Infantile psychosis in children. Psychotic

Article 155.2. Activities of organizations for orphans and children left without parental care for the upbringing, education of children, protection and representation of their rights and legitimate interests 1. Rights and obligations of organizations specified in paragraph 1 of Article 155.1 of this

1. Psychosis

1. Psychosis Letter I understand that I am in a psychiatric ward, but I cannot understand why. I keep telling my sisters that all I need is sleep. I lay my head on the pillow, close my eyes and wait. Nothing happens. I know I would feel better if

The largest group of autism in childhood is represented by the so-called childhood autism (procedural genesis), according to the domestic classification, childhood and atypical autism, according to ICD-10(WHO, 1994) In these cases we are talking about early childhood schizophrenia with onset before 3 years and between 3 and 6 years of age or infantile psychosis with onset before 3 years, atypical childhood psychosis with onset between 3 and 6 years of the child’s life. At the same time, attention is immediately drawn to the dichotomous definition of all types of autism as both autism and, at the same time, psychosis. To understand the origins of this approach to the verification of autism in childhood, it is necessary to briefly look at the history of the development of this problem in child psychiatry. Descriptions of psychoses in children acquire some clarity towards the last quarter XIX centuries. The evolutionary ideas of C. Darwin and I. M. Sechenov were the basis of the evolutionary-ontogenetic method in approaches to the study of mental disorders. Maudsley was the first to put forward the position on the need to study psychosis in the aspect of physiological maturation of the individual: from the simplest disorders in psychosis in childhood to the most complex in adulthood. Developing the doctrine of degenerative psychoses, French and English clinicians showed the possibility of developing psychosis in children of the type"moral insanity" psychopathological manifestations of which were limited only to severe behavioral disturbances. Subsequent decades XX centuries determine clinical and nosological approaches in the study of psychoses in childhood and mature age. Diagnosis of schizophrenia in childhood becomes total. There is a search in the clinic for psychoses of this type in children for symptoms similar to those in adult patients with schizophrenia [Brezovsky M., 1909; Bernshtein A. N., 1912; Weichbrodt R., 1918; Voight L., 1919, etc.]. The fact of the similarity of the clinical picture of schizophrenia in children, adolescents and adults was widely recognized in the monograph A. Homburger (1926). In the 40-60s, the work of children's clinicians in Germany and adjacent countries focused on studying the specifics of delirium, catatonic, affective symptoms, obsessions, speech disorders. Similar questions were resolved in studies of English, American and domestic psychiatrists who described catatonic, hebephrenic, anetic symptoms in schizophrenia in children [Simeon T. P., 1929, 1948; Sukhareva G. E., 1937; Ozeretsky N.I., 1938; Braedley S., 1941; Potter H. W., 1943; Bender L., 1947; Despert J. L., 1971]. On the basis of the doctrine of degenerative developments, conditions similar to schizophrenic psychoses in children began to be considered as degenerative, constitutional psychoses. At the same time, the complexity of their diagnosis was emphasized, the mandatory presence in the structure of psychosis of cardinal signs of schizophrenia, such as poverty of feelings, depersonalization symptoms, dementia, behavioral disorders. Authors who shared the theories of psychogenesis defended the multiple causation of endogenous childhood psychoses; the main place in their clinic was given to the “disorganization” of the individual. Classics of American psychiatry began to define infantile psychosis as symbiotic, which is characterized by a delay in the formation of the mother-child dyad, fragmentation of the “ego-structure” of the child’s personality. During these same years, evolutionary-biological studies in American child psychiatry