Characteristics of the course of the main forms of lesions of the nervous system

Chapter VIII. BRIEF INFORMATION ABOUT THE STRUCTURE OF THE NERVOUS SYSTEM AND ITS LESIONS LEADING TO DISTURBANCE OF SPEECH ACTIVITY

Characteristics of the course of the main forms of lesions of the nervous system

Due to the fact that a certain part of children with speech disorders suffer from certain diseases nervous system, the correct correction of a speech defect, as well as the selection of children in groups and special schools, require familiarity with the nature of the course of individual diseases and the degree of reversibility of the observed neurological, and hence speech, disorders.

Depending on the presence or absence of gross structural changes in the central and peripheral nervous system, organic and functional diseases of the nervous system are distinguished. Organic diseases are accompanied by more or less pronounced structural changes in the tissues of the nervous system. In functional diseases, the basis of the disease process is neurodynamic disorders.

It should be remembered that the division of all diseases of the nervous system into organic and functional is very conditional. On the one hand, in organic diseases, in addition to gross structural changes, many manifestations of the clinical syndrome are often due to neurodynamic disorders. On the other hand, early forms of organic diseases often manifest themselves and disguise themselves under the guise of functional neurotic disorders.

Organic diseases of the nervous system

Organic diseases of the nervous system, in turn, depending on the cause of the defect (from the etiology of the disease) are divided into: infectious diseases; injuries of the nervous system; hereditary degenerative diseases and diseases caused by metabolic disorders; diseases of the nervous system caused by a primary lesion internal organs or bones of the skeleton; tumors; vascular diseases brain. In children, speech disorders are most often associated with infections, injuries of the nervous system, intoxication, and hereditary degenerative diseases. Brain tumors and vascular diseases of the nervous system in children are much less common and have no practical significance for the work of a speech therapist.

Infectious diseases of the nervous system and intoxication

This group of diseases is united by the cause that causes damage to the nervous system - the impact on the central nervous system or its peripheral parts of an infectious or intoxicant factor. This is the largest group pathological conditions, giving the highest percentage of organic lesions of the nervous system in children. An infectious disease can be caused either by bacteria (bacterial, microbial, infections) or by viruses (viral infection).

Neuroinfections include meningitis, encephalitis, meningo-encephalitis, poliomyelitis, polyradicudo-neuritis, etc. There are acute and chronic neuroinfections.

Most acute neuroinfections are characterized by the presence of the following phases: 1) prodrome; 2) acute stage; 3) the stage of reverse development (recovery); 4) the stage of residual phenomena.

Speech therapists and teachers most often have to deal with the third and fourth stages of the disease, and speech disorders usually occur in the second stage. However, when collecting an anamnesis to determine the underlying disease, it is necessary to interview the child's parents in detail about the acute stage of the disease, since only an indication of certain features initial stage disease will allow correct diagnosis.

Thus, the presence of a history of meningeal symptom complex suggests that the patient has had meningitis. The meningeal symptom complex is characterized by headache, vomiting, and a characteristic posture of the patient - the head thrown back, legs bent at the knees (pose of the "pointing dog"). The tension (rigidity) of the muscles of the back of the head and the hip flexor muscles is determined.

The encephalitic symptom complex is accompanied by a blackout of consciousness, drowsiness, delirium, hallucinations, signs of loss of activity of certain parts of the brain (paralysis, paresis, aphasia, dysarthria, impaired muscle tone, etc.).

After the acute period, a period of reverse development of painful phenomena begins. In the first days and weeks after the acute stage, the foci of inflammatory infiltration in the brain resolve, edema and intoxication decrease, and impaired blood circulation is restored. This is manifested in the rapid restoration of a number of lost functions.

The period of rapid recovery is most often replaced by a slow recovery stage, lasting (in children) from several months to several years. At this stage, the restoration of lost functions occurs due to the slow restoration of cell function in cases where the fiber has suffered, but the function of the cell body has been preserved. In addition, at this time, the lost functions are replaced due to a compensatory increase in the role of auxiliary nervous mechanisms or other surviving departments of the system.

The stage of residual effects occurs 3-4 years after the disease. During these periods, improvements can be expected only through the formation of new skills in the patient using the surviving systems and functions.

In chronic neuroinfections, the process is less rapid, but longer. The period of damage to the substance of the nervous system is extended, especially in the absence of treatment or its ineffectiveness, for many years. The process can periodically subside and become aggravated again, affecting all new parts of the nervous system.

The scars and adhesions formed after the inflammatory process in the membranes of the brain and in especially vulnerable places of the circulation of the cerebrospinal fluid often lead to the occurrence of liquorodynamic disorders, and in some cases, dropsy of the brain. The latter is a serious complication, since the constant high pressure cerebrospinal fluid leads to compression of the brain, disruption of tissue respiration and blood circulation. Therefore, the processes of restoring lost functions in children with hydrocephalus occur much more slowly than in children with residual effects without impaired CSF circulation.

Nervous system trauma

Injuries of the nervous system are also one of the causes of impaired speech functions in childhood.

The most frequent and severe residual effects are craniocerebral injuries suffered in the prenatal period and during childbirth (birth trauma in violation of the normal birth act, extraction of children with forceps, etc.).

During the first days and weeks after injury, a rapid regression of the syndrome is observed, due to a decrease in cerebral edema, restoration of normal blood circulation, resorption of those hemorrhagic infiltrates that could occur after injury, and elimination of neurodynamic disorders.

In mild cases, complete recovery occurs in 1–3 months. In severe cases, the recovery time is delayed up to several years. However, in the subsequent time there are certain residual effects due to the presence of areas of complete decay and glial replacement of some parts of the brain, gross irreversible circulatory disorders.

After a craniocerebral injury, as well as after infectious lesions of the nervous system, liquorodynamic disorders often occur (hydrocephalus of varying severity).

Hereditary-degenerative diseases of the nervous system

This is most often steadily progressing suffering, manifested by increasing in severity signs of damage to the nervous system. These include Down's disease, various forms of myopathy, some forms of metabolic oligophrenia, etc.

For most of these forms, the appearance at a certain phase of the disease process of a progressive decrease in intelligence, a disorder of speech functions and more or less pronounced symptoms of an organic lesion of motor, coordinating or sensitive functions brain.

Close to this group of disease states are deformities and malformations of the brain and spinal cord. However, they are distinguished by a stationary course of the process. Often these painful conditions are combined with defects in the development of bone tissue, face, skull.

Despite the fact that patients with abnormal development have an irreversible defect in the nervous system, with careful work with them, quite good results can be obtained. This is due to the fact that elements of the child's pedagogical neglect and failure to use the reserve capabilities of the brain are usually added to the main irreversible neurological defect that causes the pathology of speech.

Functional disorders of the nervous system

As mentioned above, this group of disease states is characterized by the absence of a structural lesion of the nervous system.

