Kandinsky-Konovalov syndrome.

The disease of mental automatism, Kandinsky-Clerambault syndrome is a serious mental pathology, which has a third common name - Kandinsky-Konovalov syndrome. This disorder is considered one of the types of paranoid-hallucinatory diseases. Its essence lies in the development of a special condition, in which some external or otherworldly influence is exerted on the patient. In this case, the patient can commit unnatural acts, act as if "separately" from his personality and from his own desires.

The pathology was named after the little-known doctor Kandinsky, who lived during the Russo-Turkish War. He experienced the signs of mental disorder and described them, which were later combined into a syndrome. By the way, the doctor himself was unable to suppress this feeling of external influence and after some time committed suicide.

Let's consider this pathology in more detail.

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Epidemiology

The disease can appear in patients of almost any age. In children, the symptoms of the syndrome usually appear in the evening, which cannot go unnoticed.

Most cases of the syndrome are detected in adolescence and later life.

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Causes Kandinsky-Conovalov syndrome

Kandinsky-Konovalov syndrome cannot exist independently. It usually develops against the background of other mental disorders, such as schizophrenia, manic-depressive psychosis, compulsive asthenia.

Chronic course of the syndrome is detected only in patients with schizophrenia, and in cases of continuous disease process. Very rarely the disease begins its development against the background of epidemic encephalitis, mental epilepsy and progressive paralysis.

The acute course of Kandinsky-Konovalov syndrome is in most cases also diagnosed in schizophrenia, often with paroxysmal development of the disease.

Other causes – such as traumatic brain injury, alcoholic delirium, etc. – mainly cause the acute form of the syndrome.

Risk factors

Sometimes a certain dependence of the syndrome on external causes can be traced. This makes it possible to identify the following risk factors:

• chronic intoxication, long-term exposure to toxic drugs and substances;
• trauma, closed injuries of the skull and brain;
• drug addiction, the effect of psychotropic substances on the brain;
• cerebrovascular accidents, strokes;
• chronic alcoholism.

Pathogenesis

The pathogenesis of the syndrome is often associated with Wilson's neuropsychiatric disease, the onset of which is determined by a failure of copper metabolism in the body. Accumulating in tissues, copper damages the structure of organs and systems, which leads to a disruption of the stable function of nerve cells and fibers. But in most cases, the etiology of the disease is identified with schizophrenia and organic psychoses.

The majority of studies on this topic were conducted by the scientist P. Pavlov, who considered hallucinatory and paranoid signs of isolation, violence, influence and external possession as a reflection of the painful process of irritation of the central nervous system. As a consequence of such irritation, changes and disturbances occur in thought and speech processes, as well as in self-awareness, which, in turn, leads to a functional disorder of the psyche - personal disintegration.

Symptoms Kandinsky-Conovalov syndrome

The first signs of the syndrome are, as a rule, so-called affective disorders:

• emotional exhaustion;
• feigned anger;
• an artificially elevated mood with elements of rapture, which soon turns into the extreme opposite - gloomy depression.

The patient's emotional background seems to be "shaken" from side to side: the patient has the feeling that he is playing the role of a doll, whose strings are being "pulled", forcing him to perform this or that action, to be upset or happy.

As the disease progresses, the person becomes more withdrawn, often trying to hide their obsessive state. After a while, this becomes impossible, and the patient loses control over what is happening.

Sensory automatism syndrome may manifest itself with the following symptoms:

• the emergence of painful and uncomfortable sensations inside the body, often in specific organs;
• apparent increase in temperature, burning sensation throughout the body;
• increasing sexual arousal;
• difficulty urinating;
• incessant defecation.

The patient himself associates all of the listed symptoms with some orders and external forces.

The following signs are characteristic of associative automatism syndrome:

• destabilization of mental functions;
• intrusive memories;
• conversational pseudo-hallucinatory states (dialogues with thoughts, voices, etc.);
• a sign of mental openness, when the patient is confident that any of his thoughts become publicly available;
• the “echo” sign, when the patient “hears” that those around him are stealing and voicing his thoughts.

