Syndrome of increased neuro-reflex excitability

Article:

In every children's group there is at least one child who constantly strives to offend others, is rude to educators and teachers, and terrorizes others. As a result, he has no friends and is not attracted to ordinary children's games and activities. Such children are often called “difficult.” Parents themselves cannot understand why their child is uncontrollable and aggressive. It’s difficult to deal with him even at home. Psychologists advise, first of all, to examine such a child for the presence of attention deficit hyperactivity disorder in order to correct behavior.

What is ADHD

There is a category of children who are characterized by increased nervous excitability, impulsiveness, disobedience, and aggressiveness towards people around them. Sometimes even parents doubt whether such behavior is a character trait or whether the child is mentally ill. Their doubts are not unfounded. Indeed, the so-called attention deficit hyperactivity disorder is a relatively common neurological disorder that affects the behavior of the child.

This deviation occurs in approximately 5% of children. Signs become clearly visible around the age of 5-6 years. When a child goes to school, there is a need to adapt to certain rules and focus on activities that are of little interest to him. This causes a negative reaction, which is reflected in behavior. Moreover, such children are so impulsive that they cannot control their actions, although they perfectly understand “what is good and what is bad.” They are scolded by teachers and avoided by other children. Parents, no matter how hard they try, cannot cope with the negative and even dangerous consequences of their behavior.

ADHD is approximately 4 times more common in boys. It is important to understand in time what is wrong with the child, to realize that his behavior is not a cost of upbringing, but a disease. There are effective ways to treat such patients and correct their behavior with the help of medications. An adult with this syndrome also has problems with behavior, attention, and socializing. However, as a rule, they are not as significant as in childhood, and behavioral deviations can often be tolerated. There are three types of ADHD: attention deficit disorder, hyperactivity disorder and mixed disorder.

Literature

1. Meldrum B. S. (2000). Glutamate as a neurotransmitter in the brain: review of physiology and pathology. J. Nutr. 130 , 1007S–1015S;
2. Dopamine diseases;
3. Varshney LR, Chen BL, Paniagua E, Hall DH, Chklovskii DB (2011). Structural properties of the Caenorhabditis elegans neuronal network. PLoS Comput. Biol. 7 (2), e1001066;
4. Seung S. Connectome. How the brain makes us who we are. M.: Binom, 2014 - 440 pp.;
5. The molecule of sanity;
6. Parsons C. G., Danysz W., Dekundy A., Pulte I. (2013). Memantine and cholinesterase inhibitors: complementary mechanisms in the treatment of Alzheimer's disease. Neurotox. Res. 24, 358–369;
7. Trotman M., Vermehren P., Gibson C. L., Fern R. (2015). The dichotomy of memantine treatment for ischemic stroke: dose-dependent protective and detrimental effects. J. Cereb. Blood Flow Metab. 35, 230–239;
8. Krystal JH, Perry EB Jr, Gueorguieva R, Belger A, Madonick SH, Abi-Dargham A et al. (2005). Comparative and interactive human psychopharmacologic effects of ketamine and amphetamine. Implications for glutamatergic and dopaminergic model psychoses and cognitive function. Arch. Gen. Psychiatry. 62, 985–995;
9. Lahti A. C., Koffel B., LaPorte D., Tamminga C. A. (1995). Subanesthetic doses of ketamine stimulate psychosis in schizophrenia. Neuropsychopharmacology 13, 9–19;
10. Rolland B., Jardri R., Amad A., Thomas P., Cottencin O., Bordet R. (2014). Pharmacology of hallucinations: several mechanisms for one single symptom? Biomed. Res. Int. 2014 , 307106. doi: 10.1155/2014/307106;
11. Hugdahl K. (2015). Auditory hallucinations: A review of the ERC “VOICE” project. World J. Psychiatr. 5, 193–209;
12. Hugdahl K., Løberg E.-M., Nygård M. (2009). Left temporal lobe structural and functional abnormality underlying auditory hallucinations in schizophrenia. Front. Neurosci. 3, 34–45..

Causes of ADHD

ADHD occurs in children as a result of dysfunction of the nervous system and is associated with a lack of dopamine (a hormone responsible for human psycho-emotionality) and norepinephrine (a hormone that regulates aggressiveness). The causes of the syndrome are:

1. Heredity. As a rule, one of the child’s blood relatives has similar behavioral characteristics.
2. Features of the development of the frontal lobes of the brain, disruption of the activity of neurons of a certain group.
3. Deviations in the development of the central nervous system in the fetus (perinatal encephalopathy). Other manifestations of this pathology may be weak muscle tone, uncontrolled urination (enuresis) and bowel movements, and convulsive syndrome.
4. Complications that arose during pregnancy and childbirth in the mother. These include infectious diseases of the woman, the threat of miscarriage, strong feelings, taking medications to maintain pregnancy and induce labor, smoking, and drinking alcohol during pregnancy. Premature birth, entanglement of the fetus with the umbilical cord, brain hypoxia, rapid or prolonged labor, and cesarean section increase the risk of ADHD in the child.
5. Injuries and diseases of the brain suffered by children at a young age.
6. Living by a pregnant mother in environmentally harmful conditions, consuming by her, and subsequently by the child, products containing harmful additives.