These conditions are caused by a violation of neurodynamic processes occurring in the nervous system and causing nervous activity. According to the teachings of Acad. I.P. Pavlov and his followers, neurotic disorders, which make up the bulk of patients in this group, are based on disturbances in the interaction between excitatory and inhibitory processes in the cerebral cortex. In modern neurophysiology, the point of view is increasingly spreading that neurotic disorders are associated mainly with a violation of the attenuation of nerve impulses that circulate for a long time through closed cortical-subcortical-stem ring nerve structures.

In the etiology of neurotic disorders, two groups of factors are dominant - exogenous and endogenous. Most often, the cause of the disease is their combination. Exogenous factors include various infections, intoxications, psychotraumas, long-term traumatic situations for the child's psyche, etc. Endogenous factors are most often constitutional and hereditary features of the nervous system. Often neuroses in children develop in families where there are mental illnesses.

There are three main forms of neurosis - neurasthenia, hysteria, psychasthenia. In children, in a pure expanded form, these forms are not observed. However, a detailed examination of children suffering from neuroses suggests that they, too, may have individual traits that bring them closer to a certain form of neurosis, which develops in adults in various forms.

Thus, some children clinical picture the dominant place is occupied by fatigue, easy distractibility, exhaustion of active attention, sleep disturbance, memory loss. These features bring this neurosis closer to neurasthenia. Others are distinguished by the predominance of anxious and suspicious traits, uncertainty in their actions, self-doubt. Children often have fears, increased tearfulness (psychasthenic form of neurosis).

The neurosis of the hysterical type is characterized by a combination of peculiar hysterical character traits with a number of motor, sensory and visceral disorders. The hysterical character consists of increased emotionality, emotional lability, pathological suggestibility and autosuggestibility. Usually patients are egocentric. The behavior is demonstrative, theatrical. Movement disorders are also manifested by the unreasonable appearance of paralysis or paresis, impaired gait, and speech. Especially demonstrative is hysterical mutism - silence, refusal to speak in the absence of organic changes in the nervous system. With mutism, patients do not speak, but they retain the ability to write. It is characteristic that patients do not strive to pronounce sounds or words and communicate with others only with the help of letters and signs. Often there is hysterical aphonia - the soundlessness of the voice. Hysterical seizures are also observed - they arise in connection with the effects of a psychotraumatic factor. The seizure is characterized by an abundance of directional movements (accompanied by laughter, crying, clenching of teeth). Consciousness is usually not disturbed. Reflexes are not changed. Sensitivity saved. Using these moments, it is sometimes possible to interrupt a hysterical fit by a strong emotional impact or by causing unusual irritation (sprinkling cold water etc.).

neuroses are usually accompanied by a number of pronounced autonomic dysfunctions - excessive sweating, instability of vasomotor innervation, fluctuation blood pressure, pulse lability. In some cases, dysfunction is manifested by a violation of the activity of any organ - the heart, the gastrointestinal tract.

The features of motor skills observed in children with neuroses should also be noted. As a rule, patients have increased mobility, restlessness, and swiftness when performing certain motor acts. Often this is combined with increased fatigue. One of the forms of neurosis - coordinating neurosis, manifests itself in a violation of coordinated movements - motor skills when performing a certain type of activity (writing, typing, playing the piano or violin). At the same time, other activities are usually not changed. Thus, a patient who cannot write with a pen can freely play the violin and write on a typewriter, and vice versa.

Stuttering should be considered a special type of neurosis. Usually, in the vast majority of children, stuttering occurs against the background of an already developing neurosis. Only in isolated cases, stuttering occurs simultaneously with the appearance of other signs of neurosis.

In children with neurosis, along with speech disorders, it is possible to detect distinct signs of autonomic instability (pulse rate and blood pressure, trembling of the fingers, revitalization and brightness of dermographism, sweating of the palms and feet, etc.) along with increased excitability and emotional lability. Children with stuttering are usually restless, overly mobile. Their movements are abrupt, often insufficiently coordinated. Distinct disturbances are also revealed in the psychological study of these children - lack of attention, memory, etc.

The dynamics of these symptoms, as a rule, is parallel to the dynamics of the speech defect. With a decrease in stuttering, other vegetative, somatic and emotional manifestations of the neurotic process also decrease, and, conversely, an increase in stuttering is usually combined with their increase. At the same time, patients with stuttering can be observed in whom no other symptoms of neurosis can be detected.

It follows from the foregoing that when correcting stuttering, along with speech therapy measures, mandatory sanitation of the patient should be carried out.

More on the topic Organic disorders of the nervous system:

1. 4.1. RELATIONSHIP OF THE CONCEPTS "PROPERTIES OF THE NERVOUS SYSTEM" AND "TYPOLOGICAL FEATURES OF THE MANIFESTATION OF THE PROPERTIES OF THE NERVOUS SYSTEM"

The owners of the patent RU 2254571:

The invention relates to medicine, psychiatry and neurology, and in particular to methods differential diagnosis depressive disorder and organic lesions of the central nervous system in post-stroke patients. Conduct an assessment of the mental state of patients. Determine the number of eosinophils, basophils and stab neutrophils in the peripheral blood. With the number of eosinophils from 1.97 to 2.52%, basophils 0.12 to 0.14%, stab neutrophils from 0.64 to 0.91%, a depressive disorder is diagnosed. When the number of eosinophils is less than 1.32%, basophils from 0.03% or less, stab neutrophils from 1.27% and above, a diagnosis is made organic lesion central nervous system. The method allows to improve the accuracy of differential diagnosis. 10 ill., 1 tab.

The invention relates to the field of medicine, psychiatry and neurology, specifically to methods for the differential diagnosis of depressive disorder and organic lesions of the central nervous system in post-stroke patients.

A known method for the differential diagnosis of depressive and psychoorganic syndromes in post-stroke patients, based on the clinical picture, which consists in collecting anamnestic and clinical signs and describing them in the ICD10 (international classification) (8), according to which F01-F01.9 is regarded as vascular dementia ; P-07 as an organic personality disorder, F-06 as an organic mental disorder, P-07.8 as a right hemisphere organic affective disorder, F-07.9 as an organic psychosyndrome. When a gross impairment of memory and mental activity, disorientation in time, space, the appearance of confabulations, a delusional hallucinatory syndrome, and emotional disorders are detected, a severe course of vascular dementia is assessed. However, these methods are based on processing clinical symptoms and signs. Due to the lack of sufficiently reliable and reliable criteria, differential diagnostic conclusions are possible with a wide involvement of information characterizing the course of the disease. However, for the study of issues of classification in psychiatry, regular relationships of clinical symptoms that correspond to changes in various functional systems of the body and adequately reflect neurophysiological and social factors are of decisive importance. Thus, the differential diagnosis is difficult in distinguishing vascular dementia from senile dementia, depressive disorders from dementia. Differential diagnostic criteria are based on clinical signs, such as acute onset of the disease, uneven course of the disease, acute psychotic episodes (in particular, nocturnal). This condition is based on an atherosclerotic vascular process with secondary atrophy of the cerebral cortex. In the second case, only treatment with antidepressants with a good clinical effect can remove the diagnosis of dementia. It is impossible to test patients from the group with organic lesions of the central nervous system, and an adequate assessment of the psychopathological state depends largely on the subjective factor (doctor's knowledge).

