Etiological factors of mental disorders. The concept of mental illness
Chapter 1. General theoretical foundations of mental pathology
Currently described and studied a large number of factors that can cause mental disorder. It should be noted that a violation of any physiological process in the human body, due to internal (genetic defect, metabolic disorders, endocrinopathy) or external (infection, intoxication, trauma, hypoxia, and others) causes, can lead to the appearance of mental pathology. In addition, in the occurrence of mental disorders important role play factors of emotional stress, violations of interpersonal relationships and socio-psychological climate.
When diagnosing mental disorders the doctor always faces difficulty in determining the leading causes of the disease. The problem is that, firstly, the mechanisms of development of the most common mental illnesses (schizophrenia, manic-depressive psychosis, epilepsy, atrophic diseases late age and others) have not yet been determined. Secondly, the same patient can be exposed to several pathogenic factors at once. Thirdly, the influence of a damaging factor does not necessarily cause a mental disorder, since people differ significantly in mental stability. Thus, the same damaging effect can be regarded by the doctor in different ways, depending on the specific situation.
The factor that determines the entire course of the disease, equally significant in the onset of the disease, its exacerbations and remissions, the cessation of which leads to the cessation of the disease, should be defined as main cause. Influences that play an important role in starting the disease process, but after the onset of the disease cease to determine its further course, should be considered as starting, or trigger. Some Features human body, the natural phases of development can in no way be recognized as pathological and at the same time often create certain conditions for disease development, contribute to the manifestation of latent genetic pathology; and in this sense they are considered as risk factors. Finally, some of the circumstances and factors are only random, not directly related to the essence of the disease process (they should not be included in the circle of etiological factors).
Answers to many questions regarding the etiology of mental disorders have not yet been received, but the following materials from some biological and psychological studies provide important information to understand the essence of mental illness. Of particular importance are the results of epidemiological studies, which make it possible, on the basis of large statistical material, to analyze the degree of influence of a wide variety of biological, geographical, climatic, and sociocultural factors.
1.1. Etiology and pathogenesis of mental disorders
In practical psychiatry, the causal factors of mental illness are conventionally divided into internal and external. This division is indeed arbitrary, since many internal somatic diseases in relation to the human brain act as a kind of external agent, and in this case clinical manifestations diseases sometimes differ little from the disorders caused by such external causes like trauma, infection and intoxication. At the same time, many external conditions, even with a significant force of influence, do not cause mental disorders, if there was no internal predisposition of the organism for this. Among external influences, psychogenic factors, such as emotional stress, occupy a special position, since they do not directly lead to a violation of the structure of the brain tissue or a gross disorder of the basic physiological processes. Therefore, diseases caused by psychotrauma are usually isolated in independent group. In studies devoted to the study of the etiology and pathogenesis of mental illness, most attention is given to genetic, biochemical, immunological, neurophysiological and structural-morphological, as well as socio-psychological mechanisms.
From the standpoint of practical expediency, mental diseases are divided into endogenous ones by origin. Exogenous diseases are the result of the pathological influence of "v" on the activity of the brain
various external (relative to the brain tissue) physical, chemical and psychogenic traumatic factors. These include harmful infectious-allergic, metabolic, intoxication, thermal, mechanical, cerebrotraumatic, radiation and other physical and chemical effects, as well as those caused by adverse social circumstances, in particular, entailing intrapersonal conflicts. Most researchers of psychogenic traumatic mental disorders belong to the third independent group called "psychogeny".
If the main causes of exogenous diseases are sufficiently known, then the etiology of endogenous mental illnesses (schizophrenia, manic-depressive or bipolar psychosis, the so-called idiopathic or genuin, epilepsy, some psychoses of late age) cannot be called resolved. Diseases develop under the influence of hereditary, constitutional, age and other characteristics of the body, which dictate certain biochemical, immune and other changes, which leads to primary pathological disorders mental activity. According to generally accepted ideas, any external factors can influence the onset and further course of endogenous diseases, and not be their root cause.
However, some authors consider it inappropriate to single out groups of endogenous mental illnesses, because they associate the occurrence of these disorders with the consequences of exogenous influences that have become entrenched in the genetic matrix for future generations. I.e listed diseases in a particular patient due to certain exogenous (or environmental) effects on his close or distant relatives, was inherited by the patient.
