Glossary of mental illnesses

WITHDRAWAL SYNDROME. It occurs in patients who have been deprived of alcohol (in stages II-III of chronic alcoholism), as well as in drug and toxic substance abusers after stopping the use of addictive substances.

Symptoms. During withdrawal, patients develop severe somatic, autonomic, and mental disorders. During alcohol withdrawal, patients clearly experience a craving for alcohol. All thoughts of a person are occupied only with how to get alcohol. Characteristics include sudden mood swings, depression, irritability, gloominess, suspiciousness, and shallow sleep with nightmares. Weakness, sweating, tachycardia, dry mouth, headaches, heart pain, and tremors are observed.

During drug withdrawal, all symptoms are more pronounced: anger, rage, insomnia, chills, tachycardia, tremors, and anorexia. Convulsions and severe pain in the joints, muscles, and spine (“withdrawal”) occur. Patients thrash about, cry, and often develop psychosis.

During withdrawal, patients are capable of aggressive actions towards others or suicide. Those suffering from drug withdrawal can die. Such patients must be urgently hospitalized and provided with inpatient care.

Treatment. For all types of withdrawal, vitamins are prescribed in large doses parenterally (3-4 ml of a 5% solution of vitamin B1 and the same dose of vitamin B6, 3-5 ml of a 5% solution of vitamin C, 1-2 ml of a solution of vitamin PP). Detoxification is achieved through intravenous infusions of glucose, sodium chloride, hemodez, rheopolyglucin, and other solutions. Tranquilizers (seduxen, relanium, phenazepam, and tazepam) are prescribed for severe mental disorders. Reredorm is used for sleep disorders, and barbiturates (barbital and luminal) are used for insomnia with nightmares, fear, and anxiety.

The patient is advised to drink plenty of fluids (mineral water, juices, and fruit drinks) while simultaneously receiving diuretics. Depression is relieved with pyrazidol, amitriptyline, and azafen. Baralgin, butadion, and other medications are prescribed for pain. All patients are prescribed medications to support the cardiovascular system. For severe internal diseases, the patient consults a physician, and additional treatment is prescribed to address the underlying disorders. A calorie-rich, vitamin-rich diet is essential.

Chronic alcoholism is a disease characterized by the development of a pathological craving for alcohol and psychological and physical dependence on it. Alcoholism develops over long periods of alcohol abuse. Three stages are distinguished during the course of chronic alcoholism.

In the first stage, which typically lasts several years, the body’s tolerance to alcohol increases with regular and frequent alcohol consumption, requiring large quantities of alcohol to achieve intoxication. The protective gag reflex is lost, and psychological dependence and an irresistible craving for alcohol develop.

In the second stage, alcohol tolerance reaches its maximum, and a person can drink up to 1-2 liters of vodka per day. Patients have been drinking daily for many years. Breaks in drinking are usually determined by external circumstances: lack of money, work complications, family conflicts, etc. Withdrawal symptoms (hangover syndrome) develop, meaning the body becomes physically dependent on alcohol. The essence of this dependence is that the day after drinking, a small amount of alcohol relieves the discomfort and alleviates the condition. Healthy people experience symptoms of intoxication the day after intoxication (headache, nausea, weakness), and after drinking alcohol in the morning, their condition worsens, causing an aversion to alcohol.

A hangover is characterized by reddened eyes, palpitations, increased blood pressure, sweating, heart pain, weakness, fatigue, tremors, and trembling of the extremities. Some patients experience abdominal pain, loss of appetite, nausea, vomiting, and diarrhea. A hungover patient is unable to perform any work effectively, as they are only thinking about where and how to sober up to improve their condition.

Gradually, memory deteriorates, and social and intellectual decline occur. Patients become selfish, dishonest, neglectful of family, frequently change jobs, sell belongings to buy alcohol, and use surrogates. Intoxication is characterized by emotional instability, carefree cheerfulness, followed by anger, irritability, and antisocial behavior. Sleep becomes shallow, with nightmares and frequent awakenings. The early onset of mental disorders during a hangover, as well as their prevalence over physical symptoms, indicates the possibility of developing psychosis.

The third stage is characterized by intoxication occurring after consuming small amounts of alcohol. Profound physical, mental, and social degradation of the personality ensues. Patients lose the ability to work and often lose their families. Apathy and depression are observed, accompanied by a depressed mood, anxiety, and delusional ideas of self-blame and self-destruction. Physical weakness, dizziness, headaches, and leg pain appear, cardiac dysfunction develops, and toxic gastritis, ulcers, liver cirrhosis, alcoholic polyneuritis, hypertension, hand tremors, and premature aging develop. The so-called alcoholic character develops. On the one hand, all emotional reactions (grief, joy, discontent, admiration, etc.) seem to be exacerbated due to increased general excitability. Weakness and tearfulness are characteristic, with the patient crying from both joy and grief, especially when intoxicated.

On the other hand, emotional coarsening occurs, with selfishness and complete indifference toward loved ones and relatives becoming dominant. A sense of duty and responsibility disappears, and ethical norms are lost. The sufferer’s entire attention is focused on one thing only: obtaining alcohol. Drunkenness is always downplayed, and personal qualities are exaggerated. A specific alcoholic humor develops, characterized by flat, primitive, and cynical jokes. Aggression, malice, violence, and outright cynicism are increasingly manifest. Sufferers may consume any alcohol-containing substances (methylated spirits, cologne, medicinal tinctures, household chemicals, etc.) and often die from it.

Alcohol Use and Dependency in East Africa

Current data indicate that while overall per capita alcohol consumption in some African nations may appear lower than in high-income regions, the prevalence of harmful drinking patterns is severe.

• Prevalence of Disorders: Research into alcohol use disorders (AUD) in parts of East Africa has shown high rates of harmful and dependent drinking. In some localized studies, prevalence rates for alcohol use disorders have been reported to reach as high as 39% among specific youth populations, while broader estimates suggest that approximately 6% to 7% of the total population in countries like Tanzania and Burundi may struggle with alcohol-related disorders.

• The Gender Gap: Alcohol-related health burdens consistently fall more heavily on men than women. For instance, in Kenya, the 12-month prevalence of alcohol use disorders among males (aged 15+) is approximately 7.1%, compared to 0.9% for females.

• Youth Impact: Alcohol consumption is a significant concern for the region’s large youth population. Studies have identified that drinking can begin as early as age 10, and in some countries, roughly 12–13% of adolescents aged 15–19 report regular alcohol consumption.

Key Challenges

The public health response to alcoholism in East Africa is complicated by several distinct regional factors:

• Informal and Unrecorded Alcohol: A defining characteristic of the region is the high prevalence of “unrecorded” or illicit alcohol (such as traditional home-brewed spirits). In some nations, this accounts for a significant portion of total consumption, making it difficult to regulate or track through formal retail data.

• Data Scarcity: Public health stakeholders across Burundi, Kenya, Rwanda, Tanzania, and Uganda have identified the lack of robust, centralized data as a primary barrier to addressing alcohol-related harm. Many regions lack the consistent diagnostic screening required to generate exact “millions of people” statistics.

• Socioeconomic Factors: Research links the consumption of illicit alcohol to socioeconomic disadvantage, where the wide availability and low cost of unregulated brews make them accessible to vulnerable groups, including low-income individuals and youth, often leading to severe health consequences like liver disease and injury.

Alcoholism in adolescents typically begins to develop between 13 and 15 years of age, less commonly at an earlier age (childhood alcoholism). Teenagers consume alcohol in the company of peers, and less commonly with adults (e.g., at work or with parents). Tolerance develops rapidly, especially with regular alcohol consumption. A hangover syndrome develops quickly, characterized by predominantly mental disturbances, and personality changes rapidly, acquiring psychopathic traits. This manifests as increased excitability, explosiveness with aggressive behavior, or decreased activity, initiative, intellectual capacity, and apathy.

Young people’s increased interest in alcohol is often linked to the misconception that it supposedly enhances libido and sexual performance. This misconception is influenced by advertising, movies, fiction, and the unrealistic stories of friends and acquaintances. It’s based on the inherent “disinhibitory” effect of alcohol, which allows shy and indecisive people to overcome their inhibitions and fears. This helps initially, but soon comes the price of alcohol addiction in the form of serious sexual dysfunction (erectile dysfunction, impotence). Young people often combine alcohol with medications or drugs, which has an even more detrimental effect on the young body and often ends tragically.

Female alcoholism is very difficult to treat. Women with alcoholism develop a variety of mental health problems, usually more severe than those in men. Depression is more severe, recurring more frequently, and can occur even after a very short period of alcohol abuse. Such women are depressed, overcome by feelings of anxiety and hopelessness, and a sense of the futility of their existence. At these moments, thoughts of resignation to life often arise, and serious and irreparable crimes are often committed.

Many women indulge in alcohol during pregnancy, hoping for the proverbial “maybe it’ll pass.” However, regular alcohol consumption during pregnancy results in a third of children being born with signs of severe fetal alcohol syndrome, which results in delayed brain and body growth and serious damage to the nervous system. A sharp decline in intellectual abilities, including dementia, impaired vision, memory, and attention, is observed.

Alcoholism primarily affects middle-aged women (35 to 50 years old), and initially, drinking is either episodic (situational) or cyclical, with women using alcohol as a mood enhancer, a sedative, and to relieve tension, anxiety, irritation, and sleep disturbances, which sometimes occur before menstruation (premenstrual syndrome). Alcohol consumption then becomes systematic, sometimes daily.

Social interests gradually decline, jobs are lost, families disintegrate, and sexual disinhibition with promiscuous relationships without regard for the possible consequences occurs. The individual’s interests become focused solely on obtaining and drinking alcohol. Female alcoholism is usually accompanied by gastrointestinal diseases (pancreatitis, hepatitis, cholecystitis, gastritis).

Chronic alcoholism is the third leading cause of death after cardiovascular disease and cancer. Severe intoxication (alcohol poisoning) is often the cause of death at a young age. Alcohol abuse can lead to sudden cardiac death due to primary cardiac arrest or cardiac arrhythmia (such as atrial fibrillation). Furthermore, those who abuse alcohol are more susceptible to injuries, including those at home, at work, and in transport. The suicide rate among alcoholics is very high. Approximately half of all murders are committed while intoxicated.

Treatment. Successful alcoholism treatment is only achieved if the patient so desires. It is important to consider the fact that alcoholics, in most cases, do not consider themselves ill, so it is necessary to educate them. If this cannot be done within the family, the services of addiction specialists, psychotherapists, and psychiatrists can be used. Treatment aimed at suppressing alcohol cravings is carried out both on an outpatient and inpatient basis.

Initially, measures are taken to bring the patient out of abstinence (see Withdrawal Syndrome). Once a good mental and physical condition is achieved, anti-alcohol treatment is administered. This treatment is chosen jointly with the patient and their loved ones, and the nature and consequences of the proposed methods are explained. Psychotherapy is widely used, creating a focus on a sober lifestyle and achieving social and occupational rehabilitation. Treatment is effective when the patient has trusted the doctor, when the necessary rapport has been established, and mutual understanding and trust exist. A special type of psychotherapy is coding. Coding utilizes proprietary methods to which doctors have exclusive rights.

Group rational psychotherapy is also practiced in the treatment of alcoholism. For this type of treatment, a small group of patients (5-10 people) is selected, united by common psychological and social problems, which facilitates the establishment of a sense of mutual trust and understanding among them. Patients discuss a wide range of life issues, primarily related to alcoholism, with their doctor and among themselves. Discussing various issues together allows patients to gain a new perspective on themselves and evaluate their behavior. The unique atmosphere of mutual respect and trust created in groups helps them develop a lifestyle focused on sobriety and a desire to believe in themselves and their abilities.

Alcohol aversion is developed through acupuncture and hypnotherapy. In the first stage of alcoholism, a conditioned reflex to induce a gag reflex to the smell and taste of alcohol is effective. This is achieved by administering an individually adjusted dose of apomorphine hydrochloride solution subcutaneously. When nausea occurs, the patient is given alcohol to sniff, and when vomiting occurs, the patient is given small sips. Typically, after 20-25 sessions, a gag reflex to alcohol is established. In the second stage, Antabuse is effective. Treatment is carried out according to specific regimens. This method is particularly effective in treating female alcoholism.

Treatment with the aforementioned Antabuse (Teturam) is also used. The patient is given a daily dose of this drug, which is harmless in itself. However, if alcohol (even a small amount of beer or wine) subsequently enters the body, a reaction occurs, the consequences of which can be very severe and unpredictable.

Subcutaneous implantation of Esperal (Radoter) is effective. A drug reaction occurs only with alcohol consumption. Fatal outcomes are possible. The patient is warned of the possible consequences of violating the sobriety regimen and signs a written agreement, which, in turn, serves as a legal document for the physician justifying their actions.

