Description and mechanism of development of reactive psychosis
In response to some important factor in life, which represents a strong mental shock, reactive psychosis may develop. Thus, the subconscious reacts to external circumstances in the most acute way.
It must be emphasized that not every person develops such a response. For some people, a certain situation will actually be a shock, while for others it will be just an event in life. Also important is the psychological reactivity of a person, that is, his ability to react emotionally to important events.
People who have other mental illnesses or disorders are also predisposed to it. They are more sensitive to psychological and behavioral issues in their lives.
In fact, the most important component in the pathogenesis of reactive psychoses is mental asthenia. At its core, this is a process of exhaustion, which can be provoked by psychogenic and somatogenic factors. A person literally does not have enough resources to form the correct reaction to an event in life, and therefore reactive psychosis develops.
For the development of delusional symptoms, the environment and conditions in which a person lives are important. Against the backdrop of increased stress, certain ideas begin to form that have no specific meaning, but are very keenly assessed by the person. In addition, these delusional ideas are emotionally rich and have a specific affective connotation - anger, grief, fear.
Main causes of reactive psychosis
The causes of reactive psychoses can be a variety of factors that are individual in each individual case. There are predisposing conditions under which the development of this disorder is more likely:
- Psychopathic personality
. Characterological features in the form of hysterical, emotionally unstable components. - Infectious diseases
. Past infections, especially those affecting the brain, can leave residual changes in the tissues. - Injuries
. Traumatic brain injuries cause organic changes in the brain. - Intoxication
. Poisons and heavy metals can negatively affect the human psyche. - Overwork
. Mental or physical exercise exhausts the body's capabilities and impairs brain function. - Hormonal changes
. During adolescence or menopause, hormonal changes are observed. At the same time, fluctuations in a person’s emotional state are noted.
The specific factor that causes reactive psychosis can be any psychological shock.
Most often this is a loss, namely the death of a loved one, divorce or separation. It could also be an arrest, fire, flood or other natural disaster. After shock, a person can suffer reactive psychosis. Almost all important events in life can become a prerequisite for the development of this disorder, even if they are not so negative. For example, this could be an upcoming wedding celebration, the birth of a child. In addition, information about somatic disorders plays an important role. The moment when a person learns about a terrible illness, disability or other factor can become the starting point for a psychopathological reaction.
Age and gender characteristics should also be taken into account. For example, adolescents are more vulnerable to reactive psychosis because they are more sensitive to events in their lives. They are characterized by hysterical traits and a tendency to have a hard time experiencing any problem. Compared to men, women are much more likely to develop this mental disorder. They react in a special way to everything that happens and tend to interpret everything in their own way.
Causes
The cause of reactive psychoses can be various psychotraumatic situations that threaten the life of the patient or his loved ones, and also have high significance in connection with the values or personality characteristics of the patient. Very often, acute reactive psychoses develop against the background of military conflicts, natural disasters, road accidents, loss of financial well-being, etc.
An important predisposing factor is the patient's personality characteristics. Hysterical psychopathy, paranoid or schizoid type of mentality, borderline psychiatric disorders are considered risk factors. In addition, the risk of pathology increases under the following conditions:
- insomnia and other chronic sleep disorders;
- prolonged mental or physical fatigue;
- previous traumatic brain injuries and organic brain diseases;
- chronic alcohol intoxication;
- decompensated diseases of internal organs and severe infectious pathologies.
These factors in children and adults create a mental background for the development of reactive psychosis. In this regard, for effective treatment they should be eliminated.
Signs of reactive psychosis in a person
A feature of reactive psychosis is its course.
That is, it arises due to a specific event in life and passes without a trace after some time. This disorder is characterized by an acute onset, which occurs immediately after a traumatic situation. Before this, no specific mental changes occur; the person behaves absolutely normally and does not show any emotional or behavioral symptoms. After a specific clinical picture unfolds, psychosis lasts for some time. Reactive psychosis is a reversible disorder that is completely reduced. Most often, this happens after reducing the intensity of a traumatic situation, coming to terms with it, or searching for distractions.
The famous psychiatrist Karl Jaspers in 1913 identified a triad of signs of reactive psychosis:
- The reactive state of a person is caused exclusively by a psychotraumatic situation;
- This situation is reflected in clinical symptoms and its content;
- The reactive state of a person is reduced as soon as the cause disappears.
The specific clinical picture develops depending on the type of reactive psychosis. For example, depression will be manifested by low mood, general apathy, slow thinking and movements. The paranoid version of reactive psychosis will be characterized by the presence of delusional ideas and even hallucinatory symptoms.
