MENTAL ILLNESS : PROGRESSIVE PARALYSIS (PARALYSIS PROGRESSIVA; DEMENTIA PARALYTICA) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Syphilis in anamnesis. Full clarity in assessing the significance of additional factors not available.
Progressive paralysis occurs most often at the age of 35 - 50 years indefinite neurasthenic complaints; it is important in all such cases to make the study of blood and cerebrospinal fluid on Wasserman. In the extensive stage experience symptoms of progressive dementia, sudden memory loss, ability to remember, account, attention. In the emotional sphere is often observed euphoria (good humor). Celebrated a known rate of change of consciousness: the patient lives as if in a dream or in a state of slight intoxication. Often there is delirium is particularly characterized by delusions of grandeur.
According to Pavlov, judgments patients with progressive paralysis, behavioral disorders constitute a violation of the correct ratio between the first and second signal system. The first signal system operates, and the complex of the second signal system, i.e., more General concepts that are broken. The disorder of the second signal system is expressed in breach of the General concepts, causality, time, space. The patient does not go into the meaning of the contradictions that allows incredible, awkward communication phenomena. Along with the violation of the relation between the signal systems, the patient has profound disturbance of processes of excitation and inhibition. These violations affect in particular the inertia and stagnancy of inhibitory processes that are deployed on a background of sharply expressed areactively brain.
Pupillary disorders: irregular shape of the pupil, anisocoria (irregularity), miosis (constriction), lethargy or lack of reaction of pupils to light while maintaining the reaction on the accommodation. Disorders of speech (slurred, stumbling on syllables), letters (omissions of syllables), machobane face, restless innervation around the mouth, decreasing sensitivity (hypalgesia). Sharply positive Wasserman reaction in the blood and cerebrospinal fluid. Among the various forms of progressive paralysis (simple Dement, expansive, depressed, agitated) the most common is a simple Dement, characterized by a gross disorder of memory and the ability to memorize, difficulty thinking, judgment, lack of initiative, tact, loss of distance between yourself and others, rastormozheniem lower inclinations. In the initial state (marasmic stage) are especially frequent disorder of sphincter control (incontinence of urine, feces), sharp vasomotor and trophic disorders (cyanosis of the extremities, brittle bones), apolactoferrin and epileptiform seizures, ataxia, entrelace, symptom Romberg.
Prevention is mainly to systematic decisive struggle against syphilis infection.
The main method of treatment of progressive paralysis is the inoculation of malaria views tertiana.
Inoculation of malaria is made directly from the donor to the patient, and it is preferably from a donor with fresh, untreated malaria, which, too, once grafted malaria. For the success of vaccination is indifferent whether to take a blood sample during a malaria attack the donor or free from attack period. Technique: take from a vein of the patient malaria 2 to 4 ml of blood and inject the sick deep under the skin, preferably between the shoulder blades, while the needle to injure the tissue with the aim of damage to the small vessels; it is appropriate here to make additional scarification of the skin. If the blood to be transfused from a donor cannot, then it is collected in 0.5% sodium citrate (equal volume of blood and citrate); for transportation needs blood to keep on ice. The incubation period lasts on average 6 to 8 days in summer and 8 to 10 days in the winter, sometimes reaching 20 days and sometimes cutting up to 1 - 2 days. If the incubation period is desirable to reduce by 2 to 3 days, injected without prior defininitely 1 - 2 ml of blood. If, on the contrary, incubation period, it is desirable to extend for a few days, apply intradermal method, introducing only 0.1 - 0.5 ml of blood. Bouts of malaria occur first type tertiary, and after 3 to 5 attacks - mostly daily. Patients who are vaccinated for the first time to first malaria attack in a few days there is a high temperature is not above 39º and without chills. The first typical malarial attack begins with fever, and the temperature usually rises to 39 - 41º, lasts 4 to 8 hours, and when it falls you receive pouring sweat; blood found plasmodia. During the attack there is sometimes dizziness, tachycardia, complaints increased thirst, headaches, vomiting. During the febrile period must be carefully monitored for temperature, measuring her every 3 to 4 hours. When the fever is recommended to give a hot drink, warmer to the feet, and in periods of heat and cold on the head. If the temperature exceeds 41º and the patient takes it badly needed a compress on his head, cold rubdown. Of the medications prescribed piramidon with caffeine or small doses of quinine. At the height of the attack carefully monitor the state of the cardiovascular system.
If blood appears a large number of parasites and the amount of hemoglobin and red blood cells falls sharply or in connection with the disorder cardiovascular activity or severe gastrointestinal disorder (jaundice) recognition of the need to weaken or completely stop the seizures, then immediately after the attack give 0.1 to 0.2 quinine; if necessary immediately to stop the attack injected with 0.5 quinine (10 ml of physiological solution) 1 to 2 times a day for 3 - 4 days (it must be remembered that in rare cases, an intravenous infusion of quinine can give a severe complication from the optic nerves). In cases where there is danger of collapse, in patients who are free from attacks intervals keeps subnormal temperature, and when it falls, you do not receive sweating, and very obese and severely malnourished patients better malariotherapy be done in two steps. After the fourth attack, the patient was given quinine, cropped malaria, and then spend the secondary inoculation for the next 4 to 6 episodes in 1 - 1½ months after the first vaccination. If the attacks suddenly stopped or not caused by vaccination, it is necessary to provoke intramuscular injection of 5 to 10 ml of sterilized water or milk, the introduction of 2 ml intravenous 40% solution of urotropine; a bag with ice on his spleen. If these remedies don't help, make a secondary malaria vaccine intravenously (1 - 2 ml).