Outpatient treatment is provided in drug addiction and psychoneurological dispensaries and drug addiction treatment rooms at central district hospitals, clinics, and in paramedic drug addiction treatment rooms (stations) at industrial enterprises. Inpatient care is provided in psychiatric and drug addiction treatment centers and day drug addiction hospitals.

After completing treatment and being discharged from the hospital, the problem does not immediately disappear; the first 1-2 months are the most difficult for the patient, when they must adapt to their new role as a sober person. During this time, it’s important to find a new job or rehabilitate your current one, try to improve your relationships with loved ones and family, and create a “cover story” for former drinking buddies that justifies your sobriety and ensures that you won’t return to your former drinking habits. During this period, moral support from family and friends is invaluable and strengthens your confidence in your chosen path.

However, even after treatment, the desire to drink may resurface. If this desire arises, the easiest way to avoid it is to eat a hearty, tasty meal. This desire usually disappears with a full stomach. Additionally, you should take a sedative (seduxen, phenazepam – 1-2 tablets) and take them regularly until your condition improves and the craving for alcohol disappears. Psychotropic medications and their dosages should be discussed with your doctor.

The craving for alcohol can persist for quite a long time, depending on the severity of the illness. It is often accompanied by the same symptoms observed during a hangover (irritability, agitation, anger, outbursts of bad moods toward the wife and children, etc.). This condition, occurring despite complete sobriety, is called pseudo-withdrawal syndrome. Typically, after a course of treatment, the doctor will provide recommendations upon discharge on what to do in such cases to prevent a relapse and a return to drinking. If recommendations are not given, it is necessary to consult a specialist and, if necessary, undergo preventive treatment.

ALCOHOL INTOXICATION is acute alcohol intoxication. There are three degrees of alcohol intoxication: mild, moderate, and severe.

Mild intoxication is considered to be one with a blood alcohol content of 1-2%. This intoxication is characterized by elevated mood, decreased judgment, loss of motor precision, and the smell of alcohol on the breath. A person feels satisfied with themselves and others, becomes more self-confident and talkative. A feeling of muscle relaxation and physical comfort develops.

At a blood alcohol level of 3-4%, moderate intoxication develops, characterized by increased motor agitation, impaired balance and coordination, and slurred speech. A good-natured mood may be replaced by irritability, resentment, and sometimes anger and aggression. Criticism of oneself and others decreases. The person may commit unmotivated, impulsive acts. Pain and temperature sensitivity decrease. After intoxication, symptoms of intoxication are usually noted: a heavy head and headache, thirst, weakness, fatigue, and a depressed mood with apathy or irritability. Memory is usually not impaired during intoxication.

At a blood alcohol level of 5-6%, severe alcohol intoxication occurs, characterized by impaired consciousness of varying degrees (from confusion to coma). Epileptic seizures sometimes occur. Involuntary urination and defecation are possible. This condition is usually completely forgotten.

Atypical forms of intoxication are sometimes observed, where, instead of euphoria, a depressed mood, irritability, anger, and discontent appear from the very beginning of intoxication, escalating into aggressive actions towards others. In some cases, there is an elevated mood with motor agitation, silliness, or a caricatured exaggeration of personality traits. Atypical forms of intoxication are usually observed in individuals who have suffered a traumatic brain injury, those with mental retardation, and psychopaths.

The diagnosis of alcohol intoxication is based on clinical data: breath odor, motor and speech characteristics, and autonomic dysfunction. Since alcohol consumption is often concealed to avoid unwanted consequences, blood and urine alcohol levels are tested, and the alcohol vapor content in exhaled air is determined.

Treatment. Fresh air, a cool shower, plenty of fluids, hot, strong tea or coffee, and induced vomiting can all help relieve mild to moderate intoxication. A person with severe alcohol intoxication, especially with signs of coma, requires immediate hospitalization and inpatient detoxification. Sometimes, in drunken company, people are ashamed or, for whatever reason, afraid to call an ambulance. It’s important to remember that the slightest delay can cost the poisoned person their life, as symptoms of intoxication progress rapidly. If a coma develops before an ambulance arrives, ensure the poisoned person does not suffocate; perform artificial respiration if necessary. The person should be placed on their side with their head slightly lower than their feet to prevent vomit from entering the respiratory tract. The tongue should be immobilized, and the mouth should be cleared of saliva and vomit. Gastric lavage should be performed through a catheter. Cordiamine, lobelia, corglycon, and other medications should be used to support cardiovascular function. Massive doses of vitamins B1, B6, C, and PP should be administered intramuscularly. Infusion therapy should include heparin, rheopolyglucin, 5% glucose solution, and isotonic sodium chloride solution.

ALCOHOL DELIRIUM (delirium tremens) is a severe alcoholic psychosis, one of the most severe consequences of alcohol poisoning. It most often occurs during forced abstinence from alcohol (withdrawal) and is characterized by psychomotor agitation, visual hallucinations, disorientation in place and time, anxiety, fear, delusions, sleep disturbances, severe tremors, and symptoms of autonomic dysfunction. Patients can be dangerous to themselves and others.

Delirium often develops upon admission to a hospital (surgical, trauma, etc.), as in these cases, the patient is forced to stop drinking due to circumstances beyond their control.

Delirium typically develops in the evening. Anxiety and agitation increase, and visual and auditory perceptions are observed. The patient begins to see objects and phenomena that do not exist in reality (visual hallucinations). They imagine swarms of mice, rats, cats, cockroaches, and flies, and sometimes even see fantastic creatures and devils (hence the saying, “I drank myself to the devil”). The patient tries to protect themselves from them, fight them off, hide, and run away. Auditory perception delusions may also occur—the “voices” of people or devils. The patient cannot distinguish between real and hallucinatory objects, and therefore poses a danger to both themselves (they may, in an attempt to “save themselves,” jump out of a window, from a height, or commit suicide) and others (they may, for example, attack a real person nearby in self-defense, whom they perceive as a “pursuer”). The patient usually has a disorientation in place (does not know where he is), in time (what day, date), but retains orientation in his own person (knows his first and last name, who he is, how old he is, place of residence, work, etc.).

Patients experience hand tremors, an unsteady gait, illegible handwriting, and slurred speech. Along with mental disorders, severe sweating, palpitations, fluctuations in blood pressure, acute toxic hepatitis, and increased tendon reflexes are observed. During psychosis, convulsive epileptic seizures occur.

Delirium usually lasts 3-5 days. With severe concomitant somatic disorders, up to 10 days. The condition worsens at night and improves somewhat during the day. Fatal outcomes are rare, although they are possible in case of serious cardiovascular dysfunction, liver failure, or cerebral edema.

Treatment. To relieve psychomotor agitation, seduxen, diphenhydramine, and sodium oxybutyrate are administered. Patients are prescribed detoxifying infusion therapy with glucose, heparin, rheopolyglucin, etc., solutions. To prevent cerebral edema, a 1% solution of Lasix is ​​administered. To maintain cardiovascular activity, cordiamine is administered subcutaneously. Vitamin C (10 ml of a 5% solution) and B vitamins (2-3 ml of a 5% solution of vitamins B1 and B6) are prescribed.

ALZHEIMER’S DISEASE – see Presenile (involutional) psychoses.

AMNESIA – see Memory impairment.

AMNESTIC (KORSAKOV’S) SYNDROME – is observed in senile mental disorders, traumatic brain injury, and alcoholic psychosis.

Impaired memory for current events is noted. Facts from years past are retained, while events occurring immediately here and now are not recorded in the patient’s memory (fixation amnesia). Patients cannot remember people they have just met, do not know whether they had breakfast or lunch, and do not recall the season or location. They are unable to recall a speech they just heard or the content of something they recently read. Patients compensate for their lack of memory for current events with various fabrications or memories of past events (confabulations and pseudoreminiscences).

Rapid fatigue and irritability are characteristic. Severe impairment of intellectual functioning is usually not observed, as these patients retain all experience, professional skills, and all knowledge acquired previously. Patients retain the ability to reason and draw correct conclusions unless reliance on memories of immediate events is required.

APATHY is an indifferent, apathetic attitude toward one’s surroundings, a state in which internal drives, interests, and emotional reactions are diminished or completely lost. Apathy is often accompanied by signs of abulia—a morbid lack of willpower, a lack of desire, and a lack of motivation for activity. Apathico-abulic syndrome is often observed in schizophrenia, trauma, and brain tumors.

AUTISM is a condition characterized by a predominantly withdrawn inner life, active detachment from the outside world, and a paucity of emotional expression. It is observed in schizoid personality types and schizophrenia.

DELIRIUM TREMENSIS – see Alcohol Delirium.

DELIRIUM SYNDROMES. Delusions are a symptom of many mental disorders, manifested in false judgments and inferences that have a subjective justification and are not amenable to correction. Delusional ideas can be systematized or fragmentary. In the former case, the patient’s judgments are dominated by logical errors, based on which he formally correctly interprets external phenomena.

Systematized delusional ideas (delusions of interpretation or interpreted delusions) are subdivided into ideas of persecution, discovery, invention, jealousy, grandeur, self-accusation, etc. Fragmentary delusional ideas (figurative delusions) develop against a background of disturbances of perception and emotion and are characterized by mobility, versatility, incompleteness of morbid judgments, and their increased mutability.

Paranoid syndrome is a condition manifested by systematized delusional ideas. The patient’s entire attention and activity are subordinated to the desire to prove their case and realize their morbid urges. In delusions of reformism and invention, patients develop various projects and designs for perpetual motion machines; in delusions of jealousy, they constantly discover new signs of betrayal, demand confessions, organize secret inspections, etc. Painful experiences are expressed in extreme detail. Paranoid syndrome is found in schizophrenia, pathological personality development, and paranoid psychopaths.

Paranoid syndrome is expressed by fragmentary, unsystematized delusional ideas of various kinds (delusions of reference, influence, persecution, etc.). Painful statements are accompanied by hallucinations, most often auditory. Patients hear various voices, noises, screams, “transmitted by special equipment,” etc. Symptoms of depersonalization are also encountered. Paranoid syndrome is observed in schizophrenia, alcoholism, epilepsy, reactive psychoses, etc.

Paraphrenic syndrome. Delusional ideas of grandeur, often fantastical, are characteristic. Patients talk about their omnipotence, use fantastical comparisons, consider themselves masters of the world, etc. The syndrome is observed in schizophrenia, progressive paralysis, and alcoholic psychosis.

Mental (psychic) ​​automatism syndrome (Kandinsky-Clerambault syndrome)- a combination of delusions of persecution and influence, pseudo-hallucinations, and phenomena of mental automatism. Patients are convinced that someone or some phenomenon is influencing them from outside, influencing their thoughts, directing their actions, hypnotizing, electrifying, evoking vivid memories, joy, anger, hostility, etc. Movements and actions also take on the character of being performed, i.e., as if under the influence of an external force; they move their legs and tongue, turn their head, etc. Hypochondriacal syndrome is observed in schizophrenia, epilepsy, and atrophic and organic diseases of the central nervous system.

Hypochondriacal syndrome is found in psychopathy, depressive states, neuroses, and schizophrenia. It manifests itself as a constant fear of the patient’s health, a constant fear of becoming seriously and incurably ill, or a conviction of having a serious illness. Patients with this syndrome often seek medical attention and require in-depth medical examinations. Typically, no serious illnesses are detected, and patients, having received no help, accuse doctors of ill will and sabotage, consider themselves the source of a dangerous infection, claim they were hypnotized, and so on.

If delusional disorder is suspected, the patient or their relatives should be advised to consult a psychiatrist. If the patient’s behavior as a result of delusional disorder poses a danger to others, they should be hospitalized in a psychiatric hospital. Haloperidol, triftazin, trisedyl, and other medications are used to treat delusions. Dosages and treatment strategies depend on the underlying disorder.

Hallucinations are a sensory-subjective experience of perceiving images, objects, and phenomena that do not objectively exist. During hallucinations, visions, objects, smells, and sounds are apparent, not actually present. Hallucinations can be visual, auditory, olfactory, gustatory, or tactile. During visual hallucinations, patients see flashes of light, sparks, insects, people, animals, figures, etc. During auditory hallucinations, patients may hear sounds, voices, songs, screams, monologues, etc.

Treatment: In the acute onset of hallucinations, patients must be hospitalized to clarify the diagnosis. Neuroleptics (triftazin, etaperazine, leponex, etc.) are used for treatment. In cases of mental illness (schizophrenia, etc.) accompanied by chronic hallucinatory states, continuous maintenance therapy with psychopharmacological drugs is carried out under the dynamic supervision of a psychiatrist, and in rural areas under the supervision of a paramedic with constant consultations with a psychiatrist.

