Hypercorticism - symptoms and treatment

general information

Hypercortisolism is a broad concept that includes a complex of different conditions. The most common are Cushing's disease and syndrome. In the first case, the pathology is caused by disorders in the hypothalamic-pituitary system. Most often, this is a pituitary adenoma - a small, benign tumor that produces adrenocorticotropic hormone. In the second, the changes affect the adrenal glands directly. Most often these are adenomas and adenocarcinomas.

In 1–2% of cases, the nosology is provoked by ACTH-ectopic syndrome - a hormonally active tumor localized in the lungs, thymus, ovaries and testicles, endocrine glands, pancreas and prostate gland. Drug-induced hypercortisolism is a pathology caused by improper or inappropriate administration of corticotropic hormones.

Standard room

The hospital price includes:

• each room has its own bathroom, TV, wi-fi, air conditioning;
• all necessary treatment package; 24-hour medical monitoring;
• consultations with general practitioners, neurologists, psychiatrists, psychotherapists, narcologists;
• 3 meals a day with a 24-hour buffet (fruits, snacks, sweets);
• daily work with psychologists and group classes;
• necessary types of tests, ECG, EEG, pulsometry;
• daily massage and exercise therapy;
• gym and table tennis;
• board games and watching movies.

Mechanism of disease development

The development of hypercorticism is based on increased secretion of cortisol. This hormone provokes the breakdown of proteins in bones, muscles, skin and internal organs. Over time, this leads to tissue degeneration and atrophy. Increased glucose production leads to the development of the steroid form of diabetes. Disorders of fat metabolism are accompanied by characteristic fat deposition in certain areas. Excessive cortisol levels also affect the kidneys. As a result, the level of sodium in the blood plasma increases and the concentration of potassium decreases. Such patients suffer from high blood pressure, and degenerative processes in muscle tissue intensify.

The myocardium suffers the most with hypercortisolism. Externally, this manifests itself as cardiac arrhythmia, heart failure, and cardiomyopathy.

Types of psychoses

The causes of psychosis directly affect its classification. So, the following types of mental disorders are distinguished:

• endogenous phenomena - arise due to the influence of bipolar disorders, depressive factors, neuroendocrine phenomena on a person;
• exogenous phenomena - occur under the influence of various external factors, as well as due to the use of narcotic drugs, severe stress;
• organic phenomena - occur as a result of somatic pathologies, for example, myocardial infarction, head injuries and infectious diseases.

The division can be called conditional, since sometimes the occurrence of psychosis is influenced by several factors at once. As a result, a person faces serious mental disorders that lead to various problems.

Clinical picture

• The most typical symptom of hypercortisolism is obesity. This sign is detected in more than 90% of patients. Typically, fat is deposited on the face, stomach and back. The limbs remain relatively thin. This type of obesity is called Cushingoid obesity.
• The patient's face becomes moon-shaped, red with a bluish tint. Fat deposited in the area of ​​the seventh cervical vertebra creates the so-called bull hump. The skin on the back of the hand becomes thinner, almost transparent. Due to atrophic processes in the muscles, dishormonal myopathy develops. Patients complain of decreased muscle strength, muscle weakness, and muscle pain. Characteristic signs of the disease are the so-called sloping buttocks and frog belly, caused by wasting of the abdominal muscles, thighs and buttocks. The skin of patients has a specific so-called marbled tint and is prone to peeling and dryness. The vascular pattern is clearly visible. Purple stretch marks form on the shoulders, chest, abdomen, buttocks and thighs. Their average length is 8 cm, width is up to 2 cm. Certain areas of the skin are hyperpigmented, acne and subcutaneous hemorrhages are observed.
• Osteoporosis is also a common symptom of hypercortisolism. Bone tissue thins out and becomes less dense, which leads to severe pain, pathological fractures, and curvature of the spine. Due to deformation of the spinal column and compression of the vertebrae, patients become stooped and shorter.
• From the side of the heart muscle, extrasystoles, arterial hypertension, and atrial fibrillation are most often observed. Due to atrophic processes in the myocardium, heart failure develops. These are quite serious violations that can lead to death.

