Article 16. Symptomatic and other mental disorders of exogenous etiology

Diseases that are associated with mental disorders

For a long time, people have called diseases that are associated with mental disorders “diseases of the soul” because these diseases cause people to live contrary to adequate psychological health and personality traits. The process of developing the disease can be easy, while the patient can live absolutely calmly in society. But there are also severe forms of mental disorders in which the patient can no longer live a full life. The most serious mental illnesses are schizophrenia, epilepsy, and alcoholism of the 2nd and 3rd degrees. These diseases lead to serious psychosis and because of them a person can harm himself and the people around him.

Endogenous factors include:

1. Intrauterine developmental disorders, as well as developmental disorders during early childhood.
2. Genetic predisposition.
3. Somatic diseases that affect the state of the human brain due to insufficient blood supply (dyscirculatory encephalopathy in diseases of the heart, blood vessels, endocrine system), autointoxication (severe kidney and liver diseases) or hormonal imbalance (hyperthyroidism, hypothyroidism).
4. Immunological disorders.

Types of mental disorders

These species are divided into several groups. Endogenous disorders that are caused by physiological internal causes, most often genetic. This could be schizophrenia, bipolar disorder, Parkinson's disease, dementia, as well as age-related changes that occur in older people. There are also exogenous disorders that occur due to exposure to external factors. These impacts may be due to traumatic brain injuries and serious infections. In this case, a person develops reactive psychoses, neuralgia and behavioral disorders.

Previously, we have repeatedly drawn attention to the position occupied in psychiatry by diseases of the brain, designated as exogenous-organic. On the one hand, they are considered as an extremely relevant mental pathology in medical and social terms, on the other hand, they receive extremely little attention (it even decreases over time). The last statement is based on our analysis of relevant journal publications. There is evidence [1] that it is precisely this approach that allows us to reproduce the picture of the interests of specialists involved in certain scientific problems.

We studied the contents of sets of nine domestic psychiatric journals published over a 5-year period - from 2011 to 2015. These were the “Journal of Neurology and Psychiatry named after. S.S. Korsakov”, “Social and Clinical Psychiatry”, “Siberian Bulletin of Psychiatry and Narcology”, “Psychiatry”, “Russian Psychiatric Journal”, “Independent Psychiatric Journal”, “Review of Psychiatry and Medical Psychology named after. V.M. Bekhterev", "Mental health", "Psychiatry and psychopharmacotherapy named after. P.B. Gannushkina".

The frequency of publication of magazines is from four to twelve per year. Each issue contains from 15 to 20 articles. In just 5 years, according to our calculations, 4090 articles were published. It turned out that only 43 (1.05%) of them reflected certain aspects of exogenous organic pathology. Moreover, only the title of seven articles contained a direct indication that their topic was devoted to exogenous organic diseases. Their share in the total volume of publications was only 0.17%, and among articles on “organic” topics - 16.3%. In the set of one of the above-mentioned journals there were no works devoted to exogenous organic pathology at all.

These assessments are largely consistent with the results of our analysis of materials from the largest Russian psychiatric forums - the XV and XVI Congresses of Russian Psychiatrists (2010 and 2015). The theses of the XV Congress did not contain a section called “exogenous-organic” at all, and the pathology it designated was actually absorbed into the extensive section “Organic mental disorders and epilepsy. Neuropsychiatry". Moreover, in this section, out of 37 publications, only three (8.1%) had this term in their titles. In the theses of the XVI Congress, although the section “Exogenous-organic mental disorders and epilepsy” was highlighted, out of the 37 works included in it, only two (5.4%) were directly related to exogenous-organic diseases.

Definitions.

One of the key issues in psychiatry that remains without due attention is the question of the semantic content of the term “exogenous-organic”. The fact is that, despite the seemingly accepted and well-established content in Russian psychiatry, this term denotes far from homogeneous mental disorders. As a result, the essence of mental disorders called “exogenous-organic” in certain publications can be judged only by the text, but not by the names adopted in these articles. Therefore, this term turns out to be uninformative, which practically excludes it from the conceptual apparatus of psychiatry.

