Topic: Infectious psychoses in children. Manifestation and treatment of various forms of psychosis in children

Psychosis is a severe mental illness characterized by a violation of the ability to distinguish between fantasy and reality and to adequately assess what is happening. Moreover, psychosis is a general term used to describe specific types of severe mental health disorder.

Any type of psychosis significantly harms the life of the affected child. Psychosis typically creates problems with organizing thoughts, using language correctly, and controlling impulses—behaving according to social norms, expressing emotions, and relating to other people.

"Typical" psychotic behavior is difficult to describe because it can take so many different forms. One of the most obvious signs of psychotic behavior is hallucination, in which the ill child sees, hears, touches, tastes and smells things that do not exist. To others a clear sign is delusion - a misinterpretation of the intentions or meaning of something that actually exists. Similar (though less demonstrative) types of behavior include making up words, laughing at things that are not funny or even unpleasant, getting very irritated for any reason or for no reason at all.

Hallucinations, delusions and similar types of behavior can clearly distinguish children with psychosis. For example, after hearing the story of Cinderella, a non-psychotic child may dream of becoming a heroine and feel disgusted when he thinks of an evil stepmother. A child with psychosis may believe that he or she is Cinderella and that the evil stepmother is actually in this very room.

For years, medical experts have debated whether or not psychosis affects children in pre-existing conditions. adolescence, and if so, how to distinguish them from adult psychoses and from other childhood disorders. Although these controversial issues are still a matter of debate, most medical experts now agree that preadolescent children may suffer from psychoses that were once thought to be found only in adolescents and adults. Most experts also agree that definitive evidence of psychosis—namely, the ability to verbalize a grossly distorted perception of reality—must exist before a diagnosis can be made. Thus, it may be impossible to diagnose a specific psychosis unless the child is able to speak. For example, after hearing the fairy tale of Cinderella, a child without psychosis may dream of becoming a heroine and feel disgusted when thinking about the evil stepmother. A child with psychosis may believe that he or she is Cinderella and that the evil stepmother is actually in this very room.

For many years, medical experts have debated whether or not psychosis affects preadolescent children and, if so, how to distinguish it from adult psychosis and from other childhood disorders. Although these issues are still controversial, most medical experts now agree that children in their pre-teen years may suffer from psychoses that were once thought to be found only in adolescents and adults. Most experts also agree that definitive evidence of psychosis—namely, the ability to verbalize a grossly distorted perception of reality—must exist before a diagnosis can be made. Thus, it may not be possible to diagnose specific psychosis until the child is unable to speak, although psychosis may be suspected due to gross violation behavior.

Psychosis in children can occur due to a number of short-term or long-term physical conditions including use of medications (eg, when starting or stopping steroid treatment), fever, meningitis, and hormonal imbalance (eg, increased or decreased function thyroid gland). In most cases of psychosis caused by temporary physical problems, the attack ends when the problems are resolved or dulled. Sometimes, however, full recovery is not possible until several weeks have passed after the underlying disease has been treated, as the patient needs time to recover and adjust to reality.

Although many types of physical illnesses can lead to psychotic episodes, psychoses sometimes occur without such illnesses and are rapid or ongoing, or episodic for months or even years. Experts speculate that such psychoses are caused by biochemical abnormalities that may be present at birth or acquired through conditions such as drug or alcohol abuse.

It turns out that biochemical abnormalities in some people lead only to temporary attacks of psychosis and only during certain types of psychosis. external influences such as a stressful situation. IN in rare cases For example, older children experience psychotic symptoms such as hallucinations in response to a stressful situation, such as moving away from home to attend college. These "psychotic breaks" tend to be brief, lasting only a few days or weeks.

Other people seem to be born with such severe constitutional abnormalities that psychosis appears spontaneously in early age and disability persists throughout life. The reason for this phenomenon is not clear. Experts believe that external stress is never the only factor, and there is no convincing evidence that it plays any role at all when symptoms appear in early childhood. Medical researchers continue to test the theory that genetic factors play a role in persistent psychosis.

How are psychoses diagnosed in children?

