Oligophrenia: Symptoms and Treatment
Oligophrenia (or mental retardation, lack of intelligence) implies a definition of a group of pathologies that differ in their features of etiology and pathogenesis, in which they are congenital or acquired during early childhood forms of mental underdevelopment. Oligophrenia, the symptoms of which are manifested primarily in the form of defeat of the mind due to the stopping of the development of the personality against the background of the pathological development of the brain, in addition it affects the strong-willed and emotional qualities of the patient, his motor skills and speech.
Oligophrenia when considering requires its difference from the acquired form of dementia, in which quality such a pathology as dementia is distinguished. By this form it means a decrease in the intellect on the background of certain causes with concomitant brain damage, that is, the intellect decreases from the age-appropriate indicators of the norm. As for the state of oligophrenia of interest to us, the intellect of a physically adult person is not subject to development, that is, there is no tendency to achieve normative measures.
As a separate disease, oligophrenia was isolated only in the last century, and before such isolation, the definition of «dementia» was applied to any groups of patients, whether with the congenital form of the disease with mental underdevelopment or with the acquired form (dementia).
There are some difficulties in trying to determine the prevalence of oligophrenia, which is explained, first of all, by the distinctive features of the diagnostic approaches used. In addition, the degree of tolerance on the part of society with regard to mental abnormalities, as well as the degree of availability of the use of specialized medical care, plays an important role in this matter. Primarily in the industrialized countries, oligophrenia in terms of incidence among the population occurs in 1%, and in 85% of patients there is an easy form of mental retardation. The share of the average mental retardation, as well as severe backwardness and backwardness of the deep falls in the same sequence of 10%, 4% and 1%. With regard to the ratio of the frequency of occurrence of oligophrenia depending on gender, the indicator here varies for men and women in the range of 1.5: 1-2: 1.
It should be noted that mental retardation (again, unlike dementia) is not a progressing process, but a process that determines the subsequent outcome for the transferred disease.
Classification of oligophrenia
The classification of actual forms of oligophrenia exists in several variants, each of which takes into account the severity of the course of this disease and has its own peculiarities of isolation. In the traditional version, the degrees of oligophrenia can be manifested in three ways:
- debility (mildly expressed form of oligophrenia)
- Imbecility (medium degree of severity of oligophrenia)
- idiocy (the extreme degree of severity of the form of oligophrenia).
Increasingly, within the current time, the ICD-10 classification is used in accordance with the IQ indices (IQ indices, which are selected through specialized tests), which determine the severity of oligophrenia, which is proposed in the following versions:
- easy degree of oligophrenia — with IQ scores within the range of 50-70 points
- moderate degree of oligophrenia — with IQ values within the range of 35-50 points
- severe degree of oligophrenia — with IQ scores in the range of 20-35 points
- Deep degree of oligophrenia — with IQs not reaching 20 points
In general, there is no single classification for this disease. On the basis of the etiological factors provoking the development of oligophrenia, undifferentiated oligophrenia and differentiated oligophrenia are distinguished (undifferentiated mental retardation and differentiated mental retardation). Differentiated form means etiologically determined variants of the disease, under undifferentiated form, respectively, diseases, the development of which was provoked by unknown causes.
Undifferentiated oligophrenia is either manifested as a result of a brain rudiment lesion, or within the later phase of its intrauterine lesion. The above degrees of oligophrenia (debility, imbecility and idiocy) and refer to varieties of undifferentiated forms of oligophrenia, the determination of the conformity of a particular of the three forms is made on the basis of the correspondence of the IQ indices to certain boundaries above us considered. Let’s consider the indicated degrees of mental retardation separately in combination with the inherent symptomatology of each of them.
- Oligophrenia: debility
Degeneracy is the easiest manifestation of the patient’s mental underdevelopment. It, in turn, manifests itself in several forms, the determination of which is made on the basis of compliance with the IQ indicators. So, in a light form, IQ corresponds to the indices in the range of 65-69 points, in moderate severity — within the range of 60-64 points, in severe form — in the range of 50-59 points. Points are determined during a comprehensive clinical examination.
