Organic brain damage. Organic diseases of the brain
) - are reversible, the interaction is disturbed, structural disorders - the structure is destroyed. Most organic diseases are structural disorders.
Now there are methods of intravital visualization of GM. These are the methods computed tomography. Previously, many diseases were accurately determined only after an autopsy. Now even on early stages can be diagnosed.
Atrophic processes- Alzheimer's disease and Pick's disease. CT shows atrophy of the cortex, which makes it possible to treat them in the early stages of the disease, or rather, to slow down the process. Some medicines are only effective for initial stages diseases.
International Classification of Diseases (ICD-10)
based on the identification of the leading syndrome.
F 0. Organic, including symptomatic, mental disorders
F00 - dementia in Alzheimer's disease
F 01 - vascular dementia
F 02 - for other diseases
02.0 - with Pick's disease
02.2 - in case of Huntington's disease
02.3 - in Parkinson's disease
F 03 - dementia, unspecified
F 04 - organic amnestic syndrome (Korsakovsky), not caused by alcohol or other surfactants
F 05 - delirium not caused by alcohol or other surfactants
F 06 - other productive organic mental disorders (hallucinosis, delirium, catatonia, depression, asthenia, hysterioformin symptoms)
F 07 - personality and behavioral disorders due to disease, damage and dysfunction of the brain
F 09 - Unspecified organic or symptomatic mental disorders
Domestic classification of mental illness
Based on the allocation of nosological groups of mental disorders.
1. Endogenous organic diseases
1. 1. Epilepsy
1. 2. Degenerative (atrophic) processes
1. 2. 1. Dementia of the Alzheimer's type
- Alzheimer's disease
- senile dementia
1. 2. 2. Systemic organic diseases
- Pick's disease
- Huntington's chorea
- Parkinson's disease
1. 3. Vascular diseases GM
2. Exogenous organic diseases
2. 1. Mental disorders in GM injuries
2. 2. Mental disorders in brain tumors
2. 3. Mental disorders in infectious-organic diseases
3. Exogenous diseases
3. 1. Alcoholism
3. 2. Drug addiction and substance abuse
3. 3. Symptomatic psychoses.
In group 1, recovery does not occur, the changes are irreversible. In group 2, the disease can proceed regressively, i.e. mental functions are restored.
In group 3, almost everything is recoverable. The third stage of chronic alcoholism. Alcoholic encephalopathy. At the third stage of chronic alcoholism, spontaneous remissions are possible, the body refuses to take alcohol. Many of these patients become hypochondriacs. They begin to treat their diseased liver, brains ... He begins to take care of himself. In a year, such a person can simply not be recognized ... Only alcoholic will not recover. If you haven’t drunk for 20 years, and drink it, it will arise. All methods of alcoholism are based on the negative principle: "if you drink - a heart attack, stroke, blindness, impotence."
POS - psychoorganic syndrome (its severity increases from the 3rd group to the 1st).
Official mortality from drug addiction and substance abuse is low (they write - cardiovascular insufficiency ...)
Karl Bongeffer's concept of exogenously psychic preferred types, or the theory of exogenous type of reaction
GM can respond to various external harms only with a limited number of non-specific psychopathological reactions.
Five exogenous types of reactions (1908-1910)
1. Stun
2. Delirium
3. Amenia
4. Twilight clouding of consciousness, or epileptiform excitation
5. Acute hallucinosis
These five types of reactions do not occur in schizophrenia, only in organic lesions.
In 1917, K. Bongeffer expanded the phenomenology of exogenous reactions:
1. Maniaform
2. Depressive
3. Catatonic
4. Paranoid syndromes
5. Emotionally hyperesthetic weakness (asthenic syndrome)
6. Amnestic (Korsakovsky) syndrome
nine registers mental disorders according to A.V. Snezhnevsky.
K. Schneider (1959) and N. Wieck (1961) identified two groups of disorders from the “exogenous type of reactions” of K. Bongeffer:
- reversible or "transitional" syndromes
1) manic
2) depressive
3) paranoid
4) hallucinatory-paranoid syndrome without clouding of consciousness
- irreversible states
1) personality changes by organic type
2) organic dementia
3) persistent amnestic (Korsakovsky) syndrome
Acute and chronic alcohol intoxication.
Acute intoxication - any intake of alcohol. Chronic - in patients with chronic alcoholism, when the patient became alcoholic and was in an acute state for five to seven years. What reactions of exogenous type according to K. Bangeffer can we observe?
150 g of vodka in a few hours, sleep, relax and then go to a party. You will get drunk much more slowly, as alcohol dehydrogenase, which breaks down alcohol, has started (began to be produced by the liver).
Mild degree of alcohol intoxication (fun, good) - medium degree (not so easy, dysarthria). In the morning - lethargy, weakness, fatigue, palpitations, sweating, headache. This is an asthenic syndrome. Another example: someone is carrying a heavy . The disease ended - also asthenic syndrome. With mild - after, too, asthenic syndrome. So, there are three reasons: intoxication, brain injury, disease - asthenic syndrome. This is a non-specific reaction.
The person continues to drink, loss of control. They do not leave the table until the last bottle has been drunk. From the middle stage, he goes into a severe one. After it - stunning, stupor, coma. Employees of the teaching staff often encounter stupor. They pinch the inner surface of the thigh, or rub their ears strongly - then a person in a sopor can react (they retain pain sensitivity).