About every tenth patient develops diabetes mellitus associated with atrophic processes in the pancreas. A characteristic feature of such diabetes is a mild course. For a long time, patients have normal insulin levels, and the disease itself is well compensated by diet and medications that lower blood sugar levels. Women may develop hyperandrogenism, a syndrome caused by increased levels of male sex hormones. It is characterized by menstrual irregularities, infertility, and the formation of secondary sexual characteristics of the male type.

Psychosis: causes of the disorder

The rapid development of medicine has led to the fact that today many theories have been formulated and enough hypotheses have been considered about the causes of psychosis. However, at present, neither genetic, nor physiological, nor social, nor psychological studies can indicate the exact true reason why psychotic disorders arise and develop in all people without exception.

That is why the world's leading psychiatrists recognize a multifactorial system of mechanisms that gives rise to psychotic disorders. This model implies that the same type of psychosis can start in different people for different reasons. In this case, most often the disease develops due to the existence and layering of several predisposing and provoking factors (biological prerequisites and psychosocial reasons).

One of these systems is a model conventionally called “stress-vulnerability”. This theory is based on the following: there are certain genetic factors that predispose an individual to the formation of psychotic disorders. The presence of such a conditioned tendency to psychosis, coupled with a specific characterological portrait of the individual, serves as the basis for a person’s high susceptibility to the effects of stress factors, both positive and negative. At certain stages of life, for example: during puberty or pregnancy, the subject becomes especially vulnerable to the onset of traumatic events due to his tendency to excessive mental reactions and inability to withstand stress. This moment is the starting point for the formation of psychosis. At the same time, factors that have a protective effect (for example: a person’s financial stability and a happy marriage) cannot always counteract traumatic circumstances. In some situations, when the intensity of stressors is too great, such “defenders” only postpone the moment of development of psychosis and soften the severity of the symptoms demonstrated.

If we consider each of the versions proposed by scientists separately, we should highlight the most proven theories describing the causes of the development of psychosis.

Reason 1. Biological (chemical)

One of the leading causes of any psychotic disorders is a failure in the production and exchange of neurotransmitters, one of the functions of which is to ensure the transfer of information between the structural units of the nervous system. A special role in the neurotransmitter system is assigned to the catecholamine dopamine, tryptamine serotonin, and 2-aminopentanedioic (glutamic) acid.

Thus, excessive dopamine activity in the mesolimbic tract provokes an increase in positive (productive) symptoms of psychosis, for example: the appearance of motor affective reactions, the occurrence of delusional judgments and hallucinations. On the contrary, a decline in dopamine activation in the mesocortical system gives rise to the development and aggravation of negative (deficient) symptoms of psychosis, provoking apathy, poor speech, attention deficit, and lack of working memory.

Reason 2. Genetic

A family predisposition to psychotic reactions is one of the leading causes of the development of psychosis. Individuals who have close relatives suffering from schizophrenia or bipolar affective disorder are at high risk of developing psychosis.

If both mother and father suffered from psychotic-level disorders, then the probability of developing psychosis in their offspring is 50%. If only one parent has symptoms of mental disorders, then the risk of developing psychotic reactions for the child reaches 25%.

Reason 3. Personal constitution

Character traits and certain personality traits can cause psychosis. For example, people suffering from schizophrenic psychoses are often introverts. They are distinguished by egocentrism. Thus, a person of the cycloid type is prone to manic-depressive psychosis. A person with a hysterical constitution is more likely to experience hysterical disorders than others.

Reason 4. Social factors

A person’s presence in a negative emotional climate is one of the leading causes of psychosis. Regular stress and frequent traumatic situations serve as the basis for the emergence of psychotic disorders. Certain life circumstances also push people toward psychosis: low economic status, poor social status, inability to repay loan obligations, lack of their own home, poor family relationships.

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Social reasons for the development of psychosis also include an unfavorable period of growing up - a situation where a child was raised in an incomplete or problematic family, excessive severity or complete inattention of parents. Psychiatrists indicate that the risk of developing psychosis in adulthood is very high in those people who experienced sexual abuse in childhood , physical or mental violence. The chance of developing psychotic disorders is present in those people who were treated inappropriately and cruelly in childhood. A high degree of development of psychosis is present in children abandoned by their parents and who went through a “street upbringing.” Very often, people who were rejected or bullied by their peers in childhood become victims of psychosis.

