1.

SUBJECTS AND TASKS OF PSYCHIATRY

n Study the etiology and pathogenesis of mental disorders;
n Carry out their classification;
n Investigate the epidemiology of mental disturbances;
n Study the symptoms and signs, as well as syndromes and the clinical course of different mental
disorders;
n Develop find practice effective methods of their diagnosing;
n Work out and use efficient treatment methods;
n Develop a network of mental health services for the population;
n Labour, forensic and military psychiatric examination;
n Social-labour rehabilitation of patients;
n Develop a system for the prevention of mental disorders.

2. ACHIEVEMENTS OF DOMESTIC SCIENTISTS IN THE FIELD OF PSYCHIATRY
n Philippe Pinel Moral Treatment
n Kind treatment
n Minimum or restraint

n Benjamin Rush
n Signer of the Declaration of Independence
n Father of American Psychiatry
n Dorothea Dix
n Civil War nurse, campaigned

against poor treatment of the

mentally ill, especially restraints

A French psychiatrist Ph. Pinel won from the National Convention the right of taking off chains
from mental patients.

He also made notable contributions to the classification of mental disorders and has
been described by some as "the father of modern psychiatry

JEAN ETIENNE DOMINIQUE ESQUIROL
Panel's disciple and follower legalized the demand of an obligatory medical examination of the
people admitted to psychiatric establishments.

An English professor J. Conolly declared the principle of nonconstraint for mental patients.

3. STRUCTURE OF PSYCHIATRIC AND SUBSTANCE ABUSE (NARCOLOGIC) AID. STRUCTURE OF
PSYCHIATRIC HOSPITALS AND DISPENSARY
. A. Outpatient aid

a psychiatric neurological room of the children's or general polyclinic with a district pediatric or general
psychiatrist, a psychiatric room of the central district hospital
a psychoneurological dispensary or a dispensary of the mental hospital of the city, region, republic: the
general one whose structure includes pediatric, juvenile psychiatric and logopedic rooms or pediatric
one whose composition may have rooms of district pediatrics psychiatrists and consultants
a narcologic dispensary

B. In patient psychiatric aid
city and regional hospitals in the system of health service composed of various typical departments (
male and female ones, narcological, infectious, tuberculosis, forensics, etc., including children and
juvenile departments
specialized mental hospitals in the system of the Ministry of Internal Affairs (for compulsory treatment
of especially dangerous criminals who have committed illegal act)
narcological hospitals
psychoneurological department at psychoneurological dispensaries, large somatic hospital and military
hospitals ( for treating patients with acute short term psychoses, neuroses and reactive states, residual
phenomena of organic lesions of the brain and mental disorders)
day time and night time departments for completing the cure of convalescent mental patients and for
conducting anti relapse supporting courses of treatment for patients followed up at psychoneurological
rooms and dispensaries
psychoneurological sanatoria for adults and children

C. Social rehabilitative establishments
medical industrial workshops at mental hospitals and dispensaries
subsidiary farms and mental hospitals, rehabilitation centres
sanatorium schools for children with anthemic states
schools and groups for children with speech and other disturbances
boarding schools for mentally retarded children




Structure of mental hospital
different medical departments: male and female getentological, somatic, tuberculosis, emergency aid,
infectious, pediatrics and juvenile, etc.
different types of auxiliary medical services: drugstore, laboratories, X-ray, ENT, therapeutic, dental,
surgical, etc
administrative and executive personnel: head doctor, deputies, economic department, accounts
departments, medical department, archives, storehouse, food departments

4. LEGAL PRINCIPLES OF PSYCHIATRIC AID. THE MODERN CONCEPT OF MENTAL HEALTH IN UKRAINE .
THE MAIN INDICATIONS FOR HOSPITALIZATION IN A PSYCHIATRIC HOSPITAL
The law of psychiatric aid is based on 10 main principles
development of mental health and prevention of mental disorders
availability of basic psychiatric aid
assessment of mental health in compliance with generally accepted international principles
provision of psychiatric aid in the least restrictive form
self determination- receiving of patient's consent before using any type of interference
availability of reassessment procedure. Each decision reassessed within three days with help of an
official judge or deputized get person authorized to take decision and people rendering the aid
the mechanism of automatic periodical revision for decisions concerning treatment or hospitalization
with long term consequences
qualifications of ppl taking decisions(competent, informed, independent, impassive)
respect of law:
Main principles: humanism, lawfulness, observance of the rights of man and citizen, voluntarism,
accessibility



Indications for hospitalization:
absolute: of a social (danger to self or surrounding ppl) and medical (need for urgent therapy)
relative: inability to provide supervision of patient at home)

Mental health
awareness and feeling of continuity, constancy and identify of own "I"
constancy and identity of feelings in the same situations
critical attitude to self and own mental activity
adequacy of psychological reactions to the situation
ability of self directed behavior in concordance with social rules, laws and norms
ability to plan and realize own life
ability to change behavior in various situations

5. METHODS OF PSYCHIATRIC EXAMINATION: CLINICAL, PARACLINICAL, PSYCHODIAGNOSTICAL.

n clinical interview and collection of anamnesis data;
n physical examination;
n observation;
n psychological investigation (Psycho-diagnostical examination)
n additional investigations:
a) neurophysiological investigations
b) X-ray investigations
c) laboratory tests

CLINICAL INTERVIEW

This is the method of receiving information about the psychopathological
symptoms,
individual
psychological peculiarities of the personality, psychological phenomena, inner picture of the disease and
the structure of the patients problem.
History of Life
History of Disease
Subjective Anamnesis
Objective Anamnesis

OBSERVATION

is observation of an object (a person, a group of people) pending the phenomena interested by an
examiner will show themselves to be recorded and described

Mental arias

Psycho-diagnostic methods

Perception

Sensory excitability, Aschaffenburgs test, Reichardts test, Liepmanns test

Memory

Ten words test, Memorizing numbers, Story reproduction

Attention

Schultes tables, Proof test , Anfimovs tables, Counting by Kraepelin

Thinking

Classification, Exception of notions, Syllogisms, Analogies, Generalization tests

Association experiment, Pictogram

Intellect

Ravens matrices
Wechslers test

Emotions

Spielbergs test
Luschers methods of colour choices

Personality

Rorschachs test, I, Topical apperceptive test (TAT)

6. The concept of psychopathological symptom, syndrome and disease.
?????????????? ( I think not sure
By the etiological principle, mental diseases are divided into the following groups:
1. Exogenous (caused by various pathological influences from outside).
a. Infectious
b. Traumatic

c. Intoxicating
2. Somatogenies and endocrinopathies (caused by various internal, including vascular, and endocrine
diseases).
3. Psychogenies connected with various unfavourable psychological influences.
4. Endogenies diseases with an insufficiently studied etiology, a great part in their origination being
played by the factor of heredity (schizophrenia, manic-depressive psychosis, genuine epilepsy).
5. Psychoses of the old age: presenile and senile.
6. Abnormalities in
7. DISORDERS OF SENSATIONS AND PERCEPTION. CLASSIFICATION. DEFINITIONS
I.
Hypoesthesia and anaesthesia
is a decrease or absence of the subjective vividness and intensity of sensations and perceptions

II.
Hyperaesthesiae
is a increase of sensations and perceptions
III.
1. Paraesthesiae sensation of numbness, injection, pricking of bugs, insects etc.
2. Synaesthesiae are intensification of receptivity of stimuli with radiation of sensations and
perceptions to another analyzer.

Example roses smell blue

3. Senesthopathies are various, extremely unpleasant, painful and unusual sensations

originating from some internal organs and different areas of the body and having no causes for their
origination in this particular organ.
Example a sensation of fear in the frontal bone, a sensation of the lungs sticking together
IV.
Psychosensory disorders

1. Methamorphopsiae (Visual psychosensory disorders) are a distorted perception of
really existing objects with preservation of understanding of their meaning and essence, as well as a
critical attitude of the patient to them
(micropsiae, macropsiae, dysmorphopsiae)


2. Intero- and proprioceptive disturbances: an improper body scheme: distortions or
disturbances of perception of the corporal ego
Examples: the head is enormous, the arms are too long, the teeth are loose
V.
Illusions are a distorted perception of a really existing object with a change of its contents, meaning.
CLASSIFICATION OF ILLUSIONS

1. By analyzers: visual, auditory, olfactory, gustatory, tactile, of general feeling (visceral and
proprioceptive).
2. By the mechanism of appearance:
(physical, physiological, psychic)
Physical - appears as a result of peculiarities in physical properties of objects and substances
Physiological are connected with physiological peculiarities in the functioning of analyzers
Psychic (MENTAL) illusions are connected with a change in the mental activity.
They are: affective, verbal and pareidolic

VI.
HALLUCINATIONS
are an imaginary perception without any real stimulus (image, phenomenon) at this time.

Classification
1. By analyzers: visual, auditory, olfactory, gustatory, tactile, of general feeling (visceral and
proprioceptive).

