Syndrome of early childhood neuropathy. Mechanism of occurrence, manifestations and significance. Neuropathy: early, congenital, constitutional, childhood nervousness, neuropathic constitution, endogenous nervousness, nervous diathesis

- a symptom complex. Syndromes observed in childhood and adolescence. Age features of some syndromes. The significance of the genetic factor, injuries, infections and intoxications for the occurrence of certain syndromes. Syndrome and disease, their relationship and interdependence.

The normal development of the child and the formation of the body's defenses is possible with good adaptation to the social environment. In this regard, natural feeding plays an important role, during which a close emotional bond is formed between the mother and the baby, a friendly home environment in the family, care and love of parents. An early-formed emotional bond between mother and child encourages him to seek protection from his mother in any case of danger.

In this section, we will consider various types of mental disorders caused by genetic, organic or functional disorders.

Symptoms of mental disorders occur in the form of certain combinations - symptom complexes or syndromes, united by the unity of pathogenesis. N.M. Zharikov (1989), D.N. Isaev (2001) believe that the syndromes themselves are not strictly specific for a particular nosological form and can be observed in many mental illnesses. At the same time, symptoms and syndromes are the material from which the clinical picture of the disease is created. Syndromes and their dynamics manifest the pathogenesis of the disease, the sequence of its stages. The preference of syndromes and their turnover determine the stereotype of development characteristic of each disease. To diagnose a disease, it is necessary to talk about a certain age sequence of the occurrence of such syndromes in mental illness in children and adolescents, which are a clinical expression of a certain mental development of the child and correspond to the periodization of neuropsychic response levels. Syndromes of mental illness that are predominant for children and adolescents according to G.E. Sukhareva (1955) and V.V. Kovalev (1979), D.N. Isaev (2001) are those that reflect not so much the nosological nature of the disease as the type of neuropsychic response.

1. Syndrome of early childhood neuropathy

In infancy and early childhood, the symptoms of neuropathy come to the fore with a variety of somatovegetative disorders and sleep disturbance. Somatovegetative disorders are dominated by dysfunctions of the digestive organs (frequent regurgitation, vomiting, constipation, often alternating with diarrhea, loss of appetite or selectivity in food, eating disorders), respiration (respiratory arrhythmia), cardiovascular disorders (pallor and marbling of the skin, cyanosis of the nasolabial triangle , pulse instability, etc.). Other vegetative disorders are also noted, such as low-grade fever, not associated with somatic diseases, sleep disturbance, manifested as insufficient depth and in violation of the sleep formula (drowsiness during the day and anxiety at night).

In children, hypersensitivity to various stimuli is often found in the form of the appearance or intensification of motor restlessness, affective arousal, tearfulness under the influence of ordinary auditory, visual and tactile stimuli, changes in body position, a slight change in the food received, etc. Similar reactions can occur when " feeling of discomfort” associated with hunger, thirst, wet diapers, changes in temperature and humidity in the room, etc.

Many children, along with autonomic disorders and increased sensitivity, may experience instinctive disorders in the form of an increased sense of self-preservation, the expression of which is fear and poor tolerance of everything new. Fears are manifested in the intensification of somatovegetative disorders: refusal to eat, weight loss, increased capriciousness and tearfulness with any change in the situation, change in regimen, conditions of care, placement in a children's institution. These children often have an increased tendency to allergic reactions, infectious and colds.

With age, the severity of somatovegetative reactions weakens, but reduced appetite up to anorexia, selectivity in food, slow chewing of food, intestinal dysfunction, difficulty falling asleep, superficial sleep with frightening dreams persist for a long time. Gradually, new symptoms may appear: an increase in affective excitability combined with exhaustion, greater impressionability, a tendency to fear, fear of everything new.

As G.E. Sukharev, depending on the predominance of features of inhibition or affective excitability in the behavior of children, two clinical variants of early childhood neuropathy can be distinguished:

With one ( asthenic) - children are timid, shy, inhibited, highly impressionable, easily exhausted;

With another ( excitable) option children are affectively excitable, irritable, motor disinhibited.

The pathogenetic basis of neuropathic conditions is the immaturity of the higher centers of autonomic regulation associated with their functional immaturity and a lower threshold of excitability. The syndrome of neuropathy is quite often included in the structure of residual organic neuropsychiatric disorders resulting from intrauterine or early organic brain lesions ( "organic" or "residual" neuropathy according to S.S. Mnukhin, 1968). In these cases, manifestations of organic neuropathy are found already in the hospital. They are more rough and monotonous in nature (newborns do not take the breast well, are restless, moan or cry). In the future, these phenomena are combined with a variety of minimal cerebral dysfunction (MMD), increased intracranial pressure, delayed psychomotor development and speech.

According to E.I. Kirichenko and L.T. Zhurba (1976), in differential diagnosis, it is necessary to pay attention to the fact that with “true” neuropathy, personality components are more pronounced, while at the same time, cerebropathic symptoms and symptoms of motor disinhibition are more noticeable in children with “organic” neuropathy.

With age, in children with "true" neuropathy, there may be violations of the functioning of internal organs, against which somatic disorders are formed. So, in violation of the function of the gastrointestinal tract, various gastritis, colitis occur with age, and functional disorders (regurgitation or vomiting, refusal to eat) are possible, manifesting themselves in a stressful situation (the child is admitted to kindergarten or in the presence of strangers). In children with predominant disorders of the respiratory system, various inflammatory processes (bronchitis, tracheitis) and asthmatic (spasmodic) conditions are easily formed in the future. In children with manifestations of functional disorders of the cardiovascular system at an early age, later, under adverse conditions (physical or mental overload), stable or intermittent tachycardia, extrasystole, pain in the heart area are formed. These symptoms can occur in people of all ages, but they start in early childhood. It should be emphasized that at preschool age, two independent groups are formed from the group of children with early childhood neuropathy: some children with hyperactivity, others are quiet, inactive, in need of motivation to act.

Educators and teachers in a preschool institution should pay attention to the characteristics of each child and, from a conversation with parents, identify the main manifestations of developmental disabilities and provide the necessary assistance in organizing activities, drawing attention to the game, designing, helping to clean the workplace, and practicing musical rhythm , compliance with the regime.
Questions for independent work:

1. What are the differences between the concepts of "symptom" and "syndrome".

2. What are the causes of early childhood neuropathy syndrome?

3. Tell us about the manifestations of the syndrome of early childhood neuropathy.

4. What disease states develop against the background of early childhood neuropathy?

5. Tell us about the forms of work of a teacher in a preschool with difficult children.

6. Name the methods of prevention of childhood neuropathy.

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In physically weakened children, the defensive reflex is not formed. They are touchy, whiny, everyone offends them, they cannot defend themselves. Educators of preschool and school institutions should be especially attentive to physically weakened children and avoid conflict situations.

This group of diseases includes self-preservation disorder, which may appear in the form exacerbations instincts for self-preservation (distrust of everything new, change, unfamiliar objects, adherence to a stereotypical order), weakening attraction to self-preservation (lack of defensive reactions, indifference to others), perversions instincts for self-preservation (autoaggression).

Fear takes a pathological form of self-preservation drive. This is a deep life experience, completely empty of content, usually unmotivated and extreme in intensity. Its manifestation is different: with stupor (stupor) or violent motor restlessness (hysterical reactions).

Attraction to suicide suicide o mania) is usually associated with mental disorders and is observed in adolescents and young people with reactive psychoses, drug addiction, alcoholism. Mentally ill people often show great ingenuity and perseverance in carrying out their suicidal intentions. Close to the drive to take one's own life is the drive to self-mutilate, often carried out impulsively. Often this occurs against the background of delusional and hallucinatory experiences.

Disorders occupy a prominent place in the psychiatric clinic. sex drive: increased or decreased sexual excitability, sexual perversions that can be observed in various mental illnesses and conditions.

Increased sexual excitability - hypersexuality, expressed in adolescents in the form of frequent and prolonged erections, erotic fantasies, masturbation. Such conditions are observed with a sharp increase in androgen secretion due to accelerated pubertal development, under the influence of endocrine disorders or organic lesions of the hypothalamic region.

Hyposexuality- a decrease in sexual desire, manifested in adolescents by a lack of interest in the opposite sex. These disorders occur with a delay in psychosexual development.

The most common form of sexual dysfunction is homosexuality(attraction to people of the same sex). In the anamnesis of homosexuals, features of attraction disorders from childhood are often noted, most clearly manifested in adolescence and young age (interest in certain games, jewelry, girls' clothes, and vice versa). In the mental state of homosexuals, there are features associated with the pathology of their drives, often a feeling of social rejection, isolation, often severe feelings associated with the consciousness of their inferiority.

Other forms of abuse include transvestism, a pathological attraction to dressing up in clothes of the opposite sex, as well as an interest in things of the opposite sex.

The object of sexual attraction can also be small children ( pedophilia), sexual intercourse with animals ( bestiality), attraction to statues ( Pygmalion)and others. Such deviations as sadism and masochism have long been known. Sadism - characterized by the desire to inflict pain on another person in order to achieve sexual satisfaction. Masochism- receiving sexual satisfaction or pleasure from the pain or humiliation delivered by a partner.

The opposite state is a decrease in sexual activity, due to temperament, the possibility of volitional control of one's instincts, the moral level of the individual, experienced stresses. Often falls potency in chronic alcoholics.

Given that the sexual instinct is formed in childhood, the task of parents and educators is to instill in children a correct understanding of the relationship between boys and girls, respect for them.

A grandmother asked for advice about her 6-year-old grandson. Coming home from kindergarten, the boy spends a lot of time near the mirror, puts on his mother's shoes and dress, her jewelry, paints his lips and transforms into a woman. Such an interest in women's clothing worries the grandmother. Question to the grandmother: what do the boy's parents do at home? Grandma's answer: dad reads the newspaper and watches TV, mom looks at her new fashion items or talks with friends about updates. Nobody takes care of a child, he is left to himself and lives in a circle of constant conversations about things, toilets, women's jewelry, fashion. Naturally, he has formed female interests. In this regard, advice to parents: the father of the child to engage in male housework and physical education together with his son and accustom the child to work. Otherwise, the child will develop various pathological personality traits.

parental instinct formed from childhood. The girl more than ribs in the hands of a doll, shakes, bathes and dresses her, imitating her mother. Throughout life, the girl is closer to the dolls, and then to the child. The boy prefers outdoor games: war, football or plays with cars, constructor, soldiers. Nowadays, both boys and girls are addicted to computer games. The parental instinct is formed in the process of the joint life of the child with his parents, taking care of them and is expressed in the healthy, proper upbringing of his child. But various deviations can be observed in the form of hyper-custody or hypo-custody, which manifests itself in strengthening or weakening the parental instinct.

