Category: Medicine

What is Organic Delusional (Schizophrenia-like) Disorder?

Approximately 5% of patients with epilepsy may have psychosis if the underlying disease lasts up to 6 years. The question of periodic organic delusional psychosis is controversial, although all such cases are verified by objective research.

Causes of Organic Crazy (Schizophrenia-like) Disorders

The most common etiology is temporal epilepsy, as well as focal disorders of the temporal and parietal regions as a result of transferred encephalitis. This group includes epileptic psychosis without impairment of consciousness, or “schizoepilepsy.” With the defeat of the frontal and temporal divisions, hallucinatory-delusional attacks are possible, which are accompanied by episodes of unmotivated actions and loss of control over impulses of aggressiveness and other forms of instinctive behavior. It is not clear what caused the specificity of such psychosis – bilateral hereditary burden (epilepsy and schizophrenia) or damage to specific brain structures. Schizophrenia-like patterns of psychosis are also found in endocrine pathology (diffuse toxic goiter, after thyroidectomy).

Symptoms of Organic Crazy (Schizophrenia-like) Disorders

Chronic and recurrent organic delusional disorders are possible. They are united by the fact that in both cases negative organic personality changes are typologically similar to epileptic ones, that is, including bradifrenia, torpid, thorough thinking. Productive symptoms include hallucinatory-delusional pictures with the presence of visual, often religious hallucinations. Expansive paranoid states are characterized by ecstatic affect, while depressive paranoid states are dysphoric. At the height of psychosis, fragments of disturbances of consciousness are possible. Paranoiac psychosis proceeds according to the type of religious delirium, paraphrenia – with ecstasy, excitement and missionary utterances. Often, paranoid utterances are built on the basis of epilepsy-specific perceptual disorders of the type of interpretive delusion. It has been noticed that the onset of convulsive seizures can interrupt delirium, and their therapy resumes the clinical picture. There are clinical pictures of psychosis that contain symptoms of the first grade of schizophrenia. In endocrine pathology, psychosis is reminiscent of schizoaffective disorder, that is, with them, affective disorders coincide with schizophrenia-like disorders, but they last longer.

Diagnosing Organic Crazy (Schizophrenia-like) Disorders

Based on the identification of the main pathology (epilepsy or organic background), as well as specific emotional (dysphoria, ecstasy) color of paranoid experiences, the inclusion of visual hallucinations in the structure of hallucinatory-paranoid psychosis.

Differential diagnostics

Differential diagnoses are being conducted with paranoid schizophrenia, chronic delusional disorders, and schizophrenia-like psychotic disorders as a result of taking psychoactive substances, especially often amphetamines and cannabis.

In schizophrenia, along with productive symptoms of the first rank, there are also negative disorders, there are no exogenous components of psychosis and organic personality changes in the history.

In chronic delusional disorders, monothematic delirium may be the only persistent symptom, but it occurs on organically unchanged soil.

Psychotic schizophrenia-like disorders after taking psychoactive substances are characterized by the fact that they occur on the background of taking or canceling a substance, although psychotic episodes are also possible. Somato-vegetative status allows to identify the symptoms of intoxication or withdrawal, organic background is absent.

Treatment of Organic Crazy (Schizophrenia-like) Disorders

Includes treatment of the underlying disease. Effective use of aminazine, carbamazepine, depakina. The last two drugs can be used for maintenance therapy, since the risk of recurrence of psychosis is quite high. The use of antipsychotics for prolongation therapy is not recommended, as patients quickly develop intoxication symptoms.

What is a Disruption of Activity and Attention?

Previously called minimal brain dysfunction (MMD), hyperkinetic syndrome, minimal brain damage. This is one of the most common childhood behavioral disorders, many of which remain in adulthood.

Prevalence

The disorder is more common in boys. The relative prevalence among boys and girls from 3: 1 to 9: 1, depending on the criteria of diagnosis. Currently, the prevalence among schoolchildren is from 3 to 20%. In 30-70% of cases, the syndromes of the disorder turn into adulthood. Hyperactivity in adolescence in many decreases, even if other disorders remain, but the risk of asocial psychopathy, alcoholism and drug addiction is high.

Causes Disruption of Activity and Attention

Previously, the hyperkinetic disorder was associated with intrauterine or postnatal brain damage (“minimal brain damage”). Identified genetic predisposition to this disorder. For identical twins, concordance is higher than for dvuiaytsovyh. 20-30% of parents of patients suffered or suffer from impaired activity and attention. Congenital tendency to hyperactivity increases under the influence of certain social factors, since this behavior is more common in children living in adverse social conditions. Parents of patients are more likely to have alcoholism, asocial psychopathy, and affective disorders in the general population. The alleged causes of the disorder are associated with food allergies, prolonged lead intoxication and exposure to food additives, but these hypotheses are not supported by convincing evidence. A strong relationship was found between activity and attention disorders and insensitivity to thyroid hormones – a rare condition, based on a mutation of the thyroid hormone beta-receptor gene.

Symptoms Disruption of Activity and Attention

The diagnostic criteria for a disorder have changed somewhat over the years. Symptomatology almost always manifests itself to 5-7 years. The average age of a doctor is 8-10 years.