A new technical challenge is to improve the accuracy and information content of the method.

The task is solved by new methods of differential diagnosis of depressive disorder and organic lesions of the central nervous system in post-stroke patients, which consists in assessing the mental state, according to the International Classification of Diseases of the 10th revision, and additionally, the number of eosinophils, basophils and stab neutrophils in the peripheral blood is determined and the number eosinophils from 1.97 to 2.52; basophils from 0.12 to 0.14; stab neutrophils from 1.27 and above diagnose an organic lesion of the central nervous system.

The method is carried out as follows. Upon admission of the patient, except for the clinical neurological examination and assessment of the state of the mental sphere, according to the International Classification of Diseases 10th revision (ICD-10) (8), they also take peripheral blood, followed by counting of leukocytes, lymphocytes, eosinophils, basophils, stab and segmented neutrophils, and with the number of eosinophils from 1.97 to 2.52, basophils 0.12 to 0.14, stab neutrophils from 0.64 to 0.91, a depressive disorder is diagnosed, and if the number of eosinophils is less than 1.32, basophils from 0.03 or less, stab neutrophils from 1.27 and above diagnose an organic lesion of the central nervous system.

These criteria were selected based on the study of clinical material, observation of 421 patients, including 186 men and 235 women. The average age is 61.5 years. Patients were combined into 4 groups: control (C), with depressive disorders (DR), with organic damage to the central nervous system of vascular origin with psychotic manifestations (P), lethal group (L).

The control group (C) consisted of patients without psychopathological manifestations - 139 people (men - 66, women - 73). Average age - 57 years.

Patients with depressive disorders (D) were observed 195 people. The mean age was 58.3 years. Depressive disorders were assessed according to the ICD-10 criteria and refined using the Beck Depression Self-Rating Scale. Patients with a mild and moderate depressive episode predominated - 179 patients (women - 105, men - 74).

There were 37 patients with organic lesions of the central nervous system with psychotic manifestations (20 women, 17 men). The average age in this group is 65.5 years. Patients with damage to the right hemisphere predominated - 21 people.

There were 50 people who died in the acute period from ischemic and hemorrhagic stroke (25 women and men each), they were included in the lethal group. The average age was 65 years.

The assessment of white blood parameters was carried out in accordance with the normative indicators of a healthy person.

Table 1 shows the average values ​​of white blood parameters for the main groups of patients. K - control group, LDE - mild depressive episode, UDE - moderate depressive episode, TDE - severe depressive episode, L - lethal group, P - organic lesion of the central nervous system (CNS).

The study analyzed 4 groups: the control group (C), with depressive disorders (D), the group with organic lesions of the central nervous system with psychotic manifestations (P), and the lethal group (L). Observations and some patterns in the average values ​​for groups for individual indicators are shown in Fig. 1-6.

As shown in FIG. 1, there is a clear trend towards the growth of leukocytes in the series according to the severity of patients, starting with the control group (K) and ending with the lethal (L) group. For the L-group, the content of leukocytes is higher than in the K-group, more than 2 times. There is a significant difference between the groups.

As shown in FIG. 2, the average values ​​of segmented neutrophils in the L-group differ significantly (by 13% -15%) from all the others in this parameter. The remaining groups are indistinguishable by the mean value. That is, only an extremely serious condition can be determined by this parameter

Figure 3 shows a significant increase in the average values ​​of lymphocytes in the L-group (more than 2 times) compared with other groups. The groups K, D, P are indistinguishable from each other.

Figure 4 shows the average content of basophils in the study groups. There is also a clear trend, and each group is clearly distinguishable. By this parameter, one can clearly judge the severity of the patient: there is a depressive disorder or an organic lesion of the central nervous system or an extremely serious condition.

Figure 5 shows a clear trend towards the growth of stab neutrophils, depending on the severity, and their number for the L-group is greater than for the K-group, about 20 times.

Figure 6 shows the average values ​​of eosinophils in groups. There is a significant trend; the value of the indicator for the D-group is higher than that of the control group, but there is a significant tendency for this indicator to decrease with increasing severity.

Thus, the analysis of average values ​​for various groups of various blood parameters made it possible to identify some trends in the behavior of characteristics depending on the severity of the condition.

In FIG. 7 shows the average values ​​for groups different characteristics, standard deviations and confidence intervals at the 95% confidence level.

Analysis of blood components, unfortunately, does not provide additional information regarding the characteristics of groups C, D, and P; confidence intervals overlap quite strongly. Well, only group L is always distinguished, sometimes - P (Fig. 8).

Figure 9, 10 shows the confidence intervals of the average values ​​of eosinophils and lymphocytes. Well, only the lethal group and the group with organic damage to the central nervous system (CNS) are always distinguished according to these parameters.

Based on the analysis of observational data, the following conclusions could be drawn:

1. The absolute content of leukocytes is a good indicator by which one can judge the condition of post-stroke patients. Their number increases with an increase in the severity of the patient's condition: with a depressive disorder (6.51, confidence interval - 0.53 at the level of 95% reliability) and organic CNS damage with psychotic manifestations (7.8, confidence interval - 1.45) compared with the control group (5.59, confidence interval - 0.397).

2. There is a decrease in the average values ​​of basophilic neutrophils in the group of patients with depressive disorders (0.12, confidence interval - 0.11 at a level of 95% reliability) and organic CNS damage with psychotic manifestations (0.029, confidence interval - 0.058) compared with the control group (0.39, confidence interval - 0.17).

3. There is a slight increase in the mean values ​​of eosinophilic neutrophils in patients with depressive disorders (2.23, confidence interval - 0.55 at the level of 95% reliability) compared with the control group (2.1, confidence interval - 0.308).

4. There is a slight decrease in the average values ​​of eosinophilic neutrophils in patients with organic lesions of the central nervous system with psychotic manifestations (1.32, confidence interval - 0.583) compared with the control group (2.1, confidence interval - 0.308).

5. An increase in the mean values ​​of stab neutrophils was found in the groups of patients with depressive disorders (0.75, confidence interval - 0.33) and with organic CNS damage with psychotic manifestations (1.265, confidence interval - 0.732) compared with the control group (0.73 33, confidence interval - 0.108).

6. Organic damage to the central nervous system with psychotic manifestations leads, apparently, to an "unbalance" of blood parameters.

7. Thus, the obtained criteria can be used for the differential diagnosis of depressive disorders and organic lesions of the central nervous system (CNS) in post-stroke patients, as well as for predicting the course of a stroke.

