Artifact disease (Munchhausen syndrome) – synonyms, diagnosis, treatment

Artifact disease (Munchhausen syndrome) – synonyms, diagnosis, treatment

Synonyms: simulated disorder, artifact syndrome; fake disorder, Munchhausen syndrome

Definition of artifact disease. Simulation and / or artificial induction of physical or mental symptoms of the disease, covert manipulation, “self-destructive” behavior. The author of Munchhausen syndrome is presented in the photo on the right.

Epidemiology of artifact disease. Rare disorder multifactorial disorder

The main symptoms. Secretly from others, causing harm to oneself in order to recognize the sick and in need of treatment

Diagnosis of Munchhausen syndrome
– Symptoms of the disease appear or are simulated in the absence of extrinsic motivation (for example, X-ray examination data) and / or are caused by the patient intentionally
– Pathological relation to own body
– Patients deliberately seek to use diagnostic measures, while refusing to cooperate with the doctor or interfere with the diagnosis

Diagnostic criteria for Munchhausen syndrome:
1. Simulation, exacerbation and / or artificial induction of physical and / or mental symptoms of the disease
2. Repeated violations of wound healing with the exception of significant organic causes
3. Strengthening symptoms before planned discharge
4. Obsessive desire to be sent again to hospital for treatment
5. The astounding willingness to constantly expose oneself to invasive diagnostic interventions, including operative
6. Indifference to the course of the disease
7. Indications of multiple prior interventions and operations.
8. Pathological doctor-patient relationship

Additional criteria for Munchhausen syndrome:
1. Pathological personality like “pseudologic science fiction”, manifested in the confusion of truth and fiction, self-deception, intentional lies
2. Often bizarre symptoms
3. Repeated breaks in relationships, often with complete social isolation.
4. Frequent travels
5. Often self-care from the hospital, contrary to the recommendation of the doctor
Differential Diagnosis: Simulation

Treatment of Munchhausen syndrome:
– Behavioral therapy (“symptom diaries”, self-control)
– Psychodynamic and deep psychological intervention (awareness of selfish motives in the presence of the disease)
– Control in the field of combating lies (the behavior of a doctor)

Who is at risk for Alzheimer’s disease

Who is at risk for Alzheimer’s disease

There are a number of factors that prevent the occurrence of the disease in principle. For example, this disease bypasses the side of smoking people, since nicotine triggers special processes in cells that practically block the very possibility of Alzheimer’s disease. But the crude protein, in contrast, leads to an early and rapid decrease in mental functions and memory due to the activation of enzymes that stimulate the growth of amyloid (harmful protein compounds). So lovers of raw eggs and sushi should be vigilant.

The interest among psychiatrists was a statement by Dr. Nikolaos Scarmis of Columbia University. He conducted special studies and, based on their results, concluded that the cause of Alzheimer’s disease is lack of sleep. Therefore, for the prevention of this disease, it is necessary not only to eat right, but also to sleep at least 8 hours daily.

In our country, psychiatrists and neurologists rarely diagnose Alzheimer’s disease, since they believe that the main cause of memory impairment and dementia in the elderly is a deterioration in the blood supply to the brain. They know that with age, each person’s brain atrophies physically: every 10 years we lose about 10% of the medulla and by the age of 80 the human brain weighs only 1 kg, whereas at 20 years of age it weighs about 1, 5 kg. This leads, according to doctors, to age-related dementia, a variation of which is Alzheimer’s disease.

There are no drugs that can cure or at least slow down the progression of Alzheimer’s disease. However, many manufacturers today advertise their products as a means to help partially or completely recover from this disease. Believe such advertising is not worth it. Indeed, there are drugs on the market that can slow the progression of the disease, but they cannot fully cure the disease.

These drugs include cholinesterase inhibitors – an enzyme that breaks the bonds between cells of the nervous system. Also cholinomimetics are substances that enhance neurotransmission. Today, these drugs are widely available, but their effect is manifested only during the reception. Therefore, having begun the prevention and treatment of Alzheimer’s disease, it is impossible to stop. Of course, both drugs and drugs must be prescribed by a doctor.