The child may need to be seen repeatedly over weeks or even months by various professionals, such as a doctor who specializes in developmental disorders, a child psychiatrist, as well as a neurologist (a specialist in the nervous system), an otolaryngologist (an ear, nose and throat specialist). ) as well as a speech and language expert (speech therapist).

Diagnostic procedures include a thorough physical and psychological examination, long-term observation of the child's behavior, testing of mental abilities, and testing of hearing and speech.

The child may be hospitalized for various studies central nervous system. If a child with psychosis appears to have an underlying physical health problem, diagnostic procedures can be focused on identifying the underlying cause of the disease.

If parents have any doubts about the diagnosis, such as whether it is accurate enough, they should listen to the opinions of other doctors.

Treatment and prevention of psychosis in children

Brief episodes of psychosis caused by physical health problems resolve when the underlying illness disappears. However, severely affected children should be counseled by a mental health professional - a psychiatrist, psychologist or social worker to deal with psychotic episodes. Usually only a few discussions are necessary, although some children may require long-term therapy.

Also, a child who experiences a psychotic break due to a stressful situation often needs short-term or long-term psychotherapy. In some cases, these children may benefit from short-term or long-term use drug treatment, which compensates for the alleged biochemical disturbances.

Short-term psychotic episodes related to underlying disorders physical health, can only be prevented by treating or preventing the underlying causes.

Based on materials from the article “Psychosis”.

Childhood psychosis is a complex mental illness characterized by a distorted perception of reality, expressed in the inability to separate fantasy from fiction. The child tends to give inadequate reactions to some everyday situations, which makes his daily life difficult. When organizing their thinking, such children experience a breakdown; it becomes more difficult for them to control their actions, fit them into generally accepted standards, make adequate decisions and speak competently. Psychosis among children is quite rare. They are divided into early (infants, preschoolers and schoolchildren) and late stages (adolescents).

A variety of factors can be prerequisites for the onset of childhood psychosis:

• use of medications;
• heat;
• hormonal imbalances;
• meningitis;
• birth injuries;
• alcohol intoxication;
• severe stress, psychological trauma;
• congenital characteristics and malformations of the body.

When the physical cause of the disease (stress, for example) is eliminated, it disappears safely. This may take some time - on average, 1-2 weeks, during which the child adapts to the conditions of real life.

Psychosis can act as an independent disease and occur separately from other diseases. This situation is typical for child health problems due to childbirth, uncontrolled medication use, and alcohol poisoning.

Children with congenital abnormalities physical development, often experience psychosis, even in early childhood.

There is an opinion that it is not always external features The behavior of a child necessarily indicates the presence of psychosis if it occurred at an early age of the child and was symptomatic. Researchers prefer to rely on data on the genetic nature of this phenomenon.

Symptoms

Psychosis can manifest itself in different ways, but the main signs for its definition are:

• the child has hallucinations;
• rave;
• loss of clarity of consciousness;
• difficulties in orienting in space and time;
• problems with self-perception.

When hallucinations appear, the child sees and hears something that is not really happening. He interprets events in a distorted form, the baby can utter meaningless phrases, laugh at inappropriate things, experience outbursts of causeless anger and irritation. Such children easily include themselves in the fictional world of fairy tales and other people's stories. With a long course of the disease, it can leave an imprint on the child’s character, social behavior and development.

Children suffering from psychosis are characterized by lethargy, lethargy, passivity, and lack of initiative. The child shows emotional stinginess and, over time, withdraws more and more into himself. Intellectual impairment may develop, and the thinking process is unfocused and meaningless.

One of the varieties of the disease is reactive psychosis, or psychogenic shock. It occurs after a child has experienced psychological trauma or severe emotional shock. Over time, the manifestations of this disease weaken, but the connection between the nature of the injury and the manifestations of psychosis remains.

Manifestations of the disease also include autism and childhood schizophrenia.

Doctors agree that the manifestation of the disease becomes more obvious after the child masters speech skills. Although in some cases, obvious behavioral disorders may indicate the presence of psychosis.

