Retardation is a symptom of many psychological or physiological pathologies, which manifests itself in the form of a decrease in a person’s reaction speed, prolongation of speech, slowdown in mental functions and motor activity.
What is retardation?
In serious cases, a person completely stops reacting to the surrounding atmosphere and remains in apathy or stupor for a long time. There are several types of inhibition:- comprehensive;
- ideational (thinking);
- motor (motor).
Motor and emotional inhibition is a pathology, the causes of which only doctors can identify. They also prescribe adequate treatment.
Pathological inhibition of thinking is also called bradypsychia. This is not inertia of thinking or apathy, but a broader concept. It often appears with age in older people, but is not uncommon in both children and young adults.
Causes and symptoms of slow thinking
A person’s behavior, thinking, and psychological state can be disrupted due to pathologies nervous system and brain. Ideation inhibition is also caused by:
Suppression of motor and thought processes typically manifests itself after drinking alcohol, even once. The same symptoms are sometimes caused by psychotropic drugs, as well as strong sedatives. When they are cancelled, the inhibition goes away.
Causes and symptoms of motor retardation
Motor, as well as mental retardation, manifests itself as a result psychological disorders, as well as all kinds of diseases. Lethargy is sometimes or always felt in the patient's facial expressions and movements. The posture is usually relaxed; there is often a desire to sit down, lie down in bed, or lean on something.Severe motor retardation appears as a result of a stroke or cardiac pathology, when urgent hospitalization is necessary. People with mental disorders, parkinsonism, epilepsy, and chronic depression suffer from constant motor retardation. Such pathologies also require identification and therapeutic correction.
This symptom is also typical for children. It can be chronic in some neurovegetative disorders, for example, cerebral palsy, or manifest spontaneously in high temperature, after severe stress or impression. Lethargy in children often results from:
- vascular pathologies of the brain;
- endocrine pathologies;
- meningitis;
- psychological disorders;
- epilepsy;
- encephalitis;
- severe stressful situations.
For any type of inhibition in a child: speech, motor, mental, consultation with several specialists and competent diagnosis is necessary. In most cases, this condition in children is corrected with medication or with the help of a psychologist.
Diagnosis of lethargy
In case of psychological disorders, as well as physiological pathologies caused by inhibition of mental, motor or speech reactions, a thorough diagnosis is necessary, that is, a medical and psychological examination.Such patients are examined by speech therapists, neurologists, psychiatrists, psychotherapists and other specialists. It is necessary to accurately determine whether there are brain disorders, whether the person has had head injuries, hereditary diseases. To determine the organic nature of the disease, the following is prescribed:
- PET and MRI of the brain;
- blood tests.
Treatment of lethargy
- Activation of thought processes. To do this, they read new books, master languages, engage in creativity or solve mathematical problems. Such actions train the brain and activate mental activity.
- Neuroprotectors and nootropics. Drug treatment aimed at restoring and strengthening nerve cells and tissues.
- Vascular therapy. The drugs help cleanse the walls of blood vessels, this is especially important for the brain. As a result, it is activated physical activity, and mental retardation gradually recedes.
- Psychotherapy. It complements drug treatment. Modern methods of psychotherapy help to cope with the consequences of stressful situations, correct personal assessment, and form the correct models of response to certain moments.
- Sports and fresh air. Moderate exercise stress, walks outside help the brain rest and nerve cells recover due to the additional flow of oxygen.
Inhibition of emotions and movements (video)
What is inhibition of emotions and movements? How to correctly identify and treat pathology, we will learn the doctor’s recommendations from the video.
Endogenous depression - mental disorder, the classic manifestations of which are decreased mood, motor inhibition and slow thinking.
Given mental disorder very difficult for patients to tolerate. The symptoms of the disease are so pronounced that they radically disrupt a person’s usual way of life.
Endogenous depression can be either an independent disease or one of the phases within.
Causes of affective disorder
Given emotional disorder belong to the so-called diseases of predisposition. The genetic factor plays a significant role in its occurrence.
Reduced adaptive capabilities of a person and dysregulation of certain substances in the body, such as serotonin, norepinephrine, and dopamine, are hereditary. At endogenous depression there is a lack of these substances in the body.
The cause of endogenous depression is not only the pathology of certain genes. Even with the presence of such genes, a person living in favorable psycho-emotional conditions may not suffer from depression. The trigger for the development of the disease can be an external influence - a psychotraumatic situation, diseases internal organs, taking certain medications, neurological pathologies.
But in the future depressive disorder, whose development was launched external factor, may worsen on its own. This is observed, for example, with autumn depression, which occurs as a result of the change of seasons and is accompanied by hormonal changes in the body.
Symptoms
The main symptoms of depression, as mentioned above, are low mood, slow thinking and motor retardation. These symptoms are called Kraepelin's triad.
