Presenile psychoses: involutional melancholia, involutional paranoid.

Involutional depression is an affective disorder that occurs in old age under the influence of physical changes, changes in social roles and other factors associated with aging. Extremely widespread, occurring in 40% of people over 50 years of age who seek medical help. Women are affected twice as often as men, and symptoms appear on average 5 years earlier.

To make an appointment for a consultation about depressive disorder, call tel. 8(969)060-93-93.

Causes

Experts in the field of psychiatry and psychotherapy consider involutional depression to be a polyetiological disease that occurs under the influence of the following factors:

• Psychological. As people get older, they increasingly look back, think about what didn’t happen and didn’t work out, regret missed opportunities, and realize that they can’t change much. Worries about an insufficiently happy personal life, unrealized reproductive plans, real or imaginary career failures coexist with thoughts about lack of demand and inability to keep up with young people, anxiety about health and a possible deterioration in their financial situation.
• Biological. Health gradually deteriorates, chronic somatic diseases arise or worsen. The physical signs of aging are becoming more and more apparent. Women stop menstruating. In men, potency decreases and problems arise in the sexual sphere.
• Social. Children grow up, leave home, start their own families, which causes the development of “empty nest syndrome.” Professional prospects disappear, and it becomes obvious that the person has “reached his ceiling.” Difficulties arise when changing jobs. People of the same age—family and friends—begin to pass away. The number of old relationships decreases, new connections are not formed. There is a feeling of loneliness.

Mental disorders of involutionary age

What happens as a result of all the rather diverse factors: psychological, social, biological? Mental disorders may develop. In most cases we are dealing with depression; it is known to be the “queen” of most mental disorders and mental illnesses.

In disorders of involutional age, depression is also in first place in terms of occurrence.

This is usually quite severe, anxious depression

, accompanied by massive somatic accompaniment, when many experiences are transformed into bodily symptoms. This is the kind of depression that is almost always accompanied by violent anxiety; it reaches its climax in the form of panic attacks, limiting a person’s movements to a certain space.

hypochondriacal syndrome often appears in involutional depressions.

when a person begins to worry about the presence of some serious somatic disease. He becomes fixated on this, practically cannot think about anything else, and becomes a regular at most medical institutions. He undergoes many examinations, collects many alternative opinions, consults with various specialists, but all this only increases anxiety and reduces the confidence that “I can still somehow get rid of this.”

In addition to depressive disorders, the development of so-called delusional disorders

. We are not talking now about any serious manifestations of, say, paranoid syndrome, which we encounter in such serious diseases as schizophrenia or in organic severe psychoses.

These are delusional disorders, as we say, of small scope: poorly systematized, with monothematic ideas. As a rule, these are ideas of relationships. There is a conviction that my loved ones have begun to treat me worse, a conviction that I am now becoming an object of special interest on the part of this or that person. And this interest can be both negative and positive.

involutionary erotomania often arises

, it occurs in some forms of involutional psychoses. There is a conviction that those around me or one of the neighbors or work colleagues are showing some kind of erotic interest in me.

In addition, with involutional psychosis, “delusions of damage” may occur. This is quite a serious disorder when people who have reached this age begin to discover missing items in their apartment. As a rule, they are very small, but nevertheless, they record them, they pay attention to it, they begin to write many complaints and statements to the police, to the prosecutor's office, to the investigative committee, and begin to suspect their loved ones.

The most deplorable thing is that at the heart of this situation is precisely the same conflict with loved ones over imaginary damage. It contrasts with overly trusting, open relationships with people who are completely strangers, with people who may pose a danger from the point of view of fraud. Some neighbors or casual acquaintances in transport, on the street or in the elevator.

It is these people who ultimately become patients with involutional psychosis

they begin to write a will and donate their property, their apartments, and so on, finding themselves at the mercy of fraudulent actions. And loved ones who become distant as a result of the conflict ultimately turn into enemies.

