Manifestation and treatment of various forms of psychosis in children. Symptoms of psychosis
Childhood psychoses
D. p. represent a mixed group severe disorders with gross deviations from expected social and intellectual age norms. Childhood autism and childhood schizophrenia are the two most common psychotic disorders of childhood.
Almost every aspect of the problem of childhood psychoses - from names and definition criteria to the interpretation of mechanisms and treatment tactics - is marked by controversy. Despite the existing controversy, the manifestations of psychotic disorders are universally described as “deep”, “pervasive” and “severe”. There is also no doubt that these diseases last throughout life, although a small percentage of patients show significant improvements. Poor disease outcomes have been associated with low (corresponding to mental retardation) scores on an intelligence test taken at the time of diagnosis, lack of language skills before age 5, signs of psychosis before age 10, and children exhibiting introversion, timidity, and inhibition even before age 10. emergence of difficulties.
There is significant overlap between the symptoms of autism and childhood schizophrenia. A group of British psychiatrists proposed nine signs characterizing these and other forms of D. p.:
1. Serious, persistent disturbances in interpersonal relationships. They take the form of withdrawal in autism and obsessive attachment (often to the mother) in childhood schizophrenia.
2. A visible lack of consciousness of personal identity, manifested in grotesque poses and self-mutilation.
3. Increased interest in inanimate objects and unusual actions with them, often without understanding their normal function.
4. Extreme resistance to change of any kind and rituals aimed at maintaining monotony.
5. Pathological perception leading to exaggerated, deficient or unpredictable responses to sensory stimulation. In many patients have impaired concentration and lack of reactions to the environment.
6. Increased, acute, inadequate anxiety; in some cases - panic fear ordinary household items.
7. Severe speech impairment - usually loss or delay in the development of speech skills. The speech of some patients is inadequate, for example. they use pronouns incorrectly or do not use inflections.
8. Motor disorders, including spasms, immobility, hyperactivity and mannerisms. There are frequent attempts at autostimulation in the form of body rotation, tiptoeing, clapping and rocking, especially in conditions of relative motor deprivation in medical conditions. institutions.
9. General delay in the development of intellectual skills. Over 50% of patients constantly remain at a reduced level of development. However, children with autism sometimes demonstrate normal or even high intellectual functioning in specific areas, such as memory, music or arithmetic - abilities rarely seen in children with schizophrenia.
These nine signs are not observed exclusively in psychosis and are not observed in all children diagnosed with psychosis. In practice, it is often difficult to distinguish psychotic disorders from mental retardation, organic brain damage, and symptoms accompanying blindness or deafness.
In addition to social violations. adaptation and intelligence are other key features of the differential distinction between autism and childhood schizophrenia. Symptoms of autism are typically severe from the very beginning of life, while a child with schizophrenia usually appears normal until a certain point, which occurs after the first 30 months of life (up to 12 years of age). An autistic child makes a lot of effort to maintain the established routine, while a child with schizophrenia is sometimes completely uninterested in this. A child with autism has developed motor skills, while those with schizophrenia have problems with coordination and balance. A child with autism demonstrates an increased interest in mechanical objects, which do not evoke a similar attitude in patients with schizophrenia. Patients with autism are more likely to ignore the environment, while patients with schizophrenia exhibit confusion in their perception of it.
There is also a characteristic difference in the social background of people with autism and schizophrenia. Children with autism come from families belonging to relatively high strata of society; they have a low representation of cases of schizophrenia in their family. Children with schizophrenia predominantly come from poor families and have an increased level of hereditary burden of schizophrenia.
Etiology
The etiology of these psychotic states is unknown. However, etiological theories are based on assumptions about the multifactorial genesis of these disorders. Research data confirm the role of physiol. mechanisms.
According to most theories, childhood schizophrenia is similar to the adult version, which suggests that the same etiological factors operate in both cases. Modern theories emphasize the role of biochemical abnormalities (especially cerebral dopamine metabolism). In some cases, a genetic factor triggered by stress plays a decisive role. Although not all patients with childhood schizophrenia show signs of brain damage during childbirth, they are more likely to high percent birth complications and other signs of pathology nervous system compared to their siblings and healthy controls. However, the evidence supporting the presence of specific CNS defects is not convincing enough.
In autism - especially in cases where symptoms are expressed from infancy - researchers suggest cerebral pathology due to hereditary burden or complications during childbirth. Not everyone agrees on what this pathology is, whether it is present in all cases, or whether several are involved at the same time. areas of the brain. However, there is evidence of the involvement of factors such as prenatal infections (for example, rubella), hereditary neurological disorders, bleeding during pregnancy and unknown genetic disorders.
Researchers of environmental factors rarely distinguish between autism and schizophrenia in childhood, considering them to be essentially the same disorder.
Parents of psychotic children are far from a homogeneous group. Parents of patients with schizophrenia often exhibit pathology, including psychosis, schizoidism and introversion. However, there is no obvious evidence that disorders in parents precede disorders in their offspring and provoke these disorders. Schizophrenia and schizophrenic symptoms are not detected in parents of children with autism. The psychol. they have. the disorders seem most often to be caused by the birth of an autistic child or by health care workers' attitudes that blame the child's illness on the parents.
Authors who believe that this is a problem in Chap. arr. organic, based on both somatic and psychopedagogical treatment approaches. Thyroid hormones, powerful vitamin therapy, and other medications can provide relief from symptoms, especially insomnia, hyperactivity, and aggressiveness. Re-education programs, often behaviorally oriented, aim to develop coping skills and eliminate symptoms of maladjustment. Such highly structured psychoeducational programs are superior in effectiveness to other forms of psychosocial therapy.
See also Childhood neurosis, Heritability, Personality, Psychoendocrinology, Schizoid personality, Sex chromosome abnormalities
L. L. Davidoff
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Mental health is a very sensitive topic. Clinical manifestations of mental disorders depend on the age of the child and the influence of certain factors. Often, due to fear for future changes in their own life, parents do not want to notice some problems with the psyche of their child.
Many people are afraid to catch the sidelong glances of their neighbors, feel the pity of their friends, or change their usual life order. But the child has the right to qualified, timely assistance from a doctor, which will help alleviate his condition, and in the early stages of certain diseases, cure a mental disorder of one spectrum or another.