At overprotection loving parents try to do everything for their child: he grows up unsuitable for domestic work, the need to help parents. Most often, hyper-custody comes from the mother, she dresses and shoes the child, advises him with whom to sit at the table, with whom to be friends and what to say. In these cases, the child does nothing on his own, does not solve his problems. This situation (suppression of initiative) persists in school and adolescence. A certain personality warehouse is formed in a child, which is defined as psychasthenia. In difficult everyday conditions, these people are not prepared to solve any problems on their own and in difficult cases show a severe stress reaction.

In cases hypoprotection, when parents pay little attention to their children for various reasons: they work hard, abuse alcohol and spend their free time in entertainment. Children grow up under the influence of the upbringing of strangers, who are not always prosperous. In these cases, children leave home, engage in vagrancy and theft. Depending on their age, many of them end up in boarding schools, orphanages, or end up in prison when committing a crime.

In a number of cases, mothers show indifference, even disgust, towards their children immediately after childbirth. This may be an early sign of mental illness ( symptomatic postpartum psychosis, exacerbation of the schizophrenic process).

Attractions are formed on the basis of instincts. However, attraction is a broader concept, which not only implies certain forms of behavior, but also denotes the experience of a certain biological need. Thus, attraction is a state that prompts one to seek or avoid those vital situations in which it could be resolved by an instinctive movement. Attractions are formed in the process of life, but can change under the influence of the environment. Attractions periodically arise and disappear, their intensity changes. Forms of manifestation of drives are different and often depend on their satisfaction or volitional action.

Psychiatry describes a large number impulsive drives: attraction to vagrancy dromania), arson ( pyromania), theft ( kleptomania). Most impulsive drives are complex formations both genetically and structurally. Unlike obsessive states, impulsive drives are acutely emerging urges and aspirations that subjugate the entire consciousness and behavior of the patient. Impulsive actions occur with a deeper disturbance of mental activity compared to impulsive drives. They are characterized by meaninglessness and arise without any reason. The patient can impulsively commit an aggressive act or injure himself up to suicide (A.A. Portnov). Such conditions are observed in schizophrenia and psychopathy.

Pathophysiological mechanisms of emotional-volitional disorders are diverse and have genetic and social roots, are observed in many mental and neurotic disease states. In these cases, children and adolescents need a kind, attentive and caring attitude, involvement in educational and work activities.

Disorders of effector functions (motor-volitional)

Along with emotional-volitional disorders, motor-volitional disorders are also described in a psychiatric clinic.

The mechanism of occurrence of motor-volitional disorders is based on the factor of the predominance of excitatory or inhibitory processes in the cerebral cortex. In these cases, volitional activity is weakened or increased.

Motor-volitional disorders with a predominance of the excitatory process include hyperbulia- an increase in volitional activity associated with an increase in drives. It may appear in the form:

Manic excitement in which the patient is constantly in activity: without finishing one job, he starts another, while he talks a lot, his mood is cheerful, his appetite is increased. Such patients may experience hypersexuality, aggression, disinhibition of behavior. A person in this state does not feel tired and can work up to 20 hours a day, leaving several hours to sleep.

This state of manic excitement is observed for two to three weeks, then gradually calms down until the next attack or goes into its opposite state - inhibition. The disease of manic-depressive psychosis (MDP) goes through separate cycles.

catatonic excitation, which, unlike manic excitement, is not purposeful and is expressed by stereotypical movements, randomness, pretentiousness. Patients are in constant motion, impulsively jumping out of bed and aimlessly walking from corner to corner, shouting out individual words. This condition is characterized by echolalia (repetition of words), echopraxia (repetition of movements), echomimic (repetition of facial expressions). These changes in the patient's behavior are characteristic of schizophrenia.

hebephrenic excitation, which is characterized by mannerisms, foolish behavior, an abundance of ridiculous poses, jumps, jumps, antics. In adolescence, the symptoms are supplemented by the disinhibition of the lower drives. Patients talk a lot, philosophize (fruitless philosophical sophistication, reasoning). These conditions are observed in schizophrenia.

hysterical excitement, arising after fear. A person runs without looking back and cannot stop for a long time, to understand what has happened. A form of hysterical excitement also includes a hysterical attack.

Motor-volitional disorders with a predominance of the inhibitory process include all forms characterized by a weakening of volitional activity ( hypobulia) or stopping the action - stupor:

depressive stupor, in which the patient is in the same position for a long time, speaks quietly, selects words with difficulty, his movements are slow and difficult. A constant sign of a depressive stupor is depression, the predominance of feelings of melancholy, fear, anxiety. Characterized by this suffering, frozen facial expressions. Such conditions can be observed in manic-depressive psychosis in the phase of depression, in senile depression.

catatonic stupor characterized by immobility and mutism (refusal to speak, silence). There is a state of wax flexibility ( catalepsy) - the patient can be given any position and he does not change it for a long time, for example, he does not lower his raised arm until it lowers itself. Such conditions are observed in schizophrenia.

Hebephrenic stupor It is characterized by a bifurcation (splitting) of activity, negativism, expressed in the fact that patients perform actions opposite to those they are asked about. These conditions are observed in schizophrenia.

Hysterical or psychogenic stupor occurs after mental trauma: with fear, sudden grief, natural disaster. An external manifestation is a general lethargy up to complete stupor. Sometimes a person freezes and cannot move, cannot utter a word ( mutism). In these cases, diffuse protective inhibition sets in in the cerebral cortex.

Such conditions can be observed in children and adults. In children, after a fright, accompanied by phenomena of mutism, neurotic stuttering may develop.

The various symptoms of psychopathological disorders that we have considered show a variety of options for painful conditions that can be observed in childhood and adolescence. Important is the need for early detection of volitional disorders in children and adolescents, the study of the causes that cause them, the correct organization of pedagogical work, compliance with the regime of mental and physical activity, involving children in physical education, creativity, education of moral qualities and artistic and aesthetic taste. Deviations in the emotional-volitional sphere against the background of mental illness necessitate medical, psychological and pedagogical counseling.

1. What are emotions? How are they different from feelings?

2. What are the features of the formation of the emotional sphere?

3. Describe the types of emotional disorders.

4. How is the emotional-volitional sphere formed in childhood?

5. What is attraction? What types of attraction pathology do you know?

6. What types of violations of the motor-volitional sphere do you know?

7. What features of emotional disorders can be observed in childhood?

8. How do you imagine "negativism" and its significance in the educational process?

9. Name the differences between hypobulia and stupor.

10. What is sadism and masochism?

11. Features of the work of an educator and teacher with children suffering from affective and effector disorders.

MAIN PSYCHOPATHOLOGICAL SYNDROMES

The concept of a syndrome is a symptom complex. Syndromes observed in childhood and adolescence. Age features of some syndromes. The significance of the genetic factor, injuries, infections and intoxications for the occurrence of certain syndromes. Syndrome and disease, their relationship and interdependence.

In this section, we will consider various types of mental disorders caused by genetic, organic or functional disorders.

1. Syndrome of early childhood neuropathy

In infancy and early childhood, the symptoms of neuropathy come to the fore with a variety of somatovegetative disorders and sleep disturbance. Somatovegetative disorders are dominated by dysfunctions of the digestive organs (frequent regurgitation, vomiting, constipation, often alternating with diarrhea, loss of appetite or selectivity in food, eating disorders), respiration (respiratory arrhythmia), cardiovascular disorders (pallor and marbling of the skin, cyanosis of the nasolabial triangle, pulse instability, etc.). Other vegetative disorders are also noted, such as low-grade fever, not associated with somatic diseases, sleep disturbance, manifested as insufficient depth and in violation of the sleep formula (drowsiness during the day and anxiety at night).

With one ( asthenic) - children are timid, shy, inhibited, highly impressionable, easily exhausted;

With another ( excitable) option children are affectively excitable, irritable, motor disinhibited.

The pathogenetic basis of neuropathic conditions is the immaturity of the higher centers of autonomic regulation associated with their functional immaturity and a lower threshold of excitability. The syndrome of neuropathy is quite often included in the structure of residual organic neuropsychiatric disorders resulting from intrauterine or early organic lesions of the brain ( "organic" or "residual" neuropathy according to S.S. Mnukhin, 1968). In these cases, manifestations of organic neuropathy are found already in the hospital. They are more rough and monotonous in nature (newborns do not take the breast well, are restless, moan or cry). In the future, these phenomena are combined with a variety of minimal cerebral dysfunction (MMD), increased intracranial pressure, delayed psychomotor development and speech.

With age, in children with "true" neuropathy, there may be violations of the functioning of internal organs, against which somatic disorders are formed. So, in violation of the function of the gastrointestinal tract, various gastritis, colitis occur with age, and functional disorders (regurgitation or vomiting, refusal to eat) are possible, manifesting themselves in a stressful situation (admission of a child to kindergarten or in the presence of strangers). In children with predominant disorders of the respiratory system, various inflammatory processes (bronchitis, tracheitis) and asthmatic (spasmodic) conditions are easily formed in the future. In children with manifestations of functional disorders of the cardiovascular system at an early age, later, under adverse conditions (physical or mental overload), stable or intermittent tachycardia, extrasystole, and pain in the heart area are formed. These symptoms can occur in people of all ages, but they start in early childhood. It should be emphasized that at preschool age, two independent groups are formed from the group of children with early childhood neuropathy: some children with hyperactivity, others are quiet, inactive, in need of motivation to act.

Questions for independent work:

1. What are the differences between the concepts of "symptom" and "syndrome".

2. What are the causes of early childhood neuropathy syndrome?

3. Tell us about the manifestations of the syndrome of early childhood neuropathy.

4. What disease states develop against the background of early childhood neuropathy?

5. Tell us about the forms of work of a teacher in a preschool with difficult children.

6. Name the methods of prevention of childhood neuropathy.

ISPiP named after Raoul Wallenberg

Abstract on the topic:

"Psychopathology of childhood".

