Syndromal Structure and Syndromokinetic Features of Delusional Syndromes in Schizophrenia and Vascular Dementia

Analysis of syndromogenetic, syndromokinetic, psychopathogenesis and syndromotaxic aspects of delusional syndromes in the structure of paranoid schizophrenia and vascular dementia. Variants of the semiotic content of delusional syndromes, description.

Рубрика Медицина
Вид статья
Язык английский
Дата добавления 17.11.2020
Размер файла 20,0 K

Отправить свою хорошую работу в базу знаний просто. Используйте форму, расположенную ниже

Студенты, аспиранты, молодые ученые, использующие базу знаний в своей учебе и работе, будут вам очень благодарны.

Размещено на http://www.allbest.ru/

Syndromal Structure and Syndromokinetic Features of Delusional Syndromes in Schizophrenia and Vascular Dementia

Kurilo V.

Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine

Abstract

Introduction. Comparative analysis of the syndromogenetic, syndromokinetic and syndromotaxic aspects of psychopathogenesis of delusional syndromes in the structure of paranoid schizophrenia and vascular dementia with paranoid inclusions is a priority task for further improvement of nosodescriptive and differential diagnostic methodology in the field of the psychogerontology competence.

Purpose. To systematize syndromokinetic approaches to delusional syndromes in paranoid schizophrenia and vascular dementia with paranoid inclusions.

Materials and methods. 137 patients of Communal Institution "Zaporizhzhya Regional Clinical Psychiatric Hospital" of the Zaporizhzhya Regional Council, with the diagnoses F01.3 and F20.5 according to ICD-10, were examined with clinically anamnestic and clinically psychopathologic methods.

Group 1 (G1): 79 patients with the diagnosis F01.3 on the ICD-10 criteria (mixed cortical and subcortical vascular dementia) with paranoid inclusions.

Group 2 (D2): 58 patients with the diagnosis F20.5 on the ICD-10 criteria (residual schizophrenia). Results. The study describes syndromokinetic continua of delusional syndromes in paranoid schizophrenia with impact of organic radical and paranoid inclusions in vascular dementia. The variants of semiotic content of delusional syndromes in the structure of the studied pathology are identified, their population representation is investigated. There were distinguished the specific semiotic complexes, which can be considered as perspective targets for development of differential diagnostics methods of endogenous and organic delusional syndromes.

Conclusions. Three syndromokinesis stages were distinguished; the syndromal structure of psychopathological disorders was systematized; the syndromal variants of each syndromokinetic stage were described.

Keywords: paranoid syndrome, paraphrenic syndrome, schizophrenia, vascular dementia, syndromokinesis.

Резюме

Синдромальная структура и синдромокинетические особенности бредовых синдромов при шизофрении и сосудистой деменции

Запорожский государственный медицинский университет, Запорожье, Украина

Курило В.А.

Введение. Для совершенствования нозодисциплинарной и дифференциально-диагностической методологии в сфере компетенции психогеронтологии является приоритетной задачей сравнительный анализ синдромогенетических, синдромокинетических, психопатогенеза и синдромотаксических аспектов бредовых синдромов в структуре параноидной шизофрении и сосудистой деменции с параноидными включениями.

Цель. Систематизировать синдромокинетические подходы к бредовым синдромам при параноидной шизофрении и сосудистой деменции с параноидными включениями.

Материалы и методы. Были обследованы с помощью клинико-анамнестического и клиникопсихопатологического методов 137 пациентов КУ "Запорожская областная клиническая психиатрическая больница" с диагнозами F01.3 и F20.5 в соответствии с МКБ-10.

Первая группа - 79 пациентов с диагнозом F01.3 по критериям МКБ-10 (смешанная кортикальная и подкорковая сосудистая деменция с параноидными включениями).

