General characteristics and classification of involutional mental pathology
In psychiatry, the age from 45 to 60 years was considered preschool, and over 60 years old – senile. The following periodization of age was adopted at the symposium on gerontology in 1963: 45-59 years old – average age, 60-74 years old – old, 75-90 years old – old.
People of preschool and senile age often feel worse, mood, self-esteem is violated, a feeling of insecurity, dissatisfaction with themselves, anxiety, fears of loneliness, helplessness, death appear, which leads to gloom, irritability, pessimism.
Most often in pre-senile and senile age, the following mental disorders are observed: 1) nonpsychotic disorders (neurosis and psychopathic); 2) presenile, or preschool, psychoses (melancholy, paranoid, Alzheimer’s disease and Pick’s disease); 3) senile, or senile, psychoses (senile dementia). In the “International Statistical Classification of Diseases, Injuries and Causes of Death of the 9th Revision” mental disorders of presenile and senile age are represented by the following groups (we present them with codes): 1. Non-psychotic involutional disorders: 300.96 – neurosis-like conditions caused by menopause. 300.97 – neurosis-like states due to involution. 301.96 – psychopathic conditions due to menopause. 301.97 – psychopathic conditions due to involution. 311.6 – non-psychotic depressive disorders due to menopause. 311.7 – non-psychotic depressive disorders due to involution. 2. “Adement” involutional (presenile) psychoses: 296.13 – involutional melancholy. 297.21 – involutional paranoid. 298.95 – psychosis due to menopause. 298.96 – psychoses due to involution. 3. Senile and presenile organic psychotic conditions: 290.0 – senile dementia, a simple type. 290.1 - presenile dementia (290.11 – an early variant of senile dementia; 290.12 – dementia in Alzheimer’s disease and Pick’s disease). 290.2 – senile dementia of a depressive or paranoid type (290.21 – senile depression; 290.22 – senile delirium of damage, hallucinatory-delusional psychosis, senile paranoid). 290.3 – senile dementia, complicated by the phenomena of acute confusion. 290.8 – other senile and presenile organic psychotic conditions. 290.9 – unspecified senile and presenile organic psychotic conditions. The problem of nosological independence of involutional mental pathology, and especially “ademental,” the so-called functional psychoses of preschool age, is complex and raises a number of controversial issues. N. F. Shakhmatov (1980), for example, considers it quite reasonable to single out nosologically independent late psychoses due to the fact that they are characterized not only by age-related features, but also by age-related endocrine restructuring. At the same time, E. Ya. Sternberg (1977) came to the conclusion that the selection of an independent group of involutional psychoses on the basis of the characteristics of their clinical picture is methodologically insufficiently substantiated and in most cases we should talk about late detection of endogenous (schizophrenia, manic-depressive psychosis) and organic psychoses. According to a number of researchers (N. E. Bacherikov, 1980; P. G. Smetannikov, 1980; N. F. Shakhmatov, 1980; E. A. Shcherbina, 1981; S. M. Plotnikov, 1984), currently available data on the characteristics of the clinical picture and pathogenesis of psychoses make it possible to talk about the nosological independence of the “functional” and dementia forms of involutional psychoses. In favor of the nosological independence of presenile psychoses are evidenced by the uniqueness of their clinical picture, patterns of flow. It has been established that approximately 30% of patients with presenile psychoses are characterized by a hereditary burden of involutional and other psychoses and psychopathies (in paranoid cases – in 40% of cases). Premorbid personality traits in most cases are anxious-suspicious and asthenic traits with a tendency to long-term fixation of negative emotions (in 73.2% of patients with a depressive picture) or hypoparanic and stenic features (in 59.1% of patients with presenile paranoid). The onset of psychosis is often preceded by signs of a pathologically developing menopause, age-related somatic and mental changes, conflict situations at home and at work, somatic diseases. Thus, the psychotic state is the result of the interaction of biological, individual psychological and socio-psychological age factors. The clinical picture of the psychotic state is characterized at first by mood swings and anxiety in patients arising from very specific life situations – past or current. Only in the future one of the variants of depressive or paranoid syndrome with typical and persistent symptoms is formed. However, the question of the nosological nature, etiology, and pathogenesis of nonpsychotic, psychotic, and defective organic mental disorders, which are currently classified as presenile and senile, is not completely resolved. Apparently, this is a group of diseases that occupy, as it were. an intermediate position between exogenous and endogenous and based on a hereditary and acquired predisposition, age-related neuroendocrine restructuring. The onset of psychopathological conditions, including rapidly developing dementia, is often associated with the sudden onset of personality-significant psychological and social problems, with an exacerbation of somatic disease and trauma.