Completed by a student of the group 05/14

"Clinical psychology"

Kulaeva Ya.E.

Disorders of the process of cognition……………………………..4

Sensory disorders………………………………….4

Disorders of perception…………………………………5

Attention disorders…………………………………...7

Memory disorders……………………………………...8

Thought disorders………………………………….9

Affective and effector disorders……………10

Emotional disorders……………………………………..10

Disorders of the emotional-volitional sphere……………15

Disorders of effector functions (motor-volitional)………………………………………………………….17

Major psychopathological syndromes…………………18

1. Syndrome of early childhood neuropathy…………………18

2. Hyperdynamic syndrome…………………………19

3. Syndrome of leaving home and vagrancy………….19

4. Syndrome of fears……………………………………......20

5. Syndrome of pathological fantasizing…………..21

6. Syndrome of early infantile autism…………………..21

7. Dysmorphophobia syndrome……………………………..22

8. Cerebrosthenic syndrome………………………...22

9. Disorder of consciousness syndrome……………………...23

10. Convulsive syndrome…………………………….25

11. Psychoorganic syndrome…………………….26

References…………………………………………29

Psychopathology of childhood- science, is a part of child psychiatry, studying the general patterns and development of child and adolescent mental disorders, aimed at creating methods of treatment and correction.

Disorders of the cognitive process

Sensory Disorders

Agnosia is a disorder of the senses("a" - negation, "gnosis" - knowledge). The clinic describes the characteristics of optical, acoustic, olfactory, gustatory and tactile agnosia.

With optical agnosia that occurs when the occipital lobe of the cerebral cortex is damaged (congenital or acquired insufficiency), the patient does not remember or recognize objects, although he sees them and gives a descriptive description.

With acoustic agnosia(lesion of the left hemisphere) the patient does not distinguish the sounds of speech, does not understand the speech of others. In these cases, they speak of sensory aphasia in adults or sensory alalia in children. If the right hemisphere is affected, the patient does not recognize objects by their characteristic sound (a ticking clock is brought to the patient’s ear when the visual analyzer is excluded, he says “something is ticking, but I don’t know what it is”).

With olfactory and gustatory agnosia the patient, respectively, does not distinguish between smells and taste.

With tactile agnosia the patient does not recognize objects by feeling them.

Agnosia arise when the primary fields of the corresponding analyzer are damaged and can be considered both in neurology and in psychiatry with various organic and functional disorders. In childhood, insufficient development of sensations or their unformedness is often noted.

Children, adolescents and adults may experience sensitivity threshold change: decrease or increase, as well as senestopathy.

Increasing the sensitivity thresholds- mental hyperesthesia - a sharp increase in susceptibility to ordinary or weak stimuli. An example is when children cannot stand certain types of clothing, harsh noise. They fuss, cry. Such conditions are observed in children with neurotic reactions.

Lowering the sensitivity threshold- means a decrease in the reaction to acting stimuli (hypesthesia). Patients do not perceive irritation sufficiently. Such states are observed in reactive states.

Mental anesthesia- a complete decrease in sensitivity on the part of one or more analyzers with their anatomical and physiological safety: mental deafness, blindness, loss of a sense of taste or smell. Such conditions are observed in severe stressful conditions.

Senestopathy- a variety of vague, unpleasant, painful sensations in different parts of the body and internal organs in the absence of pathology in them. Such states occur in various neurotic reactions.

Perceptual disorders

Illusions- this is a distorted perception of a real-life reality. In healthy people, illusions can occur in poor lighting or poor hearing, in a state of emotional stress or fatigue. Illusory perception can occur in a child at a high temperature, and then spots on the wall or drawings on the carpet are perceived as fairy-tale characters. It can be assumed that in all cases there is a diffuse protective inhibition (equalizing phase), which causes a distorted perception of real-life objects and phenomena.

Illusions can also be observed in mental patients in delusional states, when the patient perceives the speech of others as hostile statements. In such cases, one speaks of verbal (verbal) illusions. Patients may experience affective illusions with various forms of delirium, expressed in the fact that patients in their own way perceive the appearance of others: joyful or sad, and give an appropriate reaction.

hallucinations- these are false perceptions (deception of the senses), not associated with real-life objects or phenomena, but representing the fruit of the painful activity of the brain. Hallucinations are observed only in people who are in a state of mental disorder, they arise in the mind of a person, regardless of his will. There are optical, acoustic, gustatory, olfactory and tactile hallucinations. They can be simple in the form of sparks, single sounds, shouts, voices, smells, altered taste, touch, and more complex visual and auditory hallucinations in the form of perception of objects, people or animals, speech and music.

Doctor V.Kh. Kandinsky (1880) described distinction between true and false hallucinations (pseudo-hallucinations).

With true hallucinations all objects and phenomena are located outside the patient, the patient can tell about who he sees and talks to, perceiving them realistically. The patient's behavior changes: with visual hallucinations of an unpleasant nature, the patient covers his face with his hands, hides, runs away, with auditory hallucinations, if the patients hear pleasant music or dialogue, they sit quietly, thoughtfully, listening to the conversation or music. If the words perceived by the patient are not pleasant to him, then he plugs his ears, turns away.

pseudo hallucinations, which are observed only in schizophrenia, are of a different nature. It seems to the patient that all his thoughts sound, are open and accessible to others. The behavior of the patient changes: he ties his head with a handkerchief or towel, throws on a hospital gown so that no one can hear or see what he is thinking.

How independent forms of perceptual disturbances act psychosensory disorders, characterized by a change in the perception of the environment: shapes, sizes, distances, complemented by a violation of the perception of the body scheme. Patients complain of incomprehensible sensations: it seems to them that one arm or leg has become longer, the road is bumpy, objects are perceived either far or close. Walking, writing, behavior are upset. Such symptoms of psychosensory disorders are observed in children and adolescents who are ill or have had a viral infection with encephalitic phenomena.

Derealization- this is a violation of the perception of the surrounding reality, the shape and size of the object, distance and time. Surrounding objects may appear reduced or enlarged. In a new place, it seems to patients that they have already been here, and they perceive the familiar home environment as someone else's.

Depersonalization- a distorted perception of one's own body or its parts.

These conditions are observed in psychosensory disorders after viral neuroinfections.

Visual and auditory hallucinations can be observed in children aged 5–7 years with somatic and infectious diseases against the background of high temperature. In these cases, hallucinations are of an elementary nature: flashing sparks, the appearance of some kind of contours, faces, hails, knocks, noises, the voices of animals and birds, the images of which children perceive as fabulous. With mental illness (schizophrenia), hallucinations can become more complex: for example, with visual hallucinations, there is liveliness, brightness of ideas, a tendency to fantasize, children talk about their visions. Sometimes visual hallucinations are frightening, imperative (commandable) in nature: children see terrible animals, robbers, from whom they run away, hide, perform some kind of action. After 12–14 years of age, adolescents experience gustatory and olfactory hallucinations which often leads to a refusal to eat. In these cases, hallucinations continue for a long time, the patient's behavior changes.

Attention disorders

Attention disorders include exhaustion, distractibility and stuckness.

Attention disorders can be caused by various factors: social and biological. To social factors, causing a disorder of attention, distractions of the environment can be attributed. In the cerebral cortex, new foci of excitation arise, which, according to the law of the dominant, become dominant, attract attention to themselves, inhibiting other parts of the cerebral cortex.

For biological reasons Attention disorders include weakness of active attention - inability to long-term tension in the direction of one object and difficulty in concentrating, due to weakness in the tone of the cerebral cortex, a decrease in the function of the second signaling system. The instability of active attention can be due to a number of factors.: previous trauma of the skull, beriberi, malnutrition and overwork ..

Attention exhaustion may be due to the weakness of cortical processes. Such a decline in active attention is observed in children and adults who have suffered a traumatic brain injury or infection with encephalitic phenomena.

Another type of attention disorder is distractibility pathological mobility of cortical processes with the predominance of passive attention, manifested by a quick, unreasonable change in activity, the productivity of which is sharply reduced. Such conditions are observed in children who have had a birth traumatic brain injury or early infections with subsequent weakness in the activity of the cells of the cerebral cortex. In this case, the instability of active attention is combined with restlessness, mobility, hyperactivity.

Another type of attention disorder is stuckness, poor shifting of attention from one object to another, due to the low mobility of cortical processes. Stuckness is observed in children and adults with organic lesions of the brain and manifests itself in speech, in drawings and in work.

All types of attention disorders (distractibility, exhaustion, stuckness) always point to an organic or functional basis of damage to the nervous system and require the supervision of a doctor, educator and teacher over the child's condition, as well as the identification of other disorders that need specialized help.

Memory disorders

The causes of memory disorders are different.: past traumatic brain injuries, infections and intoxications, vascular and trophic disorders, convulsive seizures that change the cortical structure.

Types of memory disorders Key words: amnesia, hypomnesia, hypermnesia, paramnesia.

Amnesia- complete loss of memory ("a" - denial, "mnesis" - memory). Distinguish anterograde and retrograde amnesia.

Anterograde amnesia- this is a loss of memory for the entire period when a person was in an unconscious state, the cells of the cerebral cortex were inhibited and no irritations reached them.

retrograde amnesia- this is a loss from the memory of events that preceded the disease, injury or condition with loss of consciousness (epileptic seizure, diabetic coma, heart failure). The duration of retrograde amnesia depends on the severity of the brain damage.

Affective amnesia (psychogenic)- these are memory lapses for some periods of life or for certain details associated with mental trauma. At the same time, unpleasant memories, details of the conflict, closely associated with difficult experiences, are forced out, forgotten.

Hypomnesia- reduction or weakening of memory. This condition occurs after an injury, intoxication or infection. In these cases, after suffering a lesion of the medulla, the activity of the cells of the cerebral cortex is weakened. This is manifested in the rapid forgetting of the information received. Such conditions are typical for children with mental retardation, mental retardation and other consequences of organic brain damage.

With sclerosis of blood vessels, less blood comes through them and the activity of cortical cells is weakened, which also leads to a decrease in memory capacity. This is senile hypomnesia, in which older people remember well what happened "once upon a time" and do not remember what happened today. Hypomnesia always has an organic basis.