Depressed mood
Decreased mood (hypotymia) is the most characteristic feature this affective disorder.
A symptom close to hypothymia is an unbearable feeling of melancholy and mental pain, which for patients is equivalent to physical suffering. Sometimes people suffering from depression even show that sadness “sits” behind their sternum or in the head and neck area. At the same time, patients clearly distinguish the feeling of melancholy from the symptoms of diseases of internal organs, for example, the heart. Melancholy can also leave its mark on the perception of the world around us - everything around seems gray and unreal.
Endogenous depression is very often accompanied by daily fluctuations in the condition, with the peak of deterioration in the condition occurring in the morning.
When describing the symptoms of endogenous depression, one cannot help but dwell on the decrease or complete loss of the ability to experience pleasure. Sometimes it is so pronounced that patients are bothered by a painful feeling of the absence of any desires or feelings.
Slowing down your thinking
Slowing down thinking is not a whim of the patient. The biochemical changes occurring in the body are reflected in such a way that a person begins to think and speak very slowly. Such patients are under no circumstances able to think or speak faster (be it a fire or something else).
In addition, patients are confident in their own worthlessness and guilt. Delusional ideas of self-blame may appear (a person thinks that if something doesn’t work out for his loved ones, then it’s all because of him), sinfulness (the patient considers himself a huge sinner), hypochondriacal (a patient with depression thinks that he is suffering from a fatal illness, for example , cancer).
Peculiar visions and ideas may arise in which a person commits some terrible actions, for example, accidentally stabbing a child or husband.
Motor retardation
With endogenous depression, patients perform all actions extremely slowly. Sometimes, against the background of motor retardation, agitation may occur, during which a person can injure himself or commit suicide.
Suicidal thoughts and even actions are a consequence of delusional ideas of guilt. In this way, a person wants to protect his loved ones from himself and save them from hassle. To avoid such negative consequences, it is necessary not only to provide timely treatment, but also.
Sleep disturbances may also occur - difficulty falling asleep, light sleep, early awakening, lack of feeling of recovery after sleep.
Signs endogenous process Compared to more pronounced and long-lasting ones, they do not go away on their own and require drug treatment. If the patient does not receive necessary assistance, then the disease can develop into chronic form, or the person may attempt suicide.
This disease is characterized by periodic relapses (exacerbations), which can occur independently, without any apparent external cause.
Treatment
The basis of treatment for endogenous depression is the use of medications. Endogenous depression is precisely the disorder for which special medications cannot be avoided, because the disorder is based on changes at the biochemical level.
Antidepressants are most often used. The choice of medication is based on the severity of the symptoms present. The best effect, as well as minimal side effects modern antidepressants such as sertraline, fluvoxamine, cipramil, fluoxetine have.
While taking antidepressants, symptoms reverse. It must be taken into account that after 1-3 weeks from the start of treatment, motor retardation decreases, at the same time, decreased mood, delusional ideas of one’s own guilt and even suicidal thoughts may still persist. Therefore, this period is considered the most dangerous in terms of suicide attempts. It is necessary to carefully monitor the patient's behavior during this period. You may even need hospitalization.
Antidepressants must be used long-term (for months, and sometimes several years). Sudden cessation of medication may result in a return of symptoms.
Psychotherapy is used only as an adjunct to drug treatment. Psychotherapy sessions help resolve existing problems and conflicts, but without antidepressants it is impossible to eliminate the metabolic disorder that occurs with endogenous depression.
Prevention and prognosis
With endogenous depression, the most important thing is to prevent the emergence of new depressive episodes. To do this, you need to take small doses of antidepressants and mood stabilizers, after consulting with a psychiatrist.
People suffering from this mental disorder need to avoid excessive stress on the psyche, work at night, do not abuse alcohol, and lead a healthy lifestyle.
The prognosis for endogenous depression is not very favorable compared to reactive depression. The cause of the disease lies inside the human body, so influencing the course of the disease is not so easy. However, the application prophylactic doses drugs can prevent the development of relapses of the disease, reduce their number, and reduce the severity of symptoms.
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Lethargy is a symptom of certain diseases, usually of the central nervous system and brain, or a consequence of severe psycho-emotional shock. This state of a person is characterized by the fact that he has a decrease in the speed of reaction to actions addressed to him or performed by himself, a deterioration in concentration, more extended, with long pauses in speech. In more complex cases, there may be a complete lack of reaction to surrounding events.
This state of a person should not be confused with a chronic depressive state, since the latter is more likely psychological factor rather than physiological.
The true causes of retardation can only be determined qualified doctor. It is strongly not recommended to carry out treatment at your own discretion or ignore such a symptom, as this can lead to serious complications, including irreversible pathological processes.
