Reactive Psychoses

REACTIVE PSYCHOSIS, along with neurosis, constitute a group of psychogenic diseases, i.e., due to mental trauma. They are characterized by the correspondence of the content of psychopathological manifestations to the traumatic factor and their disappearance after the elimination of the cause. Reactive psychoses, in contrast to neurosis, are characterized by a greater severity and severity of symptoms; Along with psychomotor and affective disorders, delirium and hallucinations, hysterical disturbances are also observed, often occurring with phenomena of upset consciousness (dissociative reactions). Patients lose the ability to critically assess their condition, coordinate their actions and behave adequately in this situation.
As a trauma that causes reactive psychosis, tragic events of a personal and social nature, conflicts that pose a threat to life, individually significant pathogenic situations can act. An essential link in the pathogenesis of reactive psychoses is mental asthenization, most often associated with mental or somatic exhaustion (forced wakefulness, injuries, somatic diseases). The following forms of reactive psychoses are distinguished: affective-shock reactions, hysterical psychosis, reactive depression, reactive paranoids.
Affective shock reactions, the most acute forms of reactive psychoses, arise in connection with sudden, excessive events (earthquake, fire, etc.). Reactions are manifested either in the form of psychomotor agitation with erratic movements, the desire to run somewhere, or in the form of a stupor with refusal to eat, loss of speech.
Hysterical psychoses are most often observed during the war, as well as in connection with the judicial and investigative situation and during the period of imprisonment. They are diverse, some manifestations can be transformed into others. Hysterical twilight states are distinguished by demonstrativeness, moeaichnosti manifestations (laughter, singing, crying, visual hallucinations, vivid imaginative visions) and fragmented amnesia. Delusional fantasies – unstable, unsystematic, changeable in content ideas of greatness and wealth; sometimes they become bizarre, ridiculous. Pseudo-dementia is manifested by the loss of basic knowledge, wrong answers and actions; sometimes childishness, moodiness, childish speech and motor skills (puerilism) predominate.
Reactive depression most often occurs in connection with psychogenic trauma, which acquire the meaning of irreparable loss for the patient (death of a loved one, etc.);
constitutional disposition is also important. In the clinical picture, along with depression, tearfulness, somatovegetative disorders and sleep disorders, massive hysterical manifestations (sobbing with moans, wringing of hands, fainting) often appear. Consciousness concentrates on the details of the misfortune that has occurred, and the theme of the experience is not deactivated even in cases where depression takes a protracted course. With bouts of despair, which sometimes occur at the initial stages of a psychogenic affective reaction, severe suicidal attempts are possible. In contrast to circular melancholy in reactive depressions, there are no expressed ideas of self-accusation, motor and ideational inhibition, unmotivated (vital) melancholy.
The most important pathogenetic link in the formation of psychogenic paranoids is the factor of the external environment (wartime paranoids, railway paranoids, delirium in a foreign language environment and delirium of the deaf, associated with mental isolation, etc.). The severity of manifestations, elementarity, imagery and emotional richness of delirium arising against the background of a pronounced affect of fear and anxiety are characteristic; sometimes visual and auditory hallucinations appear. The most common delusions are persecution and attitudes. Following vague fears (everyone around them looks at each other in a strange way, behaving unusually) and growing suspicion, patients suddenly have a feeling of mortal danger. It seems to them that they are surrounded by enemies, their relatives are already destroyed, they hear ominous whispers around, and sometimes the distinct voices of ill-wishers plotting the murder. Reactive paranoid in most cases is acute and disappears a few days after hospitalization, delusional reactions arising by the induction mechanism (reported psychosis) and litigious reactions are also observed.
Against the diagnosis of reactive psychosis, there is a discrepancy between the severity of the reaction and the relatively small severity of the trauma that preceded it, a protracted course of the reaction with the appearance in the clinical picture of symptoms unusual for psychogenic diseases (pointless anxiety, olfactory hallucinations, auditory deceptions of abstract content, ideas of influence, senestopathy, thought disorders) , the formation in the process of reverse development of psychosis of pronounced personality changes, the lack of criticism of the transferred painful disorders.
Treatment. First of all, it is necessary, if possible, to eliminate the traumatic situation. The main method of treatment carried out in severe cases in a hospital is psychopharmacotherapy. Along with this, psychotherapy, restorative agents, and physiotherapy are widely used.
The prognosis is favorable in most cases.

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