Reason 5. Biological (intrauterine development abnormalities)

Factors predisposing to the onset of psychosis include problems in human intrauterine development. Infectious diseases of the mother, poor quality or insufficient nutrition during pregnancy, alcohol abuse, and drug use have a negative impact on the development and functioning of the central nervous system of the unborn baby. Prematurity and oxygen starvation that occur during childbirth are the cause of the formation of various psychotic disorders, including psychoses.

Reason 6. Anatomical

A common cause of psychotic conditions is abnormalities in the structures of the brain that arise as a result of trauma to the structures of the cranium, as a result of vascular pathologies, infectious diseases with a predominant localization of the focus of the disease in parts of the central nervous system.

Bruises and concussions, closed and open head injuries can trigger a cascade of psychotic reactions both a few hours later and several months after the injury. Moreover, the more severe the damage to the skull, the stronger the symptoms of psychosis will be.

Psychosis is often a companion or a consequence of:

• chronic autoimmune disease – multiple sclerosis;
• epilepsy;
• acute disorder of cerebral blood supply - stroke;
• senile dementia of the Alzheimer's type - Alzheimer's disease;
• shaking palsy - Parkinson's disease.

Psychotic reactions can occur in the presence of cysts, benign and malignant tumors in the structures of the skull. The cause of psychosis may be bronchial asthma with severe debilitating attacks.

It can be argued that any somatic pathology accompanied by intense pain is a source of severe stress for a person, as a result of which the onset of psychosis is possible.

Reason 7. Intoxication

A common cause of psychosis is alcohol abuse, uncontrolled use of pharmacological drugs, and substance abuse. Quite often, a consequence of the use of cannabinoids in adolescence is the occurrence of psychotic disorders. The development of some symptoms of psychosis is provoked by taking:

• NMDA receptor antagonists, for example: ketamine, dextromethorphan and phencyclidine;
• anticholinergic drugs, for example: alkaloids atropine, scopolamine and hyoscyamine;
• glucocorticoids, for example: cortisol;
• adrenocorticotropic hormone;
• dopamine agonists, for example: tubazide;
• non-steroidal anti-inflammatory drugs, for example: dikloberla;
• sympathomimetics, for example: ephedrine;
• antidepressants, for example: Prozac;
• neuroleptics, for example: haloperidol.

Reason 8. Perceptual-cognitive and neuropsychological factors

It has been established that psychosis is very often recorded in people who have problems in neuropsychological development and have a low coefficient of intellectual potential. In such patients, the processing of visual and spatial information is quite often impaired, sensory-motor dysfunctions are determined, associative thinking is weakened, and the ability to recognize presented stimuli is impaired.

Diagnostics

The first thing to do when a patient develops signs of hypercortisolism is to confirm or refute the increased production of cortisol by the adrenal glands. For this purpose, a small dexamethasone test is used. Most often it is performed according to this algorithm:

• on the morning of the first day, the patient’s serum cortisol level is determined;
• on the same day, at 24.00, the patient takes 1 mg of dexamethasone orally;
• recheck the concentration of cortisol in the patient’s blood serum (the next morning).

In healthy individuals, cortisol levels decrease by more than half, which does not occur with hypercortisolism. A large dexamethasone test is carried out in cases where, with a small one, proper suppression of cortisol levels has not been recorded, and also, if necessary, to carry out a differential diagnosis between Itsenko-Cushing's disease and corticosteroma, as well as ACTH syndrome. The method of conducting a large dexamethasone test differs from a small one only in the dosage of the drug - instead of 1 mg, the patient is advised to take 8 mg of the drug. In Itsenko-Cushing's disease, administration of the drug provokes a decrease in the concentration of cortisol in plasma serum by 50%. With corticosteroma or ACTH syndrome, the indicator remains the same. This is explained by the peculiarities of the functioning of the hypothalamus and pituitary gland.

To identify a pituitary adenoma, an MRI of the brain is performed. In addition, if pathology is suspected, a CT or MRI of the adrenal glands is indicated - their bilateral hyperplasia indicates pathology. The same methods are used to visualize corticosteroma located in internal organs. To diagnose complications of the disease, biochemical studies, radiography of the spine and other techniques are indicated. The scope of research is determined individually, depending on the patient’s condition.