Note: Problems in the family (frequent quarrels and scandals, single-parent families, lack of attention to the child, overly strict upbringing, physical punishment, parental alcoholism) are factors that provoke the occurrence of hyperactivity syndrome in children. A big psychological trauma for a child is a forced separation from his father, who abandoned his family.

Symptoms and signs of ADHD

Symptoms of the disease, as well as the degree of their manifestation, depend on the age of the child and are associated with the conditions in which he lives.

Signs in an infant

The first signs of a baby having ADHD can be noticed in the first months of life. The baby chaotically and frequently waves his arms, bends and unbends his legs. He is restless and moody when eating. The baby has trouble falling asleep, sleeps little, wakes up and flinches at the slightest sound, and it is difficult to calm him down when he cries. Frequently vomits during and after meals.

Symptoms of ADHD in a preschooler

If increased excitability does not disappear over time, then the following behavioral features indicate the development of ADHD in a preschooler:

1. Constant body movements (jumps up while eating, swings limbs, turns head).
2. Inability to concentrate and be patient while playing.
3. The desire to break and throw toys around. The child does not have a favorite toy, since he is not able to become attached to any of them and does not enjoy quiet activities.
4. He doesn’t like being read to or told something, interrupts adults endlessly, gets distracted by running to the window, tries to do several things at once, and quickly gets bored with everything.
5. Since the brain does not control his movements, he can inadvertently push others around, break something, or hurt another child.

Despite the fact that the baby has the ability to learn, there is a lag in his intellectual development due to poor memory and lack of interest in cognitive activities and games. Often such a child begins to speak late and pronounces words incorrectly.

Physical ailments of neurotic origin often appear (tics, sudden convulsions, causeless screaming, frequent blinking, as well as involuntary urination and defecation). Such a child experiences increased energy consumption in the body, so he loses weight and often suffers from colds due to low immunity.

Manifestations of the syndrome in a schoolchild

As mental retardation from peers progresses, a student with ADHD will have even more problems learning and communicating with people. Manifestations of the disease can become dangerous. He loves to fight not only at school, but also attacks his mother, father, and grandparents. Can hit a teacher or doctor, is cruel, and prone to sadism.

Jumps up and walks around the class during the lesson, does not tolerate comments, does not react to them. Not wanting to study himself, he interferes with other children, incites them to disobey the teacher, intimidates them, and disrupts lessons.

The child is talkative, but is not capable of dialogue, does not “hear” the words of others, interrupts and shows excessive emotionality. Without listening to the question, he mindlessly shouts out the answer. If the behavior of a small child can still cause bewilderment, and only a doctor can make a diagnosis of ADHD, then in a schoolchild such symptoms clearly indicate a neurological pathology, and the diagnosis is beyond doubt.

Depending on the type of ADHD that occurs in children, the signs of the disease differ: either mental retardation (lack of attention) or physical hyperactivity predominates. With a mixed form of the disease, both are observed.

Symptoms of ADHD in a teenager

At the age of 13-15 years, the manifestations of the disease become less noticeable, the teenager becomes less impulsive and irritable. New traits appear in his character: anxiety, concern. He is fussy, constantly finds some important thing to do, but cannot complete anything, because of this he becomes embittered.

He has low self-esteem. Conflicts with others and ridicule from classmates can lead to suicide, especially if a teenager feels out of place in the family. There are no authorities for such children; they are rude to adults. They lack the ability to make independent decisions and a sense of responsibility. They usually have no fear of danger.

Disturbances in the sphere of emotional reactions

They manifest themselves as disproportionate in intensity or inadequate in quality emotional reactions in response to changes in situations that are essential for patients.

Emotional explosiveness or explosiveness . It manifests itself as an increased readiness for emotional reactions in the form of affects or disorders close to such, in response to various emotiogenic stimuli. From the outside, one may get the impression that violent emotional reactions arise over completely trivial matters (a rude word, an ironic remark, etc.). But these are usually “trifles” that greatly hurt the individual’s wounded pride. Reactions of expressed dissatisfaction, anger with verbal, and often physical aggression predominate. It happens that in such an impulse the victim is seriously injured, sometimes incompatible with life. Sometimes such patients exhibit “free-floating aggressiveness,” so that external aggression can immediately transform into auto-aggression. Such aggressors do not value their own lives or those of others. Most often they are psychopaths. During the reaction, self-control is significantly reduced, patients mostly act impulsively.

Explosiveness is often found in patients with psychopathic-like disorders of various origins (TBI, schizophrenia, etc.). E. Bleuler about and attacks of despair with attempted suicide, as well as “fear or even stuporous states.” Let us remember that we are not talking here about acute reactions to stress or reactions to repeated stress, when the first, as it were, prepared the ground for a reaction to the latter (“mental anaphylaxis”, “mental allergy”). Sometimes hysterical patients can “work themselves up” to the point of passion, especially if they have developed such a defensive reaction somewhere in the zone.

