Pathological features and organic mental disorders in Parkinson's disease

The features of the emotional-needs sphere, the severity of personal characteristics, types of attitude towards the disease in patients with Parkinson's disease and mental disorders are analyzed. Pathopsychological factors of formation of organic depressive disorder (F06.36), organic anxiety disorder (F06.4), organic emotional-labile disorder (F06.6) are revealed, mechanisms of their pathogenesis are described. With respect to dementia (F02.3) in patients with Parkinson's disease of a single pathopsychological mechanism of its formation is not found, the main role in its pathogenesis belongs to organic brain damage.

Key words: Parkinson's disease, organic mental disorders, pathopsychological patterns of formation.

Parkinson's disease is one of the most common neurological diseases of elderly people, which occurs in 1-2% of people over 65 years of age. Disappointing statistics of recent years indicate an increase in the frequency of this disease in most countries of the world, including in Ukraine, which is associated with an increase in life expectancy, adverse environmental factors and improvement in the diagnosis of this pathology.

Despite the fact that the diagnosis of Parkinson's disease is based on the detection of specific motor manifestations resulting from the lack of dopaminergic transmission in the nigrostriral system, mental disorders are equally characteristic of this disease. Mental disorders are observed at all stages of Parkinson's disease and often precede its motor manifestations. In the late stages of Parkinson's disease, mental disorders begin to dominate as factors that affect the patient's quality of life and become more important and disabling than motor disorders, making insurmountable difficulties for the patients themselves and caring for them. The most common psychopathological phenomena of Parkinson's disease include depression, anxiety, hallucinatory-paranoid and cognitive impairment.

Several studies have noted the multifactorial genesis of neuropsychic disorders, among the leading factors of their pathogenesis in Parkinson's disease are dopaminergic, noradrenergic and serotonergic dysfunction in the limbic system of the brain, in addition, the influence on their formation of premorbid psychological personality features has been noted. However, to date in the current studies on the problem of Parkinson's, do not reflect the psychological patterns and mechanisms of the pathogenesis of neuropsychic disorders in Parkinson's disease, which necessitates their detailed analysis.

The purpose of this study was to study the pathopsychological patterns of the formation of organic psychiatric disorders in Parkinson's disease.

A total of 250 patients with Parkinson's disease were examined, of which the main study group consisted of 174 people with organic psychiatric pathology in the clinical picture of Parkinson's disease (89 people with organic nonpsychotic depressive disorder (F06.36), 33 people with organic anxiety disorder (F06.4); 52 people with an organic emotional-labile (asthenic) disorder (F06.6.), 28 people with dementia (F02.3)), a control group - 76 patients with Parkinson's disease without psychiatric disorders.

The following methods were used: clinical anxiety scale (CAS); the SMIL test; Lusher's color test; a questionnaire of the Bekhterev Institute for determining the type of attitude towards the disease.

Analysis of the representation of mental pathology in patients with Parkinson's disease demonstrated a significant predominance in its structure of mental disorders of organic genesis in 68.0% of cases. Among organic mental pathologies, organic nonpsychotic depressive disorder was most often noted (F06.36) - in 29.9% of cases; organic emotional-labile (asthenic) disorder (F06.6) - 17.5%; organic anxiety disorder (F06.4) - 11.1% and dementia (F02.3) - 9.5%.

An analysis of pathopsychological factors and patterns of the formation of these mental disorders is presented below.

[1], [2], [3], [4], [5], [6],

Organic nonpsychotic depressive disorder (F06.36)

According to the results of the anxiety study (on the CAS scale), a low level of anxiety was diagnosed in patients with Parkinsonism with organic depressive disorder (F06.36) (6.5 ± 1.3, p> 0.5).

The use of SMIL in patients with Parkinson's disease and depressive disorder (F06.36) showed an increase in indices on the scale of depression (79 ± 6 T-scores); impulsiveness (75 ± 7 T-score) and anxiety (72 ± 5 T-score). Such results reflected the existence of an internal conflict associated with a contradictory combination of a high level of claims with self-doubt, high activity with rapid psychophysical exhaustion. Awareness of psychological problems and refusal to realize their intentions were accompanied by a decrease in mood.

The average SMIL profile indicated the presence of a compensatory depressive reaction that develops against the background of a pronounced conflict of conflicting motivational and behavioral tendencies in patients with dysthymic, anxious and excitable features of responding to unfavorable factors.