Major manifestations include:

• Violations of attention. Inability to maintain attention, decreased selective attention, inability to concentrate on the subject for a long time, frequent forgetting of what needs to be done; increased distractibility, irritability. Such children are fussy, restless. Even more attention is reduced in unusual situations when you need to act on your own. Some children cannot even watch their favorite TV shows to the end.
• Impulsivity. In the form of scruffy fulfillment of school tasks, despite the efforts to do them correctly; frequent shouts from a place, noisy tricks during classes; “Getting into” the conversation or work of others; impatience in line; inability to lose (as a result of this, frequent fights with children). With age, manifestations of impulsivity can change. At an early age, it is urinary and fecal incontinence; at school – excessive activity and extreme impatience; in adolescence – hooligan antics and antisocial behavior (theft, drug use, etc.). However, the older the child, the more impulsive is more pronounced and more noticeable to others.
• Hyperactivity. This is an optional feature. In some children, motor activity can be reduced. However, motor activity is qualitatively and quantitatively different from the age norm. In preschool and early school age, such children continuously and impulsively run, crawl, jump up, and are very fussy. To puberty, hyperactivity often decreases. Children without hyperactivity are less aggressive and hostile to others, but they are more likely to experience partial developmental delays, including school skills.

Additional signs

• Violations of coordination are noted in 50-60% in the form of the impossibility of subtle movements (tying shoelaces, using scissors, coloring, letters); imbalances, visual and spatial coordination (inability to play sports, cycling, ball games).
• Emotional disturbances in the form of imbalance, temper, intolerance to failure. There is a delay in emotional development.
• Relations with others. In mental development, children with impaired activity and attention lag behind peers, but strive to be leaders. It is difficult to be friends with them. These are extraverted children, they are looking for friends, but they quickly lose them. Therefore, they often communicate with more “complaisant” younger ones. Relationships with adults are difficult. They are not affected by punishment, affection, or praise. From the point of view of parents and educators, it is precisely “bad manners” and “bad behavior” that are the main reason for going to doctors.
• Partial developmental delays. Despite normal IQ, school performance in many children is low. The reasons are inattention, lack of perseverance, intolerance to failure. Partial delays in the development of writing, reading, and counting are characteristic. The main symptom is the mismatch of a high intellectual level and poor performance in school. The criterion of partial delay is considered to be a backlog of skills by at least 2 years. However, it is necessary to exclude other causes of failure: perceptual disorders, psychological and social causes, low intelligence and inadequate teaching.
• Behavioral disorders. Not always observed. Not all children with behavioral disorders may have impaired activity and attention.
• Bedwetting. Disorders of falling asleep and drowsiness in the morning.

Disorders of activity and attention can be divided into 3 types: with a predominance of inattention; with a predominance of hyperactivity; mixed.

Diagnostics Disorders of Activity and Attention

It is necessary to have inattention or hyperactivity and impulsivity (or all manifestations at the same time) that do not correspond to the age norm.

Features of behavior:

• appear up to 8 years;
• are found in at least two areas of activity – school, home, work, games, clinic;
• are not caused by anxious, psychotic, affective, dissociative disorders and psychopathies;
• cause significant psychological discomfort and maladaptation.

Inattention:

• Inability to focus on details, errors of inattention.
• Inability to maintain attention.
• Inability to listen to the speech addressed.
• Inability to complete tasks.
• Low organizational skills.
• Negative attitude to tasks requiring mental stress.
• Loss of items needed to complete the task.
• Distractibility to extraneous irritants.
• Forgetfulness. (Of the listed symptoms, at least six should be stored for more than 6 months.)

Hyperactivity and impulsivity (of the following symptoms, at least four should last at least 6 months.):

• hyperactivity: the child is fussy, restless. Jumps up without permission. Running aimlessly, fidgeting, climbing. Cannot rest, play quiet games;
• impulsiveness: cries out the answer without listening to the question. Cannot wait in line.

Differential diagnosis

For the diagnosis you need: a detailed history of life. Information must be found out with everyone who knows the child (parents, carers, teachers). Detailed family history (presence of alcoholism, hyperactivity disorder, ticks in parents or relatives). Data on the current behavior of the child.

Information is required on the child’s academic performance and behavior in the educational institution. There are currently no informative psychological tests to diagnose this disorder.

Disorders of activity and attention do not have clear pathognomonic signs. This disorder can be suspected on the basis of an anamnesis and psychological testing, taking into account diagnostic criteria. For a final diagnosis, a trial appointment of psychostimulants is shown.

The phenomena of hyperactivity and inattention can be symptoms of anxiety or depressive disorders, mood disorders. The diagnosis of these disorders is made in the presence of their diagnostic criteria. The presence of an acute onset of hyperkinetic disorder at school age can be a manifestation of a reactive (psychogenic or organic) disorder, manic state, schizophrenia, neurological disease.

Treatment Disorders of Activity and Attention

Drug treatment is effective in 75-80% of cases, with the correct diagnosis. Its effect is more symptomatic. Suppressing symptoms of hyperactivity disorder and impaired attention facilitates the child’s intellectual and social development. Drug treatment obeys several principles: only long-term therapy ending in adolescence is effective. The selection of the drug and dose proceed from the objective effect, and not the patient’s sensations. If the treatment is effective, then it is necessary to take trial breaks at certain intervals to determine whether the child can do without drugs. The first breaks are preferably arranged during the holidays, when the psychological load on the child is less.