As the intoxication deepens, therefore, disorders of consciousness already arise. With trauma, infectious diseases, disorders of consciousness can also develop. That is, the disorder is one (delirium, for example), but the causes are different.
The dividing line between alcoholic and non-alcoholic - or the withdrawal syndrome. Both drank too much - the alcoholic drank in the morning - and he felt good. And a non-alcoholic person drinks in the morning - it will be even worse for him ...
Against the background of the withdrawal syndrome, voices of blasphemous content may appear - acute hallucinosis. In acute infectious disease and trauma, there may also be hallucinosis.
Delirium can be in alcoholics, in vascular patients, in infectious ... delirium can be complicated, mushing. It's basically an amentia. Activity within the bed. In the somatic clinic there is amentia (for example, in patients with tuberculosis). For amentia, a predisposition is needed - a weakening of the body.
epileptiform disorders- Almost everyone gives. In case of poisoning with adhesives - in children.
Maniaform disorders - euphoria in drunks. Alcoholic depression has been described. The patient comes out of amentia - fixative amnesia (Koraskovsky amnestic syndrome). Alcoholism is, as an example, a model of exogenous reactions. With very many exposures to human GM, a small number of reactions occur.
Psycho-organic syndrome (POS)
POS - refers to the whole complex of organic disorders that occur with any CNS lesions (synonyms: organic psychosyndrome, encephalopathic syndrome, dyscirculatory encephalopathy or DEP)
The term "organic psychosyndrome" was proposed in 1955 by M. Bleiler.
The clinical structure of POS is characterized by the triad of Walter-Buhel (1951):
1) violation of intelligence
2) memory loss
3) a disorder of affectivity or emotionality (these are synonyms in psychiatry), which gives the features of the clinical picture of a psychoorganic syndrome
Four forms of psychoorganic syndrome. They are differentiated by the predominance of certain disorders of emotionality.
1. Asthenic
2. Explosive
3. Euphoric
4. Apathetic
Asthenic form - the easiest option for POS
- increased physical and mental exhaustion
- irritable weakness
- mental hyperesthesia
- a meteopathic symptom (if the severity increases before the rise or fall of barometric pressure, this is a more severe course, and if the severity increases during the rise or fall of atmospheric pressure, this is a lighter course)
- dysmnestic disorders (weakening or decrease in memory, difficulty in remembering surnames, names, numbers, etc. He remembers what was a long time ago. Difficulties in fixing new information).
- Minor intellectual disability
- emotional lability (example. Grandmother is walking along the road. The girl says: “Let's, I will transfer you.” Grandmother starts crying for joy. She goes on. The bag fell - she has tears in her eyes again. Watches TV, a movie with a good ending - cries With a sad ending - also crying). Uniform reaction to different events.
This form of POS is typical for vascular diseases of the brain. For example, with atherosclerosis of the GM. The person becomes more flexible. Something joyful is shown, and tears flow.
In the asthenic form, it is not memory and intellect disorders that dominate, but emotional lability.
2. Explosive shape
- dominance: irritability, anger, explosiveness, aggressiveness, affective excitability
- dysmnestic disorders - they are more pronounced than in the asthenic form
- decrease in intelligence
- weakening of volitional delays, loss of self-control, increased drives (including sexual)
- alcoholization of patients, they notice that severe emotional states are well stopped by alcohol (dysphoria with brutality)
- the formation of overvalued formations (suspicion, jealousy, ideas of damage: Where are you doing money? Where is my stash?)
- hysterical reactions (increased claims to others when it is impossible to satisfy these requirements: Where is my beer? - You drank yesterday ... - hysterical reactions begin, up to hysterical convulsive seizures. Respolept is a neuroleptic that corrects behavior with a minimum of side effects.
This form of POS is typical for traumatic lesions of the GM.
When a patient with a psychoorganic syndrome begins to become alcoholic, the severity of the psychoorganic syndrome begins to increase. In the morning, such a traumatic person wakes up, offended by the whole world (dysphoria), everything is bad for him. And the ferocious massacre of the household begins. This is dysphoria with brutality.
3. Euphoric form
- dominance - high mood with a touch of euphoria and complacency
- incontinence of affect
- a sharp decrease in intelligence and criticism of one's condition
- increased desire (often against the background of potency)
- severe memory disorders (progressive amnesia)
- symptoms of violent laughter and violent crying
This form of POS is characteristic of progressive paralysis.
Now it is well treated with antibiotics (not antipsychotics, but). 5th line cephalosparin. treated well - 5-15 years untreated - and progressive paralysis. Now patients with progressive paralysis are practically not found. In the 95s. there was a surge.
4. Apathetic variant - the most severe variant of POS
- aspontaneity (unwillingness to do something)
- indifference to the environment
- a sharp narrowing of the circle of interests
- pronounced disorders of memory and intelligence (the most pronounced among other options)
Extensive lesions of the central nervous system affecting the frontal lobes - apatico-abulic symptoms - a negative (deficit) disorder.
This form of POS is typical for atrophic processes in the brain.
