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Psycology » Psychiatry and psychotherapy » Affective psychosis » Diagnosis and treatment of 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
DIFFERENTIAL DIAGNOSIS

Affective endogenous psychosis should be differentiated from schizophrenia (circular shape), where in the disease onset may experience depressive or manic state. However, in schizophrenia there is no typical affective psychoses development of the clinical picture with a sense of "vital anguish" daily fluctuations in mood while there are characteristic disturbances of thinking with the "cliff" thoughts "parallel thoughts", and subsequently develop psychosis with symptoms of mental automatism and symptoms "first rank" (and K. Schneider). For further progression of the endogenous process with the presence of affective disorders leads to a gradual buildup of deficit symptoms, forming a "net remission" does not occur. Premorbid characteristics of schizophrenia characterized by a predominance of schizoid traits, while at the TIR and cyclothymia personality before the disease is defined as having features hyperthymic or emotional instability.

Etiology and Pathogenesis

Important role in the study of etiopathogenesis have genetic research and data biochemistry. The contribution of genetic factors in the development of affective pathology is 70%, and environmental - 30%. The contribution of random environmental factors - 8% obschesemeynyh - 22%. According to these indicators bipolar and monopolar psychoses differ: the contribution of genetic factors are much greater in bipolar disorder (76%), while 46% is monopolar.

Affective psychoses proven link with the X chromosome, which is in full accordance with the clinical data on the prevalence of patients with affective psychoses women and their hereditary transmission from a mother. These genetic mapping showed that the gene loci, which may be relevant to disease development are arranged in the pericentromeric region of chromosome 18 and chromosome 21. In addition, the researchers suggest that it is in bipolar flow variants proved their linkage to chromosome 18.

One of the main concepts of the development of affective psychoses still remains the serotonin theory. It builds on the experience of the practical application of tricyclic antidepressants, which in the mechanism of their actions reveal increasing levels of serotonin in the synaptic cleft.

Recently receives confirmation and melatonin theory. It relies on evidence-based research that the pineal gland hormone secretion of melatonin is subject to a clear circadian rhythm. Minimum hormone secretion falls on the bright part of the day, and a maximum of the dark. Here there are also clinical and biological parallels, as the practice has long been known that it is much more likely to develop depressive phase dark season (autumn - winter), and the manic phase - in the light (summer).

Treatment of affective psychosis

Currently, the main treatment is psychopharmacotherapy depressive and manic phases. The treatment of depression using antidepressants of different chemical groups - the "classic" tricyclic drugs (amitriptyline, imipramine, Anafranil, etc.) chetyrehtsiklicheskie drugs (ludiomil, lerivon) and atypical antidepressants (fluoxetine, Luvox, Cipramil, paroxetine, Zoloft). The more simple in structure and psychopathology severity of depression, the more effective action of any antidepressant. Treatment same melancholy, and in particular, psychotic depression - a more difficult task, which requires the selection of an adequate dose of an antidepressant, appropriate clinical features of depression. Preferred drug for relief of anxious depression is amitriptyline. Begin therapy with parenteral administration of 20-40 mg per day, then increase the dose during the week up to 80-100 mg / day, which usually leads to relief of anxiety, sleep recovery, the gradual improvement of mood, restore mental tone. This allows you to replace the injection drug intake tablets at a dose of 125-150 mg / day in order to achieve a complete disappearance of symptoms of depression. In the future, it is advisable to keep the maintenance dose of medication until the patient has been discharged from the hospital and have it work, complete adaptation to habitual for him to disease conditions.

With more resistant depression with a view to arresting resort to intravenous drip antidepressants (amitriptyline, ludiomil, imipramine, Anafranil) at a dose of 100-120 mg per day with gradual dose reduction in the disappearance of symptoms of depression.

In the presence of depression that do not respond to antidepressants, shown holding electroconvulsive therapy (ECT) for 5 - sessions.

In the treatment of seasonal depression developing lately recommend the use of agomelatine as a drug with melatoninergic action.

Treatment of manic phase is carried out using antipsychotics, such as haloperidol, azaleptin, klopiksol, Tisercinum etc. Preferred lithium salts, particularly lithium carbonate, which is assigned a dose of 900-1200 mg / day, increasing the dosage while requiring control of the lithium content in the blood plasma (permissible limit of 1.2 mmol per 1 ml of plasma). Lithium preparations prescribed for unipolar affective psychosis variant with the development of manic phases, as Li discovers a preventive effect, preventing the development of subsequent phases.

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