MANIAKAL-DEPRESSIVE PSYCHOSIS (MDP) (circular psychosis, cyclophrenia) – a disease manifested by periodic manic and depressive states (phases), usually separated by intermissions; does not lead to the formation of a mental defect.
Etiology, pathogenesis. Hereditary predisposition and constitutional factors play an important role. Most often, persons of a cycloid and psychasthenic warehouse become ill. Dysfunction of the submilky region and pathology of the endocrine system are also of some importance. Women get sick more often than men. The first attacks can occur both in the puberty and in old age. In most cases, the disease begins in the 3-5th decade of life.
Symptoms during. The severity of affective disorders (see Affective Syndromes) varies from mild disorders (cyclotymia), which are usually treated on an outpatient basis, to severe depression and mania requiring urgent hospitalization. For TIR, a complete reverse development of painful disorders is typical, a return to the state that was before the disease. Less often, after repeated relapses, during the period of remission, residual psychopathological manifestations are also noted, mainly in the form of erased hypomanic and subdepressive disorders. The number of phases during the course of the disease is very different. The duration of the phases is from 1 week to 1-2 years or more, the average duration is 6-12 months. Light gaps in some cases may be absent (the so-called continual course of the disease), but they are usually measured in months, years and even decades. The bipolar course – a change in depressive and manic phases – is observed in 1/3 of cases. Most often, the disease occurs in the form of periodic depression.
The diagnosis of TIR is based on the autochthonous occurrence and subsequent recurrence of affective phases, on. typical for endogenous affective disorders picture of mania and depression and the presence among relatives of persons with cyclothymic manifestations or patients with MDP. The MDP phases must be differentiated from endogenous, psychogenic, constitutional (phases in psychopaths) and somatogenically determined affective states. The distinction between TIR and periodic schizophrenia is based on the absence of hallucinations, delusions of attitude, persecution, and formal mental disorders at the time of the attack. In difficult-to-differentiate cases, it is possible to diagnose MDP only with long-term observation, if personality changes do not increase in the development of the disease.
Treatment of depressive conditions is carried out with antidepressants (amitriptyline, melipramine, pyrazidol, 50-300 mg / day). In severe cases, parenteral (IM, IV drip) administration of drugs is indicated. With psychotropic drug-resistant depressions, electroconvulsive therapy is performed. In hypomanic conditions, tranquilizers are effective [diazepam (seduxen), oxazepam (tazepam), chlordiazepoxide (elenium) at 5-40 mg / day, phenazepam at 1-3 mg], antipsychotics in small doses, lithium salts (lithium carbonate at 900-1200
mg / day). Manic states are stopped by neuroleptics (chlorpromazine 100-400 mg / day, haloperidol 6-20 mg / day, triftazine 20-50 mg, leponex 50-200 mg, sonapax, chlorprothixene 100-300 mg / day). In case of manifestations of manic excitement, intramuscular administration of drugs (chlorpromazine, haloperidol, triftazine) is indicated.
The prognosis is favorable in most cases. In depressive phases, it is complicated due to the danger of suicidal attempts. The main means of preventing subsequent affective phases is preventive therapy (for several years) with lithium salts and finlepsip. Lithium salts are given under the control of the lithium content in the blood (its optimal content, which provides a preventive effect, is 0.4-0.8 mmol / l).