What are the signs of the disease?
The concept of “involutional psychosis” appeared at the beginning of the last century. It was introduced by E. Kraepelin. Involutional psychosis is understood as a complex of human mental disorders that occurs at the age of 45-60 years. Patients suffering from this disease experience persecution mania. They also begin to think that they are being harmed in some way.
These obsessive thoughts are accompanied by depressive states and delusions. Involutional psychosis occurs in two types. The first type is melancholy. The second type is involutional paranoid. Now let's look at each type separately.
Presenile psychoses
Presenile psychoses (synonym: presenile psychoses, involutional psychoses) are a group of mental illnesses that arise at the age of 45-60 years and are manifested mainly by depression or delusions of harm and persecution.
Presenile depression (involutional melancholia). The initial period lasts from several weeks to a year. It manifests itself as anxiety, motor agitation of varying intensity, hypochondria (see Hypochondriacal syndrome), as well as sleep disorders, loss of appetite, constipation, weight loss and aging. The full picture of psychosis is determined by confusion, increased anxiety and agitation, the appearance of speech agitation, persistent attempts at suicide or self-mutilation, and the development of complex forms of depressive delirium, usually Cotard's delirium (see Affective syndromes). These disorders, once they appear, subsequently, often for many years, hardly change in their manifestations and intensity, and the whole picture of the disease is extremely monotonous.
In cases where the clinical picture of presenile depression is determined by prolonged, continuous and intense speech and motor excitation, with negativism, dreamlike stupefaction (see) with fantastic ideas (the death of the world, a flood, images of funerals), as well as severe somatic disorders (diarrhea , urinary disorders, appetite perversions, rapidly increasing cachexia), speak of malignant presenile depression. - Kraepelin's disease. It occurs at the age of 45-50 years and without treatment almost always ends in death.
A low-grade delusion of damage is manifested by a slowly developing delirium, the content of which is determined primarily by the ideas of robbery and material damage (soup was poured out of a pan, several potatoes were taken, oilcloth was burned, a door was scratched, etc.), less often by the ideas of poisoning and persecution. Delirium extends only to persons living with patients - relatives and neighbors. Patients usually complain about their offenders orally and in writing to the authorities, insert new locks on the doors, hide food and belongings. The background mood is either slightly lowered with a tinge of anxiety, or patients are energetic, active, and look at the future with optimism. Presenile psychoses are chronic.
Treatment of presenile psychoses is always carried out in a hospital. Presenile depression and delusions of harm are treated with a combination of various psychotropic drugs; malignant presenile depression - electroconvulsive therapy.
Presenile psychoses (synonym: presenile, involutional psychoses) are an insufficiently defined group of mental illnesses that occur most often at the age of 45-60 years and occur with a picture of anxious-agitated depression with delirium (presenile melancholia), sharp agitation with confusion and incoherence (illness Kraepelin), delusions of damage and persecution (presenile delusions of damage), catatonic disorders (late, involutional catatonia).
Many psychiatrists deny the nosological independence of presenile psychoses and attribute them to depressive attacks of circular psychosis and schizophrenia, partly to arteriosclerotic and reactive psychoses.
The etiology of presenile psychoses is unknown. As predisposing factors (with particular frequency and consistency in presenile melancholia), psychogenic disorders, changes in the usual life pattern, as well as various, usually mild, somatic diseases can be noted.
Women develop presenile psychoses much more often than men.
Clinical forms of presenile psychoses . Presenile (involutional) melancholia. The initial period usually lasts several months. Occasionally, as a rule, after severe psychogenic episodes, it is reduced to 3-4 weeks. In some cases, the initial period lasts up to a year or more. At this time, mental disorders are manifested by depressed mood, increasing anxiety about various life circumstances, real or expected troubles, and motor restlessness. Hypochondriacal statements are often noted. At the same time, and in some cases before the appearance of mental changes, patients experience night sleep disorders, loss of appetite, constipation, weight loss, often accompanied by aging and decrepitude.