The actual disorders of the cognitive sphere in patients with oligophrenia in this degree are manifested in the form of inability to elaborate concepts in their complex form, as a result of which attempts at complex generalization are impossible, and also limited in abstract thinking (light degree) or its impossibility.
Patients characterized by the predominance of their specific descriptive type of thinking, coverage of the situation in full is given to them with great difficulty — the primary coverage is subject only to the external side of the events required for consideration. On the basis of the degree to which the severity is manifested in patients with debility, this inability is manifested in varying degrees in each of them, while violations of abstract thinking are noted in them in any case. The possibility of schooling in such patients is allowed, but the material is to be learned with great effort, mathematics is especially difficult for them.
Demented patients do not have their own judgments and inquisitiveness of the mind, they constantly adopt the views of others and views. When memorizing expressions, rules, etc., their use occurs in a stereotyped form, often they themselves begin to learn the information thus acquired by those people who surround them. And although such a patient does not have a subtle analysis combined with the necessary generalization, this does not exclude the dexterity (especially in its mild degree) of dexterity of orientation within the conditions of ordinary situations.
The expressed delay in morbid patients of mental development in some cases determines for them the possibility of partial giftedness. It can appear, for example, in excellent mechanical memory (but with the exclusion of the comprehension of repeated information by them). Do not exclude similar skills in terms of hearing, drawing, deft operation of large numbers in the performance of certain mathematical activities (for example, multiplication), etc.
A characteristic feature of patients with debility is their mild susceptibility to falling under influence, an increased form of suggestibility. Such a trait defines a significant danger for them and for the environment, because in certain situations they can become an instrument in various types of machinations and crimes because of the impossibility of comprehending the required environment. Given the direction of someone else’s will, morbid patients can break, kill, burn, etc. — any action in this case is performed at the level of automatism, without taking into account the consequences.
Debilitated patients are often characterized by increased manifestation of primitive forms of drives. This can be vulgar and dissolute behavior, and the sexual side in their behavior also applies to primitive inclinations.
As for the characteristics of the character, in patients with morbidity, common traits with imbeciles are determined (we will discuss them below), in particular they can be friendly, friendly and good-natured. A reverse option is also possible, in which they are characterized by vengefulness, aggression, malice and stubbornness. Behavior is characterized by low mobility or motor excitability.
- Oligophrenia in the Imbecility Stage
Imbecility determines the average degree of manifestation of oligophrenia with IQ in the range of 35-39 points. The violation of cognitive activity determines the possibility of the formation of representations, but the formation of concepts, as a somewhat higher level of mental activity, either becomes an essential process in a difficult, or even completely impossible.
Generalization, abstract thinking in this case are excluded. Imbeciles have the opportunity to acquire a standard type of skills related to self-service (self-consumption of food, dressing, tidiness), in addition they can perform the simplest labor activity, which is provided by training in performing imitative actions. For example, they can be involved in cleaning the yard or premises, can rewind threads or perform some other operations that assume the same action.
Imbecile patients have an understanding of simple speech, and they themselves can learn a certain set of words. Similar to the previous form of mental underdevelopment, the severity of imbecility fall under three main options (light, medium and heavy), each of which corresponds to certain levels of manifestation.
In considering the speech of imbeciles, it can be distinguished that it consists of standard and extremely short phrases (a noun with a verb or a simple adjective).
As for the possibility of assimilation of something new, it is given to patients with great effort, often only in the framework of certain concretized representations that exclude any form of generalization. Imbeciles do not have independent thinking, so they can adapt only to the conditions of the situation for themselves familiar and sufficiently familiar. Even with minimal deviation from the plan, actions or situations, significant difficulties arise that require constant guidance.
