Mental disorders in cerebral atherosclerosis and hypertension. Mental disorders in atherosclerosis and hypertension Psychological assistance to loved ones of patients with cerebral atherosclerosis

Atherosclerosis of cerebral vessels

Atherosclerosis of cerebral vessels develops more often at the age of 50-60 years. Mental disorders can be psychotic or non-psychotic in nature.

In the early stages of the disease, neurosis-like symptoms are observed: irritability, increased fatigue, anxiety, sleep disturbances. A peculiar sharpening of personal characteristics occurs - frugality turns into stinginess, suspiciousness into suspicion, etc. Characteristic is a progressive decline in memory, which leads to a decrease in performance. Memory impairment for current events predominates. Patients forget new surnames, names, phone numbers, recently read, seen.

In a malignant course, mnestic disorders can sometimes reach the level of Korsakov's syndrome. Along with this, pronounced emotional lability is noted - patients worry about trifles, easily move from laughter to tears and vice versa, they are very touchy. Characteristic is the “flickering of symptoms,” i.e., the presence of fluctuations in the severity of certain manifestations of the disease. Progressive impairments of memory and thinking lead to the development of atherosclerotic dementia. At the same time, sometimes the consciousness of the disease remains and partial criticism takes place. Often with atherosclerosis, depressive states with anxiety, depression, tearfulness occur, and less often - hypomania with euphoria, sexual disinhibition, and emotional inadequacy. Epileptiform seizures, acute psychotic states with hallucinations, delusional ideas, and disorders of consciousness may be observed. Sometimes delusions in patients with atherosclerosis acquire a paranoid character with ideas of jealousy, relationships, and invention.

Hypertonic disease

Very often, hypertension is combined with atherosclerosis. Along with general disorders, cerebral disorders are presented (from mild cerebral crises to severe strokes). The most characteristic of the clinical picture of mental disorders are neurasthenic-like, astheno-hypochondriacal and phobic syndromes.

Patients complain of mood instability, headaches, insomnia, and decreased performance. They often express exaggerated concerns about their health, especially regarding cardiac activity, and experience various fears. They become irritable, anxious, touchy, and suspicious. With hypertension, an exacerbation of personality characteristics is also observed. Characteristic is the presence of fluctuations in the severity of psychopathological symptoms, which, in turn, is determined by the dynamics of vascular reactions.

Psychotic Disorders are most often represented by anxiety, fear, psychomotor agitation, sometimes occurring as twilight states of consciousness or delirious syndrome. Anxious-depressive and anxious-paranoid pictures may be observed.

Treatment

Treatment must be comprehensive. It is necessary to carry out general hygiene measures and adhere to a diet. Features of treatment of the underlying disease are determined by the stage of its development and the nature of clinical manifestations. Treatment of mental disorders is mainly symptomatic. For neurosis-like disorders, tranquilizers (Elenium, Seduxen) are recommended; for psychoses, treatment with antipsychotics and antidepressants should be carried out. The use of antipsychotic drugs in patients with systemic vascular diseases should be monitored by continuous measurement of blood pressure.

With cerebral atherosclerosis, mental disorders occur quite early. The earliest symptom is asthenia. The ability of patients to work decreases, they quickly get tired, have difficulty switching from one type of activity to another, master a new task, and acquire new knowledge.

Patients often complain of headaches, dizziness, heaviness in the head, and fatigue. Asthenia as a disease has a wave-like course, periods of improvement in general condition are followed by periods of deterioration. Patients are easily irritated, become touchy, and are prone to tearfulness. As the disease progresses, memory deteriorates, and this is reflected in the fact that patients cannot remember the names of acquaintances, dates of past events, and some terms. Memory loss is especially noticeable when tired.

Gradually, periods of good health become shorter, while periods of sharp memory deterioration and autonomic disorders of the nervous system lengthen. The disease progresses more and more, patients find it difficult to cope with their usual activities and responsibilities, and spend more and more time on them.

Typically, in patients with a progressive course of cerebral atherosclerosis in the initial stages of the disease, memory well retains events of long ago, but with difficulty retains past events of the next few days and even hours. Memory for the distant past gradually weakens.

Patients are almost always in a bad mood. Sometimes a bad mood turns into depression, accompanied by tearfulness and self-flagellation. In the last stage of the disease, the patient becomes verbose, obsessive, selfish, and irritable. The circle of his interests narrows sharply and mainly focuses on trifles.

The sleep of such patients is usually disturbed. Angina attacks often occur (since, along with the development of cerebral atherosclerosis, sclerosis of the coronary vessels progresses). Atherosclerotic changes in the vessels of the kidneys often lead to the development of arterial hypertension, and subsequently to hypertension.

Other mental disorders can also develop due to atherosclerosis, for example, the so-called atherosclerotic dementia (more often it develops after a stroke). The disease is expressed in the fact that, in addition to memory disorders, certain absurdities are constantly noticed in the patient’s behavior (forced laughter and crying, disorientation, complete helplessness, etc.).

Patients may develop tactile hallucinosis: they always feel as if someone is crawling over their body (insects, worms). It happens less often that with advanced atherosclerosis, delusions of persecution appear: the patient assures everyone that neighbors and relatives are conspiring against him, they want to “kill him from the world,” they are persecuting him, trying to steal. The patient locks himself in his apartment for all the constipation, stops leaving the room, writes complaints to all authorities.

attaches to low-density lipoprotein (LDL) molecules and is transported into tissues. A person gets heart disease (angina, heart attack, stroke, atherosclerosis) when the amount of HDL (“good” cholesterol) in the blood decreases and the amount of LDL (“bad” cholesterol) increases.

