Senile depression: symptoms and treatment

Causes of the disease

Presenile and senile psychoses in most cases develop in women. This pathology is formed due to atrophy of cells in the cerebral cortex. The risk of the disease increases if there are cases of senile psychosis in the patient's family. The main reasons that provoke the appearance of the disease in old age are:

• age-related death of cellular structures;
• deterioration of brain function;
• heredity;
• infectious diseases;
• somatic diseases;
• pathologies of auditory and visual analyzers;
• psychotrauma;
• use of anesthesia;
• weakening of muscle tone;
• insomnia;
• poor nutrition.

Not all older people show clinical signs of mental illness. In this regard, scientists identify heredity as the leading factor. In this case, progression of the disease is noted, despite timely treatment and provision of necessary living conditions.

Functional psychoses of presenile and senile age

Functional psychoses of late age are psychotic states that first develop in the presenium (age of onset - 45-60 years) or old age (after 60-65 years), which are presumably caused by a complex of factors directly or indirectly related to aging, and which do not lead to pronounced organic decline in personality level or dementia.

In some patients, the manifestations of such psychoses are identical or close to the picture of involutional depression or involutional paranoid. In these cases, some psychiatrists classify them as late variants of presenile psychoses, others call them functional psychoses of senile age.

In the elderly, functional psychoses of a different psychopathological structure are also observed: grumbling depression, optical, verbal, tactile and olfactory hallucinosis, acute states of confusion with gross disorientation in the environment, fragmentary hallucinatory-delusional experiences, motor restlessness and amnesia during the period of psychotic disorders.

Categories in ICD-10

Involutional depression should be classified under the heading “Mood Disorders”, categorized as a “Depressive episode” of severe or moderate degree. Involutional paranoid is allocated to a special subsection of the section “Schizophrenia, schizotypal and delusional disorders.” Functional hallucinoses of late age should be included in the subsection “Other non-organic psychotic disorders” of the same section.

Etiology and pathogenesis

The attitude of representatives of different psychiatric schools and directions towards functional psychoses of late age is ambiguous. Some researchers deny the nosological independence of these psychoses, considering them as modified by aging, atypical variants of schizophrenia, manic-depressive psychosis, reactive or somatogenic psychoses. Other psychiatrists recognize the existence of special functional psychoses of late age.

It should be noted that involutional psychoses are now rarely diagnosed, mainly in cases where the clinical picture corresponds to the classical descriptions of involutional psychoses.

Information about the etiopathogenesis of functional psychoses in late age is largely hypothetical.

Long-standing ideas about the cause of these psychoses by neuroendocrine and other biological changes that occur during aging have not yet received reliable scientific evidence. The importance of aging processes in the genesis of functional psychoses in late age is partly confirmed by the clinical connections of some of these psychoses with pathological menopause.

The most common concept is that functional psychoses of late age arise as a result of the combined action of a whole group of factors directly or indirectly associated with involution. The most important of them include, along with biological and psychological aging, mental trauma and somatic harm. A certain role in the genesis of these psychoses is assigned to the unfavorable socio-psychological consequences of aging: retirement, social isolation, housing and economic problems.

The hypothesis has gained recognition abroad, according to which functional psychoses of late age (especially involutional paranoids) are considered as unconscious defensive reactions of the individual to the situation of aging.

A predisposition to functional psychoses of late age in persons of a certain mental make-up has been established. Many patients with involutional depression have premorbid traits of anxious suspiciousness and a hypothymic emotional background. Most patients with involutional paranoid are initially characterized by uncompromisingness, straightforwardness, quarrelsomeness, and mental inertia.

The specific pathogenetic mechanisms of functional psychoses of late age are unknown.

Diagnosis

Diagnosis of functional psychoses in late age is based on the identification of a psychotic state that first emerged after 45-50 years of age with a characteristic clinical picture and course: a prolonged single attack of anxious or anxious-delusional depression, chronic interpretative delusions with predominantly flawed themes, prolonged hallucinosis. The diagnosis of functional psychosis in late age is contradicted by the identification of such productive disorders as delusions of influence, pseudohallucinations, and mental automatisms. A prerequisite for diagnosing these psychoses is the absence of a pronounced organic decline in the level of personality or dementia in the long-term stages.

