Psychomotor retardation. Endogenous depression Slowness lethargy causes

Such a cardinal symptom as 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”, beyond any explanation. 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 available to modern science suggest that changes in emotional life are most associated with disorders of the endocrine-vegetative sphere, which is predominantly localized 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.

The same physiological phenomena of age include the increased importance of life's drives and 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 turns into an even mood several times during the day. 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 of childhood depression is 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 well-being and mood in children are in the 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 “...a psychogenic disease, which is based on an unsuccessful, irrational and unproductive contradiction resolved by the individual between him and the aspects of reality that are significant for him, causing painfully painful experiences for him” 2 . One of the main manifestations of emotional disorders in neurosis 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 in different groups of subjects is determined only by the degree of severity of anxiety. However, in recent years, it has been suggested that it is impossible to equate the anxiety of a healthy person in an objective stressful situation with the 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, blood pressure fluctuations, increased GSR, etc.

Modern research has shown that to differentiate the two types of anxiety, one should turn to the analysis of sleep structure. It turned out that paradoxical sleep (PS), which is associated with dreams and plays an important role in psychological adaptation, changes differently in 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, first of all, the 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 of the problem of obsessive-compulsive neurosis (Ozeretskovsky D.S., 1950; Scanavi E.E., 1962; Simson T.P., 1955; Garbuzov V.I. et al., 1977) emphasize the special importance of the moment of transition from wakefulness to sleep. It is believed that the ease of formation of conditioned reflexes in a drowsy state (for example, playing with hair at the time of feeding) creates a “hotbed” of pathological inertia. In a drowsy state, obsessive actions such as thumb and tongue sucking, hair pulling, and obsessive fears begin. Characterizing neurasthenia as a separate form of neurosis, most authors believe that the main place in the clinic of neurasthenia consists of disturbances in the level of wakefulness and sleep, and frequent symptoms are insomnia, terrible dreams, and 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 around in bed, throwing themselves and constantly changing position, as well as sleep talking, night terrors, somnambulism, and 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, 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 he observed (V. I. Garbuzov 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 looked for their 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 primary school children. In addition, attention should be paid to the fact that in patients with neuroses, dreams are detected at an earlier 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 the cat away. 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, an increase in the duration of light stages of sleep, a decrease in the duration of deep sleep and an increase in PS. Normally, at the age of 10 years, the duration of PS is about 30% of the total duration of sleep. 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 the total time of PS decreases. the first half of the night in neurotics is less; the “first night effect” in laboratory conditions is especially indicative - all sleep indicators change almost completely, 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 individual forms of pathological sleep, we will cite cases of psychogenically caused nocturnal enuresis and nocturnal vomiting, insomnia and nightmares, etc. However, our experience convinces us that the feedback connection between neurosis and sleep disorders is no less significant, that not only a psychogenic reaction leads to a disruption of normal the 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-wakefulness 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 an approach in which some psychopathological manifestations during the day will be considered as part of a general disruption of biorhythm will be productive. 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.

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).

Retardation can be verbal and mental, that is, it has psychological causes. Sluggish and untimely motor reactions are caused by motor retardation. Memory lapses may occur. In most cases, such conditions are caused either by illness, chronic fatigue, or psychological pathologies.
Motor and emotional retardation 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 of the nervous system and brain. Ideation inhibition is also caused by:

Suppression of motor and mental 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 of psychological disorders, as well as various 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 appear spontaneously at high temperatures, 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 or hereditary diseases. To determine the organic nature of the disease, the following is prescribed:

• PET and MRI of the brain;
• blood tests.

Diagnosis of written and oral speech is also carried out. Perhaps the person suffers from stuttering, defects in sound pronunciation, which lead to speech inhibition. The patient’s intellectual development, the state of sensory functions, general motor skills, and the condition of joints and muscles are also studied.

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, motor activity is activated, 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 physical activity and walks outside help the brain rest and nerve cells recover due to the additional flow of oxygen.

If the lethargy is temporary and caused by high fever, then you should take tablets or syrups that reduce the temperature. Temporary inhibition caused by medications and strong sedatives can be stopped by abandoning such drugs. Usually it passes without a trace, the body’s reactions are completely restored.

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.

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 human condition should not be confused with a chronic depressive state, since the latter is more of a psychological factor than a physiological one.

The true causes of lethargy can only be determined by a 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, pain relief is 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 mood swings, 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 type 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 the simplest questions;
• loss of temporal and spatial orientation;
• feeling of constant fatigue.

You need to understand that this human condition can progress quickly. Even with a temporary improvement in the patient’s condition, we cannot say 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 and are fully implemented, almost complete recovery is possible even after serious illnesses - oncology, stroke, psychiatric illnesses.

  Prevention

  Unfortunately, there are no specific prevention methods. 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 a decrease in an individual’s reaction speed, a slower flow of thought processes, and the appearance of protracted speech with long pauses. In extreme cases, a person may completely stop reacting to others and remain in a daze for a long time. Inhibition may not be complex, but relate only to thinking or speech. In the first case it is called ideational, and in the second - motor.

Of course, with such a large number of diseases, the number of types of treatment should also be large. Unfortunately, until scientists have finally figured out how the brain works, there are not as many of these species as we would like. The temporary effect of inhibition in speech and thinking occurs due to lack of sleep, when the body is already exhausted, or due to the use of drugs and alcohol, which inhibit mental and motor processes. That is, the reasons can be divided into those that block activities and those that reduce the possibilities for its implementation.

Symptoms of lethargy

The image of the patient fits into the classic description of a melancholic person: lethargy, slowness, protracted speech, every word seems to be squeezed out with effort. It feels like thinking takes a lot of strength and energy from this person. He may not have time to react to what is said or may completely plunge into a stupor.

In addition to a decrease in the rate of speech and thinking, there is a muffledness of what is said - an extremely quiet and calm voice that occasionally breaks the silence. Lethargy is noticeable in movements and facial expressions, and posture is most often too relaxed. An individual may have a desire to constantly lean on something or lie down. It is not necessary that all manifestations of inhibition be observed. Just one is enough to claim that a person needs medical attention.

Diagnosis of bradyllalia

Persons with speech tempo disorders, including bradyllalia, need a comprehensive medical and psychological-pedagogical examination, which is carried out by a neurologist, speech therapist, psychologist, and psychiatrist. When examining a patient with bradyllalia, a detailed examination of the medical history regarding previous diseases and brain injuries is necessary; presence of speech tempo disorders in close relatives. In some cases, to clarify the organic basis of bradyllalia, instrumental studies are required: EEG, REG, MRI of the brain, PET of the brain, lumbar puncture, etc.

Diagnosis of oral speech in bradyllalia includes assessment of the structure of the organs of articulation and the state of speech motor skills, expressive speech (sound pronunciation, syllabic structure of the word, tempo-rhythmic aspect of speech, voice characteristics, etc.). Diagnostics of written speech involves completing tasks for copying text and independent writing from dictation, reading syllables, phrases, and texts. Along with a diagnostic examination of speech, for bradyllalia, the state of general, manual and facial motor skills, sensory functions, and intellectual development is studied.

When making a speech therapy report, it is important to differentiate bradyllalia from dysarthria and stuttering.

Psychotherapy is carried out only as a secondary addition to drug therapy. Modern psychotherapeutic techniques help to identify and eliminate the true cause of the disorder, form a new model of response to stressful situations, and correct personal assessment.

Before visiting a psychotherapist, the patient can only engage in prevention - all drug treatment has a significant number of contraindications, which the specialist takes into account when choosing one or another remedy. In case of bradypsychia, it is imperative to consult a doctor - there is not a single “easy” reason for such a mental state.

Forecast and prevention of bradyllalia

The prognosis for overcoming bradyllalia is most favorable with an early start of correctional work and psychological reasons for the violation of speech tempo. But even after developing normal speech skills, long-term observation by specialists and constant self-monitoring of the rate of speech are necessary.