In the United States of America, Dr. Dean Ornish conducted a famous experiment that showed the dependence of the development of heart disease on lifestyle.

In this experiment, patients with heart disease were divided into 2 groups - control and experimental. The control group was provided with constant medical care, they were treated and systematically examined. Participants in the experimental group were simply asked to eat a low-fat vegetarian diet for one year. The diet included fruits, vegetables, beans and soybean products, and whole grains. All participants in the experiment were allowed to consume as many calories as they wished, provided that the only animal product allowed was egg whites, and they consumed no more than 1 glass of skim milk (or yogurt) per day. The experimental group was also asked to perform stress reduction exercises (breathing exercises, relaxation, meditation) for 1 hour per day and exercise for at least 3 hours per week.

A year later, all participants in the experimental group showed a significant decrease in atherosclerotic processes in the arteries, their condition improved significantly and many patients even forgot that they had “heart” diseases. Studies have shown significant regression of coronary atherosclerosis. In the other, control group, things were completely different. Despite the fact that patients from this group received special treatment and followed a standard atherosclerotic diet, they only experienced progression of the disease. Participants in the control group felt significantly worse than participants in the experimental group.

Dr. Murray Michael, in his book The Healing Power of Food, provides two tables that any patient with atherosclerosis or other heart disease should pay attention to.

Since animal products are the main source of cholesterol and saturated fat, their consumption should be reduced to a minimum. Margarine and refined sugar should also be limited in the diet due to their properties that promote the development of atherosclerosis.

Instead of foods containing saturated fats, the diet should consist mainly of plant foods, especially since the body processes these foods better than foods of animal origin.

It is very important to try to replace any meat with fish. Numerous studies have proven that fish contains eicosanoic acid (EA), which significantly reduces serum cholesterol levels.

In the diet of a patient with atherosclerosis, it is necessary to limit foods that increase blood clotting.

Fiber is a very important nutritional factor in the diet of an elderly person. Coarse vegetable fiber (rye bread, sanaty, vegetables) enhances intestinal motor function and helps eliminate excess cholesterol, salts and nitrogen compounds from the body. In addition, it prevents the development of constipation in old age, which is very important for the functioning of the body.

Carbohydrates in food should be contained in significant quantities. There are many of them in cereals, vegetables, fruits, bread, honey, jam. Food rich in carbohydrates improves heart function and increases the deposition of glycogen in the liver, which increases its functional cleansing ability.

Fats are necessary in the diet of a patient with atherosclerosis, as they contain fatty acids and fat-soluble vitamins necessary for the human body. But fats should be treated with caution and taken in moderation, primarily paying attention to fats of plant origin. Patients with high blood cholesterol are recommended to spend vegetarian days and vegetarian weeks. The best option is to completely switch to vegetarian food.

Patients with atherosclerosis should avoid cold and carbonated drinks and cold foods. Food eaten cold makes digestion much more difficult. No one should forget this.

Many spices and herbs reduce the amount of cholesterol in the blood and promote the resorption of atherosclerotic plaques in blood vessels. These spices include onion, garlic, turmeric, and ginger. Garlic, among other things, contains the microelement germanium (the only plant containing germanium in its pure form), which helps reduce the amount of low-protein cholesterol in the blood.

Currently, the whole world is striving to switch to a healthy lifestyle, which is the best medicine for patients with atherosclerosis and heart disease. Below are a number of recommendations that are extremely useful for older people and cardiovascular patients.

diseases. So, if you want to be healthy, take them into service.

1. Fight obesity. The greater your body weight, the more cholesterol your body produces. An increase in gel weight by 500 g increases serum cholesterol levels by 2 levels. Therefore, if you have any heart disease or atherosclerosis, try to lose weight by any means. The best way is a diet that consists of 2/3 fruits, vegetables, cereals and whole grains. And only 1/3 of all calories should come from meat and dairy products.

2. Reduce the number of eggs in your diet.

3. Don't forget the corn. Corn bran effectively reduces cholesterol levels in the blood, not inferior to legumes and oats. Therefore, many nutritionists recommend that older people, as well as people suffering from diseases of the cardiovascular system, eat 1-2 tbsp per day (during meals). spoons of corn bran. After a month of such treatment, your blood cholesterol will decrease by 20-30%.

4. Benefits of skim milk. Research by Aura Kidar (USA) has proven that daily consumption of skim milk (up to 1 liter per day) significantly reduces the amount of cholesterol in the blood and liver. If you drink 1 liter of milk daily for a month, your cholesterol level will decrease by 8-10%.

5. The benefits of garlic. If you eat a small clove of garlic every day, then in a month your cholesterol level will decrease by 30-40 units.

6. Carrots, onions and broccoli

just like garlic, they reduce blood cholesterol levels to a safe level. Therefore, do not neglect these products, but introduce them into your daily diet.

7. Coffee. If you drink at least 2 cups of coffee a day, your blood cholesterol levels increase significantly. The pressure also increases. However, there is an interesting point here - if your coffee is prepared by filtering (rather than boiling), then blood cholesterol does not increase.

8. Once again about smoking. A person who smokes 20 cigarettes a day usually has significantly higher cholesterol levels in the blood and liver than a non-smoker. Swedish researchers have proven that the level of “good” HDL cholesterol in smokers is sharply reduced, and the level of “bad” cholesterol is always higher than normal. If a person quits smoking, then these ratios are leveled out.

