Month: October 2019

What is a Dissociative Fugue?

Dissociative fugue is characterized by loss of memory, usually on recent important events, in conjunction with externally targeted travel, during which the patient supports self-care. In some cases, a new identity is accepted, usually for several days, but sometimes for long periods and with an amazing degree of completeness. Organized travel can be in places previously known and emotionally significant. Although the period of the fugue is amnesized, the behavior of the patient at this time for independent observers may seem completely normal.

Causes of Dissociative Fugue

The main role in the development of the disorder is assigned to psychogenic factors, since the occurrence of this state is a protective mechanism for getting rid of emotionally painful experiences.

Symptoms of Dissociative Fugue

Dissociative amnesia combined with externally targeted actions, travel, often within a few days. Behavior seems completely normal. Sometimes there is a new identity. The fugue period is amnesized.

Diagnosis of Dissociative Fugue

For a reliable diagnosis should be:

• signs of dissociative amnesia;
• a purposeful journey beyond the limits of ordinary everyday life (the differentiation between travel and wandering must be carried out taking into account local specifics);
• maintenance of personal care (food, washing, etc.) and simple social interaction with strangers (for example, patients buy tickets or gasoline, ask how to drive, order food).

Differential diagnosis: Differentiation with postictal pug, which is observed mainly after temporal epilepsy, usually presents no difficulty in taking into account epilepsy in history, absence of stressful events or problems and less focused and more fragmented activity and travel in patients with epilepsy.

As with dissociative amnesia, differentiation with consciously simulating a fugue can be very difficult.

Treatment of Dissociative Fugue

Psychoanalysis, caffeine-amitic disinhibition, hypnosis.

Causes of Sexual Preference Disorders

The causes of disorders of sexual preference are distortions of the stages of development of psychosexuality in ontogenesis. Most of them are normal, however, these disorders are more often observed with hormonal, chromosomal abnormalities and gene abnormalities. Disorders should only be considered in a specific cultural context, as some of them are ritualized and considered acceptable in some cultures. A whole series of sexual preference disorders are successfully exploited by the modern sex industry, in particular, we are talking about sets for sado-masochism, peep shows for voyeurs, attributes of transsexualism, etc.

Symptoms of Sexual Preference Disorders

Periodic fantasies defining acts in the field of sexual behavior. These actions, in connection with the inconsistency with current cultural standards, cause maladaptation and neuroticism of the individual. Attractions are seen as necessary to relieve increasing stress or anxiety. The consequences of abnormal acts can themselves be a source of stress. However, they can only be a symptom in the syndromic structure of personality abnormalities or schizophrenia. It is also important to consider that patients carefully conceal some socially unacceptable traits of attraction, therefore observation of behavior is of particular importance in diagnosis.

Diagnosis of Sexual Preference Disorders

The diagnosis is made on the basis of the fact that the patient has periodic intense sexual drives and fantasies, including unusual objects or actions. At the same time, he either does as drives dictate, or in the fight against them experiences significant distress. This preference is observed for at least 6 months. Multiple disorders of sexual preference are possible (F65.6), when different abnormal, sexual preferences are combined in one individual more often than might be expected based on a simple statistical probability. The most common is a combination of fetishism, transvestism and bdsm, pedophilia and sadism, masochism and voyeurism.

Differential diagnosis

Disorders can be considered as monosymptoms and as inclusions in other mental disorders.

Treatment for Sexual Preference Disorders

When it comes to monosymptoms, they use methods of psychotherapy and psychoanalysis, as well as behavioral therapy in combination with substances that help control impulses: lithium, carbamazepine, beta-blockers and calcium channel antagonists.

What are Mental and Behavioral Disorders Due to Tobacco Use?

About 30% of the population smokes cigarettes, mainly between the ages of 20 and 45, men are more likely than women. Smokers are considered to smoke more than 20 cigarettes per day.

Causes of Mental and Behavioral Disorders Due to Tobacco Use

The main mechanism of the psychoactive effect of nicotine is its binding to cholinergic and nicotinic receptors in the central nervous system, adrenal medulla, neuromuscular synapses and autonomic ganglia.

Symptoms of Mental and Behavioral Disorders Due to Tobacco Use

Acute intoxication
Nausea and vomiting, increased irritability, relaxation under stress, decreased hunger, increased insomnia, tremors, relaxation of skeletal muscles, improved short-term memory.

Harmful use
Somatic changes in the form of reduced coronary blood flow and blood pressure, temperature, vasoconstriction, accelerated menopause and depletion of catecholamines, osteoporosis, cough, high risk of neoplastic processes and somatoform disorders.

Addiction syndrome
Physical dependence and mental dependence.

Withdrawal syndrome
Dizziness, hyperosmia, irritability and anxiety, decreased short-term memory, cough, change in blood pressure.

Psychotic Disorder and Amnestic Syndrome
Not typical.

Residual state and psychotic disorder with delayed debut
Resumption of anxiety, irritability and sleep disturbances in the residual period.

Diagnosing Mental and Behavioral Disorders Due to Tobacco Use

Diagnosis based on history.