These drugs help weakly. They can slow down the development of the disease only by some small percentage. And therefore, it can be argued that today there are no drugs that could effectively even inhibit Alzheimer’s disease, not to mention the treatment. All drugs prescribed by psychotherapists to patients suffering from this disease, give only hope. After all, if a doctor tells a person that nothing helps from his illness, he will have additional stress, and this can worsen his health even more.

What you need to know about Alzheimer’s disease

What you need to know about Alzheimer’s disease

On the initiative of the International Organization for the Prevention of Alzheimer’s Disease, September 21 is the World Day to combat this disease in 70 countries around the world.

Such close attention to this disease is due to the fact that the population is rapidly aging, and there are still no medicines that could cure Alzheimer’s disease or at least slow down its development. Such an unusual name of the disease was given by the name of the German psychiatrist Alois Alzheimer, who first described this most common type of dementia in 1906. Since then, 112 years have passed. During this period, Alzheimer’s disease has become a real epidemic and a serious problem of modern health care.

As is commonly believed, this disease affects mainly the elderly. Up to half of all people over 85 years old have a history of Alzheimer’s disease. However, this disease can become a companion of young people aged about 30 years. Moreover, manifesting itself at a young age, the disease proceeds much more intensively and develops faster. In women, Alzheimer’s disease is 10 times more common than in men.

Nowadays, Alzheimer’s disease has become something common. People talk about it when they mean memory disorder and related behavior. But how much do we really know about her?

Alzheimer’s disease is a neurodegenerative disease. It begins with the deterioration of short-term memory. As progress progresses, long-term memory, speech, a person ceases to recognize familiar people, places, ends with the inability to get out of bed and death.

The inheritance of this disease is a rather controversial opinion. Indeed, 5% of cases have such a hereditary pathology. However, the majority of Alzheimer’s patients still do not have any relatives who suffer from this disease. Most often, the disease is hereditary in people who have the disease began after 40 years.

Diagnosis of Alzheimer’s Disease

Diagnosis of Alzheimer’s Disease

According to ICD-10:
– decrease in memory (objectively, assessment of severity)
– loss of intellectual abilities (reduced ability to express judgment and think)
– decrease in the control of affect, stimuli, social behavior (irritability, apathy)
– destruction of higher cortical functions (aphasia, apraxia)
– minimum duration – 6 months.

Diagnostics:
– neuropsychological studies: rating scales, such as Mini Mental Status Test (MMST), DemTec, test for determining the time by the hour
– laboratory tests: in the cerebrospinal fluid (cerebrospinal fluid) an increase in tau protein, a decrease in A-beta peptide, the exclusion of syphilis of the nervous system, HIV infection, hypothyroidism, hypovitaminosis
– EEG: slow rhythm
– MRI: atrophy (primarily in the hippocampus) NINCDS-ADRDA clinical diagnostic criteria for Alzheimer’s disease (Mc Khannet al.) I.

Questionable signs of Alzheimer’s disease:
• Availability of documented (for example, according to the results of the MMST psychological test) progressive dementia syndrome with deficiencies in two or more areas of knowledge
• Continuously progressive impairment of memory and other cognitive functions.
• Lack of consciousness disorders
• Slow development of the disease between the ages of 40 and 90 years, mainly after the age of 65
• Exclusion of other diseases (brain diseases or systemic diseases) that may cause the development of dementia

Ii. Likely signs of Alzheimer’s disease:
• Progressive deterioration of specific cognitive functions, such as speech (aphasia), motor abilities (apraxia) or perception (agnosia)
• Strangeness in behavior and inability to cope with various household activities
• The presence of such diseases in family history, especially with neuropathological confirmation
• The following results of instrumental studies: cerebrospinal fluid – without pathology, EEG – without pathology or contains nonspecific changes (for example, slowing down the rhythm), an indication of brain atrophy at CT with an increase in the study of longitudinal section

III. Significant signs of Alzheimer’s disease:
• The diagnosis can be made on the basis of one dementia syndrome in the absence of other diseases that may be the cause of dementia, in the presence of the main signs of initiation, a picture of the disease or clinical course
• Also in the presence of another systemic or brain disease that is itself capable of causing dementia, but is not considered the only cause
• If, with the exclusion of other possible causes of the disease, only a progressive, severe cognitive deficit is present, it should be carefully examined.