9. Tea, especially green tea, helps prevent cholesterol levels in the blood from reaching high levels.

10. Barley, oats, rice bran, spirulina (seaweed) reduce the amount of cholesterol in the blood by 25 to 40% when consumed systematically.

11. Activated carbon interacts well with cholesterol molecules and removes them from the body. If you take 4-6 tablets of activated carbon daily for a month, you have a chance to reduce the amount of cholesterol in your blood by up to 40%.

12. Vitamin C raises levels of protective HDL cholesterol in older people. Dr. Paul Jacques (USA) believes that daily intake of 1 g of ascorbic acid can reduce the level of “bad” cholesterol by 8-10%.

13. Vitamin E, nicotinic acid, and calcium supplements are also good at reducing the amount of cholesterol in the blood of any person.

14. Olive oil, nuts, peanut butter

15. One of the best ways to raise the level of protective HDL in your blood is through exercise. In addition, exercise cleanses the blood of fats and prevents them from staying in the body for too long. Studies have shown that runners are able to clear fat from their bodies 75% faster than people who do not exercise. And if fats do not linger in the bloodstream, then they will not settle on the walls of blood vessels in the form of atherosclerotic plaques. This means that atherosclerosis, and along with it old age, will recede!

Many Tibetan and Oriental medicine recipes related to nutritional problems are known throughout the world. What do ancient scientists offer?

Dried apricots - nourishes physical strength, especially useful for men.

Raisins, nuts, cheese - constant consumption of these foods tones the nervous system, relieves fatigue, headaches, strengthens

heart muscle. These foods should also be consumed if you have liver disease. At one time it is recommended to eat no more than 30 g of walnuts, 20 g of raisins, 20 g of cheese.

Cottage cheese is one of the most useful inventions of mankind. It is necessary for diseases of the heart, blood vessels, and liver.

Lemons and oranges are especially effective in treating the initial stages of hypertension, thyroid diseases and heart disease.

Apples are extremely useful for vascular diseases and gout.

Chokeberry and other berries with such a high iodine content. Recommended for sclerosis and goiter. Preparation: 1 kg of rowan fruit per 1 kg of sugar. Take 1 teaspoon 3 times a day.

Garden parsley - drink a strong decoction of parsley like tea. Clears blood vessels of cholesterol and all plaque.

Common rowan - boil 200 g of rowan bark for 5 minutes in 0.5 liters of water, leave for 1 hour. Take 100 ml 3 times a day.

Buckwheat - an infusion of flowers is drunk for sclerosis. Brew a dessert spoon in 0.5 liters of boiling water, leave for 2 hours in a closed container. Take 0.5 cups 3 times a day.

Blood red hawthorn - 50 ripe fruits are washed, crushed, 100 ml of water is added, heated to 40 ° C and pressed with a juicer. Drink the resulting juice 1 tbsp. spoon 3 times a day. The juice has a beneficial effect on the heart, especially in old age, and prevents wear and tear of the heart muscle.

Tincture of hawthorn flowers in alcohol. IN

Drop 200 ml of alcohol 4 from. spoons of flowers and leave in the dark at room temperature for 10 days, shaking occasionally. Take 1 teaspoon 3 times a day with water.

Rosehip is an everyday health drink. Healers say: “If you want to be healthy, drink rosehip infusion.” Pour 2 teaspoons of rose hips (with top) into a glass of boiling water, brew like tea, and drink 150 ml 3 times a day.

Sea kale - in old age is an excellent remedy that enhances metabolism. Used raw as a seasoning.

Horsetail - used to cleanse the body of harmful toxins. Dried and finely chopped horsetail is brewed and drunk as tea.

Garlic tincture - 100 g of garlic, peeled and crushed in an enamel bowl. Place the resulting slurry in a bottle and pour in 150 ml of vodka. Close with a stopper, wrap in paper and place in a dark place for 2 weeks. Filter. Take 25 drops with milk after meals 3 times a day.

Contraindications: peptic ulcer of the stomach and duodenum, gastritis with high acidity.

Thyme. Pour 1 teaspoon of flowers into 200 ml of boiling water. Leave in a well-sealed container for 1 hour. Take 3 times a week, 50-60 ml per dose. Thyme is a strong remedy, has a bactericidal, calming effect, relieves spasms of cerebral vessels in atherosclerosis.

Mix 100 g of crushed dried chamomile flowers with 100 g of St. John's wort. Add 100 g of immortelle and birch buds to the mixture, mix thoroughly. 1 tbsp. pour 0.5 liters of boiling water over a spoonful of the mixture and

set for 3 hours. Then filter half of the infusion, dissolve 1 tbsp in it. spoon of honey and drink before dinner. In the morning, heat the remaining liquid, add 1 tbsp. spoon of honey and drink before breakfast. Repeat the procedure until the collection is completed.

It is very useful to take 1/4 cup of red currants half an hour before meals.

Anti-sclerotic paste. Prepare a paste from the following ingredients. Take 1 kg of raisins, dried apricots, pitted prunes, figs and rosehips, pour cold water over night, level with the berries, and in the morning pass the mixture through a meat grinder. Keep refrigerated. Take 1 tbsp. spoon 2-3 times a day half an hour before meals.

Strengthening mixture (suggested by Academician Amosov for patients with heart disease and people who have undergone surgery): 1 glass of raisins, 1 glass of walnuts, 1 glass of honey, juice of one lemon. Grind everything, mix, pour juice and honey. Take 2 teaspoons 3 times a day.