Thus, the doctrine of the etiology of mental illness is still far from perfect. At the same time, the least known, as in all other pathologies, is the causal relationship of many factors that affect mental activity.
A person's encounter with any potentially pathogenic agent does not at all mean the fatal inevitability of mental illness. Whether a disease develops or not depends on a combination of a number of factors. they can be divided as follows: constitutional-typological (genetic and congenital mindset ~ jakbstT, features, morphological and functional constitution, individual characteristics biochemical, immune, vegetative and other processes) somatic (acquired features metabolic processes, due to the state internal organs and systems and ecology) psychosocial (a peculiarity of interpersonal, including industrial, family, etc. relations of the patient in the micro- and macro-environment).
Having analyzed the mutual influence of constitutional-typological, somatogenic and psychosocial moments in each specific case, one can come closer to understanding why, for example, during an influenza epidemic, the mental reaction of one patient is limited to an adequate individual reaction within the limits of the psyche reserves, the other - to a short-term pathological reaction of the psyche , yet in another patient it takes the form of a stable neurosis-like or neurotic state or there is a clear mental disorder similar. Therefore, the emergence of mental illness methodologically cannot be put in strict dependence on any, even powerful factors. It is more correct to speak of the interaction of a certain factor with the individual mechanisms of biological, psychological and social adaptation person. So, mental illness is a consequence of the unsatisfactory integral adaptation of the individual to biopsychological influences. However, each mental illness has its own main reason, without which the disease cannot develop. For example, post-traumatic encephalopathy will not occur without a traumatic brain injury.
It should be noted the high significance of all three of the above groups of factors leading to mental disorders, and emphasize the non-absolutely pathogenic significance of each of them separately. For example, pointing out the important role of heredity in the occurrence of diseases such as schizophrenia and manic-depressive psychosis, we must remember that even if any of these diseases is present in one of the identical twins, the risk for this disease in the other is quite large, but it does not amount to 100 %. Therefore, one should talk about heredity not as an endogenous mental pathology, but as a predisposition to it. This also applies to the influence of innate personality traits, morphological constitution, typical vegetological features, etc.
In the implementation of hereditary predisposition, the influence of additional hazards plays an important role. Most researchers point out that the onset of schizophrenia and its relapses in almost two-thirds of cases are provoked by mental or physical trauma, somatic illness, intoxication, etc. against the background of somatic problems.
The origin of some mental illnesses is directly related to age. For example, oligophrenia causes mental retardation, is formed in early childhood or is a consequence of congenital underdevelopment of the brain. Pycnoleptic attacks in children stop at puberty. Pre-senile and senile psychoses occur at a later age. in crisis age periods(pubertal and menopausal) often debut or decompensate such mental disorders as neurosis and psychopathy.
Has a certain meaning gender sick. Thus, affective mental disorders are more common in women than in men. In women, the following diseases predominate: Pick, Alzheimer's, involutional, hypertensive and menopausal psychoses. Naturally, they have mental disorders due to hormonal and other changes during pregnancy or childbirth. And among people with atherosclerotic, intoxication, syphilitic psychoses, as well as patients with alcoholism and alcoholic psychoses, with neuropsychiatric disorders caused by craniocerebral injuries, men predominate.
A range of psychosocial and environmental factors that lead to mental disorders directly related to the professional activity of the patient. We are talking about such harmful production factors as mental and physical overload, emotional overstrain, intoxication, hypothermia and overheating, high level vibrations, radiation pollution, noise, hypoxia, hypodynamia, different kinds deprivation, etc. Each of these adverse effects has fairly typical psychopathological consequences. For example, psychosocial situations accompanied by excessive mental stress are more likely to lead to neurotic disorders. While a pronounced deficit of sensory and other types of stimulation mainly causes deviations in the psychotic register.
It is also worth mentioning the seasonal changes in mental activity. In some psychopathological conditions, especially endogenous psychoses with a phase course, exacerbations are observed in the autumn and spring periods. The adverse effect of intense changes in meteorological factors should be pointed out. Patients with vascular, cerebrotraumatic and other organic brain disorders are very sensitive to them.
have a negative effect on the neuro- mental condition situations leading to so-called desynchronosis. This refers to violations of biological rhythms, for example, daytime wakefulness and night sleep, the division of mental and physical activity inadequate type of character ("owl" and "lark"), artificially provoked violations of the cycle of menstruation, etc.