Involutional disorders always pass, they always end. But some of the involutional disorders end with a very poor prognosis. With age, even without treatment, depression, anxiety, panic attacks, delusional disorders go away, but some part after all this passes, unfortunately, goes into the atrophic process.

And closer to old age, when memory, intellect, attention rapidly begin to collapse, and when we finally take this patient for supervision, and he ends up in an MRI machine, we see a picture of the atrophy that already exists. That is, the actual result of neuronal death, which may be irreversible.

Symptoms

Emotional disorders vary greatly. Some patients experience despondency, melancholy and anxiety. Others become picky and irritable. Still others suffer from tearfulness, touchiness, and frequent mood swings. A common feature is the deterioration of the emotional background, the predominance of heavy, unpleasant feelings.

At the same time, the reason for turning to specialists is often not negative experiences, but physical ailments. People complain of heart pain, gastrointestinal disorders, high blood pressure, and joint problems. Decreased mood, combined with age-related changes, prompts patients to compare their previous and current levels of activity, overly focusing on the negative aspects of their physical condition.

In such a situation, ordinary ailments begin to be perceived as serious incurable diseases. Anxiety for their health forces patients to become increasingly fixated on internal sensations. According to statistics, only half of elderly patients suffering from involutional depression complain of real somatic disorders. In other cases, objective changes are absent or only slightly expressed.

Excessive concern about one’s own health distracts a person from other areas of life, narrows the range of interests, and negatively affects relationships with family. The problem is aggravated by the disappearance of previous responsibilities, which provokes a feeling of uselessness and lack of demand. Left alone with himself, a person becomes immersed not only in bodily sensations, but also in unpleasant experiences about lost opportunities, which causes further progression of depressive symptoms.

So several factors connect with each other, creating a vicious circle from which it is very difficult to get out without the help of a specialist. In addition, as we age, our psychological and physical ability to adapt decreases. A person becomes more susceptible to stress, reacts sharply to those events and experiences that previously “would not have been thrown off track.”

Involutional depression is characterized by a gradual onset and slow increase in symptoms. Less often, for example, in the situation of the death of a loved one, loss of a job, or diagnosis of a serious illness, affective disorders arise suddenly and the illness develops rapidly. The listed options determine the characteristics of care. Thus, for chronic disorders, it is important to provide sufficient support, and for acute disorders, it is important to prevent suicide attempts.

In general, worries about health and disappearing opportunities are typical for the initial stages of the disease, and gloominess, grumpiness, irritability, and attacks of aggression on minor occasions are typical for the later stages. The clinical picture is complemented by melancholy and anxiety, which reach a maximum in the evening and night hours. Due to mental fatigue during the day, confusion, agitation, a feeling of defenselessness or, on the contrary, indifference and lethargy are also possible during this period.

Sleep disturbances, manifested in the form of late falling asleep and early awakenings, are quite typical. During the day, a person can spend significant time in bed, not interested in surrounding events, suffering from a feeling of hopelessness and meaninglessness of his own life. In severe cases there is a risk of suicide.

Involutional (presenile) psychoses

Involutional psychoses were described by E. Kraepelin at the end of the 19th century. Currently, there are two clinical forms of these psychoses: involutional depression and involutional paranoid.

Clinical picture and dynamics of involutional depression (presenile melancholia)

The onset of involutional depression is usually slow, although an acute onset is possible in cases where the onset of psychosis is preceded by a sudden mental trauma or acute somatic illness. Depression, unfounded or exaggerated fears for one’s own health, the condition of loved ones, and material well-being appear and increase. Over time, these manifestations intensify and develop into a picture of severe anxious depression.

It is believed that the combination of depression and anxiety is the most significant clinical feature of involutional melancholia. Anxiety is pointless in nature, devoid of specific content or filled with unjustified gloomy forebodings and the expectation of all sorts of misfortunes. It intensifies in the evening and night hours. A symptom of mental adaptation disorder is often identified in the form of a sharp increase in anxiety with senseless resistance to any minor changes in the usual environment. For example, anxiety increases when a patient is transferred to another place in the ward, or when a new patient appears.

