Psychiatry - O. K. Napreenko 2001

General Psychiatry
Disorders of Intellect

The term "intellect" originates from the Latin intellectus, meaning "mind" or "understanding". It refers to a person's ability to utilize cognitive operations (analysis, synthesis, comparison, abstraction, generalization, and concretization), apply acquired knowledge and experience in practical activities, penetrate The Essence of surrounding objects and phenomena, identify the core link within complex chains of cause-and-effect relationships, and accumulate new knowledge and experience.

Impairments of intellectual activity in mental disorders are quite diverse. States characterized by insufficient intellect are termed dementia. It can be acquired (dementia proper) or congenital (oligophrenia).

Dementia is an acquired cognitive decline, representing The breakdown of previously established intelligence As a result of psychiatric illnesses. It is characterized by a persistent decline in human cognitive function, a progressive course, behavioral disturbances, and the impoverishment of the moral and ethical core of the personality. Clinically, dementia is categorized into lacunar, total, concentric, and transitory types.

Lacunar dementia (partial or focal dementia) manifests as partial cognitive defects resulting from memory loss. An individual's capacity for complex thought operations becomes impaired. In this condition, associative connections are restricted, leading to a deficit in resourcefulness. Lacunar dementia is accompanied by emotional lability and decreased work capacity, though professional skills are preserved to a certain extent. In the Cytology/cytology/16.html">Early stages of lacunar dementia, the patient's personality and critical awareness of their own mental state remain intact. Lacunar dementia typically occurs in focal Brain disorders (such as Vascular Diseases, TRAUMATIC BRAIN INJURIES, and syphilitic brain lesions).

Total dementia (global, paretic, or diffuse dementia) is manifested by a decline across all forms of cognitive activity. The patient gradually loses The ability to utilize thought operations and critically evaluate their condition, actions, and the surrounding world. There is a generalized (global) reduction in mental function accompanied by the disintegration of the personality core. Memory for both current and past events is profoundly impaired. Euphoria is frequently observed. The patient is incapable of goal-directed activity and requires constant care and supervision. Total dementia develops in senile dementia, progressive paralysis, Alzheimer's disease, Pick's disease, and other conditions.

Concentric (epileptic) dementia is characterized by a gradual psychological degradation of the personality with a loss of mental flexibility due to impaired cognitive operations. Characteristic features include viscosity, stiffness, and fixation of thought. The patient is unable to transition from one conversation topic to another, becoming overly meticulous, petty, and selfish. Attention is focused entirely on oneself and personal needs—predominantly biological ones—which fosters extreme egocentrism. The mood is depressed. Patients tend to be irritable and vindictive, complaining that they are mistreated by other patients or that the medical staff is inattentive. As the disorder progresses, concentric cognitive decline deepens, rendering patients helpless, apathetic, and marantic, with interests narrowed exclusively to the gratification of basic instincts. Concentric dementia is observed in Epilepsy.

Transitory (schizophrenic) dementia is characterized by a weakening of cognitive processes, developing gradually and tending to progress. The patient is unable to utilize thought operations not due to memory impairment or the loss of knowledge and skills, but rather as a result of the disintegration (dissociation) of mental processes. This type of dementia develops against a Background of reduced energetic potential. Despite possessing a sufficient level of formal knowledge, the patients' activities remain unproductive, leading to social maladaptation. Occasionally, they may surprise others with an apt remark or a witty word. Following appropriate Treatment, the patients' condition may improve, but subsequent exacerbations deepen the illness. Transitory dementia occurs in Schizophrenia.

Oligophrenia (congenital mental deficiency, intellectual underdevelopment) is a collective group of non-progressive pathological conditions that vary in Etiology, Pathogenesis, and Clinical presentation. Their common feature is the presence of generalized mental underdevelopment—either congenital or acquired in early childhood—with a predominance of intellectual deficiency.

General characteristics of oligophrenia:

1. a psychopathological Structure of dementia featuring total mental underdevelopment and a predominance of deficits in Abstract thinking;

2. the non-progressive Nature of the intellectual deficiency;

3. a slowed pace of the individual's mental development.

Depending on the degree of mental underdevelopment and the clinical picture of the deficiency, the following forms of oligophrenia are distinguished: debility, imbecility, and idiocy.

Debility (from Latin debilis — weak, feeble) is a mild degree of mental underdevelopment approaching borderline normal functioning. Patients are incapable of abstract thinking, generalization, or forming complex concepts, with a predominance of concrete-descriptive thinking. They fail to grasp situations as a whole; perception is imprecise, and attention is unstable. They are unable to master the general school curriculum, particularly mathematics, and frequently have to repeat grades, whereas learning in a specialized remedial school proves significantly easier. They cannot cope with complex tasks and require assistance from others. Being highly suggestible, they easily fall under external influence. The intelligence quotient (IQ) ranges from 50 to 70.

Imbecility (from Latin imbecillus — weak, needing support) is a moderate degree of delayed mental development. Cognitive Functions are impaired to a greater extent than in debility. Patients are unable to form concepts or engage in abstract thinking, though they acquire self-care skills (dressing, basic hygiene, etc.). They understand simple speech and acquire a small vocabulary, typically using very short sentences (consisting of a noun, adjective, and verb). New material is mastered only at the level of concrete representations. Capable of full, independent thought they are not, due to the inability to generalize; consequently, adaptation is possible only in familiar situations. The speech, facial expressions, and gestures of others are understood by patients within The Scope of everyday life. They require supervision. Their interests are rather primitive and relate exclusively to the satisfaction of physiological needs, while their behavior depends on their affective state and the strength of their drives. The intelligence quotient ranges from 20 to 49.

Idiocy (from Greek idioteia — ignorance, peculiarity) is the most severe degree of congenital mental deficiency, characterized by an inability to engage in cognitive activity. In such individuals, perception is severely restricted; they are unable to think or speak, uttering only isolated sounds. They do not understand other people, fail to recognize even close relatives, and cannot distinguish between edible and inedible items. Their facial expression is vacant. They learn to walk late, sometimes moving by crawling. They fail to acquire self-care skills and lack sphincter control. Outbursts of angry affect are occasionally observed (biting, spitting), and congenital physical anomalies are frequently present. The intelligence quotient is below 20.

In order to diagnose intellectual disability, particularly mild and moderate degrees, it is necessary to apply school, social, and psychometric criteria In addition to evaluating the clinical picture.

School criterion. Children with mild intellectual disability may attend regular school, though they typically lag behind their peers by two years up to the age of nine, and by three years thereafter.

Social criterion. This involves evaluating the individual's ability to exist independently and sustain their own life. Individuals with mild intellectual disability can work independently, whereas those with moderate disability can perform simple tasks under supervision. Both categories require oversight and guardianship.

Psychometric criterion. The intelligence quotient is determined using psychopathological tests (such as the Wechsler scale).

CONTROL QUESTIONS

1. Definition of the concept of "intellect".

2. Mental underdevelopment — oligophrenia.

3. Acquired cognitive decline — dementia.

4. Lacunar (partial) dementia. Nosological Specificity.

5. Total (diffuse) dementia. Nosological specificity.