Diagnosis of psychosis in a child

Diagnosis of the disease in a child lasts several weeks and even months. During this time, the baby’s health and behavior are carefully monitored by several specialists, including a pediatrician, neurologist, ENT, orthopedist, and speech therapist. Physical and psychological behavior child for the entire period of examination. The ability to hear, think, and speak is tested.

If it is determined that psychosis is based on a physical cause, the task

Complications

Prolonged psychosis can make a child withdrawn, uncommunicative, irritable, i.e. Disturbances in the formation of social skills of behavior, perception of oneself as a separate person may appear, and character changes. Obsessive movements develop, sometimes children repeat the same phrases for a long time.

Childhood psychosis is fraught with disorders intellectual development child, disruptions in the processes of thinking and speech, outbursts of aggression.

Treatment

What can you do

It is important for you to build a competent relationship with a sick child. There should be consistency and confidence in their behavior. Situations of stress, quarrels and domestic conflicts should be avoided; the family environment should be favorable for the baby’s recovery.

When the physical cause of the disease is eliminated, it gradually goes away. Therefore, it is important to correctly identify the source of the disease and make efforts to eliminate it.

If deviations in a child’s behavior are detected, it is wise to seek the advice of a specialist.

What does a doctor do

For children susceptible to psychosis, constant supervision of a doctor (psychiatrist, psychologist, for example) is required. In some cases it may be necessary therapeutic assistance, individual or family sessions with a psychologist, correction of the child’s behavior. For complex forms of the disease, the doctor may prescribe medications.

Prevention

The main measure to prevent childhood psychosis is to work with the reasons that caused them. It is important to avoid repeating traumatic situations. When the factor that triggers the development of psychosis is eliminated, the child gradually recovers, his behavior changes, and the disturbances weaken.

It is important to create in the family favorable climate for the harmonious development of the child, to protect him from traumatic incidents and stress. Raising children should be based on consistency, and communication with them should occur without raising the tone, rude words and physical punishment.

Childhood psychosis can develop according to the most various reasons: to provoke acute condition may be high fever, infectious diseases, endocrine disorders, neuroinfections, stress factors, mental trauma and hereditary predisposition. Psychosis is manifested by delusions, hallucinations, strange behavior and illogical reactions to events. Self-help is not recommended, it is necessary qualified assistance child psychiatrist.

IsraClinic consultants will be happy to answer any questions on this topic.

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Psychosis is an acute condition during which a child experiences sudden changes in mood, inappropriate emotions (laughter during a sad story, for example), hallucinations, delusional thoughts and ideas. Psychosis in children, as a rule, is not an independent disease, but a manifestation of some mental or organic disorder. Whatever the cause of psychosis in children, this condition significantly affects the child’s life, reducing the quality of functioning, the formation of emotions, and the control of behavior.

As a rule, a typical manifestation of psychosis in children is the presence of hallucinations and delusional thoughts. For example, a child may believe that he is a cartoon or fairy tale character, imagine that there are characters from this cartoon next to him, and show emotions in accordance with the actions of imaginary characters. The child may also express thoughts that do not correspond to reality.

Psychosis in children causes

They can be very different. Some of them have a short-term effect on the child and eliminating the cause helps to quickly restore normal functioning, while some of the reasons require long-term treatment and elaboration. Among the most common causes of psychosis in children, we highlight the following:

• Medications. Some medications can cause a psychotic state that resolves if pharmacotherapy is stopped.
• Heat. During illness, high fever can cause delirium and hallucinations in a child. After the temperature normalizes, psychosis in children quickly passes.
• Neuroinfections (meningitis, encephalitis, myelitis, etc.)
• Endocrine disorders
• Stressful situations (parental quarrels, divorce, authoritarian parenting)
• Psychotrauma (physical or mental violence)
• Hereditary causes. If one of the parents suffers from psychotic disorders, the likelihood that psychosis will be inherited by the child is very high.

Note that psychosis can manifest itself in children both in preschool and adolescence.

Diagnosis and treatment of psychosis

Very often, a diagnosis of psychosis requires examination by several specialists - a child psychiatrist, a neurologist, clinical psychologist, pediatrician. Additional tests such as MRI, EEG, blood tests, lumbar puncture or electromyography may be ordered. These tests are necessary to confirm or rule out an organic cause for psychosis in children.