Pharmacological agents used to treat this disorder are CNS stimulants. The mechanism of their action is not fully known. However, psychostimulants not only calm the baby, but also affect other symptoms. The ability to concentrate increases, emotional stability, sensitivity to parents and peers appear, and social relations are being established. Mental development can dramatically improve. Amphetamines (dexamphetamine (Dexedrine), methamphetamine), methylphenidate (Ritalin), pemoline (Ziller) are currently used. Individual sensitivity to them is different. If one of the drugs is ineffective, switch to another. The advantage of amphetamines is the long duration of action and the presence of prolonged forms. Methylphenidate is usually taken 2-3 times a day. It often has a sedative effect. The intervals between doses are usually 2.5-6 hours. Prolonged forms of amphetamines take 1 time per day. Doses of psychostimulants: methylphenidate – 10-60 mg / day .; methamphetamine – 5-40 mg / day .; pemoline – 56.25-75 mg / day. Treatment begins usually with low doses with a gradual increase. Physical dependence usually does not develop. In rare cases, the development of tolerance is transferred to another drug. Methylphenidate is not recommended for children under 6 years of age, dexamphetamine for children under 3 years of age. Pemoline is prescribed for the ineffectiveness of amphetamines and methylphenidate, but its effect may be delayed for 3-4 weeks. Side effects include decreased appetite, irritability, epigastric pain, headache, and insomnia. Pemoline – an increase in the activity of liver enzymes, possible jaundice. Psychostimulants increase heart rate, blood pressure. Some studies indicate a negative effect of drugs on growth and body weight, but these are temporary violations.

If psychostimulants are ineffective, imipramine hydrochloride (tofranil) is recommended in doses of 10 to 200 mg / day .; other antidepressants (desipramine, amfebutamon, phenelzine, fluoxetine) and some antipsychotics (chlorprotixen, thioridazine, sonapax). Antipsychotics do not contribute to the social adaptation of the child, therefore, indications for their appointment are limited. They should be used in the presence of severe aggressiveness, uncontrollability, or when other therapy and psychotherapy are ineffective.

Psychotherapy

A positive effect allows psychological assistance to children and their families. Rational psychotherapy is advisable with explaining to the child the reasons for his failures in life; behavioral therapy with teaching parents reward and punishment methods. Reducing psychological tension in the family and at school, creating a favorable environment for the child contribute to the effectiveness of treatment. However, as a method of radical treatment of disorders of activity and attention, psychotherapy is ineffective.

Monitoring the condition of the child should be established from the beginning of treatment and carried out in several directions – the study of behavior, school performance, social relationships.

There are many Energy Products: drinks, herbs, bars and even sweets. But are these products really effective?

If the names of modern energy products do not lie, energy and endurance can be obtained already in ready-made form in bars, drinks, jelly, herbs and additives.

PowerBar. Red Bull. Amp. Gatorade. Accelerade. Super Energizer. Energice. Burn

Well, the titles really sound reassuring. But are they really better than a simple candy or a bottle of soda? It depends on the product and its manufacturer, say experts, who note that with such a variety of goods it is difficult to have a clear idea of ​​each of them.

To get the full picture, we studied different types of energy products, their ingredients and the overall effect on the body. Some products provide complete information on the content of nutrients in them, while others carefully hide the secret of manufacture. But many of these products have simply not been studied.

Also we asked the experts, do these products actually add something useful to our lives? Do we all have a hard time in life, suffering from a shortage of energy – a problem that can be solved with the help of one powerful bar? Or obsession with edible energy has little to do with good nutrition?

Energy Bars and Jelly

Energy bars and other sweet foods are not all the same. Some of them are stuffed with carbohydrates, proteins or fats. Others are enriched with vitamins or minerals. Flavors are also very much, with cakes and cream, cappuccino, lemon seeds and sweet chocolate and raspberry, which appeal to the taste buds in our language.

Energy products are extremely expensive compared to what you get in the end. In their ingredients, there is nothing magical. The same nutrients can be found in bananas, yogurt or a chocolate bar, which are less expensive products.

To be honest, the carbohydrate or protein composition of some energy bars and jelly can give a more significant energy boost than products that mostly use sugar and caffeine. The inflow of energy caused by the consumption of sugar, usually lasts about 30-60 minutes, and caffeine – about 2 hours. This is usually followed by a decline in energy.

Energy bars and jelly, rich in carbohydrates, really give a charge of energy, since carbohydrates are a favorite source of energy in the body. The ideal option is when half the carbohydrates are consumed along with the fiber, since the digestion of coarse food takes more time, which for a long time charges the body with energy. This can especially help people who need stamina. Foods rich in proteins can also provide a rush of strength and energy. Nutrients help to increase muscle mass and regulate energy production in the body.

But bars and sweets are not a substitute for normal food. Energy products are artificial products. In artificial products there is not enough use of natural components – chemicals that are not vitamins or minerals, they are phytochemicals that are useful for health.

Phytochemicals are natural plant components, such as carotenoids, which give fruits and vegetables color, soy isoflavones and polyphenols from tea. They are associated with many processes, from the destruction of viruses and ending with a decrease in cholesterol and memory improvement.