Etiology
Retardation of movements and thinking in a person can be observed in the following pathological processes:
- head injuries;
- malignant or benign formations in the brain;
- diseases that affect the central nervous system;
- mental disorders;
In addition, a temporary state of slowness of reaction, movement and speech can be observed in the following cases:
- under alcohol or drug intoxication;
- with and constant lack of sleep;
- with frequent nervous overstrain, chronic;
- under circumstances that cause a person to feel fear, anxiety and panic;
- with severe emotional shock.
Psychomotor retardation in a child may be due to the following etiological factors:
- vascular diseases of the brain;
- stressful situations;
- psychological disorders.
Depending on the underlying factor, this condition in a child can be temporary or chronic. It goes without saying that if such a symptom appears in children, you should immediately consult a doctor, since the cause of the pathology can be dangerous to the baby’s health.
Classification
The following types of retardation are distinguished according to the clinical picture:
- bradypsychia - inhibition of thinking;
- mental or ideational inhibition;
- motor or movement retardation;
- emotional inhibition.
Establishing the nature of this pathological process lies within the competence of only a qualified physician.
Symptoms
The nature of the clinical picture, in this case, will entirely depend on the underlying factor.
When the brain and central nervous system are damaged, the following clinical picture may be present:
- (hypersomnia), lethargy;
- , which will intensify as the pathological process worsens. In more complex cases, elimination pain syndrome impossible even with painkillers;
- memory impairment;
- decreased quality of cognitive abilities;
- the patient cannot concentrate on performing usual actions. What is noteworthy is that it is the professional skills that are retained;
- sudden changes mood, traits appear in the patient’s behavior that were not previously characteristic of him, most often attacks of aggression are observed;
- illogical perception of speech or actions addressed to him;
- speech becomes slow, the patient may have difficulty finding words;
- and, which is most often observed in the morning;
- unstable blood pressure;
In a child, the general clinical picture with this kind of pathology may be complemented by moodiness, constant crying, or, on the contrary, constant drowsiness and apathy towards usual favorite activities.
It should be noted that the symptoms described above are also observed after. If you suspect that a person is having a seizure, you should call emergency medical attention and rush them to hospital. It is the urgency and coherence of primary medical measures after a stroke that largely determine whether a person will survive or not.
If the cause of a delayed reaction in an adult is a mental disorder, the following symptoms may be present:
- or drowsiness, which is replaced by an apathetic state;
- unreasonable attacks of aggression;
- sudden change in mood;
- causeless attacks of fear, panic;
- suicidal mood, in some cases, actions in this direction;
- state of chronic depression;
- visual or auditory hallucinations;
- nonsense, illogical judgments;
- neglect of personal hygiene, sloppy appearance. At the same time, a person can be firmly confident that everything is fine with him;
- excessive suspicion, the feeling that he is being watched;
- deterioration or complete loss of memory;
- incoherent speech, inability to express one’s point of view or specifically answer simple questions;
- loss of temporal and spatial orientation;
- feeling of constant fatigue.
You need to understand that this human condition can progress quickly. Even if the patient’s condition improves temporarily, it cannot be said that the disease has been completely eliminated. In addition, such a person’s condition is extremely dangerous both for him and for the people around him. Therefore, treatment under the guidance of a specialized doctor and in an appropriate institution is, in some cases, mandatory.
Diagnostics
First of all, a physical examination of the patient is carried out. In most cases, this should be done with a person close to the patient, since due to his condition he is unlikely to be able to answer the doctor’s questions correctly.
In this case, you may need to consult the following specialists:
- If the cause of such a person’s condition is either the central nervous system, then an operation is performed to excise it, followed by drug treatment and rehabilitation. The patient will also need rehabilitation after a stroke.
Drug therapy may include the following drugs:
- painkillers;
- sedatives;
- antibiotics if the disease is of an infectious nature;
- nootropic;
- antidepressants;
- tranquilizers;
- drugs that restore glucose levels;
- vitamin and mineral complex, which is selected individually.
In addition, after completing the main course of treatment, the patient may be recommended to undergo a rehabilitation course in a specialized sanatorium.
Provided that therapeutic measures are started in a timely and correct manner, they full implementation, almost complete recovery is possible even after serious illnesses- oncology, stroke, psychiatric illnesses.
Prevention
Unfortunately, specific methods there is no prevention. You should follow a rest and work schedule, protect yourself from nervous experiences and stress, and begin treatment for all diseases in a timely manner.
Retardation is pathological condition, which is a symptom of physiological or mental illness. Manifested by such signs as: reduced human reaction; extended speech; slow flow of thoughts and movements. Sometimes the patient may involuntarily ignore the world and remain in a state of stupor for a long time.
When thinking is impaired, this symptom is called ideation, and if it manifests itself in speech, then motor.
Inhibited human behavioral reactions, as well as all mental processes, occurring in the body, can be triggered by various reasons: diseases of different nature; ; the action of tranquilizers that cause such a reaction; stressful conditions; and sadness.
