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Chapter 18. CEREBROVASCULAR DISEASES

Mental disorders caused by pathology of the vascular system have various clinical manifestations, which can manifest due to different diseases (atherosclerosis, hypertension, thromboangitis) or their combinations. For example, for the development of cerebral arteriosclerosis, symptoms of mental disorders depend on what is affected: Small cerebral vessels or great ones. Nevertheless, in practice, it is possible to systematise a mental pathology of vascular genesis by using the nosological principle only in some cases. It is only possible to distinguish forms with a predominance of the pathology of atherosclerotic or hypertonic nature.

The prevalence rate of vascular mental disorders is not exactly known. A clinical and epidemiological examination of mentally sick patients at the age of 60 and older at the Moscow Psychiatric Dispensary № 2 present vascular mental disorders in 22.9% of mentally sick patients (M.G. Schchirina). Only 57.4% of these patients had vascular psychoses, while the other showed non-psychotic disorders (neurosis-like, psychopathic, affective, psychoorganic personality stigmas). A similar situation was noted in foreign studies

(G. Guber, 1972).

In this regard, the following systematisation of vascular mental disorders (by E.Ya. Sternberg), which reflects both clinical diversity and possible differences in mental disorders with due consideration of their pathogenesis, is the most convenient practically: initial, or non-psychotic, neurosis-like, pseudoneurotic syndromes; various types of vascular dementia; vascular psychoses (exogenous syndromes, affective, delusional, hallucinatory ones, etc.).

The need to identify the initial syndromes of vascular genesis specifically is confirmed not only by the frequency of their onset but also by the fact that in most cases of vascular pathology, these syndromes can be the only possible in the clinical picture of the disease throughout along the whole its length. In such cases, no further progression of the disease, the active condition stabilises at exactly this stage of development.

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