It is known from literary sources that it is necessary to differentiate the severity of depressive disorders, psychoorganic states in order to obtain the most reliable information, which affects the appointment of adequate therapy. Our research has shown that there is agreement with this opinion. It is necessary to differentiate depressive disorders and organic damage to the central nervous system in the early stages, because. "the elimination or reduction of psychopathological manifestations creates the prerequisites for the restoration of the patient's social functioning" . The teachings of G. Selye "on the adaptation syndrome" had a great influence on various fields of knowledge. At present, the study of the nature and applied aspects of the stress response has stepped from laboratory experiments on animals to their broad study by representatives of various scientific disciplines in application to a healthy and sick person. Stroke is seen as a catastrophic reaction of the brain, stress, which has both physiological and psychological components. Adaptive reactions are formed in the central nervous system. Under the action of strong stimuli (stress reaction), a sharp excitation develops in the central nervous system, which is replaced by transcendental inhibition. The literature describes the types of adaptive reactions, which are determined by the percentage of lymphocytes in the leukocyte formula and their ratio with segmented neutrophils,. The rest of the formed elements of white blood and the total number of leukocytes are only additional signs of reactions. The position remains unshakable about the presence of anxiety reactions with lymphopenia, eosinopenia, leukocytosis and neutrophilia in all types of stress. In the literature, we did not find data on the types of adaptive reactions in patients with depressive disorders and organic damage to the central nervous system (CNS) of vascular origin.

The stress reaction is divided into two types: controlled and uncontrolled. In both cases, it affects the limbic system in the CNS, associated with the neuroendocrine subsystem "hypothalamus - pituitary gland - adrenal cortex". With an uncontrolled stress response, mental illness can develop due to a disruption in the interaction of neurotransmitters. In this case, the value of subjective load plays a crucial role. When considering stress within the framework of the “stress response” process (SRP), first there is a primary assessment, which reflects the event in its impact on one’s own personality, then an assessment over time, associated with the realization of individual possibilities for overcoming with an understanding of the situation. This is followed by the process of overcoming (Coping). RPS is characterized by a constant feedback between the source of stress and multi-phase cognitive and emotional assessment of the load. This is important for the stability and integrity of the individual: if he manages to overcome the RPS on his own, there is a controlled RPS (cPSR), otherwise - an uncontrolled RPS (nPSR). For cPSD, the body has methods of overcoming, which, together with adaptation processes, lead to the optimal efficiency of the reaction mechanism , . Uncontrolled stress is associated, on the contrary, with a process that cannot be overcome by the body's own forces. According to Huether G., in this case, the state becomes labilized, a partial termination of the non-optimal behavioral modus. This process of destabilization is fraught with the danger of decompensation of the body, which is realized in the form of stress-induced diseases (psychosis, myocardial infarction, coronary artery disease). In patients who have had a stroke complicated by an organic lesion of the central nervous system with psychopathological symptoms, one can speak of uncontrolled stress. It is important to differentiate this condition from an affective disorder, senile psychosis. After acute disturbances cerebral circulation a syndrome of amnestic dementia with severe memory impairment such as fixation amnesia, gross disorientation and confabulations, the development of lacunar (postapoplectic) dementia with a Korsakoff-like syndrome are possible. Perhaps the development of "pseudo-paralytic" dementia with carelessness, euphoria, talkativeness, disinhibition of drives, lack of a sense of illness, a sharp decrease in criticism and the level of judgments - with a relatively lesser severity of memory and orientation disorders. The psychotic state is characterized by the presence of confusion, disorientation, delirious agitation, anxiety, periodic hallucinatory and delusional disorders. It is impossible to test patients from the group with organic lesions of the central nervous system, and an adequate assessment of the psychopathological state depends largely on the subjective factor (doctor's knowledge). In this regard, the detection of changes in the leukocyte blood count is an objective additional criterion. Thus, the proposed method allows the most accurate assessment of the patient's status due to the identified criteria.

Deviations of white blood parameters in patients with organic CNS damage with psychotic manifestations occupy an intermediate position between patients with depressive disorders and the lethal group. These changes indicate the presence of inferiority, tension of adaptive reactions. These data make it possible to build rehabilitation programs for the category of post-stroke patients with depressive disorder and organic damage to the central nervous system (CNS) with psychotic manifestations. Most important point is the appointment of antiplatelet agents or indirect anticoagulants, angioprotectors, antihypoxants to prevent recurrent strokes and prevent progression mental disorders, as well as small doses of neuroleptics, tranquilizers to relieve psychopathological symptoms. It is mandatory to prescribe modern selective antidepressants to post-stroke patients with comorbid depressive disorders, since depressive disorders have been shown to increase the risk of stroke. In addition, by assessing the white blood parameters of post-stroke patients in dynamics, it is possible to predict the further course of the disease.

Bibliography.

1. Beck A. Cognitive Therapy and emotional disorders. - New York. - International University Press - 1976.

2. Bleuler E. Dementia praecox oder Gruppe der Schizophrenien. - In: Handbuch der Psychiatric / Ed. G. Auschaffenburg. - Leipzig. - Wien, 1911. - 420 S.

3. Shumakov V.M., Gindikin V.Ya., Ryashitova R.K. et al. // Disorders of the nervous system and mental activity in somatic diseases. M., 1979, pp. 406-409.

4. David O. Vibers, Valery Feigin, Robert D. Brown. Guide to cerebrovascular diseases // Per. from English prof. V.L. Feygin. M.: CJSC "Publishing house BINOM", 1999. -672 p.

5. Troshin V.D., Gustov A.V., Troshin O.V., 2000. Acute disorders of cerebral circulation. Publishing house of NGMA. - N. Novgorod, 2000. - 435 p.

6. Guide to psychiatry. T.2. / Ed. Acad. USSR Academy of Medical Sciences A.V. Snezhnevsky. M., 1983. S.508.

7. Garkavi L.Kh., Kvakina E.B., Ukolova M.A. Adaptive reactions and body resistance. Publishing House of Rostov University, 1977. - 109 p.

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Published according to the publication: Zakharov A.I. “How to prevent deviations in the behavior of a child: Book. for educators children. gardens and parents" - 2nd ed. add. - M .: Education, 1983, p.; 7-19. The manual discusses the types and causes of neuropsychiatric disorders. Deviations in the behavior of the child with various disorders are described, the knowledge of which is necessary for educators and parents to solve the problems of strengthening the health of children and the correct formation of the personality of a growing person.

Neuropsychiatric disorders in children, referred to for brevity as nervous disorders, or nervousness, contain a diverse range of their manifestations. According to the degree of prevalence, they can be divided as follows:

1. Minimal brain failure (dysfunction).

2. Neuropathy.

3. Neurotic reactions, neuroses, psychosomatic diseases.

4. Organic disorders of the nervous system.

5. Mental underdevelopment, mental retardation.

6. Psychopathies (pathological characters) and patho-characterological development.

7. Mental illness. From this list, neurotic reactions, neuroses and psychosomatic diseases belong to such a field of activity of a doctor as psychoneurology. Minimal brain failure, neuropathy and organic disorders of the nervous system will recede to neuropathology. Mental underdevelopment, psychopathy and mental illness are within the competence of psychiatry. Therefore, at least three doctors in the field of neuropsychiatric diseases are needed - a neuropsychiatrist, a neuropathologist and a psychiatrist.

