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A group of mental and mental development disorders that lead to syndromic intellectual disabilities has been termed mental illness in clinical psychiatry, called oligophrenia or dementia.
For this disease, WHO uses the term "mental retardation", and the pathology has a code for the ICD 10 F70-F79. In the next edition of the International Classification of Diseases, oligophrenia may receive the definition used by foreign psychiatrists - intellectual developmental disorder or intellectual disability.
Causes of Oligophrenia
Oligophrenia is a pathology inherent or acquired in early childhood. Experts associate the disease with genetic, organic and metabolic disorders. The key causes of oligophrenia can be divided into prenatal (fetal), perinatal (from 28 to 40 weeks of gestation) and postnatal (postpartum).
Prenatal disorders can be caused by infections from the mother (rubella virus, treponema, toxoplasma, herpesvirus, cytomegalovirus, listeria); teratogenic effects on the embryo of alcohol, drugs, certain drugs; intoxications (phenols, pesticides, lead) or elevated levels of radiation. So, rubyolar oligophrenia is a consequence of the fact that the pregnant woman in the first half of gestation had rubella and rubella, and the embryo contracted from the mother through the blood.
Oligophrenia or dementia are caused by brain development abnormalities, such as: insufficient brain size (microcephaly), complete or partial absence of cerebral hemispheres (hydrangephalus), underdevelopment of the cerebral gyrus (lissencephaly), underdevelopment of the cerebellum (pontocerebral hypoplasia), various forms of maxillo- facial dysostosis (skull defects). For example, with fetal disturbances in the formation of the pituitary gland in the male fetus, the secretion of the gonadotrophic luteotropin hormone (luteinizing hormone, LH) is disrupted, which ensures the production of testosterone and the formation of secondary male sexual characteristics. As a result, hypogonadotropic hypogonadism or LH linked oligophrenia develops. The same picture is observed when the 15th gene is damaged, which leads to the birth of a child with Prader-Willi syndrome. This syndrome is characterized not only by the hypofunction of the sexual glands, but also by the retardation of mental development (an easy form of oligophrenia).
Often the pathogenesis of mental and mental development disorders lies in metabolic disorders (glucosylceramide lipidosis, sucrose, latostelorosis) or enzyme production (phenylketonuria).
Almost inevitable is the congenital oligophrenia in the presence of such a genetic factor as the restructuring of the structure of chromosomes leading to such syndromes of dementia as the syndromes of Patau, Edwards, Turner, Cornelia de Lange, etc., which give impetus to the development of pathology even at the stage of embryogenesis.
In most cases, hereditary oligophrenia is also genetically determined, and one of the most common endogenous causes of mental retardation is the defect of the 21st X chromosome - Down syndrome. Due to damage to some genes, degeneration of the hypothalamus nuclei may occur, and then the Lawrence-Moon-Barde-Biddle syndrome is manifested - a kind of hereditary oligophrenia often observed in close relatives.
Postnatal oligophrenia in children may be due to intrauterine chronic oxygen deficiency and asphyxia during childbirth, head trauma during childbirth, as well as destruction of red blood cells - hemolytic disease of newborns that occurs due to rhesus-conflict during pregnancy and leading to serious dysfunction of the cortex and subcortical neuronal nodes of the brain.
From the moment of birth for the first three years of life, the causes of oligophrenia include infectious brain damage (bacterial meningitis, encephalitis) and its traumatic injuries, as well as acute nutritional deficiencies due to chronic infant malnutrition.
According to psychiatrists, in 35-40% of cases the pathogenesis of oligophrenia, including congenital, remains unclear. And in this situation, the formulation of the diagnosis of mental underdevelopment can look like an undifferentiated oligophrenia.
The diagnosis of family oligophrenia is made when the doctor is convinced that some form of inferiority of mental development and some other characteristic signs is observed in family members, in particular, in siblings - siblings. In this case, as a rule, the presence or absence of obvious damage to the brain structures is not taken into account, since in the clinical practice the study of morphological cerebral anomalies is not carried out in all cases.
Symptoms of Oligophrenia
The commonly recognized clinical symptoms of oligophrenia - congenital or manifested over time - include:
- delay in the development of speech skills (children begin to speak much later than the normal deadlines and speak poorly - with a large number of pronunciation defects);
- limited and concreteness of thinking;
- the complexity of teaching norms of behavior;
- weakened motor skills;
- motor disorders (paresis, partial dyskinesia);
- significant delay in mastery or inability to act on self-care (eating, washing, dressing, etc.);
- lack of cognitive interests;
- inadequate or limited emotional reactions;
- lack of behavioral framework and inability to adapt behavior.
