Month: August 2019

Causes of Paranoid Personality Disorder

Features of education and early development, forming a basic distrust of others. Distrust develops in early childhood as a result of the child’s distance from the mother; as a result, he develops a diffuse fear, which later turns into a wary and distrustful attitude towards others. A pronounced protective mechanism of projection is characteristic.

Symptoms of Paranoid Personality Disorder

Starting from adolescence, there has been a persistent tendency to interpret the actions of other people as suspicious, degrading the patient’s dignity and causing his fear, distrust and the need to protect themselves from them in a strictly defined way. Patients believe that those around them exploit, wanting to take away their acquired benefits, social prestige or economic success, harm them, often behave in such a way as to discredit or humiliate the patient. Often they are pathologically jealous, demanding without reason evidence of loyalty to their spouse or sexual partner. At the same time, they consider observance of personal fidelity completely optional. Externalizing their own emotions, they use protection in the form of a projection, attributing to others their own unconscious traits, intentions, motives, motives. By virtue of affective flatness, they seem unemotional, devoid of heat, they are impressed only by the strength and power that they worship and obey. In social terms, paranoid personalities look businesslike and constructive, but their tendency to intrigue to identify fidelity or infidelity subordinates often cause fear and create conflict. They constantly protect the basic desire to experience their increased importance and usefulness, and each time they attribute everything that happens to their own account, they are overly sensitive to failures and failures. Patients with paranoid personality disorders are predisposed to chronic delusional disorders, induced delusional disorders and paranoid schizophrenia.

Diagnosis of Paranoid Personality Disorder

It should be distinguished from chronic delusional disorders in which the development of paranoid monoids is possible. However, with personality disorders, suspicion and a tendency to overvalued formations are noted already from childhood.

Treatment for Paranoid Personality Disorder

Individual psychotherapy, anxiolytics and small doses of antipsychotics.

Reasons for the Lack of Genital Reaction

Sexual disharmony or psychogeny. Equivalent to psychogenic impotence.

Symptoms of a Lack of Genital Reaction

If there are signs of sexual dysfunction in men, a full erection occurs in the early stages of sexual intercourse, but disappears during intercourse, so an erection is present, but not during intercourse. Partial erection is sometimes possible.

In the presence of signs of sexual dysfunction in women, stimulation of erogenous zones does not lead to the disappearance of vaginal dryness for psychogenic reasons (disharmony) or as a result of menopause, the addition of an infectious lesion of the bartholin glands.

Diagnosis of the Absence of a Genital Reaction

In men, erectile dysfunction is characterized in that the erection persists during sleep, masturbation, or with another partner. In women, vaginal dryness, psychogenic or pathological (infection, menopause).

Differential diagnosis

It should be differentiated with other disorders of the erection component, for example, with organic damage to the brain, vascular lesions of the cavernous bodies, cerebrospinal disorders.

Treatment of the Absence of a Genital Reaction

Psychotherapy, behavioral therapy, including sex therapy. Erectotherapy and treatment with local negative pressure.

Symptoms of Acute Polymorphic Psychotic Disorder with Symptoms of Schizophrenia

This diagnosis is considered not only as the first with a schizophrenic manifest, but also in cases of a favorable course of the disease, for example, with prolonged remissions and spontaneous exits from psychosis, it is advisable to attribute each subsequent psychosis to this group, and not to schizophrenia or schizoaffective disorder. In the clinic of acute psychosis of this group, there are productive symptoms of the first rank characteristic of schizophrenia, but there are no negative emotional-volitional disorders. The affect of anxiety, expansion, confusion. Motor activity is increased up to excitement.

Diagnosis of Acute Polymorphic Psychotic Disorder with Symptoms of Schizophrenia

1. Rapid changes in the symptoms of delirium, including delirium exposure, delusional interpretation and delusional perception characteristic of schizophrenia.
2. Hallucinations, including auditory commentators, contradictory and mutually exclusive, imperative truths and pseudo-hallucinations, somatic hallucinations and a symptom of open thoughts, sounding of one’s own thoughts related to symptoms of the first rank in schizophrenia.
3. Symptoms of emotional disorders: fear, anxiety, irritability, confusion.
4. Motor excitement.
5. The above productive symptoms of schizophrenia are noted for no more than a month.

Differential diagnosis

It should be differentiated from schizoaffective disorder, psychotic schizophrenia-like disorders in dependence on psychoactive substances. This psychosis differs from the clinic of schizoaffective disorder in that the period of affective disorders is shorter than the productive one, and productive symptoms of the first rank characteristic of schizophrenia are noted. Schizophrenia-like psychoses in addiction diseases and organic schizophrenia-like psychoses can be delimited using additional research methods (laboratory, somatic, neurological, neurophysiological) and on the basis of anamnesis.

Treatment of Acute Polymorphic Psychotic Disorder with Symptoms of Schizophrenia

In the treatment it is necessary to use detoxification therapy, antipsychotics in medium and sometimes in maximum doses. You should always prescribe supportive treatment with prolongations or conduct episodic short-term courses of therapy due to the risk of developing schizophrenia, and also insist on outpatient monitoring of the patient for at least one year. Pay attention to periods of sleep disturbances, emotional disturbances (episodes of anxiety), suspiciousness. It is these symptoms that can precede exacerbations, and therefore they are a signal for preventive therapy.