Currently, there are only the last two specialists, which makes it impossible to timely diagnose and help children with such widespread neurotic reactions, neuroses and psychosomatic diseases. In practice, neuropathologists believe that psychiatrists should deal with neuroses, and the latter refer patients to neuropathologists, citing the absence of mental illness. A partial solution to this problem was the involvement of psychologists to help children who are in disadvantaged conditions, experiencing personal problems and stress.

Today, very slowly, but still expanding the network of medical psychologists, more closely in contact with the issues of neurology and psychotherapy. Note that psychotherapy is basically a method of not so much mental as psychological impact on the patient in order to eliminate functional neuropsychic disorders and layers that have arisen as a result of mental trauma, prolonged experiences and conflicts, that is, a state of distress. Psychotherapeutic influence can be useful both on the part of a neurologist and on the part of a psychiatrist. But as the main method of treatment, psychotherapy finds the greatest application in psychoneurology, allowing it to successfully influence neuroses and psychosomatic diseases (functional disorders of internal organs and skin due to stress). The psychotherapist is essentially a specialist in the treatment of neuroses, which we will talk about later, devoting a large part of the book to them. In the meantime, let us consider other types of nervousness with which the educator often encounters in the nature of his work.

Minimal cerebral insufficiency (MMN for short) is the most common, although not the most severe, type of nervousness. Its reasons are varied. This is a difficult course of pregnancy, especially the first half: toxicosis, the threat of miscarriage. This is the harmful effect on the body of a pregnant woman of chemicals, radiation, vibration, infectious diseases, as well as some microbes and viruses. These are premature or delayed births, weakness of labor activity and its long course, lack of oxygen (hypoxia.) Due to compression of the umbilical cord, entanglement around the neck. After childbirth, poor nutrition, frequent or severe diseases and infections, accompanied by various complications, helminthic invasions and giardiasis, brain bruises, poisoning and, of course, the ecological situation in the region have an adverse effect on the brain. The genetic factor also works, when parents with similar manifestations will be more likely to give birth to nervously weakened, intolerant and often ill children.

Symptoms of MMN: increased mental fatigue, distractibility, difficulty in memorizing new material, poor tolerance to noise, bright light, heat and stuffiness, motion sickness in transport with the appearance of dizziness, nausea and vomiting. Headaches, overexcitation of the child by the end of the day in kindergarten in the presence of choleric temperament and lethargy in the presence of phlegmatic temperament are possible. Sanguine people are excited and inhibited almost simultaneously.

MMN is not a constant type of nervousness: there are significant fluctuations due to the deterioration or improvement of the somatic condition, season, age, combination with other types of nervousness. 42% of parents of children aged 4 give a positive answer to the question: does your child quickly get tired, distracted, lethargic or irritable during class? To the maximum extent, the signs of MMN are manifested in the primary grades of the school.

In the literature, instead of MMN, you can find the abbreviation MMD - minimal brain dysfunction. It seems to us practically more convenient to designate MMD as the following complex of disturbed behavior: increased excitability, restlessness, distraction, disinhibition of drives, lack of restraining principles, feelings of guilt and feelings, and also criticality accessible to age. Often these children, as they say, “without brakes”, cannot sit still for a second, jump up, run, “without understanding the road”, are constantly distracted, interfere with others. They easily switch from one activity to another without finishing what they started. Fatigue sets in much later and is less pronounced than in children with MMN. Promises are easily given and immediately forgotten, playfulness, carelessness, mischief, and low intellectual development are characteristic. The weakened instinct of self-preservation is expressed in frequent falls, injuries, bruises of the child.

Children with MMD do not necessarily have a choleric temperament, as it might seem at first glance. Rather, their restlessness, distractibility are manifestations of MMN, a general weakening of the brain. At the same time, this is also a lack of self-control, restraining principles due to the congenital, genetically determined underdevelopment of the frontal parts of the brain responsible for the functions of control, volitional concentration and criticism. In the vast majority of cases, the directly organic cerebral (brain) underlying cause of MMD will be chronic alcoholism of the parents, which has a damaging effect on the embryonic (initial) stage of intrauterine development. Together, genetic and cerebro-organic changes in the brain create the features of the character and behavior of these children described above.

Neuropathy is another common type of nervousness in children, defined as painfully increased nervous sensitivity. It may be congenital, since neuro-somatically weakened parents are more likely to have children with such disorders. This is a constitutional-genetic factor in the origin of neuropathy. Can be inherited: affective instability and sensitive or extremely deep sleep; tendency to headaches; fluctuations in blood pressure, allergies and spasms of the gastrointestinal tract on a nervous basis; increased sensitivity to the action of meteorological factors and much more, united by the neuro-vegetative regulation of the internal environment of the body.

Another factor of neuropathy will be various deviations during pregnancy, mainly in the second half, in the form of nephropathy-late toxicosis of pregnancy (high blood pressure, edema, protein in the urine). Along with the constitutional-genetic factor, the factor of acute or chronic stress during pregnancy is of great importance in the origin of neuropathy. Stress is caused by a number of unfavorable life circumstances: difficulties with studying at the institute, lack of normal living conditions, conflicts with relatives, uncertainty about the strength of marriage, unwanted pregnancy, fear of childbirth, etc.

Stress caused by negative experiences - distress leads to hormonal changes in the mother's body. The hormone of anxiety and fear, adrenaline, released at the same time, through the common circulatory network with the fetus, easily enters its developing brain, and in particular, into the so-called diencephalic region, where the nerve (vegetative) control centers of the internal organs and skin are located. The fetus begins to worry in a corresponding way, or it calms down for a while, instinctively calming itself by sucking its thumb (this is clearly seen in the pictures starting from 4.5–6 months of the prenatal period). After birth, such a child shudders from the slightest noise, sleeps restlessly, often burps, he is tormented by flatulence (swelling of the tummy) and pain in the intestines due to recurrent nerve spasms (colic at 3–5 months). By the year, the manifestations of neuropathy become more noticeable, by 2–3 years they reach their maximum, then, under favorable circumstances, they gradually decrease and disappear by the age of 10. It is from the age of 10 that the child's nervous system begins to function at a qualitatively new level of its development, while the nerve cells are covered with a myelin protective sheath, and a sleep biorhythm close to that of an adult is established.

The most stable, pronounced manifestations of neuropathy are as follows:

1. Emotional instability - lability, including the ease of the onset of affects, crying, anxiety, mood disorders.

2. Vegetovascular dystonia in the form of fluctuations in blood pressure, mainly in the direction of its decrease (hypotension), dizziness, excessive sweating, chills, palpitations and pulse instability, poor health with fluctuations in barometric pressure (meteopathy). Autonomic instability is expressed by the ease of occurrence of spasms of the face (redness or blanching), head (headaches), respiratory tract (false croup in children of the first years of life, asthma in subsequent years), esophagus (“lump in the throat”, “porridge in the mouth”) , stomach and intestines (regurgitation in infants, nausea and vomiting, abdominal pain in the navel, nervous stool disorder), biliary tract (dyskinesia).