In addition, imbeciles are also characterized by an increased degree of suggestibility. Their personal interests are mostly very primitive, they are reduced mainly to the quenching of ordinary physiological needs. Often behind them there is a special gluttony, slovenliness in the consumption of food. As for the other side, related to the quenching of the needs for sex, here, in only a few cases, there is an increased degree of sexual desire, which in this way manifests itself in combination with promiscuity in behavior.
Depending on the oligophrenic inherent in this stage of behavior, they are divided into two main groups. So, the first group includes very mobile, energetic and active patients, to the second group — on the contrary, apathetic and listless, indifferent patients, they do not react to anything and are only interested in satisfying those needs that are important to them.
Depending on the nature of the imbeciles are also divided into two groups, thus separating themselves into affable, good-natured, sociable and complaisant and aggressive and spiteful.
Despite the fact that imbeciles have the ability to perform primitive actions, they are unable to live independently, they need constant supervision of qualified personnel.
- Oligophrenia: idiocy
Idiocy represents the deepest degree of mental retardation when IQ scores are less than 34 points. In this case, the patients are absolutely unlearnable, in movements there is clumsiness and lack of purposefulness, speech is also practically absent (it becomes possible only indistinct pronunciation of individual words). The manifestation of emotions is reduced to the reproduction of the simplest reactions (pleasure or, accordingly, displeasure). The reason for idiocy is genetic pathology. In the overwhelming majority of cases, patients are inactive, they are unable to control urination and defecation, this applies to meals, and often they are not able to distinguish edible from inedible. To master such patients can only visual-spatial forms of coordination, elementary skills.
Idiocy, as a rule, is accompanied by gross forms of structural brain damage, severe and diverse neurological symptoms, defects associated with sensory organs, epileptic seizures, defects in the structure of internal organs and the body as a whole are noted. If adequate care is provided for such patients, some of them can survive to the age of 30-40 years, mostly they die in childhood or adolescence because of the development of intercurrent type of diseases.
Given the fact that such patients can not develop intellectually, nor are they able to independently satisfy their own needs, they need constant assistance, care and supervision in the conditions of specialized institutions.
In domestic medicine, a two-level classification is used, based primarily on time, within which there was a corresponding pathological effect, as well as on the quality of the lesion by the harmful factor and its general severity. Regarding the time of exposure (including the characteristic features and similarities of the onset of the disease and its development), this classification defines three main groups of oligophrenia, namely:
- family and hereditary oligophrenia
- embryonic lesion or fetal damage
- the development of oligophrenia within certain harmful influences during the period of labor, the first months / years of life of the child.
Differentiated oligophrenia, that is, those oligophrenia, the etiology of which has already been studied, can thus be divided into the following groups:
- oligophrenia, resulting from hereditary pathologies (chromosomal or gene)
- oligophrenia, resulting from exposure to a certain type of harmful substances and microorganisms (intoxication, infection, etc.) within the fetal development period
- oligophrenia resulting from exposure to a certain type of harmful substances and microorganisms within the perinatal period, as well as the first months and years of life of the child
- oligophrenia, resulting from the negative type of psychosocial phenomena
Select some varieties of differentiated oligophrenia.
Microcephaly is characterized by a significant decrease in the size of the skull, which, accordingly, determines similar dimensions for the brain (other parts of the body at the same time correspond to the norm). Thus, with horizontal coverage of the skull, microcephaly determines a figure less than 49 cm (the minimum indices in the coverage of the skull are 22 cm). Sharply reduced and the indicators of the mass of the brain (ranging from 150 to 400 grams). The hemispheres are characterized by underdevelopment, underdevelopment is also noted in the gyrus (in particular, this applies to the frontal gyri).
Simultaneously with these pathologies, there is a frequent observation of the norm of the size of the cerebellum in combination with the subcortical nodes. As for mental disorders that are relevant for microcephaly, they are very significant in manifestations, the degree of manifestation of oligophrenia is deep enough, which indicates that the patients’ state is approaching the absolute form of idiocy (much less often idiotities manifest themselves in this state in their easy form). The causes of microcephaly are the effects of various types of harmful factors on the fetus within the initial periods of pregnancy (this includes diseases transmitted by the mother: Botkin’s disease, rubella, influenza, etc., chronic intoxications (diabetes, tuberculosis, alcohol), the use of certain chemotherapy drugs Type sulfonamides, quinine, etc.), toxoplasmosis (see below).