The classic picture of involutional melancholia is characterized by a combination of anxious-depressive affect with speech and motor restlessness, which in more severe cases reaches excitement and even frenzy (agitated depression). The speech of patients is inconsistent or incoherent, consisting of fragments of phrases or a meaningless list of words that sound similar and express bewilderment and anxiety (verbigeration). Patients sob, lament, moan, look around in confusion, wander confusedly or rush around the room.

Agitation is traditionally considered as an essential clinical sign of involutional depression. However, pronounced speech and motor restlessness or agitation is not a mandatory manifestation of this psychosis. In recent decades, agitated depression has become less and less common. In many cases, the anxious-melancholy affect is combined not with agitation, but with slow, inexpressive speech, lethargy, and inactivity.

In some patients, depression is accompanied by delusions. More common are delusional ideas of unfair accusations and condemnation of the patient by others. There are pathological ideas of persecution, poisoning, damage, jealousy, and hypochondriacal delusions. Delusional ideas of self-blame are practically not characteristic of involutional depression.

Sometimes, at the height of severe involutional melancholy, delusions of depressive-fantastic content develop (delusions, or Cotard syndrome). This syndrome is characteristic of psychoses of late age. In earlier age periods it rarely occurs.

Cotard's syndrome is characterized by nihilistic delirium, or delusion of denial, a kind of sensual delirium close to hypochondriacal. Patients claim that they lack vital organs and functions (no stomach, intestines, food enters directly into the abdominal cavity and accumulates there without being digested, there are no physiological excrements for months). The structure of the syndrome may include ideas of evil power (with his existence the patient causes incalculable suffering and death to people, to all of humanity: people die, suffocating in the toxic fumes and miasmas emanating from the patient that have filled the entire atmosphere). There are ideas of painful immortality (the patient considers himself doomed to eternal suffering, like sinners in hell. The spread of delusional experiences over an entire country, planet or even the Universe is the basis for designating such delirium as megalomaniac, or delusion of enormity. The occurrence of Cotard's syndrome indicates a special depth, exceptional severity of depression.

Deceptions of perception within the framework of involutional melancholia rarely occur. Verbal illusions and hallucinations are possible, the content of which corresponds to anxious-depressive affect.

The dynamics of involutional melancholia most often have the character of a protracted single attack. With a more acute onset of psychosis and timely active therapy, a fairly deep and lasting remission sometimes occurs after a few months. However, in most patients, anxiety-depressive and delusional symptoms persist for a number of years almost unchanged. Monotony, monotony of affective-delusional disorders is one of the clinical features of involutional depression.

Gradually, anxious-depressive and delusional manifestations are smoothed out, become more scarce, a peculiar mental defect is formed in the form of a sad-pessimistic coloring of emotions, anxiety over trifles, inertia, rigidity of all mental processes. Involutional depression does not lead to pronounced organic changes in the psyche or dementia. Some weakening of memory and intelligence observed in some patients is due to the natural processes of aging and the addition of cerebral atherosclerosis.

Clinical manifestations and dynamics of involutional paranoid (involutional paranoia

The onset of the disease is usually slow. Distrust and suspicion arise and gradually increase. In random statements and actions of relatives and neighbors, the patient sees signs of an unkind attitude towards himself, hostility. Gradually, these experiences are transformed into interpretative delirium, the content of which is characterized by small-scale, specificity and often plausibility. Delirium concerns people from the immediate environment of the patient and everyday life events, which gives grounds to call it delusion of ordinary relationships, or of small scope.