DELIRIUM – see Clouding of consciousness.

DEMENTIA (acquired dementia) – a persistent decline in mental abilities and intellect, expressed in a decrease in the stock of knowledge, memory, and judgment disorders, emotional impoverishment, loss of skills, and activity. Develops as a result of progressive paralysis, atrophic processes in the cerebral cortex (Alzheimer’s and Pick’s diseases), epilepsy, schizophrenia, head injuries, senile psychosis, etc.

DEPRESSIVE STATES – the most common manifestations of almost all mental illnesses. Depression is characterized by depressed mood, slowed thinking and speech, motor retardation, loss of interest in life, feelings of guilt, sleep disturbances, appetite (sometimes with refusal to eat), and frequent suicidal thoughts and intentions. Sometimes depression is accompanied by severe anxiety (anxious depression) or motor agitation (agitated depression), in which patients rush about, sob, and tear at their clothes and hair. External signs of depression do not always reflect the severity of the condition and the risk of suicidal behavior, so the patient must be monitored around the clock. A psychiatrist should accurately assess the severity of the depressive state. A lack of awareness of the illness, as well as ideas of guilt, suicidal tendencies, and refusal to eat, indicate the need for inpatient treatment.

Dysphoria is a mood disorder characterized by depression, anger, melancholy, irritability, and even outbursts of anger and aggression. Dissatisfaction with everything around them is present. It usually begins suddenly, without any external trigger, lasts for several days, and ends just as suddenly. It is observed in epilepsy, intellectual disability, organic brain diseases, and excitable psychopathy.

Treatment depends on the underlying disorder. Rest, sedation, and symptomatic therapy are recommended.

ILLUSIONS are a distorted perception of real objects and phenomena. Sometimes illusions are caused by a specific mental state—fear, anxiety, etc.—whereby ordinary objects can be perceived as frightening images, and a faint cracking sound can be perceived as a loud gunshot. The presence of a falsely imagined object distinguishes illusions from hallucinations. Illusions can be observed in otherwise healthy people under unfavorable conditions of perception (an unfamiliar place, darkness, etc.). In alcoholic delirium, infectious delirium, and other morbid conditions, illusions are a sign of the severity of the condition and impaired consciousness.

Patients must be hospitalized for appropriate treatment.

INTOXICATION PSYCHOSES. Toxic effects on the brain from various factors (industrial poisons, medications, etc.) often cause mental disorders. Acute intoxication is characterized by the development of clouding of consciousness, most often in the form of delirium, sometimes progressing to stupor and coma. Accompanied by some somatic and neurological disorders. With prolonged chronic intoxication, depressive-paranoid, catatonic syndromes develop, sometimes amnestic (Korsakoff’s) syndrome. Subsequently, a decrease in intelligence, memory impairment, and progressive dementia may be observed.

Treatment is symptomatic and detoxifying. Hospitalization of patients is necessary, and bed rest is indicated.

HYPOCHONDRIC SYNDROME – see Delusional syndromes.

HYSTERICAL SYNDROMES – include a group of disorders that are reversible in nature, characterized by dynamism, a variety of symptoms and their combinations, and sometimes imitating the manifestations of various somatic and neurological diseases (seizures, fainting, paresis, paralysis, hyperkinesis, anesthesia, algia, blindness, deafness, disorders of consciousness, etc.). Hysterical reactions most often occur in conflict or extreme situations and are usually accompanied by a violent, theatrical, and demonstrative expression of emotions. Hysterical symptoms are often observed in reactive psychoses, neuroses, and schizophrenia.

KANDINSKY-CLERAMBAULD SYNDROME – see Delusional Syndromes.

CATATONIC SYNDROMES – characterized by a predominance of motor disturbances. Observed in schizophrenia, symptomatic and organic psychoses. A distinction is made between catatonic stupor and catatonic excitation.

Catatonic stupor is characterized by immobility, increased muscle tone, mutism, and freezing in unnatural, bizarre poses. Sometimes the patient maintains the assigned position for a long time (waxen flexibility).

Catatonic excitation is absurd, silly behavior, accompanied by grimacing, repeating the words and actions of others, and meaningless, stereotypical movements. Sometimes patients are aggressive, easily angered, can hit, and strive to destroy everything around them.

Manic-Depressive Psychosis (MDP) is a disorder characterized by recurring depressive and manic states (phases), usually separated by periods of relief.

The depressive phase is characterized by a triad of symptoms: a depressed, melancholy mood, inhibited thought processes, and motor constraint. Patients are sad and sullen; their movements are slow and monotonous. They complain of melancholy (an oppressive feeling of hopelessness, mental pain, a nagging feeling in the heart or pit of the stomach), indifference to loved ones, and to everything that previously brought pleasure. Patients are inhibited, sitting in one position or lying in bed. Their facial expression is mournful and sad. They answer questions in monosyllables, with a delay. The future seems hopeless, and life is meaningless. The past is viewed only in terms of failures and mistakes. Patients report feeling worthless, useless, and ineffective. A feeling of oppressive melancholy sometimes leads to suicidal attempts.

Appetite is lost, food seems tasteless, and patients lose weight. Women during depression often experience a loss of menstruation (amenorrhea). Mild depression is characterized by diurnal mood swings typical of MDP: They feel worse in the morning (waking up early with feelings of melancholy and anxiety, inactive), while in the evening their mood improves somewhat, and their activity increases. With age, anxiety (unmotivated restlessness, a premonition that “something is about to happen,” “inner turmoil”) increasingly plays a role in the clinical picture of depression. Patients are typically aware of the changes occurring within them, evaluate them critically, but are unable to do anything about them, and suffer greatly from this (in schizophrenia, patients do not critically evaluate their condition and do not worry about it).

The manic phase is characterized by elevated mood, accelerated thought processes, and psychomotor agitation. Everything around them seems beautiful and joyful; patients laugh, sing songs, talk a lot, and gesticulate actively. A disinhibited state of instincts is characteristic, which can result in promiscuous sexual activity. Patients often overestimate their abilities and apply for various positions that are inappropriate for their level of knowledge and qualifications. They often discover extraordinary abilities, posing as actors, poets, or writers. They quit their jobs to pursue creative pursuits or simply change professions. Patients have a healthy appetite, but they may lose weight due to excessive energy expenditure. Sleep is short (3-4 hours).

Depressive phases are usually longer than manic episodes. Relapses are typically seasonal, most often in the fall and spring. Sometimes the disease is characterized by the occurrence of depression alone (less commonly, mania alone), in which case it is referred to as a unipolar course. The duration and frequency of depressive and manic episodes vary, ranging from a few days and weeks to several months.

Severe forms are treated in a hospital, while milder forms are treated on an outpatient basis. Methylpramine, amitriptyline, tranquilizers, and other medications are used to relieve depressive episodes. Electroconvulsive therapy is used for prolonged and drug-resistant depression. Aminazine and haloperidol are prescribed for manic episodes. Carbamazepine, finlepsin, and lithium preparations are used (as prescribed by a doctor) to prevent relapses.

MANIC STATES are characterized by a morbidly elevated mood, unreasonable optimism, and excessive activity. Manias most often occur in schizophrenia, manic-depressive psychosis, organic diseases of the central nervous system, and certain intoxications. Characterized by verbosity, a desire to constantly expand one’s sphere of activity and contacts, and an overestimation of one’s own capabilities, sometimes accompanied by ideas of grandeur. Increased irritability and conflict are often observed. Sleep is typically disturbed (reduced sleep with early awakening), and appetite is increased.

MUTISM is silence, the absence of speech despite an intact vocal apparatus. The patient understands speech addressed to them, but remains silent, attempting to explain themselves through signs. This is observed in schizophrenia, hysteria, and reactive psychoses.

Drug addiction and toxic substance abuse are disorders caused by a pathological craving for drugs and other toxic substances that alter a person’s psyche, behavior, and emotions. Repeated use of these substances develops a compulsive need for their systematic use. The craving for the drug becomes so strong that the person is unable to suppress it, and all thoughts, feelings, and desires are reduced to one thing: finding the drug and injecting it into the body. Narcotics are administered subcutaneously or intravenously (opium, morphine, codeine, barbiturates), or by inhalation (cocaine) or smoking (marijuana, hashish). Often, with prolonged use of tranquilizers, neuroleptics, antidepressants, and stimulants (phenamine, caffeine, concentrated tea infusion – “chifir”), tolerance and dependence are observed. Polydrug addiction, with an addiction to the use of several drugs, sometimes develops. For example, drug use is combined with alcohol consumption, or a medication is added to a dose of alcohol. Drug addiction is accompanied by the development of mental and physical dependence on drugs.

Mental dependence is characterized by constant thoughts about drugs, depression, and a depressed mood in their absence. All the patient’s interests, interpersonal, and social relationships are focused on finding ways to use drugs. Gradually, the person’s spiritual world is rebuilt, family relationships are disrupted, rudeness and dishonesty increase, and personality degradation occurs. A wide variety of mental changes develop, from asthenic syndrome and neurosis-like states to dementia (in some forms of drug addiction). Engaging in a particular activity in the early stages of the disease can temporarily reduce mental dependence on the drug.

As the disease progresses, physical dependence and withdrawal symptoms (see below) develop. The body’s vital functions are maintained at a certain level only with the constant use of the drug. Abrupt cessation of drug use disrupts most bodily functions—abstinence. Drug withdrawal symptoms occur, accompanied by insomnia, chills, tachycardia, tremors, and anorexia. Convulsions and severe pain in the joints, muscles, spine, and other areas are also common. Examinations of drug addicts often reveal vascular dystonia, phlebitis, myocardial dystrophy, hepatitis, liver cirrhosis, gastroenterocolitis, chronic pneumonia, and other conditions.

A reliable diagnosis is made in a psychiatric (narcological) hospital based on the withdrawal syndrome specific to each type of drug addiction, manifestations of pathological cravings for drugs, and characteristic behavioral changes. Treatment for drug addiction is provided by narcologists in drug treatment centers and hospitals. The patient is hospitalized, deprived of the opportunity to take the drug, and undergoes detoxification and general strengthening therapy. Psychotherapeutic methods are used to develop a mindset of abstinence from the drug. Measures are taken to ensure the patient’s social and occupational rehabilitation.

MEMORY DISORDERS. Memory is the reflection of life experience in our consciousness through the memorization, storage, and retrieval of information. One of the most common memory disorders is amnesia—partial or complete memory loss. There are several types of amnesia.

Anterograde amnesia is characterized by the loss of memory of events immediately following the disease condition that caused the memory impairment.

Retrograde amnesia is the inability to recall events immediately preceding a brain disorder or traumatic brain injury.

Retroanterograde amnesia is a combination of these disorders.

Fixation amnesia manifests itself in the inability to remember current events or newly incoming information (amnestic (Korsakoff’s) syndrome).

In severe depressive states, accompanied by melancholy and depression, patients complain of an exacerbation of memory for unpleasant events and misfortunes of the distant past. The memorization process as a whole is impaired, and hypomnesia develops: initially, difficulty recalling terms, names, and key dates is observed, then the fixation properties of memory are weakened (atherosclerotic lesions of the cerebral vessels, brain injury). Paramnesias are erroneous, false memories. These include pseudoreminiscences, in which the patient recalls events that actually happened to them, but not at the time they indicate. Confabulation is a condition in which gaps in memory are filled with fictitious, often fantastical, events that never actually occurred. Cryptomnesia is a memory impairment in which the patient cannot distinguish facts and events that actually occurred from those previously heard, read, or seen.

Pseudoreminiscences and confabulations are symptoms of the development of senile dementia. Paramnesias that occur with infectious diseases, vascular, or alcoholic psychoses usually resolve during recovery. Nootropil, piracetam, aminalone, pyriditol, and others are prescribed to alleviate progressive memory impairment.

NEUROSES– a group of so-called borderline mental disorders that develop as a result of prolonged exposure to psychotraumatic factors, emotional or mental overstrain, and sometimes under the influence of infections and other diseases. Based on the characteristics of clinical manifestations, a distinction is made between neurasthenia, hysterical neurosis, and obsessive-compulsive disorder.