Disease Prevention
Due to the instability of a person’s psyche, reactive psychosis can recur several weeks or months after the initial trauma. To prevent this condition, it is necessary to follow a number of recommendations:
- Avoid stressful and traumatic situations.
- Close people should support the person and reduce possible social pressure on him.
- It is necessary to normalize sleep and wakefulness. Overwork, including at work, should be completely avoided.
- In the diet, it is recommended to increase the amount of vegetables, fruits and nuts containing large amounts of vitamins and microelements.
Simple recommendations can prevent relapse. In addition, the patient is recommended to attend individual or group psychotherapy.
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Types and forms of reactive psychoses
The symptoms of reactive psychosis may differ from person to person due to the characterological characteristics of each person.
Depending on the variant of this disorder, the clinical picture of the disease will change. There are hyperkinetic and hypokinetic forms of reactive psychoses. The first of them is manifested by psychomotor agitation, increased motor reactions and productive symptoms. The person is in a state of hyperactivity and is in constant motion.
The hypokinetic form is manifested by characteristic stupor and inhibition of psycho-emotional reactions. In some cases, there is numbness, which is caused by psychological factors. Speech disturbances may also occur.
Sometimes these two forms alternate, causing cyclical changes in a person’s psyche and behavior. In this case, there is a clouding of consciousness. For the entire period of reactive psychosis, retrograde amnesia can develop, which manifests itself in partial or complete form.
The following classification of disorders is distinguished depending on the duration of exposure to the traumatic factor:
- Acute reactive psychosis
. This is an extremely acute shock reaction to a psychotraumatic factor, which develops immediately after its exposure. Most often observed when there is a direct immediate threat to human life. - Subacute reactive psychosis
. This type of reaction is characterized by a less immediate onset. A person has little time left to think about the event that has happened and form a ready-made reaction. It manifests itself most often in the form of paranoid, reactive depression or hysterical psychosis. - Protracted reactive psychosis
. This condition is formed during prolonged exposure to a traumatic factor. Under conditions of constant chronic stress, a person begins to develop various delusional ideas and experience depressive states.
In the international classification, reactive psychoses are not included in one category. Since the clinical picture can manifest itself in different ways, the disorder is classified into different categories of psychiatric diseases:
- Reactive depression
. The constitutional personality traits of some people predispose them to the development of depressive reactions to various traumatic situations in life. This variant of the disorder will be characterized by depression, a feeling of hopelessness and hopelessness in the near future. Sleep disturbance often manifests itself in the form of insomnia. At this time, there is an influx of thoughts that are focused on the events that have occurred. All attention is fixed on the past, the person constantly remembers what happened and becomes fixated on it. The problem is that reactive depression becomes the main idea and dominant feeling for a long time. Unlike the endogenous process, there are no diurnal mood swings in this disorder. - Ganser syndrome
. Reactive psychosis can develop in the form of hysterical twilight stupefaction. In addition, there is a loss of human orientation in space and time. He behaves defiantly and demonstratively. Answers the questions posed incorrectly, even if they are elementary and simple. Speech is characterized by absolute absurdity and illogicality. From the outside it may seem as if a person is imitating the symptoms of a serious mental illness. May report hallucinations and other symptoms. Very often, after the end of a specific period of hysterical twilight stupefaction, partial or complete amnesia occurs. - Pseudo-dementia
. This condition is also called false dementia. In this case, orientation in time and space is grossly disrupted. The person deliberately gives incorrect answers to questions. Behavioral disturbances are also observed, that is, there is illogicality, facial expressions do not correspond to the situation, grimaces are noted. In fact, all the signs of dementia are observed, only they develop very quickly. Speech is not connected with each other, articulation is animated. Sentences are constructed with violation of grammatical and semantic content. - Hysterical stupor
. It is a type of reactive hysterical psychosis. It manifests itself as a general lethargy and a stopping state. In this case, there is a strong tension in all the muscles of the body. Even changing the situation is not at all easy. A person is caught in one position and does not succumb to external influences. A facial mask forms on the face, which can cause sorrow, grief or other feelings of suffering. After the current situation is resolved, there is a gradual disappearance of all symptoms. In this case, partial pseudoparalysis or tremors in the limbs may also be noted. - Paranoid
. Another name is reactive delusional psychosis. It develops in the form of a system of delusional ideas, when a person reasons illogically and draws incorrect conclusions. The fact is that in this case a person’s thinking changes. Over time, all his ideas and judgments begin to acquire a paralogical connotation. At the same time, he cannot critically perceive his own behavior.