Delusions of damage are especially characteristic. Patients are convinced that neighbors or relatives are harassing them, secretly entering the premises, scratching furniture, dirtying and tearing linen, stealing small money or taking meat out of a pot of soup. Ideas of poisoning often arise, for the substantiation of which another ailment, pathological sensations in connection with a somatic illness or age-related illness are involved. There are also paranoid hypochondriacal ideas and ideas of jealousy. Illusions and hallucinations occur rarely and do not occupy a significant place in the picture of psychosis.

In some cases, delirium is accompanied by anxious depression, in others the patients’ mood is somewhat elevated and optimistic.

Patients are often characterized by activity and sthenicity in the fight against imaginary ill-wishers. Patients file complaints and statements against the “offenders” to the police, administrative bodies, and call on the public for help.

The course of involutional paranoids is usually chronic. In most patients, delirium persists for many years, and sometimes for the rest of their lives, showing no tendency either to progression or to reverse development. Recovery, as a rule, does not occur. At the same time, involutional paranoid, like involutional depression, does not lead to dementia.

In some patients, delusional experiences become less intense over time, have less and less influence on the patients’ behavior, become fragmentary in nature, or are almost completely leveled out. Only some wariness, suspicion, and occasional fears of hostile actions on the part of individuals from the immediate environment remain. At the same time, phenomena of mental weakness, monotony, and inertia of all mental processes are noted.

Diagnostics

The diagnosis is made by a psychiatrist or psychotherapist. It is often carried out with a delay, since the patient and his relatives do not turn to specialists, regarding the symptoms of involutional depression as a natural consequence of aging.
Even if the patient consults a doctor, he will most likely complain of physical ailments rather than affective disorders. Because of this circumstance, older people with this disorder are sometimes mistakenly given a preliminary diagnosis of a somatic disease and are prescribed unnecessary examinations using hardware and laboratory methods. To determine the nature of the pathology, conversation data and observation results are used. Indifference, lethargy, reluctance to engage in contact, or an inability to maintain contact without additional stimulation may be considered indications of the presence of a depressive disorder. Some patients, on the contrary, demonstrate tearfulness and emotional instability. The reliability of diagnosis increases when special tests are performed.

Cost of services

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INVOLUTIONAL PSYCHOSES

INVOLUTIONAL PSYCHOSES (from Latin involutio – coagulation, fading) (presenile psychoses, presenile insanity), a group of psychoses that arise primarily. at the age of 50–60 years and manifesting hl. arr. anxiety-depressive and delusional disorders, but, as a rule, not leading to dementia. More often observed in women during menopause. Isolation of I. p. in independent. nosological group by E. Kraepelin was associated with the hypothesis about the decisive influence in their origin of the age factor - involution, first formulated by K. Kahlbaum in 1879. Initially they were designated by the term “paraphrenia” (psychoses during puberty were called hebephrenia, and mental disorders during puberty were called presbyophrenia ). As a main forms of I. p. were distinguished by involution. melancholy and involution. paranoid However, subsequent studies showed that I. p. represent syndromes of different mental disorders. diseases, including endogenous, vascular and other somatically caused, which arise in involution. age and acquire clinical similarity due to pathoplastic influence of the body's fading factor. In modern international classifications of mental diseases I. p. as independent. group of diseases are not included.

For involution. melancholy (involution depression) is characterized by deep melancholy with anxiety, excitement, delusions of damage, ruin, self-accusation; high risk of suicide. Patients are in constant psychomotor agitation. During an exacerbation, they lament, moan, rush about, try to injure themselves, and commit suicide. Excitement may be replaced by immobility, numbness (stupor). Gradually, delusional ideas take on more and more fantastic content, reaching melancholic. paraphrenia with megalomaniac delusions of denial internal. organs, own life, the world around us with the paradoxical delirium of our own. eternal torment in eternal immortality (Cotard's syndrome, nihilistic delirium). The course is protracted, long-term with possible remissions or continuous. Clinical picture of involution. paranoid (presenile delusion, involutional paraphrenia) is manifested by delusional tension, suspicion with delusional ideas of damage, poisoning, adultery, which are associated with others - relatives, neighbors. Characterized by active delusional behavior aimed at exposing imaginary persecutors and protecting against them. The course is chronic. With both forms of I. p., the prognosis for recovery is questionable. With the so-called malignancies involution melancholy (Kraepelin's disease) develops motor and speech excitation with stubborn resistance, negativism, refusal of food and medical procedures, rapid onset of physical symptoms. exhaustion and cachexia. If left untreated, death soon occurs.