Вторая группа - 58 пациентов с диагнозом F20.5 по критериям МКБ-10 (остаточная шизофрения). dementia schizophrenia syndromokinetic

Результаты. Исследование описывает синдромокинетические континуумы бредовых синдромов при параноидной шизофрении с влиянием органических радикальных и параноидных включений при сосудистой деменции. Определены варианты семиотического содержания бредовых синдромов в структуре исследуемой патологии, исследована их представленность у населения. Выделены специфические семиотические комплексы, которые можно рассматривать как перспективные цели для разработки методов дифференциальной диагностики эндогенных и органических бредовых синдромов.

Выводы. Были выделены 3 синдромкинетические стадии, систематизирована синдромальная структура психопатологических расстройств, описаны синдромальные варианты каждой синдромокинетической стадии.

Ключевые слова: параноидный синдром, парафренный синдром, шизофрения, сосудистая деменция, синдромокинез.

The problem of differential diagnosis of delusional syndromes of elderly and senile patients is one of the central problems of an actual psychogerontological clinic [1-6]. The existence of this problem is determined by syndromokinesis of delusional syndromes, which occurs on the background of progressive pathoplastic modification by an exogenous organic radical in the context of the process of organic absorption of endogenous disorders, underlying the equifinality of psychopathology [2, 4, 5]. Within the framework of this problem, we need to consider some difficulties arising when it is necessary to differentiate the initial states of endogenous-processual pathology from residual delusion, massive ontogenetically accumulated organic arrangement and initial delusional syndromes in the structure of cerebrovascular lesions, where the specificity of the spectrum of mental spheres damage, underlying the reconnaissance of the base register of mental defeat, is lost [3, 5]. In addition, this problem is complicated by the immanent similarity of affective and contextually- attributive aspects of delusional syndromes of endogenous and organic genesis of elderly and senile age. Thereby a comparative analysis of the syndromogenetic, syndromokinetic and syndromotaxic aspects of delusional syndromes psychopathogenesis in the structure of paranoid schizophrenia and vascular dementia with paranoid inclusions is a priority task for the further improvement of nosodescriptive and differential diagnostic methodology in the field of psychogerontology competence [1, 3-6].

¦ PURPOSE

Was to systematize the conceptions of delusional syndromes' kinesis in paranoid schizophrenia and vascular dementia with paranoid inclusions.

¦ STUDY DESIGN

The study was carried out in retrospective design on a contingent of 137 patients of Communal Institution "Zaporizhzhya Regional Clinical Psychiatric Hospital" of the Zaporizhzhya Regional Council. The contingent was formed from 2 groups of patients:

¦ group 1 (G1): 79 patients diagnosed F01.3 under the ICD-10 criteria (mixed cortical and subcortical vascular dementia) with paranoid inclusions. The mean age of this group was 73±3.5 years, the duration of the disease was from 5 to 11 years.

¦ group 2 (D2): 58 patients diagnosed F20.5 under the ICD-10 criteria (residual schizophrenia). The mean age of this group was 69±1.4 years, the duration of the disease was from 13 to 52 years.

¦ MATERIALS AND METHODS

Clinico-anamnestic method - for verification of nosological belonging of psychopathological disorders in the examined contingent;

Clinico-psychopathological method - for systematization of productive psychopathological symptoms and verification of delusional disorders.

¦ RESULTS AND DISCUSSION

A serial-chronological study of the medical documentation of examined contingent in conjunction with the comparison of the obtained results to the known concept of psychopathogenesis (by V. Magnan and K. Konrad) made it possible to form the variants of psychopathogenetic continuum for G1 and G2.

Syndromokinesis of delusional syndromes in the structure of paranoid schizophrenia (G1) is the process of progredient absorption of the symptomatology formed by its clinical filling with a specific personality defect, up to reaching the initial state accompanied by total incoherence of thought. This process does not have a generally accepted system of nomination of intermediate states. As a result of this, a conventional- diagnostic dichotomy "paraphrenic syndrome - initial state" arises. Nevertheless, the dynamic of this process allows us to establish a continual and uneven character of the symptoms reduction, and to identify the vector of some symptomocomplexes reduction.