2. By complexity: simple (photopsiae, acoasm), compound (having some contents).

3. By the completeness of development: complete (true) and incomplete (false,
pseudohallucinations, hallucinoids).

4. By the attitude to the patients personality: neutral, commenting, imperative.

Particular kinds of hallucinations

Hypnagogic which appear during a transition from wakefulness to sleep Hypnopompic which
appear during waking up
Extracampine are the hallucinations localized outside the visual field.
Functional hallucinations: a hallucinatory stimulus is perceived side by side, simultaneously with
a real one.
Reflex hallucinations: these are reflected when a real stimulus (e.g., a turn of a key in a lock) is
hallucinatorily perceived in another place (a turn of a key in the heart).
Negative hallucinations: absence of perception of really existing objects.
Episodical hallucinations: they appear periodically, e.g., ecstatic ones in epileptics.
Hallucinations of Charley Bonnets type: mentally healthy people who lost their ability for
hearing develop visual or auditory hallucinations (with a critical assessment).
Phantom phenomena in people with amputations: when a person perceives presence of an
amputated limb, may feel a pain in it, etc.

8. DISORDERS OF MEMORY AND ATTENTION. CLASSIFICATION. DEFINITIONS

MEMORY is a mental process of imprinting, preservation and reproduction of the previous
experience (memories).
4 processes of memory
Memorization (fixation)
Retention
Reproduction
Forgetting

CLASSIFICATION. (QUANTITATIVE)

I. Enhancing memory (hypermnesia)

1. Fixation

2. Reproductive

II. Defective memory (hypomnesia),

loss of memory (amnesia)

1. Fixation

2. Reproductive

3. Retrograde

4. Anterograde

5. Anteroretrograde

6. Progressive

III. Paramnesiae disorders in content of recollection

1. Cryptomnesiaea - distortion of the memory manifested by disappearance of differences
between the real events and those ones which were seen during sleep, heard or read by the patient.

2. Confabulations - false recollections with some fantastic contents, recollections of the events
which did not and could not happen in the patients life (hallucinations of memory)

3. Pseudoreminiscences - are false recollections of the facts which did not take place at this
period, but were or could be in the patients past life (illusions of memory)
IV. A disturbance in the sensation of familiarity

1. Symptom of dj vu (already seen)

2. Symptom of jamais vu (never seen)

3. Capgras syndrome (named after J.M. Capgras) manifests itself by a disturbance in
recognizing people. Symptom of negative and positive double

4. Fregolis symptom is a variety of Capgras syndrome: such patients believe that their
persecutors change their appearance in order not to be recognized by anybody.

Korsakoffs amnestic syndrome includes disturbances of memory for the current events (fixation
amnesia), retro- and anterograde amnesia, pseudoreminiscences, confabulations, amnestic
disorientation.
Korsakoffs syndrome is observed in an organic cerebral lesion caused by infectious diseases of the
brain, intoxication (including alcoholic one), brain injury, vascular cerebral pathology, etc.

9. DISORDERS OF THINKING AND INTELLIGENCE. CLASSIFICATION. DEFINITIONS

1. A disturbance in the formation of concepts:

Pseudoconcepts are false concepts formed on the basis of casual, insignificant signs. For
example, a female patient asks to give her green.
Condensation of concepts manifests itself in a fusion of several concepts which are rather
remote from one another. shockoprovely after shocks my state improve
Neologisms are new, unusual concepts created by patients.
For example, complaining of her destiny a female patient says: It is not life, but apheides and
poltoraniae

2. A disturbance in the rate of thinking:

a) rapidity of thought, galloping ideas it is characterized by a rapid flow of thoughts,
easier development of associations, most frequently of superficial ones,

b) retarded thinking it is characterized by a decreased number of ideas accompanied by
a subjective sensation of stiff thinking,

c) delay, arrest (Sperrung) - a sudden arrest (delay) in the flow of thoughts,

d) mentism - obsessional automatic flow of thoughts which is painfully for the patient.

3. A disturbance in the form of thinking:
a) pathologically circumstantial thinking - increase detalisation, an inability to separate the main
from the minor, a difficulty in switching over from some subject to another,
b) Philosophizing - empty reasoning without content, direct answer on the question,
c) non-continuous thinking (schizophasia) absence of any semantic relations between concepts
with preservation of the grammatical system,
d) incoherent thinking - inability to construct associations, concepts are not connected among
themselves
e) amorphous thinking - is a deviation from the main thought to some side-thoughts which
substitute for the main one,
f) paralogic thinking disorders between judgments and conclusions,
g) autistic thinking - rests upon the patients feelings, his subjective aims, wishes, fantasies, rather
than on reality,
h) symbolic thinking various concepts with some allegorical meaning which is absolutely unclear
for other people, but for the patient himself has a certain sense,
i) Verbigerations - repetition of the same words or scraps of phrases,
j) Perseverations - sticking to some representations,

k) affective thinking - the patient constructs his judgements and conclusions on the emotions and
wishes prevailing at the moment.
4. A disturbance in the contents of thinking:
a) fixed ideas - thoughts which appear involuntarily and are alien to patients,
b) dominant ideas - thoughts which are connected with the life, prevail in a persons consciousness
and sometimes prevent him from concentrating on the current activity,
c) overvalued ideas - are judgments resulting of real circumstances but owing to their emotional
saturation they take the prevailing meaning in the consciousness which is disproportional to their
objective importance,
d) Delusion - like fantasies are relatively short-term and most typical for juvenile psychopaths who
want to appear before people of their age playing a hero,
e) Forced thoughts - they appear in the consciousness unexpectedly, any stage of doubt and
struggle is absent. The patients would ask to keep them from throwing themselves into a stair-well,
spitting into somebodys face, because they are not sure that they are able to control themselves,
Delusions are wrong judgments and conclusions which appears on a morbid basis, completely seize
the
patients
consciousness
and
can
not
be
corrected.


Forms of delusion:
1. Primary delusion (interpretative).
2. Secondary delusion (sensual, imagery).
The contents of delusions:

persecution, influence, reference, pretence, damage, self-condemnation, selfhumiliation, negation (nihilism), hypochondria, jealousy, love, invention, reforming, high origin,
litigiousness, expansive delusions, induced delusions.
Disturbances of intellect

congenital (oligophrenia)
Degrees of oligophrenia: idiocy, imbecility, debility

acquired (dementia)
Total dementia
Lacunar dementia

10. DISORDER OF EMOTIONS AND EFFECTOR-VOLITIONAL SPHERE.

 CLASSIFICATION. DEFINITION.

(1. ) Disorders in the strength of emotions.

1) Pathological strengthening:
a) hyperthymia -a merry, joyful mood
b) euphoria - pathologically high spirits, often appearing without any connection with reality

c) Moria - a combination of high spirits with a disinhibited drive, foolishness, stupid and
incongruous jokes
d) Hypothymia - pathologically low spirits
e) Depression - a pathologically depressed, melancholic, sad mood, deep grief
f) Alarm - a feeling of internal anxiety, expectation of some trouble, misfortune, catastrophe

2) Pathological weakening:
a) Paralysis of emotions - a feeling of an absolute spiritual bankruptcy and indifference
developing under the effect of sudden severe psychic traumas
b) Apathy - a painfully felt indifference to the surroundings and the patients own behaviour
c) Emotional flattening - loss of differention of emotional responses: delicacy and the ability to
feel for other people
d) Emotional bluntness - a steady and absolute indifference, particularly to sufferings of other
people
( 2). Disorders in the motility of emotions:

1) faint-heartedness (emotional weakness) - unstable mood, unrestrained emotions
2) Lability - an easy change of emotions, a rapid transition from some emotion to another
accompanied by a significant expressiveness of emotional responses
3) inertness (stickiness) of emotional feelings - persons could not change their emotions

4) Explosiveness - a failure to restrain affect. It is revealed in dysphoriae and manifested by

strong emotional and sometimes motor responses, which are not adequate to their cause.
(3.) Disorders in the adequacy of emotions:
1) Inadequacy - a lack of correspondence between emotional responses and external situations
2) ambivalence - a simultaneous development of two contradictory feelings (e.g., love and
hatred) to the same object
3) Phobiae strong fears
4) Dysphoriae - a suddenly appearing and unmotivated disorder of emotions characterized by a
strained, depressed and malicious mood
5) Dysthymiae - a short-term mood disorder in the form of anxious depression with irefulness,
displeasure, irritability.
6) pathological affect - is a short-term psychotic state, whose sudden appearance is caused by
factors which traumatize the mentality.
Stages
First, preparatory.
Second, the phase of explosion.
Third, the concluding phase.

11. DISTURBANCES IN EFFECTOR-VOLITIONAL SPHERE
. Disturbances of drives (instincts)
1. Disturbances of food drives:

a) intensification (bulimia, polyphagia)

b) weakening (anorexia)

c) polydipsia

d) perversion: parorexia (coprophagy, etc.)