GLUCOCORTICOIDS

They are used as mandatory medications for status asthmaticus and exacerbation of bronchial asthma.
Currently, about 20% of patients receive glucocorticoids as basic therapy for the disease. The mechanism of action of these drugs is as follows:

– they suppress the late asthmatic reaction (reduce the number of antigen-antibody complexes), which is associated with a nonspecific anti-inflammatory effect;

– inhibit the production of antibodies, preventing the development of anaphylaxis;

– stabilize lysosomal membranes, thereby reducing the release of lysosomal enzymes;

– reduce the formation of free histamine, inhibiting its release from mast cells;

– increase the sensitivity and number of b2-adrenergic receptors, thereby potentiating the effect of sympathomimetics; ,

– inhibit the metabolism of leukotrienes;

– have a direct relaxing effect on the bronchi. The influence of glucocorticoids on the metabolic processes of the human body goes beyond allergic reactions and respiratory pathologies.

They play an important role in the exchange of electrolytes, proteins, fats, carbohydrates, and influence the physiological activity of almost all body systems. As a result, corticosteroid therapy may be accompanied by a number of adverse reactions. The most common are:

– Itsenko-Cushing syndrome (moon-shaped face, obesity, hypertension);

– steroid diabetes;

- arterial hypertension;

– reduction of the body’s overall resistance and resistance to infections;

– osteoporosis and myopathies;

– steroid psychosis.

In this regard, glucocorticoids are used as basic therapy only if there are strict indications:

– Progressive course of the disease with severe attacks of suffocation;

– inability to achieve remission using other means;

– a state of hormonal dependence, when therapy of this kind is considered as replacement therapy.

The most commonly used drugs are:

– Hydrocortisone , used for parenteral administration. Ampoules contain 25 and 125 mg of the drug. The daily dose for the treatment of asthma can reach 500 mg or more.

– Prednisolone is 5 times more active than hydrocortisone. Available in tablets of 5 mg and ampoules of 30 mg of the drug. The maintenance dose of prednisolone is 5-10 mg, cushingoid develops at a dose above 10 mg per day with long-term use”:

– Urbazon is better tolerated by patients than prednisolone and is less likely to cause dyspeptic symptoms. One tablet contains 4 mg, a maintenance dose of 6-10 mg per day.

– Polcortolone , compared to other drugs, has the most pronounced anti-asthmatic effect. However, after its use, myopathies and mental disorders very often develop. Available in 4 mg tablets, which are equivalent to 5 mg prednisolone.

– Dexamethasone has high anti-inflammatory activity and is available in 0.5 mg tablets, which corresponds to 3.5 mg of prednisolone. The drug has a high diabetogenic effect, often causing stomach ulcers and osteoporosis. The maintenance dose is 1.5-2 mg/day, which is sufficient for the development of Itsenko-Cushing syndrome and steroid-induced diabetes.

– Betameson is a drug similar in action to dexamethasone. The maintenance dose is 1-1.5 mg. Complications occur when prescribing more than 2 mg per day. (4 tablets per day).

– Beclomethasone is used only for topical use in the form of an aerosol (beclomed). The therapeutic dose is 16 inhalation doses, and the maintenance dose is 8-10 inhalations per day.

Suppression of adrenal function is observed when using doses exceeding 30 breaths.

When taking the drug, changes in taste, dry mucous membranes, thrush, fungal infections of the oral mucosa, trachea, and bronchi often develop.

To reduce side effects and complications of basic therapy with glucocorticoids, it is recommended to use short-acting drugs (prednisolone, prednisone, methylprednisolone), the entire maintenance dose of 1.5-2.5 tablets of the drug is taken once, before 8 a.m. More promising is an intermittent regimen: the drug is used every other day in a dose ,

slightly exceeding the total for two days (for example, instead of 2 tablets daily, give 5-6 tablets every other day in one dose in the morning).

Long-acting glucocorticoids ( triamcinolone, dexamethasone ) are not recommended for basic therapy, since the meaning of intermittent treatment is lost and the risk of side effects increases.

If the patient has not previously received hormones, the initial dose is selected empirically, considering that it should be significantly higher than the expected maintenance dose. If there is no positive dynamics within 5-7 days, the dose is increased by 1.5 times.

Upon stabilization, they switch to maintenance doses, and then try to select the lowest effective dose of the drug. Cancellation is carried out extremely carefully, 0.5 tablets of prednisolone every 7-10 days.