One of the most complex mental illnesses is childhood psychosis. This disease is understood as an acute condition of a child or a teenager, which manifests itself in his incorrect perception of reality, his inability to distinguish the real from the imaginary, and his inability to really understand what is happening.
Features of childhood psychoses
Mental disorders and psychoses in children are not diagnosed as often as in adult men and women. There are mental disorders different types and forms, but no matter how the disorder manifests itself, no matter what symptoms the disease has, psychosis significantly complicates the life of the child and his parents, prevents him from thinking correctly, controlling actions, and building adequate parallels in relation to established social norms.
Childhood psychotic disorders are characterized by:
Childhood psychosis has different forms and manifestations, which is why it is difficult to diagnose and treat.
Why are children susceptible to mental disorders?
Multiple causes contribute to the development of mental disorders in children. Psychiatrists identify whole groups of factors:
The most important provoking factor is a genetic predisposition to mental disorders. Other reasons include:
That's all for today possible reasons have not been fully studied, but studies have confirmed that children with schizophrenia almost always have signs of organic brain disorders, and patients with autism are often diagnosed with cerebral insufficiency, which is explained by hereditary causes or injuries during childbirth.
Psychosis in young children can occur due to parental divorce.
Thus, children are at risk:
Types of psychotic disorders among children
Children's mental illnesses are divided according to certain criteria. Depending on age, there are:
The first type includes patients with mental disorders of infancy (up to one year), preschool (from 2 to 6 years) and early school age (from 6-8). The second type includes patients of pre-adolescence (8-11) and adolescence (12-15).
Depending on the cause of the disease, psychosis can be:
Depending on the type of course, psychoses can be:
A type of psychotic disorder is affective disorder. Depending on the nature of the course and symptoms of affect disorders, there are:
Symptoms depending on the form of failure
Different symptoms of mental illness are justified by different forms of the disease. Common symptoms of the disease are:
Psychogenic shock often occurs in children and adolescents. Reactive psychosis occurs as a result of psychological trauma.
This form of psychosis has signs and symptoms that distinguish it from other mental spectrum disorders in children:
IN early age mental health disorders manifest themselves in the child’s autistic behavior. The baby does not smile or in any way show joy on his face. Up to a year, the disorder is detected in the absence of humming, babbling, and clapping. The baby does not react to objects, people, or parents.
Age crises, during which children are most susceptible to mental disorders from 3 to 4 years, from 5 to 7, from 12 to 18 years.
Mental disorders early period manifest themselves in:
Later ages up to adolescence
Mental problems in a 5-year-old child should concern parents if the child loses already acquired skills, communicates little, does not want to play role-playing games, and does not take care of his appearance.
At the age of 7, the child becomes mentally unstable, he has an appetite disorder, unnecessary fears appear, his performance decreases, and rapid fatigue appears.
At the age of 12-18, parents need to pay attention to their teenager if he or she develops:
More painful signs of psychosis in older children include:
Diagnostic criteria and methods
Despite the proposed list of signs of psychosis, no parent can definitely and accurately diagnose it on their own. First of all, parents should take their child to a psychotherapist. But even after the first appointment with a professional, it is too early to talk about mental personality disorders. A small patient should be examined by the following doctors:
Sometimes the patient is admitted to a hospital for examination and necessary procedures and analyses.
Providing professional assistance
Short-term attacks of psychosis in a child disappear immediately after their cause disappears. More severe diseases require long-term therapy, often in an inpatient hospital setting. Specialists use the same drugs to treat childhood psychosis as for adults, only in appropriate doses.
Treatment of psychoses and psychotic spectrum disorders in children involves:
If parents were able to identify a mental disorder in their child in time, then several consultations with a psychiatrist or psychologist are usually sufficient to improve the condition. But there are cases that require long-term treatment and being under the supervision of doctors.
Psychological failure in a child, which is associated with his physical condition, is cured immediately after the disappearance of the underlying disease. If the illness was provoked by a stressful situation experienced, then even after the condition improves, the baby demands special treatment and consultations with a psychotherapist.
IN extreme cases In cases of severe aggression, the baby may be prescribed tranquilizers. But for the treatment of children, the use of heavy psychotropic drugs is used only in extreme cases.
In most cases, psychoses experienced in childhood do not return in adulthood in the absence of provoking situations. Parents of recovering children must fully adhere to the daily routine, do not forget about daily walks, a balanced diet and, if necessary, take care of taking medications in a timely manner.
The baby cannot be left unattended. At the slightest violation mental state you need to seek help from a specialist who will help you cope with the problem that has arisen.
To treat and avoid consequences for the child’s psyche in the future, it is necessary to follow all recommendations of specialists.
Every parent concerned about the mental health of their child should remember:
Love and care are what any person needs, especially a small and defenseless one.
Neuroses in children: classification, causes, symptoms and help for the child
Neuroses are classified in medicine as a reversible dysfunctional state of the nervous system, provoked by experiences, unstable emotions, chronic fatigue and other factors. This diagnosis is often made in adult patients, which is not surprising in modern conditions vanity, turmoil, problems and troubles. But doctors are alarmed by the fact that neurosis has become “younger” - more and more often children with symptoms of this disease are being brought to specialists.
Classification of neuroses in childhood
Doctors differentiate several types of neuroses that can manifest themselves in childhood. Each of them has its own characteristics, is distinguished by individual characteristics and must be subjected to professional treatment.
Anxiety (neuroses of fears)
Anxiety is paroxysmal in nature - it occurs only in certain situations. Preschoolers are very often afraid of the dark, this anxiety can also be intensified by their parents - young children are frightened by “a woman, a black old woman.” An anxiety attack occurs only before sleep at night; during the rest of the day there are no manifestations of fear neurosis.
Primary school age children are exposed to fear of the teacher, a new group of children, and bad grades. According to statistics, this type of childhood neurosis is more often diagnosed in those children who did not attend kindergarten and immediately went from their home environment to a large school group with its own rules and responsibilities.
note: fear neurosis in this case is manifested not only by stiffness, tears and whims, but also by active resistance to the onset of the “X-hour” - children run away from home, skip classes, and persistent lies appear.