After establishing the exact cause of psychotic attacks, therapy is prescribed. If we're talking about O psychological reason, can be assigned sedatives, consultations with a child psychologist or family psychotherapy. In some cases, quite long sessions with a psychotherapist are required to stabilize the condition - up to six months. If we are talking about an organic cause, treatment is prescribed depending on the diagnosis that caused the psychosis.

In Israel, in the psychiatric clinic “IsraClinic” it is customary to conduct comprehensive examination and treatment of children with psychotic episodes for staging accurate diagnosis and prescribing the most effective therapy. In addition to pharmacotherapy and psychotherapy, the clinic’s methods include art therapy, hippotherapy, hydrotherapy or sports therapy, depending on the interests and inclinations of young patients. Such auxiliary techniques for the treatment of psychosis have been proven to produce sustainable results. After treatment, the main efforts of doctors and parents are aimed at preventing psychosis, in particular, physical and mental health child and his family.

Psychoses in children respond well to treatment; the main thing is to promptly contact a specialized center with good specialists.

TO schizophrenic psychoses include mental illness, leading to personality disintegration. At the same time, they are developing characteristic disorders thinking, perception and affective sphere. Intellectual abilities and consciousness are usually not impaired, but cognitive impairment often develops during the course of the disease.

Due to the unknown etiology of schizophrenic psychoses modern classification schemes, such as ICD-10 (WHO) and DSM-3R (APA), are guided by symptoms and time criteria when establishing a diagnosis. According to the ICD-10 diagnostic guidelines, a diagnosis of schizophrenic psychosis is justified if there is at least one of the specific symptoms (or two or three less specific ones) from symptom groups 1-4 listed below or at least two symptoms from groups 5-8.

These symptoms should be clearly present almost constantly for a month or longer.
1. Echo of thoughts, insertion or subtraction of thoughts, influxes of thoughts.
2. Delirium of influence, control, feeling of being done, clearly related to movements of the body or limbs or to certain thoughts, actions and sensations; delusional perception.
3. Commentary voices discussing the patient and his behavior, or voices emanating from some part of the body.
4. Persistent delusional ideas, not related to a given culture and completely inconsistent with reality, such as identifying oneself with religious or politicians, the idea of ​​having superhuman powers and abilities (for example, the ability to control the weather or contact with aliens).
5. Constant hallucinations in any sphere of feelings, accompanied by either unstable or not fully formed delusional ideas without clear affective manifestations, or persistent overvalued ideas that appear daily for weeks or months.
6. Breaks in thoughts or interference in the thought process, leading to interrupted speech and neologisms.
7. Catatonic symptoms such as agitation, stereotypical rigidity or waxy flexibility (flexibilitas cerea), negativism, mutism and stupor.
8. Negative symptoms, such as apathy, poor speech, flatness and inadequacy of emotional reactions (which usually leads to social isolation and decreased social productivity). It should be obvious that these symptoms are not due to depression or antipsychotic treatment.

a - self-portrait of a 54-year-old patient suffering from a hallucinatory-paranoid form of schizophrenia since the age of 11
b - drawing of the same patient - plan of the city of New York.

Moreover, in accordance with diagnostic criteria ICD-10 The following clinical subtypes of schizophrenic psychoses can be distinguished:
F 20.0 Paranoid
F 20.1 Hebephrenic schizophrenia
F 20.2 Catatonic schizophrenia
F 20.3 Undifferentiated schizophrenia
F 20.5 Residual schizophrenia (chronic undifferentiated schizophrenia)
F 20.6 Simple schizophrenia

Regardless of this division into clinical subtypes of schizophrenia Based on psychopathological symptoms and the nature of the course, other classification options for schizophrenic psychoses were developed (Leonhard, Crow, Andreasen, Kay). Of particular importance for the treatment and dynamics of schizophrenia in childhood and adolescence is the concept of positive (type I) and negative (type II) schizophrenia. The table shows the most important psychopathological symptoms characteristic of type I and type II schizophrenia.