In medicine, this condition is noted as bradypsychia (many mistakenly assume apathy). However, this is a different disease with different mental and pathophysiological basis. Bradypsychia is often diagnosed in older people. But it also occurs in people young, and there are reasons for this.
Etiology and classification
To date, the reasons for its appearance have not been fully studied. Disorders of behavior, thinking and psychological states may occur when various diseases brain In some patients, this manifests itself due to disorders in the nervous system. That's why the following diseases are indicated as reasons.
Diseases blood vessels: spicy or chronic pathologies cerebral blood flow in atherosclerosis, hypertension, embolism and thrombosis of head vessels. Such diseases affect the parts of the brain responsible for the speed of thinking.
The specialist conducts and prescribes the following examination:
- visual examination of the patient;
- collection of anamnesis of the disease (carried out to clarify the brain injuries received, neuroinfections suffered and to find out about the presence of such pathology in the patient’s closest relatives);
- laboratory blood and urine tests;
- identifying the level of pituitary hormones;
- cerebral angiography;
- psychiatric tests;
- electroencephalography;
- rheoencephalography;
- positron emission tomography;
- magnetic resonance imaging of the brain;
- lumbar puncture and many other methods.
Diagnosis of speech changes is carried out by assessing the structure of the organs of voice formation and speech production.
The letter is checked by copying the text, writing a dictation and reading. In addition, the patient’s manual motor skills, sensory abilities and intellectual development are studied.
Before making a diagnosis, you should differential diagnosis, the difference between inhibition and stuttering and dysarthria.
Depending on the cause of this condition, the doctor will decide on the method of therapy and hospitalization of the patient.
Treatment
Therapy for this pathology is carried out using conservative treatment and radical measures.
Radical refers to surgery if such a patient has a tumor of the brain or nervous system. During treatment, removal is carried out followed by the administration of medications. Afterwards, the patient undergoes rehabilitation.
As medications he is prescribed:
- painkillers;
- sedatives;
- antibiotics in the treatment of an infectious disease;
- nootropic;
- antidepressants;
- tranquilizers;
- means for restoring glucose levels;
- complex of vitamins and minerals (selected individually).
Psychotherapy is carried out as an addition to drug treatment. Modern methods Such therapy will help to establish the true cause of inhibition. The doctor forms new behavior for the patient during stressful situations, and also corrects the personal assessment.
Self-medication is strictly prohibited, so as not to aggravate an already difficult situation. Before visiting a psychotherapist, preventive measures can be taken. All drug prescriptions and dosages should be performed only by a qualified specialist. Therefore, you should definitely consult a doctor for medical help.
If the patient fully follows all the doctor’s recommendations and prescriptions, provided that the treatment was started in a timely manner and correctly selected, then his full recovery is possible.
If necessary take medicines to lower it. If the phenomenon appears after taking strong sedatives, then it must be stopped by stopping their use. In this case, the inhibition will go away without a trace and all reactions will be restored.
Prognosis and prevention
Forecast this state It will be favorable if it was diagnosed in the early stages of development, and if correction of the condition was started in time.
As a preventive measure, the main thing is to prevent damage to the central nervous system during puberty. The same applies to head injuries, infectious diseases And asthenic syndrome. It is important that the child learns to speak correctly, and for this, role models are needed.
The main thing to remember is that the work of the brain depends on its workload. Unused cells die off because they are no longer needed. Because of this, naturally, the “reserves” of the psyche decrease. Throughout his life he must be loaded with work. For example: learn a new language, master science.
In addition, you should adhere to a work-rest regime, avoid stressful situations and nervous tension, conduct timely treatment diseases of various types.
35 years .
Education:1975-1982, 1MMI, san-gig, highest qualification, infectious disease doctor.
Science degree: doctor of the highest category, candidate of medical sciences.
Such cardinal symptom, How psychomotor retardation, found in our material in the majority of patients, and in circular patients with schizophrenic and reactive depression this can sometimes be shown as clearly as in adult patients. But with epilepsy and in some cases of non-circular schizophrenia, lethargy gives way to great agitation. This latter has nothing to do with the elements of mania and leads its way from great internal anxiety, extreme tension, which finds no other way out than motor discharges and disinhibition. Patients in a state of infectious and post-infectious depression do not show much inhibition either. If at first, due to physical weakness, one sees lethargy and passivity, then later, despite the general asthenic-depressive background, patients do not show inhibition; they do not feel any physical difficulty in acting.
IV. Fears
Fear manifests itself differently and, apparently, has a different origin in one or another painful form. It is quite clear that with reactive depression, fear usually has a psychological Tenesis. Often fear is associated with an experience that served as a source of mental trauma.