Summary. All organic diseases are characterized
- types of reactions K. Bongeffer
- POS of one option or another
Ranks of psychopathological disorders according to A. V. Snezhnevsky
9. Psychoorganic - organic diseases
8. Convulsive - epilepsy
7. Paramnesia
6. Stupefaction (delirium, amentia, twilight states)
5. Catatonic, paraphrenic, hallucinatory-paranoid -
4. Paranoid, verbal hallucinosis - TIR
3. Neurotic (obsessive, hysterical, depersonalization) -
2. Affective (depressive, manic)
1. Emotional-hypersthetic disorders - asthenia.
Repetition
Clinical forms:
- simple
- paranoid
- catatonic
- hebephrenic
+ juvenile malignant
(lucid catatonia, hebephrenic, simple)
Types of the course of schizophrenia:
- continuously flowing
- paroxysmal-progredient (fur-like)
- recurrent (acute attacks, in remission - a fairly benign condition)
The forecast depends on the type of flow: how quickly the defective state will occur (or not at all ...)
Attacks (acute state) and remissions (interictal state) are characteristic.
Schizotypal disorder (sluggish schizophrenia)
It can be added to clinical forms of schizophrenia.
- neurosis-like (for example, senestepathic-hypochondriac syndrome)
- psychopathic (heboid syndrome), this is a personality disorder or psychopathy that occurs as part of schizophrenia
40% of schizophrenics are indolent schizophrenia
affective psychoses
- mania
- depression
Flow types: bipolar, unipolar. In both types of flow, depression occurs. But if mania occurs, we talk about bipolar affective disorder. Unlike seizures and remissions, affective psychoses are characterized by phases and intermissions.
Forms of psychoses:
- bipolar
- unipolar
- cyclothymia (subdepression and hypomania, they are less pronounced and less prolonged)
- dysthymia (at least two years)
- endoreactive dysthymia (depression begins as reactive, there is a traumatic factor, for example, someone died in a woman, depression lasts for many years, the significance of psychotrauma decreases, and depression continues, and the phases are like endogenous depression, i.e. this dysthymia gradually endogenized)
- involutional depression (55+, the dominant syndrome is anxiety depression)
Scale: Schizotypal Disorder - Schizophrenia - Schizoaffective Psychosis - Mood Psychoses
Schizoaffective psychosis - he has signs of both affective psychosis and schizophrenia.
- schizodominant form
- affect-dominant form
The symptoms are schizophrenic, but proceed at a high emotional level. It is essentially recurrent schizophrenia. It is considered the most favorable type of flow.
Types of the course of diseases
continuous type
- the absence of productive symptoms, the growth of negative symptoms. The hebephrenic form of schizophrenia will increase in a similar way. The most unfavorable type. A simple form, hebephrenic and catatonic (included in juvenile malignant).
Phase type
characteristic of affective psychosis. There must be an intermission - a return to the mental norm, no matter how many phases there are.
Recurrent flow type
First, during the course of the disease, intermissions occur (this may be the case for a schizotypal disorder). The first few attacks may end with a return to mental normality. Therefore, the diagnosis of MDP is erroneously made. Then, from the third attack, negative disorders join. Then it is either schizoaffective psychosis or recurrent schizophrenia.
Fur-like type of flow or paroxysmal-progressive type of flow.
In interictal intervals, personality changes increase. With each attack, the sharpness of the peaks decreases, and the productive symptoms become less and less, and the negative ones become more and more. Translated from him. “fur coat” is a shift (the personality shifts towards the appearance of negative disorders). This flow eventually becomes like a continuous type. This is how the paranoid form of schizophrenia flows. A lot depends on genetics, on the personality itself. Progression is very individual. 10-15-25 years old.
When diagnosing schizophrenia, the basis is negative symptoms (4 "A" according to Blair). She is surrounded by productive symptoms and symptoms of the 1st rank according to K. Schneider. And has flow types. It is necessary to pay attention to the "+" symptoms, "-" symptoms and types of flow.
Alzheimer's disease
It starts with memory loss. There is a hereditary predisposition. Also - untreated hypertension, sedentary lifestyle.
The GM bark dies. This leads to progressive memory loss, first of all memory for recent events suffers. Dementia develops, the patient needs outside help. From the first signs of forgetfulness to the death of the patient takes 5-10 years. The rate of progression is slow. Suspension of the course of the disease is possible. The diagnosis is made by a neurologist or psychiatrist.
Methods of therapy slow down the development of the disease.
Signs of BA:
1. Repeating the same question
2. Multiple repetition the same story, word for word
3. Loss of everyday skills, such as cooking or cleaning the apartment
4. Inability to manage financial affairs, such as paying bills
5. Inability to navigate in a familiar place or place common household items in their usual places
6. Neglect of personal hygiene, statements like "I'm already clean"
7. Instructing someone to make decisions in life situations that a person previously managed on their own
early dementia
Memory loss, impairment of other cognitive abilities. The person cannot find the way. Starts at age 60 or older.