According to the results of the Luscher test, the prevalence of green and brown (+ 2 + 6) colors in the first and second positions (79.8% and 75.3%) and yellow and red (-4- 3) - at the seventh and eighth positions of the series (in 84.3% and in 80.9%), p <0.05. The results obtained indicated the frustration of the need for self-realization and recognition, which led to a passive-defensive position and distress, manifested as irritability, anxious uncertainty, fatigue and depression.

Among the prevailing types of attitude towards the disease in patients with Parkinsonism with depression (F06.36) melancholic (77.5%) and neurasthenic (60.7%) were diagnosed (for p <0.01). These types were characterized by a depressed mood with depressive utterances; disbelief in improving their health, in the success of treatment; flashes of irritation, culminating in repentance and tears; impatient attitude towards the medical staff and procedures.

Thus, the main pathopsychological features of the formation of an organic nonpsychotic depressive disorder were: frustration of needs for self-realization and recognition; a combination of dysthymic, anxious and excitable features of responding to unfavorable factors; the formation of a compensatory depressive reaction against the background of a pronounced conflict of conflicting motivational and behavioral tendencies.

The trigger factor in the development of depression (F06.36) was the fact of the presence of Parkinson's disease and its physical consequences, which led to the frustration of a high level of claims, the need for self-realization and recognition. Persistence in defending frustrated positions in combination with internal diverse motivational and behavioral tendencies (achievement of success - avoidance of failure, activity and determination - blocking of activity, aspiration for domination - self-doubt) caused a compensatory depressive reaction characteristic for individuals with dysthymic, anxious and excitable peculiarities of responding to unfavorable factors.

Organic emotional-labile (asthenic) personality disorder (F06.6)

Parkinsonism with organic disorder (F06.6) was diagnosed with a low level of anxiety (5.2 ± 2.8) according to the results of the CAS scale.

In the personal profile (SMIL) in patients with the disorder F06.6, there was an increase in indices on the scale of depressiveness (72 ± 6 T-scores); anxiety (70 ± 7 T-score) and neurotic overcontrol (68 ± 7 T-score), which indicated a pronounced hyposthenic form of emotional and behavioral response to unfavorable factors.

According to the results of M. Luscher's test, a shift of gray and dark blue (+ 0 + 1) colors to the first positions of the series (in 82.7% and in 78.8%) and red and brown (- 3-6) - to the last positions of the series (in 86.5% and 82.7%) (p <0.05), which reflected the frustration of physiological needs, infringing the feeling of independence and causing fatigue, a sense of impotence, a need for rest and restrictive behavior.

Among the prevailing types of attitude towards the disease in patients with Parkinsonism with F06.6, neurasthenic (61.5%) and apathic (48.1%) types of attitude towards Parkinson's disease (p <0.01) were noted, which were characterized by outbreaks of irritation; pronounced psychophysical exhaustion; indifference to one's destiny, the outcome of the disease, the results of treatment; passive submission to procedures and treatment; loss of interest in everything that previously worried.

Consequently, among the main pathopsychological features of the formation of the disorder F06.6 in patients with parkinsonism, the frustration of physiological needs that excessively restricted the patient's independence was identified; a combination of acquired dysthymic and psychasthenic personality characteristics leading to a hyposthenic (psychasthenic) form of emotional and behavioral response of patients to adverse factors.

The starting factor in the development of the organic emotional-labile disorder (F06.6) was the fact of the presence of a recurrent Parkinson's disease, which caused the frustration of physiological needs in full physical and mental activity through restriction of independence. This frustration against the background of the brain, dysthymic and psychasthenic personality acquired due to organic damage led to the formation of a compensatory hyposthenic form of emotional and behavioral response.

Organic anxiety disorder of personality (F06.4)

According to the results of the CAS scale, anxiety of a high degree (20,2 ± 1,1) was diagnosed in patients with Parkinsonism with anxiety disorder (F06.4). The most significant components of anxiety were mental stress (78.8%), muscle tension (72.7%), anxiety (69.7%) and fears (63.6%) (p <0.05).

The SMIL profile in patients with Parkinson's disease and anxiety disorder (F06.4) showed an increase in anxiety scores (78 ± 8 T-score) and introversion (72 ± 6 T-score), reflecting the weakening of social contacts, isolation and exclusion, the inertness of mental functions, rigidity of attitudes, flight from problems to solitude. The average profile of the SMIL testified to a pronounced social maladaptation and a leading alarming form of patients responding to unfavorable factors.

According to the results of the Luscher test, patients with Parkinson's disease and F06.4 had a predominance of dark blue and brown (+ 1 + 6) colors at the first and second positions of the series (72.7% and 63.6%) and yellow and red (-4-3) - at the seventh and eighth positions (78.8% and 66.7%) (p <0.05), reflecting the frustration of the need for self-fulfillment, passivity of position, dependence, anxiety, anxiety, uncertainty , suspiciousness and fear for one's health, fear of the future, a feeling of lack of emotional warmth on the part of others, the need for their protection and pom Oshchi.