Defensiveness is emotional viscosity. It manifests itself as a persistent fixation of predominantly negative emotional reactions that arose in a situation of frustration. Typical in this case are rancor, vindictiveness, and aggressive fantasies. The patient, for example, talks about a long-standing conflict with his colleague and at the same time plays with his nodules, clenching his fists as if we were talking about a very recent skirmish. He does not forget to add that if he came across this man now, “I would settle accounts with him in full.” Another patient, 15 years later, brutally beat a classmate because he “made fun of me at school in front of everyone.” Such patients overcome mental trauma for a long time and with difficulty, unable to switch to something else. They seem to be invariant and strictly adhere to previous habits and patterns of behavior. Defensiveness can also manifest itself in relation to positive emotions and attachments. Patients say that they are “monogamous” and cannot start a second family if their husband or wife dies, they prefer to live in one place, it is very difficult for them to change their occupation, hobbies, entertainment, they keep old things for a long time, but they cannot get used to new ones. quite difficult, they listen to the same music and watch old films they once loved many times, do not include new people in their circle of friends, etc. Emotional viscosity is characteristic of epileptoid psychopaths, epilepsy, individuals with age-related personality changes, and has been described in parkinsonism and postencephalitic mental disorders.

Emotive lability is a slight, capricious changeability of mood under the influence of the most insignificant reasons, sometimes not noticed by the patient himself, much less by those around him - tachythymia. The wind rose, the sun set, rain splashed, a heel broke, the pen stopped writing, a stain appeared on the blouse - all this can significantly ruin the mood. But it easily rises if pleasant little things happen right away: the seller didn’t shortchange, someone said a compliment, smiled, gave up his seat on the bus - and the mood is good again, life makes you happy again, you like all the people, and rainbow mirages appear ahead again. In some cases, emotional lability reaches the level of emotional hyperesthesia, when the mood becomes dependent on an infinite number of random details of what is happening.

These are mimosa-type people, impressionists who cringe at a random glance, the intonation of a voice, the smell of sweat, the sight of a wilting flower. Such painful fragility makes it difficult to live, maintain smooth relationships with people, think about something serious, and generally creates a feeling of ephemeral, airy existence, in which everything is so conditional and changeable. Emotive lability is a sign of corresponding psychopathy, foreshadowing the possibility of more serious affective pathology.

Emotional incontinence is the inability to control not only your emotions, but also their external manifestations. The disorder was described by E. Bleuler in mental retardation, as well as in mentally ill people. Characterizes a significant decrease in the ability of self-control and dysfunction of higher integrative authorities.

Weakness - compassionate tearfulness, excessive sentimentality, manifested when perceiving or remembering touching events. One of the early signs of cerebral atherosclerosis. Weakness is often associated with traumatic events of the past and in such cases reminds us of the approaching symptom of “living in the past.” Weakness also occurs in states of neuropsychic asthenia, when a rational attitude to what is happening is replaced by a sterile emotional one. Excessive tearfulness often occurs with mild depression and hysteria. Sometimes tears characterize impotent anger, self-pity and resentment towards someone, a state of tenderness, a release of emotional stress, and the ability to share the suffering of someone. There are also tears of joy. The latter things do not relate to weak-willedness itself.

Weakness should not be confused with forced crying, which, like forced laughter, occurs with pseudobulbar disorders. “Hysterics” with sometimes uncontrollable sobs are associated with the fact that patients fall into the corresponding role, needing consolation, but cannot immediately get out of it on their own. Tearfulness in patients with painful insensibility does not relate to weakness: here the tears flow as if on their own, mechanically, not accompanied by the experience of corresponding emotions. There are also “made tears” - someone “forces the patient to cry or he feels that it is not he who is crying, but someone else instead of him.” Tears, like laughter, have many meanings.

Emotional dullness is the underdevelopment or loss of higher feelings while maintaining or even reviving simpler emotions. Patients lack such feelings as compassion, tenderness, a sense of justice, remorse, a sense of beauty, a religious feeling, intellectual feelings, etc. Emotionally stupid individuals are callous, cruel, not prone to repentance, many of them do not even know the feeling of shame. They do not care at all what feelings they form as parents and teachers. Many parents today teach their children to be selfish, to love only themselves, not to stand on ceremony with those who are weaker, to refuse help and to learn to say a firm “no” when asked for something, and if they hit, even when they are down. The leitmotif of such teachings is the conviction that “now you can’t live as a good person and you must win your place in the sun by force.”

Here is an example of the emotional dullness of a school teacher who, due to illness, was transferred to disability. The patient is a teacher-mathematician by profession; she taught physics and mathematics in high school. She said that she had developed a new system for teaching her disciplines and that after six months her class was unrecognizable: the eternal C students began to show miracles in solving problems. That is why - out of envy - she was suspended from lessons. Her method was to create problems of the type that would be interesting to schoolchildren. Over the course of a year, she came up with four hundred such problems and was extremely proud of it. Here are some of them. “A brick is sliding on the roof of a five-story building. The length of the sliding path is 5 m. The height of the house is H, the sliding speed is X. An old man is approaching the house at speed Y. From the place where the brick is supposed to fall, it is located at a distance B. The question is: will the brick fall on the head of this bald old man?” Or: “A climber fell from a cliff 250 m high. The question is: how long will it take him to reach the gorge and at what speed will he crash on its bottom?” The saddest thing about this story about emotional stupidity was that all the children liked the problems, and none of their parents protested.

A somewhat lesser degree of emotional dullness is designated as emotional impoverishment or impoverishment. The attachments, altruistic feelings, and empathy of such patients are significantly weakened, fragile and quickly dry up. Thus, a 30-year-old patient reports that he is still not married and does not intend to get married, that he has never been interested in anyone before, has never been in love and has never liked anyone.