Wherein positive and negative symptoms are in no way specific to schizophrenic psychosis - they are also observed in psychoorganic syndromes, depressive syndromes, personality disorders and neuroses (Angst et al.). Negative symptoms dominate within schizophrenic psychoses in children younger age(5-10 years) and in children and adolescents with cognitive development below average.

Epidemiology of schizophrenic psychoses

Results from several studies on the epidemiology of schizophrenic psychoses can be summarized as follows:
1. The prevalence of schizophrenia with primary manifestation before the age of 12 is less than 1 in 10,000 children. Thus, it is less common than early childhood autism (Burg, Kerbeshian).
2. Schizophrenic psychoses with primary manifestation in childhood are 50 times less common than schizophrenia in adults (Karno, Norquist).
3. Schizophrenic psychosis in childhood and prepubertal age is a rare phenomenon, but in adolescents it is a relatively common disease. The primary manifestation of schizophrenic psychoses in 2.4% of cases occurs between the 5th and 14th years of life and in 22.1% - between the 15th and 19th years (Remsclrmidt).
4. The gender distribution in childhood is more favorable for boys, and in adolescence this difference apparently smoothes out (Remschmidt et al.).

Aspects of psychopathology in the development of schizophrenic psychoses

Schizophrenic psychoses in childhood and adolescence must always be considered in the context of development processes. Symptoms in a particular patient are often determined by the phase of its development. In this case, it is necessary to distinguish manifestations in childhood from those that occur in adolescents. Age and level of development from a modern point of view are considered as factors that greatly influence the clinical picture of psychoses in childhood and adolescence (Remschmidt, Remschmidt et al.). Taking into account aspects of developmental psychopathology, schizophrenia includes both independent psychoses of childhood, for example, early childhood catatonia (Leonhard), and mental disorders that develop into schizophrenia when they manifest in childhood until prepuberty. In general (Kanner), childhood psychoses are divided into:
1) early childhood autism not related to schizophrenia,
2) disintegrative psychoses of childhood as primary organically caused disorders and
3) childhood forms of schizophrenia.

Knowledge of the cognitive and emotional characteristics of the relevant age period and an accurate analysis of developmental tasks are prerequisites for understanding psychoses and their symptoms such as delusions and hallucinations. The latter are characterized by typical age-related features: in children they are less systematized and associated with the world of children's fantasies, which makes it necessary to clearly distinguish them from normal childhood experiences.

U teenagers so-called pubertal crises and maturation crises can precede schizophrenic psychoses, and also initially mask them (Remschmidt, Martin). During teenage crises, we are talking about normal variants of experiences and behavior in the form of distorted self-esteem, feelings of guilt, feelings of inferiority, conflicts associated with physical and mental self-esteem, often causing self-harm, suicidal attempts, leaving home and oppositional behavior at the behavioral level ( Remschmidt). Deviations and crises that arise when overcoming problems can be initial manifestation psychosis and participate in the development of its symptoms. The onset of schizophrenic psychosis, according to modern data, can be explained by the interaction of the patient’s predisposition and premorbid personality characteristics with aggravating life circumstances and family factors, which leads to failures in overcoming problems and decompensation of psychosis.

Significant signs of predisposition to schizophrenic psychoses are:
limited processing of information (impaired attention, increased distractibility with extraneous stimuli, difficulties in selecting them);
inadequate autonomic reactions (hypo- or hyperexcitability, insufficient adaptive abilities of the autonomic nervous system);
limited social competence;
insufficient defense mechanisms.

Forms of infectious psychoses in children

Infectious diseases require the close attention of a child psychiatrist. Mental disorders occur not only with infections of the central nervous system, but also with many common childhood infections (influenza, malaria, scarlet fever, measles, etc.). This justifies the generally accepted classification of infectious psychoses into two groups. The first group includes symptomatic infectious psychoses - psychotic disorders that develop during common infections and are only one of the manifestations of the underlying disease. In these cases, the nervous system is affected by toxins circulating in the blood. The second group includes organic psychoses that occur as a result of infections directly localized in the brain.