Among the types of attitude towards Parkinson's disease, anxiety (81.8%) and hypochondriacal (42.4%, p <0.01) were mainly diagnosed in these patients, which were manifested by anxiety, anxiety and suspicion regarding the unfavorable course of the disease, possible complications, inefficiency treatment; search for new ways of treatment, additional information about Parkinson's disease, possible complications, methods of treatment; focusing on subjective painful sensations; exaggerating the actual and non-existent manifestations of Parkinson's disease; requirements of a more thorough examination.

In general, the main pathopsychological factors in the formation of anxiety disorder (F06.4) in patients with Parkinsonism were the frustration of the need for self-realization and recognition, frustration and fear of the future; passivity of position, dependence, feeling of lack of emotional warmth on the part of others, need for their protection and assistance; disturbing personal characteristics leading to an alarming form of emotional and behavioral response of patients to unfavorable factors and the development of social maladjustment.

The trigger factor for the development of anxiety disorder (F06.4) was the fact of the presence of Parkinson's disease, which caused the frustration of the need for self-realization and recognition due to the inferiority complex formed due to manifestations of Parkinson's disease. This frustration against the background of constitutional disturbing personality traits contributed to compensatory anxious forms of behavior, expressed in passivity, dependence, anxiety, uncertainty, suspiciousness, a sense of lack of emotional warmth on the part of others, the need for their protection and assistance.

Dementia (F02.3) in Parkinson's disease

According to the results of the study of anxiety on the CAS scale in patients with Parkinsonism with dementia (F02.3), a low level of anxiety was diagnosed (5.5 ± 1.1, p> 0.5). When using the SMIL test in patients with dementia (F02.3), unreliable results were obtained, because of their intellectual defect, patients from this group could not cope with the questionnaire, and the results were not amenable to interpretation. According to the Luscher test, statistically significant patterns of color distribution in the first, second and seventh to eighth positions were not revealed in patients with Parkinsonism with dementia (F02.3). Among the types of attitude towards the disease, apathy (57.1%), anosognotic (35.7%) and euphoric (32.1%), p <0.01, predominated in patients of this group, characterized by complete indifference to their fate, the outcome of the disease , the results of treatment; passive submission to procedures and treatment; loss of interest in everything that was previously worried; neglect and frivolous attitude towards illness and treatment; denial of manifestations of the disease, attributing them to other non-serious diseases; refusal of examination and treatment.

The results obtained in the course of the study do not allow us to single out a single pathopsychological mechanism of dementia formation (F02.3) in Parkinson's disease. The main role in this process belongs to organic brain damage, and the pathopsychological mechanisms involved in the formation of individual clinical psychopathological manifestations are the derivatives of cognitive disorders and thinking disorders with this form of dementia.

Thus, the conducted study of organic mental disorders in patients with Parkinsonism allows us to identify common pathopsychological patterns of the formation of organic psychiatric disorders in Parkinson's disease: the main reason for the formation of organic psychiatric disorders is the fact of the presence of severe Parkinson's disease and its consequences. Parkinson's disease triggers organic (F06.6) or combined (F06.36, F06.4) mechanisms for the formation of mental pathology, or mental pathology is a pathogenetic non-motor manifestation of Parkinson's own disease (F02.3).

The main reason for the formation of organic mental disorders in patients with Parkinsonism is the frustration of a high level of claims, the need for self-realization and recognition (for patients with F06.36 and F06.4), physiological needs for full physical and mental activity (for patients with F06.6). The main mechanism of formation of organic mental disorders in patients with Parkinson's disease is the mechanism of a constitutionally conditioned or acquired cognitive, emotional and behavioral response to the frustration of basic needs: a depressive reaction as a compensatory response to a pronounced conflict of conflicting motivational and behavioral tendencies (for F06.36); hyposthenic form of emotional and behavioral response due to acquired dysthymic and psychasthenic personality traits of organic genesis (for F06.6); an alarming form of emotional and behavioral response of constitutional-organic genesis (for F06.4).

The results obtained in the course of the study are necessary to use in the development of prevention programs and differentiated therapy for patients with Parkinson's disease, complicated by organic psychiatric pathology.

Cand. Honey. Sciences D. Yu. Saiko. Pathological features and organic mental disorders in Parkinson's disease // International Medical Journal - 2012 - №3 - p. 5-9