“Love,” he explains, “is animal magnetism, the relationship between a male and a female. Why marry - to mate? And then, even if you get married, you have to adapt to society, and tedious legal procedures will follow.” He doesn’t think about becoming a father at all. “What is this, what is the point of having children, I don’t love them, and caring for them disgusts me.” I got a job several times, even for good pay. After 1–2 months, he quit his job, but did not formalize his dismissal, without notifying him in advance of his intention. Questions about duties, responsibilities, and the fact that he had let someone down were ignored. His motivation to leave work was: “The work is boring, monotonous, I would like bright impressions, but everything gets boring quickly.” He does not visit his parents, does not write letters to them. I had only one friend at school. He is not interested in anything at the moment, does not communicate with anyone, and practically does not leave the house. Lives on the help of his parents. At home he sometimes plays computer games, sometimes watches TV, and occasionally reads anything he can get his hands on.

“Of course, I would have to work, but there is nothing that I would like.”

The degree of emotional impoverishment varies, of course, but usually it concerns higher feelings: affection, love, friendship, gratitude, cordiality, respect, compassion. Even minor emotional changes play, according to E. Bleuler, “an outstanding role” and “especially because in any disorder it is the affective mechanisms that first reveal symptoms.”

Emotional paradox is a disproportion between the intensity of affective reactions and the objective significance of emerging situations and developing circumstances. Thus, a 31-year-old patient, a prosector at a children's hospital, is satisfied with his work, it does not depress him, does not darken his mood. Explains: “At the cellular level, the corpse is not visible.” A good photographer, he especially likes to photograph children. Loves nature, serious music, “pop music disgusts me.” Very vulnerable - “one word is enough to ruin your mood for the whole day.” Not married, never been in a close relationship: “This is pure physiology; love was invented so as not to feel like beasts.”

He tolerates the environment of the psychiatric ward (located in the general ward) calmly, is not burdened by being here, communicates with patients on equal terms, goes with them to lunch and to work. He accepted the offer to undergo treatment without resistance. Informed by the doctor that he is ill, and quite seriously. He listened to this calmly and did not ask why he was sick. He didn’t ask about the threat of this disease or how it would affect his life. I calmly accepted the offer to register for disability. For some reason I remembered that I once spent the night in the morgue for a whole month. “The only bad thing there is that it’s hot.” Another patient reports: “I’m not afraid of fights, men fight bloody, with knives, and I try to separate them. Lately, one has broken up seven fights. “More than anything else, I’m afraid of mysticism and watching thrillers.”

Another patient stoically endures the atmosphere of the department, the noise, quarrels, fights between patients, he is not traumatized by the fact of the disease (he knows what he is sick with), and the not very bright prospects of remaining virtually thrown out of life. And yet one day he suddenly became very indignant, shouted, and was agitated - the reason was that he was moved to another bed in the ward.

Irritability is a tendency to frequent and relatively shallow reactions of dissatisfaction for various, usually minor reasons, which often have no direct relationship to the true causes of the disorder. One of the most common causes of irritability is the egocentrism of patients - many of them are dissatisfied only because “everything is not done as it should be,” that is, “not my way.” An egocentric person gets irritated when people don’t listen to him: how can you not listen to me, others are capable of talking nonsense, but not me. It infuriates him when he is interrupted, although he himself does not allow anyone to open their mouth: “he also interrupts, boorish, it would be better for him to keep quiet, listen to what smart people say.” An egocentric person constantly reproaches someone, lectures, instructs, gives very impartial assessments, he is generally irritated by everything that, in his opinion, is unfair, that is, it hurts his exorbitant pride. They are irritable to the point of scandals and hysterics: they are offended that they are not appreciated, not understood, not thanked at every step, they need their path to be strewn with roses of admiration.

Often, irritability is a way of releasing accumulated resentment on someone. Resentment and tension spill out onto household members, children, animals; goes to objects too. Dishes are shattered, clothes are torn to shreds, pens and pencils are broken. One patient smashed his car with a hammer because it would not start. The transfer of emotions from one object to another is sometimes called the transportation of emotions. Patients, irritated, often want at all costs to maintain the illusion of their control over what is happening by demonstrating aggression, the strength of their ego. Irritability can be a consequence of dissatisfaction with themselves: few are able to understand themselves in order to understand what is wrong with them . The easiest way is to find the culprit in order to distract your attention from yourself with a flash of irritation, as if to crowd out dissatisfaction with yourself, and at the same time restore self-esteem. Sometimes irritation is a mild form of expressing indignation, that is, dissatisfaction with the essence of the matter, which does not affect the dignity of another; such people are often dissatisfied with themselves, or rather, with the fact that they did something wrong, at the wrong time, let someone down, and generally did something unworthy of themselves.

Usually they are immediately ready to apologize and correct the situation as soon as possible. Finally, irritability is a constant companion to asthenia - irritable weakness or “failure of the brakes” - hypersthenia. Such patients are at first indignant, then they think, and then they realize that they “got excited” and were wrong. Emotions are generally difficult to bring under control, but losing control over them is much easier. And when this happens, they always have the first word. If irritability is combined with other manifestations of increased emotional sensitivity, it may be a sign of excessive impressionability in depressed patients. So, irritability can be characteristic of patients with various disorders; we think we have identified some of its main causes.