Hypermnesia- an increase in memory capacity, when people memorize and store in memory for a long time the signals that came to the corresponding areas of the cortex. These features of memory are manifested in a person's life from early childhood and acquire a persistent character.

paramnesia- false memories, which are divided into confabulations and pseudo-reminiscences, and are observed in mentally ill or elderly people.

Confabulations- fabrications, when patients talk about the events in which they took part, while in fact these events did not exist or they happened to someone else, taken from books or films.

Pseudo-reminiscences- these are false memories when the patient talks about events that may have happened to the patient, but shifted in time.

Various forms of memory disorders may be observed in children with organic lesion of the central nervous system accompanied by intellectual disability.

With hydrocephalus, which is a consequence of a trauma of the skull or meningitis, mechanical memory may predominate. Children have reasoning when they talk a lot about everything that attracts their attention, without going into the meaning of what was said. This condition is due to the weakness of cortical processes, insufficient generalizing function of the cortex.

Thinking disorders

Thinking- the highest stage of cognitive activity, which is based on the processing of the information received (sensations and perceptions), their analysis and synthesis. 2 types of violations of the thought process: quantitative and qualitative.

Quantitative thinking disorders manifested in the form of limitation of mental activity or its underdevelopment with mental retardation ( ZPR) or mental retardation ( mental retardation). In adolescents and adults, the breakdown of mental activity - dementia observed in chronically ongoing mental processes.

Qualitative Disorders mental activity are observed in various neuroses and psychoses and are manifested in a disorder in the pace of mental activity, obsession and delirium.

Violation of the pace of mental activity due to the predominance of excitation or inhibition in the cerebral cortex.

Accelerated thought flow up to the breaking of the mind. In these cases, the formation and change of associations is accelerated, one image is replaced by another, there is an influx of thoughts. The sequence is broken, the loss of logical connections between parts of sentences is growing. The process of thinking is characterized by disorder, and statements become incomprehensible, absurd. The accelerated pace of thinking is combined with excited behavior, which fits into a certain manic syndrome.

Slowed down thought process observed with the predominance of inhibition in the cerebral cortex. Patients complain about the lack of thought, "there is some kind of emptiness in the head." A slowdown in the rate of mental activity is observed in depressive states.

Another form of disorder is thoroughness of thinking - detailing, in which the patient leaves the given topic, speaks in detail, repeats and cannot switch to the continuation of the main topic. Excessively detailed thinking, stuckness and poor switchability, viscosity of thinking are characteristic of children and adults with organic lesions of the central nervous system (epilepsy, psychoorganic defect).

One form of thought disorder is reasoning, in which the patient does not answer the question asked, but begins to reason, teach the interlocutor. The verbal production of the patient in this case is lengthy and distant from the essence of the issue. Such features of speech utterance can be observed in psychosis, in hydrocephalus.

One of the forms of thought disorder can be perseverations and stereotypes, which are characterized by a repetition of the answer to the first question asked. At the same time, there is a long-term dominance of any one thought, one idea, which is based on the stuck associations. Such states of inhibition are observed in patients with cerebral hemorrhages or brain tumors.

Incoherent, broken thinking is characteristic of a number of infectious diseases that occur with a high temperature, as well as in patients with schizophrenia. At the same time, thoughts do not unite with each other, but represent separate fragments in which there is no analysis and synthesis, there is no ability to generalize, speech is meaningless.

autistic thinking characterized by the subject's isolation from the outside world, its isolation, immersion in one's own experiences that do not adequately correspond to reality.

Thinking disorders include obsessive thoughts (obsessional syndrome). These are thoughts from which the patient cannot free himself, although he understands their uselessness. Obsessive thoughts can occur in practically healthy people, in neurotics and in mentally ill people. Obsessive thoughts in neurotics are more complex and persistent. This is also a focus of stagnant excitation, but deeper. The patient is critical of his condition, but he cannot free himself from his experiences. Obsessive thoughts in neurotics can have a different character and manifest themselves in the form of irresistible desires, inclinations and fears.

Obsessive fears or phobias are varied and difficult to overcome. A thought may arise, and with it fear, before performing some kind of task or action, especially in an atmosphere of excitement, tension. Children develop a fear of punishment for poorly done homework or poor grades in school. The same thoughts, and with them fears, may appear in a teenager or an adult performing a difficult task in an unfavorable environment. Sometimes logophobia(fear of speech) manifests itself in the presence of one person, a strict educator or teacher at school, while in the presence of another person who is calm and kind to the child, these thoughts and fear do not exist.

Obsessive thoughts in mentally ill people are persistent, patients are not critical of them and do not seek help. According to their clinical picture, obsessive thoughts in mentally ill people are close to delusional ideas and cannot be dissuaded.

Overvalued ideas observed in adolescence and are characterized by certain features. If emotionally brightly colored thoughts predominate in the mind of a person, then they speak of the presence of overvalued ideas. These thoughts are not of an absurd nature, but the patient attaches such great importance to them, which they objectively do not have. Overvalued ideas are not accompanied by a painful sense of imposition and a desire to be free from the wrong way of thinking.

Brad and crazy ideas occur as a result of brain disease. Delirium can occur against the background of an upset consciousness during infection or intoxication, at the height of a painful condition (high temperature or alcohol poisoning), when patients utter single words or short phrases that are not related to the environment.

crazy ideas- these are incorrect, untrue judgments, conclusions that cannot be dissuaded. Patients are under the influence of thoughts that have arisen in them, ideas that change their behavior. Crazy ideas are systematized, are pronounced against the background of intact consciousness, accompany a mental disorder, and can be observed for a long time. Delusional ideas can be combined with hallucinations.

Crazy ideas vary in content: ideas of attitude, persecution, poisoning, jealousy, greatness and enrichment, invention, reformism, litigation and others.

Most common forms of delusional statements: ideas of relation and ideas of persecution. At delusional ideas of enrichment patients talk about their untold riches. At delusional ideas of greatness they call themselves names of great people. At crazy ideas of invention patients design various devices. At delusional ideas of litigation patients write complaints to various organizations, endlessly sue for some kind of rights. One of the types of delusional ideas is characterized by an underestimation of one's personality, the patient is convinced of his worthlessness and uselessness, inferiority (delusional ideas of self-humiliation). Patients in these cases develop a depressive state in which they consider themselves to be bad, worthless. hypochondriacal delirium characterized by unreasonable beliefs and statements of the patient that he has an incurable disease and he must die soon.

Along with the primary delirium, it is possible to single out sensual (figurative) delirium, which is characterized by a disorder of sensory cognition, develops against the background of other mental disorders, is visual in nature with many images perceived fragmentarily, forming images, conjectures, fantasies, which explains its incoherence and absurdity. Allocate various forms of sensual delusions.

Delusion of self-accusation It manifests itself in the fact that the patient ascribes to himself various mistakes, misconduct, which were in reality or significantly increased, up to a crime. Such conditions occur in adolescents who have suffered a skull injury or encephalitis. With delusions of impact the patient believes that his thoughts, actions, deeds are due to the extraneous influence of hypnosis, radio waves, electric current. Delusions of persecution lies in the fact that the patient considers himself surrounded by enemies who seek to destroy him or harm him, and therefore takes various precautions to prevent this from happening. Among the forms of sensual delusions are also described delusions of self-abasement, prejudice, nihilistic, expansive, fantastic, religious, erotic, jealousy, cosmic impact, etc. Unsystematized nonsense, called paranoid, is incoherent, based on guesses and assumptions.

Affective and effector disorders

Emotional disorders

Euphoria- prolonged pathologically elevated mood, inappropriate to the environment. Euphoria is observed in children and adolescents with organic psychoses, with mental illness caused by certain infections, with reactive psychoses.

Depression- depressed mood, inconsistent with the environment, accompanied by melancholy, self-accusation, motor and speech retardation, painful sensations in the body, a sharp decrease in drives. Depression occurs under the influence of external and internal factors and is always a symptom of a psychogenic reaction. In pubertal (adolescent) age, depression can be observed in severe somatic diseases and reactive states.

Dysphoria- an emotional disturbance characterized by constant dissatisfaction with the environment, the actions of relatives or medical personnel, food, viciously irritable melancholy, a tendency to aggressive actions, often with altered consciousness, a sense of fear and delusional ideas. Dysphoria can be observed for several hours or several days; it is typical for patients suffering from epilepsy, who have suffered a skull injury and who abuse alcohol.

emotional weakness represents a fluctuation of mood from good (with elements of euphoria) to low mood (with elements of depression), with periods of easy tearfulness. In preschool children, emotional weakness is a physiological phenomenon: they do not know how to restrain themselves and therefore react violently, not embarrassed by the presence of strangers, and show their joy or anger, but with age, the ability to regulate emotions is developed.

Emotional ambivalence manifested by the simultaneous realization of opposite feelings for the same object (at the same time love and hatred coexist). Most often, ambivalence is observed in schizophrenia, less often in hysterical psychopathy.

Apathy- an excessive decrease in emotional excitability, complete indifference and indifference to the environment, to oneself, lack of desires and motives, complete inactivity. It occurs in various mental illnesses (intellectual deficiency, psychogeny and other conditions).

Emotional dullness observed in cases where the patient does not respond to external stimuli and their own feelings. Similar conditions are observed in chronically ongoing forms of schizophrenia.

Negativism- unmotivated opposition, resistance to any influence from the outside, refusal to perform actions. Passive negativism characterized by resistance to any change in the position of the body and limbs. Resisting any instructions or doing the opposite of what is required is called active negativism. The concept of "negativism" refers to pathological resistance, therefore, the stubbornness of children, which has its own reasons, is mistakenly called negativism.

Pathological affect- a strong, short-term, suddenly arising negative emotion, accompanied by anger, indignation, rage, destructive action, sometimes brutal murder. Such conditions can be observed in children and adolescents who have had a traumatic brain injury, in adolescents and young people who abuse alcohol. In some cases (combination of skull trauma and alcohol consumption), pathological affect may be accompanied by a disorder of consciousness, delirium and subsequent amnesia. Persons who have committed crimes in a state of pathological affect with a disorder of consciousness are recognized as insane. Children and adolescents with these conditions can be observed in kindergarten and at school.