Further complication of the disease depends on the appearance of confusion, increasing anxiety and the development of complex forms of depressive delirium. Patients do not understand what is happening to them and around them, cannot stay still, constantly move, rush about, try to escape, injure themselves, and make frequent, often extremely persistent attempts to commit suicide. In many patients, motor excitement takes on the character of a frenzy. Speech arousal is manifested by monotonous groans, moans, screams, and screams. Patients repeat the same word or phrase many times in a row. Speech and motor arousal of patients increases when trying to talk to them, when transferring them from one room to another, during medical procedures, etc. States of excitement can be interrupted by retardation, reaching the intensity of stupor. However, the predominant form of movement disorders is agitation (see Agitation in Mental Patients).
Of the delusional ideas, the most common are the ideas of self-accusation, accusations, and hypochondriacal ideas, combined in various proportions. As the psychosis becomes more complex, the delirium begins to take on a more and more fantastic character.
Patients accuse themselves of having committed terrible crimes in the past and present, surpassing the crimes of the most negative historical figures; they talk about eternal torment awaiting them, about the death of states, the Earth, and the Universe. Statements that their various internal organs are destroyed or missing are much less common.
Sometimes patients say that time, space, truth have disappeared, that is, denial extends to abstract concepts. The totality of these fantastic statements is called Cotard's delusions. When Cotard's delirium appears, the mood of patients, in addition to anxiety, is often determined by fear and despair. Almost always one can note verbal illusions and much less often the symptom of a negative double (relatives seem to the patient to be strangers imitating their relatives). All mental disorders are characterized by uniformity and monotony, especially noticeable after psychosis has reached the culmination of its development. The course of presenile melancholia is always protracted. The disease continues for years, and without treatment, over time, patients develop a state of mental weakness with a monotonous, anxious affect and delusional and motor disorders reduced in their manifestations.
Kraepelin's disease (malignant presenile melancholia) is a rare form of mental illness. Occurs mainly at the age of 45-50 years. After a short initial stage, similar in its clinical manifestations to the initial mental disorders observed in ordinary forms of presenile melancholia, patients develop unusually sharp, monotonous and monotonous motor excitation, often not interrupted even at night. It is usually accompanied by negativism and self-torture and continues for many days. Patients constantly scream, utter meaningless and incoherent phrases and individual words. It is impossible to start a conversation with patients. Some statements from patients indicate that they have a dreamlike clouding of consciousness with fantastic ideas about impending catastrophes and world cataclysms. The state of affect can be judged both by the patients’ statements and by their facial expressions, which alternate between fear, horror, confusion and bewilderment. At times, speech and motor excitement is replaced for a short time by states of adynamia with helplessness, prostration and clearly visible confusion.
Mental disorders are accompanied by insomnia, changes or perversions of appetite (complete absence or gluttony). A number of patients experience profuse diarrhea or urinary disorders. Physical exhaustion increases progressively, quickly reaching the level of severe cachexia. If left untreated, the disease always ends in death, either from increasing insanity or from an associated somatic disease.
Presenile delusions of damage (involutional paranoia, involutional paraphrenia) are manifested by subtle, slowly and gradually developing delusions of damage and robbery, jealousy, and, less commonly, delusions of persecution and poisoning. Delusional ideas primarily spread to relatives living together, neighbors in the apartment and house and usually do not concern people who are unfamiliar or unfamiliar to the patient. It is typical for new delusional ideas to appear in relation to people around the patient when the situation changes, for example after moving to a new place of residence, when being admitted to a hospital, etc., while delusional ideas in relation to people with whom the patient has stopped contacts are starting to weaken. Delusional ideas do not have a tendency to progressive systematization or development with modification of content: delusions of physical impact, grandeur, delusions of a mystical nature, etc. do not appear. Severe sensory disorders, in particular mental automatisms, do not occur with this disease. Despite its long-term course, the disease manifests itself and is limited to monothematic delirium. Presenile delusions of damage are often defined as delusions of habitual relationships and small scope. Patients are characterized by delusional activity, manifested in relation to imaginary offenders by litigious behavior and the adoption of protective measures. Features of delirium are concreteness with an abundance of small and at first quite probable “everyday” details. Thus, patients may claim that their neighbors poured a bowl of soup out of their pot, changed potatoes, deliberately spilled water in front of the door, etc. Such complaints from patients to government authorities are often not regarded as a manifestation of mental illness for a long time. The protective measures taken by patients (changing door locks, changing place of residence, carefully monitoring food preparation, etc.) seem just as “natural” at first.
