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.

Dissociative Fugue

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.

Disorders of Sexual Preference

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.

Mental and Behavioral Disorders Due to Tobacco Use

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.

Mental and Behavioral Disorders Due to the Use of Volatile Solvents

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.

Mental and Behavioral Disorders Due to Cocaine Use

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.

Mental and Behavioral Disorders Due to the Use of Hallucinogens

What are Mental and Behavioral Disorders Due to the Use of Hallucinogens?

It develops thanks to the psychedelic movement in modern culture.

Causes of Mental and Behavioral Disorders Due to the Use of Hallucinogens

The group includes the use of psychotomimetics such as LSD, mescaline, psilocybin, as well as phencyclidine and Ecstasy (3,4-methylenedioxymethamphetamine), which have both hallucinogenic and amphetamine effects. Used per os, as applications on the mucous membranes, in cigarettes.

Symptoms of Mental and Behavioral Disorders Due to the Use of Hallucinogens

Acute intoxication

Uncontrolled laughter, crying, mood changes, formal disturbances in thinking, euphoria, synesthesia, depersonalization and derealization. Phencyclidine intoxication resembles amphetamine.

Harmful use

Somatic symptoms include tachycardia, increased blood pressure, mydriasis, sweating, fever, nausea, dizziness, and psychopathological symptoms include mental dullness and depression.

Addiction syndrome

Mostly mental addiction.

Withdrawal syndrome

Mood change. There is no pronounced withdrawal syndrome.

Psychotic disorder

Schizophrenia-like disorder with symptoms of depersonalization and derealization, panic attacks, distorted perception of time, visual and auditory pseudo-and true hallucinations, stereotyped repetition of visual images, ideas of exposure. Delusions of attitude, meaning and harassment.

Amnestic syndrome

Not very pronounced.

Residual wealth and psychotic disorder with delayed debut

Mental dullness and the re-emergence of visual or depersonalization images.

Diagnosis of Mental and Behavioral Disorders Due to the Use of Hallucinogens

Based on the history and description of the clinic of intoxication.

Differential diagnosis

Differentiate with schizophrenia, schizoaffective disorder and alcohol delirium, organic narcolepsy based on follow-up observation, history data.

Treating Mental and Behavioral Disorders Due to the Use of Hallucinogens

Prescription of benzodiazepines and barbiturates, detoxification and increased excretion of psychoactive substances.