home Diseases Organic damage to the central nervous system. CNS damage in newborns

Organic damage to the central nervous system. CNS damage in newborns

This diagnosis is currently one of the most common. An organic lesion of the central nervous system (central nervous system) in its classical content is a neurological diagnosis, i.e. is in the competence of the neuropathologist. But the symptoms and syndromes accompanying this diagnosis can refer to any other medical specialty.

This diagnosis means that the human brain is defective to a certain extent. But, if a mild degree (5-20%) of "organics" (organic damage to the central nervous system) is inherent in almost all people (98-99%) and does not require any special medical interventions, then an average degree (20-50%) of organics is not just a quantitatively different condition, but a qualitatively different (fundamentally more severe) type of disturbance in the activity of the nervous system.

The causes of organic lesions are divided into congenital and acquired. Congenital cases include cases when, during pregnancy, the mother of the unborn child suffered any infection (ARI, influenza, tonsillitis, etc.), took certain medications, alcohol, and smoked. A unified blood supply system will bring stress hormones into the body of the fetus during periods of psychological stress of the mother. In addition, sudden changes in temperature and pressure, exposure to radioactive substances and X-rays, toxic substances dissolved in water, contained in the air, in food, etc. also affect.

There are several especially critical periods when even a slight external impact on the mother's body can lead to the death of the fetus or cause such significant changes in the structure of the body (including the brain) of the future person that, firstly, no medical intervention correct, and secondly, these changes can lead to early death of a child before 5-15 years of age (and mothers usually report this) or cause disability from a very early age. And in the very best case lead to the emergence of a pronounced inferiority of the brain, when even at maximum voltage the brain is able to work only at 20-40 percent of its potential capacity. Almost always, these disorders are accompanied by varying degrees of disharmony of mental activity, when, with a reduced mental potential, far from always positive qualities of character are sharpened.

This can be facilitated by taking certain medications, physical and emotional overload, asphyxia during childbirth (oxygen starvation of the fetus), prolonged labor, early placental abruption, uterine atony, etc. After childbirth, severe infections (with severe symptoms of intoxication, high fever, etc.) up to 3 years can give rise to acquired organic changes in the brain. Brain injury with or without loss of consciousness, long or short general anesthesia, drug use, alcohol abuse, long-term (several months) self-administration (without the prescription and constant supervision of an experienced psychiatrist or psychotherapist) taking some psychotropic drugs can lead to some reversible or irreversible changes in the functioning of the brain.

Diagnosis of organics is quite simple. A professional psychiatrist can already determine the presence or absence of organics by the face of a child. And, in some cases, even the degree of its severity. Another question is that there are hundreds of types of disorders in the functioning of the brain, and in each specific case they are in a very special combination and connection with each other.

Laboratory diagnostics is based on a series of procedures that are quite harmless to the body and informative for the doctor: EEG - electroencephalograms, REG - rheoencephalograms (study of cerebral vessels), UZDG (M-echoEG) - ultrasound diagnostics brain. These three examinations are similar in form to an electrocardiogram, only they are taken from a person’s head. Computed tomography, with its very impressive and expressive name, is actually capable of revealing a very small number of types of brain pathology - a tumor, a volumetric process, aneurysm ( pathological expansion vessel of the brain), expansion of the main cisterns of the brain (with increased intracranial pressure). The most informative study is the EEG.

It should be noted that practically no disorders of the central nervous system disappear by themselves, and with age not only do not decrease, but increase both quantitatively and qualitatively. The mental development of a child directly depends on the state of the brain. If the brain has at least some defectiveness, then this will certainly reduce the intensity of the child's mental development in the future (difficulty in the processes of thinking, memorization and recall, impoverishment of imagination and fantasy). In addition, the character of a person is formed distorted, with varying degrees of severity of a certain type of psychopathization. The presence of even small, but numerous changes in the psychology and psyche of the child leads to a significant decrease in the organization of his external and internal phenomena and actions. There is an impoverishment of emotions and their flattening, which is directly and indirectly reflected in the facial expressions and gestures of the child.

The central nervous system controls all internal organs. And if it works defectively, then the rest of the organs, with the most careful care of each of them separately, will not be able to work normally in principle if they are poorly regulated by the brain. One of the most common diseases of our time - vegetative-vascular dystonia against the background of organic matter acquires a more severe, peculiar and atypical course. And thus, it not only causes more trouble, but these "troubles" themselves are of a more malignant nature. The physical development of the body goes with any disturbances - there may be a violation of the figure, a decrease in muscle tone, a decrease in their resistance to physical exertion, even of a moderate magnitude. The likelihood of increased intracranial pressure increases by 2-6 times. This can lead to frequent headaches and various kinds of unpleasant sensations in the head area, which reduce the productivity of mental and physical labor by 2-4 times. It also increases the likelihood of endocrine disorders increases by 3-4 times, which leads with minor additional stress factors to diabetes, bronchial asthma, imbalance of sex hormones with subsequent violation of the sexual development of the body as a whole (an increase in the amount of male sex hormones in girls and female hormones- in boys), the risk of developing a brain tumor, convulsive syndrome (local or general convulsions with loss of consciousness), epilepsy (group 2 disability), disorders cerebral circulation in adulthood, in the presence of even moderate hypertension (stroke), diencephalic syndrome (attacks of causeless fear, various pronounced unpleasant sensations in any part of the body, lasting from several minutes to several hours). Hearing and vision may decrease over time, coordination of movements of a sports, household, aesthetic and technical nature is disturbed, making it difficult for social and professional adaptation.

Organic treatment is a long process. It is necessary to take vascular preparations twice a year for 1-2 months. Concomitant neuropsychiatric disorders also require their own separate and special correction, which must be carried out by a psychiatrist. To control the degree of effectiveness of the treatment of organics and the nature and magnitude of the resulting changes in the state of the brain, the control of the doctor himself at the reception and EEG, REG, and ultrasound is used.

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This diagnosis is currently one of the most common. To be strictly dispassionate, then it can be put on 9 out of 10 people of any age. And with age, the number of people who have this disorder (or disease) increases more and more. Even those who had a strong "ferment" and almost never got sick, now feel quite a certain discomfort associated with some changes in the brain.

An organic lesion of the central nervous system (central nervous system) in its classical content is a neurological diagnosis, i.e. is in the competence of the neuropathologist. But the symptoms and syndromes accompanying this diagnosis can refer to any other medical specialty.

Of course, in most cases, even this degree is not a reason for panic and tragedy. And it is this intonation that sounds in the voice of doctors who “make” this diagnosis to any of the patients. And the calmness and confidence of doctors are immediately transferred to patients and their families, thus setting them up in a carefree and frivolous way. But at the same time, the main principle of medicine is forgotten - "the main thing is not to treat the disease, but to prevent it." And this is where it turns out that there is absolutely no warning for the further development of moderately pronounced organic matter and in the future leads in many cases to rather sad consequences. In other words, organic matter is not a reason for relaxation, but a basis for a serious attitude to this disruption of the central nervous system.

As practice has shown, doctors, if they start sounding the alarm, then only when organic matter has already reached a severe degree (50-70%) of severity and when all medical efforts can only give a relative and temporary positive effect. The causes of organic matter are divided into congenital and acquired. Congenital cases include cases when, during pregnancy, the mother of the unborn child suffered any infection (ARI, influenza, tonsillitis, etc.), took certain medications, alcohol, and smoked. A unified blood supply system will bring stress hormones into the body of the fetus during periods of psychological stress of the mother. In addition, sudden changes in temperature and pressure, exposure to radioactive substances and X-rays, toxic substances dissolved in water, contained in the air, in food, etc. also affect.

There are several especially critical periods when even a slight external impact on the mother's body can lead to the death of the fetus or cause such significant changes in the structure of the body (including the brain) of the future person that, firstly, no intervention physicians cannot correct, and secondly, these changes can lead to the early death of a child up to 5-15 years of age (and usually mothers report this) or cause disability from a very early age. And in the best case, they lead to the appearance of a pronounced inferiority of the brain, when even at maximum voltage the brain is able to work only at 20-40 percent of its potential capacity. Almost always, these disorders are accompanied by varying degrees of disharmony of mental activity, when, with a reduced mental potential, far from always positive qualities of character are sharpened.