Attributive disturbances are reduced by a progressive loss in the degree of delusional systematization and expansion of its plot up to the formation of a delusional worldview. The pretentiousness of delusion also grows due to the increase in the degree of ambivalence, pathological symbolism, contamination of concepts, reaching in its end a total subjective incomprehensibility. Thus, syndromokinesis in this case includes a spectrum of "metaparaphrenic" states, determined by the nature and proportion of the progression of personality's defect components and doesn't get to stratification on the basis of a single trait.

The continuum of syndromokinesis of delusional syndrome in the structure of paranoid schizophrenia might be reflected in the scheme "paranoid syndrome ^ paraphrenic syndrome (+ organic impregnation) ^ metaparaphrenic states ^ decay of the delusional system / residual delusion".

The influence of exogenous-organic pathoplastic factors on psychopathogenesis is determined by two competing processes: the progression of personal deficiency caused by schizophrenic defect and progression of organic CNS damage. The result of this process is the expansion of the spectrum of "metaparaphrenic" states due to the inclusion of pathoplastic modification of derivate states in their number, as well as due to an increasing number of possible initial states caused by a disproportion between the dynamic of endogenous and organic radicals' progression.

Psychopathological continuum of paraphrenic syndrome with an organic impregnation should be reflected in the scheme "organic background + endogenous process / endogenous process + organic radical ^ paranoid syndrome with an organic impregnation ^ paraphrenic syndrome with an organic impregnation ^ initial state with incoherency".

Delusional syndromes'syndromokinesis in structure of vascular dementia is determined by a progressively increasing psychoorganic syndrome.

The dynamic of psychopathological disturbances for delusional syndrome in structure of vascular dementia is determined by progrediently progressive psychoorganic syndrome and might be reflected in the scheme "moderate cognitive-mnestic disorders / + delusional syndrome of paranoid circle (including depressive-paranoid states) / + delirious episodes with delusional interpretation ^ rapid exacerbation of delusional syndrome on the background of a vascular crisis or reaching threshold of ischemical- hemorrhagic lesions of morphological substrate on the background of steadily progressing course of the disease (paranoid / paraphrenic / pseudoparalitical / Kotar's delusion) ^ initial state in the form of total dementia with delusional inclusions".

Thus, it is possible to distinguish 3 stages of syndromokinesis for both nosological forms:

1) paranoid (represented by paranoid syndrome or its equivalents);

2) paraphrenic (represented by paraphrenic syndrome or its equivalents);

3) metaparaphrenic (represented by derivatives of paraphrenic syndrome's pathoplastic modifications and initial states).

As a result of the clinical-descriptive analysis of the structure of psychopathological disorders in the examined contingent, its systematization was carried out and its syndromal structure was represented by 3 clusters corresponding to the stages of syndromokinesis, was identified (Table).

Thus, structure and psychopathological features of delusional syndromes in structure of investigated nosological forms of psychopathology are identified: in G1 paranoid phase is represented by the secondary delusion after previous delirium episodes and organic equivalent of Kandinsky - Clerambo's syndrome, it corresponded to 10 (12.66%) of patients, paraphrenic phase is represented by confabulations and expansive paraphrenia, pseudoparalitical syndrome, depressive-paranoid syndrome and Kotar's syndrome, it corresponded to 51 (64.56%) patients, metaparaphrenic phase is represented by initial state with undifferentiable delusion with severe verbal disorders, it corresponded to 18 (22.78%) patients. In G2: paranoid phase is represented by hallucinatory-paranoid syndrome and Kandinsky - Clerambo's syndrome, it corresponded to 11 (18.97%) patients, paraphrenic phase is represented by paraphrenic syndrome and its pathoplastically-modified embodiments, it corresponded to 31 (53, 45%) patients, metaparaphrenic phase is represented by initial state with undifferentiable delusion and incoherence of thinking with schizophasia, it corresponded to 16 (27.59%) patients. This determines the targets of syndromal differentiation at each stage delusional disorders' syndromokinesis that are necessary to further improvement of the differential-diagnostic methodology.