Toxoplasmosis is defined as a parasitic disease that develops as a result of exposure to toxoplasma, as a source of infection, they consider various species of domestic mammals, as well as mammals of wild animals (dogs, cats, rabbits, predators, rodents, herbivores, etc.). Toksoplazmy penetrate the fetus through the placenta through the infected mother, it is possible and infection of the child during the first years of his life.
With toxoplasmosis, the actual degree of oligophrenia for a patient can manifest itself in different ways. In addition, it is also possible to manifest catatonic disorders and epileptiform seizures. The development of oligophrenia against this background can also be accompanied by the transfer of encephalitis / meningoencephalitis toxoplasmosis. Toxoplasmosis can also occur in combination with such pathologies as hydrocephalus or microcephaly. The course of toxoplasmosis, in addition to these features, is accompanied by eye damage (retinal detachment, iridocyclitis, pigmentary choreoretinitis). In the bones of the skull and in the brain regions of calcification are formed (calcifications — that is, deposition of calcium salts in these areas in the absence of them here in the norm).
- Phenyl pyruvic oligophrenia
This form of pathology is due to the fact that there is a violation in the body of phenylalanine metabolism with the simultaneous formation of phenylpyruvic acid in significant amounts, to determine its content can be in urine, blood, in sweat. The state is accompanied by a manifestation of deep degrees of oligophrenia (idiocy or imbecility), as well as hypopigmentation of the iris and skin. The phenyl pyruvic oligophrenia is also accompanied by a pathological condition with impaired metabolism of B vitamins.
- Langdon Down’s disease
She is also a trisomy on chromosome 21, Down’s syndrome. This pathology is characterized by the presence of the patient not 46, but 47 chromosomes, which occurs for unknown reasons so far (it is assumed that the pathological form of heredity or the chromosomal abnormality is the fault of the development of the syndrome). The number of chromosomes is determined by the fact that the chromosomes represented by the 21st pair do not have a standard pair, but three copies (less often, other variants of chromosome pathology are considered).
Here, as in other considered cases, there is a manifestation of mental disorders and oligophrenia in particular, moreover, there are its characteristic features accompanying this disease in combination with Down’s syndrome. So, oligophrenia in Down syndrome determines the considerable mobility of patients, their good nature and affection, they have expressive movements and facial expressions, there is a tendency to imitate.
The appearance of the patients is also very characteristic, it consists in the spherical shape of the head with widely spread eyes, a characteristic fold (epicanthus) appears on the upper eyelid, the nose is somewhat flattened, upturned, short, and striated. Also in patients the muscle tone is lowered, joint looseness is determined, they have low growth.
- Pilivia oligophrenia in combination with dyskeratosis
This form of the disease is caused by an insufficient amount in the body of the future mother of vitamin A during the period of pregnancy, which is especially important in the first trimester. In addition to oligophrenia, ichthyosis develops against this background, epileptiform seizures develop.
- Ruby embryopathy
This pathology is relevant in case of transfer by a future mother during the first trimester of a viral disease such as rubella. In this case, oligophrenia manifests itself in a profound degree, accompanied by pathologies in the form of cataracts, congenital heart defects, deafness.
- Oligophrenia developing against a positive Rh factor
This pathology is relevant for a negative factor of the fetus. In this case, the reasons for oligophrenia are due to the fact that Rhesus antibodies get to the fetus through the placenta, as a result of which the brain is subsequently damaged. Oligophrenia, the symptoms in children with which develop against the background of this factor, is also accompanied by paralysis, paresis, hyperkinesia.