To prevent bradyllia, it is important to prevent perinatal lesions of the central nervous system, head injuries, neuroinfections, and asthenic syndrome. It is necessary to take care of the child’s normal speech development and surround him with the right role models.

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The information on the site is provided for informational purposes only. Do not self-medicate, be sure to consult your doctor.

Slow thinking treatment

Slowing down (inhibition) of thinking is characterized by a slowdown in the pace of thought processes and a decrease in the number of ideas. The patients themselves speak of a feeling of difficulty in thinking, of a feeling of intellectual inadequacy, and complain that they have “few thoughts.” In such individuals, there is a significant slowdown in the rate of associations, clearly manifested by an increase in the latent period of verbal reactions in the associative experiment. Slow thinking is characterized by a decrease in the number of ideas; it is sedentary and inert. It is difficult to move from one thought to another. This leads to a kind of stuck thought. This phenomenon is referred to as monoideism. One might think that it plays a significant role in the persistence of delusional experiences in patients with slow thinking. Although the level of generalization and abstraction processes is not reduced, difficulties in comprehension are noted. The patient is slow in his reasoning, has difficulty approaching the goal, and has difficulty in forming a verbal report on the course of his thoughts. A qualitative change in thinking is also manifested in the fact that its direction suffers - patients complain about the inability to complete the process of thinking, they say that it is difficult for them to bring their reasoning to the end.

The patient’s idea of ​​the purpose of mental activity does not suffer significantly, but it is formed much more slowly than in a healthy person. But, even having realized the goal of thinking and not detecting a decrease in the intellectual level in his mental activity, the patient either does not achieve it at all, or achieves it only partially and with great difficulty. Slowing down thinking equally affects the difficulties both in forming a thinking goal and in achieving this goal, that is, in the effectiveness of mental activity.

Slow thinking is often part of the structure of dippsychism, which includes slowing of other mental functions - speech, emotional reactivity, psychomotor skills.

Slowing down of thinking in its clinical manifestations is the opposite of accelerating thinking and is most often observed in depressive states and asthenia. The classic picture of slow thinking is observed in circular depression. Stiffness of thinking, monoideism, a peculiar selectivity of thinking due to the patient’s affective state (negatively emotionally charged thoughts seem most relevant to the patient and thoughts that contradict a sad mood are unacceptable), which contributes to the emergence in patients of delusional ideas of self-accusation, self-abasement, and sinfulness.

Slow, inhibited thinking is also observed in organic brain lesions, for example in some forms of epidemic encephalitis, brain tumors, in these cases it is closely related to the phenomena of bradypsychism. The reason for slow thinking in this case is a general slowdown in the pace of mental processes due to the pathology of the subcortical formations of the frontal regions and the brain stem.

Slow thinking can also be observed in schizophrenia, mainly in mutism, which is observed in defective states, in the presence of pronounced emotional-volitional changes, and poverty of motives. In this case, there is both a significant inhibition of the thought process, as well as a decrease in motor-speech activity, and difficulties in verbalizing thoughts.

E. Bleuler (1920) pointed out that mutism can be based on various causes (negativism, delusional experiences, the presence of imperative hallucinations that prohibit the patient from speaking). However, its main reason is the impoverishment of the mental world of a patient with schizophrenia, indifference to the questions asked to him, and lack of interest in his surroundings. In a number of cases, schizophrenic mutism reflects the paradoxical nature of mental processes inherent in this disease. For example, in a catatonic stupor, a patient does not respond to ordinary speech, but exhibits a natural reaction to quiet, whispered speech (this symptom is interpreted from the point of view of I.P. Pavlov’s concept of hypnoid-phase states and is therefore called Pavlov’s symptom). Another such symptom is the symptom of the last word (K. Kleist, 1908) - the patient answers the question after the person asking it has left the room.

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Retardation of thinking, movements and the mental sphere: causes, symptoms

From time to time, every person may notice that the brain is not functioning fully. Such a disorder is expressed in difficulty performing movements (bradykinesia) and in remembering information, inhibition of reactions and thinking disorders (bradypsychia).

It should be said that in most situations these disruptions are temporary and can be explained by natural factors: fatigue or nervous exhaustion. However, there are cases when the awkwardness of movements, inhibition of thinking and the mental sphere is a pathological process, the causes of which must be promptly identified and appropriate therapy selected.

Features of bradypsychia

Pathological inhibition of thinking is called bradypsychia. This phenomenon has no parallels with apathy or inertia of thinking, but suggests mental and pathophysiological disorders.

Bradypsychia is considered as a kind of neurological symptomatology, which in most cases develops in people in old age. But sometimes people at a young age, as well as children, experience inhibition in their thinking processes.

Poverty and insufficiency of mental processes is a symptom of many psychological or physiological pathological processes, manifested as a decrease in reaction speed, slow speech, slow thinking and motor activity. In difficult situations, the individual is not able to react to what is happening and remains for a long time in an apathetic state or stupor. The following types of inhibition are distinguished:

Thought processing can be disrupted at any age

Retardation also occurs in speech and thought, which has psychological factors. Weak and involuntary movements can cause motor retardation. Memory problems and failures appear. In many cases, such conditions are provoked by a neurological disease, constant fatigue, or psychological pathological processes.

Slowness of movements and emotional inhibition is a pathological process, the causes of which only specialists can detect. They also recommend proper therapy.

Associated disorders

Bradypsychia is the result of damage to the central nervous system, which is responsible for brain activity. Depending on the element of the lesion, different types of disorders develop. These include:

• bradybasia - slow walking;

Bradykinesia is characteristic of parkinsonism

When bradypsychia is a consequence of Parkinson's disease, it is necessary to focus on the symptoms of the underlying pathological process. These include feelings of fatigue, anxiety, sleep disorders, etc.

Provoking factors and diseases

The pathophysiology is very complex and not fully understood. It is only known that thinking, behavior, emotional component and other functions of the human brain are associated with the activity of the limbic system. In everyday practice, only conditions are identified - diseases, during which bradypsychia and accompanying deviations are observed:

1. Vascular diseases of the brain. Acute, often chronic disorders of blood flow in the brain, which arise due to progressive atherosclerosis, hypertension, embolism and vascular thrombosis, are a factor in the destruction of substances in the brain. The structures that are responsible for quick thinking are also susceptible to disruption.
2. Parkinson's disease. A common cause, the characteristic manifestation of which is slow thinking. In addition to such depressing symptoms (patients at a late stage of development of this pathological process do not tend to notice any changes), there are a large number of other unpleasant manifestations. For example, thoughts will become not only slow, but also viscous; the patient will be characterized by importunity and slow, confused speech.
3. Epilepsy. At a late stage in the development of the disease, when experts observe the destruction of personality as a result of a progressive disease, inhibition may be noted, as well as other symptoms of altered thinking.
4. Schizophrenia. As with epilepsy in schizophrenia, bradypsychia is not considered an initial symptom of pathological processes, but develops gradually over time.
5. Depression. A mental illness that is characterized by a large number of symptoms, often disguised as somatic difficulties - including toothache or ischemia. These also include sluggish thinking.
6. Hypothyroidism. Improper functioning of the thyroid gland. With this disease, the symptoms are extremely pronounced and are one of the first to occur.
7. Toxic lesions. Such a subgroup of diseases does not exist in the international classification. However, the term best describes the causes of painful symptoms - intoxication of the body.

The short-term effect of lethargy appears after lack of sleep, due to exhaustion of the body, or as a result of the use of drugs and alcohol, which inhibit thinking and movement. The reasons can be divided into those that block brain activity and those that reduce the possibilities for its implementation.

Naturally, with such an abundance of provoking diseases, treatment can also be different.

What does it look like?

The image of a “inhibited” patient falls under the typical characteristics of a melancholic person: weakness, slowness, drawn-out speech, every word is pronounced with effort.

There may be a feeling that the thought process takes a large amount of strength and energy from a person who does not have time to react to information or is completely plunged into a stupor.