Childhood obsessive-compulsive disorder
Neurosis of this type in childhood is manifested by involuntary movements that are absolutely not controlled - for example, flinching, blinking one or two eyes, sniffing, a sharp turn of the neck, slapping palms on the knees or table, and more. With obsessive-compulsive disorder, there may be nervous tics, but they are typical only during negative/positive emotional outbursts.
The category of obsessive states also includes phobic neurosis - this is a condition in which a child develops a fear of being called to the blackboard at school, a teacher, visiting a doctor, or a fear of closed spaces, heights or depths. A very dangerous condition is when a child suffers from a phobic neurosis, and parents perceive this neurosis as a whim - reproaches and ridicule can lead to nervous breakdowns.
More details about obsessive neuroses says the specialist:
Depressive psychosis
Depressive psychosis is more common in children during adolescence and has very characteristic symptoms:
A psychologist talks about ways to combat depression in teenagers:
Hysterical neurosis
The well-known tantrums of young children in the form of falling to the floor, kicking their feet on the floor, screaming and crying are a manifestation of hysterical neurosis. This condition is typical for preschool children and may first appear at the age of 2 years.
Children's neurosis, manifested by irritability, poor appetite, sleep disturbance and restlessness, is classified by doctors as neurasthenia, or asthenic neurosis.
note: similar view of the one in question reversible impairment arises due to excessive load at school, kindergarten or in additional classes.
Hypochondriacal neurosis
Hypochondriacs are suspicious people who doubt everything. A similar name for neurosis suggests that children experience suspiciousness towards themselves, their mental and physical abilities, and health. Patients experience great fear about identifying any complex, life-threatening disease.
Stuttering of neurotic etiology
Neurotic stuttering can occur between the ages of 2 and 5 years—the period when a child’s speech is developing. It is noteworthy that stuttering of neurotic etiology is more often diagnosed in boys and can be caused by excessive mental stress.
About the causes of stuttering and correction methods - in the video review:
They are also more common in boys and can be caused not only by mental factors, but also by diseases. For example, with long-term conjunctivitis, a habit of rubbing your eyes hard appears. The disease is eventually cured, but the habit remains - a persistent neurotic tic will be diagnosed. The same may apply to constant “sniffling” of the nose or dry coughing.
Such movements of the same type do not cause discomfort in ordinary life child, but can be combined with enuresis (bedwetting).
Sleep disorders of neurotic etiology
The causes of such neurosis have not yet been clarified, but it is assumed that sleep disturbances of a neurotic nature may be caused by sleepwalking, talking in sleep, restless sleep with frequent awakenings. These same signs are also symptoms of sleep disorder neurosis.
Neuroses in children preschool age may be purely physiological in nature:
Doctors say that neuroses accompanied by enuresis and/or encopresis are caused by overly strict upbringing and great demands from parents.
The pediatrician talks about methods of treating enuresis:
Pathological actions of a habitual nature
We are talking about biting fingertips, biting nails, pulling out hair, rocking the body with rhythmic movements. This type of neurosis in children is diagnosed before the age of 2 and is very rarely recorded at an older age.
Causes of childhood neuroses
It is believed that the main reasons for the development of neuroses in childhood lie in the family, in the relationship between the child and his parents. The following factors are identified that can provoke the formation of stable childhood neurosis:
note: the listed factors are very conditional. The fact is that for each child the concepts of “psychological impact, psychotrauma” have an individual emotional connotation. For example, many boys and girls will not even pay attention if their parents raise their voices at them, and some children begin to experience panic fear of their own mothers/fathers.
The main causes of neuroses in children:
Pathogenesis of neuroses in children and adolescents:
In no case should you blame a child for having a neurosis of any kind - it is not his fault; you should look for the reason in the family, specifically in the parents.
note: children with a pronounced “I” are more susceptible to the appearance of neuroses, who from an early age can have their own opinion, they are independent and do not tolerate even a hint of dictate from their parents. Parents perceive such behavior and self-expression of the child as stubbornness and whims, they try to influence with force - this is a direct path to neuroses.
Neurosis is considered a reversible process, but it is still a disease - treatment should be carried out on professional level. Doctors dealing with the problem of childhood neuroses are qualified as psychotherapists and use hypnotherapy, play sessions, treatment with fairy tales, and homeopathy in their work. But first of all, you need to restore order in the family, establish a relationship between the child and the parents.
Very rarely, neuroses in childhood require the prescription of specific medications; usually a competent specialist will find an option for providing assistance at the level of psycho-emotional correction.
As a rule, the results of treatment of childhood neuroses will only be achieved if not only the child, but also his parents go to see a psychotherapist. Healing a child from neuroses will be facilitated by:
- drawing up a clear daily routine and following the recommended regime;
- physical education – often it is sport that helps bring a child out of a neurotic state;
- frequent walks in the fresh air;
- spending free time not in front of the computer or TV, but in communication with parents or friends.
- born with a long anhydrous interval;
- with extremely low body weight;
- c congenital with malformations and injuries with violation of the integrity of the skin;
- with intrauterine infection;
- with syndrome respiratory disorders and pulmonary edema;
- with catheterization of the central and umbilical veins;
- the presence of gestosis and numerous abortions in the mother’s history;
- mother's presence bacterial vaginosis during pregnancy and childbirth, as well as detection of B hemolytic streptococcus;
- rapid fetal heart rate and lack of pathological changes in the mother’s body (fever, decreased blood pressure, blood loss);
- presence of accompanying bacterial diseases in the mother (pyelonephritis).
Hippotherapy (horseback riding), dolphin therapy, art therapy—in general, any non-traditional methods of correcting a child’s psycho-emotional state—are very effective in treating childhood neuroses.
note: It is very important that parents also take the path of treatment - in case of selecting therapy for a child, they need to take into account the mistakes of the parents and try to level out the stressful situation in the family. Only through joint work of parents/psychotherapist/child can good results be achieved.
Neuroses of childhood are considered whims, self-indulgence and character traits. In fact, this reversible condition can worsen and over time develop into serious problems with the psycho-emotional state. Patients of neurologists often admit that in childhood they often experienced fears, were embarrassed by large companies and preferred solitude. To prevent such problems from arising in your child, it is worth making every effort to professionally overcome childhood neuroses. And no matter how trivial it may sound, only moderate love, the desire to understand the baby and the willingness to come to his aid in difficult times can lead to a complete cure.
