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УДК 616.895.8-073.432.19
Agranovsky M.L.
Soliev D.M.
Mirzaev A.A.
Muminov R.K. department of psychiatry and narcology Andijan State Medical Institute
PSYCHOPATHOLOGICAL STRUCTURE OF SCHIZOPHRENIA ATTACKS FORMED UNDER CONDITIONS OF EXOGENOUS
EXPOSURE
Resume: The purpose of this study was to study the features of the psychopathology of schizophrenia attacks formed under conditions of exogenous exposure. 70 patients with schizophrenia aged from 18 to 51 years were examined. Typological differentiation of acute psychotic states formed under conditions of exogenous exposure has established different ratios of exogenous and endogenous manifestations in the psychopathological structure and dynamics of manifest psychoses and allowed us to distinguish four syndromic types of acute psychotic states.
Keywords: exogenous factors, acute psychotic states, attacks of schizophrenia.
Relevance. The importance of the role of exogenous factors in the etiology, pathogenesis and course of endogenous diseases remains relevant to the present time and does not cease to be discussed[3]. The data of the conducted studies confirm the multifactorial nature of the predisposition to endogenous diseases, among which genetic and environmental components are distinguished [2]. The connection of exogenous factors with the clinical picture of an endogenous psychotic attack, the differentiation of various symptoms and syndromes in the structure of psychoses of different nature (exogenous/endogenous) has been one of the most difficult problems of psychiatry for many decades[7]. The difficulty of differential diagnosis of schizophrenia complicated by exogenous factors and clinically endoform, but exogenous in origin, psychoses is largely due to the limited methodological possibilities of their phenomenological distinction, due to the lack of a stable and independent connection of a specific etiological cause and a specific clinical sign [5]. Expressed by K. The belief that affective, catatonic and paranoid symptoms can enter into the picture of an exogenous type of reaction, and the hypothesis of the existence in the body of a particular individual of an etiological "intermediate link" between the pathogenic factor and the clinical syndrome began to be confirmed in the era of intensive development of psychopharmacotherapy[ 1].
Despite the fact that the leading importance of hereditary determinants in the etiology of schizophrenia is quite obvious, understanding the role and specific weight of environmental factors in the pathogenetic mechanisms of psychosis development can be a real basis for solving their diagnostic, prognostic, therapeutic, preventive and rehabilitative aspects[4].
The purpose of the study. The purpose of this study was to study the features of the psychopathology of schizophrenia attacks formed under exogenous exposure. 70 schizophrenia patients aged 18 to 51 years were examined.
Materials and methods of research. In the present study, an attempt is made to identify the preference for the development of a particular type of schizophrenia attacks formed under conditions of exogenous exposure, as well as to assess the possibility of reflecting the influence of exogenies in the psychopathological picture of these psychotic states.
Based on the tasks set, 70 patients (34 men and 36 women) aged from 18 to 51 years at the time of curation were examined.
The results of the study. The dynamic study of the paroxysmal forms of schizophrenia formed in the conditions of exogenous exposure carried out in this study revealed some features in the psychopathological and clinical picture of these disorders.
Depending on the exogenous factors against which the psychopathological and clinical picture of the studied cases of painful conditions was formed, the patients were distributed as follows:
1) in 31 patients, the development of an acute psychotic state was preceded by chronic alcohol consumption without the formation of dependence. In all cases, alcohol abuse was observed at all stages of paroxysmal schizophrenia with a picture of psychopathological symptoms of neurotic and/or affective registers;
2) drug abuse was observed in 19 patients, the intake of which was episodic, regardless of the duration of anesthesia. In all cases, there were no signs of drug addiction and abstinence, the repeated use of drugs in patients coincided in time with the manifestations of psychopathological symptoms of the underlying disease of a neurosis-like and/or affective level;
3) psychotic state in 18 patients developed against the background of acute infectious disease, at the height of its clinical manifestations (13 patients) or during the attenuation of the painful process and recovery (in 5 patients). Acute adenovirus infections were predominant, 6 patients were diagnosed with influenza during epidemic outbreaks. All cases of infectious diseases have been documented verified.
Acute psychotic states with clouding of consciousness were formed under the influence of exogenous factors that were relevant and immediately preceded the development of a manifest psychotic attack. The latter appeared in the form
of alcohol abuse or acute infectious diseases at the height of their clinical manifestations.
In all observations, the initial manifestations of psychoses were affective disorders. Their peculiarity was the predominance of mixed affective states, as well as a high proportion of anxiety, which was constant and accompanied by a sense of internal tension and unconscious diffuse fears, which allowed us to talk about the modification of the circular affect in delirium. In addition, in the overwhelming number of observations, an increase in affective symptoms was noted in the afternoon and went in parallel with an increase in the intensity of anxiety disorders. These signs are more characteristic of the exogenous type of reactions, which allows already at this stage of the attack to assume a known pathoplastic effect of exogenous factors.
