Personality changes in epilepsy are characterized. Epilepsy

With a long course of epilepsy, patients often develop certain features that were previously not characteristic of them; a so-called epileptic character arises. The patient’s thinking also changes in a peculiar way, which, if the course of the disease is unfavorable, can reach typical epileptic dementia.

At the same time, the range of interests of patients narrows, they become more selfish, they “lose the richness of colors and their feelings dry up” (V. Griesinger). The focus of the patient’s attention is increasingly placed on his own health and his own petty interests. Internal coldness towards others is quite often masked by ostentatious tenderness and courtesy. Patients become picky, petty, pedantic, love to teach, declare themselves champions of justice, usually understanding justice in a very one-sided way. A peculiar polarity appears in the character of such persons, which is manifested by an easy transition from one extreme to the other. They are either very friendly, good-natured, frank, sometimes even sugary and intrusive, or, on the contrary, unusually angry and aggressive. One of the most bright features of an epileptic nature is a tendency to sudden violent attacks of anger. In patients with epilepsy, rage often occurs without any reason.

In addition, the thinking of patients with epilepsy typically changes, often becoming viscous, with a tendency to detail. With a long and unfavorable course of epilepsy, the features of thinking become more and more distinct, which manifests itself in an increase in signs of a kind of epileptic dementia. The patient loses the ability to separate the main, essential from the secondary, from other small details. Everything seems important and necessary to him, he gets bogged down in details, and has great difficulty switching from one topic to another. The patient’s thinking becomes more and more concretely descriptive, memory decreases, and depletion lexicon, so-called oligophasia appears. The patient, as a rule, operates with a very small number of words and standard expressions. Some epileptics have a tendency to use diminutive words - “little eyes”, “little hands”, “doctor, dear, look how I cleaned up my little bed.” The unproductive thinking of patients with epilepsy is in some cases called labyrinthine.

Example. A patient with epilepsy, wanting to inform the doctor about another seizure, describes her condition as follows: “So, when I got up, I went to wash, there was no towel yet, Ninka, the viper, probably took it, I’ll remember that to her. While I was looking for a towel, I had to go to breakfast, and I hadn’t brushed my teeth yet, the nanny told me to go quickly, and I told her about the towel, and then I just fell, and I don’t remember what happened then.”

All of the above symptoms do not necessarily have to be completely present in every patient with epilepsy. More typical is the presence in a person of only some specific symptoms that naturally manifest themselves in the same form.

Most common symptom The disease is a convulsive seizure, although there are cases of epilepsy without major convulsive seizures. In such cases, they talk about the so-called masked, or hidden, epilepsy (epilepsia larvata). Epileptic seizures are not always typical. There are also various types of atypical seizures, as well as rudimentary and abortive ones. In the latter case, the seizure that has begun can stop at any stage (for example, everything can be limited to just the aura). There are situations when epileptic seizures arise reflexively according to the type of centripetal impulse. The so-called photogenic epilepsy is characterized by the fact that major and minor seizures occur only when exposed to intermittent light (flickering light), for example, when walking along an infrequent fence illuminated by the sun, under intermittent light from a ramp, or when watching programs on a faulty TV.

Late-onset epilepsy (epilepsia tarda) occurs after the age of 30 years. Its peculiarity is the faster establishment of a certain rhythm of seizures, the relative rarity of the transition of seizures to other forms, i.e., it is characterized by a greater monomorphism of epileptic seizures compared to early-onset epilepsy.

In addition to various paroxysmal-convulsive disorders, epilepsy is characterized by mental disorders, manifested by changes in the entire personality structure of the patient, as well as various psychotic states.

Personality changes in epilepsy are characterized by irritability, pickiness, a tendency to quarrel, outbursts of rage, often accompanied by dangerous aggressive actions.