In addition to a decrease in the speed of speech and thought processes, muffled words are observed - a very quiet and calm voice, sometimes breaking the silence. Weakness is visible in movement and facial expressions; posture is often too relaxed.

A person has a desire to constantly find support or lie down.

Not all symptoms are always observed. Just one thing is enough to recommend a person to seek medical help from specialists.

Diagnostic criteria and methods

People with speech rate disorders, including bradyllalia, need comprehensive medical, psychological and pedagogical diagnostics carried out by a specialized specialist. During the examination, the patient’s medical history should be studied in detail, which concerns previous illnesses and brain lesions, as well as the presence of disturbances in the rate of speech in relatives.

In certain situations, in order to find out the organic basis of the disease, it is necessary to conduct instrumental studies, including:

The study of oral speech involves assessing the structure of the organs of articulation and the state of motor skills, expressive speech (pronunciation of sounds, syllables, words, tempo-rhythmic side, voice characteristics, etc.). Diagnostics of written speech involves performing tasks such as copying text, writing from dictation, and reading. In addition to a diagnostic examination of speech function, a study of general condition, manual motor skills, sensory functions, and intelligence is carried out.

When making a diagnosis, it is necessary to differentiate this disease from dysarthria and stuttering.

What does modern medicine offer?

To carry out proper treatment of the disease, you must first consult with a specialist. He will recommend effective treatment, and will also warn about the presence of contraindications to the use of certain therapy methods or any medication.

The following methods of therapeutic and preventive action are used more often than others:

1. Activation of thinking processes. For these purposes, you need to read new books, study foreign languages, engage in the creative process, or solve various puzzles. This technique helps train the brain and activate thinking.
2. Neuroprotectors and nootropics are prescribed. Drug therapy that is aimed at restoring and strengthening nerve cells and tissues.
3. Treatment of vascular pathologies. Products are used that make it possible to cleanse the vascular walls, which is necessary for proper brain function. As a result, mental and physical activity is activated.
4. Psychotherapy. It acts as an auxiliary drug therapy. Modern therapeutic techniques help counteract the effects of stress, adjust personality assessment, and form the necessary models of response to specific situations.
5. Sports activities and walks in the fresh air. Moderate physical stress and walks give the brain the opportunity to rest and the nerve cells to recover thanks to the influx of oxygen.

If emotional and mental retardation is caused by tranquilizers, then discontinuation of any drugs is required. In most cases, reactions recover over time.

Summing up

The prognosis is relatively favorable with early initiation of correction and the presence of psychological causes of disorders of motor activity and speech motor skills. However, after regaining your skills, you should be observed by doctors for a long time and constantly independently monitor your movements and train of thoughts.

As preventive measures, damage to the central nervous system should be prevented, head injuries should be avoided, and asthenic syndrome should be detected in time.

Pathological inhibition of thinking involves various mental and pathophysiological disorders. This phenomenon should be qualified as a symptom that in most situations occurs in older people. But in certain cases, a similar problem can manifest itself in childhood and young people.

If you notice that your thinking processes are slow, you should immediately seek advice from a doctor. It is likely that this condition is the result of dangerous disruptions in the functioning of the central nervous system and requires special correction.

This section was created to take care of those who need a qualified specialist, without disturbing the usual rhythm of their own lives.

Slowing down your thinking

It is also designated by the terms bradyphrenia (from the Greek bradys - slow + mind, mind), bradypsychism, bradypsychia, bradylogy (slow + Greek logos - word, speech, mind). Along with the slowing down of the pace of mental processes, bradyphasia (bradyphrasia) - slowing of speech, bradythymia - slow change of emotional manifestations, as well as bradykinesia - slowing down the pace and limiting the amplitude of movements, including acts of expression, are observed.

A variant of bradykinesia is bradypraxia - slowness of purposeful actions. Slow gait is referred to as bradybasia, and slow reading is called bradylexia. The term bradytelekinesia refers to the slowing of movement towards the end of a motor act. Typical manifestations of slow thinking are observed in depression.

The disorder is manifested by a slow change of thoughts and ideas, a significant depletion of their total number. The time to think about answers to questions increases, pauses between words and phrases lengthen, and the number of words spoken per unit of time decreases. It is believed that bradyphrenia produces 40–50 words per minute or less. Slowing of speech is accompanied by unclear pronunciation of phonemes, stumbling speech, as well as increased stuttering if patients previously suffered from logoneurosis. The voice becomes dull, quiet, and sometimes the speech approaches a whisper.

Subjectively, bradyphrenia is experienced not only as a slow flow of thoughts, their “inhibition,” but also as a painful feeling of “vatness,” “cloudness of thinking,” and its “dullness,” when thoughts are perceived indistinctly, vaguely and seem illusory. This indicates a disorder of self-perception in the form of a decrease in the activity of self-awareness processes. The patients seem to have much fewer thoughts than in the normal state - “the head is empty, there is nothing in it, everything has stopped there, some kind of barrier has appeared, it prevents one from thinking.”

Perhaps this is due to the fact that what is normally recognized as thoughts does not reach the threshold of consciousness. In some cases, thinking seems to stop completely; in this state, according to patients, “you don’t think about anything” - ideation stupor (from the Latin stupor - numbness). Ideation stupor probably arises due to the aspontaneity of thinking, and perhaps also because patients lose the ability to realize their own impulses to think, any interest in mental activity, the need for it. Patients associate this with the loss of the ability to quickly understand what is happening: “They ask me something, I hear it, but the meaning doesn’t get through, I don’t understand what they asked. Although it is inconvenient, I am sometimes forced to ask questions again. Only when they repeat them to me do I begin to understand what they asked me. It’s easier for me to answer with “yes” or “no”, the phrases don’t fit, the wrong words turn up.”

Some patients, on the contrary, experience an uncontrollable flow of thoughts, when “thoughts float in and go on their own” and their flow is usually perceived with a tinge of intrusiveness, that is, alienation - depressive mentism (from the Latin mens - mind, reason). Depressive mentalism should not be confused with obsessive thoughts, although actual obsessions are likely to occur in depression. Usually, with slow thinking, thoughts of gloomy, sad, mournful content predominate - “thoughts go in circles, you grind the same things, nothing new comes to mind” - a symptom of depressive monoideism (from the Greek monos - one, idea - thought, image, performance).

Attention is disrupted. Patients note that they cannot concentrate on anything, unable to “think through a single thought to the end.” It also seems to them that there are few memories, they are incomplete, inaccurate, appear slowly, and are delayed. A common complaint from patients is memory loss. External impressions are often perceived as “superficial”, “quickly fading”, “faded”, sometimes leaving no trace in memory.

The translation of thoughts into speech forms suffers. It’s difficult to find the right words, it’s difficult, incomplete and inaccurate to form phrases. Patients usually cannot talk about their well-being in more or less detail without outside help, even if they want to do it themselves. Imagination becomes impoverished.

This is especially difficult for patients engaged in creative work. N.V. Gogol bitterly stated that during the six years that he spent in depression, he did not write a single line “for the world.” Complex forms of mental activity, such as planning, forecasting, resourcefulness, and the ability to integrate heterogeneous impressions into holistic structures, are impaired. Therefore, at least in part, patients’ own life situation seems simpler than it actually is; it looks in their eyes as if it were ruined and is often perceived as a sign of despair. In general, the productivity of thinking is significantly reduced, excluding, perhaps, mild degrees of bradyphrenia, when patients compensate for the slowness of thinking with persistent efforts.

Bradyphrenia is also observed in cases of stunned consciousness, postencephalitic parkinsonism, in states of apathy, adynamia and catatonic retardation.

Slow thinking

Suppression of thinking is scientifically called “bradypsychia”. Not apathy or inertia of thinking. These are completely different conditions that have different pathophysiological and mental foundations. Bradypsychia is a symptom that often appears in old age. In any case, most people associate slow thinking with unhurried and eloquent elders. However, it can also occur at a young age. Indeed, under each manifestation of ill health there are certain reasons hidden.