Motor automatism syndrome is characterized by loss of will, absolute indulgence in "forced" external influence, complete loss of control over statements. The patient becomes rude and uncontrollable.

Forms

For a more accessible description of the clinical picture, Kandinsky-Konovalov syndrome is usually divided into several types and forms of the disease.

Thus, the following main types of this condition are distinguished:

• motor automatism syndrome – characterized by external, tactile and internal sensations of influence. For example, the patient constantly has the feeling that he is making some movements against his own will. As a result, those around him note that the patient’s behavior becomes constrained and unnatural;
• associative automatism syndrome - this type is characterized by a pathological feeling that the patient's thoughts become accessible to everyone. The patient complains that his thoughts and ideas are being stolen, forcing him to express in exchange someone else's interpretations that are not his own;
• sensory automatism syndrome – characterized by pseudo-hallucinations that arise in the patient’s morbid imagination.
• The stages of the syndrome should be highlighted separately:
• the acute stage is characterized by a rapid progression (no longer than 3 months) and frequent changes in the clinical picture, from excessive emotionality to depressive stupor;
• The chronic stage progresses slowly, with a sluggish increase in symptoms.

Complications and consequences

The main consequence of Kandinsky-Konovalov syndrome is a gradual loss of working capacity, loss of control over oneself and connection with society. At the initial stage of the disease, there is a deterioration in thinking processes, concentration, memory. Over time, the patient begins to suffer from insomnia, behaves inappropriately in society and even avoids it, withdrawing into himself.

Often the syndrome leads to dysfunction of internal organs, which further affects human adaptation.

Along with the public's misunderstanding, the patient also receives misunderstanding from his family and loved ones. This often leads to conflicts and scandals. As a result, the patient withdraws into himself, becomes angry, touchy, and intimidated.

The last stages of the disease are characterized by the most dangerous complication - a complete loss of control over one's actions and thoughts. Unfortunately, in most cases this condition provokes the patient to commit suicide.

Diagnostics Kandinsky-Conovalov syndrome

The diagnosis of Kandinsky-Konovalov syndrome is established based on the complaints of the patient and his environment. Also of great importance is the information obtained during the examination and testing by a psychiatrist, who may additionally prescribe special psychological testing.

Typically, doctors are interested in the following anamnestic data:

• when suspicious signs of the disease first appeared;
• whether any of your blood relatives suffered from mental disorders;
• what was the reason for the illness;
• how often during the day do symptoms of the pathology occur;
• what can provoke an attack.

It is often possible to observe situations when such patients undergo treatment from therapists, cardiologists and gastroenterologists without results, trying to cure an imaginary somatic pathology. Therefore, the doctor must take into account all the nuances in order to correctly diagnose the syndrome.

• In some cases, the doctor prescribes laboratory diagnostics. Most often, tests are done to exclude somatic diseases, to assess the condition of the patient's organs and systems. The patient undergoes a biochemical blood test, determines the quality of fat and carbohydrate metabolism processes, and examines the hormonal level.
• Instrumental diagnostics can help to clarify the diagnosis if there are any doubts. Such studies as ECG, ultrasound of the thyroid gland, abdominal cavity, kidneys are of no small importance. Such diagnostics are necessary because such mental disorders often occur against the background of inflammatory infectious diseases.

In addition, it is possible to use color triplex scanning of the brain. This method allows assessing the quality of blood supply and blood filling of the arteries and veins of the head.

Differential diagnosis

Differential diagnostics are carried out with obsessive-compulsive disorder, schizophrenia, other anxiety-phobic and obsessive-compulsive disorders. An accurate diagnosis is established only after receiving the results of all the listed studies.

Treatment Kandinsky-Conovalov syndrome

Kandinsky-Konovalov syndrome is a rather complex mental disorder, so its treatment must be qualified and competent. It is impossible to cure the disease completely: it is important to reduce the severity of clinical manifestations in a timely manner and ensure the patient's control over his condition.

For most patients, treatment consists of the following steps:

• taking appropriate medications;
• help of a psychotherapist;
• rehabilitation period.