The impetus for all of the above during critical periods can also be the intake of certain drugs, physical and emotional overload, etc. and so on. But this is where the "misadventures" of the future owner of the neuropsychic sphere are just beginning. For at present, only one in twenty women gives birth without any complications. Not all women, to put it mildly, can boast that they gave birth in conditions of high technical equipment, the presence of a qualified doctor and midwife. Many were neither psychologically nor physically ready for childbirth. And this creates additional difficulties during childbirth.

Asphyxia during childbirth (oxygen starvation of the fetus), protracted labor, early placental abruption, uterine atony, and dozens of other causes sometimes cause irreversible changes in the fetal brain cells.

After childbirth, severe infections (with severe symptoms of intoxication, high fever, etc.) up to 3 years can give rise to acquired organic changes in the brain. Brain injuries with or without loss of consciousness, but repeated, will necessarily cause not only some organic changes, but will create a situation where the pathological processes that have arisen in the brain will themselves develop quite intensively and create the most diverse in type and form of mental and psychic disorders. human activity (up to delirium and hallucinations).

Prolonged general anesthesia or short, but frequent, in the absence of proper correction in the future, also strengthen the organic matter.

Long-term (several months) independent (without the appointment and constant monitoring of an experienced psychiatrist or psychotherapist) taking certain psychotropic drugs can lead to some reversible or irreversible changes in the functioning of the brain.

Taking drugs causes not only physical changes in the body, but also mental and mental ones, literally killing many brain cells.

Alcohol abuse necessarily reduces the potential of the most important centers of the brain, since alcohol in itself is a toxic product for the brain. Only very rare people with increased activity of liver enzymes are able to tolerate alcohol intake with minimal harm. But such people were born more before, and now it is a rarity (1-2 per 1000). Not to mention that alcohol itself has a toxic effect on the liver, reducing its activity in general, thus reducing the chance for it to quickly and fully neutralize alcohol in the body. Moreover, the earlier alcohol consumption is started, the more difficult the results of such a hobby will be, since until adulthood the body is in the stage of formation of a stable and stable work of its most important functions and therefore is especially sensitive to any negative influences.

Laboratory diagnostics is based on a series of procedures that are quite harmless to the body and informative for the doctor: EEG - electroencephalograms, REG - rheoencephalograms (study of cerebral vessels), UZDG (M-echoEG) - ultrasound diagnostics of the brain. These three examinations are similar in form to an electrocardiogram, only they are taken from a person’s head. Computed tomography, with its very impressive and expressive name, is actually capable of revealing a very small number of types of brain pathology - a tumor, a volumetric process, aneurysm (pathological expansion of a brain vessel), expansion of the main brain cisterns (with increased intracranial pressure). The most informative study is the EEG.

In the old days (20-30 years ago), neuropathologists were inclined to answer the parents of children and adolescents that the identified changes can go away on their own with age, without any special treatment. According to the author's personal observations over the past 20 years for a large group of patients himself different ages and disorders in the work of the brain, different in severity and nature, one can draw a very clear and extremely specific conclusion that practically no disorders of the central nervous system disappear by themselves, and with age not only do not decrease, but increase both quantitatively and qualitatively.
And what does it threaten, parents ask me? Should I be worried? Worth it and still worth it. Let's start with the fact that the mental development of a child directly depends on the state of the brain. If the brain has at least some defectiveness, then this will certainly reduce the intensity of the child's mental development in the future. Yes and mental development will not go well. The question in this case is not necessarily about a fundamental mental abnormality. But the difficulty of the processes of thinking, remembering and remembering, the impoverishment of imagination and fantasies can nullify the efforts of the most industrious and diligent child while studying at school.

The character of a person is formed distorted, with varying degrees of severity of a certain type of psychopathization. The shortcomings are especially aggravated. Yes, and the whole structure of the personality turns out to be deformed, which in the future will be practically impossible to somehow significantly correct it.

The presence of even small, but numerous changes in the psychology and psyche of the child leads to a significant decrease in the organization of his external and internal phenomena and actions. There is an impoverishment of emotions and their flattening, which is directly and indirectly reflected in the facial expressions and gestures of the child.

The central nervous system regulates the work of all internal organs. And if it works defectively, then the rest of the organs, with the most careful care of each of them individually, will not be able to work normally in principle if they are poorly regulated by the brain.

One of the most common diseases of our time - vegetative-vascular dystonia (see the article on VVD in the book "Neuroses") against the background of organic matter acquires a more severe, peculiar and atypical course. And thus, it not only causes more trouble, but these "troubles" themselves are of a more malignant nature.
The physical development of the body goes with any disturbances - there may be a violation of the figure, a decrease in muscle tone, a decrease in their resistance to physical exertion, even of a moderate magnitude.

The likelihood of increased intracranial pressure increases by 2-6 times. This will lead to frequent headaches and various kinds of unpleasant sensations in the head area, which reduce the productivity of mental and physical labor by 2-4 times.
The likelihood of endocrine disorders increases by 3-4 times, which leads, with minor additional stress factors, to diabetes mellitus, bronchial asthma, imbalance of sex hormones, followed by a violation of the sexual development of the body as a whole (an increase in the amount of male sex hormones in girls and female hormones in boys ).

The risk of a brain tumor also increases, as well as convulsive syndrome (local or general convulsions with loss of consciousness), epilepsy (group 2 disability), cerebrovascular accident in adulthood in the presence of even moderate hypertension (stroke), diencephalic syndrome ( attacks of unreasonable fear, various pronounced unpleasant sensations in any part of the body, lasting from several minutes to several hours).

Hearing and vision may decrease over time, coordination of movements of a sports, household, aesthetic and technical nature is disturbed, making it difficult for social and professional adaptation.

Organics, as such, drastically reduces the degree of attractiveness and attractiveness, charm, beauty and outward expressiveness of a person. And if for boys this can be a relative stress, then for most girls it will be quite a powerful stress. Which, given the increased cruelty and aggressiveness of modern youth, can significantly violate the foundations of the well-being of the life of almost any person.

Most often, a decrease in the general immunity of the human body occurs. Which is expressed in the occurrence of many different colds - tonsillitis, acute respiratory infections, bronchitis, pharyngitis (inflammation of the back of the throat, laryngitis, otitis media (ear inflammation), rhinitis (runny nose), pyelonephritis (kidneys), etc. Which, in turn, gets in many cases a chronic course and leads to glomerulonephritis (complex and malignant kidney disease), rheumatoid arthritis, rheumatism, heart valve disease, and other extremely serious illnesses leading in most cases to disability or significantly reducing life expectancy. The presence of organic matter contributes to more early emergence atherosclerosis of cerebral vessels and its more intensive development (serious mental and mental disorders that cannot be cured).

Organics directly and indirectly contributes to the emergence of neurosis and depression, asthenic conditions (general pronounced weakness), schizophrenia (the protective threshold for stress factors decreases). But at the same time, any neuropsychiatric disorder or disease begins to proceed atypically, paradoxically, with many oddities and peculiarities, making it difficult both to diagnose and treat them. Because the body's sensitivity to the effects of psychotropic drugs changes to a certain extent (in proportion to the degree of organic matter). One tablet can produce as much therapeutic effect as two or four. Or four tablets - as one. And side effects from medications can be much more numerous and more pronounced (and therefore more unpleasant). Connection between individual symptoms and syndromes becomes unusual and a decrease in their severity then occurs according to completely unpredictable rules and laws.

themselves pathological symptoms become more drug resistant. And often there is a kind of vicious circle when a drug-resistant (resistant) syndrome requires the appointment of more high dose one drug or another. And the increased sensitivity of the body to the action of this drug greatly limits the amount of dose that can be prescribed to a particular person. So the doctor has to strain not only his logical thinking, but also intensely listen to his professional intuition in order to understand what needs to be done in each specific case in his work.

Organic treatment is a special article. Because some drugs that are indicated for the treatment of some types of brain pathology are absolutely contraindicated for others. For example, nootropic drugs improve the activity of most brain centers.
But, if there is a lower threshold of convulsive readiness or some mental disorders or diseases (fear, anxiety, agitation, etc.), then this threatens to cause such a condition (epilepsy or psychosis, for example), which is many times worse and more difficult than that which we want to correct with the help of nootropics.

Treatment of organics is a long, if not lifelong process. At a minimum, you need to take vascular preparations twice a year for 1-2 months. But the accompanying neuropsychiatric disorders also require their own separate and special correction, which can only be carried out by a psychiatrist (by no means a neuropathologist, since this, in fact, is not his competence). The possibilities of one or two cycles of treatment are very relative and in most cases concern only minor symptoms.