Part of the symptom in AD belongs to the syndromic series of depression. It all starts with depressive complaints: the mood is bad, inhibited, it is difficult to concentrate. The woman ceases to understand how to fill out receipts. Doctors often attribute this to depression, and when memory and intelligence disorders are already blooming, it is too late to treat.
moderate dementia
The areas of the brain that control speech and intellect are damaged. Symptoms: progressive memory loss and general confusion. Difficulty performing multi-step tasks (dressing), problems recognizing loved ones, etc.
severe dementia
They cannot communicate and are completely dependent on outside help. The patient spends most of the time in bed. Severe dementia includes the inability to recognize oneself and relatives, weight loss, skin infections, moaning, crying, inability to control pelvic functions.
Atrophy - parietotemporal lobes in Alzheimer's disease. With Pick's disease - frontal lobes.
Dementia:
- lacunar
- total
In Alzheimer's disease, first lacunar, then total. With Pick's disease - immediately total. Therefore, their behavior is very different.
Vascular: flow in waves (worse - better), atrophic immediately flow with an increase. Loss of memory and intelligence - with atrophic, with vascular - the symptoms can be reversible until a crisis occurs (such as a stroke).
One of the first symptoms characteristic of Alzheimer's disease is digital agnosia (they stop recognizing and naming fingers).
Aphato-apracto-agnostic syndrome (aphasia, dysarthria, apraxia and gnosis). This is typical for BA. Appearance: apathetic look. Aspontaneous, amimic, speaks in a monotonous voice
Concept definition organic diseases- These are diseases that occur as a result of primary or secondary damage to the brain tissue. Ø Although the division into organic and functional disorders is widely used in medicine, in some cases it is not possible to draw a clear line between these concepts. Ø For example, in schizophrenia, traditionally considered as a functional psychosis, non-specific signs of organic changes in the brain are often found. Ø The term "organic" does not imply that in all other mental illnesses there are no changes in the structure of the nervous tissue, but indicates that in this case the cause of brain damage or the nature of such damage is known. Ø
The main groups of organic diseases of the brain Vascular (CVA, dyscirculatory encephalopathy both against the background of atherosclerosis and hypertension) Ø Degenerative (Alzheimer's disease, Pick's disease, dementia with Lewy bodies, Huntington's chorea, Parkinson's disease) Ø Exogenous organic (consequences of TBI, neuroinfections, chronic intoxications, radiation, alcoholism, drug addictions) Ø
The theory of "exogenous types of reactions" Karl Bongeffer (1908): The brain responds to external harmfulness of various etiologies with a limited number of similar non-specific psychopathological reactions.
The following syndromes are most often encountered under the influence of exogenous hazards (“reactions of an exogenous type”): , manic, dysphoria, euphoria, emotional lability, etc.) Hallucinatory-delusional syndromes Catatonic syndrome Amnestic (Korsakovsky) syndrome Convulsive syndrome (symptomatic epilepsy)
The theory of "reactions of an exogenous type" Opposes the nosological principle in psychiatry (because it recognizes that the same mental disorders occur under the influence of different etiological factors) Ø Reflected in the ICD-10. The diagnosis for organic disorders is given by the type of reaction + the cause that caused it (if known). For example: l organic amnesic syndrome due to brain injury, l organic amnesic syndrome due to cerebral vascular disease Ø
Psycho-organic syndrome It is represented by a combination of various disorders of three areas of mental activity (Walter. Buell's triad): Ø Intellect (change in thinking according to the organic type, a decrease in the level of generalization, concrete thinking, clinically sometimes misunderstanding, misunderstanding) Ø Memory (hypomnesia, amnesia, paramnesia) Ø Emotions (emotional lability, weakness, emotional coarsening, dysphoria, euphoria, apathy)
Psycho-organic syndrome Leading symptoms - A variety of affective disorders (irritability, emotional lability, weakness, explosiveness, depression, obnoxiousness, grouchiness, malice, complacent euphoria, indifference, apathy) - Violation of attention (exhaustion, distractibility, difficulty switching) - Violation of the mobility of thinking from detailing to viscosity - Volitional disorders (weakening of initiative, narrowing of the circle of interests, stereotyping of activity) Ø
Psycho-organic syndrome Mandatory signs Deterioration of quick wit (stupidity); Decreased work capacity and productivity; Weak social adaptation; Psychopathic behavior Ø
Forms of psychoorganic syndrome Indicated by the leading symptom of emotional disorders: Ø Cerebrasthenic - asthenia, accompanied by symptoms of organic pathology of the central nervous system (headaches, meteorological sensitivity, poor tolerance to alcohol, etc.) Ø Explosive - excitability, aggressiveness, mood instability, tendency to dysphoria Ø Euphoric - superficial unjustified fun, inadequate playfulness, disinhibition, fussiness. Ø Apathetic - inactivity, lethargy, spontaneity, adynamia, indifference to one's fate and the fate of loved ones
Diagnostic variants of the psychoorganic syndrome according to ICD-10 Organic neurosis-like disorders - organic emotionally labile disorder (asthenic), organic anxiety disorder, organic dissociative disorder (hysterical) Ø Organic personality disorder - characterized by a significant change in habitual behavior, emotional-volitional and behavioral disorders predominate Ø Mild cognitive impairment - dominated by intellectual-mnestic disorders, which, however, do not reach the degree of dementia Ø
Vascular diseases of the brain Ø Cerebral atherosclerosis Ø Hypertonic diseaseØ Acute violation cerebral circulation(stroke)
Atrophic (degenerative) diseases of the brain Ø Ø Ø Atrophic processes include a number of endogenous organic diseases, the main manifestation of which is dementia: l Alzheimer's disease l Pick's disease l Huntington's chorea l Parkinson's disease l some rarer diseases In most cases, these diseases begin in mature and old age without an obvious external cause. The etiology is mostly unclear. For some diseases, the leading role of heredity has been proven. Pathological anatomical examination reveals signs of focal or diffuse atrophy without inflammation or severe vascular insufficiency. Features of the clinical picture depend primarily on the localization of atrophy.
