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*Corresponding Author: Rumiyya Karimova, Department of Psychiatry of the Azerbaijan Medical University, Gerontological department of the Republican Psychiatric Hospital of the Ministry of Health of the Azerbaijan Republic.
Citation: Rumiyya Karimova (2021). Pathomorphosis of Vascular Dementia with Psychotic Symptoms. J. Neuroscience and Neurological Surgery. 11(1); DOI:10.31579/2578-8868/221
Copyright: © 2021 Rumiyya Karimova, This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 24 November 2021 | Accepted: 27 December 2021 | Published: 07 January 2022
Keywords: vascular dementia; pathomorphosis; psychotic symptoms; pandemic
Objective: To study the pathomorphosis of vascular dementia over the past 30 years. The study of the pathomorphosis of mental disorders makes significant adjustments to the criteria for diagnosis and nosography. Dementia has also undergone pathomorphosis over the years.
Materials and Methods: The research was carried out in the Psychiatric Hospitalsin Azerbaijan. A retrospective analysis was carried out for the period 1990-1999, which were compared with a similar contingent during 2010-2020.
Results: The number of hospitalized patients with vascular dementia has increased over the past 10 years, which means both an increase in the incidence of the disease and an increase in symptoms requiring psychiatric treatment.
Conclusions: Pathomorphosis has also manifested itself in sex. Thus, the number of female patients has increased in the last 10 years. As a result of the disease, there is a positive trend, a decrease in mortality.
Everything around us is changing. The world is constantly evolving and changing rapidly. The same thing happens with the human body and mind. This means that diseases are changing. Some of them are exacerbated, and some are no longer as scary as they used to be. Some diseases even disappear as a result of this change. In medicine, this is called pathomorphosis, and sometimes nosomorphosis. Pathomorphosis (from the ancient Greek πάθος - suffering, illness and μορφή - type, form) - a change in the signs of a disease, as well as a change in morbidity and causes of death under the influence of various influences and external factors. The complexity and variety of reasons leading to a change in the clinical picture, course and outcomes of the disease form a steady interest of researchers in these problems. 1929 German psychologist Willie Hellpach introduced a new term "pathomorphosis" [1]. L.K. Khokhlov, G. Avrutskiy in 1975, S.F. Semenov in his research wrote about various types of pathomorphoses [2, 3].
There are various definitions of pathomorphism: "change in the clinical and anatomical manifestations of the disease, as well as the structure of morbidity and mortality under the influence of various influences", "amendment to the prevailing ideas about the stability of nosological forms", etc. [4, 5, 6].
The term "pathomorphosis" is often used in anatomy, microbiology, clinic, especially in the clinic of infectious diseases; in psychiatry, this term is used quite widely, but not always adequately. Pathomorphosis of mental disorders has long been discussed in the psychiatric community [7, 8].
The problem of the pathomorphosis of mental disorders acquired particular urgency in the second half of the twentieth century. This is associated not only with a change in the clinical picture and the nature of the course of mental disorders, but also with a significant revision of views on their nature [9].
The study of the pathomorphosis of mental disorders makes significant adjustments to the criteria for diagnosis and nosography [10].
As we have already mentioned, there are different types of pathomorphoses. In most cases, the following types of pathomorphosis have been studied and observed in psychiatry: psychogenic pathomorphosis, psychosomatic pathomorphosis, somatogenic pathomorphosis, ecological pathomorphosis, drug pathomorphosis, cultural pathomorphosis, etc. Some types of pathomorphosis cannot be used to explain mental changes.
For example, the article mentions: “Despite the importance of the processes of therapeutic pathomorphosis in changing the structure of mental disorders, it does not explain many of the most significant changes in the course of illness. Aspects of mental disorders, such as the age of onset of the disease, the characteristics of manifestations, as well as a change in the ratio of forms of mental disorders, cannot be a consequence of drug pathomorphosis, since they are formed before therapeutic interventions [11].
Dementia, which has been called a pandemic since the middle of the last century and which is one of the biggest problems in an aging society, has also undergone pathomorphosis over the years. Dementia develops in one person every 3 seconds. This figure is expected to increase to 152 million by 2050 [12, 13].
Among them, vascular dementia ranks second with 30% [14, 15, 16]. In vascular dementia, one or another psychopathological symptom is observed in 33.7% of cases, and 2 or more symptoms - in 64.6% of cases [17].
Considering all this, it can be concluded that the pathomorphosis of vascular dementia with psychotic symptoms requires more detailed study.
The purpose of the study
To study the pathomorphosis of vascular dementia over the past 30 years.
Thus, a brief analysis of the literature data gave us the basis to form the next goal of the study - to study the pathomorphosis of vascular dementia over the past 30 years.
Materials and methods
The research was carried out in the Republican Psychiatric Hospital No. 1 and Clinical Psychiatric Hospital No. 2 of the Ministry of Health of Azerbaijan. A retrospective analysis was carried out, the frequency of diagnosing vascular dementia among hospitalized patients was studied using a descriptive method of epidemiological analysis, and the role of this pathology in the structure of mental morbidity was established.
At the second stage, a continuous detailed study of the archival case histories of all patients undergoing inpatient treatment of vascular dementia with psychotic symptoms in the period 1990-1999 was carried out, which were compared with a similar contingent that we observed during 2010-2020.
The analysis of the syndromological structure of disorders, anamnestic data was carried out to establish clinical dynamics to assess the outcome. A total of 431 case histories were analyzed. Some medical records in which data was lost were excluded from the study, and patients with vascular dementia who had to stay in hospital due to lack of caregivers were excluded from the study for more accurate results. The data were collected and processed using the SPSS-23 software.
Results and discussion
During the research, we tried to explore the following topics.
1. Change in the number of hospitalized patients,
2. Change in the average age of patients,
3. The number of psychotic symptoms,
4. Changes in the duration of inpatient treatment,
5. Changes as a result of treatment.
You are provided with information and results that can be accurately calculated and obtained in SPSS. The 431 subjects had a mean age of 70, 6 ±7, 6 years. Of the 431 subjects, 256 (60, 1%) were women.
In the course of the study, we examined the increase in the number of patients with vascular dementia treated in hospital in 1990–1999 and 2010–2019 compared to other inpatients (Figure 1).
The distribution of patients with vascular dementia by years is included in Table 1.
We tried to learn the change in the number of male and female patients with vascular dementia who received treatment in 1990-1999 and 2010-2019. Chi square test was used. (Table 2). The change in gender by years is given in Figure 2.
Interesting results are related to the duration of inpatient treatment of patients with vascular dementia (Table 3, 4)
In our retrospective study, we observed that one of the reasons for patients to go to the hospital is suicidal ideation and suicide attempt. Thus, during 2015-2019 suicidal ideation and atempt were observed in 5.8% of patients, and the incidence rate increased every year (Figure 3).
Conclusion
The study of the pathomorphosis of vascular dementia makes significant adjustments to the criteria for diagnosis and nosography. Therefore, further study of this problem remains an extremely important and urgent problem.
Limitations
This study has some limitations. This study was not intended to assess regional differences. Despite the obvious limitation of this study due to the small number of samples,we canarguet hat it showspromising data. On the usefulnessof the study the pathomorphosis of vascular dementiain multicenter countries in other countries. The study of the pathomorphosis of mental disorders makes significant adjustments to the criteria for diagnosis and nosography. Dementia, which has been called a pandemic since the middle of the last century and which is one of the biggest problems in an aging society, has also undergone pathomorphosis over the years.
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