Further, among the psychotic manifestations in the structure of psychosis as a whole, it was possible to note a significant proportion of true visual (elementary, microscopic, zoological) hallucinations, as well as numerous illusory disorders against the background of incomplete orientation in place and time or transient disorientation. The observed features of psychosis, fluctuation of visual hallucinatory disorders and impaired consciousness with a clear increase in the evening and at night formed a picture of delirium as one of the characteristic psychopathological disorders of the exogenous circle. However, already at this stage of the distinct exogenous type of manifestations, their atypia was noted in the form of inclusion in the structure of syndromes characteristic of endogenous psychopathological formations — scenicity in the picture of delirious manifestations, a shade of acute sensory delirium in delusional experiences. With the reduction of delirious disorders, signs of oneiroid confusion of consciousness (scenelike, detachment, dreamlike, etc.) were increasingly developing in the picture of psychosis, and the manifestations of psychosis were increasingly "endogenous" in nature, its dynamics went towards the formation of acute sensory delirium and largely corresponded to that of oneiroid seizures. This was manifested by a consistent change in the syndrome of staging, acute antagonistic delirium, which, however, differed in the concreteness and ordinariness of the content and were of a reduced nature. It should be noted that the exogenous "plaque" in the psychopathological manifestations of type 1 seizures persisted throughout their entire course, despite the subsequent apparent "endogenization", which was determined by the preservation of the true nature of visual hallucinations during the transition to oneiroid-type confusion, the reduction of catatonic disorders, the concreteness of the plot of fantastic delirium, the preservation of the circadian rhythm in the manifestations of psychosis with deterioration by evening.
Despite certain signs of the pathoplastic influence of exogenies on the picture of the initial manifestations of acute psychotic states with clouding of consciousness, the pattern of development of psychotic seizures in its finally formed form corresponded to the psychopathological picture of oneiroid-
catatonic psychosis, which, however, proceeded atypically under the influence of exogenous factors.
The formation of acute psychotic states with verbal hallucinosis coincided in time with the post-intoxication state associated with alcohol abuse and the period of asthenia after fever with adenovirus diseases.
The reflection of exogenous influence was expressed in the formation of true verbal hallucinations at the initial stage of psychosis. Auditory perception deceptions arose in close connection with mood disorders, were detected with an increase in symptoms of anxiety depression and manifested by true auditory hallucinations characterized by timbre shades of audible speech and rhythmicity, increased in the evening and at night, as well as the rapid pace of development of the psychotic picture and the transient nature of the actual psychotic disorders in the attack. The complication of psychosis was manifested by the addition of elements of acute sensory delirium with a perceptual delusional interpretation of perception deceptions, delusions of influence, up to the formation of acute Kandinsky-Clerambault syndrome, or the development of depressive-paranoid syndrome, that is, a psychotic picture characteristic of endogenous mental disorders. The peculiarities of the manifestation and dynamics of true hallucinations in the picture of psychosis allow us to speak about the similarity of its psychopathological manifestations with exogenous hallucinosis, the origin of which may be due to the influence of exogenous factors preceding the development of manifest seizures. The picture of verbal hallucinosis at the initial stages of the dynamics of psychosis made it very difficult to recognize its nosological essence, which in turn testified to the significant participation of exogenous factors in the pathoplastic modification of the psychopathological picture of an endogenous type 2 attack.
Acute psychotic states with Kandinsky-Clerambault syndrome occurred in conditions of episodic drug use (heroin) and intoxication after alcohol abuse. The impact of exogenous factors that precede the development of psychotic states with acute Kandinsky-Clerambault syndrome was not
as clearly as in types 1 and 2, but nevertheless it was possible to note the peculiarities of psychopathological manifestations, which, on the one hand, modified endogenous seizures with Kandinsky-Clerambault syndrome, and on the other — allowed them to be interpreted as a consequence of the pathoplastic influence of exogenous hazards. Thus, it was possible to note the predominance in the picture of the syndrome of senestopathic automatisms, characterized by persistence and pretentious character, with the localization of unusual painful sensations in the peripheral vessels, which were observed in patients with predominant injectable use of narcotic drugs. A certain similarity of the psychopathological structure of the acute Kandinsky-Clerambault syndrome in these attacks with the psychotic symptoms of alcoholic genesis was indicated by the noticeable representation in its manifestations of pareidolia, which had a pseudo-hallucinatory character, as well as the so-called oropharyngeal
hallucinations, attributed by some authors to specific exogenous symptoms. It should be noted, however, that the latter appeared here as deeper, pseudo-hallucinatory disorders peculiar to endogenous conditions. Acute psychotic states with Kandinsky-go-Clerambault syndrome, despite the atypia of their manifestations, were qualified as part of an attack of an endogenous process.
Such a statement was based not only on the structure, depth and dynamics of psychopathological disorders, revealing a clear complication during the development of the attack, but also on the peculiarities of the condition of patients after coming out of psychosis, when in most cases they revealed negative personality changes in the form of a decrease in energy potential and regressive syntonicity. Taking into account the deeper register of the defeat of mental activity in
3 type of manifest psychoses (acute psychotic states with Kandinsky-Clair-bo syndrome), it can be assumed that the "endogenous" mechanism of formation of the acute Kandinsky-Clair-Rambo syndrome in these cases was predominant and the influence of exogenous harms here was limited only to giving an "exogenous" coloring to a number of components of the syndrome, which caused some atypia of their psychopathological manifestations.
Conclusion. Thus, a detailed analysis of the symptoms of endogenous seizures formed in the context of exogenous exposure, carried out within the framework of this study, revealed the psychopathological features of their manifestations, which may be of some importance for the correct early diagnosis of the disease and the optimal choice of adequate therapy.
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