Exogenous organic diseases of the brain Ø Consequences of TBI Ø Neuroinfection Chronic intoxication Ø Radiation Ø Alcoholism Ø Drug addiction Ø
Mental disorders in traumatic brain injury (traumatic brain injury) Ø Traumatic brain injury (TBI): 1. Open TBI: - penetrating (with damage to the dura mater) - non-penetrating (damage to the soft tissues and bones of the skull) 2. Closed TBI - concussions (concussions) - concussions (bruises)
Commotions and concussions Commotions - concussion of the GM due to a fall on any part of the body or as a result of a direct head injury. At the same time, blood vessels, cerebrospinal fluid and lymph begin to move, damage the higher autonomic centers (located in the walls of the 3rd and 4th ventricles and at the bottom of the Sylvian aqueduct), and intracranial pressure rises. General cerebral neurological symptoms (damage to the brain stem) come to the fore during concussions: nausea, vomiting, headache, dizziness, etc. Ø Contusion is a local organic damage to the brain and its membranes at the site of impact. With concussion, concussion also occurs, but the clinic of the disease is determined by local (focal) symptoms of damage to the cerebral cortex. Ø
Periods of traumatic disease GM I. Initial (acute, primary or “chaotic”, according to N. N. Burdenko) period. Ø Duration - “minutes-days”. Ø The condition is determined by cerebral edema. Ø Disconnection of consciousness is characteristic (by the type of stunning, stupor or coma). In the future (if a fatal outcome does not occur), the reverse development occurs: coma is replaced by stupor, then stunning, and lastly, orientation in time appears.
Periods of traumatic illness GM II. acute period. Ø Duration “days-weeks”. Ø It is characterized by adynamia syndrome, cerebral symptoms predominate (associated with increased intracranial pressure): Ø 1) Diffuse headaches, aggravated by external stimuli (noise, bright light), when moving Ø 2) Dizziness, aggravated by movement, vestibular disorders Ø 3 ) Diverse vegetative disorders Ø 4) Severe asthenia, manifested by a combination of exhaustion and irritability in various proportions. Ø Mnestic disorders are presented, acute psychoses are possible
Memory disorders of the acute period of TBI 1) retrograde amnesia - depending on the severity of TBI, it can capture only the moment of injury, or days, weeks, months and even years before the injury; Ø 2) anterograde amnesia - usually occurs with severe head injury and extends for short periods of time immediately following the period of turning off consciousness; Ø 3) anteroretrograde amnesia; Ø 4) fixation amnesia. Ø
Psychosis of the acute period of TBI Develop in the first days of the acute period Differ in the relative poverty of psychopathological symptoms against the background of a severe somatic condition Ø With concussions, they are more common than with concussions, while the clinic of psychosis often depends on the location of the lesion: - occiput - visual hallucinations - frontal lobe - disinhibition , euphoria, foolishness - temporal lobe - auditory hallucinations, depersonalization, "already seen" phenomena - with damage to the right hemisphere - depression Ø Ø
CLINIC OF PSYCHOSIS OF THE ACUTE PERIOD OF TBI 1). Twilight obscurations of consciousness. Occur usually after a short period of clarification of consciousness. Ø Duration - from several hours to several days. Ø After leaving the twilight stupefaction, complete amnesia is observed. 2) Delirious clouding of consciousness. Ø It develops mainly in persons who abuse alcohol, after the disappearance of the symptoms of stunning, against the background of asthenia. Ø Duration from several hours to 2-3 days. Ø It is characterized by vivid visual hallucinations with the affect of fear, anxiety, on the basis of which secondary delusions may occur.
CLINIC OF PSYCHOSIS OF THE ACUTE PERIOD OF TBI 3). Oneiroid clouding of consciousness. Ø Rare. Occurs in the first days of the acute period Ø Lasts from hours to 5-6 days. Ø It is characterized by complete disorientation in the environment with a predominance of euphoric or ecstatic delirium. Ø Patients report the content of experiences after the psychosis has passed. 4). Amnestic (Korsakovsky) syndrome. Ø One of the severe forms of traumatic psychoses. Ø Duration: from days to 1.5-2 months (longer in persons who abuse alcohol) Ø Mental disorders in Korsakov's syndrome of traumatic etiology are considered reversible.
CLINIC OF PSYCHOSIS OF THE ACUTE PERIOD OF TBI 5). affective psychoses. Ø a). dysphoric states Ø b). hypomanic or manic states with a euphoric shade of mood, morio-like disorders, expansive confabulations; Ø c). subdepressive or depressive states, colored with anxiety, fear, hypochondriacal experiences. 6). Hallucinatory-delusional psychoses Ø (schizophrenia-like). Ø Acute sensual delusions, confabulations, verbal hallucinations, individual mental automatisms, impulsive and aggressive actions are possible against the background of the prevailing affect of anxiety and fear. Ø Psychosis usually lasts for several days and is replaced by asthenia.