Treatment for all forms of I. p. is carried out in a psychiatric hospital. hospital, regardless of the patient’s consent in accordance with Art. 29 of the Law of the Russian Federation on mental health. assistance and guarantees of the rights of citizens in its provision.

Treatment

Patients with mild forms of the disorder are observed on an outpatient basis. In severe cases, hospitalization in a psychiatric department is necessary. An unambiguous indication for inpatient treatment is indications of the possibility of suicide (suicide attempts, conversations about the desire to commit suicide, typical preparations).

Drug therapy is carried out using antidepressants. The most commonly used drugs are from the SSRI group, which do not have a significant negative effect on the cardiovascular system. The duration of treatment is at least 4-6 months. Additionally, the therapeutic regimen may include sleeping pills and mild tranquilizers. To prevent the development of dependence, the duration of taking such medications should not exceed 1 month.

After the condition improves (in mild cases - from the moment of treatment), psychotherapeutic sessions are carried out. This helps the patient find the sources of his problems, share his experiences, develop a new view of what is happening, and find relevant meanings for further movement. In some cases, psychotherapy and drug therapy are complemented by physiotherapeutic procedures and cognitive training.

An appointment with a specialist in the treatment of senile depression can be made by phone. 8(969)060-93-93.

Involutionary melancholy

The clinical picture is characterized by anxiety-depressive syndrome. A depressed mood, deep melancholy with a constant feeling of restlessness and anxiety come to the fore. There is a fearful expectation of imminent misfortune, which can lead to the death of the family and the patient himself. Patients lament, wring their hands, are sure that “their body has rotted, decomposed” (Cotard’s syndrome), that “children and relatives have died.” They ask for help, sometimes express ideas about the destruction of the world, the complete destruction of all life on earth, and believe that a general catastrophe has occurred.

Anxious-depressive state, as a rule, is accompanied by physical activity (agitated depression ) and the expression of delusional ideas of self-blame and self-deprecation . Patients demand to be punished and make suicide attempts, inflicting severe wounds and mutilations on themselves.

symptom of adaptation disorder is also characteristic . When changing location or transferring to another ward, the anxiety of patients increases. symptom is also observed , the patient laments for a long time and asks for help. If a doctor starts talking to a patient, he immediately falls silent and refuses to talk; as soon as the doctor leaves, he starts wailing again).

Illusory perceptions of the environment are also common . Relatives seem like strangers to the patient, who judge him and look at him in the wrong way. Patients express hypochondriacal ideas, believe that they suffer from cancer, are infected with tuberculosis, and sexually transmitted diseases.

Often the disease takes on a protracted course and after a few years, patients experience a decrease in the intellectual sphere and emotional flattening.

A common form of senile psychosis is involutional paranoid .

It begins gradually with the development of delusional ideas . They are convinced that neighbors and relatives enter the apartment at night, or in their absence, using specially made keys, steal things, poison food, release poisonous gas, add poisonous powders, that they confer at night, and organize gatherings of suspicious people. They file complaints with various authorities (the police, the prosecutor's office), demand that people be punished, and lock chests, cabinets and even pots. The progression of the disease is accompanied by the appearance of verbal and olfactory hallucinations; in rare cases, phenomena of mental automatism are observed.

Involutional (late) catatonia is somewhat less common .

The disease begins with a feeling of restlessness and anxiety, which is replaced by the emergence of delusional ideas of persecution, self-blame, and Cotard's syndrome.