Typically, patients experience either an anxious or slightly elevated mood with traits of optimism and confidence in exposing their ill-wishers. In the latter case, patients are especially willing to tell strangers about the troubles happening at home and seek sympathy, which makes their delirium even more similar to ordinary “everyday” squabbles. Despite the chronic and long-term course of the disease, no noticeable characterological changes occur.
Late (involutional) catatonia begins with anxious-delusional excitement, which soon takes on a distinctly catatonic character. Subsequently, a prolonged substuporous or stuporous state occurs, lasting for years, with mutism, negativism, muscle tension, and refusal to eat. Most often, either the so-called negativistic stupor or negativistic stupor with puerilism develops. At the same time, delusions of persecution and hallucinatory disorders may occur. Most researchers attribute late catatonia to a disease associated with organic brain damage.
Treatment . For involutional melancholia, combined treatment with antipsychotic drugs (aminazine) and antidepressants (melipramine) is recommended. Therapy must be carried out over a long period of time, over many months. It is necessary to prescribe sufficiently high doses of drugs (aminazine up to 200-450 mg, melipramine up to 150-300 mg per day).
The ratio of drugs and dosages must be varied depending on the condition of the patients. Treatment with nosinane (tizercin) in doses of 200 to 400 mg per day is more effective than aminazine. Despite the successes of psychopharmacotherapy, the most effective method of treating involutional melancholia remains electroconvulsive therapy (see) - 10-12 sessions (2 sessions per week).
For malignant involutional melancholia, electroconvulsive therapy is the only treatment. Intramuscular administration of aminazine for malignant involutional melancholia is not indicated due to the frequent occurrence of tissue necrosis at the injection sites.
For presenile delusions of damage (involutional paranoia) and late catatonia, long-term (3-6 months or more) treatment with antipsychotic drugs in fairly high doses is indicated: aminazine 300-450 mg per day, stelazine 50-80 mg per day. Considering the possibility of the appearance of neuroleptic disorders, it is necessary to add corrective drugs from the very beginning of therapy: artane, dynesin, etc.
In all cases of treatment of presenile psychoses, it is necessary to use symptomatic agents (vitamins, glucose, cardiovascular drugs, saline solution). This therapy is of greatest importance in cases of malignant presenile melancholia.
Melancholy
Involutional melancholy develops slowly. Although there are exceptions. They usually occur in those people who have experienced mental trauma associated with external factors. In this case, the disease will progress rapidly. There are two types of this condition: ordinary age-related melancholia and malignant depression. The latter is called Kraepelin's disease. Involutional psychosis is a human condition associated with common age-related melancholy and is accompanied by anxiety.
Worries can arise for any reason, for example, worry about yourself, loved ones, money or health, etc. As the disease progresses, anxiety turns into depression. A feature of the condition is the absence of any one reason for experiencing. That is, a person begins to worry about everything and nothing in particular. Moreover, these experiences are vague. The state of anxiety and depression intensifies in the evening and at night. There are factors that can provoke an exacerbation. For example, cleaning or the desire of relatives to get rid of unnecessary things. Or the appearance of a new stranger in the house. These factors can cause anxiety and worry for an elderly person.
Kraepelin's disease, or involutional paranoid
Emil Kraepelin is the founder of the classification of human mental illnesses. All his medical activities were aimed at studying and regulating such disorders. Kraepelin tried to unite human mental illnesses according to certain characteristics. So that it is easier to understand them. Microbiology has made it possible to understand the causes of certain mental disorders. Kraepelin studied and observed patients with disorders.
He kept his own card index, recorded and studied people's medical histories. Analyzing the symptoms and course of diseases, he classified them into groups. His works have been published and published. In them, Kraepelin divided the mental changes of people into groups to make it easier to understand the causes and development of diseases. For example, he identified psychoses with a cyclical and periodic course, as well as progressive dementia and affective psychoses. Despite the fact that his works were first published at the end of the 19th century, scientists and doctors still use them in their work.
