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Psychomotor disorders. We identify disorders of the child’s psychomotor development. The concept of psychomotor disorders.

Psychomotor disorders; general characteristics.

Symptoms of psychomotor disorders can be represented by difficulty, slowness in the performance of motor acts (hypokinesia) and complete immobility (akinesia) or symptoms of motor agitation or inadequacy of movements.

Symptoms with difficulty in motor activity include the following disorders: catalepsy, waxy flexibility, in which, against the background of increased muscle tone, the patient has the ability to maintain a given position for a long time; the air cushion symptom, related to manifestations of waxy flexibility and expressed in tension in the neck muscles, with in this case, the patient freezes with his head raised above the pillow; a symptom of the hood, in which patients lie or sit motionless, pulling a blanket, sheet or robe over their head, leaving their face open; passive submissiveness of the state, when the patient does not have resistance to changes in the position of his body, posture, position of the limbs, in contrast to catalepsy, muscle tone is not increased; negativity, characterized by unmotivated resistance of the patient to the actions and requests of others.

There is passive negativism, which is characterized by the fact that the patient does not fulfill the request made to him, when trying to get him out of bed he resists with muscle tension; with active negativism, the patient performs the opposite of the required actions.

When asked to open his mouth, he compresses his lips when they extend their hand to him to say hello, and hides his hand behind his back. The patient refuses to eat, but when the plate is removed, he grabs it and quickly eats the food.

Mutism (silence)- a condition when the patient does not answer questions and does not even make it clear by signs that he agrees to come into contact with others.

Psychomotor agitation (manic, depressive raptus, catatonic, hysterical, impulsive, hebephrenic-catatonic).

Manic- patients are in constant motion, striving for activity, all their actions are purposeful, but due to increased distraction, not a single task, as a rule, is completed. Patients in this state also experience speech agitation, they talk a lot, during a conversation they easily switch from one topic to another, often do not finish phrases, and miss words. It can be extremely difficult to collect anamnesis from such patients. The voice of patients with severe speech agitation is usually hoarse.

Depressed raptus-?

Catatonic agitation- is completely unmotivated and meaningless. At the same time, unrelated, scattered automated actions are performed, directed outward, as well as towards oneself (it is difficult, however, to say whether the patients retain consciousness of themselves or whether they perceive their body at this time as a foreign object).

Hysterical excitement- it is always a person’s reaction to a traumatic situation and is always expressed in the most striking demonstrative forms of behavior. Patients fall to the floor, wring their hands, roll around, try to tear their clothes. Resolution of the traumatic situation leads to the cessation of excitation.

Impulsive excitement. Sudden aggressive actions both against others and against oneself. They throw food around, smear themselves with feces, and masturbate. Committing suicide attempts. Negativism is always pronounced. Impulsive excitement can be silent.

Hebephrenic-catatonic agitation. Foolishness, grimacing, ridiculous, senseless laughter, rude, cynical jokes and unexpected ridiculous antics, ridiculous body movements. Hysterical and pseudodementia-puerile shades of mood, it is unstable.

Violation of psychomotor development in young children (formation of cortical functions) is manifested by a lack of exploratory interest in toys, in others, poverty of emotions, lack of object-manipulative activity, delay in the formation of impressive and expressive speech, and play activities. Delayed motor development is closely related to mental skills. The assessment of psychomotor development (PMD) is proposed to be carried out according to the calendar of critical periods in the 1st, 3rd, 6th, 9th and 12th months (calendar method) with determination of the correspondence of the child’s chronological age to the age standard of psychomotor skills:

If the chronological age deviates from the calendar age by no more than 3 months, a mild degree of VMR impairment or VMR delay (“tempo” delay) is diagnosed. A delay in certain motor skills is observed in rickets and in children who have suffered from somatic diseases. The outcome of this form of PMR, as a rule, is the complete restoration of motor and mental functions, if there are no signs of brain damage according to neuroimaging. At the same time, the presence in a full-term three-month-old baby of a psychomotor status corresponding to 4 weeks of development may be an alarming symptom of deviations in PMR.

A developmental delay of 3 to 6 months is recognized as a moderate violation of VUR, which determines the tactics of a detailed examination in order to find the cause of the disease. The average degree of PMR occurs in patients with neonatal hypoxic-ischemic encephalopathy with leukomalacia, periventricular hemorrhage of the second degree, in children who have had meningitis, with epilepsy, gene syndromes, and brain dysgenesis.

A delay in the development of a child for more than 6 months is recognized as a violation of severe VUR, which is combined with brain defects: aplasia of the frontal lobes, cerebellum, hypoxic-ischemic encephalopathy and periventricular hemorrhage of the third degree, metabolic disorders of amino acids and organic acids, necrotizing encephalopathy, leukodystrophy, tuberous sclerosis, chromosomal and gene syndromes, intrauterine encephalitis, congenital hypothyroidism.

In Western European countries, the Prechtl method (H.F.R.Prechtl) is used to assess the spontaneous motor activity of an infant. The child is observed for 30 - 60 minutes (including using video recording), then a table of various types of movements is filled in with a score. Indicative is the normal type of motor activity at 3 - 5 months, which is called “fidgety” and represents multiple rapid movements of the neck, head, shoulder, torso, hip, fingers, feet, with special attention paid to hand-face contact. , “arm - arm”, “leg - leg”. Convulsive synchronous movements of the arms and legs at 2–4 months reflect early manifestations of tetraparesis. A significant decrease in spontaneous movements of the arms and legs on one side in 2–3 months of life may subsequently manifest as spastic hemiparesis. Markers of spastic and dyskinetic forms of cerebral palsy at 3-5 months are the absence of leg lifting in a supine position, the absence of fussy movements (fidgety).