Raisin. Increases hemoglobin content in the blood and has a good effect in the treatment of atherosclerosis. Pour 1 teaspoon of raisins into a glass of boiling water overnight. In the morning, eat berries and drink water. The course of treatment is 3 weeks.

Birch, buds. 10 g of dry crushed kidneys per. 200 ml of water, boil for 3-5 minutes. Strain. Take 1 tbsp. spoon 3-4 times a day.

Coltsfoot (leaves). Pour a tablespoon of dry crushed leaves into a glass of boiling water. Leave for 30 minutes, strain. Take 1 tbsp. spoon 4-6 times a day.

Dandelion. The roots and herbs are used for medicinal purposes. 1 tbsp. spoon of dry crushed raw materials per

glass of water. Boil for 10 minutes, strain. Take 1 tbsp. spoon 3-4 times a day.

Yarrow. Pour 15-20 g of dry crushed herb into 200 ml of boiling water, boil for 10 minutes, leave for 1 hour, strain. Take 1 tbsp. spoon 3-4 times a day before meals.

Elecampane (roots and rhizomes). 20 g of dry crushed raw materials per glass of water. Boil for 30 minutes over low heat. Strain. Take 1 tbsp. spoon 3 times a day before meals.

Rowan, bird cherry, garlic, onion, cranberry, blackberry, plum, pear, honeysuckle, apples, strawberries, currants. Take daily in any form.

Sandy immortelle. 1 tbsp. Pour a spoonful of immortelle inflorescences with a glass of boiling water, leave for 1 hour, strain. Take 1/3 cup 3 times a day.

Lemon. For patients with atherosclerosis and heart disease, it is very important to eat at least 1 lemon (with peel) or a thread of lemon juice mixed with water every day. Lemon juice contains a large amount of potassium and rutin, which, in combination with ascorbic acid, strengthen and make the walls of blood vessels elastic.

Apples. In the morning, an hour before breakfast, and in the evening, half an hour after dinner, eat 1 apple.

Mix 1 teaspoon of honey, juice of half a lemon, 1/3 cup of boiled water and drink at night.

Peel 0.5 lemon, chop, pour over a glass of pine needle decoction (pour 1 tbsp of pine needles with a glass of boiling water, boil for 2-3 minutes, cool, strain) and take on an empty stomach for 3 weeks 2-3 times a day . After a month's break, the course of treatment can be repeated.

Melissa. Perfectly relieves nerve spasms, improves brain function, relieves dizziness and tinnitus due to atherosclerosis. Melissa in any form can be added to tea or prepared as a decoction: 1 tbsp. a spoonful of dry herbs per glass of boiling water. Boil for 3 minutes, strain. Leave for 1 hour and take 100 ml 3 times a day.

Horseradish root decoction. Wash 250 g of horseradish, grate it on a coarse grater, pour in 3 liters of boiled water and boil for 20 minutes. Strain. Take 0.5 cups 4 times a day 30 minutes before meals.

Onions - useful for atherosclerosis, diabetes, and for improving digestion. Pour 2-3 fresh onions with a glass of water, leave for 8 hours at room temperature, strain. Take 1 glass 3 times a day.

Sophora japonica - pharmacy tincture. Removes organic deposits from the walls of blood vessels. Take 25 drops 3 times a day for atherosclerosis.

Celandine is our Russian ginseng. Helps in the fight against atherosclerosis, clearing blood vessels of cholesterol. Leaves, flowers, stems are used. Dry in the shade, turning often. 1 tbsp. A spoonful of dry crushed herb is poured with a glass of boiling water. Leave for 1 hour, filter. Drink 50 ml 3 times a day. It is recommended to take a two-week break after each week of treatment, then continue treatment again. The course of treatment with celandine is 30 days.

Since ancient times, pollen from flowers and plants has been considered a source of energy and vitality. Used to treat atherosclerosis and heart diseases. Helps against premature aging of the body, increases potency in men.

ATHEROSCLEROSIS: PATHOGENESIS, PREVENTION, LIQUANIA

Atherosclerosis– an independent general disease with a chronic course, occurring more often in older people, although it can also appear at a fairly young age.

Cerebral atherosclerosis is accompanied by a number of neuropsychic changes and, if unfavorable, can lead to severe dementia or even death.

The clinical picture of cerebral atherosclerosis varies depending on the period of the disease, its severity, and the nature of the course. Quite often, the disease debuts with neurosis-like symptoms in the form of irritability, increased fatigue, and decreased performance, especially mental. The sick become absent-minded, have difficulty concentrating, and get tired quickly. Characteristic feature initial cerebrosclerosis is also an intensification, as if a kind of caricature of previous personality traits: people who were previously distrustful become openly suspicious, carefree - even more frivolous, thrifty - very stingy, prone to anxiety - clearly anxious, unfriendly - openly angry.

As the disease progresses, it becomes more and more clear are revealed memory impairment and decreased performance. Patients forget what they need to do, do not remember where they put this or that thing, and have great difficulty remembering new things. Particularly weakening memory for current events(patients can remember the past quite well), names and dates (violation of chronological orientation). This forces patients, who usually evaluate their condition critically, to increasingly resort to a notebook. As the disease progresses, the thinking of patients: it loses its former flexibility and mobility. Excessive thoroughness, emphasis on some details, verbosity appear, patients have increasing difficulty in highlighting the main thing, switching from one topic to another. A very characteristic feature of cerebral atherosclerosis is the occurrence pronounced emotional lability- the so-called weakness.