It would be better if people ate a sandwich or fruit instead of these PowerBar bars. So you get whole grains of bread, squirrels – from the contents of a sandwich – depending on whether it’s meat, fish or cheese – and fiber from fruit.

Add a glass of low-fat milk, and you will also get calcium, vitamin D and minerals that are found in dairy products and help strengthen bones.

Other healthy foods include yoghurt, lentil cheese, nuts, ready-to-eat cereals, peanut butter, toast, fruit drinks and fruits such as bananas, grapes, apples and nectarines.

In a situation where there is no other choice but snacks and fast food, energy bars can be a more useful alternative, but they still can not replace a full meal.

Energy products can be useful for physically active people. Energy bars and jellies can satisfy the need for an energy supply of people who regularly engage in sports. Bars can be a convenient, appetizing and thought-out solution for some athletes. Low-active people, on the other hand, will not benefit from high-calorie foods.

To determine if you are suited to energy sweets, think about the needs of your body. Are you physically active? Do you lead a sedentary lifestyle? Then, compare the composition of different products. Pay attention to the number of calories, proteins, carbohydrates, fiber, fat, vitamins and minerals.

Sports, Vitamin and Energy Drinks

The thirst for energy has opened up a wide market for various drinks. Sports drinks, energy cocktails and vitaminized liquids offer a wide variety.

Sports drinks such as Gatorade and Powerade are usually not even better than water, experts say, but some people allow them to consume a sufficient amount of liquid. They can have different flavors and be of different colors.

“If, thanks to sports drinks, you drink more than if you had to drink plain water, then perhaps this is a good choice for you,” says Moore, noting the importance of sufficient fluid intake. Sports drinks usually contain water, which is necessary for the production of energy and the proper functioning of the body. The amount of liquid used must depend on the individual level of activity and the environment.

A possible disadvantage of sports drinks is that they contain calories, while water does not contain calories. This can be an important observation for those who are experiencing because of their weight.

Many energy drinks also contain soda and other electrolytes, which compensate for the loss of minerals through sweat. Replacement of electrolytes is important for physically active people and for those who must work in hot and humid areas.

Most people who lead a sedentary lifestyle do not need electrolyte replacement at all. They just need to consume enough fluids, and this can be achieved with water and juice.

Some sports, vitamin and energy drinks also contain substances such as caffeine, chromium, amino acids and various patented mixtures.

It is known that caffeine improves the reaction of athletes, but it can also have undesirable effects such as addiction, anxiety and rapid heartbeat.

Chromium is an important mineral that can help control blood sugar levels, increasing sensitivity to insulin. Controlling the level of sugar in the blood can regulate energy. This mineral can be found in beef, broccoli, ham, grape juice and bananas.

Amino acids are a constituent element of proteins, and they can be found in meat, cheese, soy, nuts and fish. Manufacturers of sports drink Cytomax combined amino acids with non-acid form of lactic acid. The result is an alpha L-polylactate product, a beverage ingredient that should provide us with constant energy and reduce fatigue from endurance exercises. For this reason, such beverages are more suitable for athletes, and not for people engaged in ordinary daily activities.

Some vitamin and energy drinks consist of so-called patent mixtures that sound mysterious. Marketers focus on the aura of secrecy in order to sell their products. But in fact there is no magic formula.

If you look at the contents of energy drinks such as Red Bull, Red Stallion and Sobe Adrenaline Rush, you will see that the most common ingredients are inositol and taurine. They do not have any special properties of energy strengthen our body gets so inositol and taurine from the foods that we eat. Inositol is a chemical substance found in foods such as beans, brown rice and corn. Taurine is an amino acid that enters the body from animal sources.

Herbs and Supplements

Many energy products contain herbs that are supposedly giving people extra energy. Popular herbs include ginseng, guarana, Paraguayan holly, golden root and cordyceps mushrooms. They are also available in the form of additives.

How effective are they in raising energy? In general, the evidence varies from suggestive (some small studies indicate their usefulness) to contradictory (the results of different studies differ) and nonexistent (no studies have been conducted).

Among the herbs used as power engineers, ginseng has probably been studied most, but the results of the study are contradictory. In addition, there are different types of ginseng, and scientists do not always know what kind of species they are studying.

Asian ginseng, also known as ginseng panax, is known as a stimulant and has long been used to increase energy. The Asian species has a reputation for aphrodisiac for men, which is also used to improve athletic performance.

American ginseng, on the other hand, is used more as a tonic and over time strengthens the immune system.

Herbs of guarana and holly Paraguay are rich sources of caffeine. They stimulate the central nervous system, much like coffee. Caffeine can improve brain reaction and probably contribute to weight loss.

The golden root was used in Sweden and Denmark as a remedy for fatigue. There is evidence that it improves aspects of mental and physical activity, but apart from that, we know little about this herb.

Golden root is often combined with mushrooms Cordyceps, another grass that has been little studied by scientists. Cordyceps fungi on their own and the combined formula of cordyceps and the golden root were tested for their effect on athletic performance, and the results were contradictory.

Mushrooms Cordyceps bring certain benefits. It gives energy to older people, exhausted by age or illnesses, and young athletes who need to improve their athletic performance.

If you are thinking about using herbs or supplements, it is better to first consult with your doctor. Some plant components, no matter how natural they are, can react with medications and have an adverse effect.