Subsequently, a stuporous state occurs with complete immobility and mutism . Over a long period of time, this form of presenile psychosis leads to the development of dementia.

should also be considered a type of involutional catatonia .

The course of this disease is catastrophic. An anxious-depressive state develops, incoherent speech, confusion with pronounced psychomotor agitation, followed by general calm. Disorders of consciousness of the oneiric type with illusory and delusional experiences, Cotard's syndrome, are observed. Patients feel as if they are participating in their own funeral or the funeral of relatives. They see various events and regard them as “the death of the Earth, the catastrophe of the Universe.” After 4-6 months, when cachexia occurs, death occurs from the addition of any somatic disease.

A milder form of mental disorders is involutional hysteria in menopause.

It is a complex of neurotic disorders with a predominance of hysteroform symptoms. The disease is characterized by emotional lability, moodiness, tearfulness, hypochondriacity, and demonstrative behavior. During anxiety, patients experience throat spasms, nausea, and sometimes vomiting. Less common are hysterical paralysis and hysterical seizures. The disease usually ends with gradual recovery.

The group of presenile psychoses includes presenile dementia . They arise in connection with the development of atrophic processes in the brain. What these diseases, named after the authors who described them (Pick's disease, Alzheimer's, etc.), have in common is a subtle onset, progression and irreversibility of the disorders; progressive dementia, combined with local focal disorders.

Alzheimer's disease . The disease often develops gradually, the average age of patients when they get sick is 55–60 years, women get sick three times more often than men.

Hypothetical risk factors for DBA (dementia due to Alzheimer's disease) are: maternal age at birth of the patient 30 years or older; aluminum intoxication, traumatic brain injury, acetylcholine deficiency in the brain, autoimmune diseases, etc.

The discovered connection between Alzheimer's disease and Down's disease confirmed the theory of the genetic origin of DBA (dementia in Alzheimer's disease). All patients with Down syndrome who survive to age 30 develop brain changes characteristic of DBA.

First, memory for current events weakens, then fixation amnesia occurs, and then progressive amnesia . Complete amnestic disorientation develops. Autopsychic disorientation can reach the level of not recognizing oneself in the mirror. However, problems in memory are not filled with mnemonic (replacement) confabulations and revival of past experiences (shifting the situation into the past), as in senile dementia. Along with mnestic disorders, disturbances of all types of mental activity arise and progress: attention, perception, comprehension of the environment. Thinking disorders begin with a decrease in the ability to analyze, synthesize and abstract and steadily progress to complete intellectual helplessness. Despite the global nature of dementia, in the initial stages a vague awareness of the disease and one’s own inadequacy remains for a long time (which distinguishes it from senile dementia). The feeling of inadequacy is accompanied by confusion and anxiety, and is subsequently replaced by indifference and indifference.

The combination of increasing intellectual-mnestic insufficiency with the breakdown of speech, reading, writing, recognition (gnosis), and actions (praxis) is an essential component of Alzheimer's disease. The breakdown of speech is manifested by amnestic, sensory and agnostic aphasia . Patients forget the names of objects and have difficulty understanding other people's speech. At first, words are pronounced unclearly, then speech becomes more and more dysarthric, with stereotypical turns, pronounced disturbances in expressive speech arise - repeated repetition of the initial letter of a word, reminiscent of stuttering, and then individual words (logoclonia), involuntary automatic repetition of heard words (echolalia). In the later stages, patients completely cease to understand the speech of others, and their own coherent speech disintegrates. Along with aphasia, the ability to read (alexia), write (agraphia) and count (acalculia) is lost. All types of apraxia occur. Loss of ambulation is associated with extreme, universal apraxia. Patients lose mobility skills - they cannot get up, sit down, or walk. A state of complete “apraxic immobility” or “motor confusion” arises, manifested by the impossibility of any purposeful action; the patients lie silently without changing their position.

The average life expectancy of patients is 8 years; Fluctuations from 1 to 20 years are possible.