Additional information :

Stages of sequential replacement of hand movements in a child up to one year old :

In a newborn and a child of 1 month. the hands are clenched into a fist, he cannot open the brush on his own. The grasping reflex is evoked. At 2 months the brushes are slightly open. At 3 months You can put a small rattle in the child’s hands, he grabs it, holds it in his hand, but he himself is not yet able to open his hand and release the toy. At the age of 3 - 5 months. the grasping reflex gradually reduces and is replaced by the ability to voluntarily and purposefully pick up objects. At 5 months the child can arbitrarily pick up an object lying in his field of vision. At the same time, he extends both hands and touches it. Delayed reduction of the grasping reflex leads to late formation of voluntary movements in the hands and is a clinically unfavorable sign. At 6 - 8 months. the accuracy of grasping an object is improved. The child takes it with the entire surface of his palm. Can transfer an object from one hand to another. At 9 months The child randomly releases toys from his hands. At 10 months a “pincer-like grip” appears with the opposable thumb. The child can grasp small objects by extending his thumb and forefinger and holding the object with them, like tweezers. At 11 months a “pincer grip” appears: the thumb and index finger form a “claw” when grasping. The difference between a pincer grip and a pincer grip is that in the former the fingers are straight, while in the latter the fingers are bent. At 12 months a child can place an object precisely in a large dish or in the hand of an adult. In the future, fine motor skills and manipulations are improved.

Stages of sequential replacement of movements in the lower extremities in a child under one year old :

In a newborn and a child 1 - 2 months old. life there is a primitive reaction of support and automatic gait, which fades away by the end of 1 month. life. Child 3 - 5 months. holds his head well in an upright position, but if you try to stand him up, he draws his legs in and hangs on the arms of an adult (physiological astasia-abasia). At 5 - 6 months. The ability to stand with the support of an adult, leaning on a full foot, gradually appears. During this period, the “jumping phase” appears. The child begins to jump, being placed on his feet: the adult holds him under the armpits, the child squats and pushes off, straightening his hips, legs and ankle joints. The appearance of the “jumping” phase is an important sign of proper motor development, and its absence leads to delay and impairment of independent walking and is a prognostically unfavorable sign. At 10 months The child, holding onto the support, stands up independently. At 11 months the child can walk with support or along a support. At 12 months it becomes possible to walk holding one hand and, finally, take several independent steps.

source: article “Neurobiological and ontogenetic bases of the formation of motor functions” by A.S. Petrukhin, N.S. Sozaeva, G.S. Voice; Department of Neurology and Neurosurgery, State Educational Institution of Higher Professional Education, Russian State Medical University of Roszdrav, Maternity Hospital 15, Moscow (Russian Journal of Child Neurology, Volume IV Issue No. 2, 2009)

read also:

article“Development of a child’s psychomotor skills in the first year of life and early diagnosis of its disorders” E.P. Kharchenko, M.N. Telnova; Federal State Budgetary Institution of Science Institute of Evolutionary Physiology and Biochemistry named after. THEM. Sechenov RAS, St. Petersburg, Russia (scientific and practical journal “Neurosurgery and Neurology of Children” No. 3, 2017) [read] or [read];

article (lecture for doctors) “Diagnostics and treatment of movement disorders in young children” by V.P. Zykov, T.Z. Akhmadov, S.I. Nesterova, D.L. Safonov; GOU DPO "RMAPO" Roszdrav, Moscow; Chechen State University, Grozny; Center for Chinese Medicine, Moscow (magazine “Effective Pharmacotherapy” [Pediatrics], December, 2011) [read]

read the post: Early diagnosis of cerebral palsy(to the site)

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A violation of the perception of objective reality, manifested in hallucinations, delusional states, changes in consciousness and complete disorganization of the personality, is called psychosis. This phenomenon is characterized by gross disturbances in human mental activity.

Psychoses can occur under the influence of many internal or external factors. Mental disorders caused by endogenous causes, such as somatic and mental illnesses, age-related pathology, develop gradually. Acute psychosis develops suddenly and intensely. The main source of such a spontaneous state is the influence of exogenous factors, these include mental trauma, intoxication and infection. With properly selected therapy, exogenous psychoses can be treated fairly quickly.

Main types of psychoses and their symptoms

According to their origin, they are divided into two groups:

Endogenous pathology is understood as the influence of negative factors of internal origin: somatic diseases, hereditary mental pathologies, age aspect. The exogenous type of psychosis is caused by exposure to external destructive stimuli: traumatic brain injury, psychogenicity, infection and intoxication.

The endogenous group includes the following mental disorders:

manic-depressive psychosis,
senile,
schizophrenic,
cycloid,
symptomatic psychosis caused by a somatic disease (hypertensive, epileptic).

The exogenous group of psychoses includes:

jet acute,
intoxication,
infectious.

Psychosis can develop slowly, progressing with the intensity of the stressor, or occur suddenly - an acute type of disease. The main signs of psychosis include:

delirium, delirium-like states,
hallucinations,
complete or partial amnesia,
motor-motor disorders,
changes in consciousness
cognitive impairment,
pathology of emotions.

