Mental disorders of childhood (up to 10

, Doctor of Medical Sciences, doctor of the highest category, head of the Department of Psychiatry and Medical Psychology, Russian National Research Medical University named after. N.I. Pirogova, chief physician of the Alter clinic:

Today in the series on comparative age aspects of mental disorders we will talk about mental disorders of childhood

We will talk about pre-pubertal age, that is, up to approximately 10–12 years, during which the child goes through several stages of his psychophysical development. This is a very important age from the point of view of the development of his mental functions, his personality, and character. This age also has its most significant periods. They are distinguished by the special vulnerability of the child’s psyche to external social, sometimes pathogenic factors. These periods of particular vulnerability are called age-related crises.

In childhood, age-related crises are well known to psychiatrists, psychologists, and teachers - these are the ages of 3 years and 7 years.

Formation of the first communication connections

At the age of 3, the child finds himself on the threshold of kindergarten. When, on one of the joyful days of September 1, his mother takes him to some strange institution, in which for some reason he must be without his parents for quite a long time, surrounded by very strange people who are similar to him, and even some kind of aunt , calling herself “the educator,” demands that he fulfill the requirements that are necessary.

This age is very important from the point of view of the formation of the child’s first communicative connections with peers. It is at this age, at 3 years old, that the first rudiments of role identity appear. The child begins to recognize himself as an individual and identify himself as an individual, separate from those around him. Finds in himself those traits that are not in others, and finds in others those traits that he does not have. He begins to understand the difference between himself and others, the first signs of his individuality are formed.

This is a very important period, and personally, I categorically do not advise ignoring preschool institutions, kindergartens, sports sections, clubs, where the child has the opportunity to develop a sufficient number of communication skills.

Children at home who sit with their grandparents around the clock and only go out in good weather to the sandbox in the yard are much less well adapted to school than those children who in preschool age had the opportunity to establish communicative connections and form their social role.

Diagnosis of childhood psychoses in medical

A child patient is in many ways similar to an adult in matters related to visiting a specialist. At an early age, he can be “lured” to a consultation in the form of a game, but when children are already capable of analyzing what is happening, this is much more difficult to do. Therefore, we tried to organize the appointment at the clinic in such a way that the visit to the doctor would be comfortable and would not cause fear in the future.

First of all, the doctor collects anamnesis and carefully listens to the story of the parents (guardians). The doctor is interested in :

whether there were cases of mental disorders in the family (or alarming symptoms - the person simply did not go to a specialized clinic);
when exactly changes in behavior appeared;
how the child behaves with peers during walks or in classes (in a kindergarten group or class), with adults;
does he show interest in the world around him, new toys, books, etc.;
behavioral characteristics (tendency to aggression, or vice versa, high spirits, euphoria);
possible causes of neurological disorders (pregnancy and childbirth, injuries, previous diseases).

The rooms are equipped with everything necessary so that while playing with a child, the psychotherapist has the opportunity to compare the level of development (both mental and emotional) with age, and assess the patient’s behavior in various situations.

Attention is also paid to other diagnostic methods. Prescribed:

encephalogram;
X-ray examination of the skull bones;
brain tomography;
angiography;
ECG;
Ultrasound of internal organs.

Standard clinical tests of blood and urine, determination of hormonal status, and assessment of basic metabolic parameters are also indicated. If deviations from the norm are detected, highly specialized specialists are invited for consultation.

Neurotic disorders of childhood

During this period, the child is stressed, he may have a large number of various types of neurotic disorders. And we know these disorders well. enuresis may suddenly appear

– urinary incontinence, we can observe bitten nails in these children. These children may experience a large number of fears; they refuse to sleep in a separate room with the lights off; even if they are forced to sleep in the nursery, they still find the opportunity to sneak into their parents’ bedroom at night and crawl under their blanket.

These children very often develop behavior problems

in case they face quite a lot of stress factors. And kindergarten teachers pay attention to these behavior problems. Sleep disturbances, bad mood, tearfulness, capriciousness, loudness, sometimes excessive demonstrativeness, posturing may appear - we call all this childhood neuroses or childhood neuroses.

Children do not display such neurotic symptoms as we are used to seeing in adults, because their affective emotional sphere has not yet matured, and they cannot experience this or that difficult life situation the way adults do, so most often they react with their bodies.

Children have a very developed psychosomatic reaction

. Their neuroses, as a rule, are of a somatic nature. As I already said, enuresis is one of the types of childhood neuroses. There is also stuttering - this, too, in 90% of cases is attributed to the psychological neurotic problems of the child. This also includes various kinds of conditioned diseases; most likely, they can be found in the form of symptoms from the gastrointestinal tract. Children may experience pain symptoms that are not confirmed by examinations.

Sometimes children experience what is called aspiration syndrome.

, when at the moment of just such another violent emotional reaction they suddenly begin to choke, they experience bronchospasm, the question arises that perhaps this is bronchial asthma. Well, and many, many other such polymorphic, unusual things that happen to children precisely during their age-related crises.

Symptoms

The clinical picture of childhood psychosis largely depends on the specific type of disorder. It is often noted:

abnormally elevated mood;
excessive playfulness, inappropriate, noisy fuss predominates;
disobedience;
motor activity;
verbosity.

Usually all of the above is accompanied by importunity, unceremoniousness, and cynical statements. The child seeks to provoke a conflict, behaves aggressively, and is extremely irritable. At the age of puberty, manifestations of sexual activity are likely.