Fear in schizophrenia or manic-depressive psychosis has a completely different character. This fear is completely unaccountable, unreasonable, coming “from within”, and cannot be explained. We always get the impression that such amorphous fear arises physiologically. We have not had such vivid cases of vital fear associated and localized with a specific part of the body. However, its complete lack of accountability and colorlessness, its appearance in connection with severe somatic sensations, indicate the vitality of this feeling. Sometimes fear arises in children as a primitive defensive reaction.
V. Course of the disease
Consideration of the course of the disease further strengthens our understanding of the differences between individual depressive syndromes. In manic-depressive psychosis and circular schizophrenia we have a phasic course, and in epilepsy it is often paroxysmal. In case of infections and reactive conditions, the course of depression depends on the pathogenic causative factors: mental and physical (exhaustion).
And infectious dysthymia has an unequal course, which is determined by the pace and intensity of the underlying disease, acute or chronic.
VI. The role of personality
A number of authors distinguish two types of depression - endogenous, or vital, and reactive. K. Schneider attributes additional symptoms of vital depression to personality characteristics. The dejected-sad background of depression is conveyed by syntonic properties, irritated-dissatisfied - by schizoid components.
Analysis of the clinical picture indeed confirms the presence of two depressive forms - endogenous and reactive. However, endogenous depression is by no means uniform, but has different pathogenesis. And constitutional data cannot yet explain the entire diversity of depressive states.
If the question concerns infectious conditions, then the importance of the constitutional factor is small. The psychopathological picture in these cases is quite monotonous, as is the course, and yet the premorbid background is different. Consequently, the role of the individual is small compared to the significance of the infectious-toxic moment.
In epilepsy, these relationships are much more difficult to trace. Epileptic mood disorders are difficult to associate with any premorbid personality characteristics. With great right, the psychopathological picture of epileptic depression and the features of its course, as well as its genesis, can be attributed to the features of the process itself.
We get clearer connections with premorbid characteristics in manic-depressive psychosis and circular schizophrenia. Constitutional data define here
phasic course, isolated manic attacks. The openness and accessibility that are characteristic of circular depressions also depend, perhaps, on the premorbid syntonic character.
As for reactive depression, the material reviewed allows us to join those who believe that reactive mood disorders can appear on a different constitutional basis. However, depressive reactions in children are favored by elements of instability, affective lability, sensitivity, and vulnerability in the patient’s personality.
Summarizing our clinical data, we can say with some probability that the mechanisms of depression are not the same in different nosological forms. True, our knowledge regarding the pathogenesis of depressive states is still very limited. A number of researchers have discovered endocrine and metabolic disorders in endogenous depression. This includes changes in the activity of the pituitary gland, gas exchange disorders, etc. (Omorokov, Bondarev, Chalisov, Ewald, etc.).
The data that is available modern science, lead us to assume that changes in emotional life are most associated with disorders of the endocrine-vegetative sphere, which has a predominant localization in the subcortical zone (thalamic and hypothalamic regions).
In conclusion, it is necessary to answer in advance the reproach that can be made regarding the fact that the question of pathogenesis cannot be completely resolved on the basis of one clinic. Of course, a comprehensive laboratory examination in accordance with possible anatomical findings will help to definitively clarify the issue. However, with the current level of our knowledge, clinical research is one of the most important ways to resolve this issue, which has not been sufficiently developed in child psychiatric clinics.
Let's move on to the second part of the final chapter - to features of childhood depression.
The key to understanding these features lies in the anatomical, physiological and mental uniqueness of children.
The fact that the cerebral cortex finally develops in the extrauterine period, while the subcortical centers are formed at the time of birth, does not go unnoticed. For a long time, the relatively greater importance of the activity of the subcortical zone and the physiological weakness of delays have been established in children. A tendency to disinhibition in children has also been noted
by old clinicians (Kovalevsky) and is confirmed in all new works.
To the same physiological phenomena The age order can be attributed to the increased importance of life's drives and the lability of emotions. Affective instability leaves its mark on the structure of the syndrome and, to one degree or another, affects the picture and course of psychosis.
As a result of these factors, the child’s personality remains for a long time (until puberty) not fully formed, either emotionally, volitionally, or intellectually. It is clear that the child is not capable of sufficient intrapsychic processing of his perceptions, sensations, and feelings. His feelings are “naked” in nature, his experiences are more primitive than those of an adult.
1 . Nakedness of feelings very clearly visible in vital depression. Melancholy is completely amorphous, vague, unaccountable in nature. That's why she doesn't seem so strong. Of the two components - vital feeling and reactive processing on the part of the personality - in children there is mainly one immediate “deep” affect. Reactive deposits are kept to a minimum. The younger the child, the more this point is emphasized. We have already said that in schizophrenia, procedural inactivity and lethargy overshadow the affect of melancholy. But even with reactive depression, sadness also does not have much brightness. It is not unconscious, but at the same time monotonous and manifests itself in a low-intensity form.