Classification of endogenous psychoses

Shifting changes in mood, irresistible mania, delusional manifestations, severe depressive states with suicidal thoughts may indicate manic-depressive psychosis. The peculiarity of the disease is the change in phases of mood and arousal processes: from the manic stage to the depressive stage. Such a pathology may arise due to a hereditary predisposition to the disorder, the symptoms of which may progress as provoking factors act: stress, brain injuries, diseases of internal organs.

Senile psychoses develop due to age-related dysfunctions and destructive changes in the brain. Elderly people suffering from this disease become withdrawn, depressed, aggressive and completely inert towards themselves and others. Mental disorders include amnesia, disorientation in the area, dementia, and impaired consciousness.

Schizophrenic psychosis is characterized by pathological changes in personality, thinking and perception are disrupted, and inadequate affective reactions are observed. The clinical picture of this psychosis sometimes manifests itself in hallucinations, delusional states, and patients are presented with fictitious pictures of fantastic content. The disease does not always occur with hallucinosis and delusions; the personality structure is mainly affected.

Cycloid psychoses occupy a transitional position between schizophrenic and manic-depressive symptoms. Signs of pathology are manifested in constant changes in mood, excitability, and motor activity. An example of such psychosis could be a sharp change in the emotions of fear and happiness, stupor and chaotic movement. The disease is highly treatable at any stage of development.

Sometimes the human body reacts to illness not only with physiological, but also with mental changes. The sudden development of symptomatic psychosis manifests itself in the form of emotional exhaustion, decreased motor activity, affective reactions and confusion. A gradual increase in symptoms is called a protracted type of disorder, in which hallucinosis, depression and manic phases are observed.

Myocardial infarction may be accompanied by panic, depression or euphoria, and cases of delirium are not uncommon. A malignant tumor causes a constant feeling of anxiety, hallucinations and illusions are observed, and in severe stages, motor activity decreases and an apathetic stupor sets in.

Types of exogenous psychoses

Acute psychosis indicates that the disease arose suddenly, for example, as a result of psychotrauma, intoxication with toxic fumes, etc. In reactive acute psychosis, hallucinations, delusions, pathology of affect, behavioral disturbances and self-criticism are observed. When exposed to a negative psychogenic stimulus, a person begins to manifest affective reactions. The following types of psychoses of psychogenic origin are distinguished:

hysterical psychosis,
affective shock reaction,
psychogenic psychopathy.

Hysterical psychosis develops in cases where a person is subjected to all kinds of psychological infringement and discrimination. The duration of the pathology directly depends on the effect of the stressor. The following forms of hysterical psychogenic psychosis are distinguished:

feral syndrome,
puerilism,
pseudodementia,
delusional fantasies,
Ganser's syndrome.

Feralization syndrome is understood as a gross behavioral disorder in which a person imitates the habits of an animal: grimaces, moves on all fours, sniffs, etc. This form of psychogenic psychosis manifests itself extremely rarely and mainly in the presence of idiopathic personality traits. Puerilism is a kind of “playing like a child,” when a person becomes extremely infantile, foolish and naive. With pseudodementia, there is a sharp depression of the intellectual sphere, the patient answers questions incorrectly, and commits ridiculous acts. Delusional fantasies are characterized by ideas about hyper-significance, reformist delusions or self-deprecation, and the patient himself believes in his fantasies. The pathology of consciousness, manifested in disorientation and selective perception, is called Ganser syndrome.

A sudden affective state, characterized by distortion and narrowing of conscious activity, which occurs in life-threatening moments, is called a shock reaction. Pathological affect manifests itself in the experience of horror, fear and extreme despair. There are two types of specific reactions during an affective-shock reaction:

Hyperkinetic behavior is manifested by motor excitability in the form of erratic, aimless movements, increased gesticulation, exclamations, screams, fragmentary or complete amnesia. Lack of motor activity, stupor, and mutism are characteristic of the hypokinetic response option. Both types of reactions may be accompanied by involuntary defecation or urination, vegetative-somatic changes and memory impairment.

Among the acute psychogenic changes in the psyche of the individual, the following are also distinguished:

depressive states,
crazy ideas.

Psychogenic acute depression most often occurs due to emotional loss, be it the death of a loved one or isolation from relatives. Depressive experiences can occur in various forms: hysterical, anxious, auto-aggressive, etc. The melancholy state may be preceded by anxious-affective reactions in the form of stupor, immobility or hyperkinetic manifestations. Psychogenic depression usually begins on the second day after exposure to a negative stimulus and can last from several days to a year. Reactive delusional states result from discrimination, insult, or injury to a person who becomes obsessed with revenge, paranoia, or reformist thoughts.

Intoxication psychoses develop due to toxic effects on the functioning of the brain and its structure. The disease can occur suddenly due to the action of a large dose of a toxic substance or develop gradually (substance abuse, drug addiction). The clinical picture of this pathology manifests itself in hallucinations, cognitive impairment, and confusion.

Infectious diseases can have a destructive effect on the human psyche, for example, with Botkin’s disease, disturbances in consciousness, thinking and perception are often observed, and the flu sometimes causes depressive states with suicidal overtones. Acute forms of the disease are characterized by fragmented amnesia, pathology of consciousness and cognitive impairment.