To understand how you can help your child, and, most importantly, to be able to recognize the signs of neurosis in time, we recommend watching this video review. A child and adolescent psychologist with 10 years of experience, Candidate of Psychological Sciences Anton Sorin talks about neuroses:
Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category.
Symptoms of sepsis in children
Sepsis is one of the most terrible diseases. In children, it most often occurs during the neonatal period and is characterized by a lightning-fast course. One of the main causes of systemic inflammatory response syndrome is the imperfection and weakening of the immune system. In everyday life, this disease is usually called “blood poisoning”, since the body is poisoned by pathogenic organisms and their toxins. In this article we will talk in detail about what sepsis symptoms are in children and the causes of the pathological process in the body.
Sepsis is a generalized inflammatory reaction of the body with an acyclic course. In most cases, the cause of the disease is opportunistic microorganisms. When a septic focus forms in the body, a rapid development of a systemic inflammatory response (SIR) occurs, which is a nonspecific immune response in response to endogenous or exogenous factors.
In some cases, the immune response may be insufficient or incorrect when the pathogen enters the internal environment of the body. One way or another, the child’s body loses the ability to fully protect itself from a generalized infection.
Classification of sepsis Blood poisoning is usually divided according to time and conditions of development into: neonatal (early, late), hospital-acquired, community-acquired and in immunodeficiency states. By infections: pulmonary, rhinoconjunctival, nasopharyngeal, ear, skin, intestinal, umbilical, pulmonary, abdominal and occurring after venous catheterization. According to clinical manifestations, this disease can occur in two forms: with septicopyemia and septicemia.
Cause of sepsis
Systemic inflammatory response syndrome most often develops in children who were born prematurely or with extremely low body weight. In a newborn baby the immune system underdeveloped and unable to fully protect the baby. In the first few months of a child’s life, compensation for immunoglobulins is carried out through mother’s milk. Thus, early artificial feeding is a predisposing factor to the development of sepsis.
Infants who are being treated in a hospital are at high risk of contracting sepsis. A newborn can become infected when passing through birth canal mothers, in contact with infected people or things. Also, do not forget that sepsis in children can develop as a result of intrauterine infection.
At risk of developing neonatal sepsis children included:
At an older age, the cause of illness in a child may be a generalized infection by bacterial, viral or fungal infections. There are frequent cases when local foci of infection lead to sepsis.
This scenario is possible with pyelonephritis, meningococcus and pneumonia caused by bacteria.
People who are asymptomatic carriers pose a greater danger pathogenic microorganisms. Some infectious diseases can be complicated by sepsis. In this case, microbes and released toxins from a local focus are spread throughout the body through the blood. The circulation of pathogenic microorganisms and their metabolic products in the blood leads to the formation of new foci of infection. If in this case adequate therapy is not provided, the disease will progress to the next form and lead to multiple organ failure and death. The development of purulent-inflammatory processes can be caused by about three dozen microorganisms. At the moment, sepsis is increasingly caused by opportunistic bacteria.
There are no pathognomonic symptoms of sepsis in children. As you have already noticed, this disease has different forms and therefore clinical manifestations can be very diverse.
Typical symptoms of sepsis in children:
- Are common:
- Change in body temperature. There is an increase in body temperature to febrile levels with fever and chills. In patients with sepsis, there are 2 types of fever: remitting (fluctuation in daily temperature by 2 0 C) and wavy (a high temperature is observed and begins to subside after identification and drainage of foci of infection). Remitting fever is observed with septicemia, and wave-like changes are characteristic of septicopyemia. If a patient's sepsis lasts long enough, exhaustion occurs and body temperature drops.
- Weakness and drowsiness.
- Aversion to food, dry and coated tongue, nausea, vomiting, and in some cases diarrhea.
- Neuropsychiatric disorders: apathy, psychosis and confusion.
- Redness of the face gives way to pallor, yellowness and sallow skin. A quarter of patients have yellowness of the sclera.
- The color of the skin becomes marbled. Changes in skin color occur due to impaired blood circulation.
- Appear on the skin and mucous membranes minor hemorrhages and purulent lesions.
- Damage to the gastrointestinal tract:
- Hepato-lienal syndrome.
- Absence of peristaltic sounds, which indicate paralytic intestinal obstruction.
- Respiratory failure:
- Increase in quantity breathing movements, tachycardia and increase blood pressure, possible respiratory arrest.
- What happens at the primary site of sepsis? Even before complications develop, granulations are observed at the site of the primary lesion, which begin to bleed when touched. The wound discharge is purulent or putrefactive in nature. The tissue around the focus of sepsis in a child acquires a pale tint. If the purulent-inflammatory process is caused by an aerobic infection, then the localization of the process is very easy to determine. With anaerobic sepsis, infection spreads very quickly through adipose tissue.
- hemodynamic support with vasopressins and glucocorticoids;
- sanitation of the source of infection;
- antibiotic therapy with macrolides and cephalosporins;
- respiratory support;
- correction of metabolic disorders;
- removal of endotoxins from the body;
- correction of hemostasis.
Treatment of sepsis in children is based on primary and basic therapy. Primary therapeutic measures aimed at stabilizing the patient’s condition and performing diagnostic measures. The child must be treated in compliance with the following points:
At the first signs of sepsis in children, you should immediately seek help from a doctor. Treatment of childhood sepsis is carried out in a hospital setting since it poses a serious threat to the patient’s life. When treating sepsis, consultation with highly specialized doctors and a pharmacologist is often required to select further treatment tactics, as well as to minimize the manifestations and consequences of sepsis.
Preventive actions
When receiving injuries with a violation of the integrity of the skin, in order to prevent the development of a generalized purulent-inflammatory infection, it is necessary to carry out primary processing wound surface followed by local or general treatment. Foci of local infection are subject to surgical intervention.
Reactive psychosis– a short-term mental disorder that occurs in response to an intense traumatic situation. Clinical manifestations can vary greatly; they are characterized by disturbances in the perception of the world, inappropriate behavior, and the development of psychosis against the background of acute stress, the reflection of stress in the picture of a mental disorder and the completion of psychosis after the disappearance of traumatic circumstances. Symptoms of reactive psychosis usually appear soon after mental trauma and last from several hours to several months. The diagnosis is made based on history and clinical manifestations. Treatment is pharmacotherapy; after recovery from the psychotic state, psychotherapy.
