixed states), their complete reversibility with the onset of recovery, and restoration intermission all mental functions.

Definition of affective psychosis meets all the criteria of endogenous diseases previously attributed to the TIR (cyclophrenia, circular psychosis, flowing phase unipolar or bipolar disorder).

Affective psychosis manifested exclusively affective phases of varying degrees of depth and duration. In accordance with the ICD-10 diagnostic criteria of affective phases is their duration at least one to two weeks with a "complete violation of the usual health and social activity of the patient necessitates seeking medical attention and treatment." Practice has shown that there may be phase ultrashort (hypomania, and alternating subdepression every other day), and also extremely long (several years). Period of one phase and the accompanying intermission referred to as "the cycle of affective psychosis."

Disease "mania" and "melancholia" described by Hippocrates (V BC. E) as an independent disease, although he watched and such cases when one patient developed and manic psychosis and melancholic. One of the first definitions of melancholy gave Aretha Cappadocia (I century AD), describing it as a "depressed state of mind while focusing on a single thought." By itself, the idea arises sad without reason, but sometimes marked any excitement preceding the emergence of melancholy.

In 1854, J. and J. Falre Bayyarzhe simultaneously describe "intermittent insanity" and "insanity in the form of a double", we mean the phase flowing psychosis which does not lead to dementia. Isolation affective psychosis as an independent nosological entity and contrasting it with schizophrenia in its final form was the result of long-term studies, which held Kraepelin (1899). He's big enough clinical material (more than 1000 cases) showed that in these patients the phase of melancholy and mania alternate throughout life. Only one patient after long-term follow-up was recorded only manic phase, in other cases of mania and depression followed each other (the term "depression" has become firmly established in the arsenal of clinical psychiatry as a result of the new designation of the disease, which gave Kraepelin - manic-depressive psychosis or MIS). Important clinical sign TIR Kraepelin believed the development of mixed states in which the combined symptoms of depression and mania. The most common one is the mixed phase alarming depression, moreover observed manic state of stupor, and others. In the development of such states Kraepelin saw the principal sign of asserting the independence of the disease, its clinical and special biological foundation. He especially emphasized the presence of a characteristic triad of braking (ideational, affective, motor) in the depressive phase of the TIR while in mania manifested triad corresponding excitation. Did not escape his attention, and the fact that some patients were observed or manic or depressive phase (monopolar current options TIR), but he is such types specifically singled out.

SS Korsakov, agreeing with the validity of the findings in relation to E. Kraepelin TIR believed that the main symptom of the disease - is embedded in the body tendency to repeat the painful phase disorders. Kraepelin himself wrote about this disease, "Carnet covers, on the one hand, the entire area of ​​the so-called periodic and circular psychosis, and on the other - simple mania, most of the pathological condition called melancholia, as well as a considerable number of cases amentia. We refer here, finally, some light is the lightest and periodicals, the persistent painful mood changes, which on the one hand, serve as a prelude to more serious disorders, and on the other - to flow seamlessly into the personal characteristics "[1]. And he believed that subsequently can be released a number of varieties of the disease or even some of her cleavage occurs groups.

At first, the "basic" breakdown in the TIR include "vital" melancholy - a sign, especially frequent in the depressive phase of the TIR. However, after the description of G. Vaytbrehtom "endoreaktivnoy dysthymia" it was found that such "vital" manifestations may occur in severe chronic psychogenic depression.

Since the second half of the XX century there are more studies that emphasize autonomy of monopolar and bipolar variants of the TIR, so now, as predicted by Kraepelin, isolated unipolar affective psychosis with depressive phases monopolyany affective psychosis with manic phases of bipolar affective psychosis with a predominance of depressive phases of bipolar depressive illness with a predominance of manic phase and a typical bipolar disorder with regular (often seasonal) alternation of depressive and manic phases, or classic type TIR by Kraepelin.

Furthermore, Kraepelin found that the duration of affective phases may be different, and it is virtually impossible to predict. Likewise, remission with TIR may persist for several months, a few years, so some patients simply do not live up to the next phase (when remissions over 25 years).

The prevalence of affective psychoses evaluated differently, but in general is 0,32-0,64 per 1000 population (in the cases of "big" depression), 0.12 per 1000 population for bipolar disorder. Most of the cases are persons with unipolar depressive phases and the prevalence of depressive phases of bipolar flow. Greater frequency of TIR in later life was first noted by Kraepelin, and this is confirmed in modern works.

The ICD-10 mood disorders (affective disorders) are Syndromological only according to the severity of the phases and their polarity (heading F30-F39).

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