ABSTRACT
OBJECTIVE: A clinical and psychopathological analysis, nosological differentiation of prolonged and chronic manic and manic-delusional states (PMDS) within the framework of the paroxysmal course of endogenous psychoses, determination of the patterns of their development, diagnostic criteria and prognosis. MATERIAL AND METHODS: The study included 76 female patients (average age 37.2±8.3 years) who were hospitalized for endogenous mental illnesses with a paroxysmal course that occurred with the clinical picture of PMDS. The patients were divided into two groups: clinical (n=43) and follow-up (n=33). Clinical-psychopathological, clinical-follow-up, psychometric, statistical methods were used. RESULTS: A clinical and dynamic typology of PMDS has been developed, according to which 2 groups have been identified: «monomorphic¼ PMDS and «polymorphic¼ PMDS. «Monomorphic¼ PMDS included 2 subtypes - «acute¼ and «chronified¼ and were characterized by the same clinical picture that remained unchanged throughout, while «polymorphic¼, which also included 2 subtypes - «developing¼ and «double mania subtype¼, were characterized by the variability of clinical picture. «Acute¼ and «developing¼ subtypes of PMDS predominantly developed in schizoaffective psychosis and bipolar disorder; the «chronified¼ subtype and the «double mania¼ subtype were more often observed within the framework of the schizoaffective variant of paroxysmal-progressive schizophrenia. CONCLUSION: The clinical and dynamic structure of PMDS is heterogeneous and differs in psychopathological structure, as well as in the level of stability of symptoms and characteristics of its course. The developed clinical typology of PMDS is prognostically significant and provides information about the further dynamics of the disease.
Subject(s)
Bipolar Disorder , Humans , Female , Adult , Bipolar Disorder/diagnosis , Bipolar Disorder/classification , Mania/diagnosis , Middle Aged , Chronic Disease , Prognosis , Diagnosis, DifferentialABSTRACT
OBJECTIVE: To study the neurocognitive profile of patients with protracted and chronic endogenous manic and manic-delusional states (EMDS). MATERIAL AND METHODS: Thirty-two female patients, aged 18 to 55 years (mean age 36.2±10.2 years), with protracted and chronic EMDS were studied. Based on the clinical typology of EMDS, patients were divided into 4 groups of 8 patients each: group 1 - «acute¼ subtype, group 2 - «chronified¼ subtype, group 3 - «developing¼ subtype and group 4 - subtype «double mania¼. Neuropsychological, clinical-psychopathological and statistical methods were used. RESULTS: Disturbances of regulatory and executive functions and a decrease in neurodynamic indicators of mental activity in patients with EMDS are significantly more pronounced compared with the control group (p<0.05). The values of the index of severity of disturbances of regulatory and executive functions in patients with EMDS range from 0.95 points (group 1) to 1.14 points (group 4), without statistically significant differences between the groups. The highest severity of neurodynamic disorders is observed in group 1 (1.88 points), while in other groups the index values range from 0.88 points in group 2 to 1.09 in group 4 (p<0.05). Patients of group 1 have greater severity and wider spectrum of neurodynamic symptoms compared with group 2 (U=45.00; p<0.0021), group 3 (U=30.00; p<0.04), and group 4 (U=45.00; p<0.001). It should be noted that the cognitive impairments identified in patients with EMDS did not reach the level of dementia. CONCLUSION: The most characteristic of EMBS are cognitive impairments associated with a decrease in the parameters of the neurodynamics of mental activity related to the first functional block, as well as with deficiency of executive functions, impaired planning and organization of cognitive activity, due to the weakness of the structures of the third functional block.