Reactive psychosis (psychogeny) is an acute mental disorder that occurs during severe stress, characterized by a disturbance in worldview and disorganization of behavior. It is a temporary, completely reversible condition. Reactive psychosis is similar to other psychoses, but differs from them in the greater variability of the clinical picture, variability of symptoms and high affective intensity. Another feature of reactive psychosis is the dependence of the course of the disease on the resolution of the traumatic situation. If unfavorable circumstances persist, there is a tendency for a protracted course; when stress is eliminated, a rapid recovery is usually observed. Treatment of reactive psychoses is carried out by specialists in the field of psychiatry.
Causes and classification of reactive psychoses
The cause of the development of psychogenics is usually a situation that poses a threat to the patient’s life and well-being or is of particular significance for some reason related to the beliefs, character traits and living conditions of the patient. Reactive psychoses can occur during accidents, natural disasters, military operations, losses, bankruptcy, threat of legal liability and other similar circumstances.
The severity and characteristics of the course of reactive psychosis depend on the personal significance of the traumatic situation, as well as on the characteristics of the patient’s character and his psychological constitution. Such conditions are more often diagnosed in patients with hysterical psychopathy, paranoid psychopathy, borderline personality disorder and other similar disorders. The likelihood of developing reactive psychosis increases after traumatic brain injury, mental or physical fatigue, insomnia, prolonged alcohol intake, severe infectious and somatic diseases. Particularly dangerous periods of life are puberty and menopause.
There are two large groups of reactive psychoses: prolonged psychoses and acute reactive states. The duration of acute reactive states ranges from several minutes to several days, the duration of protracted reactive psychoses - from several days to several months. Acute reactive states include reactive stupor (affectogenic stupor) and reactive excitation (fugiform reaction). Protracted psychoses include hysterical reactive psychoses, reactive paranoid and reactive depression.
Protracted reactive psychoses
Hysterical reactive psychoses
Within the framework of hysterical reactive psychoses, hysterical twilight stupefaction (Ganzer syndrome), pseudodementia, wildness syndrome, delusional fantasy syndrome and puerilism are considered.
Ganser syndrome called reactive psychosis, accompanied by a narrowing of consciousness and pronounced affective disorders: anxiety, foolishness, emotional lability. Patients quickly move from crying to laughter, from joy to despair. Some patients suffering from reactive psychosis experience visual hallucinations. Productive contact is impossible, since patients understand speech addressed to them, but answer questions incorrectly (“mimic speech”). Orientation in place and time is impaired; patients often do not recognize people they know.
Wernicke's pseudodementia– reactive psychosis, reminiscent of dementia. Orientation in place, time and one’s own personality is disturbed, and these violations are of a deliberately pronounced nature. The patient says obvious absurdities (for example, to the question “how many eyes do you have?” he answers “four”), makes gross mistakes when performing the simplest tasks (for example, tries to put shoes on his hands instead of on his feet), while his answers and actions always correspond to the given topic. There is confusion, and affective disorders are possible. Reactive psychosis lasts from 1 to 8 weeks.
Puerilism– psychogenia, in which the patient’s behavior becomes deliberately childish. A patient with reactive psychosis talks like a small child, lisps, plays with toys, cries, is capricious, calls others aunts and uncles, cannot answer simple questions or answers them from the position of a child. Facial expressions, movements, intonations and peculiarities of phrase construction in this reactive psychosis resemble those in preschool children. Retention of some “adult” skills, such as applying makeup or lighting a pipe, appears to be retained.
Feral syndrome– reactive psychosis, in which the patient’s behavior resembles the behavior of an animal. Occurs against a background of intense fear. The patient shows aggressiveness, growls, runs on all fours, sniffs objects, takes food from the plate with his hands rather than with a spoon or fork. Delusional fantasy syndrome is a reactive psychosis that develops against a background of severe anxiety and is accompanied by the formation of delusional ideas about one’s own greatness, genius, extraordinary abilities or incredible wealth.
Reactive paranoid– reactive psychosis that occurs when living conditions change, with a lack of productive contacts with other people, in an environment that represents real threat or seems frightening, dangerous and incomprehensible to the patient. This group of reactive psychoses includes reactive paranoid proper, reactive paranoia and induced delusions. Reactive paranoid and reactive paranoia develop in conditions of imprisonment and captivity. They can be observed when moving from a small village to a huge metropolis. Sometimes such reactive psychoses occur in deaf people who cannot read lips and find themselves surrounded by people who do not speak sign language. The risk of development increases with lack of sleep.
The onset of reactive psychosis is preceded by severe anxiety. Patients feel restless and sense “impending disaster.” Against the background of affective disorders, hallucinations appear, and delusions of special meaning, persecution or relationship develop. Consciousness is narrowed. Delirium reflects a traumatic situation. Patients suffering from reactive psychosis try to run away and hide, beg for mercy, or become detached, humble and doomedly await the onset of a tragic outcome. Some patients attempt suicide in an attempt to “escape punishment.” Reactive psychosis ends after 1-5 weeks; after recovery from psychosis, asthenia occurs.
Jet Paranoia accompanied by the formation of paranoid or overvalued ideas, limited by the framework of the traumatic situation. Ideas of invention or jealousy may develop. Some patients with reactive psychosis become convinced that they have a serious illness. Highly valuable ideas are specific, clearly related to real circumstances. In situations not associated with highly valuable ideas, the patient’s behavior is adequate or close to adequate. Affective disturbances are observed, marked anxiety, tension and suspicion are noted.
Induced delirium– reactive psychosis, provoked by close communication with a mentally ill person. Usually, close relatives who are emotionally attached to the patient and living with him in the same area suffer. Predisposing factors are the high authority of the “inducer”, as well as passivity, intellectual limitations and increased suggestibility of the patient suffering from reactive psychosis. When you stop communicating with a mentally ill relative, the delusion gradually disappears.
Reactive depression
Reactive depressions are reactive psychoses that develop in circumstances of severe mental trauma (usually sudden death loved one). In the first hours after the injury, stupor and numbness occur, which are replaced by tears, remorse and guilt. Patients suffering from reactive psychosis blame themselves for not being able to prevent a tragic event and not doing everything possible to save the life of a loved one. At the same time, their thoughts are directed not to the past, but to the future. They anticipate their lonely existence, the emergence of material problems, etc.