Presenile melancholia (involutional melancholia)
Presenile melancholia (involutional melancholia)
- one-time psychosis in the form of anxiety-agitated depression with delusions and the development of a picture of melancholic paraphrenia at the height of the disease; occurs in the form of a protracted, multi-year attack or chronically. Occurs almost exclusively in women. For most patients, a certain personality type is typical: conservatism, for example, the desire to maintain the established rhythm of life and fear of all kinds of changes; pedantry, “getting stuck” on negatively colored emotional events - the so-called. mental rigidity, combined with a tendency to worry even in connection with minor circumstances; seriousness and lack of a sense of humor; conscientiousness and extreme conscientiousness, as well as frugality that in some cases reaches the point of stinginess. Many people have a pessimistic attitude towards life, i.e., so-called traits. constitutional depression. In adulthood, a certain sharpening of personality traits is often observed, primarily mental rigidity, anxious suspiciousness, in addition, new properties such as callousness and selfishness arise. Typically, the onset of the disease is preceded, as a rule, by mental trauma - from relatively mild (retirement, change of place of residence) to very severe (death of a close, especially only, relative); psychosis occurs much less frequently after somatic illnesses.
The initial period lasts from several weeks (after severe mental trauma) to a year or more. The longer this period, the greater the likelihood that, other things being equal, psychosis will be chronic. From the very beginning of the disease, the affect of anxiety about individual, including specific, situations dominates - one’s own health, especially in the presence of senestopathies (see) or real somatic ill-being, the health of loved ones, possible financial difficulties, etc. In the future, anxiety along with a sharp increase in its intensity, it takes on a diffuse character, spreading to any event in the past, present or future. At the same time, a depressed mood arises, initially combined with irritability or dissatisfaction; subsequently an affect of melancholy develops. From the very beginning of the disease, agitation is observed, expressed to varying degrees (see Depressive syndromes). Delusional ideas of ruin, damage, hypochondriacal nature often appear, less often self-accusation and self-humiliation, which are fragmentary and monotonous in content (see Delirium). Despite the fact that the disease often begins after mental trauma, the reactive component contained in the statements of patients disappears quickly. In some cases, simultaneously with mental symptoms or ahead of them, sleep disorders, loss of appetite, constipation, weight loss occur; Premature aging and decrepitude are often observed. Complication wedge. the picture of the disease is expressed by the appearance of confusion (see), a sharp increase in anxiety, melancholy and agitation, accompanied by complex pictures of depressive delirium. Tense anxiety predominates, not knowing shades or fluctuations; the strength of the affect seems to exceed the limits of human endurance and persists for an indefinitely long period. Increased affective disorders are accompanied by the emergence of fear. Patients are unable to stay in one place - they constantly move, sometimes rushing about until they become frantic. Often, especially in a state of melancholic raptus, they try to injure themselves or commit suicide; their speech arousal is manifested by groans, moans, monotonous lamentations, screams, screams, and many experience anxious verbalization (see Depressive syndromes). Speech motor arousal increases sharply when talking with patients, when transferring them from one room to another, honey. manipulations (symptom of adaptation disorder). States of motor excitement can be interrupted by episodes of depressive substupor and even stupor (see Stuporous states). However, almost always in these states rudiments of agitation remain, most often in the form of incessant movement or wringing of the fingers. Delusional ideas acquire more and more fantastic content; at the height of development, Cotard syndrome appears (see Cotard syndrome). Sensory disorders are represented by verbal illusions (see), illusory hallucinosis of condemning or threatening content, a symptom of a negative double (see Capgras symptom).
The detailed picture of the disease can remain unchanged for years. Then, under the influence of therapy or spontaneously, a gradual weakening of the main mental disorders occurs - anxiety, depressive affect, agitation, speech agitation; individual delusional statements are preserved in a reduced form. Regression of behavior is often possible (sloppiness, gluttony appears) and a decrease in mental level, in particular dysmnestic disorders (see Memory). In remissions as a result of treatment, a tendency to anxious reactions and subdepressive affect usually remain.
Some domestic psychiatrists identify a variant of late presenile melancholia, which can begin after 60 and even 80 years. It is characterized by less pronounced agitation and anxiety, a predominance of melancholy and ideomotor retardation.
In the development of presenile melancholia, the characterological characteristics of patients, gender, and additional harm (mental trauma, intoxication, etc.) are important.
The diagnosis is based on the characteristics of the wedge. paintings. Differential diagnosis is carried out with manic-depressive psychosis (see), which first manifests itself in the second half of life, with reactive depression (see Reactive psychoses) and schizophrenia (see). In some cases, P. p. must be differentiated from endoform depressive syndromes that occur in senile dementia against the background of vascular diseases of c. n. With.