The frequency of emotional disorders in children is due to the physiological characteristics of their mental activity, the weakness of active inhibition, the instability of metabolic processes, the function of the endocrine system, and the characteristics of the course of critical periods in the development of children and adolescents.

Disorders of the emotional-volitional sphere

Will is a conscious purposeful mental activity .

instincts- these are innate reflexes inherited by a person from his ancestors. Instincts include: food, defensive, sexual, parental.

motive- this is an act of reflection, i.e., a critical attitude to desire in accordance with real possibilities.

Volitional activity- this is an action aimed at the realization of a consciously set goal, purposeful mental activity.

Volitional processes can be disturbed in various forms and are characterized by various manifestations.

In patients with manic depressive syndrome there is an increase in volitional activity, manifested in increased activity, indefatigability, verbosity, increased good mood.

A decrease in volitional activity is accompanied by inactivity, apathy, a sharp decrease in motor activity and is observed in some mental disorders. (reactive and endogenous psychoses).

attraction- these are phylogenetically old, inherited, complex unconditionally reflex (instinctive) vital reactions aimed at preserving the genus and prolonging the species. With some lesions of the cerebral cortex, inferiority, the disinhibition of drives is possible.

Violation of the food instinct. Cravings for food are observed in the form of an increase in the food instinct (gluttony, greed). Such conditions are observed in patients who have had encephalitis, and are called bulimia. Most often, you have to deal with the suppression of food cravings. Persistent refusal to eat (anorexia) leads to exhaustion of the patient. Persistent refusal of food may be associated with a delusional mood (delusional ideas of poisoning, etc.) or the belief that food is made from poor quality products. Peak symptom- Eating inedible items. coprophagia- eating feces. Refusal to eat can be observed in various forms of stupor, in states of depression, in hysteria.

perversion of attraction under certain conditions: pregnancy, in patients who have had a concussion, some psychoses. The perversion of the food reflex is manifested in the desire to eat one food or refuse another.

Attraction to suicide(suicide mania) is usually associated with mental disorders and is observed in adolescents and young people with reactive psychoses, drug addiction, alcoholism. Mentally ill people often show great ingenuity and perseverance in carrying out their suicidal intentions. Close to the drive to take one's own life is the drive to self-mutilate, often carried out impulsively. Often this occurs against the background of delusional and hallucinatory experiences.

In a psychiatric clinic, a prominent place is occupied by sexual desire disorders: increased or decreased sexual excitability, sexual perversions that can be observed in various mental illnesses and conditions.

Erotism- hypersexuality, expressed in adolescents in the form of frequent and prolonged erections, erotic fantasies, masturbation

Hyposexuality- a decrease in sexual desire, manifested in adolescents by a lack of interest in the opposite sex.

The most common form of sexual dysfunction is homosexuality(attraction to people of the same sex). In the anamnesis of homosexuals, features of attraction disorders from childhood are often noted, most clearly manifested in adolescence and young age (interest in certain games, jewelry, girls' clothes, and vice versa).

Other forms of abuse include transvestism, a pathological attraction to dressing up in clothes of the opposite sex, as well as an interest in things of the opposite sex.

The object of sexual attraction can also be small children ( pedophilia), sexual intercourse with animals ( bestiality), attraction to statues ( Pygmalion)and others. Such deviations as sadism and masochism have long been known. Sadism- characterized by the desire to inflict pain on another person in order to achieve sexual satisfaction. Masochism- receiving sexual satisfaction or pleasure from the pain or humiliation delivered by a partner.

Psychiatry describes a large number impulsive drives: attraction to vagrancy (dromomania), arson (pyromania), theft (kleptomania). Unlike obsessive states, impulsive drives are acutely emerging urges and aspirations that subjugate the entire consciousness and behavior of the patient. They are characterized by meaninglessness and arise without any reason. Such conditions are observed in schizophrenia and psychopathy.

Disorders of effector functions (motor-volitional)

Motor-volitional disorders with a predominance of the excitatory process include hyperbulia- an increase in volitional activity associated with an increase in drives. It may appear in the form:

manic excitement, in which the patient is constantly in activity: without finishing one job, he starts another, while he talks a lot, his mood is cheerful, his appetite is increased. Such patients may experience hypersexuality, aggression, disinhibition of behavior.

catatonic excitation, which, unlike manic excitement, is not purposeful and is expressed by stereotypical movements, randomness, pretentiousness. These changes in the patient's behavior are characteristic of schizophrenia.

Hebephrenic excitation, which is characterized by mannerisms, foolish behavior, an abundance of ridiculous poses, jumps, jumps, antics. In adolescence, the symptoms are supplemented by the disinhibition of the lower drives. These conditions are observed in schizophrenia.

hysterical excitement that occurs after a fright. A person runs without looking back and cannot stop for a long time, to understand what has happened. A form of hysterical excitement also includes a hysterical attack.

Motor-volitional disorders with a predominance of the inhibitory process include all forms characterized by a weakening of volitional activity (hypobulia) or a stoppage of action - stupor:

depressive stupor, in which the patient is in the same position for a long time, speaks quietly, selects words with difficulty, his movements are slow and difficult. Such states can be observed in manic-depressive psychosis in the phase of depression, in senile depression.

catatonic stupor characterized by immobility and mutism (refusal to speak, silence). There is a state of wax flexibility (catalepsy) - the patient can be given any position and he does not change it for a long time, for example, he does not lower his raised arm until it lowers itself. Such conditions are observed in schizophrenia.

Hebephrenic stupor It is characterized by a bifurcation (splitting) of activity, negativism, expressed in the fact that patients perform actions opposite to those they are asked about. These conditions are observed in schizophrenia.

Hysterical or psychogenic stupor occurs after mental trauma: with fear, sudden grief, natural disaster. An external manifestation is a general lethargy up to complete stupor.

Major psychopathological syndromes.

1. Syndrome of early childhood neuropathy

Syndrome of early childhood neuropathy or "congenital childhood nervousness" (V.V. Kovalev, 1979) is the most common syndrome of mental disorders in early childhood (from 0 to 3 years). The main place in the structure of the syndrome is occupied by a sharply increased excitability and pronounced instability of vegetative functions, which are combined with general hypersensitivity, psychomotor and affective excitability and rapid exhaustion, as well as with more or less pronounced features of inhibition in behavior (in the form of timidity, fearfulness, fear of all new). Among somatovegetative disorders, digestive, respiratory, and cardiovascular disorders predominate. In children, there is increased sensitivity to various stimuli in the form of increased motor restlessness, affective arousal, tearfulness, and changes in body position. Instinctive disorders in the form of an increased sense of self-preservation, the expression of which is the fear and poor tolerance of everything new. Fears are manifested in the intensification of somatovegetative disorders: refusal to eat, weight loss, increased capriciousness and tearfulness with any change in the situation, change in regimen, conditions of care, placement in a children's institution. With age, in children with "true" neuropathy, there may be violations of the functioning of internal organs, against which somatic disorders are formed. These symptoms can occur in people of all ages, but they start in early childhood.

2. Hyperdynamic syndrome

Hyperdynamic syndrome (motor disinhibition syndrome), which is also referred to as hyperactivity syndrome, occurs in the age period from 1.5 to 15 years, but is most pronounced in preschool age. The main components of the hyperdynamic syndrome are: general restlessness, restlessness, an abundance of unnecessary movements, lack of focus and, often, impulsive actions, impaired concentration of active attention. In some cases, there are: aggressiveness, negativism, irritability, explosiveness, a tendency to mood swings. The behavior of children is characterized by the desire for constant movements, extreme restlessness. They constantly run, jump, sit down for a while, then jump up, touch and pick up objects that fall into their field of vision, ask many questions, often do not listen to the answers to them. Their attention is attracted for a short time, which makes it extremely difficult to conduct educational work with them. Due to increased motor activity and general excitability, children easily enter into conflict situations with peers and educators or a teacher due to violations of the daily regimen, when performing class assignments, etc.

This syndrome is most often found in the long-term consequences of early organic brain lesions, which led to its identification with the so-called "minimal brain dysfunction" (MMD) syndrome. Hyperdynamic syndrome is formed against the background of MMD and can be combined with other syndromes resulting from early brain damage.

Developmental disorders of the type of psychosomatic disorders - somatopathies, are considered an expression of a neuropathic constitution. In childhood psychiatry, this variant of developmental disorder was previously called childhood neuropathy.

neuropathy- syndrome of increased neuro-reflex excitability and immaturity of autonomic regulation.

The term "neuropathy" was introduced in 1915. E. Kraepelin to designate non-specific hereditary disorders, characteristic mainly for infancy. Along with this term, such definitions as “congenital childhood nervousness”, “constitutional nervousness”, “endogenous nervousness”, “neuropathic constitution”, “ syndrome of vegetative-visceral disorders», « syndrome of increased neuro-reflex excitability”, “hypoxic-ischemic encephalopathy of the newborn”.

The above terms denoted congenital painful forms of children's response, which are based on constitutional anomalies.

Etiology. neuropathy may be caused endogenous, exogenous-organic and psychosocial factors or their combination.

About a certain role hereditary factors the genesis of neuropathies is evidenced by observations in the families of neuropathic children, where an accumulation of persons with psychopathy, hysterical and other mental personality disorders is found. Parents of these children are often characterized by anxiety, emotional lability and inadequate affective reactions.

Among exogenous organic factors the first place is given to perinatal combined hypoxic and traumatic lesions of the nervous system, especially the hypothalamic region of the brain and the limbic system, which are characterized by increased sensitivity to hypoxia and cause dysfunction of the autonomic nervous system. The risk factors for fetal hypoxia include maternal diseases that cause uteroplacental circulation disorders (cardiovascular, bronchopulmonary, endocrine, blood loss, umbilical cord pathology, etc.).

T.P. Simeon (1929, 1961) suggested that early childhood neuropathies may be a form of acquired functional mental disorders, she singled out a group of children with exogenous neuropathy. Among exogenous reasons the author pointed to acute childhood infections, tuberculosis, syphilis, hearing loss, physical trauma, etc., which cause underdevelopment or damage to individual brain systems. But she did not exclude the role of a special psychological situation, especially one when the child becomes the center of attention.

Psychosocial factors can reinforce pathological, dysfunctional, emotional-vegetative style and level of response.