At the same time, drugs that stimulate adrenal function are prescribed - GLYCERAMS (30-40 mg per day) or TIMIZOL (0.3 g per day).

Treatment of hormone-resistant forms of bronchial asthma is an extremely difficult task. Sometimes a combination with ketotifen helps. Sometimes exchange plasmapheresis allows you to restore sensitivity to hormones.

INTAL

A drug that does not have bronchodilating activity. It stabilizes mast cell membranes and inhibits the release of mediators that can cause bronchospasm (histamine, leukotrienes). Available in powder form in capsules containing 20 mg of intal.

The capsules are placed in a special “spinhaler” inhaler and the patient inhales the powder. Treatment is carried out only in the remission phase. The drug is prescribed 4-6 times a day, the effect can be assessed only after 10-14 days. If the effect is persistent, intal is used as the main means of basic therapy.

Good results have been obtained in the treatment of aspirin-induced asthma and exercise-induced asthma.

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Treatment

Both conservative and surgical methods are used to treat the disease. First of all, the patient is prescribed drugs that inhibit the synthesis of steroids. They are effective for the endogenous nature of the disease. If magnetic resonance imaging can clearly visualize a pituitary adenoma, surgical removal is indicated. In this case, stable remission develops in nine out of ten patients. If the adenoma is not visible, the patient is recommended to use proton therapy on the pituitary gland.

The main treatment method for corticosteroma is adrenalectomy. Sometimes, especially in severe cases of the disease, unilateral removal of the adrenal gland is performed. This allows you to reduce the severity of symptoms of the disease.

Symptomatic treatment plays a special role in this pathology. As a rule, patients are recommended medications that lower blood pressure, lower blood sugar, and medications intended for the treatment of osteoporosis. To normalize electrolyte metabolism, potassium supplements are prescribed.

Signs of illness

In psychosis, a distortion of the perception of the surrounding world appears. Hallucinations occur, which can be gustatory, auditory, visual, tactile and any other nature. A person can hear sounds that are not there, and even voices. The patient cannot evaluate what is happening, may talk to himself or laugh for no reason.

In addition, changes in behavior are noticeable from the outside. With depressive disorders, a person may sit in one position for a long time, not communicate with people around him, he is constantly in a pessimistic mood, has sleep and eating disorders. At this time, the person suffering from such symptoms often has thoughts of suicide. In the case of manic psychosis, the patient becomes overly active: he is very sociable, and his speech is fast and emotional, the person makes many unrealizable plans, practically does not sleep, often abuses alcohol and leads a dissolute lifestyle.

Another striking symptom that manifests itself in psychosis is delusional ideas. In this case, a thinking disorder occurs in which a person has thoughts that do not correspond to reality. There can be many manifestations of delirium. For example, ideas related to one’s own health, when a person persistently claims that he is seriously ill with some disease, while he proves that he feels all the symptoms of the disease.

Thoughts of invention, while he is confident that he has done something truly unique and important. There is also alcoholic delirium of jealousy, which is accompanied by frequent suspicions of treason and the search for evidence of them. Ideas of damage are usually associated with the fact that the person claims that there were attempts to rob his apartment and that he was poisoned. Sometimes persecution mania occurs. In this case, the patient thinks that aliens want to steal him, someone wants to cause damage.

Impaired motor functions, lethargy, stupor, or a large number of fast and aimless movements may also be observed. Sometimes a person is unable to perform simple actions because he cannot control them. The symptoms depend on the patient himself. For example, if he has some inclinations or fears, then during illness they will certainly intensify. It is necessary to be able to identify such symptoms and signs of psychosis, since the patient himself, as a rule, denies the presence of the disease and refuses to undergo treatment.

Prognosis and prevention

The prognosis for Itsenko-Cushing syndrome depends on the following factors:

• timeliness of diagnosis and initiation of treatment;
• patient's age;
• individual response to therapy;
• root causes of the disease.

In the absence of adequate therapy or improper treatment, the mortality rate in the first five years from the moment of diagnosis of the disease reaches 50%. The highest likelihood of a good clinical outcome is with corticosteroma, despite the fact that the function of the second adrenal gland is restored in only eight out of 10 patients.

For malignant corticosteroma, the average five-year survival rate does not exceed 25%. The average life expectancy without treatment is one year and two months. Timely diagnosis and early treatment significantly improve the prognosis for the life and health of the patient.