Neurasthenia (asthenic neurosis, nervous weakness, exhaustion neurosis). A distinction is made between hypersthenic and hyposthenic neurasthenia. Hypersthenic neurasthenia is characterized by excessive irritability, emotional exhaustion, impatience, sleep disturbances, and decreased performance. Intolerance to loud sounds, odors, and fluctuations in atmospheric pressure is observed. Somatic disorders include headaches, sweating, tachycardia, and unstable blood pressure. The hypersthenic form is usually the first stage of the disease, gradually giving way to the second stage – hyposthenia. Hyposthenic neurasthenia is characterized by increased fatigue, lethargy, passivity, and a feeling of constant tiredness. Patients are drowsy and indifferent, and sexual suppression is often observed. Sometimes neurasthenic disorders take on a depressive tint and, as the disease progresses, can develop into neurotic depression. Initial signs of neurasthenia usually quickly resolve with the elimination of emotional stress and the normalization of work and rest patterns. In severe cases, tranquilizers (Relanium, phenazepam, mezapam, etc.) are prescribed, along with psychotherapy and physiotherapy.

Hysterical neurosis has a wide variety of clinical symptoms. Patients may experience various emotional disturbances, manifested by theatrical posturing, loud sighs, screams, groans, and wringing of the hands. Sometimes, consciousness is impaired, and seizures occur. Somatic disorders manifest as hysterical hiccups, vomiting, coughing, shortness of breath, and refusal to eat. Pain syndromes mimicking various inflammatory diseases of the internal organs are often observed, as well as hysterical deaf-muteness (surdomutism), blindness (amaurosis), paralysis and paresis, and inability to stand or walk. These disorders are not based on organic damage to the central nervous system and are functional in nature. Due to the variety of clinical manifestations, hysteria has received characteristic names: “the great malingerer,” “chameleon,” etc. In treatment, eliminating psychotraumatic factors and conducting psychotherapy are very important. Tranquilizers (Relanium, phenazepam, etc.) are prescribed.

Obsessive-compulsive disorder is characterized by the emergence of obsessive thoughts, memories, fears, and actions contrary to the patient’s wishes. The patient maintains a critical attitude toward obsessive thoughts but is unable to free themselves from them through willpower. Frequent manifestations of this form of neurosis include phobic disorders, particularly the fear of contracting an incurable disease and the fear of death. During everyday activities, such as professional ones, obsessive expectations of failure arise (in a lecturer during a lecture, in an actor during a performance, etc.). The disease tends to recur. Treatment includes psychotherapy, tranquilizers, antidepressants, and low doses of antipsychotics.

Oligophrenia is a congenital or early-acquired intellectual disability. Oligophrenia can occur due to genetic pathologies (Down syndrome, enzymopathies), intrauterine damage to the embryo and fetus (rubella, hormonal imbalances, viral infections, toxoplasmosis, etc.), asphyxia of the fetus and newborn, birth trauma, etc. There are three degrees of oligophrenia: idiocy, imbecility, and debility.

Idiocy is the most severe degree of intellectual disability. It is characterized by a complete lack of speech; patients make inarticulate sounds, are unable to navigate their environment, do not recognize their parents, make chaotic or stereotypical movements, and are prone to unmotivated behavior and laughter.

Imbecility is a moderate degree of mental retardation. Speech is poorly developed, thinking is poor, and the vocabulary is approximately 200-300 words. Imbeciles are capable of learning to count in single digits, wash dishes, clean the apartment, feed and dress themselves, but they do so in a sloppy and careless manner. They recognize family members, show affection for them, and are capable of experiencing joy, anger, resentment, and fear. They are sometimes prone to antisocial behavior and aggression.

Morbidity is a mild form of mental retardation. Patients are capable of learning with a special program and mastering work skills, but they do everything slowly, lacking activity and initiative, and are incapable of abstract thinking and generalization. They can lead an independent life, obtain some professional training, and start a family.

Treatment. Among medications, positive effects are achieved with medications that improve cerebral circulation and stimulate the maturation of nerve cells (aminalon, nootropil, pyriditol), as well as B vitamins. It is important to teach patients self-care skills and, whenever possible, professional skills using specialized methods.

CLOUDS OF CONSCIOUSNESS are disorders of objective consciousness and self-awareness characterized by impaired perception of the surrounding environment, an inability to think coherently, disorientation in place and time, and a complete or partial loss of memory of the period of clouded consciousness. Several clinical manifestations of clouded consciousness are distinguished.

Confusion is a condition in which external stimuli are perceived with difficulty, patients have a poor understanding of the situation, are inhibited, and are unable to make basic judgments. Stupor and coma are more severe conditions characterized by a complete loss of consciousness.

Delirium is a condition characterized by disorientation in the surrounding environment, visual and auditory hallucinations, vivid delusional ideas, motor agitation, etc. Partial amnesia is observed after delirium. Depending on the cause, delirium is classified as alcoholic, vascular, infectious, or intoxication. Patients with delirium are hospitalized and undergo detoxification therapy and mental health management in an inpatient setting.

Oneiroid is a dream-like clouding of consciousness characterized by complete detachment from reality and vivid delusional, illusory, and hallucinatory experiences of a fantastic nature, which may be accompanied by catatonic agitation or stupor. It is observed in schizophrenia, epilepsy, and organic brain diseases.

Amentia is a state of acute confusion, disorganization, and bewilderment. Patients perceive their surroundings fragmentarily, but are unable to comprehend them. Monotonous motor agitation, limited to the confines of the bed, may be observed. Amentia is observed in severe somatic and infectious diseases, as well as sepsis in the postpartum period. Twilight consciousness disorder is accompanied by a fragmented perception of the surrounding environment, one’s own personality, and amnesia for the duration of the illness. The patient’s consciousness is constricted, and the outside world is perceived as if viewed through a long tube. This condition is accompanied by hallucinatory and delusional experiences, as well as emotions of melancholy, anger, and fear. It is most often seen in epilepsy and hysteria.

PRE-SENILE (INVOLUTIONARY) PSYCHOSES develop between the ages of 45 and 65. Mental illnesses of old age are divided into involutional functional (reversible) psychoses, which do not lead to dementia, and senile organic psychoses, which arise from a destructive process in the brain and are accompanied by the development of severe intellectual impairment. Several forms of involutional psychoses are distinguished. The most common are involutional (presenile) melancholia and involutional paranoia.

Involutional (presenile) melancholia is manifested by a prolonged anxiety-depressive syndrome and is more often observed in women aged 50-65 years.

Characterized by a depressed mood, profound melancholy, and a constant feeling of restlessness and anxiety. The anxious-depressive state is often accompanied by motor activity and the expression of delusional ideas of self-blame, self-deprecation, and hypochondriacal thoughts. Patients constantly anticipate an “inevitable” misfortune that will destroy everyone, ask for help, consider themselves terminally ill, and sometimes express thoughts of the end of the world. Patients are fidgety, thrashing about, restless, lamenting, and repeating the same words. Suicidal attempts are possible in this state. The condition can be complicated by auditory illusions: judgment, reproach, and accusations are heard in the conversations of others. Delusional ideas of self-blame, condemnation, ruin, impoverishment, and so on are added.

Involutional melancholia is characterized by a protracted course, lasting from several months to several years. Outcomes of the disease vary. With timely and proper treatment, recovery is possible.

When diagnosing involutional melancholia, consideration is given to the patient’s age, the absence of a history of mental disorders and depressive episodes, and the prevalence of depressed mood with anxiety, fear, restlessness, the expectation of punishment for themselves and their loved ones, and a preoccupation with their illnesses, often imaginary.

Treatment: Treatment is usually carried out in a psychiatric hospital setting, as constant monitoring of the patient’s physical and mental state is necessary. Antidepressants are used in combination with antipsychotics. These medications are prescribed with caution. If medication is ineffective, electroconvulsive therapy is sometimes used.

The prognosis is generally favorable, with full recovery possible. Sometimes, unstable sleep, headaches, and mild anxiety persist for some time after recovery from psychosis. Typically, recovered patients can lead a full life, communicate with neighbors and relatives, care for themselves and loved ones, and manage their household.

In involutional paranoia, patients’ behavior is characterized by suspiciousness, mistrust, and a tendency toward various everyday squabbles and squabbles. The disease usually develops after age 50.

The disease is characterized by the gradual development of persistent delusions against a background of clear consciousness and seemingly orderly behavior. Delusional ideas typically spread to people in the immediate environment (family members, neighbors, acquaintances). Patients are convinced that neighbors are secretly breaking into their apartment, picking keys and master keys, damaging their belongings, poisoning their food, letting toxic gas under their door, trying to drive them out, and so on. Suspicious individuals conspiring with their neighbors visit them. All these actions are done with the specific goal of seizing the patient’s living space, causing material damage, or harming their health. The patient attributes any disturbances to the actions of ill-wishers: for example, coughing and palpitations are interpreted as the result of gas poisoning, while diarrhea is attributed to poisons added to food. Patients actively and persistently defend their delusional beliefs and wage a relentless battle against these imaginary enemies. They write endless complaints to various authorities, put numerous locks on their doors, spy on ill-wishers, etc.

Sometimes delusional jealousy develops, more often in men. They are jealous of their neighbors, whether they live in the same apartment, live in the same country house, or are work colleagues. For example, a wife might talk to a neighbor over the fence, suggesting a date, or bumping into an acquaintance on the street—a pre-planned encounter. Those with delusional jealousy are dangerous to others, as they may attempt to deal with a supposed lover or mistress, or with the object of their jealousy (wife or husband). Outside of delusional states, patients maintain social connections and navigate everyday matters.

Even with prolonged illness, there is no tendency for delusional disorders to worsen, as occurs in schizophrenia, and dementia does not develop, unlike in senile psychosis. Difficulties in identifying the disease usually occur in its early stages, when the patient’s delusional statements are mistaken for ordinary domestic quarrels and conflicts. Understanding the situation in communal apartments can be especially challenging, as real facts are intertwined with fiction. Unlike melancholy, depressed mood is not common in patients.

Treatment is carried out in a hospital. Antipsychotics (triftazin, haloperidol) are used in combination with tranquilizers (seduxen, phenazepam). Comprehensive general strengthening therapy is administered.

The prognosis is favorable with timely treatment.

Mental disorders in the elderly may be accompanied by progressive atrophic processes in the brain. These processes are characteristic of Pick’s disease and Alzheimer’s disease.

Pick’s disease develops between the ages of 50 and 60 and lasts for 5 to 8 years, leading to total dementia. It is characterized by localized brain atrophy, primarily in the frontal and temporal lobes. Women are affected more often than men. The disease begins with personality changes. Lethargy and apathy appear, initiative disappears, and emotional reactions become less vivid. The ability to generalize and comprehend diminishes, and self-critical thinking and behavior disappear. Some patients experience euphoria with disinhibition of drives and a loss of moral and ethical principles. Severe writing disorders occur: handwriting, literacy, and semantic expression change. Speech becomes impoverished, with a progressively reduced vocabulary and stereotypical repetitions of the same words and phrases. The patient gradually ceases to recognize objects and understand their purpose (for example, they cannot name a fork, pen, or cup and what they are used for), and therefore cannot use them. The patient’s personality changes dramatically, speech and thought become increasingly impoverished, the patient mindlessly repeats words or actions, loses the ability to perform everyday activities, and becomes disoriented. The disease culminates in a complete breakdown of mental function, leading to physical and mental dementia.

Alzheimer’s disease. Onset occurs between the ages of 55 and 60 and lasts 8 to 10 years. It arises from atrophic processes primarily in the temporal and parietal lobes of the brain. Women are affected more often than men. The disease begins with progressive memory loss. Patients notice these problems and the associated decline in intellectual abilities and try to hide them from others. As memory loss worsens, a feeling of confusion, incomprehension, and bewilderment arises, which in some cases forces them to seek medical attention. Gradually, patients lose their sense of place and time, and accumulated knowledge, experience, and skills are lost from their memory. The process of loss progresses from the present to the past, i.e., first the most recent events are forgotten, followed by more distant ones. Patients cannot state their location or their home address (though they may be able to give the address of the house where they lived in their youth). Having left home, they cannot find their way back. People in their immediate circle begin to be called by unfamiliar names, such as younger generations, by the names of their brothers and sisters, or by the names of long-dead relatives and acquaintances. Handwriting deteriorates and becomes illegible, eventually becoming a series of irregular circles, curves, and straight lines. Speech becomes increasingly unintelligible, consisting of isolated parts of words and syllables. Memory impairment reaches the point where the patient cannot even recognize their own image in the mirror (mirror symptom). Everyday skills (apraxia) are lost, as is the ability to recognize surrounding objects, and the ability to reproduce the names of surrounding objects and phenomena is impaired. Patients gradually lose all the skills and habits acquired throughout their lives: they cannot dress, cook, perform basic tasks such as sewing on a button, or ultimately, perform even a single purposeful action.

Mood is unstable: apathy alternates with gaiety, agitation, and incessant and incomprehensible speech. In the final stages of the disease, gait disturbances, seizures, and reflexive movements of the lips and tongue (sucking, smacking, chewing) may be observed. The disease ends in profound dementia and marasmus, with the grasping and sucking reflexes preserved.