Experts note that in early childhood, the first signs of oligophrenia, in particular, a minor degree of debility or imbecility, are rarely obvious and can be clearly manifested only after 4-5 years. True, in all patients with Down syndrome, an anomaly of facial features; for the damaging girls of Turner's syndrome, the characteristic external features are small growth and short fingers, a wide fold of the skin in the neck, an enlarged thorax, etc. And with LH linked oligophrenia and Prader-Willi syndrome, by the age of two, increased appetite, obesity, strabismus, poor coordination of movements.
Moreover, even when the fact of poor performance, inhibition and inadequacy is evident, a thorough professional assessment of children's mental abilities is needed - in order to distinguish the mild form of debility from emotional-behavioral (psychiatric) disorders.
It should also be taken into account that mental retardation in children is caused by a large number of causes (including pronounced congenital syndromes), and the symptoms of oligophrenia are manifested not only in reducing cognitive abilities, but also in other mental and somatic abnormalities. Dysfunction of the brain due to disruption of the synthesis of tissue activator plasminogen neuroserpine manifested by symptoms such as epilepsy and oligophrenia. And patients with idiocy are disconnected from the surrounding reality, and nothing attracts their attention, which, as a rule, is completely absent. A frequent symptom in this pathology is senseless monotonous movements of the head or swinging of the trunk.
In addition, the lack of capacity for conscious behavior caused by abnormalities in the cerebral cortex and cerebellum with pronounced debility and imbecility leads to emotional-volitional disorders. This manifests itself either as hypodynamic oligophrenia (with inhibition of all actions and apathy) or as hyperdynamic oligophrenia, in which psychomotor agitation is observed, increased gesticulation, anxiety, aggressiveness, etc.
Mental changes that occur during oligophrenia are stable and do not progress, so psychosomatic complications are unlikely, and the main difficulty for patients of this category is the lack of the possibility of full adaptation in society.
Forms and degrees of oligophrenia
In the domestic psychiatry distinguish three forms of oligophrenia: debility (debilizm), imbecility and idiocy.
And, depending on the volume of missing cognitive abilities, three degrees of oligophrenia are distinguished, which are applied independently of the etiology of the disease.
Easy degree (ICD 10 - F70) - debility: the level of intellectual development (IQ) ranges from 50-69. Patients have minimal sensorimotor slowdown; in the preschool age can develop communication skills, are able to acquire some knowledge, and at a later age - and professional skills.
The average degree (F71-F72) is imbecile: there is the ability to understand someone else's speech and at the age of 5-6 years formulate short phrases; 30 attention and memory are significantly limited; thinking is primitive, but you can teach reading, writing, counting and self-service skills.
Severe degree (F73) - idiocy: thinking with oligophrenia of this form is almost completely blocked (IQ is below 20), all actions are limited to reflex acts. Such children are hindered and unlearnable (with the exception of some development of motor skills), and constant care is required.
Western specialists attribute cretinism to oligophrenia of metabolic etiology, which is a syndrome of congenital hypothyroidism-iodine deficiency in the body. Regardless of the reasons for iodine deficiency (endemic goiter or thyroid pathology of a pregnant woman, developmental defects of the thyroid gland in an embryo, etc.), the physician can encode this form of mental retardation F70-F79 with an indication of the etiology - E02 (subclinical hypothyroidism).
Diagnosis of oligophrenia
To date, the diagnosis of oligophrenia is carried out by collecting a detailed anamnesis (taking into account the data of obstetricians on the course of pregnancy and information about diseases of close relatives), general, psychological and psychometric examination of patients. This allows to assess their somatic state, to establish the presence of not only physical (visually determined) signs of mental underdevelopment, to determine the level of mental development and compliance with its average age norms, and also to reveal the features of behavior and mental reactions.
To accurately determine the specific form of oligophrenia, tests (general, biochemical and serological blood test, blood test for syphilis and other infections, urinalysis) may be required. Genetic tests are performed to identify the genetic causes of the disease.
Instrumental diagnostics includes an encephalogram, as well as CT or MRI of the brain (to detect local and generalized craniocerebral defects and structural cerebral disorders). Also see - diagnosis of mental retardation.
For the diagnosis of "oligophrenia" differential diagnosis is necessary. Despite the presence of some obvious signs of oligophrenic conditions (in the form of characteristic physical defects), many neurological disorders (paresis, seizures, trophic and reflex disorders, epileptiform seizures, etc.) are observed in other neuropsychiatric pathologies. Therefore, it is important not to confuse oligophrenia with diseases such as schizophrenia, epilepsy, Asperger's syndrome, Geller 's syndrome, etc.
When distinguishing from other diseases that give symptoms of mental insufficiency, one should especially take into account the fact that oligophrenia does not show any signs of progression, is manifested from early childhood and in most cases is accompanied by somatic symptoms - defeats of the musculoskeletal system, cardiovascular system, respiratory organs, vision and hearing.