2. Disturbance of the instinct for self-preservation (surviving):

a) intensification (active-defensive form: aggressiveness, etc.; passive-defensive form: an
imaginary death, etc.)

b) weakening (suicidal acts)

c) perversions (self-torture)

3. Disturbances of sexual drives:

a) intensification (hypersexualism: satyriasis, nymphomania)

b) weakening (hyposexualism, frigidity)

c) perversion (narcissism, exhibitionism, voyeurism, transsexualism, transvestism, onanism,
fetishism, sadism, masochism, paedophilia, gerontophilia, homosexuality, etc.)
4. Obsessive actions - suddenly appearing drives and actions which are alien to the person at the given
moment, with a critical attitude towards them and a yearning for getting rid of them
5. Forced actions - actions or acts appearing without ones own will, irrespective of the personality; they
are fulfilled without any struggle of motives, with a feeling of their forced and alien character
6. Impulsive actions - sudden, outwardly unmotivated, meaningless actions and acts

II. Disturbances of volitional motives

1. Hyperbulia-

2. Hypobulia

3. Abulia

4. Parabuliae

5. Ambivalence

III. Disturbances of attention

1. Distractibility

2. Riveting

3. Exhaustibility

IV. Psychomotor disturbances

1. Signs with difficult motor activity:

a) catalepsy

b) hood sign

c) passive-subjected state

d) negativism

e) mutism

f) specific disorders in the development of school skills (dyslexia, dysgraphia, dyscalculia,
acalculia, dyspraxia)

2) Signs with excitement and inadequacy of motor activity:

a) hyperkinetic disorders

b) impulsiveness

c) stereotypies

d) echopraxia

e) verbigeration

f) miss-speech

V. Syndromes of motor disturbances

1) Stupor:

a) catatonic

b) depressive

c) apathetic

d) psychogenic

2) Excitement:

a) catatonic

b) maniacal

c) hebephrenic

d) hallucinatory-delirious

e) in disturbances of consciousness

3) Catatonic syndrome

4) Hebephrenic syndrome
5) Apathoabulic syndrome


DISTURBANCES OF CONSCIOUSNESS
1. Non-psychotic (non-productive) forms (disengagement of consciousness)

1) Obnubilation

2) Torpor

3) Somnolence

4) Sopor

5) Coma

2. Psychotic (productive) forms accompanied by delirium, hallucinations, a disturbance in
behaviour

1)

Delirious syndrome

2)

Oneiroid syndrome

3)

Syndrome of asthenic confusion

4)

Syndrome of perplexity

5)

Amentia

6)

Twilight state of consciousness

a)
with outwardly regulated behaviour a simple form (ambulatory
automatism, somnambulism)

b)

psychotic form

c)

pathological affect

d)

pathological intoxication

e)

drowsiness



syndrome)

f)

short-circuit response

g)

hysterical twilight states (puerilism, pseudodementia, Gansers

Unit 2 Questions 1-19

1.Depressive syndrome: psychotic and non-psychotic variants, diseases it occurs in.
Disorder of emotion (.67)
Depressive triad: melancholic mood, delayed thinking and motor inhibition
Motor inhibition = delayed movement; low, slow speech;
thinking = scant thoughts, slow flow of thoughts;
Symptoms of depression (bad mood, physical and mental weakness, sleep disorders, appetite disorders,
apathy, anxiety, lack of pleasure in previously enjoyable things)
Autonomosomatic disorders: tachycardia, unpleasant sensations in heart region, hypertension, GIT
disturbance like constipation, loss of appetite and body weight,
Depression may manifest as other disorders aka it can have masks:
Psycho pathological disorder mask: anxiety, doubts, panic attacks, obsessive compulsive,
hypochondriac, neurasthenic
Biological rhythm disorder mask: insomnia, hypersomnia
Autonomic, somatic and endocrine disorder mask: vertigo, dysfunction of internal organs like
hyperventilation, cardioneurosis, irritable colon syndrome; neurodermatitis, skin itch, anorexia,
bulimia, impotency, disturbed menstruation
Mask in form of algiae: cephalgia, cardialgia, abdominalgia, fibromyalgia, neuralgia etc
Mask in form of patho-characterological disorders: disturbances in drive (narcomania,
toxicomania, dipsomania), hysterical response, asocial behavior (impulsiveness, aggression)

Psychotic variant of depressive syndrome includes delusions of self-condemnation, self-humiliation,
sinfulness.
Diseases depressive syndrome occurs in :
depressive phase of manic-depressive psychosis
presenile and reactive depressions
schizophrenia
somatogenic psychoses


2. Asthenic syndrome p. 106
Asthenic syndrome manifests as physical and mental tiredness/weakness
Person has trouble concentrating, poor memory, lacks emotional restraint, is emotionally labile; delayed
thinking and difficulty solving complex mental tasks; increased sensitivity to sounds and light
Variant of asthenic syndrome:
Asthenoneuortic: asthenic characteristics listed above + hot temper, increased irritability, tearfulness
Asthenodepressive: asthenic characteristics + depression
Asthenohypochondriac: asthenic characteristics + increased attention to own health

Asthenoabulic: asthenic characteristics+ inability to complete work

Asthenic syndrome occurs in somatic diseases, exogenous-organic diseases and psychogenic diseases.
Somatic diseases like myocardial infarction, hypertension, renal failure, hepatic cirrhosis,
hepatolenticular degeneration (Wilsons disease).


3.Neuroasthenic syndrome = asthenia (fatigue) + easily irritable OR irritable weakness;
It can involve autonomic symptoms (sweating, tachycardia, headache, hypertension, )
Such people are anxious, irritable, unsure, cry easily.
Diseases in which neurasthenic syndrome occurs: neurasthenia (the neurosis), ??



4. Obsessive compulsive syndrome
Manifests as annoying thoughts, phobiae obsessive desires and action. Obsession appears suddenly and
object doesnt match persons thought at the moment.

Diseases obsessive compulsive syndrome occurs in (p.77, 106):
neurosis (obsessive-compulsive)
schizophrenia
cerebral atherosclerosis
somatic diseases
exogenous-organic brain disease

5. Dysmorphophobia, dysmorphomania syndromes. Diseases in which they occur
Dysmorphophobic syndrome
over-estimation of deformities, constantly seeks cosmetic operations (obsession with the flaw)
Typically develops in puberty with psychogenic mechanisms
Diseases: obsessive compulsive disorder,

Dysmorphomaniac syndrome
Triad= delusions of deformity and reference, and depression
Actively tries to correct deformities with surgery or if denied surgery may attempt it themselves
Patient tries to disguise bodily defects (p.46,
Disease dysmorphomaniac syndrome is seen in: schizophrenia

6. Apathoabulic syndrome p. 81, 106
Emotional-effector volitional disorder
Apathy (indifference to self and surroundings) + abulia = reduced will or motive for activity (patient sits
around, does nothing)
Disease its seen in:
schizophrenia
Organic brain lesions

7. Delirious syndrome p.88, 104
Disorder of consciousness: disturbed time and place orientation, but orientation in self is preserved
Hallucinations (complex, visual and frightening), delusions, illusions

Anxiety, fear due to hallucinations, psychomotor agitation (running)

Negative critic
Aggressive behavior (motor excitation)
Afterward episode, there is amnesia

8. Oneiroid syndrome p. 91, 104
Disorder of consciousness which develops and ends gradually
Fantastic, non-frightening visual hallucinations
Illusions, delusions (of persecution)
perplexity
Can be motor disorders like stupor , speechlessness
Diseases in which it occurs in
Endogenous oneiroid in schizophrenia
Exogenous-organic oneiroid in delirium tremens, senile psychoses, somatogenic psychoses, acute
intoxications


9.Amentia syndrome
Disorder of consciousness
Predominant features: incoherent speech, perplexity and movements confined to the bed
Perplexity = disorientation in place and time
Patient is lying or sitting; he wont leave the bed, any movements made are not purposeful i.e. rotating
the head, fidgeting, throwing their limbs
No memory of this period (amnesia)
Complex hallucinations, visual and auditory

Diseases amentia syndrome occurs in
Severe somatic, infectious and noninfectious diseases
Rarer in intoxications
Acute period of epidemic encephalitis

10. derealization and depersonalization syndrome p.33
Disorders of sensation and perception
Derealization
Surroundings are perceived in unusual state i.e. building made of chocolate
Derealization occurs in depression and schizophrenia


Depersonalization
Patient feels estranged from his body or his mental processes (can bemental orphysical)
Patient feels like he cannot control actions
Estranged mental processes like thinking an behavior
Depersonalization occurs in schizophrenia


11.Maniacal syndrome
Disorder of emotion
Maniacal triad: euphoria (inadequately high spirits), accelerated thought processes an motor excitation

Excess physical energy which makes person eager to be active and over-estimate their abilities
Distraction is common, superficial associations
Will talk willingly but without stop
Sexual drive may increase

Maniacal syndrome observed in:
manic-depressive psychosis
schizophrenia
long term symptomatic psychoses
after brain injuries
acute intoxications
progressive paralysis


12.paranoid syndrome p. 52, includes hallucinatory-paranoid, hypochondriac, dysmorphomanic,
Kandinsky-Clerambault syndrome of psychic automatism p. 105
Disorder of thinking
Paranoid /nonsystematic/ secondary delusion = wrong judgment is made without logic
Paranoid syndrome = unsystematized delusion (of persecution anxiety, fear), hallucinations,
pseudohalluciantions, passive defensive behavior

Diseases paranoid syndrome occurs in (p.52) :
Schizophrenia
Exogenous and psychogenic psychoses