As a first step in treatment, medications may be prescribed:

Psychotropic drugs
	Haloperidol	Triftazin
Method of administration and dosage	The dose is determined individually and can be approximately 2-10 mg in the form of intramuscular injections, which are administered every 4-8 hours.	Prescribed intramuscularly, 1-2 mg every 4-6 hours. The course of treatment is no more than 3 months.
Contraindications	Pregnancy, childhood, breastfeeding, severe CNS depression, comatose state.	Childhood, pregnancy, breastfeeding, tendency to allergies, severe liver damage.
Side effects	Extrapyramidal disorders, dyspepsia, hyperprolactinemia, decreased blood pressure, tachycardia.	Headache, sleep disturbances, clouding of the lens, appetite disorders, liver dysfunction.
Special instructions	The maximum daily dose is 18 mg.	The daily dosage should not exceed 6 mg, as signs of drug accumulation may occur.

Neuroleptics
	Aminazine	Tizercin
Method of administration and dosage	The drug can be prescribed orally, as intramuscular or intravenous injections. The dosage is selected by the doctor individually.	Prescribed in tablet form at 25-50 mg per day, gradually increasing the dosage until a stable improvement in the condition. The usual daily dose of the drug is 250 mg.
Contraindications	Liver cirrhosis, hematopoietic disorders, cardiac decompensation, comatose states.	Glaucoma, problems with urination, Parkinson's disease, childhood, decompensation of cardiac activity, tendency to allergies.
Side effects	Allergic reactions, dyspepsia, skin pigmentation, depressive states, lethargy.	Decreased blood pressure, drowsiness, disorientation, weight loss, indigestion.
Special instructions	The drug enhances the effect of sleeping pills and painkillers.	Use with caution in elderly people.

Antidepressants
	Pyrazidol	Amitriptyline
Method of administration and dosage	Prescribed at 50-75 mg per day, gradually increasing the amount of the drug to 200-300 mg per day. The treatment regimen is individual.	Take 50-75 mg orally per day, gradually increasing the dosage until a stable improvement in the condition is achieved. After 14-28 days, the amount of the drug is gradually reduced.
Contraindications	Acute liver damage, hematopoietic diseases, concomitant treatment with MAO inhibitors.	Severe heart disease, arrhythmia, hypertension, gastric ulcer and duodenal ulcer, difficulty urinating, childhood, pregnancy.
Side effects	Dyspepsia, tremors of the extremities, dizziness, increased sweating, allergies.	Deterioration of vision, headache, fatigue, arrhythmia, dyspepsia, enlargement of the mammary glands, changes in sexual desire, allergic reactions.
Special instructions	Should not be administered together with MAO inhibitors.	Concomitant consumption of alcohol is prohibited.

The second stage is the psychotherapist's consultation sessions. Such treatment is started only when the doctor observes clear positive dynamics from drug therapy. This approach is necessary because only in this case can the patient fully understand his illness.

The rehabilitation period includes psychotherapeutic sessions in groups with other patients, nutritional and lifestyle adjustments, massage and exercise therapy.

Prevention

A person's mental health is closely related to their lifestyle, intellectual activity, adaptation in society, and overall health. Therefore, the following recommendations can be given to prevent Kandinsky-Konovalov syndrome or other similar disorders:

• avoid stressful situations, don’t get nervous or worry (especially without reason);
• fight your own fears, learn to abstract;
• lead a healthy and active lifestyle, engage in feasible social activities, be socially active;
• do not take alcohol or drugs;
• ensure good rest and long sleep;
• do what you love: it could be fishing, reading books, caring for pets, sewing, etc.;
• periodically provide yourself with emotional release in the form of laughter or other positive emotions. Sex with a loved one is also good for this purpose.

Each of us should understand that frequent or long-term psycho-emotional stress and tension can sooner or later lead to mental problems. The same applies to alcohol abuse or drug use. Therefore, it is worth preventing the disorder, without waiting for the development of psychopathology.

Forecast

The acute course of the syndrome usually ends favorably. This cannot be said about the chronic form of the disease, which requires patience and long-term treatment. Kandinsky-Konovalov syndrome requires mandatory hospitalization of the patient in a psychoneurological clinic, where doctors will conduct the necessary complex therapy.