The pathogenesis (or mechanism of development) of mental illness is determined by the interaction in the prenatal and postnatal periods of hereditarily determined factors of the individual's body and unfavorable psychosocial, physical and chemical influences on his personality, brain and extracerebral somatic sphere. Biochemical, electrophysiological, immune, morphological, systemic and personality changes arising from such interaction and which can be investigated modern methods accompanied by characteristic pathophysiological disorders. In turn, such changes are subject to certain spatial and temporal patterns, which ultimately determine the stereotype of manifestations of painful neuropsychic symptoms, their dynamics and specificity.
Thus, the pathogenesis, and hence the form of mental illness, is due to the peculiar individual reactions that have developed in the process of ontogenesis and phylogenesis to many situations, both exogenous and endogenous. It should be noted that the neuropsychic sphere of each particular person responds to various pathogenic influences with limitations typical for this individual and a stereotyped set of reactions.
At the same time, the same harmful effect in different people, depending on the individual compensatory capabilities of the body and a number of other circumstances, can lead to a variety of psychopathological complexes. For example, alcohol abuse is accompanied by psychotic states that are markedly different from each other. Here it is worth recalling alcoholic delirium, acute and chronic alcoholic hallucinosis, acute and chronic alcoholic paranoid, Korsakov's polyneurotic psychosis, alcoholic pseudoparalysis, Gaye-Wernicke's encephalopathy. The same infectious disease can lead to febrile delirium, or amentia, epileptiform syndrome, symptomatic mania, and in the long term - to Korsakov's amnestic syndrome, post-infectious encephalopathy, etc.
Examples of monoetiological monopathogenetic diseases should also be given. So, in the origin of phenylpyrovine-deliberative oligophrenia, the leading role is played by genetically determined disorders. metabolism. Or a second example: cytological studies specific chromosomal disorder on which the pathogenesis of Down's disease is based.
At the same time, various etiological factors can “trigger” the same pathogenetic mechanisms that form the same psychopathological syndrome. As already mentioned, a delirium state, for example, occurs in patients with alcoholism and in infectious diseases in a state of fever. It is also observed after traumatic brain injury, intoxication various substances, with somatic diseases (somatogenic psychosis). A convincing illustration of the existence of such psychopathological conditions arising from different reasons, is epilepsy, which refers to polyetiological monopathogenetic diseases.
However, the persistence of an individual psychopathological response is relative. Quality and quantitative characteristics painful symptoms depend on many circumstances. In particular, on the age of the person. So, for children, due to the morphological immaturity of the central nervous system, and then the insufficiency of abstract-logical, thought processes, atypical ideational, formerly delusional, deviations. For this reason, pathological psychomotor (convulsions, agitation, stupor), as well as emotional (weakness, excessive lability, fear, aggression) phenomena are observed quite often in them. As the child progresses to adolescence, youthful and mature periods of development, elements of delirium may first appear, and then delusional disorders and finally - persistent delusional states.
The study of the etiology of a mental disorder in each case is an indispensable prerequisite for the rational construction of the so-called etiological therapy, the purpose of which is to sanitize the external and internal environment sick. Disclosure of pathogenesis contributes to the choice of strategy, tactics and methods pathogenetic treatment, aimed at the destruction of internal pathological connections that determine individual symptoms and syndrome kinesis.
Knowledge etiological factors and pathogenetic mechanisms of mental illness, along with the analysis of clinical psychopathological and somato-neurological signs, is the basis for the classification of the disorder, and hence the prediction, solution of social problems of psychiatric care.
Chapter 1. General theoretical foundations of mental pathology
Currently, a large number of factors that can cause a mental disorder have been described and studied. It should be noted that a violation of any physiological process in the human body, due to internal (genetic defect, metabolic disorders, endocrinopathy) or external (infection, intoxication, trauma, hypoxia, and others) causes, can lead to the appearance of mental pathology. In addition, factors of emotional stress, violations of interpersonal relationships and socio-psychological climate play an important role in the occurrence of mental disorders.