The combination of emotional lability and vegetovascular dystonia gives rise to ease of occurrence. emotional stress and vegetative disorders from the internal organs or systems, weakened like places of "least resistance of the body" to the adverse effects of constitutional (congenital) and acquired factors.

3. Sleep disturbances: difficulty falling asleep, sensitive with awakenings or excessively deep sleep with involuntary urination, poor health in the morning, early (up to 4 years) refusal to sleep in the afternoon.

4. Metabolic disorders mainly in the form of diathesis: exudative-catarrhal (diaper rash, weeping skin, itching with subsequent development under the influence of stress, neurodermatitis), lymphatic-plastic (puffiness, pastosity, adenoids in preschool and tonsillitis in primary school age), nervous -arthritic (increased sensitivity of bones and joints to cold, dampness, polyarthritis - inflammation of the joints and rheumatism in adolescence).

Separately and in connection with diathesis, it should be said about allergies - a painfully acute reaction of the body to odors, drugs, dust and some food substances in the form of irritation of the mucous membranes (cough) of the skin (itching, urticaria), swelling of the face.

Children with neuropathy are characterized by insufficient enzymatic activity in the first years of life, poor appetite, and reduced body weight. Making them eat is always a problem for parents, often developing into a conflict. Forced feeding is accompanied by a growing aversion to food, and even vomiting, and is fraught with the development of gastrointestinal disorders such as gastritis due to the low amount of gastrointestinal juice secreted.

5. Minimal brain weakness - MMO. Reminds MMN with a greater emphasis on the fatigue of nerve cells with noise and prolonged mental stress. After 2-3 hours of being in the monotonous atmosphere of the group, the child becomes less and less focused, more and more lethargic and irritable at the same time. He needs to be alone, play, relax, get distracted, switch to the usual rhythm of life. Upon returning home from kindergarten it takes at least 1-2 hours to relieve neuropsychic stress and restore the natural state. Therefore, the evening hours are not the best time to talk with the child about his behavior.

6. Somatic weakness of the body, due to a general decrease in its reactivity, protective, immune forces and the above-mentioned autonomic dysfunction in the management of internal organs. It is expressed by frequent diseases primarily from the upper respiratory tract, their chronic course. There is a clear connection with the action of nervous, stress factors, confirmed by the disease soon after visiting the nursery and kindergarten.

7. Psychomotor disorders in the form of nervous tics, stuttering, nocturnal and daytime urinary incontinence, encopresis (fecal incontinence). Psychomotor disorders of a neuropathic nature are mostly not recognized, not noticed by the child. They depend on the season, fatigue, nervous tension (stress).

It is not necessary to think that emotional lability, vegetovascular instability, sleep disturbances, metabolism, MMO, somatic weakness and psychomotor disorders are found only in neuropathy. They can exist both separately and be manifestations of other neuropsychiatric diseases. Neuropathy as a general nervous weakness of the body can be said in the presence of at least three of the above signs. The more of them, the more pronounced neuropathy.

A common type of nervousness also includes neurosis, which often occurs against the background of neuropathy and certain malfunctions in the somatic and physical spheres of the body. The main thing that distinguishes neuroses from other types of nervousness is the predetermining role of psychogenic factors in their origin - mental traumas, experiences and stresses that a child cannot cope with and which, like distress, lead to a painful disorder of the neuroregulatory and adaptive functions of the body. The psychogenic, psychologically motivated nature of the origin of neuroses implies their functionality and reversibility, provided that timely qualified assistance is provided by an educator, psychologist and doctor.

In addition to neuroses as diseases, neurotic reactions are distinguished - relatively short-term affective experiences in response to the action of psycho-traumatic factors. Neurotic reactions include: increased excitability, capriciousness or lethargy during the first visit to a preschool institution; fears that temporarily worsen mood and sleep; a state of depression (depression) at parting; sharpened feelings due to the presence of a disease or physical defect, etc.

Neurotic reactions require rather than treatment, but the correct pedagogical and psychological approach on the part of adults. It is important to understand the sources of children's experiences, which is impossible without the ability of parents to analyze and self-criticize. In the presence of emotional contact with children and the authority of parents, mutual understanding in the family, neurotic reactions are copied (pass) rather quickly. If they are repeated and tend not to decrease with age, but to increase in intensity, then a state of chronic emotional stress is not excluded, which easily develops into a neurotic state (when neurotic reactions merge with each other) and neurosis as a neuropsychiatric disease, implying a certain uniqueness of the emerging personality. In this case, professional psychological and psychotherapeutic assistance is already required.

If we combine neurotic reactions and neuroses into one group, then statistically it will occur no less frequently than neuropathy, and almost on a par with MMN. A combination of neurotic reactions and neuroses with an emphasis on the latter can be said in the presence of the following manifestations: increased excitability, nervousness; capriciousness; unstable, easily changing mood; sharpened emotional sensitivity and impressionability; vulnerability, tendency to be easily upset, to worry a lot; tearfulness; inability to protect oneself; timidity, fearfulness, self-doubt.

If we take only such a characteristic as “emotionally sensitive and impressionable, vulnerable, easily upset”, then it does not speak of neurosis and neurotic reaction, but of sensitivity - emotionally sharpened sensitivity. According to parents, sensitivity is most common in 4-year-old girls and 5-year-old boys. This is confirmed by the educators. They also note an increase in 5-year-old boys, in addition to sensitivity, mood lability, timidity, indecision and timidity. This can already be regarded as neurotic deviations in the behavior of the braked circle. In a less pronounced form, they will occur in girls of 6 years. It is at the older preschool age (according to interviews with children) that the greatest number of fears occur, reflecting an increased understanding of danger and awareness of the finiteness of the life path - death. It is not for nothing that fear neurosis is typical at this age, while hysterical neurosis is more common in younger preschoolers and neurasthenia at the age of 3 in response to unresolved problems of adaptation in kindergarten.

We see, according to the assessment of parents and educators, a high probability of the appearance of neurotic deviations in behavior in boys of 3 and 5 years old, in girls of 4 and 6 years old. These ages will be sensitive in their own way to the appearance of neurotic disorders, which in itself requires the provision of timely psychological assistance to prevent the development of neurosis as a disease and the neurotic formation of personality.

Let us turn to the consideration of organic disorders of the nervous system, which again have a hereditary and acquired character. Of greatest interest to us will be residual cerebral organic insufficiency (residual cerebral organic insufficiency). The appearance of organic disorders is most often associated with a severe pathology of childbirth that disrupts the supply of oxygen to the brain of a newborn (the state of asphyxia-suffocation, the absence of a cry or causing mechanical damage and hemorrhage in the brain (cephalohematoma). In some cases, organic changes are the result of severe viral lesions of the fetus that began , but a stopped miscarriage or a severe bruise with partial separation of the placenta (the fetal place through which the vessels pass, supplying the fetal brain with oxygen and nutrients).The Rhesus conflict also has a damaging effect when antibodies appear along with pathological (as opposed to physiological) jaundice and lack of timely medical care.We should mention sepsis (microbial infection of the blood) and pneumonia (pneumonia) in the neonatal period with complications in the brain.One of the common causes of organic brain disorders is severe prematurity of the child due to prenatal preterm birth or less often postmaturity due to their delay.