2. In addition to the simplicity and nakedness of affect in childhood depression, it is also necessary to point out poverty of psychopathological phenomena. Where in adults, especially with circular depression, delusional ideas of persecution, self-abasement, etc. are observed, in children we only sometimes see elements of ideas of self-blame; They do not go further than ideas of relationship in a very primitive form. With depressive reactions, children's statements are also very poor.
3. Many symptoms found in adults are found in children rudimentary condition. Children are not able to fully process individual ideas and concepts. The older child says that he has become “weird”, feels confused, helpless and is somehow aware of this. In a more complete form, this phenomenon would be called depersonalization.
Extremely often, with circular and schizophrenic depression, one encounters uncertainty in sick children,
indecision, anxiety, suspiciousness, low self-esteem.
A similar psychasthenic syndrome often appears in a child as a vestige of ideas of self-accusation. This is explained
[I believe that the child is not able to intrapsychically process those changes in well-being, those experiences of inhibition that give him the idea of his own inferiority.
4. A very characteristic feature of childhood depression is its instability And short duration. Children are more easily distracted from difficult experiences than adults. Even endogenous mood disorders can often be mitigated and switched to other tracks. A melancholy child sometimes suddenly gets involved in school activities and easily starts working in the workshop. The younger the child, the more often his depression changes several times during the day to an even mood. The physiological lability of affect is probably important here. It must also have an effect on the short duration of depressive phases. Their duration in manic-depressive psychosis and circular schizophrenia, especially at the onset of the disease, rarely exceeds 5-15 days. We see the same thing in other painful forms. If depression drags on, then we need to look for additional factors accompanying the underlying disease (general exhaustion, etc.), or focus on studying premorbid personality traits.
The general part indicated that somatic instability and lability of the affective sphere in a prepsychotic state favor a protracted course of depression.
5. It feels like fear, manifests itself in children often and in various forms. But it is precisely in children that one can observe unaccountable, incomprehensible, unmotivated fear, such a feeling of fear is akin to vital melancholy. In children, fear arises especially easily and as a primitive defensive reaction. Where the child does not understand - and in his painful sensations he does not understand much - there he begins to be afraid. The frequency of fears in childhood depression is indicated by Emmingaus, Ziegen, Kovalevsky, Homburger, Gilyarovsky, Sukhareva, Vinokurova.
6. In the picture of childhood depression, it should also be noted that there is less irritability, comparative rarity of general dissatisfaction and anger, which so often colors the depression syndrome in adults.
Elements of general dissatisfaction and irritability can be observed only in epileptic mood disorders. This observation cannot be explained in the same way in all cases. In reactive states, apparently, the answer lies in the simplicity of children’s experiences, their primitiveness, and the absence of additional layers.
In epilepsy, aggression, anger, and irritability are apparently associated with the main process and its impact on the patient’s personality.
In general, if there is general discontent in a child, it manifests itself not in anger, but in capriciousness.
7. Among the interesting and important properties childhood depression refers to its external paradoxicality. The younger the child, the more reason to expect it. This is understandable, since in younger children the lability of affect and the tendency to disinhibition are most clearly represented; At the same time, a change in the life of instincts often comes to the fore.
More clear manifestations of this paradox are observed in reactive depression. We described sharp changes in character (pranks, rudeness) after severe mental trauma with the subsequent appearance of sadness as a new unpleasant experience in one patient. In another case, significant disinhibition and fussiness were discovered, which made it difficult for a 9-year-old boy to study at school after the death of his father, whom he loved very much and whose loss, as it turned out, he was very worried about; however, the affect of melancholy was not immediately detected.
8. Daytime fluctuations in children’s well-being and mood vary reverse order compared to adults. In the morning, children feel better, but in the evening their condition worsens.
In conclusion, I express my great gratitude to Professor G. E. Sukhareva for her constant leadership in this work.
A. I. Golbin
SLEEP AND WAKE DISORDERS IN CHILDREN WITH VARIOUS DISEASES AND ANOMALIES 1
SLEEP DISORDERS IN NEUROSIS
The important place of sleep disturbances in the clinical picture of neuroses is not disputed in any of the main sources.
Neurosis is defined as "... psychogenic illness, which is based on an unsuccessful, irrational and unproductive contradiction resolved by a person between him and the aspects of reality that are significant to him, causing painfully painful experiences for him” 2. One of the main manifestations emotional disturbances with neurosis there is anxiety. Most researchers consider anxiety as a homogeneous condition with a single pathogenetic mechanism. It is generally accepted that the difference in objective data between different groups subjects is determined only by the severity of anxiety. However, in recent years, it has been suggested that anxiety cannot be equated healthy person in an objective stressful situation and anxiety of a patient with neurosis. V. S. Rotenberg (1975), I. A. Arshavsky, V. S. Rotenberg (1976) showed that the anxiety of a healthy person, as an emotionally adequate reaction, is mobilizing and differs from neurotic anxiety that arises as a result of an unresolved conflict. The latter is not aimed at finding a way out of a behavioral conflict, but at abandoning the search when one of the motives is actively ignored. This is the demobilizing effect of neurotic anxiety. The main manifestations of physiological and neurotic anxiety are similar - pulse lability, fluctuations blood pressure, GSR enhancement, etc.