This division into symptomatic and organic psychoses is artificial, because at present many common infections(typhus, influenza, chicken pox, parotitis) are considered not only as somatotropic, but also as neurotropic. Reversibility criterion mental disorders, which is taken as the basis for delimiting symptomatic infectious psychoses, is often not justified, since different outcomes can be observed in this group. If most often the outcome is favorable and all disorders are reversible, then in a minority of cases changes in the central nervous system are more persistent. However, there is still a fundamental difference between these two groups, and for practical purposes the division into symptomatic and organic psychoses is convenient.

Even in the old manuals on general psychiatry, you can find an indication that at high temperatures, patients experience lethargy, adynamia or motor agitation with hallucinations and a disorder of consciousness - the so-called febrile delirium. E. Kraepelin drew attention to the fact that the occurrence of mental disorders during infections cannot be explained only by high temperature, since psychosis does not always develop when the temperature rises. Often psychotic states occur during a period when there is no longer elevated temperature. The cause of infectious psychosis, according to E. Kraepelin, is a factor directly related to the pathogenesis of the underlying disease - autointoxication due to disorders metabolic processes. Therefore, psychosis often occurs not at the height of the disease, but during its attenuation. The clinical manifestations of symptomatic psychoses are not the same, and E. Kraepelin explained these differences by the specific effect of one or another exogenous harmfulness.

However further observations showed that when various infections and intoxications clinical manifestations psychosis are often very similar or even the same. K. Bongeffer drew attention to this fact. Such forms of exogenous psychoses with etiological aspecificity were classified by him as an “exogenous type of reaction.” In the clinical picture of these forms of exogenous reactions, K. Bongeffer identified five syndromes: delirium, amentia, twilight state, epileptic agitation, hallucinosis. In the prodromal stage, the clinical picture shows symptoms of asthenia, emotional hyperesthesia, and irritable weakness. K. Bongeffer considered amnestic disorders and Korsakov's syndrome characteristic of the post-infectious period. As for other psychopathological manifestations of exogenous psychoses - manic and depressive, catatonic, paranoid - they, according to K. Bongeffer, should be considered as manifestations of an intermediate etiological link.

K. Bongeffer's concept raised many objections. E. Kraepelin drew attention to the fact that for development exogenous type reactions require greater intensity and a very acute onset of harmful effects. With a slower impact of harmfulness, manic, depressive, paranoid and other syndromes arise, usually characteristic of endogenous psychoses. The importance of the severity and rate of harmful effects was emphasized by M. I. Specht.

Soviet psychiatrists (V.A. Gilyarovsky, M.A. Goldenberg) rejected K. Bongeffer’s concept of the presence of an intermediate etiological link, citing its lack of evidence. Without objecting to the identification of an “exogenous type of reaction,” they nevertheless pointed out that in the psychopathological picture of exogenous psychosis one can note features typical of one or another etiological factor.

The question of the specificity of the exogenous type of reactions when exposed to various toxic factors is correctly addressed by I. G. Ravkin. He believes that the commonality of psychopathological manifestations in exogenous psychoses is a reflection of a single type of response due to the special sensitivity to the toxic effects of the thalamohypothalamic system. Clinical and pathological studies have proven that the autonomic centers of the hypothalamus are most affected by toxic effects. Therefore, under the influence of various exogenous hazards, similar psychopathological symptoms arise.

But still, if there is a single type of reaction in the psychopathological picture of the exogenous type of reactions, it is possible to identify a number of symptoms typical of one or another etiological factor.

Child's reaction to an infectious disease at different ages

Peculiarities of age-related reactivity play an important role in the development of infectious psychosis and the formation of its clinical manifestations. Children under the age of 5 years are more sensitive to toxic effects, under the influence of which they often experience convulsive states, hyperkinesis, stupor, more easily than in older children, turning into stuporous and comatose state. They rarely have pronounced productive psychopathological symptoms. States of motor excitation or motor retardation, rudimentary delirious states, and illusions are noted. More often, predilectional states are observed, manifested in increased impressionability, hyperesthesia, capriciousness, decreased endurance to external stimuli and attacks of fear.