Asian ginseng, for example, can increase blood pressure in those who are prone to hypertension, a recent study shows that this herb reduces the effect of Koudamine (anticoagulant) and other medications. There are also reports that holly Paraguayan, used in large quantities or a long period, can cause cancer of the gastrointestinal tract.

Remember that herbs are considered useful until their harm is proven. They are regulated more as products than as medicines. The dietary supplement of ephedra used for weight loss or in sports is one example of a plant component that has been excluded from the market after numerous deaths and injuries.

The conclusion about energy products

Energy bars, herbs and supplements can be useful in some cases, but they are not absolutely reliable tools for fatigue. And do not think that any of these funds are useful by nature. If you just sit at home, you do not need a high-energy energy bar, just like you do not have to worry about your electrolyte balance. According to experts, you just need to concentrate on a well-balanced diet.

While you eat a variety of foods – in the spirit of the food pyramid – you can meet all your nutritional needs. While you are doing this, your body will be able to perfectly perform all its functions regarding the transformation of food into fuel.

If a healthy diet does not satisfy your need for energy, check if you get enough sleep, do exercises and often experience stress in your life. These factors, plus diseases and medications, can affect the level of energy.

What is Chronic Motor or Vocal Tic Disorder?

A type of tic disorder in which there are or were multiple motor tics and one or more vocal tics that do not occur simultaneously. Almost always there is a beginning in childhood or adolescence. Characteristic is the development of motor tics in front of voice tics. Symptoms often worsen during adolescence, characterized by the persistence of elements of the disorder in adulthood.

Causes of Chronic Motor or Voice Tic Disorder

A large role is played by both genetic factors and disorders of the neurochemical function of the central nervous system.

Prevalence

A combination of chronic motor or voice tics occurs in 1.6% of the population.

Symptoms of Chronic Motor or Vocal Tic Disorder

Characteristic is the presence of either motor or voice tics, but not both together. Ticks appear many times a day, almost every day or periodically for more than one year. Start at the age of 18. Tics appear not only during intoxication with psychoactive substances or due to known diseases of the central nervous system (for example, Huntington’s disease, viral encephalitis). Types of ticks and their localization are similar to transient ones. Chronic vocal tics are less common than chronic motor tics. Voice tics are often not loud and not strong, consist of the noise created by the contraction of the larynx, abdomen, diaphragm. Rarely are they multiple with explosive, repetitive vocalizations, coughing, grunting. Like motor tics, voice tics can be spontaneously suppressed for a while, disappear during sleep and intensify under the influence of stress factors. The prognosis is slightly better in children who become ill at the age of 6-8 years. If tics cover the limbs or trunk, and not just the face, the prognosis is usually worse.

Diagnosis of Chronic Motor or Vocal Tic Disorder

It is also necessary to carry out with tremor, mannerism, stereotypes or disorders in the form of bad habits (tilting the head, swaying the body), more common in childhood autism or mental retardation. The arbitrary nature of stereotypy or bad habits, the absence of subjective grief over the disorder distinguishes them from ticks. Treatment of attention deficit hyperactivity disorder with psychostimulants enhances existing tics or accelerates the development of new tics. However, in most cases, after drug withdrawal, tics stop or return to the level before treatment.

Treatment of Chronic Motor or Vocal Tic Disorder

It depends on the severity and frequency of ticks, subjective experiences, secondary disorders at school and the presence of other concomitant psychotic disorders.

The main role in the treatment is psychotherapy.

Small tranquilizers are ineffective. Haloperidol is effective in some cases, but the risk of side effects of this drug, including the development of tardive dyskinesia, should be considered.

Causes of Schizoid Personality Disorder

Genetic predisposition and upbringing according to the type of “Cinderella”, or hyper-custody with a hyperprotective mother and a passive father. The most typical cases are caused by the education of a cold and distant mother, who at the expense of the child solves her own problems. The child further accepts this model of education and reproduces it in relation to his children.

Symptoms of Schizoid Personality Disorder

The main symptom is a lack of contact with others, autism. A characteristic psycho-esthetic proportion according to E. Kretschmer is from hyperesthetics, mimosa-like sensitivity to anesthesia. These types of personalities are prone to interest in such abstract fields of knowledge as astronomy, mathematics, philosophy, in which they can achieve success. Decompensated in situations where they require a large amount of communication and quick decision-making. Characterized by emotional coldness, inability to show warm feelings, tenderness or anger towards other people. Indifferent to prevailing social norms and conditions. There is a lack of close friends or trusting relationships and a lack of desire to have one. They prefer loneliness and a fenced off lifestyle, although in everyday life they are usually not capable of resolving elementary situations. Characteristic is the construction of fantasies, which usually do not translate into reality, but create a kind of parallel world to reality. Possible increased sensitivity to resentment, and lack of response to significant conflict situations. However, coldness can be a kind of protection in connection with hypersensitivity. Usually they do not pay attention to their appearance and neglect the presentations of those around them. Patients with schizoid personality disorder are predisposed to a simple form of schizophrenia, schizotypal disorders, they are more likely to have childhood autism in childhood, and Asperger syndrome in puberty.