Emotional coarsening is the loss of subtle, differentiated emotional reactions associated with a mild decrease in intelligence with organic brain damage in persons who are disharmonious in terms of premorbid personality. Due to an overly simplified, incomplete, fragmentary or one-sided understanding of what is happening, patients become quite inadequate: tactless, naked, familiar, boastful or even dishonest, since deception and cunning are in the order of things for them. Their sense of proportion, delicacy, courtesy, tolerance often betrays them; in polite society they resemble a bull in a china shop. They cannot understand that their inappropriate behavior will shock someone, may injure someone with an obscene phrase, offend or cause self-loathing. They also love to joke. But their jokes are vulgar, obscene and often repeated to the accompaniment of their own laughter.

Because of their importunity, they shamelessly barge into someone else’s conversation and try to lead him in their direction, where they wash someone’s bones. They speak loudly, a lot, as if they are trying to shout someone down. Their phraseology is very far from subtlety, the statements of prostitutes, the beginning and end of the latter are rarely on the same line of reasoning. Patients easily cross the boundaries of subordination, interfere with personal relationships with employees, and do not take into account the self-respect and ethical position of the interlocutor. And if the interlocutor is also a subordinate, he finds himself in the position of a “fool” who should not be taken into account at all. Patients are often very cheeky, they can be rude and even mock people who are dependent on them. They are incapable of dialogue: they interrupt the interlocutor, do not allow him to complete his thought, do not try to understand him, impose their opinion, and then draw dubious conclusions from the conversation, relating not so much to the problem being discussed, but to interpersonal relationships.

Subordinates rarely leave the office of such a boss with a light heart, unless they use flattery or something else to appease the “deity.” Such dialogue is somewhat reminiscent of the communication disorder in the form of double dialogue described in families of patients with schizophrenia (J. Batesson, 1956). For example, a son, rejoicing at his mother’s visit, puts his hand on her shoulder. The mother responds with a grimace of disapproval. The patient withdraws his hand, to which the mother reproaches him for not loving her. The patient blushes, but the mother reprimands him, saying that he shouldn’t be so embarrassed. In other circumstances, emotionally hardened patients may behave completely differently: they ingratiate themselves, please, humiliate themselves, agree with everything and eat with the eyes of their boss, trying to speak less so as not to inadvertently anger him. Someone rightly said: silence is a shield for a fool, a fool is smart as long as he remains silent. The essence of the matter does not change from this change of dishes. The coarsening of emotions and feelings occurs quite often and usually comes to the fore, while intellectual decline remains, as it were, in the shadows, and gross violations are often not detected.

Anniversary reactions are the appearance or intensification of feelings of grief on the date of the tragic event. This happens, for example, on Parents' Day, on days of remembrance of victims of war or terrorist attacks, disasters, etc. For example, participants in battles in hot spots get together from time to time to remember their fallen combat friends. Usually reserved in talking about mourning events with outsiders, here they indulge in detailed memories, reviving in their memory the smallest details of what happened. At the same time, it cannot be done without a feast. They drink to remember the dead, to soften the severity of the loss and to suppress the guilt of the survivors. In hindsight, it often seems that the disaster could have been prevented.

Parathymia is an inversion of emotional reactions, the replacement of adequate emotions with the exact opposite. So, a mother congratulates her daughter on her birthday as follows: “Galina! I don't wish you a happy birthday. I don't wish you happiness. I curse you, your mother’s curse is the worst!” The girl was raped in a group; her friends held her legs. In shock, she returned home, did not say anything to her loved ones, went into the bathroom, lay down in the water with her clothes on and burst out laughing. Another patient recalled that at the age of seven she fell into the water, got scared, and began to drown. She was saved by a woman passing by. Instead of the joy of salvation and gratitude to the woman, “I scolded the savior in all sorts of ways, told her that she was a fool and ugly.”

Idiosyncrasy to emotions - intolerance of various emotions: “I perceive my emotions too acutely. And good ones too. After them there is palpitation, discomfort, I feel very bad. I try not to worry or be happy at all.” This symptom seems to be the opposite of painful insensibility. In the latter case, patients suffer from the fact that they have ceased to be aware of their emotions. In the second case, on the contrary, the patient is too acutely aware of her emotions and suffers for this reason.

Emotional ambivalence is the coexistence of polar feelings in relation to the same object or phenomenon: “I seem to have two selves: one loves my mother, the other hates her... I am attached to my husband, I am tender with him and at the same time he infuriates me, I’m ready to kill him”... The patient wants his wife to die, but when he sees her dead in hallucinations, he falls into despair. The disorder indicates a splitting of the ego.

Escalation of affectivity - excessive expressiveness (in gestures, facial expressions, postures, voice intonations) in hysterics as a means of suppressing others, self-affirmation and as a mechanism for discharging excess motivation (teaching a lesson, punishing someone, moderating libido, etc.). Patients start small: they raise their voices, cry, nervously walk around the room. Then, gradually and as if involuntarily, they inflate themselves to such an extent that they can no longer get out of the role on their own unless they are saved by fainting.