Also in the post-infectious period in the clinical picture, along with asthenia, one can note following features, typical for childhood: a) psychopathic changes in behavior: calm and obedient children become stubborn, rude, motorally disinhibited, pugnacious; b) puerile phenomena - childishness in behavior that is not appropriate for age (changes in speech, “lisping,” whims, etc.), hysterical reactions, in the occurrence of which not only the helplessness and asthenicity of the child during this period, but also the atmosphere are of great importance the warmth with which his parents surround him; c) a tendency to fears, often appearing at night, sometimes in connection with deception of perception (illusions and hallucinations), often with unpleasant somatic sensations; d) twilight states, the experiences of which often reflect mental trauma suffered in the past (as a result of which they are often incorrectly interpreted as psychogenic reactions); e) an amnestic symptom complex, which in children is not clearly expressed, although its individual elements (decreased memory for current events and insufficient retention of what is perceived) are observed in most patients. The Korsakoff symptom complex (memory loss for current events while retaining memory for long-past events) is less common in childhood than in adolescents. Children have prenatal school age under the influence of severe infection, further physical and mental development may be delayed.

Mental disorders with infectious diseases in children

Characteristic sign infectious psychoses - the presence of clouded consciousness. But the type of altered consciousness and the degree of stupefaction are not the same in different symptomatic infectious and toxic psychoses. What matters here is the severity of the disease, the stage of its development, individual and age characteristics sick. With severe toxic effects, young children are more likely to experience stunned states, which sometimes quickly increase and turn into stuporous and comatose states.

When stunned, there is still no complete switching off of consciousness - only a sharp slowdown and impoverishment of all mental activity. The irritation threshold is increased - external stimuli poorly reach the patient, their analysis and synthesis occur very slowly. Responses are delayed or completely absent. With a lesser degree of deafness, children are drowsy, inactive, and do not answer questions immediately, only after several repetitions. They are slow and have difficulty navigating their surroundings and perform only basic tasks. Understanding the surroundings is difficult. Children are indifferent and indifferent to everything, they react little even to the arrival of their relatives.

With a more severe course of the disease, stupor quickly turns into soporous state. The patient does not respond to contact with him; he retains his reaction only to strong irritants and painful sensations.

In severe cases of the disease, coma occurs unconsciousness, in which the patient does not respond to any external stimuli. Very severe cases corneal and tendon reflexes; respiratory and cardiac problems occur.

Delirious states in children, as well as in adult patients, are accompanied by disorientation in the environment, an influx of hallucinations (mainly visual), a sharp affect of fear and motor agitation. Children are rushing about, trying to hide from frightening visions, asking for help. Unlike delirium in adult patients, the delirious state in children is characterized by a greater severity of the affect of fear, as well as its short duration and episodic nature. Severe delirious states are observed mainly in school-age children. Preschoolers experience only motor restlessness, hypnagogic frightening illusions and hallucinations. IN initial stage In an infectious disease, a predilectional state often predominates: the child becomes irritable, capricious, and develops increased sensitivity, anxiety, restlessness, superficiality of perception, weakness of attention and memory, hypnagogic illusions and hallucinations are not uncommon. If the intensity of the process is low, the response may be limited to a marginal state.

In protracted infectious diseases with toxic effects of lesser intensity (rheumatism, malaria, brain infections), oneiric states of consciousness are more often observed. As with delirium, in oneiric states there are deceptions of perception, especially pseudo-hallucinations - visual and auditory. Patients see scenes from their past experiences, books they have read, consider themselves participants in ongoing events, although outwardly they remain completely motionless at this time. The nature of their painful ideas can be judged only by their facial expressions and facial expressions.

In the case where, in oneiric states, there is a slight degree of clouding of consciousness, the child does not have gross disorientation in the environment, he has, to some extent, retained contact with reality. Sometimes a double orientation is noted: children consider themselves participants in fantastic events occurring in other places and at the same time know that they are in the hospital. For more severe infectious diseases, usually in more late stages illness in the presence of physical exhaustion, an amental state may occur. It is characterized by incoherence, confusion of thinking, disruption of the synthesis of perception, complete disorientation in the environment and one’s own personality. Along with pronounced amental states, children also experience rudimentary states, but even here disorientation and motor restlessness are noted.