Along with these explosive traits in epilepsy, there are also diametrically opposed character traits - timidity, timidity, a tendency to self-humiliation, emphatically exaggerated courtesy, reaching the point of flattery and servility, exaggerated deference and affection in treatment. The mood of patients is subject to frequent fluctuations - from gloomy-depressed with a feeling of irritation, hostility and hopelessness to increased carelessness or simply somewhat excited without noticeable cheerfulness. The intellectual abilities of patients with epilepsy are also variable. They complain of sluggish thoughts, the inability to concentrate their attention, decreased performance, or, on the contrary, they become overly active, talkative, and capable of doing work that until recently seemed insurmountable to them. Intermittency psychic phenomena in the sphere of mood and mental abilities is one of the most important traits in the character of patients with epilepsy. Patients with epilepsy are characterized by slowness and stiffness thought processes(“heaviness of thinking”, in the words of P. B. Gannushkin). This is manifested in the thoroughness and verbosity of their speech, the tendency in conversation to detail, getting stuck on the unimportant and the inability to highlight the main thing, the difficulty of moving from one circle of ideas to another. Characterized by poverty of speech, frequent repetition of what has already been said, the use of formulaic ornate phrases, diminutive words, definitions containing an affective assessment - “good, beautiful, bad, disgusting”, as well as words and expressions of a religious nature (the so-called divine nomenclature). The speech of patients with epilepsy is melodious. Patients with epilepsy pay attention to their own “I” Special attention. Therefore, in the foreground of their interests and statements is always the personality of the patient himself and his illness, as well as relatives, about whom the patient speaks with emphasized respect and praises at every opportunity. Patients with epilepsy are always supporters of truth, justice, order, especially when it comes to everyday trifles. They are characterized by a love for treatment, belief in the possibility of recovery, and an optimistic attitude towards the future (epileptic optimism).

In cases where listed signs are expressed only partially, not sharply and there is no violation of the patients’ adaptation to usual living conditions, indicating an epileptic character. Their distinct manifestation, accompanied by memory changes of varying depth, suggests the presence of epileptic dementia. The rate of increase in personality changes, as well as memory changes, depends on many reasons, including the duration of the disease itself, the nature of paroxysmal disorders and their frequency.

Against the background of the described personality changes, in some cases due to seizure states (before their onset or after them), in others without visible external cause With epilepsy, a variety of psychotic disorders develop. They are characterized by the following general signs: as a rule, suddenness of the beginning and end, uniformity clinical picture(like a “cliché”), short duration or transient (from several minutes to several days).

Expressiveness personal characteristics in patients, according to most researchers, depends on the duration of the disease and the severity of its manifestations. The main features of the psyche of such patients is the slowness of everything mental processes, primarily thinking and affects. Torpidity, viscosity of thinking, a tendency to be thorough and to get stuck on small, unimportant details are well known to every practical psychiatrist and epileptologist. With a long course of the disease, such features of thinking deepen more and more, the patient loses the ability to separate the main from the secondary, and gets stuck on small, unnecessary details. Conversations with such patients drag on indefinitely. long time, the doctor's attempt to shift attention to main topic does not lead to results, patients persistently state what they consider necessary, adding more and more new details. Thinking is becoming more and more concretely descriptive, template-based with the use of standard expressions, it is unproductive; According to a number of researchers, it can be described as “labyrinthine thinking.”

A significant role in the structure of personal changes is played by the polarity of affect in the form of a combination of affective viscosity, especially negative affective experiences, on the one hand, and explosiveness and explosiveness, brutality, on the other. This determines such personality traits of patients with epilepsy as vindictiveness, vindictiveness, malice, and egocentrism. Quite often one observes also exaggerated sanctimonious sweetness, emphasized servility, affectionate behavior and a combination hypersensitivity, vulnerability with brutality, malice, hostility, sadistic inclusions, anger, aggressiveness. Even in the old days, religiosity was considered almost a pathognomonic character trait of an epileptic. Now this is explained not so much by the disease itself, but by the fanatical mood of the patients, adherence to the belief system and environment in which they were brought up, which is generally characteristic of infantile people. Patients with epilepsy are often characterized by extreme pedantry in relation to both their clothing and special order in their home and workplace. They make sure that everything is perfectly clean and that objects are in their place.