Kandinsky-Clerambault syndrome p.52
Kandinsky-Clerambault syndrome = paranoid syndrome + psychic automatism
Psychic automatism means as ideational (someone guides thoughts), motor (a force directs patient
msovementes) and emotional (someone made their mood).
Paranoid syndrome = pseudohallucinations (usually auditory), delusions of influence
-symptom of open thoughts (others can read thoughts), symptom of placed thoughts (someone put the
thought in their head)
-syndrome usually occurs in schizophrenia

Cotards syndrome p.53
Hypochondriac delirium with delusions of grandeur on background of melancholic mood
Delusions of damage, death, world destruction, self-condemnation for grave crimes
Typical statements: intestines are rotten; they have no heart, are decomposing nihilistic delusion
Disease it occurs in involutional depression

13. Paranoic syndrome p. 53, 106
Disorder of thinking
Paranoic delusion is a systematic or primary delusion= wrong conclusion is made from logical thinking ;
delusion is based on real facts.
Systematized delirium with no disturbance in perception and psychic automatisms
Diseases paranoid syndrome occurs in (p.53) :
Schizophrenia
Presenile and reactive psychoses

Alcoholism


14. Paraphrenic syndrome p. 53, 106
Paraphrenic delusion is a fantastical delusion
Systematized or unsystematized with psychic automatism, verbal hallucinations, confabulatory suffering
with fantastic contents, tendency to high spirits
Disease paraphrenic syndrome occurs in = schizophrenia (p. 44)


15. Hebephrenic syndrome p.81
Disturbance of effector volitional sphere, a motor disturbance (p.74)
Hebephrenic excitement, foolishness, non-continuous thinking
Disease hebephrenic syndrome is seen in schizophrenia

16. catatonic syndrome p.81
Diseases catatonic syndrome is seen in:
Schizophrenia
Infectious and other pyschoses

17.psycho-organic syndrome p. 105, 108
Cause = organic defect (tumor, trauma)

Classification of Defect-organic syndromes p. 105:
Pscyhoorganic syndrome (explosive, euphoric, apathetic variant)
Korsakoffs amnestic
Oligophrenia
Dementia (total and lacunar)

Psycho-organic syndrome
Mild disturbances in intellect; hard to acquire new skills and knowledge; level of judge and criticism
decreases
poor memorization and memory (hard to recall facts), poor attention,
delayed rate of thinking,
leveling of personality or intensification of streaks of disposition;
variants of this syndrome by prevailing emotional response:
- explosive = rude, aggressive, explosive
-euphoric = inadequate happiness, carelessness
-apathetic = indifference
This syndrome occrus in exogenous-organic lesions of the brain

Korsakoffs amnestic syndrome (p. 59, 108)
Involves disturbance of memory with fixation amnesia, retrograde and anterograde amnesia,
pseudoreminiscences, confabulations, amnestic disorientation
Diseases Korsakoffs amnestic syndrome occurs in :
Organic brain lesion or injury (trauma, vascular pathology)
Infectious brain diseases
intoxication




18. abstinence syndrome ??? ( page 213)
A complex of autonomic, somatoneurological and mental disorders developing in alcoholics in case of
abstinence from liquor after a prolonged and intensive intoxication.
Clinical picture of the alcohol abstinence syndrome consists of post-intoxication symptoms and those
typical for alcoholism. Headache, dizziness, general malaise, jadedness, polydipsia, dryness in the
mouth, anorexia, liquid stools, higher blood pressure, unpleasant sensations in the area of the heart and
abdomen, a bad mood, a reduced capacity for work
Also characterized by signs of chronic intoxication of the CNS: restless sleep with vivid unpleasant
dreams, hyperacousia, hypnagogic and sometimes certain true auditory hallucinations, delusions of
reference, culpability, self-humiliation, a large swinging tremor of the hands, tongue, whole body,
sweating, tachycardia, nystagmus; some patients have spasmodic seizures. The abstinence syndrome in
alcoholism develops 6-48 hours after the last intake of alcoholic drinks and lasts from 2-3 days to 2-3
weeks. The above changes result in disturbances in the vital organs and systems, and it may cause the
lethal outcome.


19. Pathological and physiological affect syndrome
Physiological affect (p.65 psychology textbook) = narrowed consciousness, incomplete loss of control
over ones action
Pathological affect (p.65 psychology textbook, p. 95 psychiatry textbook) :
Dull consciousness that is narrowed to l inciting stimulus, complete loss of control over ones actions.
Distorted perception of reality
Short term psychotic state
3 phases
1.preparatory there is a traumatizing factor, emotional tension grows, changed perception of
environment, cant assess own state situation, consciousness narrowed and directly connected with
traumatizing factor
2. explosion- fit of anger with deep clouded consciousness, absolute disorientation, illusions and
hallucinations possible. Emotional discharge has motor excitement, aggression, destructive tendencies,
autonomic-vascular response with face reddening or paling. Distorted or overly contorted facial
expression
3. concluding phase- sudden exhaustion of physical and mental strength. Deep sleep follows. If not
sleep, then prostration (general weakness, listlessness, absolute apathy to surrounding and what has
happened).

Unit 3

1 Mental disorders in somatic diseases. Classification. The clinical picture. Treatment approach .

Classification:
Cardiovascular disease:
Coronary disease

Myocardial infarction
Angina pectoris
Hypertensive disease
Cardiophobia
Cardiosurgery
Diseases of respiratory organs
Asthma
Chronic Bronchitis
Gastrointestinal pathology
Peptic Ulcers
Renal Diseases
Renal Failure
Hepatic Disease
Liver Cirrhosis
Wilsons Disease (hepatolenticular degeneration)
Brain Injuries and Tumours


Classification of mental disorders in cerebral vascular diseases
1. Neurosis-like syndromes
2. Psychopathy-like syndromes
3. Defect-organic states:
3.1. Psychoorganic syndrome
3.2. Dementia
3.3. Korsakoffs syndrome
4. Psychoses:
5. Acute vascular psychoses
6. Endophorm vascular psychoses

The clinical manifestations may be expressed by various syndromes. such disorders as:
1) Asthenic; physical and mental tiredness/weakness
Person has trouble concentrating, poor memory, lacks emotional restraint is emotionally labile; delayed
thinking and difficulty solving complex mental tasks; increased sensitivity to sounds and light
2) Neurosis-like; symptoms in the form of short temper, reduced concentration of attention, increased
fatiguability, a decrease in the capacity for work.
3) Psychopathy-like; restless people become expressively anxious, mistrustful ones suspicious, hottempered ones still more unrestrained, economical ones very misery
a) Pure asthenic: asthenic reactions of the initial period of the illness are fixed and become the basis
for forming new streaks of the character (timidity, touchiness, shyness, passiveness);
c) asthenoobsessive: with time, the asthenic syndromes give place to obsessive ones; with development

of the psychoorganic syndrome the phobiae become monotonous, and the foreground is occupied by
anxiousness and over-anxiousness about ones health;
c) asthenohypochondriacal: with the patients fixation on unpleasant sensations and formation of the
hypochondriacal syndrome, in whose genesis psychogenic moments, autonomic hyperreactivity and
diencephalic paroxysms play their part;
d) Explosive: the leading place in the clinical picture is taken by explosiveness, short temper and
groundless fluctuations in the mood.
4) Delusive states; Disorder of consciousness: disturbed time and place orientation, but orientation in
self is preserved
Hallucinations (complex, visual and frightening), delusions, illusions
Anxiety, fear due to hallucinations, psychomotor agitation (running)
Negative critic
Aggressive behavior (motor excitation)
Afterward episode, there is amnesia

5) States of cloudiness of consciousness (delirium); Acute vascular psychoses. may develop in the form
of delirium, amentia, more seldom the oneiroid syndrome and a twilight state of consciousness in case
of an acute decompensation of the cerebral circulation. In delirium, visual hallucinations are less bright
than in delirium tremens. A sharp increase in blood pressure after a period of anxiety may give rise to
amentia.

6) The psychoorganic syndrome, dementia: expressed by the loss of ability for fine differentiation in
thinking, a gradual decrease in the capacity for work, a reduced criticism, disturbances of attention and
memory- hypomnesia: Korsakoffs syndrome may develop at later stages, an emotional liability and lack
of restraint at the later stages of the illness result in behavioral disorders
7) Endoform psychoses

2 Mental disorders in infectious diseases. Classification. The clinical picture. Treatment approach.

Classification of mental disorders of the infectious genesis:.
a) syndromes of disengagement of consciousness (a nonpsychotic change): obnubilation,
somnolence, sopor, coma;
b) functional nonpsychotic syndromes: asthenic, asthenoneurotic, asthenoabulic, apathoabulic,
psychopathy-like;
c) psychotic syndromes: delirious, oneiroid, catatonic, paranoid and hallucinatory-paranoid,
asthenic confusion, a twilight state of consciousness, amentia, hallucinosis;
d) psychoorganic syndromes: simple psychoorganic, Korsakoffs amnestic, epileptiform, dementia,
parkinsonism

Protracted psychoses may develop in case of a prolonged or chronic course of an infection

Mental disorders in encephalitis

Lethargic encephalitis (von Economos disease)
tick-borne (spring-summer) and mosquito-borne (summer-autumn) encephalitis
Rabies
Meningititides

Clinical pictures:
1) Asthenia with emotional labiality and hyperaesthesia.
2) Delirium develops with deep cloudiness of consciousness

Treatments: is provided at mental hospitals or infectious in-patient departments under the observation
by a psychiatrist and supervision by the personnel active treatment of immune therapy, administration
of antibiotics, disintoxication, dehydration, general health improving therapy. Psychoactive drugs are
administered
Neuroleptic

3 Mental disorders in HIV - infection. Classification. The clinical picture. Treatment approach.

Classification of clinical manifestations in people of risk groups
The first group (a grey area) consists of persons affected by AIDS virus. Though seropositivity by AIDS
virus is a risk factor, it does not always show presence of this disease in a human being. The incubation
period between the viral infection and development of the disease lasts from 1 month to 5 years.
The second risk group includes the people who are the most vulnerable to a danger of AIDS infection, i.e.
those engaged in narcomaniae, homosexuality and prostitution. A smaller part is composed of bisexuals,
heterosexuals with numerous occasional intercourses, and
those who suffer from haemophilia or another disease requiring frequent blood transfusions.