CLINIC OF PSYCHOSIS OF THE ACUTE PERIOD OF TBI 6). Paroxysmal states of the acute period. Ø More often develop with contusions than with concussions (associated with the presence of a pathological focus in the cortex of m.) Ø These include the following types of epileptic seizures: a). simple partial motor (Jacksonian); b). simple partial with impaired mental functions (fits of metamorphopsia, disorders of the “body scheme”, “already seen”, “already heard”, “already experienced”, emotional-affective, ideational, hallucinatory seizures; c). simple partial secondarily generalized tonic-clonic seizures, which can be single and serial. Sometimes status epilepticus develops.
Periods of traumatic illness GM Ø Ø Ø III. Late period (reconvalescence). Lasts weeks - months (up to 1 year). In this period, all the phenomena of the acute period are gradually smoothed out, and a significant number of patients recover. The clinical picture of this period is characterized by the syndrome of posttraumatic cerebral palsy. In addition, as well as in the acute period, affective psychoses, delusional (schizophrenic) psychoses, as well as epileptic seizures can be observed.
Periods of traumatic illness GM IV. The period of long-term consequences (residual, chronic period). Ø It can last for many years, sometimes for a lifetime. Ø Mental disorders can be represented by: Ø Various options psychoorganic syndrome ("traumatic encephalopathy"); Ø Traumatic endoform psychoses (similar in clinical picture with endogenous Ø Symptomatic (post-traumatic) epilepsy Ø Deterioration of the mental state in this period is provoked by exogenous hazards (alcohol consumption, sudden changes in weather and atmospheric pressure, overwork, infectious diseases, stress, etc.).
DEMENTIA IN ICD-10 Ø Dementia is a syndrome caused by a disease of the brain, usually of a chronic or progressive nature, in which there are impairments to a number of higher cortical functions, including memory, thinking, orientation, understanding, counting, learning ability, language and judgment . Consciousness is not changed. As a rule, there are violations of emotional control, social behavior or motivation.
Dementia (ICD criteria - 10) (Ø Memory disorders ll Ø Impairment of the ability to memorize new material Difficulty in reproducing previously learned information Impairment of other cognitive functions ll impairment of thinking l Ø impairment of the ability to judge information processing impairment Clinical significance of detected impairments Emotional and motivational impairments Baseline higher level of cognitive abilities Ø Duration of symptoms for at least 6 months Ø Consciousness preserved Ø Ø
DEFINITION OF DEMENTIA ACCORDING TO ICD-10 The main diagnostic requirement is evidence of a decrease in both memory and thinking, to such an extent that this leads to a disruption of individual daily life.
Schematic classification of dementia Dementia Primary forms of dementia (90%) Degenerative (50%) Vascular (15 - 30%) Secondary forms of dementia (10%) Mixed (15 - 25%) (degenerative + vascular)
Development of dementia Mild dementia Moderate dementia Severe dementia 24 Cognitive impairment Onset of dependence 20 on others MMSE 16 Behavioral impairment Absolute dependence 10 on care 0 3 6 Years 9
TREATMENT OF COGNITIVE DISORDERS IMPACT ON MICROCIRCULATION Ø Calcium channel blockers nimodipine, cinnarizine, flunarizine Alpha-blockers nicergoline Ø Phosphodiesterase inhibitors Ø Vinpocetine, pentoxifylline, eufillin
TREATMENT OF COGNITIVE DISORDERS NEUROPROTECTIVE THERAPY Piracetam and its derivatives Peptidergic preparations and amino acids actovegin, cerebrolysin, semax, glycine Ginkgo biloba preparations tanakan Antioxidants and antihypoxants mexidol
TREATMENT OF COGNITIVE DISORDERS Dopaminergic therapy Ø Dopaminergic mediation plays a key role in the process of switching attention from one activity to another Bradyphrenia, perseveration - Piribedil (pronoran)
TREATMENT OF COGNITIVE DISORDERS EFFECTS ON THE ACETYLCHOLINERGIC SYSTEM ACETYLCHOLINESTERASE INHIBITORS Ø I generation: l l l Ø physostigmine tetraaminoacridine (tacrine, cognex) amiridine (neuromidine) II generation: l l ipidacrine (axamon) rivastigmine (exelon) donepezil (ariseptal)
Organic damage to the brain, manifested as a disorder of memory, understanding, speech function, thinking and other functions of the cognitive type. As a rule, this pathology has a progressive character, is accompanied by social maladjustment and can subsequently lead to disability. The disorder is often seen in older people.
Organic brain damage. Types of pathology
There are several types of illness. This pathology, in fact, is not considered an independent disease. Most often, it acts as a symptom of other ailments. Among the main types of pathology, organic brain damage associated with neurological and vascular diseases is distinguished. This condition is noted in Alzheimer's disease or vascular atherosclerosis. Brain disorders can develop against the background of pathologies internal organs. In such cases, the disease accompanies chronic liver or kidney failure. In some cases, organic brain damage occurs as a result of alcohol poisoning, poisoning with nitrogenous compounds or arsenic in conditions of harmful production. In older people, pathology is often caused by taking medicines- several medicines in high doses. In case of cancellation of treatment, this violation becomes reversible. Temporary impairment of memory and intelligence is caused by antidepressants, antihypertensives, antiarrhythmics and hypnotics.