Emotional burnout is a symptom complex that includes emotional and (or) physical exhaustion, depersonalization and decreased performance (Pelmann, Hartman, 1982). Emotional exhaustion is experienced as internal emptiness, depletion of affective resources, and emotional overstrain. Interest in work is lost, the patient goes there as if “to hard labor”, without inspiration and enthusiasm, but rather with disgust. Depersonalization is expressed by a feeling of depersonalization of people; they all seem equally unpleasant.

Relations with them become purely formal; employees often cause irritation, hostility, dissatisfaction and indignation. Conflicts with them are quite likely if colleagues do not realize that they are dealing with a person whose mental strength has left them. The decline in performance is associated with such reasons as the emergence of a negative assessment of oneself as a professional, self-doubt, feelings of uselessness, doubts about one’s competence, dissatisfaction with oneself, and decreased motivation to work.

Emotional burnout occurs in individuals who are in intensive and close communication with clients, patients, students, students and colleagues when providing professional assistance. Characteristic of emotional people who do not know how to protect themselves from excessive affective reactions to work situations. The surgeon should not die with every patient, the psychiatrist should not go crazy with the patient, accepting his grief as his own; The teacher should not worry about the failures of his students as if he himself received ones and twos. Work should not exceed the optimal level of tension, otherwise it will lead to fatigue and many mistakes in simple situations. The amount of workload should be rational and in no case go beyond the scope of mental hygiene. Managers do not know anything like this or do not want to know, overloading their subordinates; Usually, unfortunately, they care more about themselves and their prestige in the eyes of their superiors.

The disorder develops at the age of 30–40 years, more often in women with these professions, as well as in scientists and managers. It is sometimes called compassion fatigue. It is necessary to timely identify patients and provide rehabilitation assistance using psychotherapy and psychopharmacotherapy (small doses of antidepressants, nootropics, sleep normalization, physiotherapy, etc.).

Learned helplessness is a condition caused by “being caught in harmful, unpleasant situations” that “can neither be avoided nor prevented” (Seligman). In experiments on animals, the helplessness of the latter becomes such that even the emerging opportunity to get out of the situation is not used. Some authors see in this disorder a factor contributing to the emergence or intensification of depression. V. Frankl observed the complete loss of the ability to resist in the Nazi death camps; For some reason such prisoners were called Muslims, perhaps because they pinned their hopes only on the Almighty.

Dyshomophilia - tension, anxiety during homoerotic fantasies. It is observed in homo-, heterosexuals and even asexual people. It is recommended not to confuse the disorder with “egodystonic homosexuality.”

Emotional paralysis of Beltz (1901), or affective anesthesia. Described as a variant of psychogenic stupor without impairment of consciousness with complete shutdown of emotions without subsequent amnesia. Derealization is also observed, the patient perceives what is happening detachedly, from the outside, as something apparent to him. At the same time, he can move and behave outwardly quite adequately.

The loss of syntony manifests itself in the fact that the patient does not feel the emotional context in someone’s conversation with him, and thus cannot discover the meaning of the speech addressed to him. Thus, the patient perceives the doctor’s usual sympathetic questions about his well-being as an “interrogation” and says that “they are getting into his soul.” When asked to clarify what he means, he states that they are pestering him and showing inappropriate curiosity. He considers the advice to get medical treatment as pressure on him, and is indignant at being “dictated” or “imposed” on him. He is offended by a joke, believing that he is being “mocked”; he regards a friendly attitude towards himself as an attempt to “manipulate” him, etc. It is more often observed in patients with schizophrenia.

Vicarious pleasure is the replacement of one’s own dissatisfaction with joy or pleasure for other people. A father is happy, for example, that his son gets an A in math at school, but no matter how hard he tried, he couldn’t do this at one time. The voyeur gets vicarious pleasure by spying on the intimate relationships of other people.

Phobic reactions are excessive fears of something, observed in timid, timid natures. It is important that such patients do not know how to assess the true extent of the danger and do not have sufficient personal experience in dealing with dangerous situations. They are not able to adequately control their fears. The best form of fear control is coping skills in threatening situations. For example, a person sees someone drowning. He runs along the shore in fear and calls for help. Another person silently rushes into the water and saves the drowning man, without feeling any fear. Phobic reactions are not obsessive, although the patient fruitlessly struggles with them, is burdened by them, would like to get rid of them, while understanding that they are something not entirely normal. In addition, he is also ashamed of his fears and tries not to tell anyone about them. V.V. Kovalev defines such fears as overvalued and exaggerated.

Hypophobia is a lack of feeling of fear, leading to an underestimation of the degree of danger or threat of any situations. Described in patients with schizophrenia, in alcoholic intoxication, and with neuroses - “thenic sting of a psychasthenic.” There are cases of complete absence of fear - anaphobia. A 30-year-old patient claims that she does not know what fear is and has never experienced it under any circumstances. She says that during her school years she went to the cemetery alone at midnight, even before school she visited the anatomy class, visited the morgue, and even took her friends there out of curiosity. She never had fears in her dreams, no matter what she dreamed. From the very beginning, she watched horror films completely calmly and said: “I don’t understand what people find scary in them.” She jumped from a parachute and “wasn’t afraid at all, even the instructor was surprised,” she drowned and “wasn’t scared at all: if I drown, I’ll drown, so that’s how it’s supposed to be.” “I wasn’t afraid of the psychiatric hospital, I came myself, what’s there to be scared of.”