Medical educational literature

Mental disorders resulting from poisoning with substances of different chemical structures are distinguished by significant similarity (In ICD-10, the nature of the toxic substance is indicated by codes from T36 to T65.). In many cases, an accurate determination of the nature of intoxication only from clinical symptoms is impossible, since mental manifestations mainly correspond to the concept of an exogenous type of reaction. Disorders caused by acute intoxication and those developed as a result of chronic poisoning with small doses of a toxic substance differ to a greater extent. Severe acute intoxication, which significantly impairs basic metabolic parameters, is usually accompanied by loss of consciousness (stunning, stupor or coma). The patient may die without regaining clear consciousness. Less dangerous poisoning can manifest itself as a state of euphoria with carelessness, foolish gaiety, and complacency. Frequent early symptoms of acute intoxication are dizziness, headache, nausea and vomiting (for example, in case of poisoning with organic solvents, arsenic salts, organophosphorus compounds). Against this background, acute psychoses are often observed. Delirium develops more often than other psychoses (especially with poisoning with anticholinergic drugs). As the condition worsens, the picture of delirium changes, getting closer and closer to excruciating delirium or even an amental state. Typical oneiroid during intoxication is observed extremely rarely, however, with some intoxications (psychostimulants, hallucinogens), pictures of fantastic content may arise, combining signs of delirium and oneiroid. A relatively rare disorder is acute hallucinosis: in case of tetraethyl lead poisoning, the sensation of the presence of foreign objects and hair in the mouth is described; psychostimulants and cocaine - the feeling of insects moving under the skin. In persons with a decrease in the threshold of convulsive readiness, intoxication may be accompanied by epileptiform symptoms - convulsive seizures or paroxysms of twilight stupefaction. In a state of epileptiform agitation (with dysphoria and twilight states), patients can be aggressive.

Recovery from an intoxicated state is often lengthy and accompanied by a variety of mental disorders. X. Vick (1956) described a number of conditions occupying a transitional position between acute exogenous psychoses and a persistent organic defect, which he called transitional syndromes. Unlike persistent psychoorganic syndrome, transitional syndromes tend to regress, and although complete restoration of health is not always observed, a significant improvement in condition is possible after some time. Transitional syndromes are also a characteristic manifestation of chronic, slowly developing intoxications.

The most favorable variant of transitional symptoms is asthenic syndrome, manifested by severe fatigue, irritability, and attention disorder. The prognosis for the occurrence of depressive and depressive-delusional states is relatively favorable. Although depression can be long-lasting and is often accompanied by painful hypochondriacal thoughts and even suicidal tendencies, timely treatment allows for complete recovery. Quite rarely, with chronic intoxication, manic and hallucinatory-delusional psychoses develop (for example, with an overdose of steroid hormones, psychostimulants or anti-tuberculosis drugs). In this case, it is necessary to carry out differential diagnosis with endogenous diseases. Unlike schizophrenia, these variants of exogenous psychoses usually also resolve favorably. A significantly worse prognosis occurs with amnestic (Korsakoff) syndrome. In the latter case, restoration of memory function is rarely complete; in most cases, an irreversible organic defect develops as a result.

In the final stage of severe central nervous system intoxication, a persistent psychoorganic (encephalopathic) syndrome in the form of decreased memory, intelligence, and personality changes with an increase in irascibility, carelessness, exhaustion, or indifference.

Listed below are some of the most common intoxications (Substance intoxications are discussed in the chapter).

Organic solvents [T52, T53] (gasoline, acetone, toluene, benzene, chloroethyl, dichloroethane, etc.) in small doses cause euphoria, often accompanied by dizziness and headaches; with increased intoxication and upon recovery from intoxication, nausea and vomiting are often observed. Occasionally, intoxication delirium occurs. Chronic intoxication is accompanied by severe signs of encephalopathy with memory loss and personality changes.

M-anticholinergic drugs [T42, T44] (atropine, cyclodol, asthmatol) cause agitation, tachycardia, mydriasis, and tremor. Very often, at the height of intoxication, delirious stupefaction is noted. Severe poisoning can cause coma and death. Signs of encephalopathy develop rarely, usually after a coma.