Reasons

Causes of slow thinking

The pathophysiology of the process is extremely complex and not fully understood. Thinking, behavior, emotional background and many other achievements of the human mind are associated with the work of the limbic system - one of the sections of the nervous system. And the limbicus cannot be properly deciphered. Therefore, in everyday practice, we can only name conditions - diseases in which bradypsychia is noted, but cannot answer the question of why it appears.

Vascular pathologies. Acute, and more often chronic disorders of cerebral circulation, resulting from the progression of atherosclerosis, hypertension, embolism and thrombosis of the vessels of the head, are the cause of destruction of the brain substance. In particular, the structures responsible for the speed of thinking also suffer.

Parkinsonism and Parkinson's disease. Narrower, but no less common pathologies, one of the manifestations of which is slowness of thinking. In addition to this depressing symptom for people around the patient (patients themselves in the later stages of development of this type of pathology do not notice any changes in themselves), there are many others that are no less unpleasant. For example, thoughts become not only slow, but also viscous, a person becomes clingy, annoying, speech is slow, often confused.

Epilepsy. In the later stages of the disease, when doctors note the destruction of the personality as a result of the progression of the disease, inhibition occurs, as do many other signs of a change in thinking.

Schizophrenia. Just as with epilepsy, with schizophrenia, bradypsychia is not an early sign of pathology.

Depressive states and depression. A mental illness characterized by an abundance of symptoms, often disguised as somatic problems, including toothache or coronary heart disease. Among them there is also lethargy of thoughts.

Hypothyroidism. Insufficiency of the thyroid glands. With this disease, the described symptom is extremely characteristic and is one of the first to appear.

Toxic bradypsychia. Of course, there is no such group of diseases in the international classification of diseases. But the name still most clearly describes the reasons for the appearance of the symptom - intoxication of the body, be it alcohol, metal salts, drugs or microbial toxins.

Of course, with such a large number of diseases, the number of types of treatment should also be large. Unfortunately, until scientists have finally figured out how the brain works, there are not as many of these species as we would like.

Treatment

Treatment of slow thinking

General preventive measures. The more the brain is loaded, the better it works. Nerve cells that are not used during life happily die off as unnecessary in the literal sense. Accordingly, the mental reserve decreases. Learning new things is possible at any age, but after thirty years it is significantly complicated by the slowdown in the development of new interneuronal connections. You can load your brain with anything, as long as it is not familiar to it. Learning a new language, solving mathematical problems, mastering new sciences, studying historical archives and understanding them. But! Solving crossword puzzles, scanword puzzles, and the like is like memorizing a large Soviet encyclopedia. Dry information only occupies cells responsible for memory, but not for thinking. Physical activity also helps keep the brain in working order. It’s difficult to say what this is connected with.

Vascular therapy. It is impossible to bring the vessels to a state corresponding to the age of twenty, however, partial restoration is possible, which is what doctors use by prescribing appropriate medications.

Nootropics and neuroprotectors. A more specific treatment that helps nerve cells recover.

Before visiting a doctor, the patient can only engage in prevention - all drug treatment has a significant number of contraindications, which the specialist takes into account when choosing one or another drug. In case of bradypsychia, it is imperative to consult a doctor - there is not a single “easy” reason for such a mental state.

Thought disorder

What is Thought Disorder

Thinking is the process of constructing an image of the surrounding world and its knowledge, which gives rise to creativity. Pathology of thinking is divided into disorders according to tempo (accelerated, slow thinking), structure (discontinued, paralogical, detailed, sperrung, mentism), content (obsessive, overvalued and delusional ideas).

History, norm and evolution

Judgments about a person are based on observing his behavior and analyzing his speech. Thanks to the data obtained, we can say how much the surrounding world corresponds (adequate) to the inner world of a person. The inner world itself and the process of knowing it constitute the essence of the thinking process. Since this world is consciousness, we can say that thinking (cognition) is the process of forming consciousness. Reasoning as such can be represented as a sequential process in which each previous judgment is connected with the next one, that is, a logic is established between them, which is formally enclosed in the “If. That". With this approach, there is no third, hidden meaning between the two concepts. For example, if it is cold, then you should wear a coat. However, in the thinking process, the third element may be motivation. A person who is hardening up will not put on a coat when the temperature drops. In addition, he may have a group (social) idea of ​​what low temperature is and his own experience with similar temperatures. A child runs barefoot through cold puddles, although he is forbidden to do this, just because he likes it. Consequently, thinking can be divided into processes of logic, processes associated with speech (including its pace), individual and social motivation (goal), and the formation of concepts. It is absolutely certain that in addition to the conscious, actually expressed process of thinking, there is also an unconscious process that can be identified in the structure of speech. From the position of logic, the thinking process consists of analysis, synthesis, generalization, concretization and abstraction (distraction). However, logic can be formal, or it can be metaphorical, that is, poetic. We can refuse something because it is harmful, but we can also because we don’t intuitively like it or its harm is justified not by experience, but by the word of authority. Such a different logic is called mythological or archaic. When a girl tears up a portrait of her lover because he cheated on her, she symbolically destroys his image, although in a logical sense, a piece of paper with a picture of a person has nothing to do with the person himself. A person and his image, or his object, or parts of a person (hair, for example) are identified in this mythological thinking. Another law of mythological (archaic, poetic) thinking is binary oppositions, that is, oppositions such as good - evil, life - death, divine - earthly, male - female. Another sign is etiology, which leads a person to think, “Why did this happen to me,” although he is well aware that a similar accident has occurred many times in others in the past. In mythological thinking, the unity of perception, feelings and thinking (statements) is inseparable; this is especially noticeable in children who talk about what they see and what they feel without a distinct delay. Mythological thinking in adults is characteristic of poets and artists, but in psychopathology it manifests itself as an uncontrolled spontaneous process. The thinking process is formed as a result of learning. Tolman believed that this occurs due to the formation of a cognitive chain, and Keller pointed to the role of sudden insight - “insight.” According to Bandura, this learning occurs through a process of imitation and repetition. According to I.P. Pavlov, thinking processes reflect the physiology of conditioned and unconditioned reflexes. Behaviorists developed this theory into the concept of operant learning. According to Torndike, thinking is a reflection of behavior associated with trial and error, as well as fixing the effects of punishment in the past. Skinner identified such operants of learning as prejudices, one's own reflective behavior, behavioral modifications associated with learning, and the formation of new behavior (shaping). Behavior and thinking shape goals as a result of reinforcement, positive or negative (one form of negative reinforcement is punishment). Thus, the thinking process can be shaped by selecting a list of reinforcements and punishments. Positive reinforcements that contribute to the formation of motivation and specific thinking patterns include: food, water, sex, gifts, money, and increased economic status. Positive reinforcement encourages reinforcement of behavior that precedes reinforcement, such as “good” behavior that is followed by a gift. In this way, cognitive chains or behaviors are formed that are rewarded or socially acceptable. Negative reinforcement is caused by darkness, heat, shock, loss of social face, pain, criticism, hunger or failure (deprivation). Thanks to the system of negative reinforcements, a person avoids the way of thinking that leads to punishment. Social motivation for the thinking process depends on culture, the influence of an authoritarian personality, and the need for social approval. It is driven by the desire for the prestigious values ​​of a group or society and consists of a strategy for overcoming difficulties. The highest needs according to Masloy are self-actualization, as well as cognitive and aesthetic needs. An intermediate place in the hierarchy of needs belongs to the desire for order, justice and beauty, as well as the need for respect, recognition and gratitude. At the lowest level are the needs for affection, love, belonging to a group, as well as physiological needs.

The main thought processes are the formation of concepts (symbols), judgments and inferences. Simple concepts are essential signs of objects or phenomena; complex concepts involve abstraction from the object - symbolization. For example, blood as a simple concept is associated with a specific physiological fluid, but as a complex concept it also means proximity, “bloodiness”. Accordingly, the color of the blood symbolically indicates the gender - “blue blood”. The sources of interpretation of symbols are psychopathology, dreams, fantasies, forgetting, slips of the tongue and mistakes.