Diagnostic criteria for Alzheimer’s disease according to ICD-10:
• presence of dementia
• Gradual onset with slowly progressive dementia
• Lack of clinical guidelines or specific examination data indicating a systemic or brain disease that could trigger dementia
• Absence of a sudden apoplectic onset or indication of a neurological focus

Important: A typical patient feels quite healthy, does not complain about forgetfulness, tries to be inconspicuous, “ordinary”, avoids answering questions, and goes to a doctor not on his own initiative. Alzheimer’s disease is a diagnosis of exclusion. It is possible to confirm the diagnosis only neurologically.

Differential diagnosis of Alzheimer’s disease
• Depressive pseudodementia: most often appears in the differential diagnosis, but does not have pathognomous signs
• Vascular dementia: undulating course, focal symptoms of damage to the nervous system; on MRI multiple microinfarcts
• Other organic brain processes leading to dementia, such as Pick’s disease, Parkinson’s disease, Creutzfeldt-Jakob disease, Huntington’s chorea, progressive paralysis, etc.
• Hydrocephalus with normal pressure
• Korsakovskiy syndrome: amnesia, confabulations, impaired oculomotor functions and gait
• Mild cognitive impairment; in case of “benign” age forgetfulness, certain “things” and “objects” are forgotten, first of all; in Alzheimer’s disease, first of all, “incidents” and “events” are forgotten.

Alzheimer’s Treatment
• Drug therapy:
– antidement drugs, acetylcholinesterase blockers (galantamine, donepezil, rivastigmine) or K-methyl-O-aspartate receptor antagonist (NMDA) memantine
– in the presence of depression, antidepressants may be used.
– in a state of anxiety, confusion and sleep disorders, the use of (atypical) antipsychotics is possible

Important: Anti-dementia drugs slow down the progression of the disease, but do not cure.

Alzheimer’s disease is synonymous

Alzheimer’s disease is synonymous

Synonyms: primary degenerative dementia, presenile and senile dementia = dementia, Alzheimer’s type

Definition of Alzheimer’s disease. An irreversible, progressive, degenerative disease of the brain with typical neurological changes (accumulation of senile plaques and tangles of thickened, spiral-shaped wriggling neurofibrils in the brain tissues), clinically – with loss of cognitive abilities (memory, thinking)

Epidemiology. The most frequent type of dementia in our country is more than 1 million patients, the increase in the number of cases due to the increase in life expectancy, as this is an age-related disease: the risk of developing in people over 65 is 2-6%, in people over 85 years old – 25-33% .

Etiopathogenesis of Alzheimer’s disease:
– Genetic factors: the 4th type of apolipoprotein E, presenilin-1. Changes in the 4th and 21st chromosomes in the presenile variant of Alzheimer’s disease; amyloid theory
– Pathological deposits: amyloid plaques, neurofibrillary tangles in the brain tissues -> nerve cell degeneration
– Increased production of amyloid beta-protein precursor; intracerebral deposition of hyperphosphorylated tau protein – Cholinergic deficiency (decrease in the level of acetylcholine, as well as serotonin and norepinephrine), an excess of glutamate
– Autoimmune process
– Cerebral adrenaline deficiency

Risk factors: age, 4th type of apolipoprotein E Decompensation of the main triggers may result, for example, change of residence, privacy, surgical intervention (anesthesia) and emotional stress.

Alzheimer’s disease classification:
• Early form (up to 65 years), late form (after 65 years)
• Inherited cases (only about 5%)

The main symptoms of Alzheimer’s disease are:
• In the beginning – protracted short-term memory disorders, abnormal thinking disorders, reduction of initiative and incentives
• Early symptoms of the non-cognitive sphere: discrete behavioral changes, passivity, emotional isolation, mood lability, loss of good faith and carelessness in everything, helplessness
• At the next stage, violations of cortical functions and neurological symptoms appear: amnesia, amnestic aphasia (word choice problems), acalculia (inability to count), apraxia, protopagnosis (inability to recognize faces); behavioral disorders (physical activity -> “runaway”); violation of perception, eating behavior; changes in the rhythm of day and night, symptoms of delirium

Important: At an early stage, one can observe a significant similarity of the clinical picture with the picture of depression (“depressive pseudodementia”). Significant problems of differential diagnosis: monitoring and treatment with antidepressants.