- Residual oligophrenia
This form of the disease is noted in practice most often. In this case, the stopping of mental development is preceded by the transfer in infancy to patients with infectious diseases (meningitis, meningoencephalitis), trauma. As for the degree of manifestation here of oligophrenia, it can be in any variant. As the most frequent form of pathology, developing against the background of infections and injuries, hydrocephalus appears (the disease is accompanied by an increase in the volume of cerebrospinal fluid in the subarachnoid spaces (this is the external form of hydrocephalus) or an increase in its volume in the ventricles of the brain (internal hydrocephalus)).
In the circular coverage, the skull with hydrocephalus in size reaches about 70 cm or more, is accompanied by a weakening of the vision, and often a complete loss of it, which is explained by the pressure exerted by the cerebrospinal fluid on the cross-section of the visual tubercles in the plastic form of their atrophy. As for the mental degree of underdevelopment that is relevant for hydrocephalus, it can be different, manifesting itself in the form of easy debility, and in the form of achieving the absolute state of idiocy. In addition to the development of hydrocephalus against the background of infections and injuries, there is a likelihood of its development and as a manifestation of the actual during the prograde process, which may imply pathologies in the form of congenital syphilis, tumor formation in the brain, etc.
It should be noted immediately that only IQ indicators can not be used as the main and only criterion in the diagnosis of oligophrenia. The fact is that it is not uncommon for people at low IQ indices to show other signs of oligophrenia in their own state that did not determine the soil for establishing such a diagnosis. Accordingly, the diagnosis of «oligophrenia» is established on the basis of a general assessment of the patient’s everyday habits and mental state, assessing the level of his social adaptation, and studying an anamnesis on the subject of previous illnesses. Only an integrated approach determines the ability to put the patient’s diagnosis of «mental retardation.»
Oligophrenia in infancy, as well as in childhood can manifest itself in such a form of developmental delay that will allow to determine a timely visit to the doctor. Under the conditions of pre-school institutions, mental retardation in children is accompanied by problems with adaptation, the regime of the day is difficult for children to observe, how difficult it is to master classes with educators — they become too complicated in this state.
Oligophrenia in school-age children can be detected through appropriate attention to the child and in particular — alertness to his heightened inattention, poor performance, behavioral peculiarities. Oligophrenia is also often accompanied by symptoms in the form of frequent headaches, convulsive seizures, tics, partial paralysis in the defeat of limbs.
In general, mental retardation is recognizable during the early age. Mental retardation, developing at the genetic level, is determined in the fetus during pregnancy (screening examination in the conditions of the women’s consultation and maternity hospital). When the symptoms characteristic of phenylketonuria (as a form of mental retardation) and treatment started in the period before the child reaches the age of two to three months, there are chances for the preservation of intelligence. Taking this into account, pediatrician observation is extremely necessary both in the period of newborns and in the period of early childhood. In general, timely treatment within the framework of possible measures allows for the child’s normal adaptation to the conditions that an independent life implies.
To date, there are many different drugs aimed at using in the treatment of mental retardation in one form or another. Nevertheless, any of these drugs should be prescribed by a doctor based on the general picture of the course of the disease. So, it can be hormonal preparations and iodine-containing preparations (in case of appearance of oligophrenia against the background of pathologies of the thyroid gland). If it is a question of phenylketonuria, then in some cases you can do only a certain diet.
Correction of mental retardation is provided due to nootropics (piracetam, pantogam, aminalon). Nootropics are designed to improve the processes occurring in the brain tissues. This effect is achieved through the use of amino acids and vitamins from group B (cerebrolysin, succinic, glutamic acid). To correct behavior disorders, tranquilizers or neuroleptics are prescribed. In general, the treatment should be comprehensive, including not only medical therapy, but also providing the patient with an individual approach to training, conducting classes with a speech therapist, a psychologist, which will make it possible to consider the success of subsequent adaptation in the conditions of society.
If you have a symptom that corresponds to some degree of manifestation of mental retardation (mental retardation), you need to visit a pediatrician and a neurologist.