To control the degree of effectiveness of the treatment of organics and the nature and magnitude of the resulting changes in the state of the brain, the control of the doctor himself at the reception and EEG, REG, and ultrasound is used.

It should also be noted that no matter how impatient the relatives of the organic patient or himself are, the rate of organic treatment cannot be significantly increased even theoretically. This is due to the fact that our body is a very perfect biochemical system in which all processes are stabilized and balanced. Therefore, the concentration of all chemicals, as those taking part in the natural biochemical metabolism human body, and alien to him, can not be higher than the allowable for a long time. For example, a person eats a lot of sweets at once. The body does not need that much glucose per day. Therefore, the body takes only what it needs, and the rest is thrown out with urine. Another question is that if too much sweet is eaten, then the removal of excess sugar will take some time. And the more glucose enters the body, the longer it will take to get rid of it.

It is precisely this moment that determines that if we introduce a 5-10-fold dose of vitamins for the brain into the body, then only the daily dose will be fruitfully absorbed, and the rest will be removed. In other words, in the correction of any metabolic processes there is its own logical sequence, a clearly defined pattern of transformation of the work of certain vital centers of the brain.

In some cases, when there is an acute pathology of the brain (concussion, stroke, etc.), it is permissible and justified to prescribe higher doses of drugs, but their effect will be short and aimed at correcting the newly emerged pathology. And the old pathology - organic matter already has an adaptive character in the body as a whole. A number of natural biochemical processes in the body have long been taking into account the available organic matter. Of course, not in the most optimal mode, but based on real opportunities and needs (organics can change in the body its system of assessing its needs and capabilities and these needs and capabilities themselves).

A. Altunin, Doctor of Medical Sciences,
psychotherapist of the medical and psychological center named after V.M. Bekhterev

A pathology characterized by cell death in the spinal cord or brain is an organic lesion of the central nervous system. With a severe course of the disease, the human nervous system becomes inferior, he needs constant care, because he cannot serve himself, perform labor duties.

However, with early detection organic disorder the prognosis is quite favorable - the activity of the affected cells is restored. The success of treatment is the complexity and usefulness of the treatment, the implementation of all the recommendations of the doctor.

Organic damage to the central nervous system has another name - encephalopathy. Its signs can be detected in most people after 65-75 years, and in some cases even in children - with toxic damage to the structures of the head. In general, experts divide the pathology into congenital and acquired forms - according to the time of traumatization and death of nerve cells.

Classification of pathology:

Due to appearance: traumatic, toxic, alcoholic, infectious, radiation, genetic, discirculatory, ischemic.
By time of appearance: intrauterine, early childhood, late childhood, adults.
By the presence of complications: complicated, uncomplicated.

In the absence of an obvious cause of death of nerve cells and the symptoms accompanying this process, there is an unclear ROP of the central nervous system (residual organic lesion of the central nervous system). At the same time, experts will recommend additional methods examinations to correctly classify the disease.

Causes of ROP in children

As a rule, an organic lesion of the central nervous system in children is a congenital pathology, which can be caused by acute severe or mild, but prolonged oxygen starvation of the site, which is formed during intrauterine development of the brain. Excessively long births. Premature abruption of the placenta - the organ responsible for feeding the baby inside the uterus. A significant weakening of the tone of the uterus and subsequent oxygen starvation of tissues.

Rarely cause irreversible changes in nerve cells fetus are infections carried by a woman - for example, tuberculosis, gonorrhea, pneumonia. If infectious agents have penetrated the protective membranes of the uterus, then they have an extremely negative effect on the course of pregnancy, especially at the stage of formation of the central head system.

In addition, the appearance of residual organic brain lesions in children can lead to:

birth trauma - when the fetus passes through the birth canal of a woman;
the propensity of the expectant mother to use tobacco, alcohol products;
daily inhalation of toxic substances by a pregnant woman - work in hazardous industries with high indoor gas pollution, for example, in paint and varnish factories.

The mechanism of development of ROP of the CNS in a child can be imagined as a distortion of information during cell division due to breakdowns in the DNA chain - brain structures are formed incorrectly, may become unviable.

Causes in adults

In most cases, specialists indicate various external causes as provoking factors for residual damage.

Traumatic brain injury, for example car crashes, household injuries. Infectious lesions - the main microorganisms of the viral nature of Coxsackie, ECHO, as well as herpes viruses, staphylococci, HIV infection. Intoxication - human consumption alcoholic beverages, narcotic drugs, tobacco, or frequent contact with salts of heavy metals, taking certain subgroups of medicines;

Vascular disorders - for example, ischemic / hemorrhagic strokes, atherosclerosis, various anomalies of cerebral vessels. Demyelinating pathologies - most often indicate multiple sclerosis, which is based on the destruction of the sheath of nerve endings. Neurodegenerative conditions are mainly syndromes that occur in old age.

Increasingly, neoplasms - tumors - lead to organic lesions of the central nervous system. When rapid growth, they put pressure on neighboring areas, injuring the cells. The result is an organic syndrome.

Symptoms in children

Signs of damage in babies can be observed from the first days of life. Such children are characterized by tearfulness, irritability, poor appetite and disturbing interrupted sleep. In severe cases, episodes of epilepsy are possible.

On early stage it is difficult to identify an organic lesion of the central nervous system even for a highly professional neuropathologist, since the movements of the baby are chaotic, and the intellect is still underdeveloped. However, p With careful examination and questioning of parents, you can establish:

violation of the muscle tone of the baby - hypertonicity;
involuntary movements of the head, limbs - more intense than it should be in children of the same age;
paresis / paralysis;
violation of the movements of the eyeballs;
sensory dysfunctions.

Closer to the year, organic lesions of the central nervous system will be indicated by symptoms:

lagging behind in intellectual development - the baby does not follow the toys, does not speak, does not fulfill the requests addressed to him;
a pronounced delay in general physical development - does not hold his head, does not coordinate movements, does not make attempts to crawl, walk;
fatigue children - both physical and intellectual, failure to assimilate the training program;
emotional immaturity, instability - rapid mood swings, self-absorption, moodiness and tearfulness;
various psychopathy - from a tendency to affects to severe depression;
infantilism of the personality - the increased dependence of the baby on the parents, even in household trifles.

Early detection and complex treatment damage to the central nervous system in childhood allows you to compensate negative manifestations and socialize the baby - he studies and works with his peers almost on an equal footing.

Symptoms in adults

If residual CNS damage in adults is due to vascular changes, it will appear gradually. Others may notice a person's increased absent-mindedness, memory loss, and intellectual capabilities. As the pathological disorder worsens, new symptoms and signs are added:

- prolonged, intense, different areas skulls;
nervousness - excessive, unreasonable, sudden;
dizziness - persistent, of varying severity, not associated with other pathologies;
jumps in intracranial pressure - sometimes up to significant numbers;
attention - scattered, difficult to control;
movements - uncoordinated, unsteady gait, fine motor skills suffer, up to the inability to hold a spoon, book, cane;
epilepsy - attacks from rare and weak to frequent and severe;
mood - changes rapidly, up to hysterical reactions, antisocial behavior.

Residual organic damage in adults is often irreversible, since its causes are tumors, injuries, and vascular pathologies.

A person's quality of life is reduced - he loses the opportunity to take care of himself, perform work duties, becomes a severely disabled person. To prevent this, it is recommended to seek medical help in a timely manner.

Diagnostics

With the manifestations of symptoms of an organic lesion of the central nervous system, a specialist will definitely recommend modern methods of laboratory, as well as instrumental diagnostics:

blood tests - general, biochemical, for antibodies to infections;
tomography - the study of brain structures through a variety of radiographic images;
brain tissue, as well as blood vessels;
electroencephalography - detection of a focus of pathological brain activity;
neurosonography - helps to analyze the conductivity of brain cells, reveals small hemorrhages in the tissue;
analysis of cerebrospinal fluid - its excess / lack, inflammatory processes.

According to individual needs, the patient will need to consult an ophthalmologist, endocrinologist, traumatologist, infectious disease specialist.

Only by examining the organic lesion of the central nervous system from all sides, the doctor gets the opportunity to draw up a complete scheme of drug therapy. Success in the fight against a negative state is the timely and complete establishment of provoking causes, as well as the fulfillment of all assigned medical measures.