In accordance with the above, it becomes obvious that it is necessary to develop clear definitions regarding the term “exogenous-organic” and, accordingly, coordinated approaches to painful forms with this name. However, this, naturally, can only be feasible with a broad discussion of this issue, which we have repeatedly proposed previously [2-4]. Neither before nor subsequently have we come across publications in which this issue was addressed. In this regard, we consider it advisable to return to it again.

We have established that in psychiatry there are at least three significantly different interpretations of the concept “exogenous-organic”.

The term “exogenous-organic” was first used by P.B. Posvyansky in 1942 in his work “Towards the doctrine of the propagated exogenous-organic type of reaction (type of process). Message 1,” published in the journal Neuropathology and Psychiatry [5]. He was the first to define these forms of pathology: “Under the protracted exogenous-organic types of reaction (or process), we combine those exogenous-organic psychoses that are caused by numerous harmful effects, acute or chronic, that produce more or less gross changes in the brain, and the latter, in turn, when the rate of progression of the disease slows down, determines the spontaneous course of psychoses, a course that is no longer directly related to the primary producing cause.” In schematic form, the concept of P.B. Posvyansky can be presented in the form of a chain of cause-and-effect relationships: exogenous pathogenic factor - organic brain damage - exogenous-organic brain disease (exogenous-organic mental disorders).

We find the second version of the interpretation of the concept under consideration in F.I. Ivanov [6]. He classified mental disorders during the immediate consequences of injuries and other severe brain damage as exogenous-organic. According to the author, they occupy an intermediate position between typical exogenous and
organic phenomena
and largely retain the features of disorders in the initial stages of brain damage, but at the same time acquire signs of an emerging organic defect.

The third version of the definition of exogenous-organic forms of pathology was given in expanded form by V.V. Kovalev: “In cases of psychotic disorders that arise in direct connection with cerebral-organic diseases (meningitis, encephalitis, traumatic brain injuries, toxic encephalopathies, brain tumors, etc.), it is more correct to talk about exogenous-organic psychoses” [7] . In general, V.V. Kovalev gives the term a broad meaning, since he classifies as exogenous-organic mental disorders of acute, subacute and long-term periods of brain infections and injuries, i.e. disorders that develop at all stages of the formation of organic brain damage

.

Without disputing the legality of using the term “exogenous-organic” in all the given meanings, we consider P.B.’s interpretation more justified. Posvyansky, the essence of which, as already noted, is to identify mental disorders caused by organic damage to the brain, formed as a result of previously suffered or existing exogenous factors. It is this interpretation that reflects the etiology and pathogenesis of the forms of mental pathology under consideration.

We cannot help but refer to the assessments of V.N. Krasnova: “...the concept of “exogenous-organic”, introduced by P.B., deserves recognition of heuristic significance. Posvyansky and reflecting not only the fact of primary exogenous influence with the corresponding types of reaction (according to Bongeffer), but also the dynamic characteristics of disorders, including secondary cerebral changes, which in themselves can constitute the cause and determine the nature of subsequent clinical manifestations” [8].

Clinical structure

exogenous-organic mental disorders require the attention of specialists. The fact is that in psychiatry the idea of ​​pronounced polymorphism of organic mental disorders has taken root, which is reflected in the works of many authors [9-13]. According to them, organic diseases of the brain are characterized by the greatest polymorphism - the largest range, range of syndromes [14], including almost all psychopathological phenomena known in psychiatry, observed in the picture of all nosological forms - from neuroses to schizophrenia and epilepsy.

Along with this, the results of a number of epidemiological studies [4, 15, 16] indicate that the range of psychopathological syndromes of exogenous organic origin is quite limited.

The main manifestation of these forms of pathology is a psychoorganic syndrome, against which epileptic, depressive and delusional states, hallucinatory phenomena, hypochondriacal and obsessive phenomena can develop. However, this circle is not characterized by syndromes of impaired consciousness (except for twilight), manic, catatonic and hebephrenic states, and mental automatisms. If any occur, then we are most likely talking about a combined exogenous-organic and endogenous pathology, or reactions of an exogenous type are taken as exogenous-organic.