Treatment of psychosis

Therapy for psychosis is carried out in psychiatric hospitals, since patients must be under the strict supervision of doctors. Psychogenic, affective-shock conditions require immediate hospitalization, since the consequences of acute psychosis can be quite serious. Often, failure to provide timely assistance to patients resulted in suicidal and socially aggressive cases. So, how to treat psychosis in a hospital setting? The main approach to treating the disease is the use of medications: tranquilizers, antidepressants, sedatives. Sometimes psychotherapy is prescribed, in particular, the cognitive approach, hypno-suggestion, but their effectiveness in correcting these psychotic conditions does not always justify itself.

Many patients are interested in how to treat psychosis at home. Doctors strongly recommend that you seek medical help at the first signs of the disease and under no circumstances resort to self-treatment. The consequences of acute psychosis can be very diverse: most patients, with properly selected therapy, are completely cured of the disease, and some of them acquire chronic forms of personal psychopathization. The course of the disorder largely depends on the nature and strength of the psychogenic stressor. In general, the prognosis for the treatment of this disease is favorable; the main thing is not to postpone a visit to the doctor, especially in the acute stages of psychosis.

Psychoses

The general concept of psychosis refers to a mental disorder manifested by an inadequate reflection of the real world with disturbances in behavior, mental activity and the development of various pathological signs (delusions, hallucinations, affective states).

One of the most striking representatives of psychoses is schizophrenia (schizo - to split, phren - soul, mind).

Schizophrenia is the most common mental illness, characterized by progression over time and manifested by two groups of symptoms. Productive symptoms are represented by psychomotor agitation, delusions, hallucinations, automatisms (impaired perception of one’s own thoughts, speech, movements), agitation, catatonia, affective states, fear, illusions. Negative symptoms are represented by autism, stupor, mutism, lack of contact and negativism, dementia, hebephrenia (in adolescents, foolishness, impaired thinking followed by dementia), schizophrenic defect (decreased mental activity, emotional emptiness, dullness, intellectual degradation), amentia (impaired consciousness, incoherent speech), apathy (isolation from the real world), abulia (lack of aspirations and desires), fragmentation of thinking and speech (lack of sick meaning in speech, speech consists of incoherent words, neologisms invented by him, an influx of thoughts - mentism).

Clinical forms of schizophrenia with pronounced productive symptoms:

1. Paranoid. Characterized by steady progression and gross personality changes. The phenomenon of catatonia, hallucinations, persistent systematized delirium, mannerisms of speech, reasoning, and neologisms occurs.

2. Periodic form. Characterized by periodic attacks of affective-delusional, catatonic states. After a period of exacerbation, remission occurs.

3. Acute form. It is characterized by the sudden rapid development of hallucinatory-delusional, affective, catatonic states.

4. Slow onset schizophrenia. Manifestations in the form of delusions and personality disorders arise gradually and grow slowly.

5. Hypochondriacal. It manifests itself as hypochondriacal delusions, characterized by absurd fears that threaten one’s own health, and thinking is impaired.

6. Hypertoxic. It occurs with sudden attacks of strong frantic motor excitement, confusion, fever, and the development of coma.

7. Paraphrenic. Manifests itself as delusions of grandeur.

Clinical forms with scant productive symptoms:

1. Simple. It is characterized by a thinking disorder, affective dullness, decreased volitional function, and the rapid development of a schizophrenic defect.

2. Nuclear (galloping). It is characterized by the rapid disappearance of previously existing productive symptoms and the development of emotional emptiness and emotional dullness.

3. Latent. It is distinguished by its very slow development and paucity of symptoms.

4. Heboid. Develops in adolescence (puberty) and is characterized by a pronounced disturbance of the affective-volitional sphere and emotional emptiness.

Treatment of schizophrenia is carried out by various means. The best effect of drug therapy is observed with productive psychotic symptoms than with negative ones.

Previously, insulin shock, pyrogenic, pyrogenic-infectious convulsive and electroconvulsive therapy were used. Sometimes psychosis was provoked to transfer it from a state with negative symptoms to positive symptoms.

Currently, medications with antipsychotic activity are used to treat schizophrenia. These include antipsychotics. They have a calming effect, eliminate productive symptoms, and slow down the further development of the disease. The main effect of antipsychotics is associated with inhibition of the dopamine metabolism system.

All antipsychotics are divided into:

Typical antipsychotics:

Phenothiazine derivatives (aminazine, triftazine, fluorophenazine).

Thioxanthene derivatives (chlorprothixene).

Butyrophenone derivatives (haloperidol).

2. Atypical antipsychotics:

Dibenzodiazepine derivatives (clozapine).

With long-term use of antipsychotic drugs, addiction may develop, but drug dependence does not occur. There are restrictions on taking these drugs for chronic and decompensated diseases of the liver, kidneys, diseases of the blood, heart and other systems.

Another prominent representative of psychoses is manic-depressive psychosis or bipolar disorder.

It is characterized by the presence of two conditions in the patient - mania and depression. The first sign is usually depression (75% of women and 67% of men). A manic episode may occur several years after the onset of depression (usually 1-2 years). In some cases, phase alternation occurs much faster. In 10-20% of cases there are only manic episodes without depression.

A manic episode develops over several hours or days, rarely over several weeks. In the early stages of the disease, psycho-social factors play a significant role in provoking mania. Before starting to use psychotropic drugs, the manic episode lasted 3-4 months, the depressive episode lasted about a year. Currently, when treated with modern drugs, the manic phase lasts 1-1.5 months, and depression lasts about 6 months. In 20% of patients, depression lasts up to 2 years. In general, a patient with TIR can experience about 7-9 phases of the disease during his life.