The course and outcome of infectious psychoses may vary depending on the course of the underlying disease, its pathogenesis, degree of progression, as well as the characteristics of brain reactivity. Therefore, in some cases, infectious psychosis is an easily reversible reaction, in other cases, more or less persistent disorders of the nervous system occur with a morphological substrate reflecting the degree of intensity and progression of brain damage. In such cases, infectious psychoses should be considered organic. It is clear that the nature of the infectious agent, the absence or presence of morphological changes, the degree of their severity and localization in the brain are not the same for different infectious diseases. Therefore they are not the same mental disorders observed in various infections.

Diagnosis of infectious psychosis in children is often difficult. Diagnostic difficulties often arise when it comes to psychoses that occur during infections with a recurrent and protracted course (malaria, rheumatism, brucellosis, etc.), since their clinical manifestations here are similar to schizophrenia.

The following case history can serve as a clinical example.

Masha is 12 years old. The face is tense, expressing either surprise or fear. The girl looks around all the time, looking for something, enters into conversation willingly, allows herself to be examined, and is not easily distracted. Confused, anxious, not oriented in the environment. Her speech is incoherent and she has difficulty understanding the question addressed to her. When counting within 100, he makes gross mistakes, quickly becomes exhausted, cannot finish a sentence he has started, and lowers his head. The expression on his face is tired. Unstable mood; It’s easy to make her laugh, but at the same time she quickly begins to cry, childishly, sob, and monotonously lament: “I want to go to my mother.” Sometimes he mistakes others for acquaintances. From time to time. restless, runs to the exit.

A somatic examination of the patient revealed satisfactory nutrition, a slightly coated, dry tongue, a hyperemic pharynx, enlarged cervical The lymph nodes; the boundaries of the heart are not changed, the tones are somewhat muffled, the pulse is soft; slight cyanosis of the hands, painless abdomen, liver at the costal edge, spleen enlarged and soft. Neurological examination did not reveal gross deviations from the norm. Malaria plasmodia (tertianae), lymphocytosis, ROE 50 mm per hour were found in the blood. The temperature in the evening on the day of admission was 39.9°, the next day and subsequent days it was normal.

The real illness began a few days ago. The girl, coming home from school, began to complain about headache. She turned pale. At night I had a high temperature and vomited 2 times. The next morning she did not answer questions, cried, refused to eat. Expressed ideas of persecution. The next night she slept anxiously, something “seemed.” In the morning she was excited, screaming, didn’t recognize her family, threw everything she could get her hands on, and tore her underwear.

Before the present illness, the girl was calm, obedient, sociable, affectionate, and intelligent. She has been studying at school since she was 8 years old, she is diligent, diligent, and has good academic performance. At the age of 3 she suffered from scarlet fever, complicated by otitis, then measles and mumps.

When establishing the diagnosis, the question of malarial psychosis arose. To substantiate this diagnosis, let us dwell in some detail on the question of the criteria for diagnosing infectious psychosis in general. When analyzing the clinical picture, two criteria are usually used for diagnostic purposes - somatic and psychopathological. The somatic criterion is one of the most valuable in diagnosing infectious psychosis.

However, the presence of infection does not mean that this mental condition is an infectious psychosis. In practice, there are often cases when an infection only contributes to the development of another, endogenous disease (schizophrenia, manic-depressive psychosis). Therefore, to substantiate the diagnosis in each individual case, it is necessary to prove that the clinical manifestations of mental disorders are characteristic of infectious psychosis.

The symptoms observed in the patient are extremely polymorphic. At the onset of the disease, motor and speech agitation, incoherent thinking, absurd behavior, hallucinations, and delusions were noted, followed by confusion, anxiety, and possibly deceptions of the senses. However, the entire polymorphism of symptoms is included in something single: impaired consciousness and greater lability of emotions with the nature of dysthymia. This combination is most typical for infectious psychosis.

Thus, the characteristics of mental disorders corresponded to the diagnosis of malaria.