Geller’s Syndrome (Symbiotic Psychosis, Childhood Dementia, Geller-Zappert Disease)

What is Geller’s Syndrome (Symbiotic Psychosis, Childhood Dementia, Geller-Zappert Disease)?

Rapidly progressing dementia in young children (after a period of normal development) with a distinct loss of acquired skills over the course of several months, with the appearance of anomalies in social, communicative or behavioral functioning.

Causes of Geller Syndrome (Symbiotic Psychosis, Childhood Dementia, Geller-Zappert Disease)

The causes of the disorder are not clarified. The prevailing idea is the presence of the organic nature of the disease.

Symptoms of Geller’s Syndrome (Symbiotic Psychosis, Childhood Dementia, Geller-Zappert Disease)

After a period of normal development up to 2-3 years for 6-12 months. total dementia is formed. Often there is a prodromal period of an obscure disease: the child becomes wayward, irritable, anxious and hyperactive. Speech becomes impoverished and then disintegrates. Previously acquired behavioral, gaming and social skills are lost. Losing control of bowel and bladder function. Interest in the environment is lost, stereotypic motor actions are characteristic. The deterioration over the course of several months is followed by a plateau state, then a slight improvement can occur. The disorder is often combined with a progressive neurological condition, which is usually encoded separately.

The prognosis of the disease is unfavorable. Most patients remain with severe mental retardation.

Diagnosis of Geller Syndrome (Symbiotic Psychosis, Childhood Dementia, Geller-Zappert Disease)

The disorder resembles adult dementia, but differs in 3 aspects: 1) there is no evidence of recognized organic disease or damage; 2) the loss of acquired skills may be accompanied by a certain degree of recovery and restoration of functions; 3) communication disorders are of a nature similar to autism, and not with intellectual decline.

Differential diagnosis

Carried out with autism, early childhood schizophrenia. Geller’s syndrome is characterized by general mental devastation.

Treatment of Geller’s Syndrome (Symbiotic Psychosis, Childhood Dementia, Geller-Zappert Disease)

Mostly symptomatic. It includes three areas: treatment of behavioral disorders and neurological disorders; social and educational services activities; family assistance and family therapy.

There is no data on the effectiveness of any form of drug therapy, with the exception of short-term treatment of behavioral disorders. (There are reports that the disorder is caused by a “filtering virus”, and the specificity of the clinic is related to the age characteristics of the lesion)

Sexual Aversion and Lack of Sexual Satisfaction

Reasons for Sexual Aversion and Lack of Sexual Satisfaction

Sexual disgust and lack of sexual satisfaction is due to the fact that sexual intercourse with a partner causes unconscious anxiety and fear, which is caused by negative feelings for a sexual partner.

Symptoms of Sexual Aversion and Lack of Sexual Satisfaction

Upcoming sexual intercourse with a partner causes disgust, fear or anxiety, is avoided, and if it occurs, it is combined with a strong sense of guilt, which blocks subsequent sexual intercourse with this partner.

In the absence of sexual satisfaction, the genital reaction is “automatic in nature” and is not accompanied by a sense of pleasure.

Diagnosis of Sexual Aversion and Lack of Sexual Satisfaction

F52.10 – Sexual Aversion

Upcoming sexual intercourse with a partner causes strong negative feelings, fear or anxiety, which are sufficient to lead to sexual avoidance.

F52.11 – Lack of sexual satisfaction

Normal sexual reactions occur, an orgasm is experienced, but there is no adequate pleasure, more often observed in women.

Differential diagnosis

The problem is to identify the primary and secondary causes of sexual dysfunction. Neurotic disorders, delirium, should also be assumed behind the facade of sexual aversion.

Treatment for Sexual Aversion and Lack of Sexual Satisfaction

Psychotherapy and family therapy. Behavioral Therapy.

Recurrent Depressive Disorder

What is Recurrent Depressive Disorder?

Recurrent depressive disorder is a disorder characterized by repeated depressive episodes of mild, moderate or severe degree, without anamnestic data on individual episodes of high spirits, hyperactivity that could meet the criteria for mania. However, this category can be used if there is evidence of short episodes of mild high spirits and hyperactivity that meet the criteria for hypomania that follow immediately after a depressive episode (sometimes they can be triggered by the treatment of depression).

The prevalence in the population is quite high and according to various sources ranges from 0.5 to 2%

Causes of Recurrent Depressive Disorder

As a rule, it is rather difficult to identify the exact cause of recurrent depressive disorder, among the main etiological factors there are: endogenous (genetically determined predisposition), psychogenic (depression is the most typical human reaction to mental trauma) and organic (residual-organic inferiority, the consequences of neuroinfections, intoxication, head injuries, etc.). The first episodes of recurrent depressive disorder are usually caused by external provocation (often by traumatic circumstances), however, factors unrelated to external circumstances predominate in the occurrence and development of repeated phases.

Pathogenesis during Recurrent Depressive Disorder

The first episode occurs later than with bipolar disorder, at the age of about 40 years, although often the disease begins much later. The duration of the episodes is 3-12 months (average duration of about 6 months). The period between attacks is at least 2 months, during which no significant affective symptoms are observed. Although recovery is usually complete in between attacks, a small proportion of patients exhibit chronic depression, especially in old age. Usually, late seizure lengthening is noted. An individual or seasonal rhythm is quite distinct. The structure and typology of seizures correspond to endogenous depressions. Additional stress can alter the severity of depression. Individual episodes of any severity are often provoked by a stressful situation and, in many cultural conditions, are observed 2 times more often in women than in men.