A characteristic symptom of severe atherosclerosis is stroke. There is a sudden deep clouding of consciousness, most often coma. There may be states of stupefaction in the form of stupor. If the lesion has captured the vital centers, death quickly occurs.

Strokes do not always occur suddenly; in some cases they are preceded by pre-stroke conditions. Harbingers are expressed in the form of dizziness, rushes of blood to the head, tinnitus, darkening or flashing of spots before the eyes, paresthesia on one or another half of the body. Sometimes paresis, speech, vision or hearing disorders, and palpitations appear. Pre-stroke conditions do not necessarily have to end with a typical stroke; sometimes the matter is limited only to these transient disorders. Strokes can occur either suddenly or due to various provoking factors: states of mental stress (anger, fear, anxiety), sexual and alcoholic excesses, stomach fullness, constipation.

Neurological and somatic disorders. Patients with atherosclerosis often experience dizziness, headaches, and tinnitus (in the form of beeps, whistles, hissing, tapping), often synchronous with the pulse. Complaints about sleep disorders are also typical (having fallen asleep in the evening, patients usually wake up quite quickly and can no longer fall asleep; there may also be a distortion of the sleep rhythm). A neurological examination often reveals a decrease in the size of the pupils and their sluggish reaction to light, tremor of the fingers, impaired coordination of fine movements, and increased tendon reflexes. As the disease worsens, neurological disorders become more pronounced, especially after strokes, when gross organic symptoms (paralysis, aphasia, apraxia) already appear.

From somatic disorders, sclerotic changes in peripheral vessels and internal organs (especially the heart, aorta and kidneys) are detected; increased blood pressure and tachycardia may be observed (with atherosclerosis of the arteries supplying the medulla oblongata).

Question

Alzheimer's disease. More than half of people who die with a diagnosis of dementia, according to the National Institute of Aging (USA), die from Alzheimer's disease. The disease often develops gradually, the average age of patients when they get sick is 55-60 years, women get sick three or more times more often than men. Progressive amnesia and total dementia are typical for the disease. In the initial period of the disease, tearful and irritable depression is often observed, in parallel with this there is a rapidly increasing deterioration of memory, close to progressive amnesia. Soon after the first signs of the disease appear, spatial disorientation develops. A feature of Alzheimer's disease is that patients maintain a general formal critical attitude towards their condition for quite a long time, in contrast to those suffering from Pick's disease. The duration of the disease varies from several months to 10 years. The prognosis of this disease is unfavorable.

Pick's disease. This disease usually occurs in people aged 50-60 years, and is four times less common than Alzheimer's disease. With this disease, first of all, a progressive personality disorder is observed: apathy, indifference, and indifference develop. Severe memory disorders are noted: patients forget the events of the past day, current events, do not recognize familiar faces when meeting them in an unusual environment. There is no critical attitude towards their condition, and although patients are upset when they are convinced of their failure, such a reaction is short-lived. Usually, patients have an even, complacent mood.

Senile dementia. In senile dementia, as the name implies, the leading role belongs to total dementia in combination with special mnestic and intellectual disorders. The disease usually begins unnoticed. The mental appearance of the patient gradually changes, there is emotional impoverishment with irritability and grumpiness, a sharp decrease in the range of interests, wariness, stubbornness along with suggestibility and gullibility. The most striking signs of the disease that determine its clinical picture are progressive memory disorders and dementia (total). Delusional ideas of robbery, impoverishment and ruin are also formed. Memory deteriorates primarily for current events, then mnestic disorders spread to earlier periods of the patient’s life. The emotional manifestations of patients sharply narrow and change; either complacency or a gloomy-irritable mood is observed. Criticism and the ability to adequately understand the environment and current events are lost; there is no understanding of the painfulness of one’s condition.

Control questions

1. Define the concepts of “health” and “disease”.

2. List and characterize the stages of attitude towards the disease.

3. Give a description of psychological disorders in old age.

4. How does involution affect psychopathological symptoms.

5. Describe mental disorders in cerebral atherosclerosis.

One of the pressing problems of modern medicine at the turn of the 20th and 21st centuries. became a pandemic of vascular diseases.
The wide prevalence of cerebrovascular pathology, the continuing increase in the number of corresponding patients, the development of the disease at a younger age, high mortality and disability of patients represent a major medical and social problem.
Mental disorders occupy one of the main places among the pathological manifestations in the clinic of vascular diseases of the brain and significantly aggravate the course of the disease. Among these mental disorders, psychosis constitutes a significant part. Mental disorders can often be socially dangerous, which determines their special medical and social significance.
Mental disorders of vascular origin are the most common form of pathology, especially in later life. After 60 years, they are found in almost every fifth patient (S. I. Gavrilova, 1977). Among the entire group of mental disorders of vascular origin, approximately 4/5 of cases have mental disorders that do not reach the level of psychosis (V. M. Banshchikov, 1963-1967; E. Ya. Sternberg, 1966).
The need to study mental disorders in vascular diseases of the brain is dictated primarily by a significant increase in the number of such patients.
Over the past decades, both the number of insane people among this group of patients has increased (Ya. S. Orudzhev et al., 1989; S. E. Wells, 1978; R. Oesterreich, 1982, etc.), and the severity of the manifestations of torts committed by these persons.
At the same time, many authors (S. P. Razumovskaya, 1983; I. M. Barkov, 1985; Scwarz, 1978; M. M. Maltseva, V. P. Kotov, 1995) emphasize the great difficulties in assessing the mental state of these individuals .
Patients with mental disorders due to cerebral atherosclerosis and hypertension, related to various forms of vascular pathology, have much in common: age factor, heredity, premorbid