The syndromal structure of psychopathological disorders in the examined contingent

Stage

Group

Syndrome

G1,

N=79

G2,

N=58

Paranoid

Paranoid

Secondary interpretative delusion with persecutorial content on the background of delirious episodes of vascular origin - 4 (5.06%) patients

Hallucinatory-paranoid syndrome with refractory ideas of attitude or persecution - 6 (10.34%) patients

Delusion of influence on the background of hallucinatory phenomena with phenomena of ideatory automatism (organic equivalent of Kandinsky - Clerambo's syndrome) - 6 (7.59%) patients

Delusion of influence with ideatory automatisms (Kandinsky - Clerambo's syndrome) - 5 (8.62%) patients

Paraphrenic

Paraphrenic

Megalomaniac delusion with massive confabulation phenomena (confabulatory paraphrenia) - 11 (13.92%) patients

Megalomaniac delusion of special significance with the messianic plot and domination of persecutory ideas and pathetical-hyperthymic affective arrangement (paraphrenic syndrome) - 19 (32.76%) patients

Megalomaniac delusion on the expansive- euphoric affective background (expansive paraphrenia) - 9 (11.39%) patients

affective-

delusional

Megalomaniac delusion with exaggerated plot and euphoric affective background (pseudo-paralytical) - 7 (8.86%) patients

Megalomaniac delusion of special significance with exaggerated plot, an euphoric affective arrangement (paraphrenic syndrome with organic impregnation) - 12 (20,69%) patients

Megalomaniac delusion with a depressive affective background (depressive- paranoid) - 21 (26.58%) patients

Megalomaniac, depressive, or hypochondriac-nihilistic delusion (Kotar's syndrome) - 3 (3.80%) patients

Metaparaphrenic

Undifferentiable (the initial state)

Gross verbal and behavioral violations with spontaneous episodes of psychomotoric excitement (in case of delusional syndrome's presence in the anamnesis) - 18 (22.78%) patients

The incoherence of thinking with schizophasia, incongruent behavioral phenomena, spontaneous episodes of psychomotoric excitement in case of delusional syndrome's presence in the anamnesis and absence of the catatonic-gebephrenic spectrum's disorders) - 16 (27.59%) patients

Conclusions

1. Psychopathological continuums of paraphrenic syndrome with an organic impregnation were reflected in the scheme "organic background + endogenous process / endogenous process + organic radical ^ paranoid syndrome with an organic impregnation ^ paraphrenic syndrome with an organic impregnation ^ initial state with incoherency", and delusional syndroms in structure of vascular dementia were reflected in the scheme "moderate cognitive-mnestic disorders / + delusional syndrome of paranoid circle (including depressive-paranoid states) / + delirious episodes with delusional interpretation ^ rapid exacerbation of delusional syndrome on the background of a vascular crisis or reaching threshold of ischemical-hemorrhagic lesions of morphological substrate on the background of steadily progressing course of the disease (paranoid/paraphrenic/pseudoparalitical/Kotar's delusion) ^ initial state in the form of total dementia with delusional inclusions".

2. Three stages of syndromokinesis were singled out; in this view, the syndromal structure of psychopathological disorders in the examined continent was systematized, and syndromal variants of each isolated stage of syndromokinesis for the investigated nosological forms were described. In G1 paranoid phase is represented by the secondary delusion after previous delirium episodes and organic equivalent of Kandinsky - Clerambo's syndrome, it corresponded to 10 (12.66%) of patients, paraphrenic phase is represented by confabulations and expansive paraphrenia, pseudoparalitical syndrome, depressive- paranoid syndrome and Kotar's syndrome, it corresponded to 51 (64.56%) patients, metaparaphrenic phase is represented by initial state with undifferentiable delusion with severe verbal disorders, it corresponded to 18 (22.78%) patients. In G2: paranoid phase is represented by hallucinatory-paranoid syndrome and Kandinsky - Clerambo's syndrome, it corresponded to 11 (18.97%) patients, paraphrenic phase is represented by paraphrenic syndrome and its pathoplastically-modified embodiments, it corresponded to 31 (53, 45%) patients, metaparaphrenic phase is represented by initial state with undifferentiable delusion and incoherence of thinking with schizophasia, it corresponded to 16 (27.59%) patients.