What is Organic Emotionally Labile (Asthenic) Disorder?

Almost all severe somatic and infectious diseases result in convalescence with asthenia.

Causes of Organic Emotionally Labile (Asthenic) Disorder

More often occurs in connection with cerebrovascular diseases, the so-called discirculatory encephalopathy, as well as in the long term (after a year) of craniocerebral injuries. Asthenia is also noted in the follow-up of individuals who have committed suicide attempts, after prolonged anesthesia, encephalitis, and all prolonged and severe somatic and infectious diseases, with brain tumors.

Symptoms of Organic Emotionally Labile (Asthenic) Disorder

The basis of the clinic is asthenic syndrome, which is characterized by: weakness, hypersensitivity (hypealgesia, hyperesthesia, hyperacusis, often photophobia), dizziness, decreased motor activity, rapid fatigability, irritability, impaired concentration, and tearfulness.

Diagnosis of Organic Emotionally Labile (Asthenic) Disorder

Based on the identification of a history of probable causes of emotional lability.

Differential diagnosis

More often it should be differentiated from neurotic disorders (neurasthenia, other specific neurotic disorders), in which there is no characteristic history and which are associated with psychological causes and stress. Significant physical and intellectual stress can lead to a clinic of neurasthenia, which can be distinguished from organic asthenia only after identifying the causes of the disorder.

Treatment of Organic Emotionally Labile (Asthenic) Disorder

It consists in taking non-specific stimulants (aloe, ginseng, fibs, eleutherococcus), nootropics (nootropil, phenibut, glutamic acid, encephabol, aminalon) for several courses of vitamin therapy with large doses, physiotherapy.

What is Organic Delusional (Schizophrenia-like) Disorder?

Approximately 5% of patients with epilepsy may have psychosis if the underlying disease lasts up to 6 years. The question of periodic organic delusional psychosis is controversial, although all such cases are verified by objective research.

Causes of Organic Crazy (Schizophrenia-like) Disorders

The most common etiology is temporal epilepsy, as well as focal disorders of the temporal and parietal regions as a result of transferred encephalitis. This group includes epileptic psychosis without impairment of consciousness, or “schizoepilepsy.” With the defeat of the frontal and temporal divisions, hallucinatory-delusional attacks are possible, which are accompanied by episodes of unmotivated actions and loss of control over impulses of aggressiveness and other forms of instinctive behavior. It is not clear what caused the specificity of such psychosis – bilateral hereditary burden (epilepsy and schizophrenia) or damage to specific brain structures. Schizophrenia-like patterns of psychosis are also found in endocrine pathology (diffuse toxic goiter, after thyroidectomy).

Symptoms of Organic Crazy (Schizophrenia-like) Disorders

Chronic and recurrent organic delusional disorders are possible. They are united by the fact that in both cases negative organic personality changes are typologically similar to epileptic ones, that is, including bradifrenia, torpid, thorough thinking. Productive symptoms include hallucinatory-delusional pictures with the presence of visual, often religious hallucinations. Expansive paranoid states are characterized by ecstatic affect, while depressive paranoid states are dysphoric. At the height of psychosis, fragments of disturbances of consciousness are possible. Paranoiac psychosis proceeds according to the type of religious delirium, paraphrenia – with ecstasy, excitement and missionary utterances. Often, paranoid utterances are built on the basis of epilepsy-specific perceptual disorders of the type of interpretive delusion. It has been noticed that the onset of convulsive seizures can interrupt delirium, and their therapy resumes the clinical picture. There are clinical pictures of psychosis that contain symptoms of the first grade of schizophrenia. In endocrine pathology, psychosis is reminiscent of schizoaffective disorder, that is, with them, affective disorders coincide with schizophrenia-like disorders, but they last longer.

Diagnosing Organic Crazy (Schizophrenia-like) Disorders

Based on the identification of the main pathology (epilepsy or organic background), as well as specific emotional (dysphoria, ecstasy) color of paranoid experiences, the inclusion of visual hallucinations in the structure of hallucinatory-paranoid psychosis.

Differential diagnostics

Differential diagnoses are being conducted with paranoid schizophrenia, chronic delusional disorders, and schizophrenia-like psychotic disorders as a result of taking psychoactive substances, especially often amphetamines and cannabis.

In schizophrenia, along with productive symptoms of the first rank, there are also negative disorders, there are no exogenous components of psychosis and organic personality changes in the history.

In chronic delusional disorders, monothematic delirium may be the only persistent symptom, but it occurs on organically unchanged soil.

Psychotic schizophrenia-like disorders after taking psychoactive substances are characterized by the fact that they occur on the background of taking or canceling a substance, although psychotic episodes are also possible. Somato-vegetative status allows to identify the symptoms of intoxication or withdrawal, organic background is absent.

Treatment of Organic Crazy (Schizophrenia-like) Disorders

Includes treatment of the underlying disease. Effective use of aminazine, carbamazepine, depakina. The last two drugs can be used for maintenance therapy, since the risk of recurrence of psychosis is quite high. The use of antipsychotics for prolongation therapy is not recommended, as patients quickly develop intoxication symptoms.