Treatment tactics

Elimination of an organic lesion of the central nervous system is not an easy task, which requires maximum efforts from both doctors and the patient himself. Treatment will require time and effort, as well as finances, since the main emphasis is on rehabilitation - spa courses, specialized training, acupuncture, reflexology.

Only after the main cause of brain damage has been established, it needs to be eliminated - to restore blood circulation, improve nerve conduction of impulses between cells, remove a tumor or a blood clot.

Subgroups of medicines:

means for improving local and general blood circulation - nootropics, for example, Piracetam, Phenotropil;
drugs for the correction of mental processes, the suppression of perverted desires - Phenozepam, Sonopaks;
sedatives - on a plant / synthetic basis.

Additional procedures:

massage - correction of muscle activity;
acupuncture - impact on the nerve centers;
physiotherapy treatment - magnetotherapy, electrophoresis, phonophoresis;
swimming;
psychotherapeutic impact - classes with a psychologist to establish connections between the patient and the surrounding people, society;
speech correction;
specialized training.

The ultimate goal of therapeutic measures is to maximize the condition of a person with organic lesions of the central nervous system, improve his quality of life and adapt to the disease. Of course, the main burden of caring for such a patient falls on the shoulders of his relatives. Therefore, doctors also work with them - they teach the skills of administering drugs, the basics of gymnastics, and psychological behavior.

With due diligence and patience positive result and the impact will be obvious - the manifestations of residual encephalopathy will be minimal, life will be active, and self-care will be the maximum possible for the level of damage. ROP is not a sentence at all, but a severe test that can and must be overcome.

Lecture XIV.

Residual organic lesions of the CNS

Consequences of early residual-organic lesions of the central nervous system with cerebrasthenic, neurosis-like, psychopathic-like syndromes. Organic mental infantilism. Psychoorganic Syndrome. Attention deficit hyperactivity disorder in children. Mechanisms of social and school disadaptation, prevention and correction of residual effects of residual organic cerebral insufficiency and child hyperactivity syndrome.

Clinical illustrations.

^ EARLY RESIDUAL-ORGANIC CEREBRAL INSUFFICIENCY in children, a condition caused by lasting effects brain damage (early intrauterine brain damage, birth trauma, traumatic brain injury in early childhood, infectious diseases). There are serious reasons to believe that in recent years the number of children with the consequences of early residual organic lesions of the central nervous system has become more and more, although the true prevalence of these conditions is not known.

The reasons for the increase in the residual effects of residual-organic damage to the central nervous system in recent years are diverse. These include environmental problems, including chemical and radiation contamination of many cities and regions of Russia, malnutrition, unjustified abuse medicines, untested and often harmful dietary supplements, etc. The principles of physical education of girls - expectant mothers, whose development is often disturbed due to frequent somatic diseases, sedentary lifestyle, restrictions on movement, fresh air, feasible housework or, on the contrary, excessive participation in professional sports, as well as early onset of smoking, drinking alcohol, toxic substances and drugs. Improper nutrition and heavy physical labor of a woman during pregnancy, mental experiences associated with an unfavorable family situation or unwanted pregnancy, not to mention the use of alcohol and drugs during pregnancy, disrupt its proper course and adversely affect the intrauterine development of the child. The result of imperfect medical care, primarily the lack of any ideas of the medical contingent of antenatal clinics about the psychotherapeutic approach to a pregnant woman, full-fledged patronage during pregnancy, informal practice of preparing pregnant women for childbirth and not always qualified obstetric care, are birth injuries that disrupt the normal development of the child and affecting later on throughout his life. The introduced practice of “birth planning” is often brought to the point of absurdity, turning out to be useful not for the woman in labor and the newborn, but for the staff maternity hospital who has received the legalized right to plan his vacation. Suffice it to say that in recent years, children are born not at night or in the morning, when they are supposed to be born according to biological laws, but in the first half of the day, when tired personnel replace new shift. It also seems unjustified overindulgence caesarean section, in which not only the mother, but also the baby for quite a long time receives anesthesia, which is completely indifferent to him. The above is only part of the reasons for the increase in early residual organic lesions of the central nervous system.

In the very first months of a child’s life, an organic lesion of the central nervous system manifests itself in the form of neurological signs that are detected by a pediatric neurologist, and all the familiar external signs: trembling of the hands, chin, muscle hypertonicity, early holding of the head, tilting it back (when the child seems to be looking at something behind your back), restlessness, tearfulness, unjustified screaming, interrupted night sleep, delay in the formation of motor functions and speech. In the first year of life, all these signs allow the neurologist to register the child for the consequences birth injury and prescribe treatment (cerebrolysin, cinnarizine, cavinton, vitamins, massage, gymnastics). Intensive and properly organized treatment in non-severe cases, as a rule, has a positive effect, and by the age of one the child is removed from the neurological register, and for several years a child brought up at home does not cause much concern for parents, with the possible exception of some delay. speech development. Meanwhile, after being placed in a kindergarten, the child's characteristics begin to attract attention, which are manifestations of cerebral palsy, neurosis-like disorders, hyperactivity and mental infantilism.

The most common consequence of residual organic cerebral insufficiency is cerebrosthenic syndrome. Cerebrosthenic syndrome is characterized by exhaustion (inability to concentrate for a long time), fatigue, mood instability associated with minor external circumstances or fatigue, intolerance loud sounds, bright light and in most cases is accompanied by a noticeable and prolonged decrease in performance, especially with a significant intellectual load. Schoolchildren have a decrease in memorization and retention of educational material in memory. Along with this, irritability is observed, taking the form of explosiveness, tearfulness, capriciousness. Cerebrosthenic conditions caused by early brain damage become a source of difficulty in developing school skills (writing, reading, counting). The mirror character of writing and reading is possible. Speech disorders are especially frequent (delay in the development of speech, articulatory deficiencies, slowness or, conversely, excessive speed of speech).

Frequent manifestations of cerebrosthenia may be headaches that occur upon awakening or when tired at the end of lessons, accompanied by dizziness, nausea and vomiting. Often, such children have transport intolerance with dizziness, nausea, vomiting, and a feeling of lightheadedness. They also do not tolerate heat, stuffiness, high humidity, reacting to them with a rapid pulse, increase or decrease blood pressure, fainting states. Many children with cerebrovascular disorders cannot tolerate merry-go-rounds and other rotational movements, which also result in dizziness, lightheadedness, and vomiting.

In the motor sphere, cerebrosthenia manifests itself in two equally common variants: lethargy and inertia, or, on the contrary, motor disinhibition. In the first case, children look lethargic, they are not active enough, they are slow, they get involved in work for a long time, they need much more time than ordinary children to comprehend the material, solve problems, do exercises, think about answers; the mood background is most often reduced. Such children become especially unproductive in activities after 3-4 lessons and at the end of each lesson, when tired, they become drowsy or whiny. They are forced to lie down or even sleep after returning from school, in the evenings they are lethargic, passive; with difficulty, reluctantly, for a very long time preparing homework; difficulty concentrating and headaches are aggravated by fatigue. In the second case, fussiness, excessive motor activity, and restlessness are noted, which prevents the child from not only engaging in purposeful educational activities, but even playing a game that requires attention. At the same time, the child's motor hyperactivity increases with fatigue, becomes more and more disorderly, chaotic. It is impossible to involve such a child in the evenings in a consistent game, and in school years - in preparing homework, repeating the past, reading books; he almost fails to get to bed on time, so that from day to day he sleeps much less than his age.

Many children with the consequences of early residual organic cerebral insufficiency have features of dysplasia (deformity of the skull, facial skeleton, auricles, hypertelorism - widely spaced eyes, high palate, wrong height teeth, prognathism - protruding forward upper jaw, etc.).

In connection with the disorders described above, schoolchildren, starting from the first grades, in the absence of an individual approach to learning and mode, experience great difficulties in adapting to school. They are more than their healthy peers, sit through the lessons and even more decompensated due to the fact that they need a longer and more complete rest than ordinary children. Despite all efforts, they, as a rule, do not receive encouragement, but, on the contrary, are subjected to punishments, continuous remarks and even ridicule. After a more or less long time, they stop paying attention to their failures, interest in learning drops sharply and there is a desire for an easy pastime: watching all television programs without exception, outdoor games and, finally, craving for the company of their own kind. At the same time, direct skimping on school activities is already taking place: absenteeism, refusal to attend classes, escapes, vagrancy, early use alcoholic beverages, which often causes home theft. It should be noted that residual organic cerebral insufficiency greatly contributes to the rapid emergence of dependence on alcohol, drugs and psychoactive substances.