In the treatment of presenile melancholia during the period of increasing anxious agitation, chlorpromazine, triftazine (stelazine), tizercin, followed by the addition of antidepressants, primarily amitriptyline, are indicated. In a number of cases, both at the beginning of psychosis and during the period of significant reduction of psychopathol. disorders, among which persistent subdepression with elements of anxiety begins to predominate, a course of electroconvulsive therapy is recommended (see).
The prognosis for recovery is always questionable. In rare cases, complete disappearance of psychopathological disorders occurs.
Signs of illness
What are the signs of psychosis? Kraepelin's disease is a condition of a person with persistent states of anxiety. In this case, the patient has problems sleeping, speech is disrupted and absent-mindedness occurs, and concentration deteriorates. This disease does not occur very often. People over 65 years of age are at risk. This age period is characterized by a decrease in the performance of neurons in the brain. This property of the body leads to susceptibility to various anxiety states and the appearance of depression.
Brain training is a great way to prevent mental illness
To avoid this situation, older people are advised to train their brain. Give him a certain load. It is necessary to do this, since as a result of such training, new neural connections will be formed, which will ensure the normal functioning of the human body without any disturbances or the occurrence of depressive conditions. The signs of psychosis will also go away. An excellent way to improve performance are various crosswords or scanwords. Solving them keeps the brain busy, which is great therapy. Also, a positive effect is achieved when studying poems.
Age-related psychosis. Symptoms and treatment of paranoid
The main symptom of this condition is that the person is haunted by thoughts of causing him any harm. Namely, it seems that relatives want to enter his house or apartment in order to take possession of any personal belongings. Typically, such conditions occur in people after 60 years of age. They are called presenile psychoses. People who suffer from this disease can convince strangers that they are right and find allies. Indeed, from the outside it may seem that relatives have an interest in the property of an elderly person. Relatives in this situation are advised not to leave everything as it is. Often close people attribute everything to age and do not pay attention to the patient’s behavior. In fact, presenile psychosis can be cured. Therefore, if such symptoms are detected in a close relative, you should consult a specialist. It should be said that if a person suffering from this illness is not provided with timely medical assistance, then his condition may be aggravated by hallucinations.
The patient may begin to feel as if someone is walking around his apartment, or that his neighbors are plotting some kind of action against him; he may even begin to hear their conversations behind the wall. There are also cases when an elderly person is sure that he is being given poisoned food or drinks. It must be remembered that involutional and senile psychoses are mental in nature. That is, physically a person can be absolutely healthy. If such a disorder arose at the age of 60-65 years, then the patient can still lead a completely active lifestyle and take care of himself. But at the same time, his mental state needs treatment. There are external signs of a person's internal feelings about being harmed. Namely, the patient may lose weight, his hair may begin to fall out, and he may have problems sleeping. If these symptoms are noticed, this means that the man (or woman) is unwell and needs help.
If an elderly person complains that they want to poison him or take over his property, but in reality no one is making such attempts, you should pay close attention to him and provide medical assistance. If you take all the necessary measures to treat this disease at an early stage, then there is a high probability of complete recovery.
Presenile delirium of damage
Presenile delirium of damage
(involutional paranoid, involutional paranoia, involutional paraphrenia) - chronic delusional psychosis in the form of delusions of harm and persecution of ordinary content. It occurs predominantly in individuals with paranoid character traits - persistent, stubborn, despotic, prone to the formation of overvalued ideas (see) - and with mental rigidity. Delusional ideas develop unnoticeably, spreading primarily to people in the immediate environment (neighbors, less often to relatives and co-workers living together). When the situation changes, for example. change of place of residence, delusions arise in relation to people in the new environment, while previously existing delusional ideas are reduced to the point of complete disappearance. Delusional ideas of material damage, bullying, and, less commonly, poisoning predominate. Delirium is always systematized in the most general form, for example. the conviction that neighbors, in the absence of the patient, enter his room, spoil things and food, i.e., they do everything to ensure that the patient leaves the apartment. As a rule, such a delusional concept does not receive further development; the delirium is not complicated by hallucinations and mental automatisms (see Kandinsky - Clerambault syndrome); Among sensory disorders, verbal illusions (see) and senestopathies (see) can be observed. Delusional statements of patients always contain a large number of specific details of an everyday nature, and therefore such delirium is called delirium of everyday relationships or delirium of “small scope.” Psychosis is accompanied by pronounced delusional behavior: in some cases, patients defend themselves (putting additional locks on the doors, preparing and storing food in the room, changing their place of residence or work), in others they complain to various government agencies. The commonness of the content of delirium and the presence of real conflicts with others often for a long time do not allow us to assess the patient’s condition as pathological. In some cases, the patient can induce relatives and friends who, in an effort to protect him, also become involved in litigious activities (see Induced insanity). Typically, delirium is accompanied by either an anxious or slightly elevated mood with traits of optimism and confidence in the success of exposing one’s ill-wishers. As a rule, patients willingly talk about all the persecution carried out against them and about the protective measures they themselves take. Despite the chronic long-term course of the disease. no pronounced personality changes are observed: patients, including those who are single, in most cases are well adapted to everyday life, and many of them, despite their age, maintain a professional profile for a long time. performance.