All these children used to, as a rule, did not survive; now, cases of death during childbirth have become much rarer, but, unfortunately, not yet an excluded phenomenon. Accordingly, the number of children whose cause of nervousness is a long-term result of the pathology of childbirth and the neonatal period has increased.

Later damaging factors can also lead to organic disorders of the brain, mainly up to 2 years, when the brain is especially vulnerable and immature. Among them, mechanical damage to the brain during concussion and bruising is in the first place, and inflammatory phenomena such as meningitis are in the second place.

As it develops, the body to some extent compensates for inherited and especially acquired disorders of the central nervous system, but until this has happened completely, we can qualify them as residual phenomena, as residual cerebral insufficiency. Outwardly, this is quite often manifested by the so-called psychopath-like behavior, i.e., resembling psychopathy, but not being such in its essence. Increased excitability, anger, rage, aggression easily arise for any reason or without it against the background of a bad mood, irritability and anger.

Children with severe organic brain disorders usually lack restraining principles, feelings of guilt and feelings of what happened. They are unceremonious and disinhibited, their sexual desire wakes up early and acquires pathological forms. When communicating with peers, they are characterized by constant conflict and pugnacity, which are noticeably expressed by the end of the day in the group. The best thing What can be done for these children is to pick them up as early as possible from kindergarten or not to take them to kindergarten at all. In the group, they need to be given an additional opportunity to relieve pathologically accumulating nervous tension. For example, let them play on their own in the gym. We should not forget about the possibility and even the need to provide these children medical care, including the appointment of restorative, sedative and reducing intracranial pressure funds.

In another variant, organic brain disorders are manifested by rapid fatigue and exhaustion in class, inhibition of feelings and drives; general passivity and lethargy, which is referred to as cerebrosthenic syndrome. Such behavioral changes are reminiscent of MMN, but they are much more pronounced, especially in terms of exhaustion, lethargy and lethargy that occur even without any tangible neuropsychic stress. Sometimes fatigue is so pronounced that it is simply contraindicated for these children to stay for a long time among a large number of peers. The main thing that adults should remember is that children with organic brain disorders need psychological help. You can not consider them harmful, stubborn, lazy and fight these negative qualities, as this can cause great harm to the health of children.

A few words should also be said about psychopathy - pathological characters, manifested by persistent deviations in behavior. Unlike organic disorders of the nervous system, the occurrence of psychopathy is determined not by external (exogenous) factors, but by internal (endogenous) or genetic mental disorders. In other words, this is the influence of the abnormal temperament of the parents or grandparents. Pathological heredity often makes itself felt in adopted children, whose behavior begins to deviate already in the first years of life, despite the best attitude towards them in the family. Moreover, improper upbringing or the absence of it as such contribute to the strengthening or manifestation of genetic abnormalities in the behavior of children. These are cases when children are abandoned to the mercy of fate by parents leading an immoral and often antisocial lifestyle, when a child is superfluous, rejected, when he is beaten in the literal sense of the word and sees constant examples of cruelty, conflicts and falsehood on the part of adults. Moreover, the latter do not notice or react inadequately to their deviations in the treatment of children. Naturally, such parents do not seek psychological and, even more so, psychotherapeutic help, and if the child is under the supervision of a neuropathologist or psychiatrist, they not only do not follow the doctor's instructions, but also resist them in every possible way. Pathology gives rise to pathology, just as parents suffering from alcoholism, the more characterologically changed and deprived of a sense of responsibility for the health and upbringing of children, the more they have deviations in relations with them.

Various anomalies in upbringing can in themselves lead to significant violations in the formation of the child's character, referred to as pathocharacterological development. In fact, it is a response to the pathologically altered behavior of parents, dictated by their inadequate attitudes towards education, as well as psychopathic features of character and personality. In this series there will be: authoritarian upbringing that suppresses the will of the child; excessive adherence; connivance with any whims and whims of the child; inconsistency, impulsiveness and cruelty; lack of care and concern. Constant conflicts between parents, their rudeness and aggressiveness also have a pathological effect. how a child spontaneously learns this style of communication.

Psychopathy as a pathological temperament fully manifests itself in adolescence and youth. But already in the first years of life, children with psychopathic traits attract the attention of disinhibition or less often inhibition along with conflict, hostility and aggressiveness, as well as the stability of pathological manifestations, uncritical perception in their perception, the difficulty of psychological and pedagogical correction and psychotherapy.

It is still possible to help these children, first of all, precisely at preschool age, but only in a complex of well-thought-out social, psychological, pedagogical and medical measures.

In practice, it is sometimes difficult to separate and clearly, unambiguously differentiate the considered types of nervousness and deviations in behavior. But in itself, the understanding by educators of the painful, unnatural nature of their origin makes it possible, as early as possible, to use the entire available arsenal of psychological and educational measures.

Some criteria for distinguishing between neuropathy and psychopathy, neuroses and psychopathy are given in tables 1, 2.

Table 1. Differences between neuropathy and psychopathy

If you try to determine the percentage of nervous children of preschool age, which includes all the types of nervousness considered, then the most appropriate for this purpose will be an affirmative answer from the parents to the question: does the child have nervous disorders, about which you applied or would like to apply to a neurologist? For boys, this percentage will be 34, for girls - 26.5 (analysis data of 1267 questionnaires of parents of children aged 3-7 years). Problems with the nervous system or one or another trouble in the neuropsychic sphere are thus more characteristic of boys (every third) than girls (every fourth).

Table 2 Main differences between neuroses and psychopathy

The nervousness of boys is more pronounced in an incomplete family. They often manifest either aggressiveness in communicating with peers or lack of independence, dependence, infantilism, fears. Both boys and girls from an incomplete family more often show increased excitability and instability of mood, conflict, stubbornness and negativism. In addition, they experience great problems in adapting and communicating with peers. In all cases, children from an incomplete family require special attention from the educator la, since if they fail in communication, they easily become even more nervous and negative to outside help.

Lebedinsky V.V.

organic personality disorder It is a permanent brain disorder caused by a disease or injury that causes a significant change in the behavior of the patient. This condition is marked by mental exhaustion and a decrease in mental functions. Disorders are detected in childhood and are able to remind of themselves throughout life. The course of the disease depends on age and critical periods are considered dangerous: puberty and menopause. Under favorable conditions, a stable compensation of the individual with saving the ability to work can occur, and in the event of negative influences (organic disorders, infectious diseases, emotional stress), there is a high probability of decompensation with pronounced psychopathic manifestations.