Reactive states are a special group of mental disorders (psychogenies) that develop as a result of mental trauma and reflect the content of a traumatic event.
This is an attempt to adapt the psyche (including the normal one) to extreme stress.
In the current International Classification of Diseases, Tenth Revision, there is no separate section dedicated to psychogenies; they are scattered across different blocks of ICD-10.
The prevalence of reactive psychoses in the population remains to be determined. It is known that women suffer from them approximately twice as often as men. Reactive depressions account for 40-50% of all reactive psychoses.
In our practice, we often encounter the following diagnoses: “Depressive episode”; "Mixed disorder of emotions and behavior due to adjustment disorder."
Patients with psychogenic illness tend to focus on the internal re-experiencing of a misfortune that recently happened to them. These experiences are extremely valuable for them. But in typical cases, they do not want to discuss what happened with strangers (in particular, with psychiatrists). On the contrary, when asked the appropriate questions, patients become withdrawn and may stop talking altogether. Low mood, with ideas of self-blame. Sometimes externally blaming tendencies predominate. There is often anxiety. Some patients develop reactive paranoid - fear, suspicion, thoughts of persecution, possible murder. Mental disorders that occur during a reactive state are not easy to distinguish from attitudinal behavior, when for one reason or another it seems beneficial to the patient to feign mental illness. According to our observations, attitudinal behavior can be combined with real symptoms.
In PKB No. 5 of the Moscow City Health Department, the patient is usually in a reactive state until he recovers from a temporary painful disorder. He is coming to us, being under investigation on suspicion of an offence. He has a forensic psychiatric examination under his belt, during which it was impossible to resolve the question of his sanity precisely because of his reactive state, which, in turn, is a consequence of the stress of the forensic investigative situation. In addition, we must not forget about the stress that a person experienced during a socially dangerous act (whether it was committed by him or someone else).
Treatment in almost all cases includes antidepressants, and, if necessary, antipsychotics. Psychotherapy can help such patients, but there are significant difficulties in its implementation due to attitudinal behavior.
The prognosis is usually favorable. Within a relatively short period of time (usually within a few months), the psychogenic disorder is leveled out, although this process is not always smooth. We have to rather talk about a wave-like attenuation with a return of symptoms.
It should be remembered that reactive states occur not only against the background of health, but also in patients suffering from chronic mental illnesses. The clinical picture may be influenced by the underlying psychopathological process. But in many cases, psychogeny obscures the characteristic manifestations of schizophrenia or other long-term mental illness.
Features of the treatment of reactive psychoses in humans
For reactive psychosis, treatment must be carried out under the supervision of a qualified specialist. When the first symptoms occur, you should seek help from a psychiatrist or psychotherapist. The sooner treatment is started, the faster reactive psychosis is reduced. First, it is necessary to eliminate the root cause of the disease, then begin drug and psychotherapeutic treatment.
Drug treatment
Pharmacological drugs for reactive psychosis are used in the form of symptomatic therapy.
With their help, specific signs of the disease that manifest themselves individually in each person are eliminated. Several groups of drugs are mainly used:
- Neuroleptics
. They are powerful antipsychotics that can eliminate delusional ideas and hallucinatory experiences. The most commonly prescribed drugs are Haloperidol, Triftazin, and Clopixol. - Tranquilizers
. With their help, psychomotor agitation with motor reactions that are observed in the hyperkinetic version of reactive psychosis are eliminated. They remove anxiety and fear, which is often observed as part of the clinical picture of this disorder. The most commonly used drugs are benzodiazepines. - Antidepressants
. These drugs are used exclusively in the presence of depressive symptoms as part of the symptom complex of reactive psychosis. Their prescription must be strictly adjusted due to the biochemical features of interaction with drugs from other groups. The most commonly used are Amitriptyline, Clomipramine and Fluoxetine.
Important! The prescription of a specific psychotropic drug should be carried out by a psychiatrist. Self-medication can have an extremely negative impact on a person’s mental state.
Psychotherapeutic treatment
In fact, the main method of treating reactive psychosis remains psychotherapy.
In the absence of productive psychotic symptoms in this disorder, with the help of several sessions you can get rid of the consequences of the reaction to a traumatic situation. An experienced psychotherapist will help identify specific reasons from the past on which a person’s attention is fixed. First, the main factors that support symptoms are studied. It is to them that specific psychotherapeutic assistance will be directed.
A specialist will help you develop the right protective reactions against stress. The main goal of the sessions is to help a person adapt to ordinary life. The psychotherapist focuses his activities around excessive concentration on problems and transfers it to more important and relevant moments in the patient’s life.