Without fear, she walked at night along the unlit streets of the city, where “I know they killed, robbed, and raped.” “I’m not brave, no, I just don’t have developed fear. Well, there are people without legs, I have something similar to this.” There is also a known phenomenon called contophobia - the desire to get into dangerous situations for the sake of acute impressions that are not accompanied by fear.

Satomura syndrome (1979) is a peculiar fear of superiors or other high-ranking officials. This is the fear of appearing funny or unpleasant in their eyes. It is considered as a neurosis characteristic of the Japanese. Apparently, it occurs not only among them.

Disorders of the sense of humor are the inability to see something worthy of compassion behind the comical, playful form. First of all, the sense of humor changes when perceiving real life situations of a humorous nature. At the same time, the sense of humor in relation to oneself suffers. The perception of humor in corresponding images (cartoons, etc.) seems to be preserved to a greater extent (Bleicher, Kruk, 1986).

According to our preliminary impressions, the loss of a sense of humor first manifests itself, apparently, in the fact that when an individual meets an object of humor, he becomes very happy, his mood rises, so that he himself is not averse to making someone laugh, and then having a pleasant time the rest of time. The second, hidden level of humor is not distinguished, light sadness and in-depth reflections about human nature, and about oneself usually do not exist. The next stage of a sense of humor deficit occurs when an individual becomes funny, very funny, when he encounters manifestations of humor. He is sometimes filled with Homeric laughter, and he does not think about anything serious.

Once he starts laughing, he will do it all evening (for example, at a laughter concert) and at very dubious jokes. As soon as you provoke some “decoy duck” to laugh, the rest of the humor lovers begin to laugh together, as if on command. A funny person resembles a stoned drug addict who laughs at everything you show him. A. Maslow, meanwhile, noticed that people with a genuine sense of humor usually do not have fun and laugh, only a sad smile runs across their face. Statistics say there are only 1–3 such people per hundred. The continuing degradation of the sense of humor is expressed in the fact that the individual will laugh with pleasure when someone is laughed at. But he does not accept jokes directed at himself; moreover, he may be offended by this or, worse, get angry. Finally, humor dies when it is taken “seriously,” that is, not taken at all.

The lack of a sense of humor is especially acute in patients with schizophrenia, who are educated, intelligent, knowledgeable, but who take jokes and allegories very literally. The best sense of humor, as is well known, is developed among pessimists, who see the weaknesses and shortcomings of people better than others and, nevertheless, treat them with particular delicacy and care. However, in depressed patients, their sense of humor, like other high feelings, is blocked, which makes it extremely difficult for them to survive depression - they are deprived of the internal support that only helps people in misfortune. Patients with epilepsy are deprived of a sense of humor once and for all.

With their rigidity, getting bogged down in trifles, they do not have time to notice how this spark of God flashes over them - a moment of humor. With alcoholism, the sense of humor degrades to banality, vulgarity, cynicism with an indispensable element of greasiness - mentions of betrayal, meetings with passionate beauties and something else like that. One would like to call such humor genital. “Black humor” has only one similarity with genuine humor - the use of a comic configuration. In its depths lies not compassion, not high sadness, but merciless cynicism, ready to strike all the saints and everything that is called the existential, enduring and eternal values ​​of human existence.

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Consequences of ADHD

The inability to properly perceive new material, delayed development of speech and mental development lead to the fact that the child does not study well and does not have basic skills in reading, writing, or performing simple tasks. His unpredictable behavior makes him an outcast among his peers. He constantly faces the condemnation of others. Tries to “revenge”: takes and spoils other people’s things, reacts inadequately to comments.

Due to the lack of a natural feeling of fear and the inability to control their actions, hyperactive children are more likely to find themselves in dangerous situations and get injured. A teenager can commit a crime as his character traits such as cunning and cruelty progress. There is a tendency to smoke, alcoholism, and take drugs.

If an adult with such a deviation does not have criminal inclinations, then it can be assumed that he has ADHD if he is prone to conflicts, sudden outbursts of anger, neglects his promises, and is unable to listen to his interlocutor.

How does nervousness and internal trembling manifest?

Each person can feel the manifestations of nervousness differently, so it makes no sense to list the numerous variations of this painful feeling. Increased nervousness is considered a symptom of a disorder of higher nervous activity. Yeast manifestations also have many different variations. More often it manifests itself in the form of internal trembling in the chest, “fluttering”, internal vibration, “buzzing” inside. Less commonly, these symptoms may appear more locally, for example, a person may feel a trembling in the hand or tremors in the leg. At the same time, it is not uncommon to observe muscle twitching in this area of ​​the body.

Related complaints

• Feeling of constant or frequent anxiety.
• A feeling of constant or frequent fear.
• Strong, rapid heartbeat or extrasystoles.
• Feeling tense or on edge.

Diagnosis of ADHD

If such signs of mental and psychological development disorders are observed in children, it is necessary to make an accurate diagnosis in order to know what kind of medical or psychological help they need. It is impossible to completely eliminate neurological pathology, but modern medications and psychological techniques help smooth out the most acute symptoms. Treatment helps children “outgrow” a dangerous age and subsequently adapt to normal adult life.