In general, the disease has a chronic course, and in some cases it progresses and leads to social maladaptation. With appropriate treatment, it is possible to improve the patient's condition. Often, patients avoid treatment without recognizing the fact of the disease.

Causes of Organic Personality Disorder

Organic disorders due to the huge number of traumatic factors are very common. The main causes of disorders include:

- injuries (craniocerebral and damage to the frontal or temporal lobe of the head;

- brain diseases (tumor, multiple sclerosis);

- infectious lesions of the brain;

- vascular diseases;

- encephalitis in combination with somatic disorders (parkinsonism);

- cerebral palsy;

- chronic manganese poisoning;

- temporal lobe epilepsy;

- the use of psychoactive substances (stimulants, alcohol, hallucinogens, steroids).

In patients suffering from epilepsy for more than ten years, an organic personality disorder is formed. It is hypothesized that there is a relationship between the degree of impairment and the frequency of seizures. Despite the fact that organic disorders have been studied since the end of the century before last, the features of the development and formation of symptoms of the disease have not been fully identified. There is no reliable information about the influence of social and biological factors on this process. The pathogenetic link is based on brain lesions of exogenous origin, which lead to impaired inhibition and the correct correlation of excitation processes in the brain. At present, the integrative approach in detecting the pathogenesis of mental disorders is considered the most correct approach.

An integrative approach involves the influence of the following factors: socio-psychological, genetic, organic.

Symptoms of Organic Personality Disorder

The symptoms are characterized by characterological changes, expressed in the appearance of viscosity, bradyphrenia, torpidity, sharpening of premorbid features. The emotional state is either marked or unproductive, and emotional lability is also characteristic of the later stages. The threshold in such patients is low, and an insignificant stimulus can provoke an outbreak. In general, the patient loses control over impulses and impulses. A person is not able to predict his own behavior in relation to others, he is characterized by paranoia and suspicion. All his statements are stereotypical and are marked by characteristic flat and monotonous jokes.

At later stages, organic personality disorder is characterized by dysmnesia, which can progress and transform into.

Organic personality and behavioral disorders

All organic behavioral disorders occur after a head injury, infections (encephalitis) or as a result of a brain disease (multiple sclerosis). There are significant changes in human behavior. Often the emotional sphere is affected, and the ability to control impulsiveness in behavior is also reduced in a person. The attention of forensic psychiatrists to a person's organic disorder in behavior is caused by the lack of control mechanisms, an increase in self-centeredness, and the loss of normal social sensitivity.

Unexpectedly for everyone, previously benevolent individuals begin to commit crimes that do not fit into their character. Over time, these people develop an organic cerebral state. Often this picture is observed in patients with trauma to the anterior lobe of the brain.

An organic personality disorder is taken into account by the court as a mental illness. This disease is accepted as a mitigating circumstance and is the basis for referral for treatment. Often problems arise in antisocial individuals with brain injuries that exacerbate their behavior. Such a patient, due to the antisocial stable attitude to situations and people, indifference to the consequences and increased impulsivity, can appear very difficult for psychiatric hospitals. The case can also be complicated by the anger of the subject, which is associated with the fact of the disease.

In the 70s of the 20th century, the term "episodic loss of control syndrome" was proposed by researchers. It has been suggested that there are individuals who do not suffer from brain damage, epilepsy, but who are aggressive due to a deep organic personality disorder. At the same time, aggressiveness is the only symptom of this disorder. Most of the people with this diagnosis are men. They have prolonged aggressive manifestations that go back to childhood, with an unfavorable family background. The only evidence in favor of such a syndrome is EEG anomalies, especially in the temples.

It has also been suggested that there is an abnormality in the functional nervous system leading to increased aggressiveness. Doctors have suggested that severe forms of this condition are due to brain damage, and they are able to remain in adulthood, as well as find themselves in disorders associated with irritability, impulsivity, lability, violence and explosiveness. According to statistics, a third of this category had an antisocial disorder in childhood, and in adulthood most of them became criminals.

Diagnosis of organic personality disorder

Diagnosis of the disease is based on the identification of characterological, emotional typical, as well as cognitive changes in personality.

The following methods are used to diagnose an organic personality disorder: MRI, EEG, psychological methods (Rorschach test, MMPI, thematic apperceptive test).

Organic disorders of the brain structures (trauma, illness or brain dysfunction), the absence of memory and consciousness disorders, manifestations of typical changes in the nature of behavior and speech are determined.

However, for the reliability of the diagnosis, a long-term, at least six months, observation of the patient is important. During this period, the patient should show at least two signs in an organic personality disorder.

The diagnosis of organic personality disorder is established in accordance with the requirements of the ICD-10 in the presence of two of the following criteria:

- a significant decrease in the ability to carry out purposeful activities that require a long time and not so quickly leading to success;

- altered emotional behavior, which is characterized by emotional lability, unjustified fun (euphoria, easily turning into dysphoria with short-term attacks and anger, in some cases a manifestation of apathy);

- drives and needs that arise without taking into account social conventions and consequences (anti-social orientation - theft, intimate claims, gluttony, non-compliance with the rules of personal hygiene);

- paranoid ideas, as well as suspicion, excessive concern for an abstract topic, often religion;

- change in tempo in speech, hypergraphia, over-inclusion (inclusion of side associations);

- changes in sexual behavior, including a decrease in sexual activity.

Organic personality disorder must be differentiated from dementia, in which personality disorders are often combined with memory impairment, with the exception of dementia. More precisely, the disease is diagnosed on the basis of neurological data, neuropsychological examination, CT and EEG.

Treatment of organic personality disorder

The effectiveness of the treatment of organic personality disorder depends on an integrated approach. It is important in the treatment of a combination of drug and psychotherapeutic effects, which, when used correctly, enhance the effect of each other.

Drug therapy is based on the use of several types of drugs:

- anti-anxiety drugs (Diazepam, Phenazepam, Elenium, Oxazepam);

- antidepressants (clomipramine, amitriptyline) are used in the development of a depressive state, as well as exacerbation of obsessive-compulsive disorder;

- neuroleptics (Triftazine, Levomepromazine, Haloperidol, Eglonil) are used for aggressive behavior, as well as during an exacerbation of paranoid disorder and psychomotor agitation;

- nootropics (Phenibut, Nootropil, Aminalon);

— Lithium, hormones, anticonvulsants.

Often, medications affect only the symptoms of the disease, and after discontinuation of the drug, the disease progresses again.

The main goal in the use of psychotherapeutic methods is to ease the psychological state of the patient, help in overcoming intimate problems, depression, and learning new behaviors.

Help is provided both in the presence of physical and mental problems in the form of a series of exercises or conversations. Psychotherapeutic influence using individual, group, family therapy will allow the patient to build competent relationships with family members, which will provide him with emotional support from relatives. Placing a patient in a psychiatric hospital is not always necessary, but only in cases where he poses a danger to himself or to others.

Prevention of organic disorders includes adequate obstetric care and rehabilitation in the postnatal period. Proper upbringing in the family and at school is of great importance.