Clinical manifestation:
neurotic and neurosis-like symptoms, though sometimes they acquire the form of psychotic
ones with resultant anxiety, nervousness, shortness of temper, sleeplessness, loss of appetite,
sometimes with a very expressed loss of body weight.
Dementia develops in connection with diffuse subacute encephalitis, meningitis.
Depression accompanied by anguish with ideas of self-condemnation, guilt to ones relatives,
suicidal thoughts and tendencies, organic symptoms and disorders of consciousness

Treating mental disorders in AIDS patients, it is possible to use psychoactive medicines, tranquillizers,
antidepressants of the tricyclic line,

4 Mental disorders in brain injuries. Classification. The clinical picture. Treatment approach.

Mental disorders caused by a brain injury depend upon the period of the traumatic disease. Thus, at the

most acute initial period, torpor, sopor, coma, disturbances in the cardiovascular activity and respiration
are observed. The acute period is more frequently characterized by nonpsychotic syndromes (asthenic,
apathoabulic syndromes, epileptiform seizures, anterograde and retrograde amnesia, surdomutism) and
psychotic ones (a twilight state of consciousness, posttraumatic delirium, dysphoriae, Korsakoffs
syndrome).

At the late period, nonpsychotic disorders are observed: the asthenic, asthenoneurotic, epileptiform,
psychopathy-like (affective instability) syndromes, while late posttraumatic psychoses (hallucinatoryparanoid, manic-paranoid, depressive-paranoid) rarely occur. Remote consequences of a brain injury
include cerebrasthenia, encephalopathy, dementia, posttraumatic epilepsy, a posttraumatic
development of the personality.

The treatment of mental disorders in brain injuries depends upon the stage of the disease, its severity
and expressiveness of clinical manifestations. Slight injury of the head, must be hospitalized and follow
bed regimen during 7-10 days, children and elderly people require a more prolonged stay at in-patient
department. Symptoms demonstrating an increased intracranial pressure, dehydration is
recommended. Autonomic disturbances are controlled with tranquillizers, and oxybarotherapy is
recommended for reducing cerebral hypoxia. Neuroleptics, large doses of Diazepam (up to 30 mg
intramuscularly) and sodium oxyburate are administered for productive psychopathological symptoms
and excitement. Anticonvulsive therapy treating epileptiform disorders, antidepressants for affective
depressive disorder


5 Mental disorders owing to intoxications. Classification. The clinical picture. Treatment approach.

Classification of mental disorders caused by intoxication.
The intoxication-induced mental disorders are systematized by 2 principles: depending upon the toxic
agent and depending upon the clinical picture. Depending upon the toxic agent, there are the following
kinds of intoxications:

a) drug-induced (poisoning with soporifics, sedatives, bromine, atropine, mepacrine hydrochloride,
neuroleptics, tranquillizers, steroid hormones, reserpine);
b) food-induced (poisoning with ergot, mushrooms, botulism);
c) occupational and domestic (poisoning with mercury, lead, tetraethyl lead, carbon monoxide,
organophosphorous compounds, petrol, benzene, antifreeze, acetone, pesticides, aniline, hydrogen
sulphide, carbon sulphide, illuminating gas, manganese, arsenic.
By their course, intoxication-induced mental disorders are subdivided into acute and protracted.
Mental syndromes in acute intoxications are as follows:
1) asthenic (asthenoneurotic, asthenodepressive, asthenohypochondriacal) in all kinds of poisonings;
2) disengagement of consciousness (barbiturates, tranquillizers, carbon monoxide, antifreeze,
pesticides);

3) delirious (melipramine, amitriptyline, bromine, hydrogen sulphide, carbon monoxide, atropine,

illuminating gas, Leponex, diphenylhydramine hydrochloride, benzhexol hydrochloride, tetraethyl
lead, aniline, petrol, mushrooms, botulism);
4) oneiroid (acetone, ether, steroid hormones);
5) amentia (organophosphorous compounds, ergot);
6) maniac (mepacrine hydrochloride, steroid hormones, carbon sulphide);
7) paranoid (psychostimulants);
8) catatonic (corticoids, ACTH)


6 Mental and behavioral disorders owing to alcohol drinking. Classification. The clinical picture.
Treatment approach.

Classification of alcoholic mental disorders
I. Acute alcoholic intoxication
1. Simple alcoholic intoxication
2. Pathologic intoxication
II. Habitual alcoholism
III. Chronic alcoholism
IV. Metalcoholic psychoses
I. Acute alcoholic intoxication a symptom complex of mental, autonomic and neurological disorders
caused by the effect of liquor.

1. Simple alcoholic intoxication there is three degrees of severity of alcoholic intoxication: mild,
moderate and severe.

The mild degree of simple alcoholic intoxication develops if the alcohol concentration in the blood is
within 20-100 mM/l (20-100 mg of alcohol per 100 ml of blood) feeling of mental and physical
comfort, talkative and they feel cheerful and surging with energy. Their social contact becomes
easier (in a shy person- they mingle and start conversation with strangers, joke and laugh.) They may
rise in work capacity but feels delusional, but with poor attention span. Quantity and quality of work
completed decreases.

The moderate degree of simple alcoholic intoxication develops if the alcohol concentration in the
blood is within 100-250 mM/l and is characterized by a reduction in the process of excitement. The
mood changes: the person develops excessive touchiness, short temper, and dissatisfaction with
what is taking place- drunkard state and acts.
Ability to correctly Asses situation decreases, often resulting in illegal actions. Process of thinking is
slower, statement trivial, speech slurred with preservation. Difficult choose words- dysarthria.
Acoustic perception elevated- speech becomes loud; they find it difficult to switch attention-
handwriting is rough and ataxia develops. Movements is uncoordinated- sensitivity to pain and

temperature decrease. Hyperaemia of the face- cyanosis and paleness.

The severe degree of simple alcoholic intoxication develops if the alcohol concentration in the blood
is within 250-400 mM/l. It manifests itself by disturbance of consciousness from torpor, somnolence
(stage of being half asleep during the day) to spoor (pathological sleep- lies motionless) to coma
(only vital organs are active). Expressed neurological disturbances, ataxia, muscular atony,
dysarthria and amnesia are present. Vestibular disturbances (nausea, vomiting, dizziness, a feeling
of tinnitus) develop. The acuity of vision decreases; the orientation in the place is affected.
Psychosensory disorder (Metamorphopsiae (Alice in Wonderland)) and illusion. Cardiac activities
become weaker- BP and body temperature falls. Intoxicated person looks sleepy and soon falls
asleep with narcotic sleep or awkward position. If the blood alcohol level exceeds 700ml the patient
may become sick due to respiratory and cardiac paralysis
1st stage MONKEY (due to excitement and foolish behavior)
2nd stage LION (bad mood negative delusions)
3rd stage PIG (cause they fall down, sleep and loss of consciousness)

2. Pathologic intoxication (idiosyncratic intoxication) an acute psychotic state, which develops after
taking various, doses of alcohol (from 300-500 ml to 50-150 ml if evaluated in 40 drinks), develops
suddenly, patients become anxious, confused, estranged from the world. Movements are accurate
and quick and statements are threatening. The patient does not look drunk, the look certain of
himself or herself. Development of a twilight state of consciousness, Delusion of relationships- they
feel someone wants to harm them, they are defensive towards others, threatening character with
resultant confusion, anxiety, fear, horror and posses wrong judgment. They dont usually speak but
if they respond its usually premature, short and resembles zombie forms.

The treatment of acute alcoholic intoxication consists of the following components: gastric lavage, a
subcutaneous administration of 0.25-0.5 ml of apomorphine hydrochloride to cause vomiting,
catheterization of the bladder in case of retention of urine. In the state of coma: injection of cardiac
drug preparations, IV by 100 mg of pyridoxine (vitamin B6), up to 1,000 ml of a physiological solution
with 40 % glucose

II. Habitual alcoholism ( Russian- Black Humor) A bad habit that becomes a disease-Alcoholism. The
main indices of habitual alcoholism is drinking alcohol but never exceeding the first acute stage.
(Countries like France at Lunch)

III. Chronic alcoholism

Chronic alcoholism, the clinical practice distinguishes 3 stages: initial (I), middle (II) and final (III).