Prevalence neuropathy in the child population is relatively small - 0.6% (even less in rural areas).

Clinic. Currently neuropathy is considered as a group of syndromes of different genesis, main features which are:

- immaturity of autonomic regulation;

- increased excitability;

- increased exhaustion (inhibition) of the nervous system.

Clinically, neuropathy is most pronounced in early childhood. In older children, it disappears or is replaced by other mental disorders - borderline syndromes.

Allocate 3 main types of neuropathy: constitutional (true), organic (cerebral) and mixed type. G.E. Sukhareva (1959) additionally highlights asthenic and excitable options.

Constitutional (true) neuropathy.

physical status children are distinguished by asthenic, gracile build, small stature and body weight. Children are born with low weight, often premature, and in the following months of life they gain weight poorly. They have are celebrated decreased immunity and increased susceptibility to allergic reactions, exudative and colds, skin rashes. However, the neuropsychic development of these children, as a rule, proceeds not only in a timely manner, but often even ahead of schedule in motor and mental development.

characteristic general hyperexcitability child. Already from 2-3 months of age, for no apparent reason, the child begins to constantly cry, take the breast poorly, startle at the slightest noise, worry when changing diapers; at the same time, a tremor of the arms and legs occurs. Even to positive stimuli, such children react with a diffuse reaction with a general tremor, waving their arms, vocalizations, and at the moment of negative affect they are frightened, their pupils are dilated, bright vasomotor reactions and hyperhidrosis are noted. The attention of a child with neuropathy is unstable, quickly exhausted. Sleep disorders are especially pronounced. Sleep becomes restless, intermittent with frequent awakenings and difficulty falling asleep; often before going to sleep comes excitement. The duration of daytime and nighttime sleep is shortened.

Somatovegetative dysfunctions are also represented by digestive disorders (loss of appetite, persistent regurgitation, constipation, diarrhea, etc.). Emotional reactions are usually violent, labile and exhaustible. Behavior in general is characterized by constant excitement, crying, whims.

On neurological examination, symptoms of focal lesions of the nervous system, as a rule, are not detected, but bright, rapidly appearing dermographism, a delay in the reduction of the Moro reflex, and other autonomic dysfunctions are noted. Orienting reactions are accompanied by a sharp start, fright, vasomotor reactions, crying.

Moro reflex(E. Moro) - with a sudden impact on the surface, the child lies on the cut, a physiological reflex occurs in children under the age of several weeks - abduction and straightening of the shoulders, forearms and palms, spreading of the fingers, extension of the legs, followed by flexion of the forearms, palms and legs and slowly bringing the shoulders to the chest.

In the 2nd and 3rd years of life, vegetative and emotional-reactive lability in children persists (cries at night and awakenings with psychomotor agitation). Along with this, more definite signs of low mood appear - a tendency to sadness, hypochondriacal complaints (hands, head, etc. hurt), as well as increased fearfulness, fear of the new, painful impressionability. If a child is faced with a psychic trauma, then neurotic reactions and reactive states very easily arise in him. At this age, rudimentary personality traits of the inhibited type can also be detected: excessive attachment to the mother, difficulty in adapting to a new environment, establishing initial contact with adults and children, elective mutism, etc.

At preschool age, the insufficiency of autonomic regulation and emotional reactive lability are smoothed out and personal characteristics appear even more clearly in the form of increased inhibition or, conversely, excitability, combined with rapid exhaustion.

Organic (cerebral) neuropathy occurs in the first days after birth in the form syndrome of vegetative-visceral disorders. Syndrome of vegetative-visceral dysfunctions- a constant companion of early brain damage. With constitutional forms of neuropathy, it reflects the inability of the autonomic nervous system of the newborn, due to its congenital "inferiority", to adapt relatively quickly to existence outside the mother's body. In cases of cerebral perinatal pathology, the same syndrome, which is an expression of the residual (residual) state after perinatal cerebral pathology, indicates damage to the nervous system.

On neurological examination symptoms of focal lesions of the nervous system are detected.

Associated psychopathological and neurological syndromes determined by the nature and severity of early damage to the nervous system.

For organic neuropathy, such vegetative manifestations as transient vascular spots (Harlequin symptom), cyanosis, thermoregulation disorders, gastrointestinal dyskinesias with pylorospasm, increased intestinal motility, regurgitation, vomiting, as well as lability of the cardiovascular and respiratory systems (arrhythmia, tachycardia and tachypnea, followed by bouts of bradycardia and bradypnea). Also typical is a violation of the biological rhythm of sleep - wakefulness. Hypersensitivity (especially tactile), hyperacusis are noted. The Moro reflex in the first months is pronounced, often accompanied by crying. These manifestations in most cases are observed in combination with sleep disturbance, increased excitability, emotional lability, and a tendency to phobic reactions. In the neurological status - scattered neurological signs and sometimes symptoms of focal lesions of the central nervous system.

The clinical manifestation of the syndrome of vegetative-visceral disorders in newborns is vegetative-vascular dysfunction (lability of vascular tone and heart rate). The child has a "marble" skin pattern, transient cyanosis. In premature babies, due to the immaturity of the centers of regulation of vascular tone, changes in skin color, cyanosis of the feet and hands are more pronounced than in full-term babies. It is believed that even practically healthy premature babies in the first weeks of life are prone to hypostasis, i.e., to the accumulation of blood in the underlying sections. Very preterm infants may experience Finkelstein's symptom (or Arlekino). If this symptom is observed in more mature children, it indicates a lesion of the diencephalic vasomotor centers or an insufficiency of adrenal function.

The syndrome of vegetative-visceral dysfunctions in organic neuropathy is rarely isolated, can be combined with hypertensive-hydrocephalic and convulsive syndromes, delayed psychomotor development, and in children older than 1 year, the development of hyperdynamic, cerebrosthenic and other residual cerebral syndromes is possible. Personal changes are less pronounced than in constitutional neuropathy.

At neuropathies of mixed origin when there is a combination of signs of constitutional neuropathy and symptoms of perinatal encephalopathy, there is a great severity of clinical manifestations that can be detected from the first days of life. The signs of reactive lability, a tendency to reactions of fright, anxiety, which change the behavior of children, are especially clear. In these cases, in children very early in the clinical picture, personality traits come to the fore (as in true neuropathy). But these are not so much features of inhibition as excitability, egocentrism, capriciousness, exactingness, against which protest reactions and affective-respiratory paroxysms arise.

None of the forms of neuropathy is accompanied by intellectual decline. According to L.A. Budareva (1982), IQ with them is quite high: with true - 96-110, with organic - 85-115, with mixed - 85-130.

Forecast neuropathy is not yet well understood. On the one hand, its manifestations are leveled with age, on the other hand, neuropathy becomes the basis for the formation of personality anomalies. There are also observations that neuropathies with marked reactive lability and instability of autonomic functions may precede childhood schizophrenia and early childhood autism.

"Psychic diathesis".

diathesis(gr. diathesis), as is known, in therapy and pediatrics is called constitutional predisposition body to certain diseases due to congenital features of the exchange, psychophysiological reactions etc. Hemorrhagic, lymphatic, exudative and other diatheses are known.

There are groups of children with a high risk of developing mental pathology (burdened by heredity for psychosis), with features of mental development ( special forms of dysontogenesis)as overt mental disorders, even in cases where they do not develop subsequently. Most often this applies to children who were subsequently diagnosed with schizophrenia.

V. Fish in 1952 began to observe the mental development of children born to parents with schizophrenia from the day of birth. Developmental disorders in them in the first 2 years of life were characterized as two syndromes:

- « malnutrition syndrome» and

- syndrome of "pathologically calm children" .

The first syndrome is characterized by a general disorganization of motor and visual-motor development and growth without gross neurological symptoms. In this regard, V. Fish believes that this is not an organic defect, but rather a violation of time and integration of the maturation of the nervous system, uneven rates of its development. But the most important feature of the B. Fish syndrome is the possibility of smoothing out the noted violations or even their complete disappearance as children develop, if they do not develop schizophrenia (this disease, according to her, develops in 50% of high-risk children).

The authors of similar works designate a complex of polymorphic, non-specific changes observed in children from a high-risk group and generally fit into the concept of dysontogenesis, as "neuropsychic disintegration", "mild non-localized defect", "neurointegrative defect", "deficiency in information processing and attention", "endophenotype" and others. Many of them believe that the symptom complex under consideration may be an expression of a predisposition to psychosis, and some of the signs may become markers of such a predisposition.

Recently, in domestic child psychiatry, a set of signs characterizing a predisposition to mental pathology has been designated by the term "mental diathesis" .

I.V. Davydovsky (1969) considered diathesis as a special state of the body, when the metabolism and the functions of the body associated with it are for a long time in unstable balance. Diathesis itself - not a disease, but a violation of the body's adaptation to the external environment in the form of readiness for hyperergic and sometimes allergic individual responses.

Diathesis in general pediatric practice is regarded as a borderline condition, which can turn into a disease under the influence of exogenous (infections, injuries, psychosocial effects) and endogenous factors - a general decrease in immunological protection due to genetically determined anomalies and unfavorable intrauterine development (toxicosis, poor nutrition, exposure to harmful substances, etc.).

In psychiatry, the problem of diathesis was practically not developed. A.V. came closest to her. Snezhnevsky (1972), who, from the standpoint of general pathology, considered it within the framework of the concept pathos- a state that includes only the possibility of developing a pathological process(illness or nosos). Attributing diathesis to pathos, he characterized them as peculiar reactions to physiological stimuli, manifested by a predisposition to certain diseases.

S.Yu. Tsirkin (1995) considers mental diathesis as a general constitutional predisposition to mental illness, in which there are markers (signs) of this predisposition (clinical and biological), in most cases still poorly understood. In his opinion, specific signs of predisposition to a certain mental disorder are generally uncharacteristic of mental diathesis.

The problem of mental diathesis received the greatest development in the study of schizophrenia. In the course of a long-term study of children from a high-risk group for schizophrenia, features were revealed schizophrenic diathesis named schizotypal.

Schizotypal diathesis represent one of the options specific diathesis or predisposition (in this case to schizophrenia) in the general group of undifferentiated mental diathesis. Apparently, clinical forms of predisposition to other mental illnesses are also possible - affective, personal, paroxysmal, psychosomatic.