References

1. Bleyher V. (1998) Klinika priobretennogo slaboumiya [Clinical manifestations of acquired dementia]. Saint Petersburg: Peter. (in Russian)

2. Gavrilova S. (1970) Klinika shizofrenii, oslozhnennoy v pozdnem voz-raste tserebralnyimi formami ateroskleroza i gipertonicheskoy bolezni [Clinic of schizophrenia, complicated with cerebral atherosclerosis and hypertension in elderly age] (PhD Thesis). Moscow: The State Scientific Center of Social and Forensic Psychiatry named after Serbsky. (in Russian)

3. Gulyamov M. (1968) Diagnosticheskoe i prognosticheskoe znachenie sindroma Kandiskogo [Diagnostic and prognostic value of Kandinsky syndrome]. Dushanbe: Ifron. (in Russian)

4. Morozova V. (1987) Osobennosti kliniki shizofrenii, sochetayuscheysya s tserebralnoy sosudistoy patologiey [Features of the clinic of schizophrenia, combined with cerebral vascular pathology] (PhD Thesis). Moscow. (in Russian)

5. Podvigin S. (2010) Osobennosti proyavleniy negativnyih rasstroystv i neyrokognitivnogo defitsita u bolnyih paranoidnoy shizofreniey s komorbidnoy arterialnoy gipertenziey [Features of manifestations of negative disorders and neurocognitive deficits in patients with paranoid schizophrenia with comorbid hypertension]. Vestnik novyih meditsinskih tehnologiy, vol. 2 (17), pp. 138-140.

6. Shternberg E. (1967) Klinika dementsiy pozdnego vozrasta [Clinic of late life dementias]. Moscow: Meditsina. (in Russian)

Размещено на Allbest.ru

...

Подобные документы

  • Different classification schemes for dementias. His reasons. Risk Factors for Dementia. Dementia is diagnosed by using many methods such as patient's medical and family history, physical exam, neurological evaluations, cognitive and neuropsychological.

    презентация [775,8 K], добавлен 10.06.2013

  • Introduction to the functionality of the most important internal organs. The main causes of supraventricular and ventricular tachycardia. Features of the structure and basic functions of the human heart. The study of the three phases of the heart.

    презентация [3,8 M], добавлен 12.05.2013

  • Study of method of determining the amount of osteocyte lacunar and estimation of specific numerical closeness of lacunes by a three-dimensional impartial expecting method at the analysis of anisotropy of types of the vascular ductings of human bone.

    реферат [8,6 K], добавлен 01.12.2010

  • Definition, pathophysiology, aetiologies (structural lesions, herniation syndromes, metabolic disturbances) of coma. Physical examination and investigations. Differential diagnosis - the pseudocomas. Prognostic signs in coma from global cerebral ischemia.

    презентация [875,4 K], добавлен 24.03.2015

  • Features of the structure and anatomy of the heart, it's main functions and tasks in the body. Changes taking place in the human heart in the course of his life from birth to aging. Age-related disorders in the blood supply system and the heart.

    презентация [725,8 K], добавлен 16.10.2016

  • Respiratory system brief. Structure of the Lungs. Structure of the Lungs. Examples of ailments of the lung: asthma, emphysema, pneumonia, tuberculosis. The characteristics and causes of diseases that cause them.. Visual of healthy vs. non healthy lungs.