When diagnosing mental disorders, the doctor always faces difficulty in determining the leading causes of the disease. The problem is that, firstly, the mechanisms of development of the most common mental illnesses (schizophrenia, manic-depressive psychosis, epilepsy, atrophic diseases of late age, and others) have not yet been determined. Secondly, the same patient can be exposed to several pathogenic factors at once. Thirdly, the influence of a damaging factor does not necessarily cause a mental disorder, since people differ significantly in mental stability. Thus, the same damaging effect can be regarded by the doctor in different ways, depending on the specific situation.
The factor that determines the entire course of the disease, equally significant in the onset of the disease, its exacerbations and remissions, the cessation of which leads to the cessation of the disease, should be defined as main cause. Influences that play an important role in starting the disease process, but after the onset of the disease cease to determine its further course, should be considered as starting, or trigger. Some features of the human body, natural phases of development can in no way be recognized as pathological and at the same time often create certain conditions for the development of the disease, contribute to the manifestation of latent genetic pathology; and in this sense they are considered as risk factors. Finally, some of the circumstances and factors are only random, not directly related to the essence of the disease process (they should not be included in the circle of etiological factors).
Answers to many questions regarding the etiology of mental disorders have not yet been received, but the following materials from some biological and psychological studies provide important information for understanding the essence of mental illness. Of particular importance are the results of epidemiological studies, which make it possible, on the basis of large statistical material, to analyze the degree of influence of a wide variety of biological, geographical, climatic, and sociocultural factors.
1.1. Etiology and pathogenesis of mental disorders
In practical psychiatry, the causal factors of mental illness are conventionally divided into internal and external. This division is really arbitrary, since many internal somatic diseases act as a kind of external agent in relation to the human brain, and in this case, the clinical manifestations of the disease sometimes differ little from disorders caused by such external causes as trauma, infection, and intoxication. At the same time, many external conditions, even with a significant force of influence, do not cause mental disorders, if there was no internal predisposition of the organism for this. Among external influences, psychogenic factors, such as emotional stress, occupy a special position, since they do not directly lead to a violation of the structure of the brain tissue or a gross disorder of the basic physiological processes. Therefore, diseases caused by psychotrauma are usually distinguished into an independent group. In studies devoted to the study of the etiology and pathogenesis of mental illness, the greatest attention is paid to genetic, biochemical, immunological, neurophysiological and structural-morphological, as well as socio-psychological mechanisms.
ETIOLOGY AND PATHOGENESIS OF MENTAL DISORDERS
A psychiatrist working in a clinic, while studying the case histories, constantly notes in patients the presence of various factors influencing the psyche that are involved in the development pathological process. P. Yu. Moebius (1893) was the first to propose that all causes of psychosis be divided into external (exogenous) and internal (endogenous). In line with this dichotomy, mental illness subdivided into exogenous and endogenous.
Among endogenous causes disease special meaning have genetic factors, developmental disorders in early age, somatic diseases that impede and impair brain function due to ischemia, autointoxication, endocrinopathy.
Exogenous factors are mainly divided into two groups. The first includes organic brain-damaging effects - such as trauma, intoxication, infection, and radiation damage. The second group includes the effects of emotional stress due to intrapersonal or interpersonal conflicts, various unfavorable environmental, negative social influences on personality. A special role is played by the characteristics of the personality itself, primarily those that determine individual reactions.
In practical psychiatry, it is well known that exogenous and endogenous factors often act together, while in some cases the endogenous radical prevails, and in others the exogenous radical. For example, the toxic effects of alcohol can manifest themselves in different ways. In some cases, this exogenous factor can become a trigger for an endogenous process (schizophrenia), in other cases it causes a typical exogenous psychosis, which can have different clinical shades, sometimes creating schizoform pictures. This circumstance must be taken into account when diagnosing the underlying disease. The main causative factor of mental illness should be considered the one that determines the debut pictures and is noted throughout the disease process, emphasizing the features of its dynamics, the picture of remission and the initial state. In a number of cases, there is evidence of an external triggering factor for the disease, which later loses its role and is not of decisive importance in the formation of the psychopathological structure of the underlying disease. These factors are considered as provoking. The difference in the causal mechanisms of psychosis is clearly seen in the examples of the development of "axial" ("axial", according to A. Gohe) syndromes - such as exogenous organic, underlying exogenous organic diseases; endogenous symptom complex underlying endogenous process diseases (schizophrenia); personality development syndrome underlying the decompensation of psychopathy (personality disorder). personality traits largely determine the risk of developing mental illness (risk factors). In each case, the doctor takes into account and analyzes the role of all factors leading to the onset of psychosis, establishes the main causal mechanism, which plays a decisive role in establishing the final diagnosis of the disease.