When diagnosing Pick’s and Alzheimer’s diseases in the early stages, vascular pathology, brain tumors, and other conditions must be excluded. Modern diagnostic methods (computed tomography of the brain) are used to confirm the diagnosis. Effective treatments for atrophic processes have not yet been developed.

MENTAL DISORDERS IN TRAUMATIC BRAIN INJURIES Traumatic brain injuries (concussions, contusions) are often accompanied by the development of mental disorders. Short-term mental disorders occur in the acute phase of traumatic brain injury and develop immediately after the injury or within the next 6 months. Later, delayed mental disorders develop, which may manifest themselves months or years later.

During the acute phase, traumatic delirium most often occurs, characterized by acute psychomotor agitation and an influx of visual hallucinations. Periodic lucid intervals occur during which the patient regains consciousness and communicates with the doctor. Amnestic (Korsakoff’s) syndrome sometimes develops, characterized by fixation amnesia, combined with confabulations and pseudoreminiscences. Most often, the clinical picture of mental disorders is mixed and is accompanied by the appearance of anxiety, individual signs of impaired consciousness, memory impairment, attention deficit, fatigue, and irritability.

The late effects of traumatic brain injury are characterized by encephalopathy—asthenia with increased fatigue, memory loss, irritability, and sometimes seizures. Traumatic encephalopathy is characterized by asthenic disorders, autonomic instability, sleep disturbances, headaches, and dizziness; traumatic encephalopathy by increased excitability, aggressiveness, and memory loss; and traumatic encephalopathy by apathy, lethargy, and weakness. Clinical manifestations of various types of traumatic encephalopathy often include epileptiform seizures, twilight consciousness disorder, and dysphoria. Alcohol abuse or somatic illnesses can often lead to decompensation of traumatic encephalopathy, leading to traumatic dementia with severe memory impairment, personality decline, loss of critical judgment, and more.

Treatment. During the acute phase, patients are advised to remain completely still and in bed for 2-4 weeks. Intravenous infusions of glucose solutions and magnesium sulfate are administered, along with general strengthening and symptomatic therapy (B vitamins, aminalon, piracetam, nootropil, etc.). Careful treatment during the acute phase often prevents long-term complications.

The prognosis for recovery and ability to work depends on the clinical course of the disease.

PSYCHOMOTOR EXCITATION– a mental disorder that occurs in people with a wide variety of mental illnesses. Psychomotor agitation is characterized by unmotivated, unnecessary movements, verbosity (sometimes shouting), unpredictable behavior, and rapid mood changes. Psychomotor agitation is often accompanied by anger, anxiety, fear, delusions, hallucinations, and impaired consciousness. Patients with schizophrenia experience catatonic and hebephrenic agitation. Catatonic agitation is characterized by motor restlessness with chaotic, sometimes bizarre, and stereotypical movements and incoherent speech. Impulsive motor reactions and aggressive actions are also common.

Hebephrenic agitation is characterized by grimacing, affectation, emotional instability, fragmentary auditory hallucinations, and sometimes delusions.

Hallucinatory-delusional agitation can arise from threatening hallucinations or acute delusional ideas of persecution, influence, or poisoning. Patients perceive a threat to their lives in everything, running away, hiding, defending themselves from “pursuers,” and may attack others.

Treatment. To relieve catatonic and hebephrenic agitation, as well as manic agitation, first aid typically involves administering 2-4 ml of a 2.5% solution of chlorpromazine or tizercin intramuscularly. To prevent collapse, administer 2 ml of cordiamine intramuscularly. To relieve delusional agitation, administer 3-5 ml of a 0.2% solution of trifluoperazine (stelazine) with chlorpromazine. If hallucinatory symptoms and mental automatism predominate, administer 2-3 ml of a 0.5% solution of haloperidol with chlorpromazine. In cases of psychopathic agitation, reassure the patient and attempt to defuse the conflict verbally or physically. In cases of hysterical agitation, it is sometimes helpful to leave the patient alone. Since consciousness is usually preserved in such patients, they can be prescribed oral medications: seduxen (Relanium) at 0.04-0.06 g per day, elenium at 0.05-0.08 g per day, and chlorpromazine at 0.05-0.1 g per dose. In severe cases, these medications are best administered intramuscularly.

To isolate a patient who poses a danger to others, three to six people are required. Assistance should be provided calmly and kindly. Approach the patient from the side and try to coax them into sitting or lying down. If the patient is unresponsive, several people should approach from behind and to the sides, grasp them under the arms, holding their arms across their chest. Grasp their legs at the knees, and lift them in this position, laying them on their back on the bed. To secure the patient, pin their arms and legs to the bed (preferably with a blanket to prevent fractures). Support their head with a towel (preferably a damp one) draped over their forehead. Avoid applying pressure to the chest or abdomen. If the patient is unwilling to be approached, armed with an object, approach them from several sides, holding pillows, blankets, or mattresses in front of you. Try to throw a blanket over the patient, and then lay them down on the bed.

A patient must be transported to the hospital by car, accompanied by three people. One person stands in front of the patient, two stand on either side. When leading the patient out of the room or car, two people hold their wrists. The third person stands behind. To prevent the patient from hitting their head, their arms should be raised and spread apart.

PSYCHOPATHY is a constitutional and genetically determined personality disorder that leads to a disharmonious development of a person’s mental makeup. Psychopathy is a personality disorder that impairs social adaptation and causes suffering to both those around them and the patient. Psychopathic individuals are typically emotionally unstable, inconsistent in their judgment, and not always adequate in their actions. However, they do not exhibit intellectual disability. Their inherent pathological qualities are permanent, innate personality traits that, although they may intensify or develop in a certain direction throughout life, are not subject to any drastic changes. Psychopathy lies between mental illness and health, representing a borderline state. Psychopaths are characterized by a deficiency (deficiency) of the emotional-volitional sphere and thinking, but without dementia.

Psychopathy is based on a congenital deficiency of the nervous system, which can arise from hereditary factors, from exposure to harmful factors in the womb, from birth trauma, and from severe early childhood illnesses. Incorrect upbringing and psychological trauma play a significant role in the development of psychopathy. In cases where external factors play a leading role in the development of a pathological character, this is referred to as pathocharacterological personality development. However, true psychopathies are constitutional (innate).

Predominant disharmonious character traits determine the psychopathic personality type: asthenic, psychasthenic, paranoid, hysterical, schizoid, etc.

Asthenic psychopaths are highly impressionable, narcissistic, sensitive, vulnerable, and irritable, prone to fatigue. When working at challenging levels, they quickly become absent-minded, and their concentration is impaired. They are shy, indecisive, and impressionable, becoming lost in unfamiliar surroundings and new environments, experiencing feelings of inferiority. These individuals often cannot tolerate the sight of blood or sudden temperature changes, and react painfully to rudeness and tactlessness, but their displeasure may manifest itself in silent resentment or grumbling. Various autonomic disorders are common, including headaches, heart discomfort, gastrointestinal disturbances, sweating, and poor sleep. They are easily exhausted and tend to focus on their well-being.

Psychopathic psychopaths are prone to doubt, are characterized by an anxious, suspicious nature, and are impressionable. These individuals are meticulous and conscientious, and any deviation from the established order irritates them and provokes an angry reaction, especially toward family members or subordinates. They are characterized by a desire for constant introspection and self-control, a tendency toward abstract logical constructs divorced from reality, obsessive doubts, and fears. Psychasthenics find any change in life or disruption to their usual routine (changing jobs, moving, etc.) difficult, as this increases their insecurity and anxiety. The need to make independent decisions and demonstrate initiative is extremely difficult for them. At the same time, they are diligent, disciplined, and often pedantic and intrusive.

Paranoid psychopaths are willful, insincere, and distrustful individuals prone to the formation of overvalued ideas. Depending on the subject matter of these ideas, they are classified as reformers, religious fanatics, litigious, jealous, and so on. Overvalued ideas, unlike delusional ones, are based on real facts and events and are concrete in content. However, their judgments are based on subjective logic and a superficial and one-sided assessment of reality, aimed at confirming their own point of view. Overvalued ideas can include invention and reformism. Failure to recognize the merits and achievements of the paranoid personality leads to clashes with others and conflicts, which, in turn, can become a real breeding ground for litigious behavior. The “fight for justice” in such cases consists of endless complaints, letters to various authorities, and legal proceedings. The patient’s activity and persistence in this struggle cannot be broken by requests, persuasion, or even threats.

Such individuals may also place an overvalued value on ideas of jealousy and hypochondriacal ideas (obsession with their own health, constantly visiting medical institutions with demands for additional consultations, examinations, and the latest treatments, all without any real basis). A constant desire for self-affirmation, unquestioning categorical judgments and actions, egotism, and extreme self-confidence create the basis for conflicts with others. These personality traits typically intensify with age.

Hysterical psychopaths are characterized by a constant desire to attract attention and an inability to objectively evaluate the actions of others and their own. They always try to demonstrate their originality and talent. They resort to any means to be the center of attention, and to this end, may fake a heart attack or fainting, threaten suicide, or recount extraordinary adventures or inhuman suffering. Sometimes, to attract attention, these patients will not hesitate to lie and incriminate themselves, for example, attributing crimes they did not commit to themselves. These individuals are called pathological liars (Munchausen syndrome). Their feelings are superficial and unstable. Their judgments are extremely contradictory, often without foundation in reality. Instead of logical understanding and a sober assessment of the facts, their thinking is based on immediate impressions and their own inventions and fantasies. Hysterical psychopaths rarely achieve success in creative work or scientific work, as they are hampered by an unbridled desire to be the center of attention, mental immaturity, and egocentrism. They feel best in an atmosphere of scandal, gossip, and squabbles.

Unstable (weak-willed) type. People of this type are characterized by an increased subordination to external conditions. They are weak-willed, easily influenced, “spineless” individuals, easily influenced by others. Their lives are usually determined by random circumstances. They often fall into bad company, become alcoholics, drug addicts, and swindlers. At work, such people are unreliable and undisciplined. They constantly need control and authoritative leadership. Under favorable conditions, they can work well and lead a healthy lifestyle.

For the excitable type, characteristic features include extreme irritability and excitability, explosiveness, sometimes even outbursts of anger and rage, with the reaction usually out of proportion to the stimulus, occurring over the most insignificant provocations. After a burst of anger or aggressive behavior, sufferers quickly calm down, express regret, but soon act the same way again. They are perpetually dissatisfied with everything, looking for reasons to find fault, engaging in arguments on any issue, displaying excessive vehemence, and trying to outshout their interlocutors. Inflexibility, stubbornness, self-righteousness, and a constant struggle for justice, ultimately boiling down to a struggle for their rights and the pursuit of personal selfish interests, lead to incompatibility within the workplace and frequent conflicts at home and at work. In some cases, drive disorders such as alcohol and drug abuse (to relieve stress) and a tendency to wander come to the fore. Psychopaths of this type include gamblers and binge drinkers, sexual perverts and murderers.

Schizoid psychopaths are characterized by emotional coldness, selfishness, restraint, prudence, rudeness, cruelty, and isolation. They are usually focused solely on satisfying their own interests; they enjoy expressing abstract, intellectual (essentially empty) concepts that are difficult for others to understand. Their hobbies are often unusual, original, and unconventional. Many of them are involved in art, music, and theoretical science. In real life, they are usually called eccentrics and originals. Their judgments about people are categorical, unexpected, and even unpredictable. At work, they are often unruly, as they work based on their own ideas about life’s values. However, in certain fields that require artistic extravagance and talent, unconventional thinking, and symbolism, they can achieve great things.

They typically lack permanent attachments but are willing to sacrifice themselves for the sake of abstract concepts and imaginary ideas. Such a person might be completely indifferent to their sick mother, yet at the same time advocate for starving people on the other side of the world. Passivity and inaction in solving everyday problems are combined in schizoid individuals with inventiveness, enterprise, and persistence in achieving goals that are particularly meaningful to them (e.g., scientific work, collecting).

When recognizing psychopathies, it’s important to consider that personality traits are manifested not so much in the patient’s statements as in their actions and behavior. Psychopathic individuals often come into conflict with others. This leads to the development of a psychopathic reaction, manifested by an exacerbation of abnormal personality traits. Psychopathic reactions arise over any minor provocation and are accompanied by pronounced psychopathic traits, protest, indignation, and opposition. The most important diagnostic criterion for diagnosing psychopathy is the absence of disease progression. This is crucial for distinguishing psychopathies from psychopathic-like conditions that can occur at the onset of illnesses (such as schizophrenia), with a progressive course, or as a result of mental changes caused by infections and intoxications.