made it possible to express the opinion that in early childhood schizophrenia, psychopathological symptoms are modified forms of normal behavior combined with somatoform symptoms. Schizophrenic psychosis in children, according to L. Bender (1968), is considered primarily as impaired child development; after work L. Kanner (1943) - as childhood autism. The coexistence of symptoms of impaired development and positive symptoms of the disease, the mutual influence of age and pathogenic factors in the clinic of schizophrenia in early childhood is widely discussed by a number of domestic researchers [Yudin T.I., 1923; Sukhareva G. E., 1937, 1970; Ushakov G.K., 1973; Kovalev V.V., 1982, 1985]. A section is being developed devoted to developmental pathology such as constitutional and procedural dysontogenesis of the schizophrenia spectrum [Yuryeva O. P., 1970; Bashina V. M., Pivovarova G. N., 1970; Ushakov G.K., 1974; Bashina V.M., 1974, 1980; Vrono M. Sh., 1975]. Isolation L. Kanner (1943) early childhood autism has led to significant changes in the diagnosis and classification of psychosis in childhood. Main question, which confronted clinicians, was that Kanner's syndrome is identical to schizophrenia and is its earliest manifestation, and the difference between them is only a consequence of the different physiological maturity of the ill child. Or maybe it's various diseases? This question remains controversial until recently. In the works of domestic authors on endogenous dysontogenesis, this problem has to some extent found its solution. It turned out to be possible to show that Kanner's syndrome occupies an intermediate place in the continuum of constitutional and procedural dysontogenies of the schizophrenia spectrum [Bashina V. M., Pivovarova G. N., 1970; Yurieva O.P., 1970; Ushakov G.K., 1973; Vrono M. Sh., Bashina V. M., 1975]. Kanner's syndrome was classified as an independent circle of dysontogenies of evolutionary-processual origin. The need to highlight both special disorder childhood autism of procedural genesis |Bashina V. M., 1980; Vrono M. Sh., Bashina V. M., 1987]. Childhood autism of procedural origin was considered a disorder similar to early childhood schizophrenia. In the 70-90s, early childhood schizophrenia and infantile psychosis in the predominant number of works began to be considered in the circle of degenerative constitutional, symbiotic psychoses, and childhood autism. In the ICD-10 classification (1994), the understanding of childhood autism went beyond Kanner syndrome and became broader. Childhood autism as a type of isolated disorder includes such developmental disorders as Kanner syndrome, infantile autism, autistic disorder, as well as infantile psychosis (or early childhood schizophrenia in our understanding, with onset from 0 to 3 years). TO atypical autism classified as atypical childhood psychosis with onset at the age of 3-6 years, in our understanding - paroxysmal-progressive childhood schizophrenia. Based on clinical and nosological approaches in the qualification of psychoses and different types dysontogenies in childhood, we consider it reasonable to distinguish Kanner’s syndrome as an evolutionary-process disorder and childhood autism of a processual origin, i.e., childhood schizophrenia. What explains this position? The presence of endogenous genesis in psychosis in childhood is not only positive psychopathological symptoms, but also developmental disorders, the equal significance of these two series of disorders, and the presence of symptoms of autism serve as the basis for verification of childhood autism of procedural genesis, i.e., maintaining a dichotomous approach, which is very important. In such verification we also see a deontological aspect. Diagnosis of this type makes it possible to age stage child to avoid the dire diagnosis of schizophrenia. This serves as the basis for hope for positive physiological possibilities of ontogenesis. At the same time, such a double diagnosis makes it clear to the clinician that we are talking about an ongoing process with all the ensuing consequences, knowledge of which is also necessary when selecting treatment, rehabilitation, and prognosis.