Mental and Behavioral Treatment for Tobacco Use

Behavioral therapy, group therapy and psychotherapy. Nicotine replacement therapy: nicotine chewing gums and transdermal nicotine patches, clonidine.

What are Mental and Behavioral Disorders due to the use of volatile solvents?

One out of ten students before grade 11 tried or systematically used volatile solvents.

Causes of Mental and Behavioral Disorders Due to the Use of Volatile Solvents

Volatile liquids and gases, the inhalation of which causes euphoria: glues, aerosols, solvents, gasoline, heated dry cleaners, gases for anesthesia (nitrous oxide), volatile nitrates. The effect depends on the active substance: aliphatic hydrocarbon, ether, ketone, mixed compound.

Symptoms of Mental and Behavioral Disorders Due to the Use of Volatile Solvents

Acute intoxication
Euphoria, disinhibition, disorientation, dizziness, fainting, headache, inappropriate behavior, convulsions.

Harmful use
Somatic changes in the form of arrhythmias, hypotension, bradycardia, lacrimation, dilation of the blood vessels of the sclera and conjunctiva, visual impairment and diplopia, burns, dehydration. Dementia with cognitive dysfunction, ataxia and dysarthria, paresthesia, encephalopathy with diffuse atrophy.

Addiction syndrome
The phenomena of mental and physical dependence.

Withdrawal syndrome
Irritability, conflict, drowsiness, or insomnia.

Psychotic disorder
Schizophrenic psychoses with auditory true and pseudo-hallucinations. Paranoid states with ideas of attitude, persecution.

Amnestic syndrome
Violation of concentration, fixative amnesia.

Residual state and psychotic disorder with delayed debut

Encephalopathy and delayed schizophrenia-like psychotic conditions.

Diagnosis of Mental and Behavioral Disorders Due to the Use of Volatile Solvents

Medical history, halitosis, runny nose, tinnitus, dermatitis, liver changes and toxic intoxication clinic.

Differential diagnosis

Differentiate with psychotic disorders in organic brain diseases, other mental and behavioral disorders as a result of the use of psychoactive substances.

Treatment for Mental and Behavioral Disorders Due to the Use of Volatile Solvents

Symptomatic therapy and detoxification. Psychotherapy and behavioral therapy.

Causes of Mental and Behavioral Disorders Due to Cocaine Use

Cocaine exists in the form of cocaine-HCl, a cocaine base. The first has a bitter taste and is soluble in water. Cheaper stimulants are added to the powder, as well as local anesthetics, the “freezing” effects of which are taken as the effect of cocaine. Cocaine alkaloid crystals are obtained by heating or smoking (crack) cocaine base powder when mixed with water and baking soda. The drug is administered iv, it is smoked, sniffed. It increases synaptic levels of dopamine, norepinephrine, serotonin by inhibiting their reuptake in the synaptic cleft.

Symptoms of Mental and Behavioral Disorders Due to Cocaine Use

Acute intoxication
Euphoria, a surge of energy, an increase in the resolution of perception, an increase in mental activity, a decrease in appetite, anxiety, a decrease in the need for sleep, and increased self-confidence.

Harmful use
Pain behind the sternum, myocardial infarction, sudden death, pneumothorax, pulmonary edema, keratitis, ulcerative gingivitis, change in sense of smell. Depression and episodes of anxiety, a tendency to suicide and accidents, convulsions, hyperthermia.

Addiction syndrome
The rapid development of physical and mental dependence.

Withdrawal syndrome
After a withdrawal period of 1-5 days, withdrawal syndrome is noted. Depression, depression, irritability, insomnia, apathy, lethargy are typical.

Psychotic disorder
Cocaine delirium with tactile and olfactory hallucinations, incoherent thinking, disorientation. Cocaine delusional disorder with ideas of harassment, suspicion, bouts of aggression. Schizophrenia-like cocaine disorder with inadequate behavior, dysphoria, auditory, visual and tactile hallucinations (cocaine bugs swarming under the skin). Impact ideas.

Amnestic syndrome
Fixative amnesia, retro-, anterograde amnesia.

Residual state and psychotic disorder with delayed debut
In the residual period, tics, echolalia, ataxia, obsessive and compulsive disorders. Delayed psychoses with depression, delirium, schizophrenia-like conditions.

Diagnosing Mental and Behavioral Disorders Due to Cocaine Use

Symptoms of cocaine intoxication, in particular, perforation of the nasal septum, cocaine marks at the injection site (orange-pink bruising), crack keratitis, crack finger as a result of repeated contact of the finger with the lighter wheel, crack hand with hyperkeratosis and burn changes, tooth erosion.

Differential diagnosis
Mental and behavioral disorders due to the use of other psychoactive substances should be distinguished.

Treating Mental and Behavioral Disorders Due to Cocaine Use

Detoxification using bromocriptine and antidepressants. Benzodiazepines, cooling wraps, beta blockers and calcium channel blockers, activated carbon and laxatives. Psychotherapy against relapse, behavioral therapy.