With this form of reactive psychosis, tearfulness, persistent depression of mood and loss of appetite are observed. Patients become inactive, stoop, lie or sit in one position for a long time. Movements slow down, it seems as if patients do not have enough strength and energy to perform the simplest actions. Gradually, the mood normalizes, depression disappears, however, the duration of reactive psychosis can vary greatly depending on the character of the patient and the prospects for his further existence. In addition, reactive depression can be observed in prolonged unresolved traumatic situations, for example, in the case of the disappearance of a loved one.
Diagnosis and treatment of reactive psychoses
The diagnosis is made based on the medical history (presence of a traumatic event), characteristic symptoms and connections between symptoms and the traumatic situation. Reactive psychosis is differentiated from schizophrenia, delusional disorders, endogenous and psychogenic depression, manic-depressive psychosis, narcotic or alcohol intoxication And withdrawal syndrome that developed after stopping drug or alcohol use.
Patients with reactive psychosis are hospitalized in the psychiatry department. The treatment plan is drawn up individually, taking into account the characteristics of psychogenicity. For agitation, tranquilizers and antipsychotics are prescribed. Antipsychotics are also used for delusional ideas, and antidepressants are used for depression. After recovery from reactive psychosis, psychotherapy is carried out aimed at working through the feelings that arose in connection with a traumatic situation, adapting to new living conditions and developing effective defense mechanisms that help maintain adequacy under stress. The prognosis is usually favorable.
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Psychosis is the collective name for a group of various mental disorders.
Psychosis is a pronounced disorder mental activity, which is accompanied by a gross contradiction of mental reactions and the real situation. This is expressed by a violation of the perception of the real world, disorganization of behavior, pathological disorders memory, perception, thinking.
Causes
Psychosis can be caused by internal or external factors. Internal causes include neurological disorders, endocrine diseases, provoking the development of an endogenous disease. TO external factors- infectious diseases (tuberculosis, influenza, syphilis, typhoid); poisoning by alcohol, drugs, industrial poisons; psychotrauma, stress.
Risk factors for the development of psychosis: the presence of a severe chronic or acute mental disorder (schizophrenia, depression, mania), previous severe infectious or somatic diseases, intoxication, trauma and degenerative changes in the brain. Possible influence of genetic factors.
Psychosis is manifested by various changes in behavior, thinking, and emotions, which demonstrate a person’s loss of real perception of the world.
The patient is in a depressed state, which is accompanied by hallucinations and delusional statements. Examples of hallucinations: talking to oneself, laughing for no reason, listening and falling silent. Signs of delusional behavior: the appearance of secrecy and hostility, statements of a dubious nature (persecution, self-aggrandizement, etc.).
Psychosis is diagnosed through a pathopsychic examination during an appointment with a psychiatrist. During a face-to-face appointment, the doctor observes a person’s behavior and asks him questions on various topics to assess his thought processes, sensations and feelings. To establish the true nature of the occurrence of psychosis, laboratory and hardware examinations are used.
Some symptoms of psychosis are normal in children and adolescents. For example, young children often have imaginary friends they talk to, and teenagers may suddenly begin to sleep more due to physiological changes in the body. If you suspect that your child has psychosis, describe his behavior in detail to a psychiatrist. If necessary, he will schedule an in-person appointment.
Based on their origin and causes of development, psychoses are classified into endogenous, organic, somatogenic, psychogenic (reactive and situational), intoxication, abstinence, post-abstinence.
According to the leading clinical picture, psychoses are divided into paranoid, hypochondriacal, depressive, manic, and others, as well as combinations of these forms.
According to the nature of the course, reactive and acute psychoses are distinguished.
A patient with psychosis needs hospitalization because he is not able to assess the degree of changes in his psyche, often does not control his actions and poses a danger to others and himself. People around you should call for emergency help.
Treatment begins with the use of antipsychotic drugs medications, which reduce the occurrence of hallucinations and delusions and promote clearer thinking. The selection and dosage of these drugs depend on the causes of psychosis and individual characteristics development of the nervous system.
In further stages, treatment may include cognitive behavioral therapy.
Most patients recover completely with adequate treatment and timely medical care. Otherwise, psychosis may recur repeatedly.
Without treatment, psychosis can lead to a significant decrease in a person’s quality of life, and also pose a threat to the lives of the patient himself and those around him.
Without adequate medical care, psychosis causes damage to brain functions that worsen over time.
There is evidence that using cognitive behavioral therapy can reduce the likelihood of developing psychosis in patients from the group increased risk. They relate to her.
TO schizophrenic psychoses include mental illnesses leading to personality disintegration. At the same time, characteristic disorders of thinking, perception and affective spheres develop. Intellectual abilities and consciousness are usually not impaired, but cognitive impairment often develops during the disease process.
Due to the unknown etiology of schizophrenic psychoses modern classification schemes, such as ICD-10 (WHO) and DSM-3R (APA), are guided by symptoms and time criteria when establishing a diagnosis. According to the ICD-10 diagnostic guidelines, a diagnosis of schizophrenic psychosis is justified if at least one of specific symptoms(or two or three less specific) from the following groups of symptoms 1-4 or at least two symptoms from groups 5-8.
These symptoms should be clearly present almost constantly for a month or longer.
1. Echo of thoughts, insertion or subtraction of thoughts, influxes of thoughts.
2. Delirium of influence, control, feeling of being done, clearly related to movements of the body or limbs or to certain thoughts, actions and sensations; delusional perception.
3. Commentary voices discussing the patient and his behavior, or voices emanating from some part of the body.
4. Persistent delusional ideas that are not associated with a given culture and completely inconsistent with reality, such as identifying oneself with religious or political figures, the idea of having superhuman powers and capabilities (for example, the ability to control the weather or contact with aliens).
5. Constant hallucinations in any sphere of the senses, accompanied by either unstable or not fully formed crazy ideas without clear affective manifestations, or persistent overvalued ideas that appear daily for weeks or months.
6. Breaks in thoughts or interference in the thought process, leading to interrupted speech and neologisms.
7. Catatonic symptoms such as agitation, stereotypical rigidity or waxy flexibility (flexibilitas cerea), negativism, mutism and stupor.