A pervasive developmental disorder defined by the presence of abnormal and/or impaired development that begins before age 3 years and abnormal functioning in all three domains social interaction, communication and restricted, repetitive behavior. Boys develop the disorder 3-4 times more often than girls.

Diagnostic instructions:

The previous period is undoubtedly normal development usually not, but if present, anomalies are detected before the age of 3 years. There are always qualitative disturbances in social interaction. They take the form of an inadequate assessment of socio-emotional signals, which is noticeable by the lack of reactions to the emotions of other people and/or the lack of modulation of behavior in accordance with social situation; poor use of social cues and little integration of social, emotional and communicative behavior; Particularly characteristic is the lack of socio-emotional reciprocity. Qualitative disturbances in communication are equally obligatory. They appear in the form of a lack of social use of existing speech skills; violations in role-playing and social simulation games; low synchrony and lack of reciprocity in communication; insufficient flexibility of speech expression and relative lack of creativity and imagination in thinking; lack of emotional reaction to verbal and non-verbal attempts of other people to engage in conversation; impaired use of tonality and expressiveness of the voice to modulate communication; the same absence of accompanying gestures, which have an enhancing or auxiliary value in conversational communication. This condition is also characterized by restricted, repetitive and stereotyped behaviours, interests and activities. This is manifested by a tendency to establish a rigid and once and for all established order in many aspects Everyday life, this usually refers to new activities as well as old habits and play activities. There may be a special attachment to unusual, often hard objects, which is most typical for early childhood. Children may insist on a special order for performing rituals of a non-functional nature; there may be a stereotypical preoccupation with dates, routes or schedules; motor stereotypies are common; characterized by a special interest in non-functional elements of objects (such as smell or tactile qualities of a surface); The child may resist changes to routines or details of his environment (such as decorations or furnishings in the home).

In addition to these specific diagnostic signs Children with autism often exhibit a number of other non-specific problems, such as fears (phobias), sleep and eating disorders, angry outbursts and aggressiveness. Self-harm (eg, wrist biting) is common, especially if there is concomitant severe mental retardation. Most children with autism lack spontaneity, initiative, and creativity in leisure activities, and have difficulty using general concepts when making decisions (even when completing tasks is well within their abilities). The specific manifestations of the defect characteristic of autism change as the child grows, but throughout adulthood this defect persists, manifesting itself in many ways with a similar type of problems in socialization, communication and interests. To make a diagnosis, developmental anomalies must be noted in the first 3 years of life, but the syndrome itself can be diagnosed in all age groups.

Autism can occur at any level of mental development, but about three-quarters of cases have a distinct mental retardation.

Differential diagnosis:

Besides other options general disorder important to consider: specific developmental disorder receptive speech(F80.2) with secondary socio-emotional problems; reactive attachment disorder in childhood (F94.1) or attachment disorder in childhood of the disinhibited type (F94.2); mental retardation (F70 - F79) with some associated emotional or behavioral disorders; schizophrenia (F20.-) with unusually early onset; Rett syndrome (F84.2).

Included:

Autistic disorder;

Infantile autism;

Infantile psychosis;

Kanner's syndrome.

Excluded:

Autistic psychopathy (F84.5).

F84.01 Childhood autism due to organic disease brain

Included:

Autistic disorder caused by an organic disease of the brain.

F84.02 Childhood autism due to other causes

AUTISM CHILDHOOD

property of a child or adolescent whose development is characteristic sharp decline contacts with others, poorly developed speech and a peculiar reaction to changes in the environment.

F84.0 Childhood autism.

A. Abnormal or disrupted development occurs before age 3 years in at least one of the following areas:

1) receptive or expressive speech used in social communication;

2) development of selective social attachments or reciprocal social interaction;

3) functional or symbolic game.

B. A total of at least 6 symptoms from 1), 2) and 3) must be present, with at least two from list 1) and at least one from lists 2) and 3):

1) Qualitative violations reciprocal social interaction manifests itself in at least one of the following areas:

a) inability to adequately use eye contact, facial expression, gestures and body posture to regulate social interaction;

b) inability to establish (in accordance with mental age and despite existing capabilities) relationships with peers, which would include common interests, activities and emotions;

c) lack of socio-emotional reciprocity, which is manifested by a disturbed or deviant reaction to the emotions of other people and (or) lack of modulation of behavior in accordance with the social situation, as well as (or) weakness in the integration of social, emotional and communicative behavior.

d) absence of a spontaneous search for shared joy, common interests or achievements with other people (for example, the child does not show other people objects that interest him and does not attract their attention to them).