Prevalence

Information on the prevalence of functional psychoses in late life is fragmentary and contradictory. According to various sources, patients with functional psychoses make up from 11 to 48% of all patients with psychoses in late life.

Forecast

Although functional psychoses of late age do not lead to dementia, their prognosis is usually unfavorable due to a protracted or chronic, long-term course. Clinical recovery is extremely rare. Acute and protracted states of senile confusion, which often precede death, are especially unfavorable in prognostic terms.

Treatment and prevention

Treatment of late-life functional psychoses usually begins in a hospital setting and continues on an outpatient basis for a long time. In connection with exacerbations of psychosis, there is often a need for repeated hospitalizations. The main treatment is medication. The doses of most psychotropic drugs prescribed to elderly patients are 2/3-1/2 of the average doses of the corresponding drugs used in young and middle-aged people. When treating the elderly, doses of psychopharmacological drugs are reduced to 1/3, and more often to 1/4, compared to the doses used in elderly patients.

For patients with involutional depression, a combination of sedative or balanced antidepressants (amitriptyline, anafranil, rexitin, paxil) with antipsychotics is recommended. For agitated depression, sedative neuroleptics (tizercin, azaleptin, propazine) are used. The presence of a delusional component in the structure of depressive psychosis is the basis for prescribing neuroleptic drugs with antipsychotic effects (triftazine, etaprazine, clopixol, haloperidol, rispolept) in small doses. In many cases, the prescription of Eglonil is justified, given its antidepressant and anti-delusional properties.

In patients of involutionary age with deep and persistent depression, Cotard's delirium, with the ineffectiveness of psychopharmacotherapy and the absence of somatic and neurological contraindications, electroconvulsive therapy (6-10 sessions) is used.

For delusional psychoses and hallucinosis, antipsychotic drugs with an antipsychotic effect are used.

An essential place in the complex therapy of functional psychoses of late age belongs to the correction of somatic pathology, age-related ailments and care for physically frail patients who are not capable of self-care.
Psychotherapy in the form of calming and encouraging conversations and training in everyday skills plays a supporting role. It is aimed at restoring and strengthening social connections. Next »

Classification of senile senile psychosis

Senile mental disorder has acute and chronic forms. The most common is the acute form of psychosis, characterized by a sharp development of the pathological process. In this case, the duration of the disease does not exceed 30 days and ends in remission.

The chronic form of the disorder does not have specific symptoms, which makes diagnosing the pathology difficult. The disease of this form can last about 20 years, during which the person remains mentally active.

Acute forms of senile psychosis

The occurrence of this form of hydrocyanic disorder in old people occurs under the influence of somatic diseases that have progressed in the body over a long period. The formation of pathology is also influenced by the use of anesthesia, surgical interventions and complications during rehabilitation.

The acute stage is preceded by a prodromal period of 24-72 hours. At this time, the patient experiences loss of appetite, insomnia, weakness, and slight difficulties in spatial orientation. The onset of the acute phase is accompanied by delusions, hallucinations, confusion of thinking, and motor disinhibition. The patient's delusional ideas and thoughts are characterized by increased scrupulousness and aggression towards others.

Chronic forms of senile psychosis

Psychosis in older people in the chronic stage manifests itself in the form of a paranoid, hallucinogenic mixed syndrome. The first syndrome is characterized by constant delusions aimed at the immediate environment. In this state, the patient can take care of himself and communicate with other people.

Hallucinogenic syndrome is a mental disorder of verbal, visual or tactile perception. With the verbal type, a person is characterized by intimidation, the use of profanity, loss of control over one’s own behavior, and chaotic movements. Visual hallucinations at the initial stage have dim images, which over time turn into realistic pictures. Some patients talk to characters in their hallucinations.

The tactile type of psychosis is associated with a feeling of itching and burning of the skin, insects crawling over the body. This condition forces a person to constantly wash their hands, consult a dermatologist, and try to get rid of the discomfort in every possible way.

With a mixed form of psychosis, the patient experiences a combination of hallucinations and paranoia. The condition is similar to manifestations of schizophrenia - the patient sees images, performs all kinds of movements, hears voices. Mnemonic functions are preserved at the initial stage of the disease.