Symptoms of pathology
Organic brain damage can manifest itself in different ways. In many ways, the symptoms depend on the disease in which it occurs. As a rule, the main manifestations are considered to be a decrease in activity, apathy, loss of interest in life. Along with this, the patient becomes unable to take care of himself, slovenliness appears. Among the symptoms, experts also distinguish forgetfulness, impaired functions of speech, writing, counting. In some cases, patients begin to confuse words or rearrange syllables.
Organic brain damage in children
At a younger age, this pathology is caused by the influence of negative factors on the development of the fetus during the gestation period, as well as on the condition of the child in the first days of life. The main causes of pathology are birth trauma, unfavorable course of pregnancy, asphyxia of newborns, hemolytic disease of newborns, and infectious diseases. Such conditions are characterized by intracranial hemorrhage, hypoxic ischemic damage. Sometimes (more often - as residual effects of the effects of the factors described above) there is a residual-organic lesion of the brain. This condition is characterized by symptoms such as headache, fluctuations in nervousness, decreased concentration, dizziness, sleep disturbance, and others. These signs can progress, resulting in an increased risk of pathologies such as neuropathy, epilepsy, oligophrenia,
As you know, the brain is the main organ of the central nervous system person. Scientists have not yet been able to fully comprehend all the subtleties of his work. To date, experts have information about the functioning of individual cells, quite successfully diagnose and correct various diseases such an organ. So, an organic brain lesion is considered to be a fairly common disorder of this type, what it is and what causes it, we will talk on this page www ..
It is believed that organic brain damage is a fairly common pathology. Such a diagnosis, according to neurologists, can be made literally 9 out of 10 patients. However, in most cases, the violations are minimal and do not affect the activity of the brain and the well-being of a person.
What is organic brain damage?
Depending on the etiology, organic brain lesions may be diffuse (dyscirculatory encephalopathy, Alzheimer's disease, etc.) or localized (tumors, injuries, stroke, etc.).
Such pathological conditions give different symptoms. Diffuse organic lesions are manifested by memory impairment, decreased intelligence, the patient develops dementia syndrome, cerebroasthenia, psychoorganic syndrome, headache, dizziness, etc. And localized disorders make themselves felt by cerebral or focal neurological symptoms, depending on the location of the pathological focus, as well as from its volume.
Why does organic brain damage occur, what are its causes?
A fairly common factor provoking organic damage to the brain tissue is considered to be vascular ailments. Among such diseases are hemorrhagic and ischemic stroke, discirculatory encephalopathy, chronic ischemic brain disease. The main root cause of such disorders: hypertension or atherosclerosis. Vascular diseases of the brain cause mostly a psychoorganic syndrome, and with a stroke, focal neurological symptoms are also observed.
Also, organic brain lesions can be caused by traumatic brain injuries. The degree of damage in this case depends on the type of damage received (concussion, bruise, compression or traumatic hematoma), as well as on its severity. At the same time, patients can be diagnosed with a psychoorganic syndrome (hidden or pronounced form), as well as focal manifestations (represented by paralysis, paresis, impaired sensitivity, vision or speech, etc.).
Organic brain lesions are often provoked by infections. As you know, a variety of infectious agents can penetrate the blood-brain barrier, including viral and bacterial particles, fungi and some protozoa. Such pathological particles can provoke meningitis, encephalitis, arachnoiditis, abscesses. Correct and adequate therapy helps to achieve complete recovery, but in some cases the patient remains cerebroasthenia, mnestic and other mental disorders.
Organic brain damage can be explained by chronic and acute intoxications. Similar conditions can develop against the background of alcohol and drug consumption, with tobacco smoking and the use of some drugs, due to hepatic or kidney failure, poisoning with pesticides, fungi, household chemicals, carbon monoxide, etc. The manifestations of such disorders are determined by the type of poisonous substance, as well as its dosage, duration of influence. The patient may even experience intoxication psychoses, deep coma and dementia.
In adulthood, organic brain lesions most often occur due to neurodegenerative diseases. Most often, doctors diagnose Alzheimer's disease, Pick's dementia, or Parkinson's disease. With such pathologies, the patient's brain neurons are damaged and die, which causes a number of mental disorders.
Therapy of organic brain lesions is carried out only under the supervision of a qualified neuropathologist.
Organic damage to the brain, which manifests itself in the form of impaired intelligence, memory, thinking, speech, understanding and other cognitive functions, is called dementia. In most cases, this disease is progressive in nature, it is accompanied by social maladjustment, and as a result, it can cause disability. Dementia is most common in older people.
It should be noted that there are a number of varieties of dementia. This pathology, in fact, is not considered an independent disease - it rather acts as a symptom of other diseases. There are such types of dementia:
- Organic brain lesions associated with vascular and neurological diseases. This condition can be observed, for example, in or in Alzheimer's disease.
- Organic lesions of the brain in diseases of the internal organs. In this case, dementia can become a sign of chronic kidney or liver failure.
- Organic lesions of the brain during intoxication. There are situations when dementias appear with alcohol poisoning, chronic poisoning with arsenic or nitrogenous compounds in the workplace.