Modern research has shown that to differentiate the two types of anxiety, one should turn to an analysis of the structure of sleep. It turned out that paradoxical sleep (PS), which is associated with dreams and plays important role in psychological adaptation, changes in different directions with these two types of anxiety. For example, with moderate anxiety in a healthy person on the first night of a sleep study, PS decreases by
I" Golbin A. I. Pathological sleep in children. L., 1970, pp. 45-69. 2 Myasishchev V. I. Personality and neuroses. L., 1960, p. 241.
compared with subsequent nights (extension of the latent period of its appearance), which indicates a decrease in the need for PS. In neurotics, in half of the cases there is a tendency to reduce the latent period of PS, which indicates an increased need for PS. The mechanisms that reduce anxiety include primarily PS mechanisms (Rotenberg V. S., 1975; Arshavsky I. A., Rotenberg V. S., 1976). These mechanisms are functionally defective in neurotics.
It seems to us that the insufficiency of sleep mechanisms, in particular PS, is included in the content of the concept of the biological basis of neuroses and therefore sleep changes in neuroses differ from sleep disturbances in other pathologies. This, in our opinion, can explain the spread of sleep disorders in neuroses.
If we believe that in children all forms of neuroses are reduced to three main forms (neurasthenia, hysteria, obsessive neurosis), as in adults, then sleep disorders are described in each of them. Leading researchers on the problem of neurosis obsessive states(Ozeretskovsky D. S., 1950; Skanavi E. E., 1962; Simson T. P., 1955; Garbuzov V. I. et al., 1977) emphasizes the special importance of the moment of transition from wakefulness to sleep. It is believed that the ease of education conditioned reflexes in a dormant state (for example, playing with hair while feeding) creates a “hearth” with pathological inertia. In a drowsy state, obsessive actions begin, such as thumb and tongue sucking, hair pulling, obsessive fears. Characterizing neurasthenia as a separate form of neurosis, most authors believe that the main place in the clinic of neurasthenia is made up of disturbances in the level of wakefulness and sleep, and frequent symptoms are insomnia, terrible dreams, night terrors (Sukhareva G. E., 1974). It is believed (Garbuzov V.I. et al., 1977) that sleep disturbance is one of the early and even specific manifestations of neurasthenia, its leading clinical sign. V. I. Garbuzov considers neurasthenic sleep disorders to be restlessness in children aged from one and a half months to 5-6 years, when children rush about in bed, sprawled and constantly changing position, as well as sleep talking, night terrors, somnambulism, sometimes nocturnal enuresis. The characteristics of sleep in hysterical neurosis are described (Rotenberg V.S. et al., 1975). V.I. Garbuzov (1977) believes that such pathological manifestations in sleep as somnambulism, sleep-talking, night terrors, insomnia, enuresis and even rocking in sleep are a form of “night hysteria.” With the “night hysteria” syndrome in children, V.I. Garbuzov notes that
“The mannerism and pretentiousness of children’s behavior during this period is noteworthy. They, as a rule, wring their hands, bend over in the arms of their parents, scream, cry or laugh “to the point of hysteria,” pound their fists on the bed, on the parents’ face, squirm, squeal, roll their eyes, perform a rudimentary hysterical arc, and grab themselves by the throat , as if something is bothering them, they pinch themselves and those around them, that is, they demonstrate hysterical symptoms in their sleep.” V. I. Garbuzov notes similar behavior, such as “hysterical somnambulism,” in 10% of the patients with hysterical neurosis(Garbuzov V.I. et al., 1977).
Disturbance in falling asleep in neurotic children manifests itself in pronounced prolonged whims and agitation in younger children, fears and rituals in schoolchildren. There is restless sleep with an abundance of movements, often children even fall out of bed. Our studies revealed a high frequency of special postures in sleep, of which, first of all, we should mention a long stay on the stomach and the tendency to lower the head down, so that the head hangs from the bed, while the legs lie on the pillow. Sleep disorders in the form of paroxysmal phenomena in neurotics are most often represented by drooling (which is not at all associated, as is sometimes believed, with worms), grinding teeth (bruxism), and shuddering. Night terrors and nocturnal enuresis are not so common in neurotics compared to other sleep disorders. Stereotypical movements in sleep most often manifest themselves in the form of finger and tongue sucking, hair twitching, and head shaking.