Treatment: Preventive measures play an important role. It is essential to properly organize the child’s daily life and social environment. Proper upbringing, followed by employment appropriate to the child’s personality, facilitates the development of compensation for psychopathic traits. In cases of decompensation, medication is used. When treating a psychopathic personality, a strictly individual approach is needed when choosing therapeutic measures and resolving employment issues.

REACTIVE PSYCHOSES are characterized by a connection between the disease and mental trauma and the disappearance of painful phenomena shortly after the elimination of the underlying cause. Mental trauma can include life-threatening situations or tragic personal or social events. Somatic and mental exhaustion (overwork, lack of sleep, injuries, head injuries, intoxication, etc.) predispose to the development of reactive psychoses. Based on the nature of the clinical picture, acute and subacute reactive psychoses are distinguished.

Acute reactive psychoses occur with sudden exposure to life-threatening factors (fire, flood, major accident, etc.). Affective-shock reactions may occur, manifesting either as psychomotor agitation with disordered movements, thrashing, and a desire to run, or as stupor (with immobility, loss of speech, refusal to eat).

Subacute reactive psychoses develop more slowly than acute ones. After exposure to a traumatic factor, some time passes, allowing the person to psychologically process the situation, after which a morbid condition develops. Subacute reactive psychoses include reactive depression, reactive paranoia, and hysterical psychoses. Reactive depression is characterized by depressed mood and melancholy; the patient’s behavior, gestures, and facial expressions reflect the traumatic situation, often representing an irreparable loss (death of a loved one, etc.). Speech is quiet and monotonous, sleep and appetite are disturbed. Patients are constantly haunted by thoughts of unpleasant events. Sometimes the depressive state takes on the character of an explosion of melancholy. In such cases, patients rush about, scream, tear their hair out, and attempt suicide. Reactive paranoia manifests itself in various forms. The leading factor in the development of reactive paranoia is the external environment (wartime paranoia, delusions in foreign-language environments, railway paranoia, etc.). Common to all forms of paranoid disorder are delusions (most often of persecution and relationships), arising against a background of fear and anxiety, as well as visual and auditory hallucinations. Patients feel surrounded by enemies plotting reprisals, hearing ominous whispers all around, and sometimes the distinct voices of ill-wishers. Patients are agitated, tearful, and ask for help. Reactive-hysterical psychoses are varied, but the most prominent features are usually hysterical twilight states (laughter, singing, crying, visual hallucinations, and figurative visions), delusional fantasies, pseudo-dementia disorders (loss of basic knowledge, incorrect answers, and actions), puerilism (childishness, capriciousness, and childish speech), and others.

Treatment: The key to treating reactive psychoses is eliminating the traumatic environment. In most cases, patients require hospitalization. Treatment involves antipsychotics, tranquilizers, and antidepressants, depending on the severity of the psychosis. Psychotherapy is also crucial. Mild depressive episodes are treated on an outpatient basis under constant supervision by family members to prevent possible suicide attempts.

SEXUAL DISORDERS AND PERVERSIONS. Sexual dysfunctions can have organic causes (disease or injury to the genitals, alcohol or drug use) and psychosocial factors (psychological, interpersonal relationships, mental illness).

Sexual dysfunction in men. The most common is erectile dysfunction, or impotence —the inability to achieve or maintain an erection sufficient for sexual intercourse. This disorder can occur at any age. Partial erections, which are insufficient for vaginal penetration, are more common. There are cases where a man is capable of an erection under certain circumstances (with his wife), but not under others (casual sex). The most common causes of this disorder are alcoholism, spinal and genital injuries, endocrine diseases (diabetes mellitus), and prolonged use of large doses of various medications (neuroleptics, barbiturates, narcotics). Many disorders are purely functional in nature and are associated with personality traits (anxiety, suspiciousness, sensitivity), reactions to the environment (fear of sexual intercourse), and mental disorders (neurosis, depression, schizophrenia).

Premature (rapid) ejaculation (ejaculation) occurs before or at the very beginning of sexual intercourse, when control over ejaculation is lost immediately after the onset of intercourse. This phenomenon can be aggravated by excessive focus on it and the thought of failure with each subsequent sexual encounter. This type of disorder is rarely caused by organic factors; psychosocial factors (prolonged abstinence, inappropriate behavior by a partner, alcohol intoxication, etc.) usually play a role.

Ejaculatory insufficiency is the inability to ejaculate despite a sufficient erection and a high level of sexual arousal. There are cases where ejaculation does not occur during sexual intercourse, but ejaculation is possible outside of sexual contact (masturbation, nocturnal emissions). Such disorders are usually not associated with organic causes. Complete inability to ejaculate is sometimes found in drug addicts and with certain neuropsychiatric disorders.

Painful intercourse is a painful sensation in the penis, testicles, or prostate during sexual intercourse. It most often occurs due to inflammatory processes in the genitals.

Sexual dysfunction in women is usually defined as frigidity and includes a decrease or absence of sexual desire, arousal, and orgasm. Currently, the term anorgasmia is used.- Lack of orgasm (sexual satisfaction). Women suffering from primary anorgasmia have never experienced orgasm, while those with secondary anorgasmia used to have orgasm but later lost this ability for various reasons.

There are several forms of anorgasmia. Some women view sex as a marital obligation and experience no satisfaction. Others, although unable to achieve orgasm, still consider sex to be beneficial and quite enjoyable. The causes of anorgasmia vary. A very small percentage of cases are associated with diseases of the genital and internal organs. Situational anorgasmia is typical for women who experience orgasm, but only under certain conditions (masturbation, erotic dreams). Mental disorders (neuroses, depression), psychological and physiological incompatibility of partners, and sexual illiteracy are fairly common causes of anorgasmia.

Vaginismus is a condition in which, when attempting sexual intercourse, the external muscles of the vagina involuntarily contract, making intercourse impossible. It most often occurs in young women. The severity of vaginismus can vary, including complete closure of the vaginal opening and the inability to perform a gynecological examination. Some women with vaginismus are capable of sexual arousal and sexual satisfaction, but without sexual intercourse. Vaginismus can be caused by a fear of sexual intercourse from childhood (for example, a girl witnessed rape), fear of losing virginity, pain, or roughness from a partner during first intercourse, etc.

Painful intercourse can manifest as acute pain, burning, tingling, or scratching, and can occur at any stage of intercourse. The causes of pain are varied, including genital diseases, conditions following gynecological surgery, vaginal dryness due to medication or estrogen deficiency during menopause, and psychological factors (fear of intercourse). Painful sensations reduce sexual pleasure and can interfere with sexual arousal and orgasm. Severe pain can lead to avoidance of sexual intercourse.

Hypersexuality is a persistent, intense sexual desire that is rarely satisfied, despite repeated sexual acts and a large number of partners. In men, this phenomenon is called “Don Juanism,” and in women, “nymphomania.” Hypersexuality can be a constitutional personality trait or arise as a result of illness (a manic state in patients with manic-depressive psychosis or schizophrenia). Hypersexuality manifests itself as an insatiable sexual need, often interfering with everyday life. Typically, there is no attraction to a specific person; only a physiological need is satisfied.

Sexual perversions (paraphilias)- conditions characterized by a pathological orientation of sexual desire with a distortion of the methods for its realization. Sexual arousal and satisfaction depend on fantasies about unusual sexual experiences and can be triggered by unusual sexual objects (animals, small children, corpses). A person prone to sexual perversions, unlike those who engage in casual sexual experimentation, is completely absorbed in thoughts of achieving their goal and is not deterred by moral norms or possible legal liability. All other forms of sexual activity are meaningless to them.

Sexual perversions can be a manifestation of mental illness (intellectual disability, schizophrenia, senile dementia) or develop in psychopathic individuals under the influence of various psychogenic and environmental factors. Their development is largely attributed to childhood trauma, poor upbringing (including sexual), early sexual encounters involving rape, abuse, etc.

Homosexuality is a sexual orientation manifested in erotic attraction predominantly or exclusively to individuals of the same sex. Homosexuality can be either permanent or temporary. Female homosexuality is called lesbian love (lesbianism). Furthermore, a certain percentage of women and men experience equal sexual attraction to individuals of both sexes; they are called bisexual.

It is important to distinguish between homosexuality as a pathological attraction to individuals of the same sex (inversion) and homosexual behavior acquired at a certain point in life. The latter can also develop in individuals with heterosexual inclinations under the influence of appropriate external factors (seduction, coercion, curiosity, greed). Such individuals are called accidentally inverted or pseudo-homosexuals. Currently, the opinion is increasingly being expressed that homosexuality is not a pathology, but a normal variant, with the same right to exist as heterosexuality.

The causes of homosexuality are still not fully understood. There are various opinions regarding the origins of this phenomenon. Some researchers believe that the development of homosexual attraction is determined by genetic (hereditary) factors, while others associate it with pathology of the central nervous system and endocrine disorders. Freud’s psychoanalytic theory occupies a special place in this regard.

Sexual contacts between homosexuals leading to mutual sexual satisfaction are varied. Most often, this includes mutual masturbation, oral-genital contact (stimulation of the genitals with the mouth), friction of the genitals against various parts of the partner’s body, etc.

Fetishism– a sexual perversion in which the object that arouses sexual desire is an inanimate object (most often, items of a woman’s attire: underwear, clothing, shoes). These objects are present during masturbation, as well as during sexual intercourse with partners, for sexual arousal. Fetishists typically collect these items, stopping at nothing, even stealing, but carefully conceal them from others.

Transvestism is a perversion in which sexual arousal can occur when dressing in the clothing of a member of the opposite sex. Typically, men suffer from this perversion, deriving sexual pleasure from wearing women’s clothing. Wearing women’s clothing may be combined with the use of cosmetics and wigs. Most transvestites are heterosexual and have families, but some may have homosexual inclinations. Transvestism should be distinguished from transsexualism, in which a man seeks to change his gender and live a woman’s life.

Exhibitionism is the derivation of sexual gratification from displaying one’s naked genitals to passersby. It is usually observed in men, especially young men. Exhibitionists are typically impotent, incapable of other forms of heterosexual activity. Exhibitionists derive the greatest satisfaction from startling and shocking their victims. To achieve this, they deliberately target women in parks, public transportation, and beaches, then suddenly appear before them with their genitals exposed. If this behavior goes unnoticed or is ignored, sexual gratification fails, and the exhibitionist seeks other victims.

Voyeurism (scopophilia) is the pursuit of sexual gratification by observing sexual intercourse or by observing naked and undressed people. Peeping or fantasizing about it becomes the only means of sexual arousal. Voyeurs deliberately visit public baths, restrooms, and beaches, spying on people changing clothes, and peer into other people’s windows in the hopes of spying on them. They derive maximum satisfaction in situations where there is a risk of being exposed or caught. Voyeurs typically limit themselves to masturbation and avoid sexual contact with women.

Sadism is the achievement of sexual gratification by inflicting pain and suffering on a sexual partner. The term “sadism” comes from the French writer Marquis de Sade (1740-1814), who described cruelty in his works as a means of achieving sexual gratification. There are various forms of sadism: from mild insults and unquestioning submission of the victim to beatings, rape, and even murder.

Masochism– obtaining sexual gratification through moral or physical humiliation, pain, and suffering inflicted by a sexual partner. The Austrian writer Sacher-Masoch described this perversion in detail, hence the name “masochism.” Mild manifestations of masochism include achieving arousal while tied up, receiving blows to the buttocks, or being bitten. In extreme cases of masochism, pain is inflicted on oneself, sometimes in monstrous forms (stabbing with a knife, tying a rope around the neck, setting chest hair on fire). Fatal cases are not uncommon.

Zoophilia (bestiality, sodomy) is obtaining sexual gratification through contact with animals. Usually observed in men. Domestic animals (cows, donkeys, horses, goats, sheep) are used for sexual gratification. Women sometimes have sexual contact with dogs. Zoophilia may be a temporary phenomenon among some cultures, where animals are used for sexual gratification during puberty in young men. It is sometimes observed as a manifestation of mental illness (intellectual disability, schizophrenia).

Pedophilia (“love of children”) is a sexual attraction to children. It is most often observed in men, including those of advanced age. Victims are primarily girls aged 6-10, but infants are also common. To facilitate their acquaintance with children, pedophiles often choose occupations that provide such opportunities (teachers and caregivers in kindergartens, schools, boarding schools, and coaches). Some derive satisfaction from touching genitals, others from displaying pornographic images and their own genitals, followed by forcing children to perform sexual acts. Acts of violence can be accompanied by sadism, including brutal murder. Aggressive pedophiles are misogynists and people with sexual problems. Their sexual encounters are impulsive and occur with strangers. Desire usually arises suddenly, and they urgently seek out a victim and commit physical violence, often with extremely serious consequences.