The first (initial) stage of alcoholism (Tolerance) is characterized by a pathologic drive for alcoholic
drinks, a decrease of the quantitative control, and an increase of tolerance, alcoholic amnesiae.

Manifestations of the 1st stage of alcoholism form in people before 25 years of age, in others at 25-35
years It lasts from 1 to 6 years. Tolerance for spirits at this stage increases 2-3 times, the vomiting reflex
after overdosages disappear. Negative social consequences are more commonly restricted by family
quarrels and a delay in career advancement.

The second stage of alcoholism. The alcohol abstinence syndrome is its main diagnostic sign all the
symptoms of the illness typical for the 1st stage aggravate. The 2nd stage of alcoholism forms by the age
of 25-35 years, in 2/3 of the patients it lasts less than 10 years, in 1/3 10-15 years Tolerance for spirits
achieves its maximum and during several years remains constant, exceeding the initial one 5-6 times.
characterized by expressed dysadaptation. In half of the patients, their marriages break up, they often
lose their previous qualification.

The third stage of alcoholism. A pathologic drive for alcoholic drinks at this stage becomes irresistible,
develops spontaneously and requires taking liquor in large quantities. The lost of the quantitative
control is accompanied by a loss of the situational one. Any, even the smallest dose of spirits causes an
irresistible drive for alcoholic drinks with a desire to get it by any cost, even illegally. Tolerance for spirits
decreases. At the 3rd stage of alcoholism there is formation of rough, often irreversible pathological
changes in the whole organism Somatic and neurological disturbances. Chronic alcoholism is most
typically characterized by fatty degeneration of the liver and polyneuropathy. Disturbances in the
gastrointestinal tract are caused by a toxic effect of alcohol on hepatic cells, a disturbance of lipid
metabolism, deficit of proteins and vitamins of B group with resultant development of fatty
degeneration, hepatitis and cirrhosis of the liver. Cardiovascular diseases result from a direct toxic effect
of alcohol on the myocardium; it gives rise to myocardial dystrophy with development of heart failure
and disruption of the contractile function of the myocardium; atherosclerosis of the coronary vessels is
often revealed.
Diseases of the respiratory organs develop as a result of the fact that alcohol partially in an unchanged
form is breathed out through the lungs, bronchi and trachea thereby causing catarrhs of the upper
respiratory tract, atelectasis, bronchiectases.

Alcoholic psychoses ( page 219)
Alcoholic psychoses are acute, protracted and chronic disorders of the psychic activity which, according
to the WHOs data, develop in 10 % of alcoholics mostly in the 2nd and 3rd stages of the disease
In ICD-10, alcoholic psychoses are classified in the following way:
- F10.4: the state of withdrawal with delirium resulting from use of liquor
- F10.5: psychotic disorders resulting from use of liquor (hallucinosis, alcoholic delusion of jealousy)
- F10.6: alcoholic amnestic syndrome (Wernickes syndrome, Korsakoffs syndrome).
In our narcology, alcoholic psychoses are classified by their syndromic signs and course:
I. Acute alcoholic psychoses
1. alcoholic delirium

2. acute hallucinosis
3. acute paranoid
II. Protracted alcoholic psychoses
1. hallucinosis
2. paranoid
3. delusion of jealousy
4. depression
III. Alcoholic encephalopathies
1. Wernickes syndrome
2. Korsakoffs syndrome
3. dementia
Delirium tremens
Usually develops 3-7 days after discontinuation in taking spirits or a sharp reduction in the dose of
patients abusing for 5-15 years at the age of 30-40 year At the prodromal stage, which may last from a
few days to several months, there are sleep disturbances with frequent awakenings, nightmares, fears,
palpitation, sweating. At daytime, the patients usually have asthenia with anxiety and nervousness. The
classical variant of delirium tremens is characterized by a number of consecutive stages.

Alcoholic hallucinoses
Developing at the age of 40-43 years during the 10th-11th year of the alcoholic disease. hallucinoses are
subdivided into acute, prolonged (protracted) and chronic. Insomnia or interrupted sleep, the patients
develop acoasm, phonemes (some whistle, noise, whisper, separate words or short phrases). After them
come verbal hallucinations; at first they are of a neutral character, and later the patient hears a lot of
voices which threaten, comment or condemn his behavior. The hallucinations are accompanied by
anxiety, fear, despair, in the beginning of the psychosis by bewilderment; the patients make attempts of
self-defence: from seeking police help, running to suicidal or socially dangerous actions. Psychotic
symptoms usually reduce critically after profound sleep.

ALCOHOLIC ENCEPHALOPATHY
Alcohol
is a classic example of an acute and chronic ingestion that causes brain function changes. When a
person
drinks

alcohol to excess, it alters brain activity. An acutely intoxicated person demonstrates lack of judgment
and decreased reflexes and coordination. If enough alcohol is ingested, the parts of the brain that
control wakefulness and breathing can be depressed to the point that the person can become
comatose. These effects are short lived and transient as the liver metabolizes the alcohol and removes it
from the body. When the alcohol is gone, the individual returns to normal functioning. However, when
alcohol is repeatedly abused, it can cause liver disease increasing ammonia levels and encephalopathy
or there can be direct damage to the brain with loss of brain tissue.
Wernicke-Korsakoff syndrome is one type of alcoholic encephalopathy that is caused by thiamine
(vitamin B1) deficiency due to malnutrition. The malnutrition occurs because most of the dietary calories
are derived from alcohol, decreased appetite from a regular diet, and possibly malabsorption of
nutrients from the intestine. There may be memory loss and confusion, loss of coordination and ataxia
with a wobbling gait (walk), and confusion.
PRINCIPLES OF TREATMENT OF ALCOHOLIC PSYCHOSIS
1)disintoxication;
2) elimination of metabolic disturbances(hypoxia, acidosis, hypo- and avitaminosis) and correction of
thewater-electrolyte, acid-base state;
3)elimination of haemodynamic, cardiovascular disturbances;
4)prevention or elimination of pulmonary oedema, if the latter develops;
5)prevention and elimination of hypoxia and oedema of the brain;
6)normalization of the respiration;
7)elimination of hyperthermia;
8)prevention and elimination of dysfunctions of the liver and kidneys;
9)treatment of a concomitant somatic pathology.
Therapy of other forms of alcoholic psychoses and encephalopathies should be complextoo and include
disintoxication (medicamental and drugless), vitamins,neuroleptics, tranquillizers, nootropic drugs,
nonspecific stimulation in caseof a protracted course. The main place in the therapy of hallucinoses
anddelirious alcoholic psychoses is taken by psychoactive drugs: chlorpromazinehydrochloride,
Stelazine, haloperidol, methotrimeprazine. If the patientsdevelop symptoms of depression,
antidepressants are administered.

14. Anxiety-phobic disorder::

CLASSIFICATION OF ANXIETY DISORDER
o

1.1Generalized

1.2Phobias

1.3Panic disorder

1.4Post-traumatic stress disorder

1.5Separation anxiety

1.6Situational anxiety

o 1.7Obsessivecompulsive disorder
Generalized anxiety disorder

This disorder is characterized by excessive anxiety and worry. Worrying is difficult to control. Anxiety
and worry are associated with at least 3 of the following symptoms:

Restlessness or feeling keyed-up or on edge

Being easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep disturbance
Although not a diagnostic feature, suicidal ideation and completed suicide have been associated
with generalized anxiety disorder

Social anxiety disorder (social phobia)

A person with social phobia will typically report a marked and persistent fear of social or
performance situations, to the extent that his or her ability to function at work or in
school is impaired. Exposure to social or performance situation always produces anxiety.
Social or performance situations are avoided or endured with intense anxiety.
Avoidance behavior, anticipation, or distress in the feared social or performance setting
produces significant impairment in functioning.
Ask the patient about any difficulties in social situations, such as speaking in public,
eating in a restaurant, or using public washrooms. Fear of scrutiny by others or of being
embarrassed or humiliated is described commonly by people with social phobia.
Agoraphobia
Inquire about any intense anxiety reactions that occur when the patient is exposed to
specific situations such as heights, animals, small spaces, or storms. Other areas of
inquiry should include fear of being trapped without escape (eg, being outside the home
and alone; in a crowd of unfamiliar people; on a bridge, in a tunnel, in a moving vehicle).
Specific (simple) phobia
If specific phobias are suspected, specific questions need to be asked about irrational
and out of proportion fear to specific situations (eg, animals, insects, blood, needles,
flying, heights). Phobias can be disabling and cause severe emotional distress, leading to
other anxiety disorders, depression, suicidal ideation, and substance-related disorders,

especially alcohol abuse or dependence. The physician must inquire about these areas
as well.