Pick's disease . The disease usually occurs at the age of 50–60 years.

A relatively rare primary degenerative dementia, similar in clinical manifestations to DBA. However, in Pick's disease, more severe damage to the frontal lobes occurs, and therefore symptoms of disinhibited behavior may appear early in the disease.

A progressive personality disorder is observed: apathy, indifference, and indifference develop. Patients do not do anything on their own initiative, but if there is a motivating stimulus from the outside, they can perform even complex work. Sometimes the condition acquires a pseudo-paralytic character and is expressed by a complacent-euphoric mood with elements of disinhibition of drives . Severe memory disorders are noted : patients forget the events of the past day, current events, do not recognize familiar faces when meeting them in an unusual environment.

There is no critical attitude towards their condition, and although patients are upset when they are convinced of their failure, such a reaction is short-lived. Usually, patients have an even, complacent mood. Severe thinking disorders (total dementia) are noted. They do not notice obvious contradictions in their judgments and assessments. They do not understand the semantic meaning of certain events and situations. For patients with Pick's disease, so-called standing symptoms - repeated repetition of the same speech patterns . As the disease progresses, neurological disorders appear: agnosia, speech disorder, apraxia, etc.

Senile dementia . Total dementia is combined with special mnestic and intellectual disorders. The disease begins, as a rule, unnoticed: the patient’s mental appearance gradually changes, emotional impoverishment with irritability and grumpiness is observed, the range of interests sharply decreases, alertness and stubbornness increase, along with suggestibility and gullibility.

The most striking signs of the disease that determine its clinical picture are progressive memory disorders and dementia (total). Delusional ideas of robbery, impoverishment and ruin are also formed. Memory deteriorates, first of all, for current events, then mnestic disorders spread to earlier periods of the patient’s life. Patients fill the resulting memory gaps with false memories - pseudo-reminiscences and confabulations . The emotional manifestations of patients sharply narrow and change; either complacency or a gloomy-irritable mood is observed. There is a dissonance between the impaired ability to understand the situation and the sufficient preservation of habitual forms of behavior and skills, and the impossibility of correctly assessing the situation and the situation as a whole.

Behavior is passive and inert, patients cannot do anything or, on the contrary, are fussy, collecting things, trying to go somewhere. Criticism and the ability to adequately understand the environment and current events are lost; there is no understanding of the painfulness of one’s condition. Often the behavior of patients is characterized by disinhibition of instincts - increased appetite and hypersexuality. Sexual disinhibition manifests itself in ideas of jealousy, attempts to commit depraved sexual acts against minors.

Forensic psychiatric assessment . Pre-senile and old age are characterized by a significant decrease in the frequency of crimes, especially with the use of violence, but this does not apply to the number of sexual crimes , especially against young children . Due to the presence of severe mental disorders, people of pre-senile age may commit socially dangerous actions, deeds, and also lose the opportunity to fully perform civic duties and exercise their civil rights.

In cases where these persons commit criminal acts or doubts arise about the reasonableness of their actions or actions related to civil cases, a forensic psychiatric examination is carried out. In the first case, the question of their sanity is decided, in the second - about their legal capacity, i.e. about the opportunity to fully consciously conduct civil affairs and exercise rights.

Persons with severe mental disorders (psychotic states and states of dementia) are recognized as insane and incompetent .

Literature:

1. Georgadze Z. O. “Forensic psychiatry.” Textbook for university students. - M.: Law and Law, UNITY-DANA, 2003. P.129-136.

2. Kirpichenko A.A. "Psychiatry". Minsk. "Higher School" 1984 pp. 172-183.

3. “Clinical Psychiatry” Guide for doctors and students. Kaplan G. Translation from English. M., 1999. S. 214-223, 243-244, 269-289.

4. Morozov G.V. Forensic psychiatry. "Legal Literature". Moscow. 1978. pp. 226-232.