Judgment is the process of comparing concepts through which a thought is formulated. This comparison occurs according to the type: positive - negative concept, simple - complex concept, familiar - unfamiliar. Based on a series of logical actions, a conclusion (hypothesis) is formed, which is refuted or confirmed in practice.

Symptoms of Thought Disorder

The following variants of thinking disorders are distinguished: by tempo, content, structure.

Tempo thinking disorders include:

• - acceleration of thinking, which is characterized by an acceleration of the tempo of speech, a jump in ideas that, despite the significant intensity of the tempo, do not have time to be expressed (fuga idearum). Often ideas are productive in nature and are associated with high creative activity. The symptom is characteristic of mania and hypomania.

Once you think about one thing, you immediately want to talk about the details, but then a new idea appears. You don’t have time to write it all down, but if you write it down, new thoughts appear again. It’s especially interesting at night, when no one bothers you and you don’t want to sleep. It seems like you can write a whole book in an hour.

• - slowing down of thinking - a decrease in the number of associations and a slowdown in the rate of speech, accompanied by difficulty in choosing words and the formation of general concepts and conclusions. It is characteristic of depression, asthenic symptoms, and is also observed with minimal disorders of consciousness.

Here again they asked me something, but I need time to concentrate, I can’t do it right away. I’ve said everything and there are no more thoughts, I have to repeat it all over again until I get tired. When asked about conclusions, you generally need to think long and hard and it’s better if you do your homework.

• - mentism is an influx of thoughts, which is often violent. Usually such thoughts are diverse and cannot be expressed.
• - sperrung - “blockage” of thoughts, perceived by the patient as a break in thoughts, sudden emptiness in the head, silence. Sperrung and mentism are more characteristic of schizophrenia and schizotypal disorders.

All this looks like a whirlwind at the time of conversation or when you are thinking, there are many thoughts and they are confused, not a single one remains, but it is no better if they disappear. I just said a word, but there was no next word, and the thought disappeared. Often you get lost and leave, people get offended, but what can you do if you don’t know when it will happen.

The content of thinking disorders includes affective thinking, egocentric thinking, paranoid, obsessive and overvalued thinking.

Affective thinking is characterized by a predominance of emotionally charged ideas in thinking, a high dependence of thinking on others, a quick reaction of the mental and emotionally inseparable process to any, often insignificant, stimulus (affective instability). Affective thinking is characteristic of patients suffering from mood disorders (depressive or manic thinking). The system of judgments and ideas in affective thinking is completely determined by the leading mood.

It seems that you have already decided everything for yourself. But you get up in the morning - and everything is gone, your mood is gone, and all decisions have to be canceled. Or it happens that someone upsets you, and then you get angry at everyone. But it also happens the other way around, a little thing, they will tell you that you look good, and the whole world is different and you want to be happy.

Egocentric thinking - with this type of thinking, all judgments and ideas are fixed on the narcissistic ideal, as well as on whether one’s own personality is useful or harmful. The rest, including social ideas, are swept aside. This type of thinking is often formed in dependent individuals, as well as in alcoholism and drug addiction. At the same time, egocentric traits may be normative for childhood.

It’s not clear what they all demand from me, my parents think that I should study, N., with whom I’m friends, that I need to look better. It seems like no one really understands me. If I don’t study and don’t work and don’t want to earn money, then it turns out I’m not a person, but I don’t bother anyone, I only do what I like. You can’t please everyone, but let them walk the dog themselves, she loves them more.

Paranoid thinking - thinking is based on delusional ideas, combined with suspicion, mistrust, and rigidity. Delusion is a false conclusion that arises on a painful basis, for example, it can be secondary from an altered mood, increased or decreased, hallucinations, or primary, as a result of the formation of a special logic that is understandable only to the patient himself.

Too much around is connected into one chain. When I was going to work, a man dressed in all black pushed me, then at work there were two suspicious calls, I picked up the phone and heard angry silence and someone’s breathing. Then a new sign “You’re here again” appeared at the entrance, then the water was turned off at home. I go out onto the balcony and see the same man, but dressed in a blue shirt. What do they all want from me? You need to add an additional lock to the door.

Delusional ideas cannot be dissuaded, and there is no criticism of them from the patient himself. The cognitive connections that support the existence of delusions based on the feedback principle are as follows: 1) distrust of others is formed: I am probably not very friendly - that’s why other people avoid me - I understand why they do this - increased distrust of others. The stages of delirium formation according to K. Conrad are as follows:

• - trema - delusional premonition, anxiety, discovery of the source of the formation of a new logical chain;
• - apophene - the formation of a gestalt of delirium - the formation of a delusional idea, its crystallization, sometimes sudden insight;
• - apocalypse - the collapse of the delusional system due to therapy or affective exhaustion.

According to the mechanism of formation, delusions are divided into primary - it is associated with the interpretation and construction of step-by-step logic, secondary - associated with the formation of holistic images, for example, under the influence of an altered mood or hallucination, and induced - in which the recipient, being a healthy person, reproduces the delusional system of the inducer, mentally sick person.

According to the degree of systematization, delirium can be fragmented and systematized. According to the content, the following variants of delusional ideas are distinguished:

• - Ideas of relationship and meaning. People around him notice the patient, look at him in a special way, and hint with their behavior at his special purpose. He is in the center of attention and interprets environmental phenomena that were previously not significant to him as significant. For example, he associates car numbers, glances of passers-by, accidentally dropped objects, words addressed not to him as hints related to himself.

It started about a month ago when I was returning from a business trip. There were people sitting in the next compartment and they looked at me in a special way, with meaning, they deliberately went out into the corridor and looked into my compartment. I realized that something was wrong with me. I looked in the mirror and realized that it was my eyes, they were kind of crazy. Then at the station everyone seemed to know about me, they specially broadcast on the radio “Now he’s already here.” On my street they dug a trench almost to my house, this is a hint that it’s time to get out of here.

• - Ideas of persecution - the patient believes that he is being followed, finds a lot of evidence of surveillance, finds hidden equipment, gradually noticing that the circle of pursuers is expanding. He claims that his pursuers irradiate him with special equipment or use hypnosis to control his thoughts, mood, behavior and desires. This variant of delusion of persecution is referred to as delusion of influence. The persecution system may include ideas of poisoning. The patient believes that poison is being added to his food, the air is being poisoned, or objects that have been previously treated with poison are being replaced. Transitive delusions of persecution are also possible, in which the patient himself begins to pursue imaginary pursuers, using aggression against them.

It’s strange that no one notices this - there is listening equipment everywhere, they even talked about it on TV. You look at the computer screen, but in fact it is looking at you, there are sensors there. Who needs it? Probably the secret services, which are engaged in recruiting people who should be involved in the secret drug trade. They specially mix ecstasy into Coca-Cola, you drink it and you feel like you are being led. They teach it and then use it. I was washing in the bathroom, but I didn’t close the door, I felt like they were coming in, leaving a bag in the hallway, blue, I didn’t have one like that, but there was something smeared inside it. You touch it, and a mark remains on your hand, by which you can be identified anywhere.

• - Ideas of greatness are expressed in the patient’s conviction that he has power in the form of exceptional strength, energy due to divine origin, enormous wealth, exceptional achievements in the field of science, art, politics, and the exceptional value of the reforms he proposes. E. Kraepelin divided ideas of greatness (paraphrenic ideas) into expansive paraphrenia, in which power is the result of an increased (expansive) mood; confabulatory paraphrenia, in which the patient ascribes to himself past exceptional merits, but at the same time he forgets the real events of the past, replacing them with a delusional fantasy; systematized paraphrenia, which is formed as a result of logical constructions; as well as hallucinatory paraphrenia, as an explanation of exceptionalism, “suggested” by voices or other hallucinatory images.