Depending on the duration of the disease and the degree of progression of the symptomatic picture, chronic psychoses are divided into the following types:

1. Simple, manifested by character accentuations.
2. Expanded, characterized by memory loss, disruption of sleep and wakefulness, disorientation in a familiar environment.
3. The final stage, accompanied by emotional depression and complete insanity caused by the gradual age-related death of the cerebral cortex.
4. Confabulatory, associated with the development of delirium, excessive love of others, the desire to talk a lot, pathological friendliness.

All forms of senile psychosis develop gradually. The progression of the disease leads to severe disturbances in the mental state of the elderly person.

Gerontological Center "Panacea"

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A huge number of people, most often elderly, face the problem of dementia around the world. This disorder is known as dementia. Among the striking symptoms is a sharp decline in mental abilities. The reasons may be different, but the symptomatic manifestations, regardless of the etiology of the disease, are very similar. The differences are related to the severity of the disorder, the area of ​​the brain affected, and the patient’s state of health.

Manifests itself in the form of a persistent impairment of higher mental activity. Among the main signs are deterioration of memory, the ability for creative processes, learning, and abstract thinking. Problems arise in the emotional-volitional sphere, up to complete personality degradation.

Varieties and etiology

The onset and development of dementia can be caused by any reason leading to damage to the central nervous system, namely to the degradation and death of cells in the cerebral cortex. Most often, the disease is associated with severe organic damage to brain tissue. Individual pathologies such as Pick's disease, Alzheimer's, etc. are common. In these cases, destructive changes in the tissues of the cerebral cortex are the main mechanism of the disease.

There are secondary forms of central nervous system damage, which are caused by complications of the main diagnosis. These can be infectious diseases, head injuries, poisoning (including alcohol, drugs), cardiovascular diseases, pathological changes in nerve tissues.

Secondary organic brain damage is most often caused by pathologies of the cardiovascular system. Hypertension and atherosclerosis are common. In addition, chronic alcoholism and drug addiction naturally lead to dementia, as the body becomes intoxicated and the cerebral cortex is damaged. Frequent causes of dementia are head injuries and tumor formations in the central nervous system. Infectious diseases can lead to dementia. In patients with chronic meningitis, neurosyphilis, viral encephalitis and AIDS, one can often notice manifestations characteristic of dementia.

Other reasons:

• complicated course with kidney or liver failure;
• complications after hemodialysis;
• a number of endocrine disorders (Cushing's syndrome, thyroid disease);
• serious autoimmune diseases (multiple sclerosis, lupus erythematosus).

When several causes “work” simultaneously, the disease develops in a natural way. Senile (or senile) mixed dementia is a common example of this disease with a mixed etiology.

Typification of dementia by localization

There is a division of the disease into types associated with the main localization of pathological changes. With different types, the disease manifests itself in different ways:

• Cortical - the tissue of the cerebral cortex, mainly the cerebral hemispheres, is affected. Most often, this type occurs in Pick's diseases, Alzheimer's diseases and chronic alcoholism.
• Subcortical - the main lesions affect the subcortical parts of the brain, the disease is manifested by disturbances in the motor sphere: muscle stiffness (face-mask, constrained unnatural gait), tremors of the limbs. Often such manifestations can be observed in Parkinson's disease.
• Cortical-subcortical - the cerebral cortex and subcortical structures are simultaneously affected. Vascular disorders are a common cause of this type of dementia.
• Multifocal - in this case, all parts of the central nervous system are pathologically changed, progression occurs at a rapid pace, the symptoms are varied and manifest clearly.

Forms according to clinical manifestations
Medicine divides dementia according to symptoms into total and lacunar, which differ in the severity of the signs of the disease.

With lacunar dementia, individual brain structures that are responsible for mental processes are affected. It usually manifests itself as problems with short-term memory, but otherwise intellectual activity is practically unimpaired, that is, critical thinking is preserved. Changes in the emotional-volitional sphere may be slightly expressed, which is manifested by asthenic symptoms: hypersensitivity, tearfulness, emotional lability. In the early stages of Alzheimer's disease, the lacunar form can be clearly seen.

With total dementia, a complete collapse of the personality occurs. Not only are the patient’s intellectual and cognitive abilities impaired, but one can also notice disturbing symptoms in the emotional-volitional sphere. Namely: existing spiritual values ​​are devalued, important qualities such as modesty and a sense of duty disappear, the circle of life interests sharply narrows, and it becomes difficult for a person to be in society. Such manifestations are associated with the fact that the frontal lobes of the cerebral cortex are affected. Most often, the causes of these disorders are tumor formations, abscesses, hematomas, peak disease, and cardiovascular pathologies.