197

traits, various exogenous harms (alcoholism, traumatic brain injuries, psychogenic disorders). All this explains the common pathogenesis, clinical and pathomorphological picture of these varieties of the general cerebrovascular process, especially in the early stages of its development.
When describing and grouping the clinical manifestations of cerebral atherosclerosis, one should proceed from generally accepted ideas about the stages of development of the cerebral vascular process. There are clinical (psychopathological) and morphological (structural) features characteristic of each stage. The development of the process caused by cerebral atherosclerosis is characterized by three stages: stage I - initial (neurasthenic-like), stage II - severe mental disorders and stage III - dementia.
The most common manifestation of stage I (initial) (in approximately 1/3 of cases) of cerebral atherosclerosis is neurasthenia-like syndrome. The main signs of this condition are fatigue, weakness, exhaustion of mental processes, irritability, emotional lability. Sometimes reactive and depressive states may occur. In other cases of the initial period, the most pronounced is the psychopathic syndrome (with irritability, conflict, and uncooperativeness) or hypochondriacal syndrome.
Patients complain of dizziness, tinnitus, and memory loss.
In stage II (the period of pronounced mental disorders) of cerebral atherosclerosis, as a rule, mental-intellectual disorders increase: memory significantly deteriorates, especially for present events, thinking becomes inert, thorough, emotional lability increases, and weakness is noted.
Cerebral atherosclerosis in these patients is often combined with hypertension.
With cerebral atherosclerosis, psychotic states are also possible. In forensic psychiatric practice, the most important are psychoses that occur with a picture of depressive, paranoid and hallucinatory-paranoid syndromes, states with stupefaction. Sometimes epileptiform seizures are possible. The stereotype of the development of the cerebral atherosclerotic process does not always correspond to the above diagram.

198 RsectionIII

Subacute paranoid syndromes have a certain forensic psychiatric significance. These patients in the premorbid state are distinguished by isolation, suspicion, or have anxious and suspicious character traits. Often their heredity is burdened with mental illness, and there is a history of alcoholism. The content of delusions is varied: the most frequently expressed are delusional ideas of jealousy, persecution, poisoning, sometimes ideas of damage, and hypochondriacal delusions. Delusions in these patients tend to be chronic, with delusional ideas often combined with each other and accompanied by angry outbursts of irritability and aggression. In this state, they can commit severe socially dangerous actions. Depression is observed somewhat less frequently in atherosclerotic psychoses. In contrast to the asthenic-depressive syndrome of the initial period, melancholy is sharply expressed, motor and especially intellectual retardation is noted, such patients are often anxious, expressing ideas of self-accusation and self-abasement. These disorders are combined with complaints of headaches, dizziness, ringing and tinnitus. Atherosclerotic depression usually lasts from several weeks to several months, and hypochondriacal complaints are often observed. After emerging from a depressive state, patients do not show a pronounced organic decline, but they are faint-hearted and their mood is unstable. After some time, depression may recur.
Atherosclerotic psychoses with syndromes of disordered consciousness are more often observed in patients with a history of a combination of several unfavorable factors: traumatic brain injury with loss of consciousness, alcoholism, severe somatic diseases. The most common form of disordered consciousness is delirium, less often - a twilight state of consciousness. The duration of the disorder of consciousness is limited to several days, but relapses may also occur. Cases of cerebral atherosclerosis with disordered consciousness syndrome have an unfavorable prognosis; dementia often quickly sets in after recovery from psychosis.
Hallucinosis is relatively rare in atherosclerotic psychoses. This condition almost always occurs late in life. Patients hear voices “from outside” of a commentary nature.

199 Chapter 15. Disorders in brain diseases

One of the manifestations of stage III (the period of severe mental disorders) of cerebral atherosclerosis is sometimes epileptiform paroxysms. More often these are atypical and primarily generalized convulsive seizures and psychomotor episodes with automatisms. In addition to paroxysmal disorders, these patients exhibit mental disorders close to epileptic ones. The rate of increase in dementia in these cases is gradual, and severe dementia occurs 8-10 years after the onset of this syndrome.
Mental manifestations in patients with cerebral atherosclerosis are combined with somatic disorders (atherosclerosis of the aorta, coronary vessels, cardiosclerosis) and neurological symptoms of an organic nature (sluggish reaction of the pupils to light, smoothness of the nasolabial folds, instability in the Romberg position, hand tremors, oral automatism syndrome). Severe neurological symptoms in the form of sensorimotor and amnestic aphasia and residual hemiparesis are also observed. However, parallelism between the development of neurological and psychopathological symptoms is usually not found.
The initial psychopathological manifestations of hypertension are manifested by the same syndromes as in pericerebral atherosclerosis. In the structure of hypertensive psychoses, which have a clinical picture similar in basic syndromes to atherosclerotic psychoses, affective disorders are more pronounced: anxiety dominates and is expressed along with delirium, depression, and hallucinosis, which allows us to evaluate these conditions as anxious-delusional, anxious-depressive syndromes. The course of hypertensive psychoses is more dynamic and shorter than that of atherosclerotic psychoses.
A frequent manifestation of stage III hypertension is epileptiform paroxysms, often occurring in cerebrovascular accidents and more often in patients with hypertension than with atherosclerosis. There are a variety of forms of epileptiform seizures that occur in cerebrovascular disorders in patients with hypertension.
The leading role in ischemic circulatory disorders belongs to the pathology of the main arteries of the brain and damage to the areas of adjacent blood supply to the brain in the pathogenesis of focal paroxysms.