Bipolar affective disorder – synonyms, diagnosis, treatment

Bipolar affective disorder – synonyms, diagnosis, treatment

Synonyms. Manic-depressive psychosis, cyclothymia

Definition of bipolar affective disorders. Recurrent occurrence of successively replacing each other depressive and (hypo-) manic phases.

Epidemiology:
– Age prevalence – 1-5%, depending on the diagnostic criterion
– The first manifestation in most cases at the age of 25
– The ratio of men: women = 1: 1

Etiopathogenesis of bipolar affective disorders:
– Genetic factors
– Organic dementia and neurobiochemical features – Stress effects
– Impulsiveness

Classification of bipolar affective disorders by ICD-10:
– Hypomania episode (F31.0)
– Manic episode (F31.1, 31.2 depending on the severity and presence of psychotic disorders)
– Depressive episode (F31.3, 31.4, 31.5 depending on the severity)
– Combined episode (F31.6) – Other bipolar affective disorder (F31.8)
– Bipolar I: the alternation of mania and depression
– Bipolar II: the alternation of hypomania and depression

Criteria:
– The alternation of signs of mania, hypomania and depression
– The course of the disease is necessary to study

Differential diagnosis: hyperthyroidism, schizophrenia, schizoaffective / cycloid psychosis, misuse of various substances

Treatment of bipolar affective disorders:
– Basic therapy with the use of mood stabilizers for several years
– lithium preparations (confidence level A)
– carbamazepine, valproates (confidence level B)
– atypical antipsychotics (confidence level B)
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– Environmental and social therapy
– Psycho-education, behavioral therapy
– Work with relatives and relatives of the patient / family therapy

Important: With mania there is a danger of a sudden change of mood under the influence of antidepressants, therefore in such cases the use of mood stabilizers is always required!

Current / Prediction: – Bipolar disorders occur with periodic relapses and begin in most cases from a depressive episode – Early onset of depression, a family history with the presence of mania and psychotic symptoms predetermines bipolar course – A calendar of phases helps to evaluate and analyze the course, an example is shown in the figure.

The long-term prognosis is predominantly unfavorable due to the relatively late diagnosis and treatment, the “unreliability of patients,” as well as due to numerous comorbidities and personality disorders. Patients often lose their working capacity early. 5-10% of patients develop a so-called high cycle, defined as> 4 affective episodes per year.

Affective disorders – synonyms, clinic, diagnosis

Affective disorders – synonyms, clinic, diagnosis

Definition of affective disorders:
– A group of disorders and diseases characterized by a painful change in mood (affectivity) in the form of depression, mania or hypomania
– There is no clear transition from the norm to the pathological state, which may complicate the differential diagnosis

Classification of affective disorders

Depending on the severity and course (recurrent, unipolar / bipolar, chronic), the following disorders are distinguished:
– Manic episode
– Bipolar affective disorder (affective psychosis, manic-depressive diseases / cyclothymia)
– Bipolar affective disorder
– recurrent depression
– Protracted (long) affective disorder – Other affective disorders (eg, dysthymia)

The main symptoms. The predominance of either depressive or manic / hypomania symptoms, mixed symptomatic picture is less common.

Symptoms of mania:
– Peak mood boost or irritability
– Emotional arousal with euphoria or dysphoria
– Acceleration and arousal of all mental processes – thinking, speaking, motility / movements
– Deliberately relaxed behavior, excessive activity, excessive need for communication, contacts; often rash behavior, impulsiveness, aggressiveness
– Increased activity, excess energy, the desire to engage in any activity, excessive creative activity, reducing the need for sleep
– Increased self-esteem, the belief in their own superiority

Symptoms of depression:
– Despondency, depressed mood
– Stiffness, depression, a feeling of “painful insensitivity”, fear, pessimism
– Slowing mental processes: thinking, speech, motility / movements
– Immersion in oneself, lack of interests, ideas and motivation; concentration disorder, difficulty concentrating
– Lack of incentives (motives), reduced vitality, lack of energy, poor physical well-being, feeling of exhaustion
– Self-doubt, guilt, own insignificance, despondency, depression, fatigue from life, suicidal thoughts
– Sleep disorders (increased need for sleep, early awakening, feeling tired after a night’s sleep)