Diagnosis of Schizoid Personality Disorder

It should be differentiated with the development of simple schizophrenia and schizotypal disorder. The difficulties lie in the fact that the above disorders can also develop in post-puberty and the diagnosis largely depends on the assessment of the possibilities of social adaptation and the severity of emotional-volitional changes.

Treating Schizoid Personality Disorder

Group therapy with an emphasis on self-acceptance and application of the characteristics of your personality with maximum benefit for yourself and others. Perhaps the use of small doses of atypical antipsychotics, in particular rispolepta.

What is Schizotypal Disorder?

Schizotypal disorders are found as a genetic background (spectrum) among 10-15% of relatives of schizophrenic patients.

Causes of Schizotypal Disorder

The diagnosis can be considered as the equivalent of latent, sluggish, outpatient schizophrenia. The definition of this group of disorders is controversial, since schizotypal disorder is difficult to distinguish from simple schizophrenia and schizoid personality disorders. They can be considered as persistent decompensation of personality traits, while not always under the influence of stress they get schizophrenia.

Symptoms of Schizotypal Disorder

The appearance of strange and inexplicable character traits in post-puberty and middle age with inadequate behavior, eccentricity or coldness can lead to social isolation for the second time. However, social self-isolation can be primary, and is determined by a special personal philosophy and beliefs in the hostility of the environment. The style of behavior is determined by pretentiousness and lack of logic, following one’s own egoistic attitudes. Mythological thinking arises, which, however, is incomprehensible in a specific cultural context. Even being included in the composition of psychoenergetic and religious sects, the patient does not find a place for himself in connection with his own interpretation of energetic or spiritual experiences. In speech, neologisms and resonance. It is characterized by its own diet, interpretation of the behavior of the surrounding members of the family and society, its own clothing style, stereotyped creativity.

Diagnosis of Schizotypal Disorder

Over the course of 2 years, 4 signs of the following are gradually or periodically detected:

1. Inadequate affect, coldness, estrangement.
2. Eccentricity, eccentricity, strange behavior and appearance.
3. Loss of social communications, fenced off.
4. Magical thinking, strange beliefs that are not compatible with cultural norms.
5. Suspicion and paranoia.
6. Infertile obsessive philosophies with dysmorphophobic, sexual, or aggressive tendencies.
7. Somatosensory or other illusions, depersonalization and derealization.
8. Amorphous, thorough, metaphorical or stereotypical thinking, strange artsy speech, there is no fragmentation of thinking.
9. Episodes of spontaneous delusional states with illusions, auditory hallucinations.

Differential diagnosis

The differential diagnosis with simple schizophrenia and the dynamics of schizoid personality disorder is so complicated that this diagnosis is avoided if possible.

Treating Schizotypal Disorder

The treatment is based on the short-term use of antipsychotics in small doses and an emphasis on psychotherapy using methods of the therapy group, psychoanalysis.

Causes of Transsexualism

Violation of the differentiation of brain structures responsible for sexual behavior (hypothalamus), possibly associated with hormonal effects during pregnancy.

Symptoms of Transsexualism

Features of behavior are noticeable from early childhood. The desire for toys characteristic of the opposite sex, the structure of relationships and the style of behavior of the opposite sex. For example, boys like to play with dolls, embroider and prefer quiet games to mother-daughter, girls, respectively, active and aggressive games, boyish companies, weapons. Transsexualism as a whole is a violation of behavior due to the desire to live and be accepted as a person of the opposite sex, combined with a feeling of inadequacy or discomfort from its anatomical gender and the desire to receive hormonal and surgical treatment in order to make your body as suitable as possible for the chosen gender. Due to social problems and the fact that the attraction of these individuals is directed physiologically to their gender with a different psychological sexual consciousness, depression and a high risk of suicide are frequent. A diagnosis of transsexualism is sufficient to permit prompt sex change in most countries. Sometimes transsexual experiences are unstable.

Diagnosis of Transsexualism

Transsexual experiences may occur with paranoid schizophrenia in the structure of delirium obsession, but in this case, other symptoms characteristic of schizophrenia should also be present.

Transsexualism Treatment

With “nuclear” transsexualism, sex change is indicated with surgical correction and subsequent hormonal and behavioral therapy.

What is Stuttering?

Characteristic features – frequent repetition or prolongation of sounds, syllables or words; or frequent stops, indecision in speech with violations of its smoothness and rhythmic flow.

Causes of Stuttering

The exact etiological factors are not known. Put forward a number of theories:

• The theory of “block stuttering” (genetic, psychogenic, semantogennaya). The basis of the theory is cerebral dominance of speech centers with constitutional predisposition to the development of stuttering due to stress factors.
• Theories of the beginning (include the theory of failure, the theory of needs and the theory of anticipation).
• The theory of learning is based on an explanation of the principles of the nature of reinforcement.
• Cybernetic theory (speech is an automatic process of the type of feedback. Stuttering is explained by the breakdown of feedback).
• Theory of changes in the functional state of the brain. Stuttering is a consequence of incomplete specialization and lateralization of language functions.

Recent studies suggest that stuttering is a genetically inherited neurological disorder.

Prevalence

Stuttering suffers from 5 to 8% of children. The disorder is 3 times more common in boys than in girls. In boys, it is more stable.