^ neurosis-like syndrome in a child with residual organic lesion The central nervous system is characterized by stability, monotony, stability of symptoms, its low dependence on external circumstances. In this case, neurosis-like disorders include tics, enuresis, encopresis, stuttering, mutism, obsessive symptoms - fears, doubts, fears, movements.

The above observation illustrates cerebrasthenic and neurosis-like syndromes in a child with early residual-organic lesion of the CNS.

Kostya, 11 years old.

The second child in the family. He was born from a pregnancy that proceeded with toxicosis of the first half (nausea, vomiting), the threat of miscarriage, edema and increased blood pressure in the second half. Childbirth 2 weeks ahead of schedule, was born with a double entanglement of the umbilical cord, in blue asphyxia, screamed after resuscitation. Birth weight 2700. Attached to the breast on the third day. He sucked sluggishly. Early development with a delay: he began to walk at the age of 1 year 3 months, utters individual words from 1 year 10 months, phrasal speech - from 3 years. Until the age of 2, he was very restless, whiny, and had a lot of colds. Up to 1 year old, he was observed by a neurologist for trembling of the hands, chin, hypertonicity, convulsions (2 times) with high temperature against the backdrop of acute respiratory disease. He grew up quiet, sensitive, inactive, awkward. He was overly attached to his mother, did not let her go from him, got used to kindergarten for a very long time: he did not eat, did not sleep, did not play with children, cried almost all day, refused toys. Until the age of 7, he suffered from nighttime urinary incontinence. He was afraid to be alone at home, fell asleep only by the light of a night lamp and in the presence of his mother, was afraid of dogs, cats, sobbed, resisted when he was taken to the clinic. With emotional stress, colds, troubles in the family, the boy had blinking and stereotypical shoulder movements, which disappeared with the appointment of small doses of tranquilizers or sedative herbs. Speech suffered from the incorrect pronunciation of many sounds and became clear only by 7 years after speech therapy classes. I went to school from the age of 7.5, willingly, quickly got acquainted with the children, but almost did not talk to the teacher, for 3 months. He answered questions very quietly, behaved timidly, uncertainly. Tired by the 3rd lesson, "lying" on the desk, could not absorb the educational material, ceased to understand the teacher's explanations. After school he went to bed and sometimes fell asleep. Lessons taught only in the presence of adults, often in the evenings complained about headache often accompanied by nausea. Slept restlessly. He could not stand the ride in the bus and the car - nausea, vomiting were noted, he turned pale, covered with perspiration. Felt bad on cloudy days; at this time, the head almost always hurt, dizziness, decreased mood, and lethargy were noted. In summer and autumn I felt better. The condition worsened at high loads, after diseases (acute respiratory infections, tonsillitis, childhood infections). He studied at "4" and "3", although, according to others, he was distinguished by high intelligence and good memory. He had friends, walked alone in the yard, but preferred quiet games at home. He began to study at a music school, but attended it reluctantly, cried, complained of fatigue, was afraid that he would not have time to do his homework, became irritable, restless.

Starting from the age of 8, as prescribed by a psychiatrist, twice a year - in November and March - he received a course of diuretics, nootropil (or cerebrolysin in injections), Cavinton, a mixture with citral, and a sedative mixture. If necessary, an additional day off was assigned. In the process of treatment, the boy's condition improved significantly: headaches became rare, tics disappeared, he became more independent and less fearful, and his academic performance improved.

In this case, it is about pronounced signs cerebrosthenic syndrome, acting in combination with neurosis-like symptoms (tics, enuresis, elementary fears). Meanwhile, with adequate medical supervision, the correct treatment tactics and a sparing regimen, the child fully adapted to the conditions of the school.

Organic damage to the CNS can also be expressed in psychoorganic syndrome (encephalopathy), characterized by a greater severity of disorders and containing, along with all the signs of cerebrosthenia described above, a decrease in memory, a decrease in the productivity of intellectual activity, a change in affectivity (affect incontinence). These features are called the Walter-Buhel triad. Affect incontinence can manifest itself not only in excessive affective excitability, inadequately violent and explosive manifestation of emotions, but also in affective weakness, which includes a pronounced degree of emotional lability, emotional hyperesthesia with over-sensitivity to all external stimuli: the smallest changes in the situation, an unexpected word cause in the patient irresistible and uncorrectable stormy emotional states: crying, sobbing, anger, etc. Memory impairment in psycho-organic syndrome varies from its slight weakening to severe mnestic disorders (for example, difficulties in remembering momentary events and current material).

With a psychoorganic syndrome, the prerequisites for intelligence are insufficient, first of all: a decrease in memory, attention and perception. The amount of attention is limited, the ability to concentrate decreases, absent-mindedness, exhaustion and satiety with intellectual activity increase. Violations of attention lead to a violation of the perception of the environment, as a result of which the patient is not able to cover the situation as a whole, capturing only fragments, separate aspects of events. Violations of memory, attention and perception contribute to the weakness of judgments and inferences, which is why patients give the impression of helpless and stupid. There is also a slowdown in the pace of mental activity, inertness and rigidity of mental processes; this manifests itself in slowness, stuck on certain ideas, in the difficulty of switching from one type of activity to another. Characterized by the lack of criticism of their abilities and behavior with a careless attitude to their condition, loss of a sense of distance, familiarity and familiarity. Low intellectual productivity becomes apparent with additional workload, but unlike mental retardation, the ability to abstract is preserved.

The psychoorganic syndrome can be temporary, transient (for example, after a traumatic brain injury, including birth trauma, neuroinfection) or be a permanent, chronic personality trait in remote period organic damage to the CNS.

Often, with residual-organic cerebral insufficiency, signs appear psychopathic syndrome which becomes especially obvious in prepubertal and pubertal age. For children and adolescents with psycho-organic syndrome, the most serious forms of behavioral disorders are characteristic, due to a pronounced change in affectivity. Pathological character traits in this case are mainly manifested by affective excitability, a tendency to aggression, conflict, disinhibition of drives, satiety, sensory thirst (the desire to receive new experiences, pleasures). Affective excitability is expressed in a tendency to excessive easy onset violent affective outbursts, inadequate to the cause that caused them, in fits of anger, rage, impatience, accompanied by motor excitement, thoughtless, sometimes dangerous for the child himself or those around him, and, often, narrowed consciousness. Children and adolescents with affective excitability are capricious, touchy, overly mobile, prone to unbridled pranks. They shout a lot, get angry easily; any restrictions, prohibitions, remarks cause them violent reactions of protest with malice and aggression.

Together with symptoms organic mental infantilism(emotional-volitional immaturity, uncriticality, lack of purposefulness of activity, suggestibility, dependence on others) psychopathic disorders in a teenager with residual organic damage to the central nervous system create the prerequisites for social disadaptation with criminal tendencies. Offenses are often committed by them in a state of alcohol intoxication or under the influence of drugs; moreover, for a complete loss of criticism or even amnesia (lack of recollection) of the criminal act itself, a teenager with a residual-organic lesion of the central nervous system suffices relatively small dose alcohol and drugs. It should be noted once again that in children and adolescents with residual organic cerebral insufficiency, addiction to alcohol and drugs develops faster than in healthy children, leading to severe forms of alcoholism and drug addiction.

The most important means of preventing school disadaptation in residual organic cerebral insufficiency is the prevention of intellectual and physical overload by normalizing the daily routine, the correct alternation of intellectual work and rest, and the exclusion of simultaneous classes in general education and special schools (music, art, etc.). Residual effects of residual-organic lesions of the central nervous system in severe cases are a contraindication for admission to school specialized type(with in-depth study of a foreign language, physical and mathematical, gymnasium or college with an accelerated and extended curriculum).

With this type of mental pathology, for the prevention of educational decompensation, it is necessary to timely introduce adequate drug course therapy (nootropics, dehydration, vitamins, lungs). sedatives etc.) under the constant supervision of a psychoneurologist and dynamic electroencephalographic, craniographic, pathopsychological control; early start of pedagogical correction, taking into account the individual characteristics of the child; classes with a defectologist on an individual basis; socio-psychological and psychotherapeutic work with the child's family to develop the right attitudes towards the child's capabilities and his future.