2) Qualitative anomalies in communication are manifested in at least one of the following areas:

a) delay or complete absence colloquial speech, which is not accompanied by an attempt to compensate for this deficiency with gestures and facial expressions (often preceded by a lack of communicative humming);

b) relative inability to initiate or maintain a conversation (at any level of speech development) that requires communicative reciprocity with another person;

c) repetitive and stereotypical speech and/or idiosyncratic use of words and expressions;

d) absence of a variety of spontaneous role-playing games or (at an earlier age) imitative games.

3) Restricted, repetitive and stereotyped behavior, interests and activities, which manifests itself in at least one of the following areas:

a) preoccupation with stereotypical and limited interests that are abnormal in content or direction; or interests that are anomalous in their intensity and limited nature, although not in content or direction;

b) outwardly obsessive attachment to specific, dysfunctional behaviors or rituals;

c) stereotypical and repetitive motor mannerisms, which include flapping or twisting of fingers or hands, or more complex movements of the whole body;

d) increased attention to parts of objects or non-functional elements of toys (to their smell, the feel of the surface, the noise or vibration they make).

B. The clinical picture cannot be explained by other types of general developmental disorder: specific disorder of receptive language development (F80.2) with secondary socio-emotional problems; reactive attachment disorder of childhood (F94.1) or disinhibited attachment disorder of childhood (F94.2), mental retardation (F70-F72) combined with some emotional and behavioral disorders, schizophrenia (F20) with unusually early onset and Rett syndrome (F84.2).

Childhood autism

see also Autism) - early childhood autism (eng. infantile autism), first identified as a separate clinical syndrome L. Kanner (1943). Currently considered as a pervasive (general, multilateral) violation, distortion mental development, caused by biological deficiency of the central nervous system. child; Its polyetiology and polynosology have been revealed. R.d.a is observed in 4-6 cases per 10 thousand children; more common in boys (4-5 times more often than in girls.). The main signs of R.d.a. are the child’s congenital inability to establish affective contact, stereotypical behavior, unusual reactions to sensory stimuli, impaired speech development, early onset (before the 30th month of life).

Childhood autism (infantile)

a relatively rare disorder, signs of which are detected already in infancy, but are usually diagnosed in children in the first 2 to 3 years of life. Childhood autism was first described by L. Kanner in 1943 in a work with a poorly translated title “ Autistic disorders affective communication." L. Kanner himself observed 11 children with this disorder. He insisted that it had nothing to do with schizophrenia and was independent form mental disorder. This opinion is still shared today, although it is not substantiated in any way. Meanwhile, some patients exhibit affective mood disorders; some symptoms of the disorder are virtually identical to the manifestations of catatonia and parathymia, which may indicate an attack of schizophrenia suffered in infancy (E. Bleuler, as is known, believed that 1% of all cases of onset of schizophrenia relate to the first year of life after birth). The prevalence of childhood autism, according to various sources, ranges from 4-5 to 13.6-20 cases per 10,000 children under 12 years of age, and there is a tendency to increase. The causes of childhood autism have not been established. There is information that it is more common in mothers who have had measles rubella during pregnancy. It is indicated that in 80-90% of cases the disorder is caused by genetic factors, in particular, the fragility of the X chromosome (see Fragile X syndrome). There is also evidence that children with autism develop or develop cerebellar abnormalities in early childhood. The disorder occurs 3-5 times more often in boys than in girls. In most cases, signs of the disorder are detected in children under 36 months of age; its most striking manifestations occur between the ages of 2 and 5 years. By the age of 6-7 years, some manifestations of the disorder are smoothed out, but its main symptoms persist in the future. The symptom complex of the disorder is represented by the following main features:

1. the baby’s lack of a posture of readiness when being picked up, as well as the absence of a revival complex when the mother’s face appears in his field of vision;

2. disorders of sleep, digestion, thermoregulation and other, usually numerous somatic dysfunctions, difficulties in developing neatness skills, in other words, pronounced neuropathic manifestations observed already in the first year of life;