Obscene phone calls are phone conversations on erotic topics aimed at achieving sexual gratification. Relative safety and anonymity provide ideal conditions for sexual arousal and masturbation. The caller may know who they are calling or dial a random number. Pleasure is derived from a variety of conversation topics: from detailed, cynical descriptions of masturbation scenes and interrogating the partner about her intimate life to obscene language and threats against the interlocutor, etc.

Frottage is sexual gratification obtained by rubbing the genitals against the bodies of clothed people, typically on crowded public transport, in queues, or in crowds.

Necrophilia- achieving orgasm at the sight of a corpse or through contact with one. Common in mentally ill individuals. Necrophiliacs work in morgues, dig up graves, and steal corpses.

Treatment. Sexual dysfunctions rooted in diseases of the genital area are treated by appropriate specialists—gynecologists and urologists. If no organic diseases that could be the cause of sexual dysfunction are identified, it is necessary to consult a sexologist. Examination and treatment are carried out for both partners. Only mutual understanding and a desire to improve the situation can yield positive results. Treatment methods are selected individually, depending on the nature of the disorder. If sexual dysfunction is a consequence of a mental illness, then it should first be treated by a psychiatrist.

Treatment of perversions is a more complex issue. Sick people extremely rarely seek help and carefully conceal their activity from others, even family members. Most often, they are treated only after they are detained by law enforcement or exposed by their family. Such a person is unable to stop their behavior because it brings them the greatest pleasure. Modern treatment for sexual perversions, except mental illnesses (mental retardation, schizophrenia, and senile dementia), relies on various psychotherapeutic methods, particularly psychoanalysis and behavioral psychotherapy. Their goal is to uncover sexual complexes and develop normal sexual desire and behavior. Various hormonal medications are used to weaken sexual attraction to unwanted objects. Treatment for sexual perversions does not always produce the desired effect.

SYMPTOMATIC PSYCHOSES are mental disorders that arise from diseases of internal organs, infectious diseases, endocrinopathies, etc. Symptomatic psychoses can be acute, in most cases with impaired consciousness, or they can be prolonged without clouding of consciousness. Mood disorders, depression, and lethargy are characteristic. Very often, the development of somatic diseases is accompanied by the emergence or exacerbation of latent endogenous psychoses (e.g., schizophrenia). The characteristics of mental disorders depend on the somatic disorder that triggered the psychosis.

Acute heart failure may be accompanied by symptoms of confusion and amnesia. Myocardial infarction is most often accompanied by anxiety with fear of death, but sometimes an elevated mood with euphoria predominates. Deterioration of the condition may be accompanied by symptoms of impaired consciousness (delirium, amentia). During the improvement phase, prolonged hypochondriacal states sometimes develop, characterized by suspiciousness, egocentrism, and a persistent fixation on painful sensations.

Chronic heart failure is accompanied by lethargy, apathy, and lack of initiative. As the disease progresses, anxiety and depression develop.

Chronic renal failure with uremia is often complicated by delirious and delirious-oneiroid disturbances of consciousness, which progress to profound stupor as the condition worsens. Epileptiform seizures may also occur.

In terminal malignancies, as well as in the postoperative period, acute psychotic episodes often occur. These are usually short-lived and accompanied by clouding of consciousness of varying severity (delirious, delirious-amentive states). Depressive and depressive-paranoid states, accompanied by persistent insomnia, irritability, and suicidal attempts, are also characteristic.

Liver and gastrointestinal diseases are characterized by depression with apathy, fatigue, irritability, insomnia, emotional instability, and cancerophobia. Acute yellow atrophy of the liver is accompanied by delirious and twilight clouding of consciousness.

Vitamin deficiencies (thiamine, niacin, etc.) typically result in anxiety-depressive, asthenic, and apathetic states.

Acute influenza-related psychoses are often accompanied by delirious disorders and epileptiform agitation.

In the acute stage of rheumatism, brief attacks of psychosensory disturbances with depersonalization and derealization may occur alongside the dream-delirious state. Manic, depressive, and depressive-paranoid states are observed with a prolonged course.

Tuberculosis patients often experience elevated mood and manic states accompanied by euphoria and increased activity.

Postpartum psychosis is accompanied by amentia and depressive symptoms. The resulting mental disorders may be the initial stage of an endogenous disease (schizophrenia, manic-depressive psychosis, etc.).

Endocrine disorders can lead to neurosis-like, psychopathic, and depressive states.

Treatment. Therapy for symptomatic psychosis should be aimed at eliminating the underlying somatic or infectious disease. In addition, detoxification treatment is prescribed, as well as psychotropic medications, depending on the syndromological features of the mental disorders. In acute symptomatic psychosis, the patient must be under 24-hour medical supervision.

SENILE DEMENTIA– usually occurs after 65-70 years of age and lasts an average of 5 years, although cases of a longer course (10-20 years) have been reported. The cause of senile dementia, like other atrophic processes, remains unclear. Heredity plays a role, as evidenced by cases of “familial dementia.” The disease develops imperceptibly, with gradual personality changes in the form of an exacerbation of previous character traits. For example, frugality turns into stinginess, persistence into unmotivated stubbornness, mistrust into suspiciousness, etc. At the onset of the disease, forgetfulness, absent-mindedness, sloppiness, a narrowing of interests, and egocentrism are observed. As dementia progresses, judgment declines, the ability to acquire new knowledge is impaired, memory weakens, speech becomes impoverished, and only basic physical needs are preserved. Patients fail to recognize their relatives, don’t know where they are, how old they are, the names of their children, etc. Memory impairments gradually worsen. Memorization is impaired, and the ability to acquire new experiences is lost. Patients forget the present and recent past, but remember events from childhood and adolescence quite well. Gaps in memory are filled with confabulations and reminiscences (see Memory Impairments). At times, patients become restless and busy, packing and tying things into bundles—”getting ready for a trip”—and then, sitting with the bundle in their lap, await the journey. This occurs due to severe disturbances in orientation to time, the environment, and one’s own personality.

In senile dementia, there is always a discrepancy between the pronounced dementia and the preservation of certain external forms of behavior. A behavioral pattern, with peculiar facial expressions, gestures, and the use of familiar expressions, persists for a long time. Thanks to the preservation of external behavior patterns, lively facial expressions, common turns of phrase, and some memory, especially for past events, such patients may at first glance appear to be quite healthy. Only a casual question might reveal that the person engaging in animated conversation and demonstrating an “excellent memory” for past events doesn’t know their age, can’t determine the date, month, year, or season, has no idea where they are, who they are talking to, etc. Physical decrepitude develops relatively slowly compared to the increasing mental deterioration of the personality. However, over time, neurological symptoms appear: constriction of the pupils, weakened pupillary response to light, decreased muscle strength, hand tremors (senile tremor), and a gait with small, shuffling steps (senile gait). Patients lose weight, their skin becomes dry and wrinkled, and the function of internal organs is impaired. The final stage of senile dementia is the stage of physical and mental dementia. Patients almost completely lose speech, lose all skills, become gluttonous, unkempt, and constantly lie in a fetal position. Bedsores and pneumonia often develop at this stage, and the sick die.

With a pronounced clinical picture of the disease, diagnosis is not particularly difficult. Modern diagnostic methods (brain CT scan) are used to confirm the diagnosis.

Treatment. Patients require proper care and symptomatic treatment (based on individual symptoms of the disease). At the onset of the disease, it is advisable to keep them at home, without drastic changes in lifestyle. Hospitalization can worsen the condition. The patient should be provided with conditions for a fairly active lifestyle, so that they move more, spend less time lying down during the day, and focus more on their usual household chores. In cases of agitation, increased restlessness, prolonged insomnia, and psychotic symptoms, antipsychotic medications in small doses are indicated. When caring for such patients and encountering their stubbornness, quarrelsomeness, and irritability, it is important to remember that you are dealing with a sick person. Try to defuse any conflicts that arise, and do not react to the often unfounded reproaches and complaints that are so common among elderly people. An escalating relationship, and especially a confrontational showdown with a sick elderly person, will worsen the patient’s mental state and exacerbate the family situation. Only patience and kindness can ease their and your difficult situation.

In cases of severe dementia and the inability to provide constant care and monitoring at home, inpatient treatment or a stay in a specialized nursing home is indicated. For states of confusion and anxiety, antipsychotics with a sedative effect (tizanidine, teralen) are prescribed in small doses. For depression, small doses of antidepressants with a sedative effect are indicated. Nootropics (aminalone, piracetam, etc.) have a positive effect in the early stages.

SUICIDAL BEHAVIOR is expressed as the intent or desire to commit suicide. It most often occurs in depressive states, delusional experiences, or psychopathic reactions. Patients are haunted by suicidal thoughts and a loss of the will to live. The patient must be under 24-hour supervision. The bed should be moved away from the window, and all sharp objects, belts, and potent medications should be removed from the room. A psychiatric examination is necessary to determine whether emergency hospitalization is necessary.

Phobias are overwhelming, obsessive fears (fear of closed or open spaces, fear of heights, fear of blushing in public, fear of contracting an incurable disease, etc.). Phobias most often arise from obsessive-compulsive disorder (see Neuroses), but can also be a symptom of other mental disorders, particularly schizophrenia.

SCHIZOPHRENIA is a mental illness that occurs chronically, either intermittently or continuously, and results in characteristic personality changes. The main symptoms of schizophrenia are: a fragmentation of mental activity and a weakening of emotional and volitional power. The term “schizophrenia” literally means “splitting of the soul” (“schizo” from the Greek for “splitting,” and “phren” for “soul,” or “mind”). As mental activity fragments, patients gradually lose contact with reality, becoming isolated from the outside world and withdrawing into their own world of painful experiences. This condition, known as autism, manifests itself as a tendency toward solitude and isolation, with the patient’s thinking based on a distorted reflection of reality. Characteristics include fragmented thinking, a “verbal hash,” empty philosophizing, and symbolic thinking, where the patient interprets individual objects and phenomena in terms of their own meaning, meaningful only to them. Delusional ideas can arise primarily through a morbid interpretation of real facts and events, or secondarily, that is, from impaired perception (hallucinations).

Delusional ideas can have various contents: persecution, poisoning, witchcraft, influence, and jealousy.

Typical for schizophrenic patients is the delusion of physical influence, when they believe they are being influenced by hypnosis, X-rays, or some other radiation (“special rays”) via special devices or transmitters, both from Earth and from space. Patients hear “voices” in their heads from those influencing them, controlling their thoughts, emotions, and movements. They may also see “movies” or “special images” shown to them by imaginary people (whose voices they hear), smell various odors, and experience painful sensations in the body and head, such as burning, shimmering, drilling, and shooting pains.

Emotional-volitional impoverishment is characterized by emotional dullness, affective indifference to everything around, and especially emotional coldness toward loved ones and relatives. Sometimes patients become rude and spiteful toward loved ones, treating their parents like strangers, calling them by their first name and patronymic. Patients stop fulfilling their responsibilities and caring for their appearance (not washing, changing clothes, or combing their hair), wandering, and committing absurd acts.

Emotional-volitional impoverishment is often accompanied by a lack of willpower (abulia). Patients are disinterested in everything, have no plans, and have no desire to implement them; they can lie in bed for days without doing anything. Interest in studies and work disappears, and withdrawal and isolation from the outside world appear. Symptoms of schizophrenia depend on the stage of development and the form of the disease. The main forms of schizophrenia are continuous and paroxysmal.

Continuous schizophrenia is characterized by a gradual worsening of morbid symptoms with a sequential change of neurosis-like, hallucinatory-delusional, and catatonic-hebephrenic disorders (see Psychomotor agitation). In sluggish schizophrenia, there is a very slow decline in mental productivity, and the disease picture is limited to mild psychopathological disorders such as obsessive-compulsive disorder, phobias, hysterical, depersonalization manifestations, overvalued ideas, and paranoid delusions (of invention, jealousy, etc.). Personality changes are usually limited to isolation with traces of strange behavior and lifestyle, while maintaining vital activity and social adaptation.

With an average type of process progression and the predominance of hallucinatory-paranoid disorders in the clinical picture, such as delusions of persecution, physical impact, and phenomena of mental automatism (paranoid schizophrenia), negative changes (autism, emotional devastation, apathy) steadily increase. Malignant (juvenile) schizophrenia begins in adolescence (less commonly in childhood) with negative symptoms: loss of interest, withdrawal, and emotional depletion. Delusional ideas of various types, catatonic and hebephrenic disorders, and Kandinsky-Clerambault syndrome are characteristic. After 2-5 years, profound personality defects, emotional dullness, and abulia develop.

Paroxysmal schizophrenia includes two main variants: periodic (recurrent) and paroxysmal-progressive (fur coat-like).