8. Negative symptoms, such as apathy, poor speech, flatness and inadequacy of emotional reactions (which usually leads to social isolation and decreased social productivity). It should be obvious that these symptoms are not due to depression or antipsychotic treatment.
b - drawing of the same patient - plan of the city of New York.
Moreover, in accordance with diagnostic criteria ICD-10 The following clinical subtypes of schizophrenic psychoses can be distinguished:
F 20.0 Paranoid
F 20.1 Hebephrenic schizophrenia
F 20.2 Catatonic schizophrenia
F 20.3 Undifferentiated schizophrenia
F 20.5 Residual schizophrenia (chronic undifferentiated schizophrenia)
F 20.6 Simple schizophrenia
Regardless of this division into clinical subtypes of schizophrenia Based on psychopathological symptoms and the nature of the course, other classification options for schizophrenic psychoses were developed (Leonhard, Crow, Andreasen, Kay). Of particular importance for the treatment and dynamics of schizophrenia in childhood and adolescence is the concept of positive (type I) and negative (type II) schizophrenia. The table shows the most important psychopathological symptoms, characteristic of schizophrenia type I and type II.
Wherein positive and negative symptoms are in no way specific to schizophrenic psychosis - they are also observed in psychoorganic syndromes, depressive syndromes, personality disorders and neuroses (Angst et al.). Negative symptoms dominate within schizophrenic psychoses in young children (5-10 years) and in children and adolescents with below average cognitive development.
Epidemiology of schizophrenic psychoses
Results from several studies on the epidemiology of schizophrenic psychoses can be summarized as follows:
1. The prevalence of schizophrenia with primary manifestation before the age of 12 is less than 1 in 10,000 children. Thus, it is less common than early childhood autism (Burg, Kerbeshian).
2. Schizophrenic psychoses with primary manifestation in childhood are 50 times less common than schizophrenia in adults (Karno, Norquist).
3. Schizophrenic psychosis in childhood and prepubertal age is a rare phenomenon, but in adolescents it is relatively frequent illness. The primary manifestation of schizophrenic psychoses in 2.4% of cases occurs between the 5th and 14th years of life and in 22.1% - between the 15th and 19th years (Remsclrmidt).
4. The gender distribution in childhood is more favorable for boys, and in adolescence this difference apparently smoothes out (Remschmidt et al.).
Aspects of psychopathology in the development of schizophrenic psychoses
Schizophrenic psychoses in childhood and adolescence must always be considered in the context of development processes. Symptoms in a particular patient are often determined by the phase of its development. In this case, it is necessary to distinguish manifestations in childhood from those that occur in adolescents. Age and level of development from a modern point of view are considered as factors that greatly influence clinical picture psychosis in childhood and adolescence (Remschmidt, Remschmidt et al.). Taking into account aspects of developmental psychopathology, schizophrenia includes both independent psychoses of childhood, for example, early childhood catatonia (Leonhard), and mental disorders that develop into schizophrenia when they manifest in childhood until prepuberty. In general (Kanner), childhood psychoses are divided into:
1) early childhood autism not related to schizophrenia,
2) disintegrative psychoses of childhood as primary organically caused disorders and
3) childhood forms of schizophrenia.
Knowledge of cognitive and emotional characteristics appropriate age period and an accurate analysis of developmental tasks are prerequisites for understanding psychoses and their symptoms such as delusions and hallucinations. The latter are characterized by typical age-related features: in children they are less systematized and associated with the world of children's fantasies, which makes it necessary to clearly distinguish them from normal childhood experiences.
U teenagers so-called pubertal crises and maturation crises can precede schizophrenic psychoses, and also initially mask them (Remschmidt, Martin). During teenage crises we're talking about about normal variants of experiences and behavior in the form of distorted self-esteem, guilt, feelings of inferiority, about conflicts associated with physical and mental self-esteem, often causing self-harm, suicidal attempts, leaving home and oppositional behavior at the behavioral level (Remschmidt). Deviations and crises that arise when overcoming problems can be initial manifestation psychosis and participate in the development of its symptoms. The onset of schizophrenic psychosis, according to modern data, can be explained by the interaction of the patient’s predisposition and premorbid personality characteristics with aggravating life circumstances and family factors, which leads to failures in overcoming problems and decompensation of psychosis.
Significant signs of predisposition to schizophrenic psychoses are:
limited processing of information (impaired attention, increased distractibility with extraneous stimuli, difficulties in selecting them);
inadequate autonomic reactions(hypo- or hyperexcitability, insufficient adaptive abilities of the autonomic nervous system);
limited social competence;
insufficient defense mechanisms.
Psychosis is a severe mental illness characterized by impaired ability to distinguish between fantasy and reality and adequately assess what is happening. Moreover, psychosis is a general term used to describe specific types of severe mental health disorder.
Any type of psychosis significantly harms the life of the affected child. Psychosis usually creates problems with organizing thoughts, correct use language, with control of impulses - behavior in accordance with social norms, expressions of emotions and relationships with other people.
"Typical" psychotic behavior is difficult to describe because it can take so many different forms.
One of the most obvious signs of psychotic behavior is hallucination, in which the ill child sees, hears, touches, tastes and smells things that do not exist. Another clear sign is delusion - a misinterpretation of the intentions or meaning of something that actually exists. Similar (though less demonstrative) types of behavior include making up words, laughing at things that are not funny or even unpleasant, getting very irritated for any reason or for no reason at all.
Hallucinations, delusions and similar types of behavior can clearly distinguish children with psychosis. For example, after hearing the story of Cinderella, a non-psychotic child may dream of becoming a heroine and feel disgusted when he thinks of an evil stepmother. A child with psychosis may believe that he or she is Cinderella and that the evil stepmother is actually in this very room.
For many years, medical experts have debated whether or not psychosis affects preadolescent children and, if so, how to distinguish it from adult psychosis and from other childhood disorders. Although these issues are still controversial, most medical experts now agree that children in their pre-teen years may suffer from psychoses that were once thought to be found only in adolescents and adults. Most experts also agree that definitive evidence of psychosis—namely, the ability to verbalize a grossly distorted perception of reality—must exist before a diagnosis can be made. Thus, it may not be possible to diagnose specific psychosis until the child is unable to speak, although psychosis may be suspected due to gross behavioral disturbances.