Symptoms of Recurrent Depressive Disorder

Main symptoms

  • depressed mood;
  • a decrease in interest or pleasure from activities that were previously pleasant to the patient;
  • decreased energy and increased fatigue.

Additional symptoms

  • decreased self-esteem and self-confidence;
  • unreasonable sense of self-condemnation and guilt;
  • ideas or actions aimed at self-harm or suicide;
  • decreased ability to focus and attention;
  • a gloomy and pessimistic vision of the future;
  • sleep disturbance;
  • change in appetite.

Diagnosing Recurrent Depressive Disorder

The main symptom of recurrent depressive disorder is the presence of recurring depressive episodes (at least 2 episodes should last at least 2 weeks and should be separated by an interval of several months without any significant mood disorders). The possibility of a manic episode in a patient with recurrent depressive disorder cannot be completely excluded, no matter how many depressive episodes in the past. If an episode of mania occurs, the diagnosis should be changed to bipolar affective disorder.

Recurrent depressive disorder can be subdivided by designating the type of current episode, and then (if there is sufficient information) the prevailing type of previous episodes into mild, moderate or severe.

  • Mild recurrent depressive disorder is characterized by the presence of at least two main symptoms and two additional symptoms. Subdivided into:
    – Mild recurrent depressive disorder without somatic symptoms (there are, but not necessarily, only some somatic symptoms)
    – Mild recurrent depressive disorder with somatic symptoms (there are 4 or more somatic symptoms, or only 2 or 3, but quite severe)
  • Moderate recurrent depressive disorder is characterized by the presence of at least two main symptoms and three to four additional symptoms. Subdivided into:
    – Moderate recurrent depressive disorder without somatic symptoms (only some are present or are absent)
    – Moderate recurrent depressive disorder with somatic symptoms (there are 4 or more somatic symptoms, or only 2 or 3, but an unusually severe degree)
  • Severe recurrent depressive disorder is characterized by the presence of all the main symptoms and four or more additional symptoms. Subdivided into:
    – Severe recurrent depressive disorder without psychotic symptoms (no psychotic symptoms)
    – Recurrent depressive disorder, current severe episode with psychotic symptoms (delusions, hallucinations, depressive stupor should be present). Delusions and hallucinations can be classified as appropriate or not appropriate for mood.

Differential diagnosis

Recurrent depressive disorder should be differentiated from schizoaffective disorder and organic affective disorder. In schizoaffective disorders, the structure of productive experiences contains schizophrenia symptoms, and in organic affective disorders, the symptoms of depression accompany the underlying disease (endocrine, brain tumor, consequences of encephalitis).

Treating Recurrent Depressive Disorder

The treatment takes into account exacerbation therapy (antidepressants, electroconvulsive therapy, sleep deprivation, benzodiazepines and antipsychotics), psychotherapy (cognitive and group therapy) and maintenance therapy (lithium, carbamazepine or sodium valproate).

Adaptive Reaction Disorder

What is an Adaptive Reaction Disorder?

An upset of adaptive reactions is a condition of subjective distress and emotional disturbance that usually interferes with social functioning and productivity and occurs during the period of adaptation to a significant change in life or stressful life event (including the presence or possibility of a serious physical illness). The stress factor can affect the integrity of the patient’s social network (loss of loved ones, experience of separation), a wider system of social support and social values ​​(migration, refugee status). A stressor (stress factor) can affect an individual or also his microsocial environment.

Causes of Adaptive Reaction Disorders

An individual predisposition or vulnerability plays a more important role than other reactions to stress in the risk of occurrence and formation of manifestations of adaptive disorders, but nevertheless it is believed that the condition would not have arisen without a stress factor.

Pathogenesis during an Adaptive Reaction Disorder

The onset is usually within a month after a stressful event or change in life, and the duration of symptoms usually does not exceed 6 months (except for a prolonged depressive reaction due to an adaptation disorder).

Symptoms of Adaptive Reaction Disorders

Manifestations are different and include depressive mood, anxiety, anxiety (or a mixture of them); a feeling of inability to cope, plan or stay in the present situation; as well as some degree of decline in productivity in daily activities. An individual may feel prone to dramatic behavior and outbursts of aggressiveness, but they are rare. However, in addition, especially in adolescents, behavioral disorders (e.g., aggressive or dissocial behavior) may occur.

None of the symptoms is so significant or predominant as to indicate a more specific diagnosis. Regressive phenomena in children, such as enuresis or children’s speech or finger sucking, are often part of the symptoms.

Diagnosing Adaptive Reaction Disorders

The diagnosis depends on a careful assessment of the relationship between:

  • the form, content and severity of the symptoms;
  • anamnestic data and personality;
  • stressful event, situation and life crisis.

The presence of the third factor should be clearly established and there should be strong, although perhaps suggestive evidence that the disorder would not have appeared without it. If the stressor is relatively small and if a temporary relationship (less than 3 months) cannot be established, the disorder should be classified differently according to the available symptoms.