Recurrent schizophrenia has the most favorable course, characterized by periodic attacks and periods of remission between them, often very long. It occurs much more often in women than in men and begins in adulthood (25-35 years). The structure of an attack may include depressive or manic symptoms, acute delusional states, and oneiroid clouding of consciousness (may be combined with catatonic disorders). An attack typically begins with a rise or fall in mood, followed by anxiety, fear, and confusion. Patients feel as if something incomprehensible is happening around them, as if scenes or performances have been staged and performed specifically for them. Memories, surrounding events, and facts are imbued with a special, fantastical meaning.

Subsequently, depending on the mood, delusions can develop in different ways. During a depressive state, ideas of guilt, a struggle between good and evil, often with the victory of evil forces, the “devil,” or “evil spirits,” may arise, and, as a result, suicidal thoughts and attempts. Elevated moods are characterized by ideas of grandeur, special significance, and a role in the world (I am the master of the universe, I am destined for a special mission, etc.). At the height of an attack, a clouding of consciousness occurs: the patient is reincarnated, living in a fantasy world, on another planet, or in a different time period (more precisely, contemplating their life as if in a dream). Reversal of the attack can be either gradual or quite rapid. The number of attacks over the course of the illness varies (from 1-2 to annual worsening). Sometimes, attacks of schizophrenia occur, lasting from several days to 2 weeks. In women, they can develop before menstruation. With the onset of menstruation (on the 2nd or 3rd day), the condition usually improves.

Personality changes, usually occurring after repeated attacks, are characterized by decreased activity, increased sensitivity, vulnerability, and impressionability. Mood swings are common between attacks. During periods of remission, work capacity is restored, patients critically evaluate their psychosis, and residual disturbances typically include mood swings. Even with many years of illness and a large number of attacks, personality changes are subtle.

Paroxysmal-progressive schizophrenia occurs in attacks followed by remissions, but the reversal of the attack does not result in a full recovery of mental health; obsessive-compulsive, hypochondriacal, and paranoid disorders persist. The true onset of the disease usually occurs in childhood, when withdrawal and isolation appear, adaptation in children’s groups (kindergarten, school) is impaired, and physical and mental development is delayed. The presence of infantilism in the patient suggests an early onset of the disease. Attacks manifest with a variety of symptoms: depressive and manic states, obsessive-compulsive disorder, delusions, hallucinations, agitation, and silliness. However, the attacks themselves are less severe than in periodic schizophrenia, and after an attack, the patient continues to experience some symptoms of the disease, meaning they do not fully recover, requiring ongoing maintenance therapy. From attack to attack, the patient increasingly exhibits a flattening of the emotional-volitional sphere. In schizophrenia, attacks are emotionally charged, and delusional ideas are not systematized. Sometimes, schizophrenia can become continuous.

Treatment: Depending on the patient’s condition, treatment is carried out on an outpatient or inpatient basis. A variety of effective treatments for schizophrenia have been developed. Approximately 40% of patients who complete treatment are discharged in good condition and return to their previous jobs. Outpatient care is provided in a neuropsychiatric dispensary, where patients are treated during minor exacerbations and also monitored during remission. Dispensaries usually have therapeutic vocational workshops where patients with disabilities of the second and third groups can work. This helps them adapt to life and contribute to society.

Acute psychotic states in schizophrenia are usually treated in an inpatient setting. These are cases where the patient poses a danger to themselves (depression with suicidal tendencies, refusal to eat, delirium) and others (acute agitation, acute persecutory delusions, commanding “voices,” etc.). Inpatient care and observation are provided. The choice of treatment depends on the specific psychopathological symptoms, the severity of the condition, previous therapy, drug tolerance, and the patient’s physical condition. Acute conditions are treated with intramuscular administration of neuroleptics (chlorpromazine, haloperidol, triftazin, etc.). Antidepressants (amitriptyline, melipramine) are prescribed for depression, and neuroleptics are used to relieve mania. In addition to psychotropic medications, nootropics, vitamins, and physical therapy are widely used. Treatment with insulin comas and electroconvulsive therapy is administered as indicated.

Patients with schizophrenia are subject to psychiatric monitoring and ongoing observation in a neuropsychiatric dispensary. If signs of deterioration in the patient’s mental state are detected, they should be referred to a psychiatrist for treatment adjustments. Organizing patients’ free time, including occupational therapy, satisfying cultural needs, and taking walks, is of great importance. Psychotherapy, primarily explanatory, is provided to patients during recovery, before discharge, and during outpatient follow-up. Discussions with relatives and family members are also necessary to create a positive family climate after the patient’s discharge from the hospital.

Neither the patient nor their family should be alarmed by the doctor’s prescribed maintenance therapy, as most medications have virtually no side effects, and if they do occur, the doctor will inform them and provide appropriate recommendations. It is common knowledge that with many illnesses, such as diabetes, hypertension, thyroid disease, and others, patients take medications for many years, and sometimes their entire lives, to maintain their physical condition. If long-term maintenance therapy for schizophrenia becomes necessary, there is no need to fear or be ashamed. Carefully monitor your condition and report any changes to your doctor for timely treatment adjustments.

Symptoms that usually indicate a worsening of the disease include sleep disturbances, refusal to eat, anxiety and fear, suspiciousness, and unexplained mood swings. In women, such symptoms typically occur before menstruation, requiring additional treatment.

The prognosis depends not only on the type of disease but also on the timeliness and adequacy of treatment, as well as the effectiveness of rehabilitation measures.

EUPHORIA is a complacent, blissful mood with a touch of cloudless joy, carelessness, and a lack of critical assessment of one’s condition. Euphoria can be a sign of drug intoxication and other intoxications. Euphoria often occurs with brain tumors (frontal and temporal lobes) and with severe somatic diseases (tuberculosis, progressive paralysis, dementia, etc.).

EPILEPSY is a chronic brain disorder, the main clinical manifestation of which consists of repeated seizures accompanied by loss of consciousness or altered consciousness and muscle contractions. In epilepsy, foci of seizure readiness form in the brain due to various causes. The most common causes include head injury, birth asphyxia, alcohol intoxication, metabolic disorders associated with diabetes, tumors, and brain parasites. Sometimes the cause of epilepsy cannot be determined.

Epileptic seizures often begin in childhood, less commonly in adolescence, but can appear for the first time in adults and the elderly. All seizures share common characteristics: sudden onset and termination; short duration; stereotypical manifestations (all seizures are virtually identical); and recurrence of seizures. A seizure is often preceded by a bad mood, a premonition of impending disaster, when the patient already knows that a seizure is coming and can take certain precautions (staying home, insuring against possible falls and injuries). An epileptic aura, a condition accompanied by a variety of sensations, is often a direct precursor to a generalized seizure: burning, tingling in various parts of the body, bright flashes of light, the appearance of unusual odors, severe dizziness, etc. The disturbance of consciousness during the aura is not profound, with the memory of the experience preserved.

A grand mal seizure begins with a sudden loss of consciousness, the patient turns pale, falls, and develops generalized tonic and tonic-clonic seizures. During the fall, injury, burns, and mutilation may occur. The tonic phase lasts approximately 30 seconds, when all muscles are tense, and the patient assumes a specific posture with arms and legs semi-flexed and drawn up to the body. The patient first turns pale, then blue, as breathing and cardiac activity temporarily cease. The tonic phase is followed by the clonic phase, when rhythmic twitching of all muscles begins: the face, arms, and legs. During this phase, involuntary urination, defecation, and ejaculation may occur due to relaxation and contraction of the sphincters. Pink foam may be released from the mouth, which is caused by the foaming saliva being tinged with blood resulting from biting the tongue or the mucous membrane of the cheek. Seizures last 2-3 minutes. Recovery from the seizure varies: some experience a feeling of relief, while others experience drowsiness, fatigue, and headaches for several hours. After the seizure, patients typically remember nothing of the event.

Along with major seizures, epileptic patients also experience petit mal seizures, which are characterized by loss of consciousness but no seizures. The most common type of petit mal nonconvulsive epileptic seizure (absence) is characterized by a brief (a few seconds) loss of consciousness. The patient appears to “freeze” for several seconds, stopping, staring at one point, and appears to be deep in thought. Amnesia for the duration of the seizure is common.

In epilepsy, impairment of consciousness may be partial. During this twilight state, the patient may leave home, and after the seizure ends, he or she may not know how or why they arrived there. During an attack of impaired consciousness, patients often perform automatic, monotonous movements, but remember nothing of them after the attack. Sometimes, seizures are accompanied by hallucinations and illusory perceptions of the surrounding environment.

The course of epilepsy is usually progressive. The number of seizures can range from one per year to several per day. In severe cases, status epilepticus sometimes develops, when seizures follow one after another without the restoration of clarity of consciousness in the short intervals between attacks.

As the disease progresses, characteristic personality changes are typically observed in patients, often leading to the development of epileptic dementia. Characteristics of epileptic patients include slow and meticulous thinking, a penchant for detail, mental rigidity, pedantry, resentment, and vindictive rancor. They are unable to distinguish between the important and the unimportant, switch from one topic to another, and become fixated on unnecessary details. These traits are often combined with exaggerated politeness, saccharine sentimentality, and exalted religiosity.

Slowness, inhibition, excessive neatness, and discipline are evident in all aspects of life, and a constant struggle for justice and order is evident. This struggle is usually centered around their own vested interests, making them quarrelsome and conflicted within families and work settings. Patients exhibit excessive meticulousness regarding their clothing, appearance, and maintaining order at home and in the workplace. Any violation of the patient’s life “principles” by others causes irritation, anger, and other protest reactions.

The degree of personality changes varies depending on the duration and severity of the disease, the timeliness and adequacy of treatment, and any associated hazards and illnesses. The patient’s condition and the development of personality changes largely depend on social factors, including the attitude and tolerance of loved ones, teachers, and coworkers. Under favorable conditions and a positive attitude, fewer factors triggering a deterioration in the patient’s condition occur.

Treatment. If an epileptic seizure occurs, measures should be taken to prevent traumatic injuries, tongue biting, and asphyxia: place a pillow under the patient’s head or support the head with the hands, unbutton the collar, and loosen the belt. If breathing is impaired due to tongue retraction and saliva accumulation in the mouth, turn the head to the side. The patient should not be left unattended until consciousness is fully restored. In cases of status epilepticus or serial seizures, hospitalization is necessary immediately, as death is possible. Before transport, administer 4 ml of Relanium intramuscularly and 5 ml of Hexenal intramuscularly. All measures are taken to prevent traumatic injuries and asphyxia.

If this is the first seizure, a thorough neurological examination is necessary.

Epilepsy treatment is long-term, continuous, and strictly regular. Upon diagnosis, treatment should be started immediately to prevent disease progression and further seizures. Epilepsy therapy is usually comprehensive and includes various medications: anticonvulsants, psychotropics, vitamins, nootropics, aloe, and vitreous injections, etc. Phenobarbital, hexamidine, and finlepsin are commonly prescribed for major seizures. Trimethin, seduxen, and suxilep are used for minor seizures. Intravenous infusions of magnesium sulfate with glucose and Diamox are used to reduce intracranial pressure. Phenylephrine (Tegretol) is effective for virtually all types of seizures, including twilight consciousness disorder and dysphoria. In recent years, tranquilizers with muscle relaxant effects (seduxen, phenazepam, clonazepam) have been widely used.

Abrupt changes in medications or their discontinuation usually cause an increase in seizure frequency. The dosage is adjusted to achieve the maximum therapeutic effect, i.e., complete elimination of seizures or a significant reduction in their frequency, with the minimum number of medications and doses. If treatment is ineffective or significant side effects occur, medications are replaced, but this should be done gradually, preferably in a hospital setting under strict medical supervision. The doctor should gradually and carefully change medications or adjust dosages under electroencephalogram (EEG) monitoring. The patient’s mental and physical condition should be closely monitored, with regular blood and urine tests. To prevent seizures, the patient should avoid exposure to factors and situations that trigger seizures (alcohol consumption, overheating in the sun, swimming in cold water, exposure to stuffy, humid air, and physical and mental overexertion).

Epilepsy treatment should be supplemented by a proper work and rest regimen, a balanced diet, and a restriction of water, salt, and spicy foods, as well as the complete elimination of alcohol.

If seizures and other paroxysms have been absent for 5 years and the electroencephalogram (EEG) shows a stable, normal pattern, medications can be gradually discontinued under strict medical supervision.

The prognosis for epilepsy is generally favorable, except for malignant forms with early onset, varied and frequent seizures, and rapidly progressing dementia. Early treatment, appropriate medication selection, adherence to the regimen, and a supportive family and work environment (choosing the right profession, creating conditions for study, and pursuing interests) usually improve and stabilize the patient’s condition.