There is a likelihood of developing MDP after one depressive episode in life. The frequency of transition of endogenous depression to MDP is 5-20%. Of these, the transition to MDP after the first depressive episode is 50%. Factors predisposing to MDP include: hereditary history of MDP, early onset of depression (before 25 years), severe psychomotor retardation, psychotic symptoms.

After a manic episode, in 7% of patients the attacks do not recur; in 10% of patients the disease becomes chronic.

A state of remission is established if the patient has no signs of either a manic or depressive nature.

Two groups of drugs are used to treat bipolar disorder:

Side effects of antipsychotic drugs: this group of drugs is characterized by the following pattern: the higher the effectiveness of the drug (as an antipsychotic), the more pronounced the side effects of the drug.

Side effects include the following:

Acute dystonia. Violent movements: chorea - grimacing, torticollis, epileptic seizures, fear, anxiety.

Akathisia. Uncontrollable motor restlessness, desire to move, movement of legs.

Neuroleptic malignant syndrome. Accompanied by an increase in temperature to 39?, muscle rigidity, choreic hyperkinesis, salivation, and impaired consciousness. Possible palpitations, increased blood pressure, and urinary incontinence.

Tardive dyskinesia. Violent movements appear several years after the start of treatment with antipsychotics.

Perioral tremor (“rabbit mouth”).

Sedative effect (calming). Lethargy, drowsiness.

Toxic paradoxical effect. The patient's condition worsens during treatment.

Psychomotor disorders. Types of psychomotor disorders

Under psychomotor skills, understand a set of consciously controlled motor actions that are under volitional control (Gurevich M.O.; 1949). Symptoms of psychomotor disorders can be expressed in difficulty, slowdown in the performance of motor acts (hypokinesia), complete immobility (akinesia), as well as polar opposite symptoms - motor agitation or inadequate movements and actions (parakinesia). The most typical example of the pathology of effector volitional activity is catatonic disorders of various forms.

To symptoms of psychomotor disorders with difficulty in motor activity (catatonic stupor) include:

Catalepsy, waxy flexibility, in which, against the background of increased muscle tone, patients develop the ability to maintain their assigned position for a long time;
Air cushion symptom, relating to manifestations of waxy flexibility and expressed in tension in the neck muscles, while the patient freezes with his head raised above the pillow;
Hood symptom, in which patients lie or sit motionless, pulling a blanket, sheet or robe over their heads, leaving their face open;
Passive submission- a condition when the patient does not have resistance to changes in the position of his body, posture, position of the limbs, in contrast to catalepsy, muscle tone is not increased.
Negativism characterized by unmotivated resistance of the patient to the actions and requests of others.
- Passive negativism(negativistic stupor), which is characterized by the fact that the patient does not fulfill the request made to him, when trying to get him out of bed he resists with muscle tension;
- At active negativism the patient performs the opposite of the required actions. When asked to open his mouth, he compresses his lips when they extend their hand to him to say hello, and hides his hand behind his back. The patient refuses to eat, but when the plate is removed, he grabs it and quickly eats the food.
Mutism(silence) - a state when the patient does not answer questions and does not even make it clear by signs that he agrees to come into contact with others.

To symptoms of psychomotor disorders with motor agitation and inappropriate movements include:

Impulsiveness- the patient suddenly commits inappropriate actions, runs away from home, commits aggressive actions, attacks other patients, etc.;
Stereotypes- repeated repetition of the same movements;
Echopraxia- repetition of gestures, movements and poses of others;
Echolalia- repetition of words and phrases of others;
Paramimia- discrepancy between the patient’s facial expressions and actions and experiences;
Verbigeration- repetition of the same words and phrases;
Mimorech, passing- discrepancy in the meaning of the answers to the questions asked.

Reactive psychosis

Reactive psychosis– a short-term mental disorder that occurs in response to an intense traumatic situation. Clinical manifestations can vary greatly; they are characterized by disturbances in the perception of the world, inappropriate behavior, the development of psychosis against the background of acute stress, the reflection of stress in the picture of a mental disorder, and the completion of psychosis after the disappearance of traumatic circumstances. Symptoms of reactive psychosis usually appear soon after mental trauma and last from several hours to several months. The diagnosis is made based on history and clinical manifestations. Treatment is pharmacotherapy; after recovery from the psychotic state, psychotherapy.

Reactive psychosis

Reactive psychosis (psychogeny) is an acute mental disorder that occurs during severe stress, characterized by a disturbance in worldview and disorganization of behavior. It is a temporary, completely reversible condition. Reactive psychosis is similar to other psychoses, but differs from them in the greater variability of the clinical picture, variability of symptoms and high affective intensity. Another feature of reactive psychosis is the dependence of the course of the disease on the resolution of the traumatic situation. If unfavorable circumstances persist, there is a tendency for a protracted course; when stress is eliminated, a rapid recovery is usually observed. Treatment of reactive psychoses is carried out by specialists in the field of psychiatry.

Causes and classification of reactive psychoses

The cause of the development of psychogenics is usually a situation that poses a threat to the patient’s life and well-being or is of particular significance for some reason related to the beliefs, character traits and living conditions of the patient. Reactive psychoses can occur during accidents, natural disasters, military operations, losses, bankruptcy, threat of legal liability and other similar circumstances.