In the development of presenile delusions of harm, the characterological characteristics of patients, additional harm, as well as isolation are important.
The diagnosis is established on the basis of the wedge. paintings. Differential diagnosis is carried out with paranoid schizophrenia, with endoform paranoid syndromes that occur in senile dementia against the background of vascular diseases c. n. With.
For presenile delirium of damage, long-term treatment over many years with aminazine, triftazine (stelazine), and haloperidol is indicated.
The prognosis for recovery is always questionable; Patients are usually left with residual delirium.
How should this type of psychosis be treated?
First of all, you need to trust a specialist. It is necessary to correctly explain to an elderly person that he should see a doctor. The psychotherapist will assess the patient’s general condition and prescribe the necessary treatment, taking into account age-related characteristics. You should know that when a person is of advanced age, not all medications are indicated for him.
He may have to stop taking any medications and drink only those that will not harm the functioning of other organs and systems of the body. The basis of treatment for involutional psychosis is taking certain medications. Their dosage is determined by the doctor, taking into account the age of the patient. The doctor also prescribes antidepressants. They are needed in order to remove the state of anxiety in a person. Antidepressants can also be replaced with antipsychotics. They also help eliminate anxiety in the patient. If the patient's condition is accompanied by delirium, then he is prescribed antipsychotic medications with psychotropic effects.
The purpose of these drugs is to give a person clarity of consciousness. In conjunction with taking medications, conversations between the doctor and the patient have a positive effect. This type of therapy helps the patient to establish normal communication skills and return to society in a healthy state.
Therapy methods
One of the main principles of treatment of involutional psychosis is the principle of “do no harm.” It is necessary to find such an approach to treatment in order to exclude further aggravation and development of disorders, and not give rise to even greater mistrust on the part of the patient.
If you prevent the development of a chronic form of the disease, then this can already be considered, in some way, a significant victory against psychosis.
Medications play a major role in the treatment process. The number of items and dosages are strictly limited, since we usually have to deal with older people who simply cannot tolerate a large amount of medications taken.
Antidepressants Pyrazidol, Zoloft, Tianeptine, Ludoimil, Anafranil and many others are actively used. The main requirement for medications is that they must have a minimum of possible side effects.
Neuroleptics with sedative effects are often prescribed. They help suppress feelings of anxiety, relieve excitement of the nervous system, and fall asleep normally.
A sedative is best for people with Kraepelin's disease. As for involutional melancholia, the main role is played by neuroleptics with a psychotic effect. They help to cope with delusions and overcome various hallucinations, including auditory ones.
It is worth mentioning separately the importance of friendly conversations and psychotherapy sessions. This measure helps the patient become calmer, more balanced, and at least get out of an anxious state.
Prevention
Preventive measures for the development of this disease are measures aimed at improving the health of the body. You don’t need to give yourself a lot of time to relax; you should lead a healthy lifestyle. Namely, follow the regime, eat right, give up bad habits, and so on.
Old age is accompanied by a narrowing circle of friends. This is due to the fact that people retire, children are busy with their lives, friends also stop maintaining relationships for various reasons. Despite the above factors, you should not isolate yourself and remain alone with your thoughts. Man is designed in such a way that he needs to communicate and develop. Therefore, people who are elderly and have limited communication are advised to expand their range of interests. Do something you’ve long dreamed of, but didn’t have enough time for. For example, register on social networks, walk, meet people and discover something new.