Prevalence

exogenous-organic diseases of the brain are characterized by a large discrepancy in indicators, which is explained by different research methods and populations of those examined. It is only important to note that exogenous-organic mental disorders are a common form of mental pathology.

Among patients newly diagnosed, as follows from the work of A.A. Churkin and N.A. Tvorogova [17], in the group of psychoses organic pathology predominates (56.3%), and in the group of non-psychotic disorders it ranks second (28.5%) after neurotic disorders. At the same time, there is reason to believe that there is a significant number of unregistered patients. N.M. Zharikov and V.Ya. Gindikin [18], having studied the prevalence of borderline mental disorders among workers of industrial enterprises not under the supervision of psychiatric institutions, found organic disorders of various nature in 15.2% of them. True, in these cases it should be taken into account that the authors of these works did not differentiate organic pathology. Our joint with A.A. Primochenok's [19] study of a large group of adolescents - high school and vocational school students who were not registered with the psychiatric service - revealed signs of exogenous organic brain diseases in 25.9% of them of varying degrees of severity.

An increase in the number of patients with exogenous organic diseases in the population may be associated with an increase in the scale of adverse environmental impacts and the emergence of new types of them.

Exogenous-organic mental disorders and combined forms of mental pathology.

The problem of exogenous-organic mental disorders is closely related to the little-studied problem of combined (comorbid) forms of various diseases. Without dwelling on the essence of this phenomenon, we note the large proportion of combined forms. To illustrate this point, we present the results of some of our studies: 40.0-50.0% of patients with alcoholism have exogenous-organic mental disorders of non-alcoholic origin; in 20.0-30.0% of patients with neuroses, exogenous organic symptoms are detected. L.V. Leshchenko [20] showed that 21.0–33.9% of patients with schizophrenia have exogenous organic diseases of the brain.

Combined forms of mental pathology, including those including exogenous-organic mental disorders, have their own clinical and dynamic patterns, which require the development of special standards for the organization of effective treatment and rehabilitation care. These forms also require detailed study in relation to expert practice [21].

Ways to solve the problem of exogenous organic brain diseases

multifaceted. One of them lies in line with the general psychiatric problem - the creation of an acceptable classification of mental illnesses that meets clinical and theoretical requirements, which would include exogenous organic pathology. Let us note that in the classifications of a number of well-known psychiatrists [9, 22–24], special sections were dedicated to it. In ICD-10, which has become not only a statistical but also a diagnostic tool, there is no section devoted to exogenous organic diseases.

Currently, the next version of the ICD (ICD-11) is being developed. Moreover, as discussions among the psychiatric community show, it, like the previous one, will not contain headings related to exogenous organic diseases of the brain. In this regard, the conclusion suggests itself about the need to create a national classification of mental illnesses, in which exogenous-organic mental disorders would occupy a prominent place. The validity of our opinion is confirmed by the judgments of other experts. In particular, B.D. Tsygankov and S.A. Ovsyannikov [25], raising the question of the classification of mental illnesses for use in pedagogical work and in conducting scientific research, write: “With an obvious overabundance of described disorders that are very unconvincing in terms of diagnosis, ICD-10 does not include a special category for the group of exogenous-organic psychoses, the existence of which has long become a real clinical fact.” V.B. Holland and B.A. Kazakovtsev [26], among the proposals for the next revision of the ICD, indicate the need to develop a conceptual apparatus for diagnosing exogenous organic disorders. Yu.S. Shevchenko [27] proposes the creation of a domestic classification of mental illnesses based on the etiopathogenetic model and provides for the identification of an “exogenous-organic vector” in it. I.V. Makarov [28] includes exogenous organic mental disorders in the group of organic psychoses in children and adolescents.