Violation of wakefulness is characterized by lethargy, instability of attention and activity during the day with agitation in the evening. Disorders of wakefulness are also expressed in fainting, affective narrowing of consciousness when excited, drowsiness to the point of complete inversion (i.e., insomnia at night and drowsiness during the day), the occurrence of “paradoxical drowsiness” (Epstein A.L., 1928; Shpak V.M., 1968 ), when children become excited with a strong need to sleep.
The abundance of dreams in neuroses in children can confirm the hypothesis (Rotenberg V. S., 1975; Arshavsky I. A., Rotenberg V. S., 1976) about a compensatory increase in dream activity when refusing to resolve the situation during the day, avoiding the situation, or an inadequate way to resolve it - in dreams the situation is presented in a favorable light.
Often, in the dreams of children with neuroses, a conflict situation in the family is symbolically reflected (“the gypsies attacked, they were looking for mother first, they didn’t find her, but they found me, everything
they cut and cut, but they couldn’t cut it because the knife was dull”, “as if our house had exploded”, “I’m fighting snakes, black snakes bite me in the chest, and while I’m fighting, a big snake with glasses sits on a tree stump , who leads everyone, then I fight with him, he bites me painfully, and I die"). When there are conflicts between parents, the following dreams are typical: someone “stabbed someone”, “there is a war going on”, “as if our house had exploded”, etc.
In general, dreams with neuroses in children are characterized by an abundance of bright scenic pictures, often in color, symbolically reflecting internal conflicts. These dreams differ from the calm dreams of the control group of younger children. school age. In addition, attention should be paid to the fact that in patients with neuroses, dreams are found in more early age than in the control group of children. One of our patients, aged 1 year 3 months, after being frightened during the day by a cat jumping on her in a state of sleep, said “shoo, shoo, shoo” several times and made movements with her hands, like her mother, driving away the cat. Usually, the first dreams are told by children from the age of 3-3/2 years. Our studies of the structure of sleep in neuroses in children confirm the data available in the literature on the extension of the latent period of falling asleep, more frequent awakenings, increasing the duration of light stages of sleep, decreasing the duration deep sleep and increase in PS. Normally, at the age of 10 years, the duration of PS is about 30% of the total sleep duration. PS increases from the beginning of the night to the end, while in patients with neuroses the duration of PS has a peak in the middle of the night and then decreases. The total PS time in the first half of the night is less in neurotics; Particularly indicative is the “first night effect” in laboratory conditions - all sleep indicators almost completely change, and the inherent pathological sleep phenomena (enuresis, sleepwalking, etc.) almost always, even in the most severe cases, disappear. This is associated with the extreme complexity of studying pathological sleep in children and the need for consistent multi-day observation in the process of adaptation to laboratory conditions. It is interesting that before the onset of the first PS, short-term outbreaks of a “test” PS appear, which is explained not by a lack of a “triggering” mechanism, but by affective instability (Leygonie et al., 1974). Paradoxical sleep is a very vulnerable stage, and it is primarily affected by affects
day. In children, reciprocity may be observed between the duration of PS and the intensity of neurotic manifestations, in particular the intensity of neurotic fears (Leygonie et al., 1974). Thus, sleep disorders in neuroses are very extensive and pronounced.
Clinical observations show that many forms of abnormal sleep can occur after acute or chronic mental trauma. When describing separate forms pathological sleep, we will cite cases of psychogenically caused nocturnal enuresis and nocturnal vomiting, insomnia and nightmares, etc. However, our experience convinces us that no less significant is Feedback neurosis and sleep disorders, which is not only psychogenic reaction leads to a disruption of the normal flow of the biorhythm, but, perhaps, on the contrary, pathological sleep leads to a neurotic reaction during the day. An interesting and unexpected fact was a large number of sleep disorders in parents, coinciding with the type of sleep disturbance in the child. N.A. Kryshova (1946) pointed out the inheritance of some sleep characteristics, which can serve as further evidence in favor of the primary biological basis of sleep disorders in neurotics. In the same regard, we can also consider the high frequency of disturbances in the formation of the sleep-wake biorhythm in early childhood up to 3-6 months (67%), expressed either in very restless sleep with an inconsolable causeless cry, or inversion of sleep and wakefulness, when children sleep well during the day and at night they do not sleep and play quietly, or in extremely severe drowsiness, when it is difficult to wake up the child for feeding (a detailed discussion of these issues is presented in the sections on sleep inversion and childhood insomnia).
Literature data and our own observations allow us to say, with slight exaggeration, that neurosis does not exist without sleep disorders, and sometimes these disorders are the only manifestation of neurosis.
Thus, the connection between neurotic reactions and sleep disorders is very complex, and perhaps a productive approach will be in which some psychopathological manifestations during the day will be considered as part of a general disruption of biorhythm. Intimate neurophysiological mechanisms of sleep and wakefulness, which, according to modern concepts, are directly involved in emotional reactions, with a delay in the maturation of sleep in ontogenesis, can be the biological basis of a neurotic reaction.
