Psychiatry - G.T. Sonnyk 2003

General Psychopathology and Symptomatology of Mental Illnesses
Syndromes Predominantly Characterized by Intellectual Impairment

The syndrome of physical and psychic infantilism occupies an intermediate position between oligophrenia and normal intelligence. According to the International Classification of Diseases, 9th Revision, this condition is defined as "borderline mental retardation" (IQ in the range of 70-80).

Psychophysical infantilism is a pathological condition characterized by delayed physical and mental development, with the persistence into adulthood of character traits inherent in childhood and adolescence.

It is characterized by child-like judgment and behavior, increased suggestibility, emotional restraint, parental dependency, limited interests, and insufficient independence in actions and deeds, among other traits. The judgments of such individuals are immature, their logic is emotional, and their thinking is concrete and figurative. They exhibit a lack of depth in affective experiences, emotional instability, psychological fragility, non-goal-directed activity, lack of creativity, and sometimes helplessness.

Along with this, there is immaturity of psychomotor Functions and autonomic reactions. Facial expressions are uncertain, the facial expression is childishly welcoming and trusting, and movements are rapid and impulsive. At the same time, awkwardness and rapid fatigue during goal-directed activity are observed. Such individuals may experience Sleep and appetite disturbances, vasomotor lability, hyperhidrosis, and chills. Among personality traits, manifestations of immaturity, indecision, insecurity, and anxiety are frequently noted.

It is believed that psychophysical infantilism is of endogenous origin, though a genetic predisposition cannot be excluded. With age, the manifestations of infantilism become less noticeable, though they do not disappear entirely.

Oligophrenia syndrome is a term encompassing numerous pathological forms that differ in Pathogenesis but share similar manifestations, characterized by underdevelopment of the psyche and the Organism as a whole. Oligophrenia is divided into three main forms: idiocy, imbecility, and debility, which will be discussed in detail in the relevant chapter.

Psycho-organic (encephalopathic) syndrome is a symptom complex of memory, intellect, and affectivity disorders. For most diseases accompanied by this syndrome, the presence of asthenia is characteristic.

Depending on the nosological Nature of the disease, the disorders characterizing the psycho-organic syndrome combine in various configurations. The disturbances inherent to this syndrome vary in degree of severity.

Memory disorders in this condition affect to varying degrees all three of its main aspects: memorization, retention, and reproduction. In some cases, dysmnestic disorders predominate; in others, amnestic disorders—primarily fixation and/or progressive amnesia. Memory impairments, particularly in the form of amnesias, are frequently accompanied by The Emergence of figurative memories from past life events, and in some cases, confabulations.

The psycho-organic syndrome is accompanied by impaired perception of the environment—a diminished or impossible ability to grasp any situation as a whole: patients perceive only details within it. The Scope of attention is restricted. Memory, perception, and attention disorders are closely linked to impaired orientation—initially regarding the environment, and, as the condition worsens, regarding one's own person.

Impairment in intellectual activity is evidenced by a decline in the level of judgment and reasoning. One of the early signs of intellectual decline is the impairment of critical faculties regarding self-assessment and the evaluation of the environment.

Affective reactions are unstable, sometimes changing from minute to minute, and are expressed violently (affective incontinence), but are usually short-lived and quickly fade. The dominant affect easily subjugates the patients' actions, and the simultaneous decline in judgment and critique can lead to unlawful behavior.

Impaired affectivity and reduced critical faculties are sometimes combined with increased suggestibility, and occasionally with heightened, even extreme stubborness in patients. Typically, the pace of mental processes is slowed, speech is impoverished in vocabulary and often accompanied by auxiliary words and clichés. Such patients tend to get bogged down in fixed ideas, cannot immediately switch from one thought to another, and are unable to isolate the main point in conversation, thereby getting stuck on non-essential details. Dysarthria and perseveration of varying degrees of severity are frequently encountered.

Asthenia is a persistent disorder characterized by increased fatigability, up to adynamia, sometimes accompanied by irritability, explosiveness, or anger against a Background of constant fatigue.

In the Initial Stages of psycho-organic syndrome development and in cases where its manifestations are moderately expressed, there is often an sharpening of the patient's inherent character traits. With a pronounced psycho-organic syndrome, a leveling of personality traits occurs, up to their complete disappearance.

The psycho-organic syndrome is frequently accompanied by headaches, dizziness, and vegetative-vascular disorders.

This syndrome typically arises from diffuse lesions of the Brain tissue. Its causes may include vascular brain diseases, TRAUMATIC BRAIN INJURIES, intoxications, encephalitis, chronic Metabolic Disorders, syphilitic Diseases of the Central Nervous system, Brain Tumors and abscesses, and all conditions accompanied by epileptic seizures, among others.

Dementia syndrome is characterized by a profound impoverishment of all mental activity—primarily intellect, the emotional-volitional sphere, and individual personality traits—with a simultaneous deterioration (up to complete loss) of The ability to acquire new knowledge, use it practically, and adapt to the environment. It arises As a result of the Progressive development of mental illnesses.

The impoverishment of intellectual activity is manifested by a partial or complete inability to process and systematize acquired concepts, form notions and judgments, draw Conclusions and inferences, and acquire new knowledge. The utilization of past knowledge and experience becomes difficult or entirely impossible. Only isolated, habitual judgments and actions that have become stereotyped remain preserved to varying degrees. The level of mental activity decreases, including the level of drives. Critical attitudes toward one's own condition and environment suffer significantly. Emotional reactions lose their nuances, become impoverished, coarsen, and cease to correspond to real circumstances.

Often, a single, simplified, lifeless affect begins to predominate—monotonic cheerfulness and lightheartedness or, conversely, despondency and tearfulness, gloomy irritability, or irritable anger. In many cases, a profound emotional devastation arises, with complete indifference to everything, including one's own fate. Drives either decrease or increase significantly (gluttony, collecting and hoarding various types of junk, wandering, alcoholization, and sexual excesses). Personality changes are accompanied by a leveling of the patient's previously characteristic personality, making it impossible to determine what kind of person they were premorbidly. Dementia is constantly accompanied by a deterioration and, subsequently, a loss of everyday living skills, such as neatness and self-care, resulting in complete helplessness in daily life.

Based on the clinical manifestations, organic dementia is divided into total and partial.

Total dementia is accompanied by a profound leveling of the personality with the loss of the so-called "core of the personality"—that is, all basic prior individual traits—the disappearance of a critical attitude toward everything, the predominance of a carefree, indifferent mood or unmotivated anger, and frequently the disinhibition of lower drives.

Partial dementia is accompanied by a certain preservation of past individuality. With this type, awareness of the illness can always be detected. The prevailing mood is depressed, accompanied by tearfulness. As a rule, patients retain varying degrees of orientation regarding their own person and surroundings.

The progressive development of dementia culminates in a terminal stage—marasmus. In this state, patients are helpless, and There is a complete disintegration of mental activity. Patients often lose basic self-care skills, are unable to move independently, and are therefore bedridden. Various speech disorders are constantly observed. Appetite is frequently significantly increased, up to the point of bulimia. There is persistent incontinence of urine and feces.