Patients with epilepsy also experience hysterical and asthenic features personality. These can be hysterical discharges with throwing, breaking dishes, loud shouts of abuse, which is accompanied by angry facial reactions, “shaking of the muscles of the whole body,” a high-pitched squeal, or characteristic of asthenia, which is observed in about a third of patients (A.I. Boldyrev, 1971) .

E.K. Krasnushkin (1960) ranked the typical manifestations of an epileptic nature, determining that in the first place is slowness (90.3%), followed by the viscosity of thinking (88.5%), heaviness (75%), hot temper (69.5%) , selfishness (61.5%), vindictiveness (51.9%), thoroughness (51.9%), hypochondriacity (32.6%), litigiousness and quarrelsomeness (26.5%), neatness and pedantry (21.1 %). Appearance patients with epilepsy is also quite typical. They are slow, restrained in gestures, laconic, their face is inactive and inexpressive, facial reactions are poor, and a special, cold, “steel” shine in the eyes is often striking (Chizh’s symptom).

A very close connection can be traced between the personality characteristics of patients with epilepsy and the formation of final epileptic states (S.S. Korsakov, 1901, E. Kraepelin, 1881). The most successful definition of epileptic dementia is as visco-apathetic (V.M. Morozov, 1967). Along with pronounced stiffness of mental processes, patients with epileptic dementia experience lethargy, passivity, indifference to the environment, lack of spontaneity, and dull reconciliation with the disease. Unproductiveness noted viscous thinking, memory loss, vocabulary depletes, oligophasia develops. The affect of tension and malice is lost, but traits of servility, flattery, and hypocrisy may remain. In the initial states, patients lie indifferent to everything, their feelings “dry up” (V. Griesinger, 1868). One's own health, petty interests, egocentrism - this is what comes to the fore in the final stage of the disease.

Epilepsy refers to chronic pathologies brain. This disease is characterized not only by a violation of motor and sensory functions, but also by mental and thinking functions. Medical specialists They also note personality changes that are highly variable. Increased mental disorders are often observed outside of epileptic seizures. Taking medications for the treatment of epilepsy also plays a certain role in this process.

Epileptic character

There has long been debate among neurologists and psychiatrists about the role that personality disorders play in epilepsy. Some researchers believe that a change in the character of a sick person is nothing more than a background against which a tendency to convulsive reactions develops, while others emphasize specific features personality in this category of patients. This contradiction is due to the fact that the spectrum of disorders associated with this disease is very large.

In the 70-80s. XX century appeared in domestic medical science scientific works, confirming the innate character traits of children suffering from epilepsy: stubbornness, explosive behavior and outbursts of anger, increased affection towards parents and friends, excessive hypersociality, anxiety and activity in inappropriate situations.

These and other character traits were identified in children after the first epileptic seizures, as well as in their relatives who could not tolerate epileptic seizures (pettiness, severe demands for carrying out assignments, and other behavioral characteristics).

Endogenous theories

There are several hypotheses explaining the change in character in epilepsy depending on internal factors:

1. Constitutional (hereditary predisposition). According to this theory, a patient with epilepsy is a carrier of innate socially dangerous character traits, and it is possible that he is a descendant of a criminal. Such people are distinguished by their viciousness, hot temper and tendency to drunkenness and violence.
2. Organic - personality changes in epilepsy are associated with organic lesions of the brain.
3. Specific localization of lesions. This theory is similar to the previous one, but it establishes a relationship between the location of the epileptic focus in the brain and specific disorders mental activity.
4. The hypothesis of the dependence of mental disorders on the severity of the disease. According to it, the patient’s personality changes against the background of more frequent attacks due to the activation of hyperexcitable neurons, which are sources of epileptic discharges. This happens 10-15 years after the first incident. Signs of personality changes in epilepsy are increased egocentrism, which has replaced emotional involvement, and frequent manifestations of lust for power instead of altruistic traits. There are also studies that have established a relationship between such changes and the number of epileptic seizures suffered.
5. The theory of the dependence of personality changes on the form of the disease.