^ HYPERACTIVITY IN CHILDHOOD. A certain connection with residual-organic cerebral insufficiency in childhood is also hyperactivity, which occupies a special place, first of all, in connection with the pronounced school disadaptation caused by it - educational failure and (or) behavioral disorders. Motor hyperactivity is described in child psychiatry under various names: minimal cerebral dysfunction (MMD), motor disinhibition syndrome, hyperdynamic syndrome, hyperkinetic syndrome, attention deficit hyperactivity disorder in children, active attention disorder syndrome, attention deficit disorder (the latter name corresponds to the modern classification).

The standard for assessing behavior as "hyperkinetic" is a set of the following features:

1) physical activity is excessively high in the context of what is expected in this situation and in comparison with other children of the same age and intellectual development;

2) has an early onset (before 6 years);

3) long duration (or constancy in time);

4) is found in more than one situation (not only at school, but also at home, on the street, in a hospital, etc.).

Data on the prevalence of hyperkinetic disorders vary widely - from 2 to 23% of the child population. Hyperkinetic disorders that occur in childhood, in the absence of preventive measures, often lead not only to school disadaptation - poor progress, repetition, behavioral disorders, but also to severe forms of social disadaptation, far beyond childhood and even puberty.

Hyperkinetic disorder, as a rule, manifests itself already in early childhood. In the first year of life, the child shows signs of motor excitation, constantly spins, makes a lot of unnecessary movements, because of which it is difficult to put him to sleep and feed him. The formation of motor functions in a hyperactive child occurs faster than in his peers, while the formation of speech does not differ from normal time or even behind them. When a hyperactive child begins to walk, he is characterized by speed and an excessive number of movements, unrestraint, cannot sit still, climbs everywhere, tries to get different objects, does not respond to prohibitions, does not feel danger, edges. Such a child very early (from 1.5-2 years old) stops sleeping during the day, and in the evening it is difficult to put him to bed due to the chaotic excitement that grows in the afternoon, when he cannot play with his toys at all, do one thing, is naughty , playing around, running. Falling asleep is disturbed: even when physically restrained, the child constantly moves, tries to slip out from under the mother's arms, jump up, open his eyes. With pronounced daytime arousal, deep night sleep with long-lasting enuresis.

However, hyperkinetic disorders in infancy and early childhood preschool age are often regarded as ordinary vivacity within the framework of normal child psychodynamics. In the meantime, restlessness, distractibility, satiety with the need for frequent changes of impressions, and the impossibility of playing alone or with children without the persistent organization of adults gradually increase and begin to attract attention. These features already become apparent at the senior preschool age, when the child begins to prepare for school - at home, in the preparatory group of the kindergarten, in the preparatory groups of the general education school.

Starting from the 1st grade, hyperdynamic disorders in a child are expressed in motor disinhibition, fussiness, inattention and lack of perseverance when performing tasks. At the same time, there is often an increased background of mood with overestimation own capabilities, mischief and fearlessness, lack of perseverance in activities that especially require active attention, a tendency to move from one activity to another without completing any of them, poorly organized and poorly regulated activity. Hyperkinetic children are often reckless and impulsive, prone to accidents and disciplinary action due to violations of the rules of conduct. They usually have broken relationships with adults due to the lack of caution and restraint, low self-esteem. Hyperactive children are impatient, do not know how to wait, cannot sit during the lesson, are in constant non-purposeful movement, jump up, run, jump, if necessary, sit still, constantly move their legs and arms. They are, as a rule, talkative, noisy, often complacent, constantly smiling, laughing. These children need constant change activities, new experiences. A hyperactive child can consistently and purposefully engage in one thing only after significant physical exertion; at the same time, such children themselves say that they "need to discharge", "discharge energy."

Hyperkinetic disorders act in combination with cerebrosthenic syndrome, signs of mental infantilism, pathological personality traits, expressed against the background of motor disinhibition to a greater or lesser extent and further complicating school and social adaptation hyperactive child. Often, hyperkinetic disorders are accompanied by neurosis-like symptoms: tics, enuresis, encopresis, stuttering, fears - long-lasting ordinary childhood fears of loneliness, darkness, pets, white coats, medical manipulations, or quickly emerging obsessive fears based on a traumatic situation. Signs of mental infantilism in hyperkinetic syndrome are expressed in the game interests characteristic of an earlier age, gullibility, suggestibility, subordination, affectionateness, spontaneity, naivety, dependence on adults or more self-confident friends. Due to hyperkinetic disorders and features of mental immaturity, the child prefers only play activity, but it does not capture him for a long time either: he constantly changes his mind and direction of activity in accordance with who is near him; he, committing a rash act, immediately repents of it, assures adults that "he will behave well," but, getting into a similar situation, again and again repeats sometimes not harmless pranks, the outcome of which he cannot foresee, calculate. At the same time, because of affection, good-naturedness, sincere repentance for what he has done, such a child is extremely attractive and loved by adults. Children, on the other hand, often reject such a child, since it is impossible to play productively and consistently with him because of his fussiness, noisiness, the desire to constantly change the conditions of the game or move from one type of game to another, because of his inconsistency, variability, superficiality. A hyperactive child quickly becomes acquainted with children and adults, but also quickly "changes" friendships in the pursuit of new acquaintances and new experiences. Mental immaturity in children with hyperkinetic disorders determines the relative ease of the occurrence of various transient or more persistent deviations in them, violations of the process of personality formation under the influence adverse factors- both microsocial-psychological and biological. The most common in hyperactive children are pathological character traits with a predominance of instability, when the lack of volitional delays, the dependence of behavior on momentary desires and inclinations, increased subordination to outside influences, lack of skill and unwillingness to overcome the slightest difficulties, interest and skill in work come to the fore. The immaturity of the emotional and volitional personality traits of adolescents with an unstable variant determines their increased tendency to imitate the forms of behavior of others, including negative ones (leaving home, school, foul language, petty theft, drinking alcohol).

Hyperkinetic disorders in the vast majority of cases are gradually reduced by the middle of puberty - at 14-15 years. It is impossible to wait for the spontaneous disappearance of hyperactivity without taking corrective and preventive measures due to the fact that hyperkinetic disorders, being mild, borderline mental pathology, generate severe forms school and social disadaptation, leaving an imprint on the whole future life of a person.

From the very first days of schooling, the child finds himself in the conditions of the necessary fulfillment of disciplinary norms, the assessment of knowledge, the manifestation of his own initiative, and the formation of contact with the team. Due to excessive motor activity, restlessness, distractibility, satiety, a hyperactive child does not meet the requirements of the school and in the coming months after the start of studies becomes the subject of constant discussion in the teaching staff. Every day he receives comments, diary entries, he is discussed at parent and class meetings, he is scolded by teachers and the school administration, he is threatened with expulsion or transfer to individual training. Parents cannot but react to all these actions, and in the family a hyperactive child becomes the cause of constant discord, quarrels, disputes, which gives rise to a system of education in the form of constant penalties, prohibitions and punishments. Teachers and parents are trying to restrain his physical activity, which in itself is impossible due to physiological features child. A hyperactive child interferes with everyone: teachers, parents, older and younger siblings, children in the classroom and in the yard. His success in the absence of special methods of correction never corresponds to his intellectual natural data, i.e. he learns much worse than his abilities. Instead of motor discharge, which the child himself tells adults about, he is forced to sit for many hours completely unproductively preparing lessons. Rejected by family and school, misunderstood, unsuccessful child sooner or later begins to frankly skimp on school. Most often this happens at the age of 10-12, when parental control weakens and the child gets the opportunity to use transport on his own. The street is full of entertainment, temptations, new acquaintances; street is varied. It is here that the hyperkinetic child is never bored, the street satisfies his inherent passion for a continuous change of impressions. Here no one scolds, no one asks about academic performance; here peers and older children are in the same position of rejection and resentment; new acquaintances appear daily here; here for the first time the child tries the first cigarette, the first glass, the first joint, and sometimes the first shot of the drug. Due to suggestibility and subordination, the lack of momentary criticism and the ability to predict the near future, children with hyperactivity often become members of an antisocial company, commit criminal acts or are present at them. With the layering of pathological character traits, social disadaptation becomes especially deep (up to registration in the children's room of the police, judicial investigation, colony for juvenile offenders). In prepubertal and pubertal ages, almost never being the initiators of a crime, hyperactive schoolchildren often join the criminal ranks.