The concept of mental illness
Section II. General psychopathology
The development of psychiatry in recent times associated with an increase in biological sciences- anatomy, physiology of the central nervous system, pathological anatomy, physiology, biochemistry, etc.
An important stage in the evolution of psychiatric knowledge dates back to the middle of the 19th century, when it was established that mental illnesses are diseases of the brain. In the future, the position that mental disorders are caused by a disease of the central nervous system has changed somewhat, since it was established that it is important for the psyche general condition organism.
Mental illness- the result of complex and diverse violations of the activity of various systems of the human body, with a primary lesion of the brain, the main features of which are disorders of mental functions, accompanied by a violation of criticism and social adaptation.
The etiology of most mental illnesses remains largely unknown. It is not clear the correlation in the origin of most mental illnesses of heredity, internally determined characteristics of the organism and hazards. environment in other words, endogenous and exogenous factors. The pathogenesis of psychosis has also been studied only in general view. The main patterns of gross organic pathology of the brain, the impact of infections and intoxications, and the influence of psychogenic factors have been studied. Significant data have been accumulated on the role of heredity and constitution in the occurrence of mental illness.
There is no single reason that caused mental illness and cannot exist. Οʜᴎ are congenital and acquired, resulting from traumatic brain injuries or as a result of transferred infections, are found at the earliest or advanced age. Some of the reasons have already been clarified by science, others are not yet exactly known. Let's consider the main ones.
Intrauterine injuries, infectious and other diseases of the mother during pregnancy, and as a result, the "deformities" of the newborn. As a result nervous system and first of all, the brain is formed incorrectly. Some children experience developmental delays and sometimes disproportionate brain growth.
hereditary factors caused by misaligned chromosomes. In particular, nondisjunction of the 21st chromosome causes Down's disease. Modern genetics believes that the information that determines the structure of an organism is contained in chromosomes - formations that are present in every living cell. Human cells have 23 pairs of chromosomes. Anomalies in the system of the 21st pair are the cause of Down's disease. However, in the vast majority of cases we are talking about hereditary predisposition to mental illness.
Brain damage due to traumatic brain injury, cerebral circulation, progressive sclerosis of cerebral vessels and other diseases. Concussions, injuries, bruises, concussions transferred at any age can lead to mental disorders. Οʜᴎ appear either immediately, immediately after the injury ( psychomotor agitation, memory loss, etc.), or after some time (in the form of various deviations, including convulsive seizures).
Infectious diseases - rash and typhoid fever, scarlet fever, diphtheria, measles, influenza and, especially, encephalitis and meningitis, syphilis, affecting primarily the brain and its membranes.
The action of toxic, poisonous substances. This is primarily alcohol and other drugs, the abuse of which can lead to mental disorders. The latter can occur in case of poisoning with industrial poisons (teraethyl lead), with improper use medicines(large doses of quinacrine, etc.).
Social upheavals and traumatic experiences. Mental trauma should be acute, more often associated with an immediate threat to the life and health of the sick person or his relatives, as well as chronic, relating to the most significant and difficult aspects for this person (honor, dignity, social prestige, etc.). This so-called reactive psychoses a clear causal dependence, the "sounding" of an exciting topic in all the experiences of the patient and relative short duration are characteristic.
Numerous studies have shown that the mental state of a person is also influenced by the type of personality, individual character traits, intelligence level, profession, external environment, state of health and even the rhythm of natural functions.
In most cases, in psychiatry, it is customary to divide diseases into "endogenous", that is, those that have arisen based on internal causes(schizophrenia, manic-depressive psychosis), and "exogenous", provoked by environmental influences. The reasons for the latter are more obvious. The pathogenesis of most mental illnesses should be presented only at the level of hypotheses.
The concept, etiology and pathogenesis of mental illness - the concept and types. Classification and features of the category "The concept, etiology and pathogenesis of mental illness" 2017, 2018.