Exogenous hypotheses

The character of a person with epilepsy is also affected by the following: external factors:

1. Medicines. It has been established that the character of patients changes not only due to seizures, but also under the influence of antiepileptic drugs (with their long-term use).
2. Social components. Personality changes in epilepsy occur under the influence of the social environment and are associated with the patient’s reaction to his illness and the attitude of others towards him (aggression, restrictions in Everyday life). As a result, patients become very sensitive, vulnerable, touchy, or develop antisocial traits.

Characteristic changes

The most common behavioral features of epilepsy are (listed in descending order of frequency of occurrence in patients):

1. Related to character: perception of one’s point of view as the only correct one; pedantry; extreme accuracy and adherence to rules; rancor and vindictiveness; infantilism.
2. Impaired thinking and memory: slowness and heaviness; tendency to excessive detail and repetition; epileptic dementia.
3. Permanent emotional disorders: inertia of mental processes; impulsiveness; explosive manifestation of affect; obsequiousness.
4. Temperament changes: increased instinct of self-preservation; predominance of gloomy mood, hypochondria.

Forms of the disease

The relationship between personality changes in epilepsy and the form of this pathology is expressed as follows:

• generalized epilepsy, in which the patient loses consciousness during attacks - emotional sensitivity and short temper, an inferiority complex;
• awakening epilepsy (seizures 1-2 hours after sleep) - stubbornness, isolation, apathy, inability to self-control, indiscipline, lack of critical assessment, alcohol abuse;
• sleep epilepsy - arrogance, hypochondria, pedantry, egocentrism.

Effect of drugs

Antiepileptic drugs can lead to the following behavioral and cognitive disorders:

• barbiturates (“Benzobamil”, “Phenobarbital”, “Benzamil”, “Benzoal” and others) - deterioration of short-term memory, hyperactivity, aggressiveness, depressive states;
• "Carbamazepine" - aggressiveness;
• "Phenytoin" - increased fatigue, cognitive disorders;
• valproic acid preparations at high doses - aggressiveness, with long-term use- disorders of consciousness;
• succinimides (“Ethosuximide”, “Suxilep”) - slowing down of mental processes, irritability, psychosis;
• benzodiazepines (“Gidazepam”, “Diazepam”) - lethargy, in children - irritability and hyperactivity;
• "Lamotrigine" - aggression, irritability, impulsiveness, confusion.

This effect is exerted not only by traditional medicines, but also new drugs. Despite these Negative consequences, these medications are very effective in treating epilepsy.

Infantilism

Infantilism in psychology is a concept denoting immaturity, the preservation of behavioral traits inherent in previous stages of personality development. In patients with epilepsy, this phenomenon often occurs along with flattery and servility to others.

Experts believe that the decisive role in this is played by the feeling of one’s own inferiority, as well as the patient’s desire to hide excessive aggressiveness and alleviate guilt for uncontrollable impulsive outbursts. Such patients also often tend to take a passive position when faced with life's difficulties.

Temporary disturbances in the thinking process most often occur when there is a lesion frontal lobes brain in the left hemisphere and represent the following types of disorders:

• deterioration of speech (difficulty composing phrases, choosing words and understanding);
• feeling of emptiness in the head, complete absence thoughts;
• inability to remember facts from the past and vice versa, intrusive occurrence old memories not related to current life.

Temporal lobe epilepsy

The most extensive symptoms of personality changes in epilepsy are detected when the temporal lobe is affected:

• affective phenomena - unreasonable attacks of anxiety and fear, emotional instability;
• frequent occurrence feelings of guilt, self-reproach, depression, suicidal attempts, moralizing, intolerance of humor;
• speech disorders - unconscious speaking, amnestic loss of speech, its illogicality and incoherence, lack of semantic load in logically correct sentences;
• sexual disorders - loss of desire, exhibitionism, cross-dressing, attraction to inanimate objects;
• general psychopathological signs - hallucinations, delusions, schizoepileptoidia.