During a period of catastrophic inflation, when salaries amounted to millions of coupons, patient Ts., 62 years old, believes that he has extremely valuable sperm, which is used to grow an army of the SSA. The high value of excrement is characteristic of the Moses symptom (Moses), in which patients claim that their feces, urine and sweat have a value comparable only to gold. The patient also claims to be the president of America, Belarus and the CIS. He assures that a helicopter arrives in the village with 181 virgins, whom he inseminates at a special point at the breeding plant, and 5,501 boys are born from them. He believes that he revived Lenin and Stalin. He considers the President of Ukraine to be God, and Russia - the First King. In 5 days he inseminated 10 thousand and for this he received from the people 129 million 800 thousand dollars, which they bring to him in bags, he hides the bags in the closet.

• - Ideas of jealousy consist in the conviction of adultery, while the arguments are absurd. For example, the patient claims that his partner has sexual intercourse through the wall.

She cheats on me anywhere and with anyone. Even when I get down and agree with my friends about control, it still works out. Proof. Well, I come home, there is a trace of a person on the bed, such a dent. There are spots on the carpet that look like sperm, my lip is bitten from a kiss. Well, at night, sometimes, she gets up and goes, as if to the toilet, but the door closes, what is she doing there, I listened, moans were heard, as if during an orgasm.

• - Love delusion is expressed in the subjective conviction that she (he) is the object of love of a politician, movie star or doctor, often a gynecologist. The person in question is often persecuted and forced to reciprocate.

My husband is a famous psychotherapist, and he is constantly pursued by patients, especially women, but among them there is one who is different from all the other fans. She even steals our rugs and makes scandals with me that he is dressed incorrectly or looks bad. Often she literally sleeps in our yard, and there is no escape from her. She thinks that I am a fictitious wife, and she is the real one. Because of her, we constantly change phone numbers. She publishes her letters to him in newspapers and there describes various indecent things that she attributes to him. She tells everyone that her child is his, although she is 20 years older than him.

• - Ideas of guilt and self-blame are usually formed against the background of low mood. The patient is convinced that he is guilty of his actions before his loved ones and society; he is awaiting trial and execution.

Because I can't do anything at home, everything is bad. The children are not dressed like that, my husband will soon leave me because I don’t cook. This must all be for the sins of my family, if not mine. I must suffer to atone for them. I ask them to do something with me, and not look at me with such reproach.

• - Hypochondriacal delusion - the patient interprets his somatic sensations, paresthesia, senestopathy as a manifestation of an incurable disease, for example, AIDS, cancer. Requires examination, expects death.

This spot on the chest used to be small, but now it is growing. It is melanoma. Yes, they did histology for me, but probably incorrectly. The spot itches and shoots into the heart, these are metastases, I read in the encyclopedia that there are metastases in the mediastinum. That's why I have difficulty breathing and a lump in my stomach. I have already written my will and I think that everything will end quickly, as weakness is growing.

• - Nihilistic delirium (Cotard's delirium) - the patient assures that his insides are missing, they are “rotten”, similar processes are occurring in the environment - the whole world is dead or is at various stages of decomposition.
• - Delusion of staging - is expressed in the idea that all surrounding events are specially arranged as in a theater, the staff and patients in the department are actually secret service officers in disguise, the patient’s behavior is staged, which is shown on television.

I was brought here for interrogation, supposedly you are a doctor, but I see how your shoulder straps are outlined under your robe. There are no patients here, everything is arranged. Maybe a special film is being made based on an intelligence scenario. For what? To find out from me the truth of my birth, that I am not at all who I say I am. This is not a pen in your hands, but a transmitter; you write, but in reality you transmit encryption.

• - The delusion of a double consists of the conviction of the presence of a positive or negative, that is, embodying negative personality traits, double, which may be located at a considerable distance and may be associated with the patient through hallucinatory or symbolic constructions.

Patient L. assures that his incorrect behavior is not his behavior at all, but his twin, who was abandoned by his parents and ended up abroad. Now he acts on his behalf to recruit him. “He is exactly the same as me, and even dressed the same, but he always does things that I would not dare to do. You say that it was I who broke the window at home. That’s not true, I was in a completely different place at that time.”

• - Manichaean delusion - the patient is convinced that the whole world and he himself are an arena for the struggle between good and evil - God and the devil. This system can be confirmed by mutually exclusive pseudohallucinations, that is, voices that argue with each other for possession of a person's soul.

I go to church twice a day and carry a Bible with me at all times because I have trouble figuring things out on my own. At first I didn’t know what was right and what was sin. Then I realized that there is God in everything and there is a devil in everything. God calms me down, but the devil tempts me. For example, I drink water, take an extra sip - it’s a sin, God helps to atone - I read prayers, but then two voices appeared, one of God, the other of the devil, and they began to argue with each other and fight for my soul, and I got confused.

• - Dysmorphoptic delusion - the patient (patient), often a teenager, is convinced (convinced) that her face shape is changed, there is an anomaly of the body (most often the genitals), insists on surgical treatment of the anomalies.

I'm in a bad mood because I always think about the fact that my penis is small. I know that it increases during an erection, but I still think about it. I’ll probably never be sexually active, although I’m 18 years old, it’s better not to think about it. Maybe have surgery now before it's too late. I read that it can be increased with special procedures.

• - Delusion of possession - is that the patient feels himself transformed into an animal, for example, into a wolf (lycanthropy), into a bear (Lokis symptom), into a vampire or into an inanimate object.

At first there was a constant rumbling in the stomach, like turning on the ignition, then a space like a cavity with fuel formed between the stomach and bladder. These thoughts turned me into a mechanism, and a network of plexuses with wires and pipes formed inside. At night, a computer was built behind the eyes, with a screen inside the head, which showed quick codes of glowing blue numbers.

All forms of delirium are similar to mythological constructs (mythologems), which are embodied in archaic traditions, epics, myths, legends, plots of dreams and fantasies. For example, ideas of possession are present in the folklore of most countries: a girl is a fox werewolf in China, Ivan Tsarevich is a gray wolf, and the Frog Princess in Russian folklore. The most common plots of delirium and corresponding mythologies relate to the ideas of prohibition and its violations, struggle, victory, persecution and salvation in stories of origin, rebirth, including miraculous ones, death, and fate. In this case, the actor plays the role of a saboteur, a giver, a magical helper, a sender and a hero, as well as a false hero.

Paranoid thinking is characteristic of schizophrenia, paranoid disorders and induced delusional disorders, as well as organic delusional disorders. The equivalents of delusions in children are delusional fantasies and overvalued fears. With delusional fantasies, the child talks about a fantastic imaginary world, and is sure that it really exists, replacing reality. In this world there are good and evil characters, aggression and love. Just like delirium, it is not subject to criticism, but it is very changeable, like any fantasy. Overvalued fears are expressed in fears in relation to objects that do not themselves have such a phobic component. For example, a child may be afraid of the corner of the room, part of the parents’ body, a radiator, or a window. The full picture of delirium often appears in children only after 9 years.

Overvalued thinking includes overvalued ideas, which are not always false conclusions, develop in special sthenic individuals, but they dominate their mental life, crowding out all other motives; there is no criticism of them. Examples of highly valuable formations are the ideas of revolutionary transformation of the world, invention, including the invention of a perpetual motion machine, the elixir of youth, the philosopher's stone; ideas of physical and moral perfection with the help of an endless number of psychotechniques; ideas of litigiousness and struggle against a specific person through litigation; as well as extremely valuable ideas for collecting, for the implementation of which the patient completely subordinates his entire life to the object of passion. The psychological analogue of overvalued thinking is the process of formation and formation of love.

Overvalued thinking is characteristic of paranoid personality disorders.

I quarreled with my loved ones and wanted to live separately. But this is completely impossible, since I have nowhere to take my collection. They accuse me that I spend all my money on old and empty bottles and they are everywhere, even in the toilet. There are bottles from the time of the siege of Sevastopol by the British and French, for which I paid a fortune. What do they understand about this? Yes, I gave it to my wife because she broke, supposedly by accident, a bottle that was hard for me to get. But I was ready to kill her for it, because I exchanged it for a whole collection of beer bottles.