The severity and characteristics of the course of reactive psychosis depend on the personal significance of the traumatic situation, as well as on the characteristics of the patient’s character and his psychological constitution. Such conditions are more often diagnosed in patients with hysterical psychopathy, paranoid psychopathy, borderline personality disorder and other similar disorders. The likelihood of developing reactive psychosis increases after traumatic brain injury, mental or physical fatigue, insomnia, prolonged alcohol intake, severe infectious and somatic diseases. Particularly dangerous periods of life are puberty and menopause.

There are two large groups of reactive psychoses: prolonged psychoses and acute reactive states. The duration of acute reactive states ranges from several minutes to several days, the duration of prolonged reactive psychoses - from several days to several months. Acute reactive states include reactive stupor (affectogenic stupor) and reactive excitation (fugiform reaction). Protracted psychoses include hysterical reactive psychoses, reactive paranoid and reactive depression.

Protracted reactive psychoses

Hysterical reactive psychoses

Within the framework of hysterical reactive psychoses, hysterical twilight stupefaction (Ganzer syndrome), pseudodementia, wildness syndrome, delusional fantasy syndrome and puerilism are considered.

Ganser syndrome called reactive psychosis, accompanied by a narrowing of consciousness and pronounced affective disorders: anxiety, foolishness, emotional lability. Patients quickly move from crying to laughter, from joy to despair. Some patients suffering from reactive psychosis experience visual hallucinations. Productive contact is impossible, since patients understand speech addressed to them, but answer questions incorrectly (“mimic speech”). Orientation in place and time is impaired; patients often do not recognize people they know.

Wernicke's pseudodementia– reactive psychosis, reminiscent of dementia. Orientation in place, time and one’s own personality is disturbed, and these violations are of a deliberately pronounced nature. The patient says obvious absurdities (for example, to the question “how many eyes do you have?” he answers “four”), makes gross mistakes when performing the simplest tasks (for example, tries to put shoes on his hands instead of on his feet), while his answers and actions always correspond to the given topic. Confusion is observed, affective disorders are possible. Reactive psychosis lasts from 1 to 8 weeks.

Puerilism– psychogenia, in which the patient’s behavior becomes deliberately childish. A patient with reactive psychosis talks like a small child, lisps, plays with toys, cries, is capricious, calls others aunts and uncles, cannot answer simple questions or answers them from the position of a child. Facial expressions, movements, intonations and peculiarities of phrase construction in this reactive psychosis resemble those in preschool children. Some “adult” skills, such as applying makeup or lighting a pipe, are found to be retained.

Feral syndrome– reactive psychosis, in which the patient’s behavior resembles the behavior of an animal. Occurs against a background of intense fear. The patient shows aggressiveness, growls, runs on all fours, sniffs objects, takes food from the plate with his hands rather than with a spoon or fork. Delusional fantasy syndrome is a reactive psychosis that develops against a background of severe anxiety and is accompanied by the formation of delusional ideas about one’s own greatness, genius, extraordinary abilities or incredible wealth.

Reactive paranoid

Reactive paranoid– reactive psychosis that occurs when living conditions change, with a lack of productive contacts with other people, in an environment that poses a real threat or seems frightening, dangerous and incomprehensible to the patient. This group of reactive psychoses includes reactive paranoid proper, reactive paranoia and induced delusions. Reactive paranoid and reactive paranoia develop in conditions of imprisonment and captivity. They can be observed when moving from a small village to a huge metropolis. Sometimes such reactive psychoses occur in deaf people who cannot read lips and find themselves surrounded by people who do not speak sign language. The risk of development increases with lack of sleep.

The onset of reactive psychosis is preceded by severe anxiety. Patients feel restless and sense “impending disaster.” Against the background of affective disorders, hallucinations appear, and delusions of special meaning, persecution or relationship develop. Consciousness is narrowed. Delirium reflects a traumatic situation. Patients suffering from reactive psychosis try to run away and hide, beg for mercy, or become detached, humble and doomedly await the onset of a tragic outcome. Some patients attempt suicide in an attempt to “escape punishment.” Reactive psychosis ends after 1-5 weeks; after recovery from psychosis, asthenia occurs.

Jet paranoia accompanied by the formation of paranoid or overvalued ideas, limited by the framework of a traumatic situation. Ideas of invention or jealousy may develop. Some patients with reactive psychosis become convinced that they have a serious illness. Highly valuable ideas are specific, clearly related to real circumstances. In situations not associated with highly valuable ideas, the patient’s behavior is adequate or close to adequate. Affective disturbances are observed, marked anxiety, tension and suspicion are noted.

Induced delirium– reactive psychosis, provoked by close communication with a mentally ill person. Usually, close relatives who are emotionally attached to the patient and living with him in the same area suffer. Predisposing factors are the high authority of the “inductor”, as well as passivity, intellectual limitations and increased suggestibility of the patient suffering from reactive psychosis. When you stop communicating with a mentally ill relative, the delusion gradually disappears.

Reactive depression

Reactive depression is a reactive psychosis that develops in circumstances of severe mental trauma (usually the sudden death of a loved one). In the first hours after the injury, stupor and numbness occur, which are replaced by tears, remorse and guilt. Patients suffering from reactive psychosis blame themselves for not being able to prevent a tragic event and not doing everything possible to save the life of a loved one. At the same time, their thoughts are directed not to the past, but to the future. They anticipate their lonely existence, the emergence of material problems, etc.