Justifying the need to create a national classification of mental illnesses containing a section of exogenous-organic pathology, we do not assume that it can be a replacement for the ICD-11 being developed. This option is naturally excluded. Along with this, there is a relatively simple and productive way out of this situation: to make changes and amendments to highlight a group of exogenous-organic disorders in Class V of the ICD “Mental disorders and behavioral disorders,” adapted for use in the Russian Federation. Our proposal has real foundations, since it is based on certain experience of this kind. At one time, such work was done in relation to ICD-10 [29], although its results were not implemented for various reasons.

Causes of mental illness

The most common diseases have long been scientifically explained. But in practice, it happens that it is difficult for a person to establish the cause of a particular disease. Generally speaking, there are several mandatory factors and causes of mental illness due to which the disease can develop:

• unfavorable environment;
• hereditary factor;
• unwanted or unsuccessful pregnancy;
• traumatic brain injuries;
• the reason lies in childhood;
• neuro poisoning.
• injuries associated with psychological and emotional factors.

A huge number of mental illnesses are inherited. In this case, a person becomes predisposed to developing diseases. This applies in particular to those people whose both parents had mental disorders. Mental disorders that are inherited are:

• schizophrenia;
• bipolar disorder;
• depression;
• epilepsy;
• Alzheimer's disease;
• schizotypal disorder.

Symptoms

If you notice that you or your loved one has several symptoms that are typical for people who have psychological illnesses, at this moment you need to urgently consult a doctor. Because only an experienced qualified psychotherapist can help. For such an illness, he will prescribe the necessary treatment. Signs may be as follows:

• hallucinations that manifest themselves visually or auditorily;
• delusional state, feeling of depression, refusal to appear in society;
• unkempt appearance;
• drug and alcohol abuse;
• aggressiveness and rancor;
• causing physical harm to health.

Treatment of mental disorders

If you find signs of mental illness, you need to see a psychotherapist who will find out the causes of neuropsychiatric illness. In this case, you can count on a full and correct way out of the situation.

After you and a specialist find out the causes of mental disorders, you will be prescribed appropriate therapy, which can be either medication or psychotherapy. Do not be alarmed if a specialist prescribes medication for you, because this method, together with psychotherapy, helps to cope with even severe mental illnesses or at least facilitate their further development. The following medications can be used:

• Neuroleptics. Necessary in order to reduce psychomotor agitation, aggressive state, and impulsivity.
• Tranquilizers. Reduce stress levels, improve sleep, relieve nightmares.
• Antidepressants. Restore psychological processes, normalize mood.

Another way to treat the disease is therapy using hypnosis. Many diseases are treated in this way. But not everyone, because not every person is susceptible to hypnosis. But in medical practice there are many cases in which this method really helped. Hypnosis helps to clarify old traumas in the subconscious and redirect a person's train of thought, so the symptoms of the development of the disease will be reduced.

In order to carry out the prevention of mental illness, it is necessary to organize a clear organization of work and rest, learn to devote a certain amount of time per day to mental stress, not to overload, and timely identify the development of neurosis, stress and anxiety. You can also study your ancestry and find out about the health problems that your ancestors had.

What to do if mental disorders appear

Even if you are sure that you know the cause of your mental problems or the problems of your family, you should still contact a specialist as quickly as possible. Firstly, the reasons may not be at all what you expected, and may not even lie in the same plane. Thus, patients who suffer from hyperthyroidism with moderate or slight enlargement of the thyroid gland often attribute high fatigue with emotional instability to stress. Conversely, people with psychosomatic disorders often assume some kind of body disease and sometimes even resort to healing.

Secondly, awareness of the causes is clearly not enough to recover from any illness, be it a disease of the spirit or body. In such situations, timely medical assistance is necessary.

And our clinic offers you this help. With us you can not only make an appointment with a psychotherapist, psychologist or psychiatrist. Here you can undergo all the necessary research, get a consultation with a narcologist, neurologist and receive modern complex therapy that will help you get rid of the problem forever or significantly alleviate your condition.

If you need advice from a psychotherapist, psychologist or psychiatrist, make an initial appointment by phone (812) 407-24-26