Symptoms of Stuttering

Stuttering usually begins before the age of 12 years, in most cases there are two acute periods – between 2-4 and 5-7 years. It usually develops over several weeks or months, starting with repeating the initial consonants or whole words that are the beginning of a sentence. As the disorder progresses, repetitions become more frequent with stuttering on more important words and phrases. Sometimes it may be absent when reading aloud, singing, talking to pets or inanimate objects. The diagnosis is made when the duration of the disorder is at least 3 months.

Clonic-tonic stuttering (disturbed rhythm, tempo, fluency of speech) – in the form of a repetition of initial sounds or syllables (logos), at the beginning of speech clonic convulsions with the transition to tonic.

Tonic-clonic stuttering is characterized by a rhythm disturbance, smoothness of speech in the form of hesitations and stops with frequent vocal enhancement and pronounced breathing disorders associated with speech. There are additional movements in the muscles of the face, neck and limbs.

During stuttering, there are:

• Phase 1 – preschool period. The disorder appears sporadically with long periods of normal speech. After this period, recovery may occur. During this phase, stuttering occurs when children are agitated, distressed, or when they need to talk a lot.
• Phase 2 occurs in primary school. The disorder is chronic with very short periods of normal speech. Children are aware and painfully experiencing their disadvantage. Stuttering concerns the main parts of speech – nouns, verbs, adjectives and adverbs.
• Phase 3 occurs after 8-9 years and lasts until adolescence. Stuttering occurs or increases only in certain situations (call to the board, buying in a store, talking on the phone, etc.). Some words and sounds are more difficult than others.
• Phase 4 occurs in late adolescence and in adults. Expressed fear of stuttering. Typical are word substitutions and bouts of wordiness. Such children avoid situations that require verbal communication.

The course of stuttering is usually chronic, with periods of partial remission. From 50 to 80% of children with stuttering, especially in mild cases, recover.

Complications of the disorder include a decline in school performance due to shyness, fear of speech disorders; restrictions in the choice of profession. For those suffering from chronic stuttering, frustration, anxiety, and depression are typical.

Diagnosis of Stuttering

Spastic dysphonia is a speech disorder similar to stuttering, but is characterized by the presence of a pathological breathing pattern.

Unclear speech, in contrast to stuttering, is characterized by erratic and disrhythmic speech patterns in the form of quick and sharp flashes of words and phrases. When speech is unclear, there is no awareness of his lack, while those who stutter are acutely aware of their speech disorders.

Stuttering Treatment

Includes several directions. The most typical is distraction, suggestion and relaxation. Stutterers are taught to speak simultaneously with the rhythmic movements of the arms and fingers, or in a slow and monotonous manner. The effect is usually temporary.

Classical psychoanalysis, psychotherapeutic methods are not effective in the treatment of stuttering. Modern methods are based on the point of view that stuttering is a form of learned behavior that is not associated with neurotic manifestations or neurological pathology. Within these approaches, it is recommended to minimize the factors that increase stuttering, reduce secondary disturbances, convince the stutterer to talk, even with stuttering, freely, without constraint and fear, in order to avoid secondary blocks.

An effective method of self-therapy based on the premise that stuttering is a specific behavior that can be changed. This approach includes desensitization, reducing emotional reactions, fear of stuttering. Since stuttering is what a person does, and a person can learn to change what he does.

Drug treatment is of an auxiliary nature and is aimed at alleviating the symptoms of anxiety, expressed fear, depressive manifestations, and facilitating communicative interactions. Soothing, sedative, fortifying agents (valerian, motherwort, aloe vera, multivitamins and B vitamins, magnesium preparations) are applicable. In the presence of spastic forms, antispasmodics are used: mydocalm, sirdalud, myelostane, diafene, amisyl, theofedrin. Tranquilizers are used with caution, mebikar 450-900 mg / day is recommended, with short courses. Significant effect is brought by courses of dehydration.

Alternative options for drug treatment:

• In the clonic form of stuttering, pantogam is used from 0.25 to 0.75 – 3 g / day., Courses lasting 1-4 months.
• Carbamazepines (predominantly tegretol, timonyl, or finlepsin retird) with 0.1 g / day. up to 0.4 g / day. within 3-4 weeks, with a gradual reduction of the dose to 0.1 g / day. as a supportive treatment, with a duration of up to 1.5 – 2 months.

Complex treatment of stuttering also includes physiotherapeutic procedures, courses of general and specialized speech therapy massage, speech therapy, psychotherapy using the suggestive method.

What are School-specific Developmental Disorders?

These disorders arise due to violations in the processing of cognitive information, which largely occurs as a result of biological dysfunction. Characteristically, the normal acquisition of skills is impaired from the early stages of development. They are not the result of adverse learning conditions and are not related to brain injury or illness. It is necessary to evaluate not the level of education, but school achievements, taking into account the dynamics of development, since the severity and lag in reading for 1 year at 7 years old has a completely different meaning than for 1 year at 14 years old.

The type of manifestation of the disorder usually changes with age – the delay in speech in preschool years disappears in colloquial speech, but is replaced by a specific delay in reading, which in turn decreases in adolescence, and in youth these are violations of spelling / writing. That is, the condition is equal in all respects, but the dynamics of growing up are taken into account. School skills are not only a function of biological maturation, they must be taught and mastered. Specific violations of school skills cover groups of disorders manifested by a specific and significant deficiency in teaching school skills in a given age group, class, population, and school.

