Evolution of views on the importance of mental disorders in epilepsy for clinical and social prognosis


Throughout the period of study of the clinic of mental disorders in epilepsy, there was a desire of researchers to identify two main features of these conditions: their structural features and duration. This trend remains dominant today. However, these two clinical signs are considered comparatively rarely in terms of their relationship with the main characteristics of the disease – the type and stage of the course of epileptic disease.

In accordance with the objectives of the present work reproduced the literature data soposta – us have been made with the data obtained in the course of our own research. At the same time, we tried to consider the structure and dynamics of mental disorders in epilepsy, correlating its productive and negative psychopathological manifestations and, if possible, using the syndromes present in the clinical picture of the disease as prognostic criteria.

Analysis of the literature shows how gradually with the development of psychiatry as a whole formed views on the nosological specificity of these disorders, their relationship with other manifestations of epileptic disease. Detection of pathophysiological data was accompanied by attempts to establish their connection with psychopathological disorders. The treatment of epileptic psychoses was considered. Based on the results of the study in these areas, attempts were made to generalize the data on clinical prognosis.

In historical terms, there are several main periods in this regard.
The first is a description of the structure of epileptic psychoses with the transition from the statement of their random combination with epilepsy to the statement about their belonging to this disease (from ancient times to the seventies of the last century).

The second is to highlight the main features of the dynamics of psychotic and non-psychotic mental disorders in epilepsy with the continuation of the discussion of their noso – logical nature (the end of the 19th and the first two decades of the 20th century).

The third – the beginning of a comprehensive study of the role of biological, personal and social factors in the Genesis and development of mental disorders in epilepsy (1920s – 1940s). The fourth period is the period of intensive search of morphological substrate in the pathogenesis of psychotic disorders in epilepsy, the accumulation of clinical data on the importance for the prognosis of the relationship of productive and negative disorders and the development of active methods
therapy of these conditions (1950-1960-ies).

Finally, the modern – fifth – period of the synthetic approach to the consideration of bio-logical, psychological and social factors in the formation of the structure and dynamics of mental disorders in epilepsy, attempts to justify the criteria of clinical and social prognosis in patients with this pathology.

Examples of descriptions by doctors and authors, far from medicine, structural features of short-term acute psychotic disorders with confusion and psycho – motor excitation in patients suffering from black, sacred or divine disease – new, which for thousands of years was called epilepsy, you can find a lot. It suffices to point in this respect to a number of judgments and testimonies of modern authors.

In the ancient population of Mesopotamia, for example, the fate of a patient with epilepsy was prepaid for his sins by the God Moon. The Aztecs turned to Chihuapipiltin for the treatment of convulsions 9
B. A. Kazakovtsev. “Mental disorders in epilepsy» the fumes of the incense, eliminating, in their opinion, “heavy breathing at the crooked – ness of the lines.” This “pre-scientific symbolism”, according to S. Iannacoune et al. (1997), is the source available in some Nations such therapeutic practices, as is the custom to spit on patients with epilepsy out of fear of contact with their breathing or the treatment of them by laying them on the head of hot eggs etc.

In symbolic images in the painting of the middle ages, a cosmic analogy was drawn between a seizure and a thunderstorm. Those who pleaded for help were depicted in a cross-shaped pose of a generalized tonic-clonic seizure, and those who empathized with the patient were depicted in poses expressing “love for Christ” (D. Janz, 1997).

R. Sans and co-authors (1997) draw attention to the fact that later, for example, in the engravings and paintings of Goya, patients with epilepsy are presented as dangerous crazies, and also that later, in the middle of the 19th century, in the works of painting based on biblical subjects, the patients were depicted as saints in a state of ecstasy or as possessed. P. Dodd et al. (1997) show that many authors throughout the history of medicine have established a link between epilepsy and violent behavior, arguing only about whether the latter is directly due to epileptic seizure in the patient or other circumstances.

Long before the creation of E. Esquirol (1838), the first clinical classification of psychoses in patients with epilepsy, some doctors described mental disorders associated with epileptic seizures. Tyson (1650-1708) (CIT. by O. Temkin, 1945), in particular, related to ZyWALL “ordinary madness” with epileptic symptoms. J. E. Greding (1790/91) (CIT. by O. Temkin, 1945) was allocated prone to fits of mad men. Boushet and Caravieich (1825) gave a special importance to the establishment of a link between epilepsy and umopomrachitel – tion. J. S. Prichard (1822) (CIT. according to M. Trimble, 1982) talked about delirium, which began with the phenomena of excitation and continued in a patient with epilepsy is two to three days. A. Portal (1827) described in a patient with epilepsy a state of frenzy, extremely dangerous to others.

The novelty of the classification of E. Esquirol (1838) consisted in the use, in essence, of the statistical method in the study of psychotic disorders of different structure and duration. Of the 385 patients he examined with epilepsy, 12 he considered to be suffering from monomania, 30 of them were diagnosed with mania, 34 – frenzy. Of the total number of patients, 50, according to the author, “had flighty ideas”, and some – “transient
brad”N. despite the dominance of the concept of a single psychosis in psychiatry over the next two to three decades, epilepsy, as before, occupied a special place in the General classification of mental disorders. As a result of an in-depth study of the symptoms of psychotic disorders during this period, some of their structural features were outlined in detail. These included, for example, periods of depression and agitation (J. G. F. Baillarger, 1854), distrust and resentment with a violent urge to beat and destroy (L. Delasiauve, 1854) (CIT. by O. Temkin, 1945), the combination of religiosity and Beseder – tion of eroticism (V. A. Morel, 1860). Obvious signs of frenzy in a patient with epilepsy I. M. Balinsky (1859) (CIT. according to V. E. Smirnov, 1971) considered a painful megadeal – ness, irritability, tendency to violent and unbridled libido that the patients themselves rated as “elevated the energy of their abilities and will.” In a patient with epilepsy, obsessed with melancholy, on the contrary, he noted the “constantly sad mood” and corresponding to this “imaginary feelings, sublime vos – susceptibility to external impressions, bouts of despair or fear, ending in suicide.”

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