Obsessive thinking is characterized by stereotypically repetitive thoughts, ideas, memories, actions, fears, rituals that arise against the patient’s will, usually against a background of anxiety. However, in contrast to nonsense and overvalued ideas, there is complete criticism of them. Obsessive thoughts can be expressed in repeated memories, doubts, for example, memories of hearing a melody, an insult, obsessive doubts and double-checking the gas turned off, the iron, or a closed door. Obsessive attraction is also accompanied by obsessive thoughts that must be impulsively carried out, such as compulsive theft (kleptomania), arson (pyromania), suicide (suicidomania). Obsessive thoughts can lead to phobias, that is, obsessive fears, such as fears of crowded places and open spaces (agoraphobia), closed spaces (claustrophobia), pollution (mysophobia), fear of contracting a specific disease (nosophobia) and even fear of fear (phobophobia). The occurrence of fears is avoided by rituals.

Even as a child, Kostya, when he went to an exam, had to first get dressed, and then undress, touch me 21 times, and then wave me three more times from the street. Then it became more and more difficult. He washed himself for minutes, and then spent hours in the bathroom. He spent half my salary on shampoo. His hands had cracks from the water, so he rubbed his palms with a sponge, thinking that this would wash away the infection. In addition, he was afraid of sharp objects and demanded that they be removed from the table so as not to cut himself. But eating is a whole torture for him. He places the spoon on the left, then on the right, then he levels it slightly in relation to the plate, then he levels the plate, and so on ad infinitum. When he puts on his trousers, the creases must be straight, but to do this he must climb onto the sofa and pull the trousers down from the sofa. If something doesn’t work out for him, everything is repeated all over again.

Obsessive thinking is characteristic of obsessive-compulsive disorders, anancastic and anxiety personality disorders.

Thinking disorders according to their structure can be divided into changes in the system of logic (paralogical thinking), changes in the smoothness and coherence of thinking.

Paralogical thinking E.A. Sevalev divides into prelogical, autistic, formalizing and identifying. Each of these types of thinking is based on its own logic.

Prelogical thinking is the equivalent of the mythopoetic thinking we described above. In psychopathology, such thinking is characterized by filling images and ideas with ideas of witchcraft, mysticism, psychoenergetics, religious heresy, and sectarianism. The whole world can be understood in the symbols of poetic, sensual logic and explained based on intuitive ideas. The patient is sure that he should behave one way and not another based on signs of nature or his own premonitions. This type of thinking can be considered regressive because it resembles childish thinking. Thus, prelogical thinking operates with archaic logic, characteristic of ancient peoples. Characteristic of acute sensory delirium, hysterical personality disorders.

All these troubles are due to the fact that I was jinxed. I went to a psychic, and he said that I needed to put a screen against the evil eye and damage and gave me some kind of herb. This helped immediately, but then the neighbor said that the damage was repeated, and showed a dirty door and a tossed tuft of hair. I went to church and asked to bless the apartment, as the troubles continued and my husband began to come home drunk every evening. This also helped for a short time. There must be a strong evil eye. She went to Grandma Marfa, who gave her a charged photograph and hid it under her husband’s pillow. He slept soundly, but in the evening he got drunk again. Against a strong evil eye, you probably need a strong energy drink.

Autistic thinking is characterized by the patient’s immersion in the world of his own fantasies, which in symbolic form compensate for inferiority complexes. With external coldness, detachment from reality, and indifference, the patient’s rich, bizarre and often fantastic inner world is striking. Some of these fantasies are accompanied by visualized ideas; they fill the patient’s creative output and can be filled with deep philosophical content. Thus, behind the colorless scenes of the personality, magnificent feasts of mental life take place. In other cases, when their emotional state changes, autistic patients can openly express their creative imagination. This phenomenon is referred to as “inside-out autism.” An autistic child has relatively rich fantasies, and even high success in certain abstract areas of knowledge, such as philosophy, astronomy, are masked by avoidance of bodily contact, gaze, uncoordinated motor skills and motor stereotypies. One of the autists expressed his world so symbolically: “with the ring of self-creativity, you can firmly secure yourself outside.” Autistic thinking is based on fantasy logic, which is understandable based on unconscious individual motivation and is a compensation for high sensitivity to stress. Therefore, the autistic world is a kind of escape from cruel reality. It is characteristic of schizophrenia, schizotypal and schizoid personality disorders, although it can also occur with accentuations, that is, in mentally healthy people.

My son is 21 years old, and I take care of him all the time, since he has always been an unusual boy. He graduated from 11th grade, but did not know anyone in the class. I negotiated the grades myself. He doesn’t go outside on his own, only with me. He only reads books about birds. He can sit on the balcony for hours and watch sparrows or tits. But he never says why he needs this. He keeps diaries and has filled many thick notebooks. It is written in them like this: “she flew up and sat on a branch and ran her foot across her abdomen three times,” a bird was drawn next to her, and these drawings with different comments were written in all the notebooks. I tried to persuade him to go to university, but he refused, he was not interested. When we go out for a walk, he stops by some tree and looks at the birds for a long time, then writes it down. He doesn’t write to anyone about his observations and doesn’t want to talk about them, he doesn’t watch TV or read newspapers, and doesn’t know how much bread costs.

Formalizing thinking can also be called bureaucratic. The cognitive life of such patients is filled with rules, regulations and patterns, which are usually drawn from the social environment or associated with upbringing. It is impossible to go beyond these schemes, and if reality does not correspond to them, then such individuals experience anxiety, protest, or a desire for edification. Characteristic of paranoid personality disorders and Pick's disease.

There must be order throughout the world. It is completely untrue that some of our neighbors come home late, I am struggling with this, and have made a lock with keys on the entrance. Everything we achieved before was connected with order, but now there is no order. There is dirt everywhere because they don’t clean it up, state control over everything needs to be restored so that people don’t wander around the streets. They don’t like that at work I demand to report on who went where and when he will return. It is impossible without this. There is no order at home either, every day I post a diagram of how much was spent and how many calories my wife and daughter should consume depending on their weight.

Symbolic thinking is characterized by the production of symbols that are understandable only to the patient himself, which can be extremely pretentious and expressed in invented words (neologisms). So, for example, one of the patients explains the word “syphilis” this way - physically strong, and the word “tuberculosis” - I take the one that I love to tears. In other words, if an ordinary complex concept (symbol) can be interpreted based on the characteristics of culture (collective unconscious), religious allegories, semantics of the group, then with symbolic thinking such an interpretation is possible only based on personal deeply unconscious or past experience. Characteristic of schizophrenia.

I didn't just decide that my parents weren't real. The fact is that my name Kirill contains the truth. It consists of the words “Cyrus” - there was such a king, it seems, and “silt”, that is, found in a swamp. It means they just found me and I have a real name, but not a last name.

Patient L. creates a special symbolic font based on the inclusion of “feminine in the understanding of the letter”: a - anesthetic, b - shaving, c - performing, d - looking, e - extracting, f - natural, g - vital, living, h - healthy, and - walking, . n - real, . s - free, . f - milling, naval, . shch - panel board, ..yu - jewelry.

Identifying thinking is characterized by the fact that a person uses in his thinking meanings, expressions and concepts that actually do not belong to him, but to other, often authoritarian, dominant individuals. This type of thinking becomes the norm in countries with a totalitarian regime, requiring constant reference to the authority of the leader and his understanding of a particular situation. This thinking is due to the mechanism of projective identification. Characteristic of dependent and dissocial personality disorders.

I try to explain to them that there is no need to do this, because they will judge you and will not understand you. Who? All. You need to behave in such a way that you are like everyone else. When they call me “up”, I always think that I have done something bad, that they found out about me, because everything seems to be in order. I am no worse or better than others. I love the songs of singer P., I bought a dress like hers. I like our president, he is a very careful person, he says everything correctly.