Psychosis in children can occur due to a number of short-term or long-term physical conditions, including the use of medications (eg, when starting or stopping steroid treatment), fever, meningitis, and hormonal imbalances (eg, over or underactive thyroid). In most cases of psychosis caused by temporary physical problems, the attack ends when the problems are resolved or dulled. Sometimes, however, full recovery is not possible until several weeks have passed after the underlying disease has been cured, since the patient needs time to recover and adapt to reality.
Although there are many types physical illnesses can lead to psychotic episodes, psychosis sometimes develops without such diseases and occurs quickly or continues for a long time, or episodically for months or even years. Experts speculate that such psychoses are caused by biochemical abnormalities that may be present at birth or acquired through conditions such as drug or alcohol abuse.
It turns out that biochemical abnormalities in some people lead only to temporary attacks of psychosis and only during certain types of psychosis. external influences such as a stressful situation. In rare cases, for example, older children experience psychotic symptoms such as hallucinations in response to a stressful situation such as moving away from home to attend college. These "psychotic breaks" tend to be brief, lasting only a few days or weeks.
Other people appear to be born with such severe constitutional abnormalities that psychosis appears spontaneously at an early age and the disability persists throughout life. The reason for this phenomenon is not clear. Experts believe that environmental stress is never the only factor, and there is no convincing evidence that it plays any role at all when symptoms appear in early childhood. Medical researchers continue to test the theory that genetic factors play a role in persistent psychosis.
How are psychoses diagnosed in children?
The child may need to be seen repeatedly over weeks or even months by various professionals, such as a doctor who specializes in developmental disorders, a child psychiatrist, as well as a neurologist (a specialist in the nervous system), an otolaryngologist (an ear, nose and throat specialist). ) as well as a speech and language expert (speech therapist).
Diagnostic procedures include a thorough physical and psychological examination, long-term observation of the child's behavior, testing of mental abilities, and testing of hearing and speech.
The child may be hospitalized for various tests of the central nervous system. If a child with psychosis appears to have an underlying physical health problem, diagnostic procedures can be focused on determining the underlying cause of the illness.
If parents have any doubts about the diagnosis, such as whether it is accurate enough, they should listen to the opinions of other doctors.
Treatment and prevention of psychosis in children
Brief episodes of psychosis caused by physical health problems resolve when the underlying illness disappears. However, severely affected children should be consulted by a mental health professional - a psychiatrist, psychologist or social worker - to deal with psychotic episodes. Usually only a few discussions are necessary, although some children may require long-term therapy.
Also, a child who experiences a psychotic break due to a stressful situation often needs short-term or long-term psychotherapy. In some cases, these children may benefit from short- or long-term use. drug treatment, which compensates for the alleged biochemical disturbances.
Brief psychotic episodes associated with underlying physical health problems can only be prevented by treating or preventing the underlying causes.
Based on materials from the article “Psychosis”.
Childhood psychosis can develop according to the most various reasons: an acute condition can be triggered by high temperature, infectious diseases, endocrine disorders, neuroinfections, stress factors, mental trauma and hereditary predisposition. Psychosis is manifested by delusions, hallucinations, strange behavior and illogical reactions to events. Self-help is not recommended; qualified assistance from a child psychiatrist is required.
IsraClinic consultants will be happy to answer any questions on this topic.
Psychosis is an acute condition during which a child experiences sudden changes in mood, inappropriate emotions (laughter during a sad story, for example), hallucinations, delusional thoughts and ideas. Psychosis in children, as a rule, is not an independent disease, but a manifestation of some mental or organic disorder. Whatever the cause of psychosis in children, this condition significantly affects the child’s life, reducing the quality of functioning, the formation of emotions, and the control of behavior.As a rule, a typical manifestation of psychosis in children is the presence of hallucinations and delusional thoughts. For example, a child may believe that he is a cartoon or fairy tale character, imagine that there are characters from this cartoon next to him, and show emotions in accordance with the actions of imaginary characters. The child may also express thoughts that do not correspond to reality.
Psychosis in children causes
They can be very different. Some of them have a short-term effect on the child and eliminating the cause helps to quickly restore normal functioning, while some of the causes require long-term treatment and elaboration. Among the most common causes of psychosis in children, we highlight the following:
- Medications. Some medications can cause a psychotic state that resolves if pharmacotherapy is stopped.
- Heat. During illness, high fever can cause delirium and hallucinations in a child. After the temperature normalizes, psychosis in children quickly passes.
- Neuroinfections (meningitis, encephalitis, myelitis, etc.)
- Endocrine disorders
- Stressful situations (parental quarrels, divorce, authoritarian parenting)
- Psychotrauma (physical or mental violence)
- Hereditary causes. If one of the parents suffers from psychotic disorders, the likelihood that psychosis will be inherited by the child is very high.
Note that psychosis can manifest itself in children both in preschool and adolescence.
Diagnosis and treatment of psychosis
Very often, a diagnosis of psychosis requires examination by several specialists - a child psychiatrist, a neurologist, a clinical psychologist, and a pediatrician. Additional tests such as MRI, EEG, blood tests, lumbar puncture or electromyography may be ordered. These tests are necessary to confirm or rule out an organic cause for psychosis in children. After establishing the exact cause of psychotic attacks, therapy is prescribed. If we are talking about a psychological reason, sedatives, consultations with a child psychologist, or family psychotherapy may be prescribed. In some cases, quite long sessions with a psychotherapist are required to stabilize the condition - up to six months. If we are talking about organic reason, treatment is prescribed depending on the diagnosis that caused the psychosis.
In Israel, at the IsraClinic psychiatric clinic, it is customary to conduct a comprehensive examination and treatment of children with psychotic attacks to diagnose accurate diagnosis and appointments as much as possible effective therapy. In addition to pharmacotherapy and psychotherapy, the clinic’s methods include art therapy, hippotherapy, hydrotherapy or sports therapy, depending on the interests and inclinations of young patients. Such auxiliary techniques for the treatment of psychosis have been proven to produce sustainable results. After treatment, the main efforts of doctors and parents are aimed at preventing psychosis, in particular, physical and mental health child and his family.
Psychoses in children respond well to treatment; the main thing is to contact a doctor in a timely manner. specialized center to good specialists.