For edema malaria (done after 8 patients and younger patients 10 attacks) to give 0.5 quinine, 1 powder 2 times a day for 4 days and then 1 powder 0.25 quinine 4 times a day for 3 days, just to 7.0. Before the last attack, it is appropriate to give 0.1 to quinine. After chinsali attacks disappear on the 3rd day. Quinine is sure to give, and in those cases, when malaria was not accepted or seizures spontaneously stopped, as there may be latent malaria without seizures. If seizures develop jaundice, in order that the attacks were going on less intensively, should be given during the attack of 0.1 - 0.2 quinine, first making sure that this strain of Plasmodium blurred respond to quinine. It is extremely important before malariotherapy to ascertain whether the patient idiosyncrasy to quinine, in the course of the day the patient was given 2 times 0.5 quinine. Special vigilance is needed in between bouts at a temperature below 36º, especially in very obese and those who drop in temperature does not sweat. Quinine may be replaced by quinacrine (0,1). Directly after cupping malaria be treated by orally as tablets or marsanalog.
Marsena dissolved in 1 - 2 ml vegetationand water, which immediately before use, thoroughly boiled, cooled to room temperature (regardless of dose) and slowly injected into the buttock.
After the course completion, you must check the blood on the Plasmodium.
Contraindications to malariotherapy: active tuberculosis, uncompensated heart failure, high leukocytosis, a sharp decline in ROE, aged age, state of insanity, febrile disease, severe kidney disease, liver. Be careful with the sharp obesity, and especially when the "dryness" of the spinal cord (complications of the optic nerves).
From dangerous complications of circulatory disorders, collapse. To stop the attack has jaundice, sudden gastrointestinal disorders, severe weakness of the heart. Weak patients, you must first assign a high-calorie diet, insulin, or to weaken the attacks, before giving each of them a small dose of quinine. Treatment of malaria vaccines should be in a psychiatric hospital. In all circumstances, you must obtain consent from relatives to this kind of therapy.
If the cerebrospinal fluid does not lend itself within 2 years of treatment, rehabilitation, it is recommended that secondary inoculation of malaria.
Can be used in two ways:
The vaccine is made, as with malaria, and it is necessary to examine the blood for the presence of spiral. Instead of a donor, you can use the animals (mice), which infect recurrent typhus, and in this way creates the possibility of transport of grafting material. Equipment: a few drops of blood taken from the heart of these mice at the height of the attack, mixed with several milliliters of physiological saline and 0.5 - 1 ml of the mixture injected to the patient under the skin. After subcutaneous injection of the first attack appears in 6 to 7 days, the temperature rises to 40 ° C fever and severe weakness; after 1 - 2 days the temperature falls. The intervals between individual attacks from a few to 15 - 20 days. Such attacks usually 3 to 10, and each subsequent attack becomes weaker; finally, the attacks completely stopped, for the most part by themselves. The treatment should be complete by the injection of salvarsan. This therapy is particularly indicated for heart failure, in cases where malaria does not teach or no effect, or when there is idiosyncrasy to quinine, as well as in elderly and debilitated persons.
White mice infected with spirillae Japanese fever (sodoku) by the bite of the rat. The disease is easily tolerated by the blood of infected mice to humans. Infection of man by man is not happening, and therefore the method specified in this respect, safe, patients can be kept in the same room with the other patients. Strain it's best to keep in mice and rats, and the maximum spiral they appear in the blood at 3 weeks after inoculation; by this time it is best to plan a vaccination. It is best to use subcutaneous immunization half the amount of blood taken from the heart of the animal, which is 3 weeks before it was infected with spirillum. From the heart you can get up to 2 ml of blood, which is dissolved in 4 ml of saline. The patient is injected under the skin from a few drops to 0.5 murine blood. The disease is relatively easy; the incubation period is 6 to 10 days; the attacks keep 2 to 3 days, repeating over the same intervals. Starting from the 6th day after inoculation, at the injection site, you receive the primary effect of infiltrate, expanding and only 3 - 4 weeks after vaccination subjected to reverse development. To stop the attack very easily orally as tablets. You must start the infusion orally as tablets with a dose of 0.45, then 0,6 (with regular intervals), the entire course of treatment 3.45 orally as tablets. Seizures occur mostly without special somatic and mental complications, except for infiltration and frequent rheumatoid pain.
If malaria treatment dangerous physical condition or malaria, especially in secondary vaccination, does not cause a sufficient number of seizures, it is necessary to restrict usage to treat grey.
With a sharp concern shown baths and bed contents, hypnotics and sedatives. For stronger patients, especially in remission, useful tiring work; weak and unkempt sick, helpless, require care, care that they did not develop bedsores, there was retention of urine, etc. you Must persist.