These disorders are not a direct result of other conditions – mental retardation, gross neurological defects, emotional or gnostic disorders. Often combined with hyperactivity disorder and attention deficit, specific disorders of motor functions. It doesn’t mean at all that these are children with a delay in skills, and “will catch up with their peers over time” – such violations are observed in adolescence and in further education. They are associated with the appearance of secondary disorders in the form of a lack of interest in learning, a poor educational program, and emotional disorders.

Diagnosing Specific School Skills Disorders

Diagnostic Requirements

There should be the most clinically significant degree of violation of a skill:

• the presence of delays or deviations in the development of speech in the preschool period;
• associated problems – inattention or increased activity, emotional disturbances or disturbances in behavior;
• the presence of qualitative violations – a clear difference from the norm;
• inadequate response to therapy (lack of effect with increased care at home and / or school).

The violation is more strictly specific and does not depend on mental retardation or on a general decrease in the intellectual level. Diagnosis of violations is based on psychological and pedagogical testing. Violation should be present from the first years of training, and not acquired during education. Violations should not be due to untreated or uncorrected visual or auditory disorders.

Specific impairments to school skills include:

• specific violation of reading skills “dyslexia”;
• specific violation of writing skills “dysgraphia”;
• specific violation of arithmetic skills “dyscalculia”;
• a mixed disorder of school skills “learning difficulties”.

Treatment of Specific School Skills Disorders

The preferred treatment is corrective training therapy. Emotional reactions are more important than certain teaching methods. An effective neuropsychological correction with an integrative approach to mastering phonetic combinations and the spatial structure of words. Concomitant emotional and behavioral disorders should be treated with appropriate medication and psychotherapeutic methods. A good effect is provided by family counseling.

What are Specific Personality Disorders?

Personality disorders – persistent character anomalies, consisting of a combination of genetic and acquired properties that lead to social maladaptation. According to Gannushkin P.B., they are characterized by a violation of adaptation, the totality of the defeat of the psyche and low reversibility. Personality disorders are usually noticeable since childhood as special disharmonies and disproportionate development of the psyche. In dynamics, the phases of compensation and decompensation alternate. S.S. Korsakov pointed out that “The psychopathic constitution is a persistent painful disorder that is firmly connected with the characteristics of the mental warehouse, which already constitutes its fundamental weakness, becomes its characteristic property forever or for a rather long time.” O.V. Kerbikov divided psychopathy (the former name of specific personality disorders) into marginal, developing mainly under the influence of social factors, and nuclear, due to biological, constitutionally hereditary factors. M.O. Gurevich added organic psychopathies to these groups – the consequences of exogenous-organic harmfulness, manifested in anomalies of characterological development. An anomaly of personality grows in prepubertal from patho-characterological reactions, patho-characteristic development, therefore, the diagnosis of personality disorder is made from 16 to 17 years. They are related to borderline mental disorders. The exaggerated development of one of the character traits is considered accentuation (K. Leonhard, 1964), which is a variant of the norm.

E. Kretschmer considered character anomalies to be the result of development asynchrony, in which some character traits develop tremendously in connection with compensating for the insufficient development of other mental functions. J. Price believed that character anomalies are the result of a distorted development of the dominance function in the hierarchy system – this is the result of an incorrect awareness of one’s biological rank.

It is possible to distinguish constitutional genetic, organic and psychodynamic factors leading to the development of character anomalies. The contribution of genetic factors to the development of personality traits is up to 60%, most of the abnormal personality traits are transmitted according to a recessive or polygenic type. Theories of the late 19th century considered mental degeneration in families to be the cause of character anomalies. Long-term somatic and neurological disorders in childhood, pre-, postnatal pathology, traumatic brain injuries contribute to the formation of an abnormal nature. A significant role is played by upbringing in an abnormal and asymmetric family, the frequent background of which is the use by parents of psychoactive substances. Nevertheless, there are facts of the development of completely harmonious personalities even in the presence of all adverse circumstances, as well as facts of the development of abnormal personalities in outwardly harmonious and genetically prosperous families. Part of the abnormal personality traits develops as a kind of hypercompensation of mental deficiency (inferiority complex). From an analytical point of view, most personality abnormalities are associated with developmental delay and distortion of the stages of psychosexuality, while acquired abnormal features are more often the result of regression.

Symptoms of Specific Personality Disorders

General diagnostic guidelines for personality abnormalities are defined as conditions that cannot be directly explained by extensive brain damage or illness or other mental disorder. They must meet the following criteria:

• disharmony in personal positions and behavior, usually involving several areas of functioning, for example, affectiveness, excitability, control of motives, processes of perception and thinking, as well as the style of attitude towards other people;
• the chronic nature of the abnormal style of behavior that has arisen for a long time and is not limited to episodes of mental illness;
• an abnormal style of behavior is comprehensive and clearly violates adaptation to a wide range of personal and social situations;
• the aforementioned manifestations always arise in childhood or adolescence and continue to exist in the period of maturity, often sharpening of personality traits is noted at a later age;
• the disorder leads to significant personality distress, but this can only become apparent in the later stages of the course;
• usually, but not always, the disorder is accompanied by a significant deterioration in professional and social productivity.