In older people, chronic drug use is often the cause of dementia. As a rule, this pathology occurs if several medications are prescribed at the same time in too large doses. This dementia is reversible if medications are discontinued. Most often, antidepressants, sleeping pills, antiarrhythmic and antihypertensive drugs lead to a temporary deterioration in intelligence and memory.
Symptoms of organic brain damage
Organic brain damage can have a variety of symptoms - in this case, it all depends on the main disease, against which this pathology occurs. Most often, the initial manifestations are characterized by a decrease in activity, loss of interest, apathy. In addition, slovenliness and inability to care for oneself may increase.
Also, a person complains of forgetfulness, in some cases, patients forget the names of loved ones, may forget what they look like, or not remember the day of the week. Often there are violations of the function of counting, writing, speech. Sometimes patients can confuse words, swap syllables. In some cases, the ability to involuntary speech is lost - people can only repeat phrases spoken by others.
Also, there is often a significant change in emotionality. A person loses the ability to be happy or upset, he may seem detached from everything around him. In addition, the reverse situation is also possible, when people become overly emotional, and their emotions become too pretentious and inappropriate. Against the background of a disorder of emotions and thinking, hallucinations or delusions may appear.
Diagnostics
With such a pathology as an organic brain lesion, early diagnosis of the disease is of great importance. After all, even with Alzheimer's disease, with the help of correct and timely treatment, in some cases it is possible to stop the course of the disease or the progression of disorders. This is especially true for young people, since it is in young people that potentially reversible dementia is much more common.
The basis of diagnostic measures is the history of the disease, as well as data obtained during neurological examination. It is with this procedure that one can obtain essential information about the causes of organic brain damage.
Atrophic processes in the brain are considered a diagnostic symptom of dementia. To recognize such processes, it is necessary to perform a tomography of the brain. It should be noted that, by and large, the detection of vascular lesions in the brain and a pronounced deterioration in the patient's cognitive abilities give rise to just such a diagnosis.
Treatment
It should be noted that in the arsenal modern medicine there isn't enough effective means treatment of this disease. In most cases, it applies symptomatic treatment disease, which can significantly alleviate the fate of the patient. In addition, proper patient care is of no small importance. Medications prescribed in the event that there is aggressiveness in behavior, depression, hallucinations. In addition, the need for drug therapy arises if it is necessary to improve blood circulation in the brain.
It must be understood that the treatment of organic brain damage should be closely related to the diagnosis of its origin. Of great importance is the treatment of the underlying disease. It should also be noted that certain disorders of cognitive functions are reversible - for this you just need to make certain adjustments to your diet and lifestyle. This is true in the case of alcoholic or atherosclerotic dementia, as well as in certain hepatic diseases.
With regard to psychosocial treatment, a patient with a diagnosis of "organic brain damage" is in great need of psychological support the patient and his family members. The patient is advised to stay in a familiar home environment, since the inpatient psychiatry department can significantly worsen his condition. This measure is used only in cases of severe senile dementia. It is also very important to organize a certain level of psychophysical activity, to provide a person with clues regarding orientation in space and time.
Since this is a symptomatic disease, the main symptoms need to be treated - most often it is deterioration or loss of memory. It should be noted that in folk medicine There are many recipes that help improve memory.
- Blueberry. In order to improve memory, you need to drink 200 grams of blueberry juice every day. This method is effective in senile dementia.
- Rowan bark. To make a decoction, you need to take 50 grams of crushed bark, add 200 grams of boiled water and boil for 5 minutes over low heat. Infuse the resulting broth for 5 hours, then it must be filtered and taken 50 grams several times a day. This method is effective in alcoholic and schizophrenic dementia.
- Elecampane root. You need to grind 50 grams of the root and add 0.5 liters of vodka. Infuse this mixture for a month, shaking the container from time to time. After that, the tincture can be filtered and consumed several times a day before meals.
Organic brain damage in children
In children it pathological condition due to the impact of negative factors on the fetus and newborn in the prenatal period, during childbirth, in the first days after birth.
Most often, hypoxia leads to brain damage in children, which is associated with factors such as:
- unfavorable course of pregnancy;
- birth trauma;
- asphyxia;
- infectious diseases;
- hemolytic disease of the newborn.
In these conditions, hypoxic-ischemic lesions of the brain, as well as intracranial hemorrhages, may appear.
Organic brain damage in children can lead to residual brain damage. They can be transient or constantly progressive. In this case, symptoms such as:
- headaches;
- nervousness;
- dizziness;
- jumps in intracranial pressure;
- increased excitability;
- sleep disorders;
- memory impairment;
- decrease in concentration.
These signs may be of an increasing nature, resulting in an increased risk of developing diseases such as cerebral palsy, myelopathy, neuropathy, hydrocephalic syndrome, mental retardation, and epilepsy.
You need to understand that organic brain damage is an extremely serious pathological condition that significantly impairs the quality of human life. However, in some cases, this pathology can be reversible - for this it is enough to adjust your diet and lifestyle. Therefore, it is so important to consult a doctor in time, who will be able to make the correct diagnosis and choose the appropriate treatment. The sooner the necessary measures are taken, the more likely it is to return to a normal full life.