With this form of reactive psychosis, tearfulness, persistent depression of mood and loss of appetite are observed. Patients become inactive, stoop, lie or sit in one position for a long time. Movements slow down, it seems as if patients do not have enough strength and energy to perform the simplest actions. Gradually, the mood normalizes, depression disappears, but the duration of reactive psychosis can vary greatly depending on the character of the patient and the prospects for his further existence. In addition, reactive depression can be observed in prolonged unresolved traumatic situations, for example, in the case of the disappearance of a loved one.

Diagnosis and treatment of reactive psychoses

The diagnosis is made based on the medical history (presence of a traumatic event), characteristic symptoms and the relationship between symptoms and the traumatic situation. Reactive psychosis is differentiated from schizophrenia, delusional disorders, endogenous and psychogenic depression, manic-depressive psychosis, drug or alcohol intoxication and withdrawal syndrome that develops after stopping drug or alcohol use.

Patients with reactive psychosis are hospitalized in the psychiatry department. The treatment plan is drawn up individually, taking into account the characteristics of psychogeny. For agitation, tranquilizers and antipsychotics are prescribed. Antipsychotics are also used for delusional ideas, and antidepressants are used for depression. After recovery from reactive psychosis, psychotherapy is carried out aimed at working through the feelings that arose in connection with a traumatic situation, adapting to new living conditions and developing effective defense mechanisms that help maintain adequacy under stress. The prognosis is usually favorable.

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Federal State Budgetary Educational Institution of Higher Professional Education

Lipetsk State Pedagogical University named after P.P. Semenov-Tien-Shansky.

Institute of Psychology and Education

Department of Medical and Biological Disciplines

Test

On the topic: “Psychomotor disorders”

Completed by: 3rd year student, gr. LOG - 3

Paslar V.

Checked by: Doctor of Medical Sciences, Professor

Stamova L.G.

Lipetsk 2016

Introduction

Psychomotor is a complex of human motor acts that are closely related to mental activity and reflect the peculiarities of the constitution. The term “psychomotor” is used to distinguish complex movements associated with mental activity from elementary motor reactions associated with the simpler reflex activity of the central nervous system.

Psychomotor disorders is a disorder of complex motor behavior that can occur with various nervous and mental diseases. With severe focal lesions of the brain (for example, with cerebral atherosclerosis), motor function disorders occur in the form of paralysis or paresis; with generalized organic processes (for example, with brain atrophy - a decrease in its volume), such disorders may be limited to general slowness, poverty of voluntary movements, lethargy facial expressions and gestures, monotony of speech, general stiffness and changes in gait (small steps).

1. Types of psychomotor disorders

Stupor(from Lat. stupor - “numbness”) - a state of severe depression, expressed in complete immobility, weakened reaction to irritation.

The following are distinguished: types of stupor:

catatonic - complete immobility, adoption of monotonous poses, the patient does not maintain contact;

stuporous state with waxy flexibility - maintaining the given pose;

negativistic - attempts to change the patient’s posture or position cause resistance on his part;

depressive (affective) - a suffering facial expression, taking a pose that reflects the patient’s experiences;

hallucinatory - with the presence of hallucinations;

post-shock - follows a traumatic situation;

Symptoms of stupor

confusion;

complete immobility;

complete or partial mutism (silence);

muscle hypertonicity;

negativism (usually passive);

suppression of reflex reactions;

lack of reactions to external stimuli;

lack of contact with others.

Causes of stupor:

severe psychotraumatic factors;

stressful situations;

emotional negatively charged situations;

mental disorder;

organically caused damage to brain structures, bruises, concussions;

infectious disease;

intoxication;

occurrence as a mental equivalent in epileptic seizure disorders.

Prognosis of stupor. The cause of the condition is determined; with timely intensive treatment, positive results can be achieved. Symptoms may self-limit after a certain period of time.

Catatonia(from the Greek kata - “along” - and tonos - “tension”) - a neuropsychic disorder characterized by muscle spasms and disturbances of voluntary movements.

Catatonia is a whole group of syndromes that can be structurally divided into:

catatonic agitation

catatonic stupor

Excitation, in turn, is divided into three forms:

pathetic;

impulsive;

Stupor is divided into:

cataleptic (with waxy flexibility);

negativistic;

stupor with numbness.

In patients suffering from schizophrenia, a number of authors identify whatThere are four basic subtypes of catatonia:

lucid catatonia;

exclusively motor psychoses;

catatonia accompanied by hallucinations and delusions;

oneiric catatonia.

Classic symptoms of catatonia:

disgust (aversion);

muscle resistance;

subordination to other people;

constant excitement;

duality of experiences, forcing a person to feel absolutely opposite feelings in relation to the same object (ambitendency);

withdrawal or speech incontinence (logorrhea);

seizures accompanied by loss of sensation (catalepsy);

verbalization, manifested in the constant repetition of meaningless phrases; psychomotor stupor catatonia seizure

“air cushion” symptom, when a lying person holds his head above the pillow for a long time;

grimacing and mannerisms, taking pretentious poses,

repetition of the same poses, movements, emotions (perseveration)

protest behavior (negativism);

repetition of facial expressions of others (echopraxia);

complete silence (mutism..0;

grasp reflex;

wide eyes;

repeating phrases of the interlocutor (echolalia);

Causes of catatonia. Catatonic syndrome often develops against the background of a mental illness such as schizophrenia. However, in some cases, the symptom complex is observed against the background of symptomatic and organic psychoses. Violation of muscle tone (in the direction of tension) can accompany organic lesions of the brain (for example, be a consequence of tumor growth). The motor symptoms of catatonia may be due to “incorrect” modulation in the basal ganglia, which in turn is caused by a lack of an important neurotransmitter, gamma-aminobutyric acid. There is also an opinion that the development of symptoms is caused by a sudden and massive blockade of dopamine.