Thus, although the hyperkinetic syndrome, becoming especially noticeable already at a younger preschool age, is significantly (or completely) compensated during adolescence due to a decrease in motor activity and improvement of attention, such adolescents, as a rule, do not reach the level of adaptation corresponding to their natural data, since they are socially decompensated already at primary school age, and this decompensation can increase in the absence of adequate corrective and therapeutic approaches. Meanwhile, with proper, patient, constant treatment-and-prophylactic and psychological-pedagogical work with a hyperactive child, it is possible to prevent deep forms of social disadaptation. In adulthood, in most cases, signs of mental infantilism, mild cerebrosthenic symptoms, pathological character traits, as well as superficiality, lack of purposefulness, and suggestibility remain noticeable.

Misha, 10 years old.

Pregnancy with mild toxicosis in the first half; delivery at term, with a long anhydrous period, with stimulation. Born with a weight of 3300, cried after spanking. Early development of motor functions with advance (for example, he began to sit at 5 months, stood independently at 8 months, walks independently from 11 months), speech - with some delay (phrasal speech appeared by 2 years 9 months). He grew up very mobile, grabbed everything around, climbed everywhere, not being afraid of heights. Up to a year, he repeatedly fell out of the crib, hurt himself, constantly walked in bruises and bumps. He fell asleep with difficulty, he had to be rocked for hours, at the same time holding him so that he would not jump up. From the age of 2 he stopped sleeping during the day; in the evening he became more and more agitated, noisy, constantly moving, even when he was forced to sit. At the same time, he completely stopped playing with toys, did not find an occupation for himself, "lost about" idle, was naughty, interfered with everyone. In kindergarten - from 4 years. I got used to it right away, played only with the boys, not particularly singling out any of them; educators complained about his excessive mobility, senseless mischief, pugnacity. In the preparatory group, attention was drawn to restlessness, a lot of unnecessary movements even in relative peace, unwillingness to study, lack of curiosity, and distractibility. He was affectionate towards his parents, loved his younger sister, which did not prevent him from constantly bullying her, provoking scandals and fights. He repented of his pranks, but then thoughtlessly he could repeat the mischief. He started going to school at the age of 7. At the lessons he could not sit still, constantly fidgeting, chatting, playing with toys brought from home, making airplanes, rustling papers, not always fulfilling the tasks of the teacher. Distinguished by a good memory, he studied poorly - mainly at "3"; from the 5th grade, academic performance worsened even more, he did not always teach home lessons, only with the vigilant control of his parents and grandmother. During the lessons he was constantly distracted, whined, looked empty eyes, not assimilating the material, asked extraneous questions; left alone, he immediately found something to do - played with a cat, made airplanes, drew "horror stories" directly on notebooks, etc. He preferred to spend time on the street, came home later than the appointed time, every day promising to "correct himself." Remained overly mobile, did not feel the danger. Twice with a diagnosis of "brain concussion" (at the age of 7 he was hit on the head by a swing, at 9 years old he fell from a tree) and once due to a broken arm (8 years old) he was in the hospital. He quickly got acquainted with both children and adults, but there were no permanent friends. He did not know how to play one, even an outdoor game for a long time, interfered with the children or left in search of other entertainment. I have been smoking since the age of 8. From the 5th grade, he began to skip classes, several times did not spend the night at home for three days; after the police found him, he explained that he was afraid to go home after receiving several twos, fearing punishment. Sometimes he spent time in the boiler room, where he met adults, and spent the night there when he disappeared from the house. At the insistence of his parents, he began to attend sports sections and circles at school several times, but stayed there for a short time - he left them without explaining the reasons and without informing his relatives. After consulting a psychiatrist (at the age of 11), he began to receive phenibut and small doses of neuleptil, and was assigned to a folk dance school. A few months later he became calmer, more focused in his studies, at first under the supervision of adults, and then on his own, without missing, attended a dance school, was proud of his success, participated in competitions, and went on tour with the team. Achievement and discipline in the general education school have improved significantly.

The present case is an example of hyperdynamic syndrome in childhood, in which gross social disadaptation was avoided due to treatment and right action parents.

When determining preventive tactics in relation to a child with hyperactivity, first of all, it is necessary to think about the organization of the living space of a hyperactive child, which should include all the possibilities for the implementation of his increased motor activity. The morning hours preceding classes at school or attending a kindergarten, such a child should be filled with increased physical activity - the most appropriate running in the air, a fairly long morning exercise, training on simulators. As practice shows, after 1-2 hours of sports activities, hyperactive children sit more calmly in the classroom, are able to concentrate, and better learn the material. The organization of the first two lessons of physical education for such children is most adequate in elementary school. Unfortunately, in fact, this practice is not used in any school institution due to difficulties with the class schedule. Parents who understand the characteristics of the child sometimes organize physical exercises themselves, running in the fresh air before the start of classes, which immediately has a positive effect on the child's academic performance and discipline. Having dozens of children suffering from hyperkinetic disorder in one school, in order to predict school and social disadaptation in the future, the administration of each school is able to provide hyperactive children with the opportunity for adequate physical activity during breaks and after school. To do this, it is advisable to put simulators, trampolines, wall bars, etc. in a gym or other fairly spacious room (perhaps even in recreational corridors) and allow hyperactive children, under the control of one teacher on duty, to make changes in such a room. Along with the organization of increased physical activity during breaks, such children are also recommended increased physical activity during physical education classes at school. In addition, for children with motor disinhibition, for the development of perseverance, classes in sports sections are also useful, requiring great physical tension and movement and, at the same time, plasticity, attention, and fine motor actions; strength sports are not recommended. The earlier sports are introduced, the higher the positive effect, which primarily affects the performance of a hyperactive child. At the same time, the educational role of the coach is very important: if both the sport itself and the personality of the coach impress the child, then the coach is in the power to gradually and consistently demand that the student improve academic performance. The psychiatrist must explain to the parents the characteristics of their child, the origin of his excessive motor activity, lack of attention, inform them of a possible social prognosis, convince them of the need for a proper organization of the living space, as well as negative effect violent restriction of movements.

Among non-drug forms of prevention of social disadaptation in children with hyperkinetic disorders, it is also possible to conduct psychotherapy. The preferred approach in this case is behavioral psychotherapy. Given the wide range of family problems involved in pathoplasty disorders and arising in response to them, family therapy is indicated. After the end of the course, supportive psychotherapy, also including the child and the family, is advisable. The availability of medical and psychological services makes it possible to include work with teachers and educators in the assistance system, aimed at the possibility of supporting the child on their part. With signs of disadaptation in children's institutions and schools, the preferred psychotherapeutic approach is psychodynamic. It allows you to work with manifestations of individual reactions to school and emotional attitudes. Behavioral Therapy refers to changing the problem behavior of the child himself. Cognitive therapy is applicable to older students and is aimed at reorganizing the understanding of the school situation and the existing difficulties.

When hyperkinetic disorders are combined with cerebrasthenic and signs of increased intracranial pressure, for the prevention of educational decompensation, timely administration of adequate drug course therapy (nootropics, diuretics, vitamins, sedative herbs, etc.) is necessary with constant monitoring by a psychiatrist and neuropathologist and dynamic electroencephalographic, craniographic, pathopsychological control.

LITERATURE:

1. V.V. Kovalev. Psychiatry childhood. - Moscow. "Medicine". - 1995.

2. Guide to psychiatry. Edited by A.V. Snezhnevsky. - Moscow. - Medgiz. - 1983, Vol. 1

3. G.E. Sukharev. Clinical lectures on childhood psychiatry. - vol. I. - Moscow. "Medgiz". - 1955.

4. Handbook of psychology and psychiatry of children and adolescence. - St. Petersburg - Moscow - Kharkov - Minsk. - Peter. - 1999.

5. G.K. Ushakov. Child psychiatry. - Moscow. "Medicine". - 1973.

QUESTIONS:

1. What psychopathological disorders are typical for early residual organic lesions of the CNS?

2. What is the difference between cerebral palsy and encephalopathy?

3. Please name the basic principle of correcting the behavior of a hyperactive child.

The diseases of this section have a diverse nature and various mechanisms of development. They are characterized by many variants of psychopathic or neurotic disorders. A wide range of clinical manifestations is explained by the different size of the lesion, the area of the defect, as well as the main individual and personal qualities of a person. How more depth destruction, the clearer is the insufficiency, which most often consists in a change in the function of thinking.