Fear of open spaces (agoraphobia) – clinic, diagnosis

Fear of open spaces (agoraphobia) – clinic, diagnosis

Synonyms of agoraphobia: fear of open spaces

Definition Fear of open spaces, crowds of people, traveling alone or avoiding a phobic situation

Epidemiology of agoraphobia. The prevalence of about 5%, onset at the age of 28 years; in women occurs 2 times more often than in men

Classification. Agoraphobia without panic disorder / Panic disorder with agoraphobia in history (ICD-10 – F40.00 / F40.01)

Main symptoms: – Panic fear of large crowds of people, public places, queues, shops; travel with a neurosis of waiting
– Fear of dizziness, fainting, heart attack, loss of control
– Consequences: evading behavior, social isolation Diagnosis of fear of open spaces:
– The emergence of fear is accompanied by the appearance of vegetative and mental symptoms (heartbeat, excessive sweating, tremor, difficulty breathing, dizziness, fear of “losing control” over the situation) – Avoiding the above situations

Differential diagnosis: – Fears of organic etiology – Depression – Psychotic disorders – Obsessive-compulsive disorder

Treatment of fear of open spaces: – Behavioral therapy (imitation / confrontation with an irritant (exposure)) – Short courses of alprazolam (0.5-2 mg)

Current / Forecast of Agoraphobia: – Chronic – Social isolation with marked fear of expectation and avoidance behavior

Structure and classification of mental illness

Structure and classification of mental illness

Mental diseases / disorders by analogy with the ICD-10 classification are divided into the following groups:

– Organic and symptomatic mental disorders
– Dependencies
– Affective disorders
– Schizophrenic and schizophrenia-like psychosis with hereditary predisposition
– Disorders of personality and behavior For practical convenience and accurate description, we decided to arrange the most important diseases, syndromes and symptoms in alphabetical order according to the principle “Psychiatry from A to Z”. The facilitation of information retrieval is facilitated by highlighting the following key elements: synonyms, definition, epidemiology, structure / classification, main symptoms, diagnostic criteria / diagnostics, differential diagnostics, treatment, course / prognosis.

Along with the generally accepted description of diseases and symptoms, the classification includes some so-called popular diagnoses, such as “burnout syndrome”, chronic fatigue syndrome, and stalking syndrome (prosecution syndrome), in order for the patient to be able to obtain competent information about these disorders. Descriptions and classifications are based on generally accepted criteria of evidence-based medicine.

Epidemiology (prevalence) of mental disorders

Epidemiology (prevalence) of mental disorders

For a long time, mental disorders were considered chronic and “incurable”, while psychiatrists and psychiatric clinics consulted “secretly”. However, attitudes towards such diseases have changed – the importance of mental diseases is reflected in public self-awareness, their economic importance has played a significant role in this process: the treatment of mental diseases is one of the most costly, costs in this category are about 22 billion euros per year, equal to 10% of all direct health care expenditures in Germany.

Every 4th patient observed in private clinics, every 3rd patient of general hospitals suffers from mental disorders that are either not detected or not subjected to adequate treatment.

The latter, in turn, is one of the main causes of early disability. It is increasingly noted that treatment aimed primarily at stopping emergency conditions (the so-called radar syndrome: the patient suddenly appears on the “radar screen” and later “disappears”) is not adequate, given the chronic course of many mental (and somatic) diseases.

Patients with mental disorders and illnesses initially contact their family doctor (that is, a general practitioner). Based on this, every doctor should master the basics of psychiatry.

What definition can be given to this medical discipline? In psychiatry can be identified:
– clinical neurophysiological approach to the disease;
– mental-therapeutic (in the narrow sense of the word) approach to the patient (patient’s personality).

The first to whom patients with mental illness turn are mainly general practitioners and family doctors in the community. They play an important role in the primary diagnosis and initial therapy, as well as in the direction of treatment in specialized institutions.

The specialized outpatient care in the EU (Germany) is not given enough attention, the necessary funding and proper distribution of services are lacking: there are about 700 thousand mentally ill patients for 18 thousand psychotherapists and psychologists, about 4 million patients suffering from (severe) mental illness (1 psychiatrist per 17 thousand inhabitants at the rate of 60 euros per patient per quarter)!