Treatment of oligophrenia
If the cause of mental retardation is hypothyroidism, Rh-conflict, phenylketonuria, possibly etiological treatment of oligophrenia: with the help of hormonal drugs, blood transfusions to the infant, a special protein-free diet. Toxoplasmosis can be treated with sulfonamides and Chloridine. But in most cases, etiological treatment, alas, does not exist.
And although there are no specific medications for treating oligophrenia, patients with intellectual disabilities are treated with symptomatic therapy. That is, drugs can be prescribed to reduce the intensity of psychotic disorders - neuroleptics, as well as drugs for mood stabilization (helping to correct behavior).
So, psychotropic drugs-tranquilizers: Diazepam (Seduxen, Valium, Relanium), Phenazepam, Lorazepam (Lorafen), Periciazin (Neuleptil), Chlordiazepoxide (Elenium), Diazepam (Seduksen, Valium, Relaxium), psychotropic drugs are used for general calming, reducing anxiety, stopping seizures and improving sleep in psychiatric practice. Chlorprothixen (Truksal), etc. However, in addition to the possible development of dependence on these drugs, the negative consequences of their use are expressed in muscle weakness, increased sleepiness, impaired coordination of movements and speech, decreased severity of the senes i. In addition, continuous intake of all listed drugs can worsen attention and memory - up to the development of anterograde amnesia.
To stimulate the central nervous system and mental activity, use Pyracetam (Nootropil), Mesocarb (Sidnokarb), Methylphenidate hydrochloride (Relatin, Meridil, Tsenthedrin). For the same purpose, the intake of vitamins B1, B12, B15 is prescribed.
The purpose of Glutamic acid is due to the fact that it is converted into a neuromeditor - gamma-aminobutyric acid in the body, which helps in the work of the brain with mental retardation.
Alternative treatment, for example, with beer yeast, with congenital and hereditary oligophrenia is powerless. The proposed herbal treatment includes the regular use of calming decoction or tinctures of valerian roots in hyperdynamic oligophrenia. Also from medicinal plants deserve attention ginkgo biloba and adaptogen - the root of ginseng. Ginseng contains ginsenosides (panaxisides) - steroid glycosides and triterpene saponins, which simulate the synthesis of nucleic acids, metabolism and enzyme production, and also activate the work of the pituitary gland and the entire CNS. Homeopathy offers a drug based on ginseng - Ginsenoside (Ginsenoside).
One of the main roles in the correction of intellectual insufficiency is given to cognitive-behavioral therapy, that is, to medical-correctional pedagogy. For the education and upbringing of children with oligophrenia - in specialized schools and boarding schools - specially developed methods are used to adapt children in society.
And rehabilitation of patients with oligophrenia, especially with genetically conditioned forms of mental pathology, is not so much in their treatment as in training (adapted to the peculiarities of cognitive abilities) programs and instilling elementary household and, if possible, simple labor skills. Experts say that light degrees of oligophrenia in children can be corrected, and, despite the disability, such patients can perform the simplest work and take care of themselves. With moderate and severe forms of imbecility and with all degrees of idiocy, the prognosis is complete disability and, often, long stay in specialized medical institutions and disabled homes.
Prevention of oligophrenia
According to statistics, the fourth part of the defects of mental development is associated with chromosomal abnormalities, therefore prevention is possible only for non-congenital pathologies.
In the period of preparation for the planned pregnancy, it is necessary to undergo a complete examination for infections, thyroid status, and hormone levels. It is necessary to get rid of all the foci of inflammation and to cure the existing chronic diseases. Some types of mental retardation can be prevented by genetic counseling for future parents - to identify violations that are potentially dangerous for the normal development of the embryo and fetus.
During pregnancy, women should be registered with an obstetrician and gynecologist on regular basis and regularly visit their doctor, take the necessary tests on time and undergo ultrasound. Talk about a healthy lifestyle, rational nutrition and the rejection of all bad habits during the planning of pregnancy and when bearing a child should acquire a concrete meaning and lead to practical actions.
Specialists of the American National Institute of Mental Health (NIMH) argue that another important preventive measure is the early detection of certain metabolic processes that lead to mental retardation. For example, if during the first month of life to detect congenital hypothyroidism that affects one newborn of 4,000 infants born in the United States, it is possible to prevent the development of dementia. If you do not identify and up to three months of age do not treat, then 20% of infants with a deficiency of thyroid hormones will be mentally defective. A delay of up to six months will turn into morons 50% of babies.
According to the US Department of Education, in 2014, about 11% of school-age children were enrolled in classes for students with various forms of oligophrenia.