Phobias

The single largest category of anxiety disorders is that of phobic disorders, which
includes all cases in which fear and anxiety are triggered by a specific stimulus or
situation. Between 5% and 12% of the population worldwide suffer from phobic
disorders.[6] Sufferers typically

anticipate terrifying consequences from encountering the object of their fear, which can
be anything from an animal to a location to a bodily fluid to a particular situation.
Sufferers understand that their fear is not proportional to the actual potential danger
but still are overwhelmed by it

Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is an anxiety disorder that results from a traumatic
experience. Post-traumatic stress can result from an extreme situation, such as combat,
natural disaster, rape, hostage situations, child abuse, bullying, or even a serious
accident. It can also result from long-term (chronic) exposure to a severe stressor,for
example soldiers who endure individual battles but cannot cope with continuous
combat. Common symptoms include hypervigilance, flashbacks, avoidant behaviors,
anxiety, anger and depression.[22] There are a number of treatments that form the basis
of the care plan for those suffering with PTSD. Such treatments include cognitive
behavioral therapy (CBT), psychotherapy and support from family and friends.

Posttraumatic stress disorder (PTSD) research began with Vietnam veterans, as well as
natural and non natural disaster victims. Studies have found the degree of exposure to a
disaster has been found to be the best predictor of PTSD.

Separation anxiety

Separation anxiety disorder (SepAD) is the feeling of excessive and inappropriate levels
of anxiety over being separated from a person or place. Separation anxiety is a normal
part of development in babies or children, and it is only when this feeling is excessive or
inappropriate that it can be considered a disorder. Separation anxiety disorder affects
roughly 7% of adults and 4% of children, but the childhood cases tend to be more
severe; in some instances, even a brief separation can produce panic.Treating a child
earlier may prevent problems. This may include training the parents and family on how
to deal with it. Often, the parents will reinforce the anxiety because they do not know

how to properly work through it with the child. In addition to parent training and family
therapy, medication, such as SSRI's, can be used to treat separation anxiety.

Situational anxiety

Situational anxiety is caused by new situations or changing events. It can also be caused
by various events that make that particular individual uncomfortable. Its occurrence is
very common. Often, an individual will experience panic attacks or extreme anxiety in
specific situations. A situation that causes one individual to experience anxiety may not
affect another individual at all. For example, some people become uneasy in crowds or
tight spaces, so standing in a tightly packed line, say at the bank or a store register, may
cause them to experience extreme anxiety, possibly a panic attack.Others, however,
may experience anxiety when major changes in life occur, such as entering college,
getting married, having children, etc.

Obsessivecompulsive disorder

Obsessivecompulsive disorder (OCD) is not classified as an anxiety disorder by the

DSM-5 but is by the ICD-10. It was previously classified as an anxiety disorder in the
DSM-4. It is a condition where the person has obsessions (distressing, persistent, and
intrusive thoughts or images) and/or compulsions (urges to repeatedly perform specific
acts or rituals), that are not caused by drugs or physical order, and which cause distress
or social dysfunction.The compulsive rituals are personal rules followed to relieve the
anxiety. OCD affects roughly 1-2% of adults (somewhat more women than men), and
under 3% of children and adolescents.

A person with OCD knows that the symptoms are unreasonable and struggles against
both the thoughts and the behavior.Their symptoms could be related to external events
they fear (such as their home burning down because they forget to turn off the stove) or
worry that they will behave inappropriately

It is not certain why some people have OCD, but behavioral, cognitive, genetic, and
neurobiological factors may be involved.Risk factors include family history, being single
(although that may result from the disorder), and higher socioeconomic class or not
being in paid employment. OCD is chronic; about 20% of people will overcome it, and
symptoms will at least reduce over time for most people (a further 50%)

Clinical features of anxiety

Attacks are associated with a constellation of systemic symptoms, including the following:

Palpitations, pounding heart, or accelerated heart rate

Sweating

Trembling or shaking
Shortness of breath or feeling of smothering
Choking sensation
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, lightheaded, or faint
Derealization (ie, feeling of unreality) or depersonalization (ie, being detached from oneself)
Fear of losing control or going crazy
Fear of dying
Paresthesias (ie, numbness or tingling sensations)
Chills or hot flashes.

15. PTSD clinical picture, anxious-phobic state with tearfulness, nightmares, disturbances of
derealization and depersonalization. The patients develop influxes of unpleasant recollections, related
to psychic trauma.
Treatment: psychotherapy, use of psychoactive drug, physiotherapy, remedical gymnastic.
16. anorexia nervosa: is a disease expressed by a deliberate restriction in eating in order to lose flesh.
Bulimia nervosa: is a disease which manifests itself through extreme insatiable with eating too much
food followed by artificial induction of vomiting.
Binge eating disorder: characterized by recurring binge eating at least once a week for over a period of 3
month while experiencing lack of control and guilt of overeating.
17. schizophrenia: classification- delirious psychoses, schizoaffective psychoses, acute and transitory
psychotic disorders. Clinical picture: split of psychic activity with a resultant loss the inner integrity of
the intellectual, emotional and volitional functions as well as the unity of the personality with the
environment. Autism, emotional disorders, a splitting of thinking, splitting of the mind, hebephrenic,
hallucinatory-delirious. Treatment: use of psychoactive substances, neuroleptics with the sedative
(aminazine, propazine), antipsychotic; haloperidol.
18.
19. bipolar disorder(manic-depressive psychosis) is an endogenous disease characterized by alteration of
outwardly contradictory states or phases, maniac and depressive. Clinics; effector-volitional
disturbances (which at maniac and depressive phases are of the opposite character) and those of
understanding, as well as by somatoautonomic symptoms demonstrating.
20. Mask in form of algiae: cephalgia, cardialgia, abdominalgia, fibromyalgia, neuralgia etc
Mask in form of patho-characterological disorders: disturbances in drive (narcomania, toxicomania,
dipsomania), hysterical response, asocial behavior (impulsiveness, aggression)

21.Suicide:
n True
n it is usually well-planned event, whose purpose is to die at any price, regardless of the
opinions and reactions of relatives, friends and so on.
n Demonstrative (the so-called parasuicide or pseudosucide)
n Its purpose not to die but attract attention to their problems and others, "a cry for
help
Reasons (problems in ones personal life)
n Family conflicts, divorce
n Bad love;
n Death, illness or loss of a loved one
n Loneliness , the lack of care and attention from others
n Chronic or prolonged stressful situation in the sphere of interpersonal, often family relations
n Failures at work, in their studies
n Financial loss
Medical illness and suicide
n Chronic pain
n Surgery
n Lack of psychological and palliative care to patients in the terminal stages ;
n Old people somatic illnesses (oncological, cardiovascular, bronchial asthma)
n Young people ugliness
n Hereditary factor 30-50%
Severe mental disorders
n Depression (15% of depressive patients can commit suicide)
n Bipolar disorder,
n Schizophrenia,

n Borderline personality disorder,

n Alcoholism
n Drug abuse
Suicide prevention
n Suicide prevention efforts include limiting access to method of suicide such as firearms and
poisons, treating mental illness and drug misuse, and improving economic circumstances.
n Although crisis hotlines are common, there is little evidence for their effectiveness.
22.epilepsy, 3 types; idiopathic, symptomatic, cryptogenic. Clinical picture of generalized tonic-clonic
seizure; change in mood, a headache, a worsened general state developing some hours before seizures,
some patient feel aura. Minor seizure; some flushing or paleness of the face, a moderate mydriasis.
Status epilepticus; acute infection, intoxications, disturbances respiration, cardiovascular activity, blood
circulation, cerebral metabolism. Treatment; anticonvulsant, mental disorders in epilepsy- neuroleptics,
tranquilizers and antidepressants. Treatment for epilepsy; phenobarbital, benzodiazepines,
ethosuximide, valproate sodium.
23. oligophrenia; is a dementia which is congenital or acquired at early stages and manifesting itself by
general psychic underdevelopment and intellectual defect; classification; according to degree; debilitymild degree, imbecility-moderate degree and idiocy severe degree. According to Etiology; hereditary,
infection and intoxication, irradiation of pregnancy, immunological incompactibility of tissues of the
mother and foetus, incomplete pregnancies and influence of negative social-cultural factors. Clinical
picture; disorder of cognitive activity, emotional-volitional sphere, thinking, memory, attention, speech,
motility. Treatment; nootropics; pantogam, nootropil, aminalon. Dehydrating drugs; magnesium sulfate,
euphylline, glycerin. Neuroleptics; aminazine, sonapax. Tranquillizers and antidepressant; tazepam,
phenazepam, hydazepam, amitriptyline, pyrazidol.
24. personality disorders; they include character abnormalities manifesting themselves by a disharmony
in the emotional and effector-volitional spheres and mostly affective thinking. Classification; charater
accentuations, psychopathies, psychogenic pathological development of personality, psychopathization
of personality caused by various disease
25. autism; dnt know the classification. Clinical picture, some have IQ is below 50, and only 1/3 is over
70, the patient memorize complex calculations, they preserve musical, mechanical and mathematical
abilities, 2/3 of patient are not able to live independently and have no skills for unaided self-selviving.
Treatment; neuroleptics, tranquillizers, antidepressants and sedatives.
26.ADHD/Hyperkinetic disorder ( no classification for the groups)

Psychiatry unit 4. Questions 1 to 10.