Types of dementia in the elderly

The older you get, the higher your risk of developing dementia. And if older people have a less than 1% chance of getting the disease, then among people over 80 years of age the risk of getting this disease is already 20%. Most often, in presenile and senile (in other words: presenile, senile) age, the following types of dementia occur:

• atrophic (Alzheimer's) - degenerative changes in nerve cells are primary;
• vascular - due to significant circulatory impairment in the brain, degenerative processes occur in the central nervous system;
• mixed - two causes of the emergence and development of pathology “work” simultaneously.

Prognosis
Depending on the cause that led to the organic defect of the central nervous system, the course of the disease and its prognosis may be different.

For example, with a traumatic etiology (post-traumatic period, the pathology has no tendency to further develop), if the doctor prescribes adequate treatment, then compensatory reactions are likely to develop (this means that the functions of the affected part of the brain are partially distributed over other parts of the brain). This will be manifested by a significant improvement in the patient’s condition as a result of treatment. But this type of dementia is rare. Unfortunately, most patients have a different etiology of the disease.

With impaired functionality of cerebral vessels or Alzheimer's disease, dementia steadily progresses. Stopping this process using modern medicine methods is impossible, and treatment only involves slowing down the development of the disease, symptomatic therapy, prolonging the patient’s life, as well as his social and personal adaptation.

With the rapid progression of the disease, there is no need to tell the doctors at the Panacea clinic that the prognosis is favorable. Already months or at best years after the first signs of pathology appear, death can occur. Common causes of death include sepsis, pneumonia, and other diseases that are associated with disruption of the central nervous system, which regulates the activity of the entire body.

Symptoms and treatment of dementia of various etiologies

In elderly and senile patients with dementia, the causes of pathological changes in brain tissue are different. However, the clinical manifestations of the disease and the prescribed treatment will be different.

Vascular dementia

Vascular genesis of dementia is one of the most common in older people. Among all cases of dementia, its share is about 20%. Dementia can be caused by:

• ischemic stroke;
• hemorrhagic stroke.

In the first case, there is a complete or partial blockage of blood vessels in any area, resulting in impaired blood circulation. In the second case, a blood vessel ruptures. Both types of stroke result in massive death of brain cells. Depending on the main location of the lesions, one or another symptomatology will appear. The severity of symptoms will also depend on how severely the vessel is affected, what is the functional orientation of the area of ​​the brain deprived of full blood supply, what compensatory capabilities the body has, as well as how quickly and efficiently medical care was provided.

If the insufficiency of blood supply to the brain in elderly people is chronic, then the manifestations of the disease will be more uniform.

The following reasons can lead to the vascular form of the disease:

• hypertension;
• atherosclerosis of blood vessels;
• systemic vasculitis;
• diabetes;
• congenital vascular pathologies of the brain;
• embolism or vascular thrombosis (heart disease, arrhythmia).

Smoking, excess weight and a sedentary lifestyle are increased risk factors for the development of vascular dementia.

Common early manifestations:

• fast fatiguability;
• difficulty concentrating;
• decreased analytical abilities of the brain;
• decreased speed of mental activity;
• problems with goal setting and planning;
• low mood;
• rapid transitions from one mood to another;
• impaired articulation, dysphonia;
• gait disturbance;
• reduced motor activity (few gestures, facial expressions, movements).

During treatment, it is necessary to pay attention to improving cerebral circulation, for which nootropic and pathogenetic drugs are usually prescribed. This helps stabilize the process that caused the development of the disease.

Alcoholic dementia

The development of this disease occurs when the patient is exposed to the toxic effects of ethyl alcohol on brain cells for a long period of time (10-20 years). The negative effect of alcoholic beverages directly on the brain is complemented by intoxication with ethanol metabolites and the development of vascular pathologies.

At the third stage of alcohol dependence, the brain of patients undergoes atrophic changes, which directly affects its functioning.

Clinical manifestations of alcoholic dementia are the following symptoms:

• memory decreases;
• having problems concentrating;
• abstract thinking deteriorates;
• the patient deteriorates as a person.