Some authors tend to refer to such diatheses and neuropathy, evaluating it as a form of psychovegetative diathesis, or a predisposition to personality anomalies (asthenic psychopathy) and psychosomatic diseases. However, the problem of diathesis in relation to mental illnesses other than schizophrenia is little developed and further active research is required.

Prevalence schizotypal diathesis in young children - 1,6 %.

Clinical manifestations schizotypal diathesis.

Already in the early stages of ontogeny, mental abnormalities are detected in children, reminiscent of mental symptoms characteristic of older people suffering from psychosis.

Schizotypal diathesis is manifested by signs of mental dysontogenesis, i.e. mental development disorders, which are expressed in the form 4 groups of mental disorders:

1) disharmony psychophysical development;

2) irregularity or irregularity development;

3) dissociation development;

4) scarcity mental manifestations.

Disharmony psychophysical development can manifest itself as delay in maturation(24.7% of cases), and acceleration(8.5%), but more often it is about irregularity (unevenness) of development characterized by the lack of smoothness and consistency of transition from one stage of development to another. These can be short-term stops in development, jumps and “pseudo-delays”. In these cases, there is dissociation development.

Features of early childhood psychopathology: mosaic of clinical symptoms in the form combination of mental disorders with developmental disorders; "solidity" of mental disorders with neurological violations; coexistence of positive and negative symptoms; vestigiality of psychopathological phenomena ( microsymptoms); transitivity clinical manifestations.

Pathological reactions and conditions can occur at the subclinical level in the form of episodes, phases with large time intervals between them. At the same time, the recurrence of the phenomenon that has arisen, the suddenness of the development of the corresponding reaction in the absence of a distinct external cause, the severity and clinical polymorphism of the reaction indicate the transition from the subclinical level of response to the pathological one.

Children have disorder in all spheres of life organism.

AT instinctive-vegetative sphere this is expressed by dyssomnias, perverted reactions to hunger and microclimatic stimuli. There is a lack or decrease in the "food dominant" in eating behavior, a peak symptom, pathological cravings, a decrease and perversion of the instinct of self-preservation, with simultaneous protopathic reactions of panic, conservatism and rigidity of protective rituals, the phenomenon of identity. As a rule, these disorders develop against the background of various somatovegetative dysfunctions. The described violations can be noted starting from the 2nd month of life.

emotional sphere: from the first 2 months of a child's life, emotional disturbances are also noted. They are manifested by a distortion of the maturation of the formula of the revitalization complex, emotional rigidity and the prevalence of the negative pole of mood, the absence or weakness of emotional resonance, the exhaustion of emotional reactions, their inadequacy and paradox. Against the background of such a general characteristic of emotional response in children from infancy, more pronounced dysthymia, dysphoria, less often hypomania, protopathic fears, panic reactions (mainly nocturnal) are noted. Signs of depression are especially frequent: depression with phobias, masked by a somatovegetative component, with persistent weight loss and anorexia, an endogenous mood rhythm. Among the wide variety of depressive reactions, two relatively well-defined variants were identified - "infant depression" (after birth distress) and "deprivation depression".

Cognitive disorders most often expressed in the distortion of play activity in the form of stereotypical rigid play manipulations with non-play objects. Sometimes they take on the character of obsessive actions with elements of obsession. The structure of disorders of the cognitive sphere also includes symptoms of distortion of self-consciousness and self-awareness of the child. This manifests itself in the form of persistent pathological fantasizing with reincarnation and the loss of self-consciousness as a child, as well as violations of gender identification at an older age (3-4 years).

Also characteristic attention disorders observed from the 1st month of a child's life. They are expressed by a frozen "puppet" look or a look "to nowhere", which is usually associated with the phenomena of "withdrawal into oneself" (without disorders of consciousness) in the form of short "disconnections" from the environment. Among the disorders of attention, the phenomenon of "hypermetamorphosis" (overattention) and selectivity of attention are observed. In these cases, the concentration of attention is both fleeting in a forced situation and rigid in spontaneous activity.

An important component of mental state change is activity phenomenon(arbitrary and passive), reflecting the volitional activity of children with schizotypal diathesis. Activity in general is characterized by dysregularity, dissociation, and paradox; selectivity and ambitendentity are noted. If in one situation the child is passive, weak-willed and apathetic, in another he may be tireless, stubborn and rigid.

With the above features of psychopathology of early age are closely related changes in general (social) behavior and communication. Violations of social behavior are manifested by a delay and distortion of neatness and self-care skills, as well as stereotyped behavior in the form of meaningless rituals when falling asleep, eating, dressing, and playing. Communication disorders are manifested by a negative attitude towards the mother or an ambivalent symbiotic relationship with her, the phenomenon of protodiacrisis and fear of people (anthropophobia) with simultaneous indifference to them in general. Quite often, autistic behavior is noted, which, being traced from the first months of life, becomes more pronounced by the age of 1 year and older, reaching the degree of “pseudo-blindness” and “pseudo-deafness”.

In violations of the function of communication, a large place is occupied by speech disorders: true and pseudo speech delays, as well as elective mutism, echolalia, speech stereotypes, neologisms, "stuttering" and "stuttering" disorders.

Among movement disorders the most common are microcatatonic symptoms and phenomena related to a specific neurological pathology.

As already mentioned, schizotypal diathesis is characterized by "solidity" of mental disorders with neurological ones.

Neurological manifestations schizotypal diathesis are characterized by diversity and multiplicity. The simultaneous presence of a huge number of neurological symptoms in a child, sometimes their unusual combinations and varying degrees of severity form the whole a special neurological status that does not fit into the framework of any of the known neurological syndromes. The general discordance of neurological functions can be considered as a key and integral sign of the neurological status in children from high-risk groups for developing schizophrenia (as, indeed, in schizophrenia in general).

Allocate 3 variants of schizotypal diathesis, based on its severity:

Schizotypal diathesis in the form individual stigmas or mild signs of dysontogenesis;

Pronounced schizotypal diathesis, in the picture of which, against the background of the phenomena of dysontogenesis, mental disorders of the borderline level;

schizotypal diathesis with outpost-symptoms of endogenous psychoses.

The first two variants are noted mainly in infancy, starting from the 1st month of life, the third can be detected in the 1st year of life, but more often in the 2nd year. Prolonged phases of subpsychotic states of the schizophrenic spectrum become distinguishable only at preschool age and in older children. The severity of schizotypal diathesis during the first 3 years of life may change as the child develops, both in the direction of aggravating disorders and reducing them.

After 3 years of age, if schizotypal diathesis remains sufficiently pronounced, it begins to gradually transform into schizoid personality traits from character accentuations (an extreme version of the norm) to pronounced schizoid(no deficient features), sometimes with outpost symptoms of endogenous psychosis, but without signs of disease manifestation. It is possible to transform schizotypal diathesis into early childhood autism and schizophrenia, as well as its full compensation until practical recovery. In this sense, the first option is naturally more favorable, although a greater degree of its severity does not always mean an unfavorable prognosis.

early childhood nervousness(neuropathy, congenital nervousness, constitutional nervousness, neuropathic constitution, endogenous nervousness, nervous diathesis, etc.) is the most common form of neuropsychiatric disorders in young children, which is manifested by severe autonomic dysfunction, emotional and behavioral disorders. In a pediatric neurological clinic, the term “early childhood nervousness” is usually used, psychiatrists often write about neuropathy. This condition is not a specific disease in the true sense, but is only a background that predisposes to the subsequent emergence of neuroses and neurosis-like states, psychoses, and pathological development of the personality.

Causes of early childhood nervousness. In the occurrence of early childhood nervousness, decisive importance is attached to heredity and organic damage to the brain in the early stages of its development (before childbirth, during childbirth and in the first months of life). The role of constitutional and genetic factors is confirmed by family history data. In many cases, one or both parents were highly excitable, and in the pedigree there are often individuals with severe emotional disorders, anxious and suspicious character traits. Equally important are residual-organic cerebral disorders, in which brain damage occurs mainly before and during childbirth. This is indicated by the high frequency of the pathological course of pregnancy in the mother - genital and extragenital diseases, especially of the cardiovascular system, gestosis of pregnancy, threatening miscarriage, fetal presentation, primary and secondary weakness of labor, premature birth, fetal asphyxia, birth traumatic brain injury etc.

The cause of organic brain damage can also be various infections, intoxication, hypoxic conditions in the first months of postnatal ontogenesis.

Mechanisms of development of early childhood nervousness. The mechanism of occurrence of early childhood nervousness should be considered from the standpoint of the age-related evolution of the brain in the postpartum period. As is known, during certain periods of life, etiological factors can cause similar changes in the nervous system and mental sphere. This is due to the predominant functioning of certain nervous structures that provide responses of the body and its adaptation to the environment. During the first 3 years of life, the greatest load falls on the autonomic nervous system, since the regulation of autonomic functions (nutrition, growth, etc.) is formed earlier than the regulation of motor skills. In this regard, V. V. Kovalev (1969, 1973) distinguishes four age levels of neuropsychic response in children and adolescents: somatovegetative (from birth to 3 years), psychomotor (4-10 years), affective (7-12 years) and emotional-but-ideational (12-16 years old). At the somatovegetative level of response, various pathological processes affecting the body mainly lead to polymorphic autonomic disorders.

Classification of early childhood nervousness. In accordance with the results of studies by domestic and foreign authors, the following three clinical and etiological types of neuropathy syndromes (early childhood nervousness) are distinguished: true or constitutional neuropathy syndrome, organic neuropathy syndrome and neuropathy syndrome of mixed genesis (constitutional-encephalopathic). G. E. Sukhareva (1955), depending on the predominance of inhibition or affective excitability in the behavior of children, distinguishes two clinical variants of neuropathy: asthenic, characterized by shyness, timidity of children, increased impressionability, and excitable, in which affective excitability, irritability, and motor disinhibition predominate.

Clinical manifestations of early childhood nervousness. Early childhood nervousness is characterized by pronounced autonomic dysfunction, increased excitability and, often, rapid exhaustion of the nervous system. These disorders in the form of various combinations are especially clearly manifested during the first 2 years of life, and then gradually level out or turn into other borderline neuropsychiatric disorders.