Forecast. If we leave aside the variety of possible manifestations of catatonia, the severity of symptoms and the timeliness of diagnosis, then we can say that treatment (if it was carried out) bears fruit: from 12 to 40% of patients are conditionally considered cured. Certain improvements after therapy with benzodiazepine drugs were observed in 70% of patients. At the same time, the probability of death is relatively low - from 8.33% to 29.17% (with severe complications and delirium tremens).

All this allows us to come to the conclusion that catatonic syndrome at the current level of development of medicine is no longer a death sentence, and in most cases it is possible to achieve either lasting improvement or complete remission. But this does not apply to severe and advanced forms, therefore, at the slightest suspicion, it is better to immediately consult a doctor rather than self-medicate.

Seizure- This is a short-term, suddenly occurring painful condition in the form of loss of consciousness and typical convulsions.

Types of seizurekov:

A minor convulsive seizure can also, although not always, begin with an aura and is characterized by a sudden loss of consciousness for several seconds, but the patient does not fall, since there is no stage of tonic convulsions, only clonic twitching of individual muscles or a limited group of muscles is noted. The attack is generally short-lived, then the patient experiences amnesia for the entire duration of the attack.

A cataplectic seizure occurs when there is a sudden drop in muscle tone when laughing, crying, or when suddenly exposed to a sharp sound or very bright light. At the same time, the patient seems to sink, slowly sinking to the floor. Consciousness remains clear, no amnesia is noted.

Cataplectic disorders are related to a special type of seizure - Kloos seizures. They are expressed in a sudden interruption in the flow of thoughts with a feeling of emptiness in the head, disappearance of support under the feet and weightlessness of the whole body or only the lower extremities. Consciousness is completely preserved, the memory of this fleeting unusual state is complete, which distinguishes them from absence (see below). Such seizures are sometimes observed in the initial stages of psychosis, usually schizophrenia.

Pycnoleptic seizure - instantaneous freezing in one place with loss of consciousness, throwing back the head, rolling up the eyeballs, and drooling. Seizures of this kind are typical for young children.

A narcoleptic seizure (one of the components of the so-called Pickwick syndrome) is characterized by a sudden onset of irresistible drowsiness in an inappropriate place and time, in positions that are uncomfortable for sleeping, for example, while walking, traveling in public transport, performing on stage, or during outdoor games. Sleep, as a rule, lasts about an hour, after which the patient wakes up alert and active. Such seizures occur at a young age and pass as suddenly as they began, leaving no trace.

A Jacksonian seizure is an epileptic seizure in the form of tonic or clonic muscle spasms of the fingers and toes, localized or spreading to only one half of the body. Jacksonian epileptic seizure indicates the presence of a pathological focus in the cerebral cortex.

An adversive seizure is expressed by turning the head or torso in the direction opposite to the lesion in the brain.

Kozhevnikov's seizure (Kozhevnikov's epilepsy) - clonic convulsions in the muscles of the limbs without loss of consciousness. Most often it is a consequence of viral tick-borne encephalitis.

All these epileptic seizures can also be provoked by external factors, such as overwork, lack of sleep, mental overload, asthenia after a somatic illness.

Reasonss occurrence:

up to 2 years of age, seizures are usually associated with birth trauma, developmental abnormalities, metabolic lesions of the brain, maternal illnesses during pregnancy, birth injuries, toxicosis and infections of the nervous system.

Seizures that begin after 25 years of age are usually caused by injuries, tumors, other organic lesions of the brain, poisoning, and neurosurgical operations.

Convulsive seizures can be triggered by flashing lights, running, psychological trauma, infections, and alcohol.

The most common symptom of epilepsy is a grand mal seizure, which occurs in four stages:

Precursor stage

Aura stage

Seizure stage

Post-seizure stage

Epileptic coma may develop against the background of status epilepticus.

Over time, the patient’s personality changes: character deteriorates, memory deteriorates, and dementia increases.

Forecast. With a single seizure, the prognosis is good. After the first seizure, in 70% of cases, a stage of remission occurs. Drug therapy can completely eliminate seizures in 50% of cases and greatly reduce their frequency in another 35%. In the majority of patients, no noticeable abnormalities are detected in the interictal period. The progression of mental disorders is associated with the ongoing neurological disease that is the cause of the seizures.

Conclusion

In neurology and psychiatry, the study of psychomotor skills plays an important role. The patient’s motor appearance, his manner, posture, gestures and their correspondence to the nature of the statements are important signs that allow making the correct diagnosis.

References

1. Kovalev V.V. Semiotics and diagnosis of mental illness in children and adolescents, p. 25, M., 1985.

2. Guide to Psychiatry / Ed. A.V. Snezhnevsky. -- T.1-- 2,-- M.: Medicine, 1983.

3. Morozov G.V., Shumsky N.G. Introduction to clinical psychiatry (propaedeutics in psychiatry). - N. Novgorod: Publishing house of NGMA, 1998 - 426 p.

4. “Clinical psychiatry” G.I. Kaplan, B. J. Sadok (M., 1994)

5. Mukhin K.Yu., Mironov M.B., Petrukhin A.S. Epileptic syndromes. Diagnostics and therapy. Guide for doctors. Moscow, “System Solutions”, 2014, 376 p.

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