Organophosphorus compounds [T44, T60] (insecticides, karbofos, chlorophos, etc.) have the opposite mechanism of action to atropine. Causes bradycardia, nausea, vomiting, sweating, bronchospasm and bronchorrhea. Severe intoxication is manifested by coma with convulsions. In chronic intoxication, symptoms are expressed by severe asthenia, nausea, dysarthria, photophobia, and emotional lability.

Carbon monoxide (carbon monoxide) [T58] can cause severe stunning, coma and death if not treated promptly. Delirious stupefaction is less common. After resuscitation measures, memory disorders (Korsakov's syndrome), speech disorders (aphasia), and organic personality changes are often discovered.

Diagnosis of chronic poisoning with heavy metals, arsenic and manganese is quite difficult [T56]. Signs of arsenic poisoning are dyspepsia, enlarged liver and spleen. Mercury intoxication is manifested by neurological symptoms (ataxia, dysarthria, tremor) in combination with emotional lability, uncriticality, euphoria, and sometimes aspontaneity. Lead poisoning manifests itself as headache, asthenia, irritability, and depression. Even more severe depression, accompanied by anxiety, psychosensory disorders, and delusional ideas of relation, is observed with chronic manganese poisoning. With any of the listed intoxications, encephalopathy quickly forms.

Etiopathogenetic methods are predominantly used in treatment. For some acute intoxications, it is possible to administer antidotes (for example, atropine for poisoning with organophosphates, bemegride for barbituric intoxication, ethyl alcohol for taking methyl alcohol, sodium chloride for poisoning with lithium salts). Detoxification measures depend on the nature of the toxin (oxygen therapy - for inhalation of carbon monoxide, hemodialysis - for poisoning with low molecular weight compounds, hemosorption and plasmapheresis - for poisoning with high molecular weight poisons). In some cases, in case of acute intoxication (for example, barbiturates), gastric lavage is useful. Hemodesis and forced diuresis have a nonspecific detoxification effect. In case of chronic intoxication, detoxification measures do not give such a quick effect. Manifestations of encephalopathy can also be observed when the toxic substance that caused them is no longer detectable in the body. In this case, as a rule, the prescription of psychotropic drugs is required: antipsychotics - for psychomotor agitation, mania and delirium, antidepressants - for depression, tranquilizers - for anxiety, insomnia and irritability. To prevent the development of encephalopathy, nootropic and metabolic agents (nootropil, cerebrolysin, encephabol, glucose, vitamins) are prescribed quite early.

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Stages and methods of treatment of psychological psychoses

1. We diagnose psychosis
   . We examine the patient, check with him or his loved ones how long the symptoms have been observed, and whether the patient has undergone treatment before. If necessary, we send you for tests and hardware examinations.
2. We relieve acute symptoms
   . We prescribe tranquilizers to relieve agitation. We select antidepressants if the patient has apathy.
3. We eliminate the cause of psychosis with medication
   . We select antipsychotics that improve the patient’s mental state and prevent the development of relapses.
4. We conduct a course of psychotherapy
   . We organize individual consultations, family and group treatment.
5. We organize maintenance therapy after treatment
   . We provide consultations with a psychotherapist if a former patient needs support. We tell relatives how to support the patient, what conditions to organize for him at home.

Signs and manifestations of chronic psychoses

You should consult a doctor if you notice the following symptoms of the disorder in yourself or a loved one:

• problems with thinking, inability to concentrate on work or any task, difficulty remembering and perceiving information;
• delusions, such as feelings of persecution or being chosen;
• hallucinations, including visual, auditory, olfactory;
• inappropriate behavior, unusual reactions to everyday situations and events;
• overexcitement;
• stupor;
• isolation, reluctance to communicate with others.

Advantages of treatment in our clinic

1. We are hospitalized in a hospital
   . If the patient is dangerous to himself and others, does not realize there are problems and refuses to be treated, we send a team to the house. The orderlies forcefully deliver the patient to the clinic with the consent of the relatives. We have all the necessary licenses for this.
2. We are being treated in a hospital
   . We place you in a hospital if it is not possible to receive treatment at home. We provide constant supervision and assign orderlies or nurses to patients.
3. We provide comfortable conditions
   . We treat in comfortable general and individual wards with modern renovation, heating, and new comfortable furniture.
4. We select therapy individually
   . We assess the patient’s condition, duration of the disease and the number of relapses. We select therapy taking into account the general state of health and the effectiveness of previous treatment.