Early signs of damage to the temporal cortex include loss of memory of past life experiences, although thinking and criticism may persist. Such patients often keep records of events that are important to them to remember.

Frontal epilepsy

In case of defeat convex surface frontal cortex near its pole more serious changes occur - general degradation and epileptic dementia. Affective and volitional disorders(slowness, lethargy, apathy, inability to understand the meaning of speech, passive facial expressions occur), reminiscent of autism in patients with schizophrenia.

If the basal parts of the frontal cortex of the brain are damaged, then pronounced behavioral disorders are observed, which have antisocial character:

• state of euphoria;
• extreme disinhibition of lower drives (as a rule, increased eroticism, gluttony);
• lack of self-criticism.

In psychiatry, the following types of behavior of such patients are distinguished:

• manic state(excitement, facial flushing, dilated pupils, tachycardia, profuse salivation);
• reactive hysterical psychosis with narrowing of consciousness and pronounced childish behavior, violent movements or singing;
• paroxysmal sexual arousal, demonstration of one's genitals, passionate poses;
• rage, anger, limb spasms;
• attacks of melancholy, attraction to violent acts, torture;
• indifference, detachment, aimless wandering or immobility without loss or darkening of consciousness.

Today, quite a large number of people are deeply mistaken when they believe that such a diagnosis as epilepsy cannot be treated and those who are sick with it are doomed to eternal suffering for the rest of their days. In fact, epilepsy is not a death sentence and responds quite well to treatment until remission is achieved.

The most important thing is timely diagnosis and contacting highly qualified medical specialists, refusal bad habits(especially from alcoholic drinks and cigarettes), recognize all prescribed medications doctor and healthy image life (proper nutrition, avoiding lack of sleep and stressful situations).

What is epilepsy

Epilepsy, or falling sickness as it is also called, is practically the most common disease nervous system twenty-first century. As a rule, it is expressed in regular and groundless attacks and improper functioning of motor, mental, and tactile functions, which occur due to a large number of neural discharges in the brain (or, more precisely, in the gray matter).

The external manifestation of this diagnosis is considered to be suddenly occurring convulsions in a sick person, which paralyze not only the arms and facial muscles, but the entire body.

Today, due to its characteristics, falling sickness is often observed not only in older people, but also in adolescents aged 7-9 years.

Interesting fact: Epileptic seizures can be found not only in humans, but also in many animals (for example, mice, dogs, cats and other mammals)

What mental disorders can occur with epilepsy?

IN modern medicine There are only a few mental abnormalities in epilepsy (based on the predominant syndrome), namely:

• personality deviations, in the form of prodromes of attacks (in 15% of patients);
• personality deviations as an addition to an attack;
• post-ictal mental disorder personalities;
• personality deviations that are caused in the psyche in the borderline time period.

Transient paroxysmal mental disorders in humans

In addition to the above mentioned mental attacks during epilepsy, scientists also identify other epileptic syndromes, namely:

• seizures that are partially sensory in nature;
• seizures that have a simple partial nature + with a deep deviation in the functioning of the psyche;
• generalized partial seizures, which in turn are divided into the following classifications:
• transient or, as they are also called, transient mental deviations;
• dysphoria;
• twilight darkness consciousness;
• various classifications of epileptic psychoses;
• dementia associated with epilepsy, etc.

As a rule, the duration of these attacks in patients with epilepsy can last several hours or last several days.

Epileptic mood disorders

It is considered the most popular form of epilepsy with dysphoria. In most cases, such attacks are expressed in unreasonable aggression, bad mood, fear and melancholy.

During acute exacerbation of the syndrome, epileptic individuals experience strong mental stress, frequent irritation, dissatisfaction with what is happening, and a conflictual attitude towards society. Moreover, sometimes sick individuals with mental disorders can inflict wounds, cuts, abrasions on themselves, that is, cause themselves physical pain.