3. the child ignoring external stimuli if they do not cause him pain;

4. lack of need for contacts, for affection, isolation from what is happening with extremely selective perception of reality, detachment from others, lack of desire for peers;

5. lack of a social smile, that is, an expression of joy when the face of a mother or another loved one appears in the field of view;

6. a long-term lack of ability in a number of patients to distinguish between living and inanimate objects (up to 4-5 years). For example, a 5-year-old girl talks to a running vacuum cleaner or refrigerator;

7. egocentric speech (echolalia, monologue, phonographisms), misuse personal pronouns. Some patients long time exhibit mutism, so that their parents consider them to be mute. Half of the children have significant speech development disorders, especially those related to the communicative aspects of speech. Thus, children cannot acquire such social speech skills as the ability to ask questions, formulate requests, express their needs, etc. Up to 60-70% of patients are unable to master satisfactory speech. Some of the patients do not speak at all and do not respond to the speech of others until they are 6-7 years old;

8. neophobia or more precisely, the phenomenon of identity (L. Kanner’s term), that is, fear of the new or irritation, dissatisfaction with changes in the external situation, the appearance new clothes or unfamiliar food, as well as the perception of loud or, on the contrary, quiet sounds, moving objects. For example, a child prefers the same, almost completely worn out clothes or eats only two types of food, protesting when parents offer him something new. Such children do not like new words and phrases; they should be addressed only with those to which they are accustomed. Cases of a pronounced reaction of indignation in children even to omissions or substitutions of words in their parents’ lullabies have been described;

9. monotonous behavior with a tendency to self-stimulation in the form of stereotypical actions (multiple repetition of meaningless sounds, movements, actions). For example, a patient runs up dozens of times from the first to the second floor of his house and just as quickly goes down, without pursuing any goal that is understandable to those around him. The monotony of behavior will most likely continue in the future; the lives of such patients will be built according to some rigid algorithm, from which they prefer not to make any exceptions that cause them anxiety;

10. strange and monotonous games, devoid of social content, most often with non-game items. Most often, patients prefer to play alone and whenever someone interferes with their game or is even present, they become indignant. If they use toys at the same time, then the games are somewhat distracted from social reality character. For example, a boy, playing with cars, lines them up in a row, along one line, and makes squares and triangles out of them;

11. sometimes excellent mechanical memory and state of associative thinking, unique counting abilities with delayed development social aspects thinking and memory;

12. patients’ refusal of gentle conditions during illness or search for pathological forms of comfort during times of malaise, fatigue, and suffering. For example, a child with a high temperature cannot be put to bed; he finds for himself the place where it is most drafty;

13. underdevelopment of expressive skills (mask-like face, expressionless gaze, etc.), inability to nonverbal communication, lack of understanding of the meaning of acts of expression of others;

14. affective blockade (in this case we mean poverty of emotional manifestations), underdevelopment of empathy, compassion, compassion, that is, the disorder concerns mainly prosocial emotional manifestations, especially positive social emotions. Most often, patients are fearful, aggressive, sometimes show sadistic tendencies, especially towards those closest to them and/or prone to self-harm;

15. the presence in many patients of significant, clinically significant motor restlessness, including various hyperkinesis, a third of patients experience epileptic seizures, serious signs of organic brain pathology are revealed;

16. lack of eye contact, patients do not look into the eyes of the person coming into contact with them, but as if somewhere into the distance, bypassing him.

There is no specific treatment for the disorder; it is mainly used special methods training, education. It is difficult to judge the results of work with patients, but there are very few, if any, publications reporting significant successes. Some children subsequently develop schizophrenia; in other, most common cases, the diagnosis is limited to a statement of mental retardation or autistic personality disorder. There are known cases of a combination of early autism with Lennox-Gastaut syndrome om (Boyer, Deschartrette, 1980). See Lennox-Gastaut syndrome. See: Autistic psychopathy in children.