1 General principle of treatment of mental disorders
Controlling therapy:
It is given to remove acute manifestation of mental disorders (excitement,
hallucinosis) and is also given at first stage of admission to hospital. To remove
these disorders, example, In alcohol delirium give iv infusion of sibazone, In
antidepressants: 7 months normal state, antidepressants 4-6 months/1 year then
sleep. If endogenous begin treatment again to prevent next relapse.
Maintenance therapy:
It is when an actual recovery to some improvement has been achieved, but
absolute discontinuation of treatment threatens with relapse or aggravation of
state. It leads to withdrawal syndrome causing aggravation of mental state and
autonomic disorders. Aim is to prevent relapse in chance, in productive
symptoms, keep state stable. Duration is many months and years. You give long
acting drugs. To remove these disorders, example tranquillising: give sedatives
not more than 2-3 weeks.
Corrective therapy:
It is directed at removal of distressing side effects of psychoactive drugs mainly in
form of extrapyramidal disorders. To remove these disorders give
antiparkinsonian drugs orally e.g cyclodone (Artane, Romparkin, Parkopan).
Preventive or anti relapse therapy:
It is given against a background of recovery or good remission. Example Lithium
salts for manic depressive psychosis, their regular use prevent development of
the next phase.
METHODS OF TREATMENT
Psychotherapy:

It is treatment by psychic factors: words, nonverbal conditional stimulants,

situation, certain kinds of work.
Social therapy:
It is treatment by sociopsychological factors: influence of social environment,
societies of former patients or collective activities.
Pharmacotherapy:
Neuroleptics, tranquillizers, antidepressants, thymostabilizers, psychostimulants
and nootrops.
Rehabilitation therapy:
System of measures for restoration (full or partial) of patients social status.
Biological therapy.
2 CLASSIFICATION OF PSYCHOTROPICS DRUGS. INDICATIONS
Neuroleptics, tranquillizers and sedatives are drugs for treatment of psychic
disorders of different severity. Lithium salts are used to treat mania.
Classification of neurolaptics
A Typical neuroleptics
1 phenothiazines:
Chorpromazine (Aminazinum),
(Phthorphenazinum),
2 Butyrophenones:
Haloperidol, Droperidol
3 Thioxanthenes
Chlorprothixene

Trifluoperazine

(Triftazinum),

Flunazine

B Atypical neuroleptics
1 Dibenxzodiazepines
Clozapine
2 Benzamides
Sulpiride
Tranquillizers drugs
1 Benzodiazepines
Chlordiazepoxide (Chlosepidum), Diazepam (Sibasonum), Phenazepamum,
Medazepam (Mezapam, Rudotel), Gidazepam
2 Preparations of other chemical structure
Buspirone, Benactyzime (Amizilum), Meprobamte (Memprotanum)
Sedatives
1 Non organic preparations
Sodium bromide, Potassium bromide
2 Vegetable preparations
Tincture from valerian, Tincture from leonurum
3 Combined preparations
Corvalolum, Valocormidum
Drugs used to treat mania
1 Lithium salts
Lithium carbonate, Lithium ovibutyrate
2 other preparations

Carbamazepine, clonazepam, valproic acid.

Indications:
For neuroleptics: Schizophrenia, dementia, anxiety on schizophrenia, alter general
anesthesia = haloperidol.
For tranquillizers: anxiety.
For sedatives: restlessness, anxiety.
Mania drugs are used to treat mania and bipolar disorders.

3 NEUROLEPTICS. CLASSIFICATION. INDICATIONS. SIDE EFFECTS
Classification
On action of psychotic symptoms, 3 grps:
1 Neuroleptics with primary sedative effect (aminazine, tizercine, truxal).
2 Neuroleptics with general antipsychotic effect (trifluoperazine, haloperidol)
3 Neuroleptics with antipsychotic effect accompanied by stimulating component
(meterazine, perphenazine, frenolon, sonapax, neuleptil, chlorprothixene,
eglonyl)
Extrapyramidal disorders
Typical: I, II, III (haloperidol, chlorpromazine, onazepin)
Atypical: IV, V, VI, VII, VIII (azaleptin, olanzapine, rispolept)
Atypical Risperidone on antipsychotics can give kids autism, hyperkinetic disorder.
Typical provokes extrapyramidal system is older generation. Atypical can have
extrapyramidal system but not as much as typical.
Indications:

For neuroleptics: Schizophrenia, dementia, anxiety on schizophrenia, alter general

anesthesia = haloperidol.
Side effects:
Extrapyramidal system: tremor, rigidity of muscles. Convulsive cramps of tongue,
neck, eyes and face.
Depression, increase appetite, hypersomnia. Neuroleptic syndrome = apathy,
depression, parkinsonism. Seizures, gen tonic seizures i.e epistatumus,
amenorrhea.



4 Antidepressants. Classification. Indications. Side effects.
Classification
Drugs suppressing the neuronal uptake of monoamines:
Nonselective effect (imipramine, amitriptyline)
Selectively blocking the uptake of noradrenaline (maprotiline)
Selectively blocking the uptake of serotonin (fluoxetine, sertraline, citalopram)
MAO inhibitors:
Irreversible, nonselective effect, MAO-A and MAO-B (nialamide, transamine)
Reversible, selective effect, MAO-A (moclobemide)
Action on psychotic symptoms, 3 grps:
1 With a stimulatory effect (imipramine, cefidrine, petilin, nialamide, anafronil,
transamine, indopan, bediul, iprazide, moclobenid, tetrindol, incasan)

2 With a sedative effect (amitriptyline, fluoracizine, herfonal, opipramol, damilen,

azophen, trazodone, chloracizine)
3 With a stabilized stimulatory and sedative effect (pyrazidol, fluvoscasamine,
maprotiline)
Indications:
Depression when it last more than 2 weeks, panic disorders (not anxiety),
obsessive compulsive disorders (OCD), PTSD, neurosis.
Side effects:
Excitement, agitation, sleep disturbance: insomnia or hypersomnia, constipation,
tachycardia, low BP, urinary retention, dry mouth, disturbance of accommodation
(dont see well), amenorrhea, absence of menstruation and gaining weight,
dizziness.


5 TRANQUILIZERS, ANXIOLYTICS. CLASSIFICATIONS. INDICATIONS. SIDE EFFECTS
Classification
1 Agonist of benzodiazepine receptors (diazepam, phenazepam)
2 Agonist of serotonin receptors (Buspirone, campirone)
3 Substances with different types of effect (benactyzine)
Indications:
Anxiety, agitation not in anxiety of schizophrenia.
Side effects:
Addiction (no BZD goup shd be prescribe for more than 2 weeks), hypersomnia,
tremor.

6 MOOD STABILIZERS. CLASSIFICATION. INDICATIONS. SIDE EFFECTS.

Classification
Lithium carbonate
Lithium oxibutyrate
Carbamazepine
Indications:
Manic-depressive, bipolar disorders and schizoaffective psychoses.
Side effects:
Diarrhoea, tremor of mucles, thirst, enlargement of kidney and thyroid.
7 ANTICONVULSANTS. CLASSIFICATION. INDICATION. SIDE EFFECTS
Classification
1 Preparations for the treatment of epilepsy with grand mal
Phenobarbital, phenytoin (dipheninum), carbamazepine (finlepsin), valproic acid,
sodium valproate.

2 Preparations for the treatment of epilepsy with petit mal
Valproic acid, clonazepam, ethosuximide.
Indications:
Epilesy, seizures, syncope, spasms, paroxysms, sleep disorders, enuresis, bipolar
disorders
Side effects:
Ataxia, tremor, dizziness, blurry vision, addiction

8 NOOTROPIC DRUGS. CLASSIFICATION. INDICATIONS. SIDE EFFECTS.

Classification
1 GABA derivatives: pyracetam, phenibut, aminalon.
2 Combined: Neoglutin, pyriditol, orocetam, pantigam, vitapyracen.
3 Brain vasodilator: stugeron, cavinton, sermion, vinpocetin.
4 Others: aminalon, gingoging, encephabol, tanacan.
Indications:
It improves memory and thinking, restoration of speech and movement, improve
state of patients with asthenodepressive manifestations.
Side effects:
It increase production symptoms, increase blood supply to brain, increase activity
and positive symptoms, increase hallucinations, delusions.
9 DRUGS FOR DEMENTIA TREATMENT (ACETYLCHOLINESTERASE INHIBITORS).
CLASSIFICATION. INDICATION. SIDE EFFECTS.
No cure.
At earlier stagesof senile atrophic nootropics drugs are given. In cases of
psychoses, neuroleptics that dnt cause severe side effect is given (sonapax,
chlorprothixene, perphenazine) and mild antideprssants (pyrazidol, azaphen) are
used. Provide good diet, control physiological discharges and cleanliness of skin,
involve them in simple activities.

Classification
Anticholinoesterase inhibitors:
Donepezil

Indications:
Alzheimers disease.
Side effects: difficulty sleeping, muscle cramps, anorexia.
10 PSYCHOSTIMULANTS. CLASSIFICATIONS. INDICATIONS. SIDE EFFECTS.
Classification
1 Phenyl alkylamines phenamine
2 Piperazine derivatives methylphenidate hydrochloride
3 Sidnonimines sidnocarb
4 Methylxanthines caffeine
5 Benzimidazole derivatives bemitil
Indications:
Increase physical and mental capacity for work, reduce fatigue, reduce need of
sleep, lethargy, weight loss, orthostatic hypotension, tachycardia
Side effects:
Sleeplessness, short temper, restlessness, drug dependence, hypertension