200 ChapterIII. Certain forms of mental illness

With circulatory disorders in the arteries of the vertebral-basilar system, a variety of non-convulsive seizures can occur. It is known that more often they are one of the early symptoms of transient cerebral circulatory disorders that occur with pathology of the extracranial sections of the arteries, and may be their only expression.
Epileptiform seizures may be the first clinical manifestation of hypertensive cerebral crisis and occur against the background of a sharp additional increase in blood pressure.
During crises, primary generalized epileptiform seizures occur more often; focal forms of paroxysms are rarely observed. In the pathogenesis of the development of generalized epileptiform seizures, leading importance is given to cerebral edema, which acutely develops at the height of the crisis.
With hemorrhages in the brain, patients with hypertension usually develop convulsive forms of seizures, often complicated by status epilepticus. Focal seizures in the acute period of hemorrhagic stroke occur when a limited hematoma is localized, which can serve as one of the indications for surgical treatment of stroke. In the acute phase of hemorrhagic and ischemic stroke, as a result of the development of cerebral edema and dislocation of the brainstem, interencephalic epileptiform seizures may occur. They are one of the signs of dislocation of the upper parts of the brainstem, in particular displacement and compression of the midbrain (E. S. Prokhorova, 1981). Often cerebral atherosclerosis is combined with hypertension.
Mental disorders in cerebral vascular hypotension are close in origin to similar manifestations in hypertension and may have similar forms. The most common syndrome with hypotension is asthenic. Psychotic disorders are determined by affective disorders: anxious depression and short-term disorders of consciousness (episodes of twilight disorders of consciousness).
The etiology and pathogenesis of atheroscleretic and hypertensive psychoses, as well as psychopathological disorders of cerebrovascular origin, have not been sufficiently studied. It is still unclear why mental disorders occur in some cases and not in others.

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Changes in the cerebral vessels are apparently primary, and massive changes in the nervous parenchyma with pronounced phenomena of lipoid-fatty degeneration are secondary, caused largely by vascular pathology. In the pathogenesis of these changes, the leading role is played by chronic hypoxia and malnutrition of the brain tissue, caused by dyscirculatory disorders and severe vascular pathology.
When comparing pathomorphological data in cases of cerebral atherosclerosis and hypertension, a largely similar morphological substrate was noted, represented primarily by severe vascular pathology, causing chronic hypoxia and changes that generally fit within the framework of hypoxic encephalopathy.
Clinical and morphological research and analysis of mental disorders in cerebral atherosclerosis and hypertension did not reveal direct correlations between specific psychopathological syndromes and pathomorphology. The cause-and-effect relationships that arise in these cases for various mental disorders are more complex and diverse.
However, pathomorphological changes play an important role as the background against which various psychopathological pictures develop. In this case, the greatest importance belongs to discirculatory disorders and the hypoxic factor, a constant companion of the vascular process of both cerebral atherosclerosis and hypertension.
In addition, due to increased vascular permeability and impaired water metabolism, cerebral edema is apparently the most important condition for the development of certain psychotic pictures, in particular disturbances of consciousness in its various manifestations.
No less important in the development of psychotic manifestations of vascular genesis is pathologically altered soil in the broad sense, which includes pathological heredity, premorbid characteristics, changes in the patient’s reactivity under the influence of the age factor and various types of exogeny and psychogeny.
In the occurrence of dementia in vascular diseases of the brain, destructive cerebral processes as a result of the progression of discirculatory encephalopathy are of greater importance than in psychosis.

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The main risk factors for the development of encephalopathy are arterial hypertension, somatic disorders, especially cardiac pathology (F. E. Gorbacheva et al., 1995; V. I. Shmyrev, S. A. Popova, 1995; A. I. Fedin, 1995, 1997; V. A. Karpov et al., 1997; N. N. Yakhno, 1997, 1998; I. V. Damulin, 1997, 1998). In elderly patients, a combination of several risk factors is more often found, to which are added factors of an inflectional nature.
The use of neuro-imaging research methods (computer and magnetic resonance imaging) of the brain in modern clinical practice has made it possible to assess the condition of various brain structures intravitally. In this case, cerebral atrophy is most often visualized, the cause of which can be both involutional and vascular or primary degenerative processes in nature.
Cerebral infarctions detected using computed tomography or magnetic resonance imaging are considered a characteristic sign of a vascular process in the brain.
Currently, in the pathogenesis of cerebral vascular insufficiency, great importance is attached to leukoaraiosis (diffuse damage to the white matter of the brain) (I. V. Gannushkina, N. V. Lebedeva, 1987; Y. Nashincki et al., 1987; S. Fisher, 1989; T. S. Gunevskaya, 1993; N. V. Vereshchagin, 1995), which is much better visualized in T2 mode than in T1 mode MRI with CT (A. Qasse et al., 1998).
The cerebral vascular process has specific clinical and neuroimaging features. However, there is no direct correlation between the severity of dementia and the changes identified by CT and MRI. However, the most severe manifestations of dementia are found in cases with severe cerebral atrophy, multiple foci of vascular pathology and subcortical leukoaraiosis.
In the origin of vascular dementia, in contrast to atrophic processes (Alzheimer's disease), the leading role is played by dysfunction of the anterior parts of the brain, manifested by certain clinical features and neurovisual phenomena.
The cause of such disorders, especially in patients with an unfavorable course of the disease, is often the phenomenon of “disconnection” caused by damage to the cortical