Regular dizziness, weakness and brokenness throughout the body, rapid heartbeat, tremors, sudden lack of air or a feeling of suffocation are constant physical conditions with this type of mental disorder.

Twilight stupefaction

Manifests itself in the form of acute clouding of consciousness, which retains external constructiveness and consistency of action.

TO general characteristics can be attributed:

• detachment of the sick person from society and its activities;
• unconscious loss in time frame, geolocation, circumstance, and even one’s own personality;
• inconsistency of actions and thought processes;
• complete or partial amnesia.

Symptoms of twilight consciousness

Today, with such a syndrome as twilight or clouding of consciousness, a number of the following symptoms are distinguished:

• unexpected, but very quick onset of its manifestation;
• short-term duration (i.e. lasts for an hour or a maximum of two hours);
• manifestation in an epileptic personality of such affective states, How: unreasonable fear, depression and anger at the world around us;
• pronunciation of unclear and poorly intelligible phrases, phrases + lack of understanding of other people’s speech;
• loss in time, location and identity;
• sometimes manifests itself in the form of mild delirium, visual hallucination, terminal sleep, etc.

Epileptic psychoses

More often, this group syndromes are distinguished into:

• ictal;
• postictal;
• interictal

A single symptomatology manifests itself in the form of a latent or, on the contrary, acute onset. Moreover, it is very important to keep in mind general state consciousness of a sick person with epileptic psychosis syndrome (i.e. short-term and chronic psychoses + psycho-emotional reaction to treatment).

Chronic epileptic psychoses

They have the structure of schizophrenia-like seizures (sometimes also called “schizoepilepsy”).

Medical literature describes the following classifications chronic forms epileptic psychosis:

• Paranoid. They occur in the form of delirium, attempts at self-poisoning, and an anxious and aggressive mental state.
• Hallucinatory-paranoid. Take the form of fragmentation, excessive receptivity and sensuality, which often occurs along with anxious-depressive state and feeling of one’s own inferiority;
• Paraphrenic. Can be like verbal hallucinations, so pseudohallucinations;
• Catatonic. Occurs along with negativism and impulsive excitement;

Persistent mental disorders of a person

In approximately 9 out of 10 cases of this deviation in epilepsy, it is expressed in noticeable changes in the personality and even character of the epileptic. First of all, a sharp modification of the individual’s psyche begins to occur—according to the psychasthenic type (32.6% of patients). With a much lower frequency one can encounter permanent mental disorders of the explosive type (23.9%) and the glischroid type (18.5%).

As for hysteroid manifestations in mental state personality, then only 9-10.7% prevail here, paranoid - 6.6%, schizophrenic - 5.9%.

One way or another, in almost all cases one can observe rapid regression, which manifests itself in the form of egocentrism. Most often, the ability to show sympathy, understanding the words of another person begins to decrease, reflection weakens, the priority of personal opinion comes to the fore, etc.

Epileptic personality changes

According to statistical data, personality changes in epilepsy manifest themselves not only in excessive impressionability with emotional irascibility, but also in a fairly lively mind with high self-esteem.

Doctors also say that awakening epilepsy itself is characterized by a number of the following symptoms:

• limited communication;
• stubbornness and lack of goals;
• Careless attitude, changing attitude towards oneself and what is happening (indifference), complete or partial lack of self-control;
• Sometimes there may be a tendency to use narcotic drugs, alcohol. This is where personality changes occur with the manifestation of dysfunction.

Personality disorder due to epilepsy in sleep epilepsy is characterized by:

• manifestation of selfishness and egocentrism;
• narcissism;
• complexity of thought processes and unhealthy pedantry.

Epileptic dementia

Most characteristic features epileptic dementia in a person with epilepsy is inhibition of consciousness, memory impairment, narrowness of judgment (hence egocentrism), detachment from society, reluctance to communicate, loss of commutation skills.

Remarkably, but only in the last few years, epileptic dementia is observed in 69% of patients diagnosed with epilepsy, which is most often accompanied by mental disorders during the interictal period of exacerbation of the seizure.