Alcoholics in the last stages can be encouraged to treat their addiction with great difficulty. In rare cases, when the patient was able to withstand six months to a year of abstinence from alcohol, regression may occur. And based on the results of instrumental examinations of patients by doctors at the Panacea clinic, it was noticed that the organic defect was somewhat smoothed out.

Traumatic dementia

Pathology of traumatic genesis develops as a result of TBI, which leads to damage to brain tissue and its dysfunction.

Signs:

• slowing down the reaction rate;
• narrowing of attention;
• decreased critical thinking;
• predominantly specific judgments;
• difficulties with logical thinking;
• emotional instability or indifference;
• problems with goal setting;
• fussiness;
• foolishness;
• irritability;
• reduced volitional activity.

In many cases, traumatic dementia is reversible if adequate treatment is started in a timely manner.

Dysmetabolic dementia

This form of dementia is associated with dysmetabolic disorders; they are reversible. Timely diagnosis and treatment play an important role here.

Signs:

• pituitary insufficiency;
• hypothyroidism;
• lack of vitamin B12;
• liver failure;
• hypoxemia;
• cardiopulmonary failure;
• renal failure;
• alcoholism;
• lack of folic acid;
• excessive use of certain medications.

Treatment usually consists of vitamin therapy, a course of folic acid, and the necessary hormonal medications. Symptomatic treatment is indicated.

If several factors simultaneously act as the cause of the development of dementia, then the clinical picture will be more serious, the prognosis will be less favorable, and treatment should be aimed in parallel at combating impaired functionality of the blood vessels of the brain and at alleviating symptoms.

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Symptoms of senile psychosis

Psychosis in the elderly is accompanied by a symptomatic picture common to all forms of pathology:

• slow course of the disease;
• distorted perception of current events;
• fading of memory functions;
• a sharp increase in character traits;
• anxiety;
• sleep disturbance.

With psychosis, a change in personality occurs - exaggeration of character traits, narrowing of horizons, loss of interests, deterioration of critical thinking. A person becomes selfish, picky, stingy, and angry.

In the intellectual sphere, the patient loses creative and abstracting functions, mnemonic abilities, and the ability to navigate in time and space. Such people lose their memory, feel like children, and do not recognize their reflection. Emotional disorders are characterized by detachment, depression, gloominess, depressive disorders, gradually giving way to carelessness and euphoria.

Progression and consequences of untreated

Damage to brain areas can progress at different rates. In the case of Alzheimer's or Pick's disease, the decline in intelligence occurs gradually. Brick by brick, familiar functions are lost, a full-fledged member of society turns into a helpless one. Having suffered a stroke, acute infectious infections, or inflammatory processes can cause a rapid deterioration in health. On average, severe loss of memories can appear within 1-2 months (against the background of an acute lesion) or several years. Competent and effective measures can slow down the deterioration. Stimulating mental activity is also beneficial: solving crossword puzzles, learning foreign languages, playing chess.

There is an incompletely proven relationship between loss of thinking abilities and poor hearing. According to the hypothesis, a decrease in auditory function leads to an increase in cognitive load on the brain. This forces the body to redistribute resources for processing information, which significantly affects memory. In addition, poor hearing makes you avoid communicating with people. Social isolation serves as a catalyst for development. Experts believe that using a hearing aid can slow the progression of dementia.

At the first signs, you need to contact a specialist. Lack of information about the dangers of dementia leads to delay on the part of relatives. Refusal of therapy entails:

• Sharp reduction in memory;
• Loss of intelligence;
• Inability to care for yourself;
• Attacks of aggression, depression, apathy;
• Refusal to communicate with relatives and friends;
• Complete loss of personality;
• Death.

It should be said that management falls within the competence of the neurologist. However, many also require professional psychiatric help. Failure to do this leads not only to changes in all areas of higher nervous activity, but also to the formation of cognitive deviations.

Treatment of senile psychosis

Therapy of senile psychoses is based on an integrated approach using methods of psychocorrection and drug treatment. Psychotherapeutic correction has the following goals:

• reduction of worry and anxiety;
• improvement of memory, intellectual and speech functions;
• return of the patient to society.