When examining such children, the general appearance of the child attracts attention: pronounced pallor of the skin with a cyanotic tint can quickly be replaced by hyperemia, already in the second half of life, in some cases, there may be fainting-like states when the body position changes from horizontal to vertical. Pupils are usually dilated, their size and reaction to light may be uneven. Sometimes within 1-2 months there is a spontaneous narrowing or dilation of the pupil. The pulse is usually labile and unstable, breathing is irregular.

Especially characteristic are increased excitability, general anxiety and sleep disturbance. Such children almost constantly scream and cry. It is difficult for parents to determine the cause of a child's anxiety. At first, he can calm down during feeding, but soon this does not bring the desired relief. It is worth picking him up while crying and shaking him, as he will demand this in the future with an insistent cry. Such children do not want to be alone, they require increased attention with their constant cry. In almost all cases, sleep is sharply disturbed: its formula is perverted - drowsiness during the day, frequent awakenings or insomnia at night. At the slightest rustle, a short-term dream is suddenly interrupted. Often, even in absolute silence, the child wakes up with a sudden cry. In the future, this can turn into nightmares and night terrors, which can be differentiated only at the 2-3rd year of life.

Short-term rapid startling in a dream occurs early. Such conditions, as a rule, have nothing to do with generalized and focal seizures, and the appointment of anticonvulsants does not lead to a decrease in the frequency of twitches. Also characteristic is the presence of general shudders in the waking state, which usually occur under the influence of even minor stimuli, and sometimes spontaneously. Already by the end of the first - in the second year of life, they sit, sway before going to bed, are too mobile, do not find a place for themselves, suck their fingers, bite their nails, itch, hit their heads on the bed. It seems that the child deliberately injures himself in order to scream even more and show anxiety.

Digestive disorders are an early sign of neuropathy. Its first manifestation is the refusal of the breast. The cause of this condition is difficult to establish. Perhaps, due to autonomic dysfunction in a child, coordinated activity of the gastrointestinal tract does not immediately occur. Such children, just starting to suck at the breast, become restless, scream, cry. It is possible that the cause of this condition is temporary pylorospasm, intestinal spasms and other disorders. Shortly after feeding, regurgitation, vomiting, rather frequent intestinal disorders in the form of increased or decreased peristalsis, bloating, diarrhea or constipation, which may alternate, may appear.

Especially great difficulties arise with the start of complementary feeding of an infant. He often selectively reacts to various nutrient mixtures, refuses to eat. In a number of cases, only an attempt to feed, including breastfeeding, or one type of food causes a sharply negative behavioral state in him. Loss of appetite gradually increases. The transition to coarser food also causes a number of negative changes. This is primarily a violation of the act of chewing. Such children chew slowly, reluctantly, or refuse to eat solid foods altogether. In some cases, phenomena of disintegration of the chewing-swallowing act may occur, when he cannot swallow slowly chewed food and spits out of his mouth. Eating disorders and loss of appetite can turn into anorexia, which is accompanied by trophic changes.

Such children are very sensitive to weather changes, which contributes to the intensification of vegetative disorders. They do not tolerate childhood infections and, in general, various colds. In response to an increase in body temperature, they often experience generalized convulsive seizures, general arousal, and delirium. In some cases, the increase in body temperature is non-infectious in nature and is accompanied by an increase in somato-vegetative and neurological disorders.

When observing children suffering from early childhood nervousness, a decrease in the threshold of sensitivity to various exogenous and endogenous influences is revealed. In particular, they painfully react to indifferent stimuli (light, sound, tactile influences, wet diapers, changes in body position, etc.). Especially negative reaction to injections, routine examinations and manipulations. All this is quickly fixed, and in the future only the sight of a similar situation is accompanied by pronounced fear. For example, such children who have been given injections are very restless during examinations by a doctor and any medical staff (fear of white coats). Constantly there is an increased instinct of self-preservation. It expresses itself in the fear of novelty. In response to a slight change in the external situation, capriciousness and tearfulness sharply increase. Such children are very attached to the house, to their mother, they constantly follow her, they are afraid to be alone in the room even for a short time, react negatively to the arrival of strangers, do not come into contact with them, behave timidly and shyly.

Some clinical differences have also been established depending on the form of early childhood nervousness. So, with the syndrome of true neuropathy, vegetative and psychopathological disorders usually begin to appear not immediately after birth, but at the 3-4th month of life. This is due to the fact that the violation of autonomic regulation begins to manifest itself only with more active interaction with the environment - a manifestation of emotional reactions of a social nature. In such cases, sleep disturbances come first, although digestive tract disorders, as well as various deviations in the emotional-volitional sphere, are quite clearly represented. The general psychomotor development of such children, as a rule, is normal, and may even go ahead of average age norms; the child can quite early hold the head, sit, walk, often begins at the age of up to a year.

The syndrome of organic neuropathy, as a rule, manifests itself from the first days of life. Even in the maternity hospital, such a child develops increased neuroreflex excitability and signs of a slight organic lesion of the nervous system are revealed. They are characterized by variability in muscle tone, which can periodically be either slightly increased or reduced (muscular dystonia). As a rule, spontaneous muscle activity is increased.

In such children, the personality component of the neuropathic syndrome is less pronounced than in the syndrome of true (constitutional) neuropathy, and cerebrosthenic disorders come first. Emotional and personality disorders in patients of this group are poorly differentiated, the inertness of mental processes is determined.

With the syndrome of organic neuropathy, there may be a slight delay in the pace of psychomotor development, in most cases, 2-3 months later than their peers, they begin to stand and walk independently, there may be a general underdevelopment of speech, usually mild.

The syndrome of neuropathy of mixed genesis occupies a middle position between the two forms above. It is characterized by the presence of both constitutional and mild organic neurological disorders. At the same time, in the first year of life, the clinical manifestations of this pathology are more dependent on encephalopathic disorders, while in subsequent years it approaches the manifestations of the syndrome of true neuropathy. The general psychomotor development of such children in most cases is normal, although it may be somewhat slow, but very rarely accelerated.

Diagnostics. The diagnosis of early childhood nervousness and its various clinical variants is not particularly difficult. It is based on the early onset (first days or months of life) of characteristic symptoms, the appearance of which in most cases is not associated with somatic and neurological diseases in the postpartum period. In the case of autonomic dysfunction, emotional and behavioral disorders after suffering exogenous diseases, there is a clear causal relationship between these conditions. In addition, in such cases, there is often a delay in psychomotor development of varying severity, which is not characteristic of the syndrome of true neuropathy.

Various autonomic and behavioral disorders can occur in children, even in the first months of life, after psycho-traumatic effects (usually with a sudden change in the external environment). The analysis of cause-and-effect relationships also plays a significant role here.

Current and forecast. With an increase in the age of the child, the clinical manifestations of neuropathy change, which to a certain extent depends on the form of this pathology. Only in isolated cases, by the preschool period of life, all neuropsychiatric disorders disappear and the child becomes practically healthy. He often has various vegetative-vascular disorders and emotional-behavioral changes, disturbances in the motor sphere, and specific forms of neuroses (including pathological habits of childhood) or neurosis-like states are gradually formed. With long-term preservation of the clinical manifestations of neuropathy, a background is created for the formation of psychopathy.

In children with the syndrome of true neuropathy, vegetative disorders in most cases regress, and mental abnormalities in the form of increased affective excitability, combined with exhaustion, emotional instability, fearfulness, and a tendency to undifferentiated fears, come to the fore. Against this background, under the influence of acute or chronic psycho-traumatic conflict situations, systemic or general neuroses often occurred in the form of tics, stuttering, enuresis, encopresis, etc.

In patients with organic neuropathy at the age of 4 years, vegetative-vascular disorders, a syndrome of motor disinhibition (hyperactivity) and neurosis-like states of a monosymptomatic nature are predominantly observed. According to our data, the transformation of vegetative-vascular disorders into a more pronounced syndrome of vegetative dystonia is very characteristic. So, in the third year of life, vegetative paroxysms often occur during sleep (night terrors and nightmares) or in the waking state (for example, fainting). By the end of preschool age, such children often complained of pain in the region of the heart, abdomen, and from time to time they had respiratory problems. Gradually, by middle school age, vegetative dystonia develops with the presence of permanent (more often) or paroxysmal disorders.

In earlier periods, a syndrome of motor disinhibition (hyperactivity) occurs, which becomes noticeable already in the second year of life. It is manifested by unbridled behavior, emotional lability, instability of attention, frequent switching to other activities, lack of focus, inertia and rapid exhaustion of mental processes.

Monosymptomatic disorders against the background of organic neuropathy are similar in external manifestations to those in true neuropathy (enuresis, encopresis, tics, stuttering), but the mechanism of their occurrence is different. In this case, the main role is played not by psycho-traumatic factors, but by somatic diseases. True neuroses in these children are relatively rare.

With a mixed neuropathy syndrome, affective respiratory seizures and various types of protest reactions often appear. Such children are highly excitable, egocentric, they show pathological obstinacy and capriciousness in achieving their desires. It is also noted that they do not have a correspondence between poorly represented organic neurological disorders and well-defined neuropathic disorders.

Treatment. In the treatment of early childhood nervousness, regardless of its clinical forms, the organization of the correct regimen and upbringing of the child is of paramount importance. This primarily concerns feeding and sleeping, which should be carried out at the same time. However, due to severe anxiety and autonomic disorders, the child often leaves a certain regimen. Therefore, one should, if possible, identify the various points that cause anxiety and crying, and try to eliminate them. If, after feeding, the child has frequent regurgitation, vomiting, and gradually develops an aversion to food, then you should not force-feed him. This will only exacerbate unwanted manifestations. In such cases, you should feed less often so that there is a feeling of hunger. It is also necessary to avoid overexciting children, especially at bedtime. Attitude towards the child should be calm, demanding - according to age. Excessive stimuli, including an abundance of toys, the desire to give him maximum positive emotions only exacerbate neuropathic disorders. When fears arise with age, constant attachment to only one member of the family (more often to the mother), one should not frighten him, forcibly push him away from himself, but it is better to cultivate courage, resilience, gradually accustom him to independence and overcoming difficulties.

Drug treatment is prescribed if necessary by a doctor, includes general tonic and sedatives, including Noofen. You should widely use water procedures (baths, swimming, showers, wiping), classes with adults in hygienic gymnastics.