Why Organic Lesions Develop

The causes of organic lesions of the central nervous system include:

1. Peri- and intranatal pathology(brain damage during pregnancy and childbirth).
2. Traumatic brain injury(open and closed).
3. Infectious diseases(meningitis, encephalitis, arachnoiditis, abscess).
4. Intoxication(abuse of alcohol, drugs, smoking).
5. Vascular diseases of the brain(ischemic and hemorrhagic strokes, encephalopathy) and neoplasms (tumors).
6. Demyelination diseases(multiple sclerosis).
7. Neurodegenerative diseases(Parkinson's disease, Alzheimer's).

A huge number of cases of development of organic brain damage occurs through the fault of the patient himself (due to acute or chronic intoxication, traumatic brain injuries, improperly treated infectious diseases, etc.)

Let us consider in more detail each cause of CNS damage.

Peri- and intranatal pathology

There are several critical moments during pregnancy and childbirth, when even the smallest impact on the mother's body can affect the health of the child. Oxygen starvation of the fetus (asphyxia), prolonged labor, premature detachment of the placenta, decreased uterine tone and other causes can cause irreversible changes in the cells of the fetal brain.

Sometimes these changes lead to the early death of a child before the age of 5-15 years. If it is possible to save a life, then such children become disabled from a very early age. Almost always, the violations listed above are accompanied by varying degrees expressiveness of disharmony of mental sphere. With reduced mental potential, they are not always sharpened positive features character.

Mental disorders in children can manifest themselves:

- at preschool age: in the form of a delay in the development of speech, motor disinhibition, poor sleep, lack of interest, rapid mood swings, lethargy;
- during the school period: in the form of emotional instability, incontinence, sexual disinhibition, impaired cognitive processes.

Traumatic brain injury

Traumatic brain injury (TBI) is traumatic injury skull, soft tissues of the head and brain. The most common causes of TBI are car accidents and household injuries. Traumatic brain injuries are open and closed. If there is a communication between the external environment and the cranial cavity, we are talking about an open injury, if not, a closed one. The clinic has neurological and mental disorders. Neurological consist in limiting the movements of the limbs, impaired speech and consciousness, the occurrence epileptic seizures, lesions of the cranial nerves.

Psychiatric disorders include cognitive and behavioral disorders. Cognitive disorders are manifested by a violation of the ability to mentally perceive and process information received from the outside. Clarity of thinking and logic suffer, memory decreases, the ability to learn, make decisions and plan ahead is lost. Behavioral disorders are manifested in the form of aggression, slow reaction, fears, abrupt changes mood, disorganization and asthenia.

Infectious diseases of the CNS

The spectrum of infectious agents that cause brain damage is quite large. The main among them are: Coxsackie virus, ECHO, herpes infection, staphylococcus aureus. All of them can lead to the development of meningitis, encephalitis, arachnoiditis. Also, lesions of the central nervous system are observed with HIV infection in its last stages, most often in the form of brain abscesses and leukoencephalopathy.

Mental disorders in infectious pathology are manifested in the form of:

Asthenic syndrome - general weakness, increased fatigue, decreased performance;
- psychological disorganization;
- affective disorders;
- personality disorders;
- obsessive-convulsive disorders;
- panic attacks;
- hysterical, hypochondriacal and paranoid psychoses.

intoxication

The use of alcohol, drugs, smoking, mushroom poisoning, lead to intoxication of the body. carbon monoxide, salts of heavy metals and various drugs. Clinical manifestations characterized by a variety of symptoms depending on the specific poisonous substance. Perhaps the development of non-psychotic disorders, neurosis-like disorders and psychoses.

Acute intoxications in case of poisoning with atropine, diphenhydramine, antidepressants, carbon monoxide or mushrooms are most often manifested by delirium. In case of poisoning with psychostimulants, an intoxication paranoid is observed, which is characterized by vivid visual, tactile and auditory hallucinations, as well as delusional ideas. It is possible to develop a manic-like state, which is characterized by all the signs manic syndrome: euphoria, motor and sexual disinhibition, acceleration of thinking.

Chronic intoxications (alcohol, smoking, drugs) are manifested:

- neurosis-like syndrome- the phenomenon of exhaustion, lethargy, decreased performance, along with hypochondria and depressive disorders;
- cognitive impairment(impaired memory, attention, decreased intelligence).

Vascular diseases of the brain and neoplasms

Vascular diseases of the brain include hemorrhagic and ischemic strokes, as well as dyscirculatory encephalopathy. Hemorrhagic strokes occur as a result of rupture of brain aneurysms or soaking blood through the walls of blood vessels, forming hematomas. Ischemic stroke is characterized by the development of a focus that receives less oxygen and nutrients due to blockage of the feeding vessel by a thrombus or atherosclerotic plaque.

Dyscirculatory encephalopathy develops with chronic hypoxia (lack of oxygen) and is characterized by the formation of many small foci throughout the brain. Tumors in the brain arise from a variety of causes, including genetic predisposition, ionizing radiation, and exposure to chemicals. Physicians are discussing the issue of influence cell phones, bruises and injuries in the head area.

Mental disorders in vascular pathology and neoplasms depend on the localization of the focus. Most often they occur with damage to the right hemisphere and manifest themselves in the form of:

Cognitive impairment (to mask this phenomenon, patients begin to use notebooks, tie knots "for memory");
- reducing criticism of one's condition;
- nocturnal "states of confusion";
- depression;
- insomnia (sleep disorder);
- asthenic syndrome;
- Aggressive behavior.

Vascular dementia

Separately, we should talk about vascular dementia. It is divided into Various types: associated with a stroke (multi-infarct dementia, dementia due to infarcts in "strategic" areas, dementia after a hemorrhagic stroke), non-stroke (macro- and microangiopathic), and variants due to impaired cerebral blood supply.

Patients with this pathology are characterized by slowing down, rigidity of all mental processes and their lability, narrowing the circle of interests. The severity of cognitive impairment in vascular lesion of the brain is determined by a number of factors that have not been fully studied, including the age of patients.

Demyelination diseases

The main disease in this nosology is multiple sclerosis. It is characterized by the formation of foci with a destroyed sheath of nerve endings (myelin).

Mental disorders in this pathology:

Asthenic syndrome (general weakness, increased fatigue, decreased performance);
- cognitive disorders (impaired memory, attention, decreased intelligence);
- depression;
- affective insanity.

Neurodegenerative diseases

These include: Parkinson's disease and Alzheimer's disease. These pathologies are characterized by the onset of the disease in old age.

The most frequent mental disorder in Parkinson's disease (PD) is depression. Its main symptoms are a feeling of emptiness and hopelessness, emotional poverty, decreased feelings of joy and pleasure (anhedonia). Dysphoric symptoms (irritability, sadness, pessimism) are also typical manifestations. Depression often co-occurs with anxiety disorders. Thus, anxiety symptoms are detected in 60-75% of patients.

Alzheimer's disease is a degenerative disease of the central nervous system characterized by progressive cognitive decline, personality disorder, and behavioral changes. Patients with this pathology are forgetful, cannot remember recent events, and are unable to recognize familiar objects. They are characterized by emotional disorders, depression, anxiety, disorientation, indifference to the outside world.

Treatment of organic pathology and mental disorders

First of all, it is necessary to establish the cause of the occurrence of organic pathology. This will depend on the treatment strategy.

In infectious pathology, antibiotics sensitive to the pathogen should be prescribed. With a viral infection - antiviral drugs and immunostimulants. For hemorrhagic strokes prompt removal hematomas, and in ischemic - decongestant, vascular, nootropic, anticoagulant therapy. In Parkinson's disease, specific therapy is prescribed - levodopa-containing drugs, amantadine, etc.

Correction of mental disorders can be drug and non-drug. The best effect shows a combination of both methods. Drug therapy includes the appointment of nootropic (piracetam) and cerebroprotective (citicoline) drugs, as well as tranquilizers (lorazepam, tofisopam) and antidepressants (amitriptyline, fluoxetine). Used to correct sleep disorders sleeping pills(bromisoval, phenobarbital).

Psychotherapy plays an important role in treatment. Hypnosis, auto-training, gestalt therapy, psychoanalysis, art therapy have proven themselves well. This is especially important in the treatment of children due to the possible side effects of drug therapy.

Information for relatives

It should be remembered that patients with organic brain damage often forget to take prescribed drugs and attend a psychotherapy group. You should always remind them of this and make sure that all the doctor's instructions are carried out in full.

If you suspect a psychoorganic syndrome in your relatives, contact a specialist (psychiatrist, psychotherapist or neurologist) as soon as possible. Early diagnosis is the key to successful treatment of these patients.