Pharmacotherapy of senile disorder is based on the use of antidepressants, antipsychotics, and sedatives. Parallel correction of concomitant somatic diseases is also carried out. This disease cannot be completely eliminated, but symptoms can be reduced and the rate of disease progression can be reduced. In addition to medical treatment, the patient needs comfortable conditions, regular walks, visits to public places, attention and care from relatives.

Prevention

Certain measures can reduce the risk of occurrence. In particular:

• Reducing the likelihood of infection with provoking infections (meningitis, encephalitis);
• Monitoring metabolism and normalizing hormonal levels;
• Adherence to a balanced diet, sufficient intake of vitamins and minerals;
• “Training” the head – regular mental stress and exercises.

However, all of these measures cannot be called sufficiently effective. The phenomenon is difficult to predict and diagnose in the early stages. Some articles from reputable medical publications report on the positive effects of foreign languages. So people who speak several languages ​​get sick on average 4 years later than those who speak only one. Some scientists advise avoiding consumption of phosphatidylserine. This substance is present in foods of animal origin and allegedly provokes the death of nerve fibers. However, this assumption does not have solid justification and argumentation.

Prognosis and prevention

With early detection and well-chosen treatment, it is possible to control the course of senile psychosis. In the acute form of the disease, the prognosis is favorable. Chronic forms of the disorder cannot be eliminated completely. In such cases, it is possible to achieve stable remission and reduce the severity of clinical symptoms.

There are no specific measures to prevent the disease. Experts recommend what to do to minimize the likelihood of developing senile mental disorders: perform regular exercise, develop intellectual abilities, adhere to proper nutrition, and consult a doctor in a timely manner.

Concept and classification

The first mention of forgetfulness and decreased intelligence as a disease dates back to the 16th century.
Later, A. Alzheimer and O. Binswanger made their contribution to understanding the essence. The final diagnostic criteria and classification were formed only at the end of the 20th century. Currently it represents a serious medical and social problem. Some diagnoses, if complicated by the condition, lead to a threefold increase in mortality among those affected. Dementia is a lesion of the thinking process that has developed over time, accompanied by a lack of understanding of cause-and-effect relationships, a decrease in cognitive abilities, and significant memory impairment. In everyday life, the disease is called “senile sclerosis” or “senile insanity.” The diagnosis can also occur in young people. However, in this case one can hope for the normalization of mental activity. The phenomenon cannot be called an independent pathology. It accompanies:

• Systemic processes in the body;
• Infections, bacteria, viruses, fungi;
• Deficiency of certain substances;
• Improper metabolism;
• Fluctuations in hormonal levels.

A separate classification has been developed to systematize the causes of senile dementia.

Treatment

Identifying the symptoms and providing treatment is quite difficult. Because patients usually deny the presence of depression. They also do not recognize the need for complex treatment. Most patients agree to take medications, but refuse to change their lifestyle or communicate with a psychotherapist. Without comprehensive treatment, it is virtually impossible to achieve long-term remission and recovery. If you notice symptoms of depression, you should immediately seek help from a specialist.

Treatment with medications

Melipramine

The drug is a stimulant antidepressant. It affects the activity of the nervous system, reduces inhibition, improves mental tone. The drug treats various depressive conditions, which are accompanied by apathy, disturbances in motor activity, and sleep. Treatment with this drug helps improve mood and increase the overall tone of the body. The dosage is selected individually by the attending physician. During treatment with the drug it is prohibited to drink alcohol. The product is available in the form of pills and injection solution.

Atarax

It has an anti-anxiety effect and improves the functioning of the nervous system. Prescribed for anxiety disorders that are accompanied by irritability and tension. The product is available in the form of tablets, syrup and solution for injection.

Cipramil

Has calming and antidepressant properties. Treatment with the drug is carried out over a long period. Used to treat somatic diseases.

Leviron

The drug is an antidepressant with a calming effect. Used to treat all types of depression. It is one of the safest means for treating older people.

Apathy in the elderly

Older people often complain of loss of interest in life, indifference, decreased mood and weakness. These symptoms are characteristic of apathy. This is an independent mental disorder or a manifestation of another psychoneurological disorder. Also, apathy in elderly patients can occur against the background of somatic ailments. Timely examination is necessary to exclude signs of dementia and other dangerous diseases. Psychotherapeutic treatment is being carried out. In rare cases, medication is needed. With severe apathy, the patient requires help to meet primary needs.