In order to recognize attention deficit hyperactivity disorder, parents should take the child to a psychologist, neurologist or child psychiatrist. You can also contact your family doctor. The psychologist will explain some of the child’s behavior and give advice on how to improve relationships with him. A neurologist and psychiatrist will prescribe the necessary treatment and will be able to monitor the condition of the young patient.

A diagnosis of ADHD is made only when symptoms of hyperactivity and inattention have been observed in children for at least 6 months. At the same time, the doctor takes into account how they behave in a normal environment (at home, at school, when communicating with loved ones, peers, teachers). A special scale is used to assess deviations from generally accepted norms of behavior. The presence of a genetic factor in the development of such a syndrome is also taken into account.

Based on the test results, a separate diagnosis of Inattention Disorder, Hyperactivity Disorder, or ADHD may be made. In this case, manifestations of at least 6 of the symptoms indicating attention deficit, impulsivity and excessive activity must be detected. These include, for example, aggressiveness and an irrepressible desire for leadership, unceremonious and rude behavior in the classroom, inability to engage in mental activity, constant switching of attention, inability to concentrate, fussiness in movements, and others.

Additionally, ultrasound, CT or MRI of the brain may be prescribed to detect possible pathologies.

Treatment for ADHD

Treatment uses medications and psychotherapy to correct the child’s behavior. A special diet is prescribed. A hyperactive child is not recommended to drink strong tea or coffee, eat chocolate, or spicy foods. Teenagers should be protected from drinking beer and other alcoholic beverages.

Medications such as Cerebrolysin, Pantogam, Cortexin, Methylphenidate, Piracetam are prescribed. Their action is aimed at improving metabolism and brain nutrition, increasing the resistance of nerve cells to the effects of negative factors.

Thanks to the use of these drugs, a patient suffering from attention deficit hyperactivity disorder improves memory, activates mental abilities, and improves mood. Such drugs are used only as prescribed by a doctor and in strictly individual doses. Particular caution is required when treating children under 6 years of age, as the drugs can cause an allergic reaction and addiction. Their use often leads to sleep disturbances and poor appetite in children.

Sedatives are also prescribed, including folk remedies (infusions of mint, ginseng, pine buds, valerian, motherwort, St. John's wort). In addition to psychotherapy, massage of the head and neck in the collar area, physical therapy, and walks in the fresh air have a beneficial effect on the nervous system of children.

Network congestion

Figure 3. Structure of memantine. Memantine is a derivative of the hydrocarbon adamantane (not to be confused with adamantine). Drawing from Wikipedia.

In a normally functioning brain, signals from neurons are distributed evenly across all other cells. Neurotransmitters are released in the required quantities, and there are no damaged cells. However, after a stroke (acute lesion) or during dementia (a long-term process), glutamate begins to be released from neurons into the surrounding space. It stimulates the NMDA receptors of other neurons, and calcium flows into these neurons. The influx of calcium triggers a number of pathological mechanisms, which ultimately leads to the death of the neuron. The process of cell damage due to the release of large amounts of endogenous toxin (in this case, glutamate) is called excitotoxicity.

Figure 4. Effect of memantine in Alzheimer's dementia. Memantine reduces the intensity of excitatory signals that come from cortical neurons to the Meynert nucleus. The acetylcholine neurons that make up this structure regulate attention and a number of other cognitive functions. Reducing excess activation of Meynert's nucleus leads to a decrease in symptoms of dementia. Figure from [6].

In order to prevent the development of excitotoxicity or reduce its impact on the course of the disease, memantine can be prescribed. Memantine is a very attractive NMDA receptor antagonist molecule (Fig. 3). Most often, this drug is prescribed for vascular dementia and dementia due to Alzheimer's disease. Normally, NMDA receptors are blocked by magnesium ions, but when stimulated by glutamate, these ions are released from the receptor, and calcium begins to enter the cell. Memantine blocks the receptor and prevents the passage of calcium ions into the neuron - the drug exerts its neuroprotective effect by reducing the overall electrical “noise” in cell signals. In Alzheimer's dementia, in addition to glutamate-mediated problems, the level of acetylcholine, a neurotransmitter involved in processes such as memory, learning and attention, decreases. Because of this feature of Alzheimer's disease, psychiatrists and neurologists use inhibitors of acetylcholinesterase, an enzyme that breaks down acetylcholine in the synaptic cleft, for treatment. The use of this group of drugs increases the content of acetylcholine in the brain and normalizes the patient’s condition [5]. Experts recommend the combined administration of memantine and acetylcholinesterase inhibitors to more effectively combat dementia in Alzheimer's disease [6]. When these drugs are used together, there is an impact on two mechanisms of disease development at once (Fig. 4).

Dementia is a long-term brain disorder in which neurons die slowly. And there are diseases that lead to rapid and large-scale damage to nervous tissue. Excitotoxicity is an important component of nerve cell damage in stroke. For this reason, in cases of cerebrovascular accidents, the use of memantine may be justified, but research on this topic is just beginning. Currently, there is work done on mice showing that administration of memantine at a dose of 0.2 mg/kg per day reduces the volume of brain damage and improves the prognosis of stroke [7]. Perhaps further work on this topic will improve the treatment of strokes in humans.