Changes in the smoothness and coherence of thinking are manifested in the following disorders: amorphous thinking is expressed in the presence of coherence among themselves in the meaning of individual parts of a sentence and even individual sentences while the general meaning of what was said eludes. It seems that the patient is “floating” or “spreading out”, being unable to express the general idea of ​​​​what was said or directly answer the question. Characteristic of schizoid personality disorders and accentuations.

You are asking about when I left the institute. In general, yes. The situation seemed to be such that I didn’t really want to study, somehow gradually. But that’s not what we’re talking about; immediately after admission, disappointment arose, and I stopped liking everything. So day after day I wanted to change something, but I didn’t know what, and everything stopped interesting me, and I stopped going to classes because of this very disappointment. When it’s not interesting, then, you know, there’s simply no need to study further, it’s better to work smart, although there weren’t any particular troubles. What question did you ask?

Subject-specific thinking is characteristic of persons with mental retardation and is expressed in primitive speech with formal logic. For example, to the question - how do you understand the saying “The apple doesn’t fall far from the tree?” replies: “The apples always fall close to the tree.” Characteristic of mental retardation and dementia.

Reasonable thinking is expressed in reasoning about a question instead of a direct answer to the question. Thus, the wife of one patient says this about her husband: “He is so smart that it is absolutely impossible to understand what he is talking about.”

To the question “How do you feel?” the patient answers: “It depends on what you understand by the word feelings. If you understand by them your sensation from my feelings, then your sense of self will not correspond to my thoughts about your feelings.”

Characteristic of schizotypal disorders, schizophrenia and accentuations.

Detailed thinking is characterized by detail, viscosity, and getting stuck on individual details. When answering even a simple question, the patient tries to endlessly delve into the smallest details. Characteristic of epilepsy.

I have headaches. You know, in this place there is a slight pressure on the temple, especially when you get up or immediately after lying down, sometimes after eating. Such light pressure in this place happens when you read a lot, then it slightly pulsates and something beats. Then you feel nauseous, this happens at any time of the year, but especially often in the fall, when you eat a lot of fruit; however, the same thing happens in the spring when it rains. Such a strange nausea from bottom to top and you swallow. Although not always, sometimes it happens as if there is a lump in one place that you cannot swallow.

Topic slippage is characterized by a sudden change in the topic of conversation and a lack of connection between spoken sentences. For example, to the question “How many children do you have?” the patient answers “I have two children. I think I’ve eaten too much this morning.” Thematic slippage is one of the signs of a special structure of thinking and speech - schizophasia, in which a paralogical connection is likely between individual sentences. In the above example, in particular, the specified connection is established between the children and the fact that they refused food in the morning, so the patient ate it himself.

Incoherent thinking (incoherent) - with this thinking, there is no connection between individual words in a sentence, repetitions of individual words often appear (perseveration).

Verbigeration is a thinking disorder in which the connection not only between words, but also between syllables is disrupted. The patient may pronounce individual sounds and syllables stereotypically. Various degrees of fragmented thinking are characteristic of schizophrenia.

Speech stereotypies can be expressed as repetitions of individual words, phrases or sentences. Patients can tell the same stories, anecdotes (gramophone record symptom). Sometimes standing turns are accompanied by attenuation, for example, the patient utters the phrase “A headache sometimes bothers me. I get a headache sometimes. Headache me. Headache. Head". Speech stereotypies are characteristic of dementia.

Coprolalia is the predominance of obscene phrases and expressions in speech, sometimes with complete displacement of ordinary speech. Characteristic of dissocial personality disorders and manifests itself in all acute psychoses.

Diagnosis of thought disorders

Methods for studying thinking include studying the structure of language, since language is the main field of manifestation of thinking. In modern psycholinguistics, there are studies of the semantics (meaning) of a statement, syntactic analysis (the study of sentence structure), morphemic analysis (the study of units of meaning), the analysis of monologue and dialogic speech, as well as phonemic analysis, that is, the study of the basic sounds of speech that reflect its emotional content. The rate of speech reflects the speed of thinking, but it should be remembered that the only tool for comparing the speed of speech, as well as its content, is the thinking of the doctor himself. The level and course of thought processes is studied using the methods of “regularities of a number series”, a test of quantitative relations, unfinished sentences, understanding of plot pictures, highlighting essential features, tests of exceptions and the formation of analogies, as well as the Ebbenhausen test (see the corresponding section of the textbook). The processes of symbolization and identification of unconscious thinking structures are studied using the method of pictograms and associative experiments.

Which doctors should you contact if you have a thinking disorder?

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Depressive disorders are quite diverse, and inhibited depression is called those in which there is psychomotor retardation. However, there is no evidence to suggest that this condition is a distinct syndrome. In this regard, it is most correct to use the term only in descriptions. It is known that the most severe form of inhibited depression is characterized by a gradual transition to a state of depressive stupor. It has been established that the basis of every depression, including inhibited depression, is mainly due to mood swings and periodic changes in emotions, which is considered a normal phenomenon in everyone’s life.

But it often happens that emotions become painful when, in a state of depression, a person suffers from a feeling of hopelessness, expressed in a variety of combinations. First of all, anxiety, depression manifests itself, persistent pessimism and emptiness arise. Such a condition does not pass without leaving a mark on a person’s psyche, his normal rhythm of life is disrupted, and his general well-being worsens. If we consider the cause of inhibited depression at the biochemical level, then neurons are primarily involved in this disorder. If they are damaged, they lose the ability to produce the required amount of neurotransmitters such as dopamine, as well as serotonin and norepinephrine.

The release of these neurotransmitters is produced by one neuron into the synapse - a special space located between neurons. Thus, the second neuron of the electrical circuit is excited, and an electric current is directed through it. In this case, there is a lack of these neurotransmitters, therefore, in a state of depression, the transmission of nerve impulses from neuron to another neuron does not occur, which leads to general brain dysfunction. This is the cause of the symptoms of inhibited depression. Any depression interferes with a full life. If the condition is severe, then a symptom occurs in which hospitalization of the patient is inevitable. These are the patient's attempts to commit suicide. Sometimes suicide attempts are not expressed explicitly. For example, a person may begin to limit himself in food, so that exhaustion occurs.

Inhibited depression is also called passive melancholia. It is understood that the basis of inhibited depression is always a painful state of mind, based on a depressed mood and various experiences. Basically, the disease is characteristic of people who have suffered a significant amount of severe suffering of a moral nature. Inhibited depression is observed more often in young people, in the first half of life. Often among the causes of the disease, the first place is occupied by somatic diseases, leading to subsequent exhaustion, difficult childbirth, or surgical operations with large blood losses. Factors such as hard physical labor, poverty, failure, addiction to alcohol, and much more influence the development of the disease.

It has been established that women are more susceptible to inhibited depression, although there are cases of inhibited depression in childhood, and it is also observed in old age. Such depression is always caused by long-term causes that affect the psyche over a certain period of time. In addition, there are problems that have an additional negative impact, for example, it could be an insult, an unexpected insult, or financial loss. As for pathological heredity, in this case, its role is not significant and does not affect the development of the disease.

Basically, people who, by nature, have an intact heredity, are susceptible to inhibited depression. Experts believe that this type of depression may well be detected in those who are endowed with a family history, however, this is only an occasional complication and cannot be considered as the main point. To imagine what the clinical picture of inhibited depression is, we should remember the state that everyone knows in sad moments of life, when a person is sad. When receiving difficult news that is painful due to its content, most people seem to withdraw from the world and become immersed in their own thoughts and feelings. At the same time, pressure in the heart area and heaviness may be felt.

In the presence of inhibited depression, specialists prescribe symptomatic treatment. To alleviate symptoms as much as possible, psychiatrists use, they are supplemented with psychotropic drugs included in other groups, in particular, this and. But, many drugs only affect the symptoms, and they do not eliminate the cause of the disease itself, and can cause side effects, including dependence on the drug and addiction. Side effects include cardiotoxicity, which means the drug is toxic to the heart muscle. Including hematotoxicity and nephrotoxicity. At the same time, body weight may increase, the functions of endocrine organs may be disrupted, and so on.