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but-subcortical pathways connecting the anterior parts of the brain with other parts of the cortex and subcortical structures (I. V. Damulin, 1997).
Treatment and prevention

When treating mental disorders in vascular diseases, it is necessary first of all to influence the underlying pathological vascular process. For this purpose, a complex of therapeutic effects is used aimed at improving and normalizing blood supply to the brain after relieving vasospasm and brain hypoxia.
Neurotropic antispasmodic effects are exerted by agents that influence different parts of autonomic regulation. This group of drugs includes anticholinergic drugs (atropine, metamizil, etc.). Drugs with a central sedative effect have an antispasmodic effect - tranquilizers (Seduxen, Grandaxin, Elenium, etc.), sleeping pills (Eunoctin, etc.).
Cerebral and coronary blood supply is improved by well-known antispasmodics and coronary dilators (no-spa, complamin, dibazol, chimes, etc.). Nootropics, cholinergic drugs, brain metabolites (nootropil, stugeron, amiridin, Cerebrolysin, Vasobral (Oxibral), Caventon, Gammalon, Tanakan, etc. act on the medulla).
It is advisable to use hypolipemic drugs (miscleron, nicotinic acid, etc.). The effectiveness of therapy is increased by the widespread use of a complex of vitamins (A, B1, B2, B6, B12, E, PP), their combinations (undevit, panhexavit, etc.), as well as the use of hormonal drugs and anabolic steroids (nerabol, retabolil). Among the means aimed at combating hypoxia, poly- and rheopolyglucin, cocarboxylase, ATP, etc. are used.
The use of means to improve blood supply and oxygenation (hyperbaric oxygenation) is also important.
Depending on the dominant psychopathological syndrome, the use of neuroleptics for delusional disorders is indicated, and for depression - antidepressants in combination with tranquilizers (Seduxen, Elenium, etc.).
When conducting drug therapy, especially with neuroleptics, the state of the vascular system and the entire

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the patient’s body as a whole, the usual doses of these drugs in psychiatry are selected carefully, starting from the minimum, and most often are not brought up to the average therapeutic doses of drugs used in the treatment of other psychoses due to poor tolerance. In these cases, the doses of drugs are purely individual and depend both on the leading psychopathological syndrome and on the age, weight and especially the somatic condition of the patient.
Psychotherapeutic methods of treatment deserve special attention, especially rational psychotherapy and occupational therapy.
The presence of mental disorders at the initial stage of vascular disease makes it possible for patients to continue working in their profession in easier conditions. In these cases, they are assigned a Group III disability.
Forensic psychiatric examination

Persons with the initial stage of the disease - with a neurasthenic-like syndrome, mild depression, as well as psychopath-like manifestations (with irritability, hot temper, conflict), which are combined with the same insignificant severity of somatic and neurological disorders, with the ability to realize the socially dangerous nature of the actions they have committed and to manage them - are recognized as sane.
Determining the legal capacity of persons with vascular diseases of the brain in some cases presents certain difficulties due, on the one hand, to the undulating course of the disease with fluctuations in the severity of the disease process, and on the other hand, to a tendency to progress with an increase in psychoorganic symptoms. Particular difficulties arise if it is necessary to make such a decision after the death of a person who left a will or executed any other legal act, based on a retrospective study of medical records and witness testimony.
Only persons with symptoms of severe dementia or who committed the act incriminated to them during a period of vascular psychosis are recognized as insane. Regarding medical measures for these individuals, only a few of them require

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referred for compulsory treatment - angry, excitable, with delusional ideas of jealousy and persecution. In the majority of cases, patients who have committed minor acts, whose behavior is dominated by lethargy and low activity, can be sent to general psychiatric hospitals or placed in social security institutions. However, the resumption of investigative actions may lead to a new exacerbation of the painful condition, which in some cases takes a protracted course. In such cases, the subjects, recognized as sane in relation to the crime, in accordance with Art. 81 of the Criminal Code of the Russian Federation may be sent by a court decision for compulsory treatment in a psychiatric hospital until recovery.
In unfavorable cases, rapid progression of vascular disease may occur with an increase in psychoorganic defect.
Atherosclerotic dementia that develops after conviction is the basis for releasing a person from further serving a sentence.
The main criteria for forensic psychiatric assessment of mental disorders in vascular lesions of the brain are common to all described forms. Persons with the initial stages of vascular diseases of the brain and with atheroscleretic manifestations, mildly expressed neurosis-like syndromes of various structures are recognized as sane, since these disorders do not deprive them of the ability to understand the actual nature and social danger of their actions. However, it should be borne in mind that due to increased affective instability in such patients in traumatic conditions associated with a forensic investigative situation, the development of their characteristic affective and intellectual-mnestic disorders is possible. As a rule, these conditions are reversible.
Post-stroke conditions in persons with vascular lesions of the brain are also difficult for forensic psychiatric assessment. Moreover, in the acute period, which occurs with a “flickering” of consciousness, partial orientation in the outside world, speech disorder and other psychopathological disorders, transactions concluded by patients should be declared invalid. In the long-term period, expert assessment is determined by the degree and depth of mental changes that arose after a cerebral hemorrhage.

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In this case, persons with severe post-stroke dementia are recognized as incompetent. The absence of pronounced intellectual-mnestic disorders and the preservation of criticism do not prevent the person from being recognized as legally competent.