    презентация [162,8 K], добавлен 27.11.2013

  • Anatomical and physiological concepts about the structure and functions of the peripheral nervous system. Role of the autonomic nervous system in the regulation of the internal organs of the organism. The structure of the cranial and spinal nerves PNS.

    презентация [326,9 K], добавлен 21.05.2014

  • The concept and the internal structure of the lungs, the main components and their interaction. Functional features of the lungs in the human body, their relationship with other anatomical systems. Existing pathology of respiratory organ and control.

    презентация [2,5 M], добавлен 12.02.2015

  • Structure of a clinical term. The suffixes and prefixes. The final combining forms partaining to diagnostic methods, therapy, pathology, surgical interventions. Pharmaceutical term structure. The forms of medicines. Chemical, botanical terminology.

    методичка [458,1 K], добавлен 29.03.2012

  • The structures of bronchi and bronchioles that terminate with the alveolar ducts, sacs, and, finally, alveoli - that are contained within the lungs. The trachea, also called the windpipe, is part of the passageway that supplies air to the lungs.

    реферат [948,9 K], добавлен 21.12.2015

  • The structure of the human lung: diaphragmatic, rib, interlobar and medial surface; front, rear and bottom edges; tip and base. Gaseous exchange in the alveoli and bronhyoly. Lung volumes and capacities. Peak flow and causes of narrowing of the airways.

    презентация [441,9 K], добавлен 21.05.2014

  • The characteristic features of the two forms of eating disorders: anorexia nervosa and bulimia. Description body dysmorphic disorder syndrome as a teenager painful experiences of his "physical disability." Methods of treatment and prevention of disease.

    курсовая работа [17,9 K], добавлен 31.03.2013

  • Nature of infrared analysis and nature of mass spectrometry. Summary of the uses in forensic analysis. Critical comparison of infrared analysis and spectrometry. Gathering of the information about positional isomers with the help of infrared analysis.

    эссе [21,8 K], добавлен 08.12.2011

  • The concept and the internal structure of the human respiratory system, the relationship of the individual components and functions, the value in the living organism. Principles of breathing gas composition.Scheme of the human respiratory system.

    презентация [1,4 M], добавлен 08.09.2015

  • Description of the directions of medical education in USA. The requirement for continuous training of doctors. Characteristics of the levels of their training to work with patients. Licensing of doctors through specialized advice and terms of the license.

    презентация [4,0 M], добавлен 10.11.2015

  • Orderliness (methodical) of the general inspection. The patient's position in bed. Constitution types - set of congenital and acquired the morphological and functional characteristics of the organism. Distinctive features of the constitutional types.

    презентация [2,1 M], добавлен 22.02.2015

  • Churg-Strauss syndrome, microscopic polyangiitis as one of the basic types of the small vessel vasculitis. Specific features of differential diagnosis of pulmonary-renal syndrome. Characteristics of the anti-neutrophil cytoplasmic autoantibodies.

    презентация [8,2 M], добавлен 18.10.2017

  • A brief sketch of the life and professional development of Botkin as the Russian scientist, a gifted doctor. Botkin's value in world medicine, assessment of its scientific achievements. Analysis and themes of famous doctor, the direction of its research.

    презентация [1,7 M], добавлен 10.12.2014

  • The main features of uterine fibroids. The development of a tumor from the "embryonic growth site" and a microscopic nodule without signs of cellular differentiation to a macroscopic nodule. Study of surgical and conservative treatment of leiomyoma.

    презентация [1,4 M], добавлен 31.10.2021

  • The major pathogens and symptoms of cholera - an acute intestinal anthroponotic infection caused by bacteria of the species Vibrio cholerae. Methods of diagnosis and clinical features of disease. Traditional methods of treatment and prevention of disease.

    презентация [1,0 M], добавлен 22.09.2014

Работы в архивах красиво оформлены согласно требованиям ВУЗов и содержат рисунки, диаграммы, формулы и т.д.
PPT, PPTX и PDF-файлы представлены только в архивах.
Рекомендуем скачать работу.