Excessive mobility and activity is accompanied by an accelerated train of thought. This process manifests itself in many questions directed to parents and others (and usually children do not wait for an answer), commenting on everything that is happening around them. There is no feeling of tiredness or tiredness. There are severe sleep disturbances. Appetite increases, and increased food consumption is accompanied by weight loss.

With age, positive emotions are increasingly replaced by negative ones. Adolescents often exhibit antisocial, destructive behavior; attempts to escape from home during periods of exacerbation are not excluded.

In a child, psychosis may be accompanied by somatic symptoms:

abdominal pain, dyspepsia, nausea;
headaches, arrhythmia, blood pressure fluctuations;
neurodermatitis.

For many, it is against the background of psychosis that bronchial asthma, gastritis, and autoimmune disorders first appear.

Clinical signs indicating a severe course of the pathology deserve special attention. This:

hallucinations, replacement of reality with fictitious (heard in a fairy tale, seen on TV) images;
loss of interest first in studying, then in everything around him, in his appearance, hygiene, etc.;
aimless walks, sometimes the child cannot return home on his own;
loss of modesty;
delusional ideas;
obsessive fears.

Problems of school maladjustment

There is also a 7-year-old crisis. This is the age when a child starts school. And here he gains even more independence, here he begins to understand what responsibility is, begins to receive the inclinations of ideas about legal capacity, that is, the idea that his actions have some consequences, and these consequences are connected specifically with him.

At this age, the child is also quite vulnerable. First-graders can stumble already in the first months of school, we call this the problem of school maladaptation

. They are unable to establish connections with classmates, constant disagreements arise with the teacher, they refuse to go to school, they throw tantrums right in class, interfere with everyone’s learning by getting up from their seats, not realizing that they are not allowed to walk around the class. The reaction of teachers means nothing to them; this leads to a serious conflict with many participants in the school process, not only with classmates and teachers, but also with the school principal. And parents are also starting to take part in this.

Many parents take the child’s side, considering him undeservedly offended. They see the problem in the incompetence of teachers and begin to blame teachers, often adding fuel to the fire of these neurotic symptoms and behavioral disorders that I have already mentioned.

Is it possible to indulge whims?

What should a parent do if a child begins to act up?

Let's consider another example: the baby says that he doesn’t want to go home, but wants to go for a walk. And what should you do: do what the child wants or gently lead him to your decision? There are already some universal rules for such a situation. An adult is responsible for the daily routine, compliance with routine tasks, the number of cartoons watched, and the like. The child cannot control this. What to do? Warn the child in advance: “We’re leaving in five minutes,” “This is the last episode. In five minutes we turn off the cartoons.”

It is important not to cancel an important prohibition because of the child’s emotional reaction, otherwise the child will form a habit of responding to your restrictions with tears. And if a child over 4 years old lies down on the floor and starts screaming, then this already indicates errors in upbringing or neurological characteristics, and it’s time to seek advice from a psychologist or neurologist.

There should be a minimum number of prohibitions in a child’s life. Only that which is truly harmful to him or brings harm to others is prohibited.

Should parents stand their ground until the end?

It is almost impossible to come to an agreement with a small child under three years old. Children are situational. For a child, the strongest feeling is the immediate “I want.” Therefore, if you are sure of the correctness of your ban, then do not cancel it, even if the child screams and stomps his feet.

Use a parental trick when you can switch the child’s attention to another activity: put the bear to sleep, call the child to talk and discuss the cartoon.

How to react to hysteria?

The most correct thing is to temporarily stop interacting with the child. But if the baby runs after you and grabs your leg, then do not push him away, but give him the opportunity to calm down. Afterwards, take pity on him, hug him, tell him that you love him and are very glad that he stopped screaming.

If you go to some place where good behavior is required from your child, think in advance what will help you with this (books and toys, things interesting for the baby, a snack, the opportunity to get up from your seat sometimes, and so on).

Does a small whim always turn into hysteria?

There is no universal answer to this. Most likely not, that is, not every whim will develop into hysteria. Sometimes whining is a common way of communicating with adults, but the baby is not that upset. In addition, as children grow up, they understand where they can and cannot make demands and be capricious.

At what age can the first whim occur?

It is important to understand that if a baby under one year old cries and screams, then these are not whims. This means that something went wrong, the baby is experiencing discomfort and it is important to respond to his need. After a year and up to 6-7 years, the child’s ability to self-regulate develops, that is, he learns to understand and restrain his own emotions. There are especially many whims in children who do not yet know how to speak - they are not able to express their desires and sorrows in words.

Is it possible to predict the temperament and character of a child at an early age?

Temperament is an innate characteristic. A child can only learn to control his behavior. And character is formed on the basis of temperament and is associated with the conditions of upbringing, living, and behavior patterns in the family. It is possible to make some forecasts, but this is a very long process.

The child hits his head against the wall and hits his parents. What should I do?

The biggest trouble for a child is being ignored. No matter how painful it may be for you to hear your child banging his head, don’t give in. If possible, distract him with an interesting activity. But don’t focus on his behavior in any way. If the switch doesn’t work out, just wait.

And if a child swings at you, hold your hand and say out loud: “I understand that you are angry, but you can’t hit anyone.” Under no circumstances return blow to blow, otherwise this behavior will become ingrained in the child.

How to teach a toddler and older child to express their emotions differently?

Firstly, say it out loud and your emotions, both positive and negative. Secondly, it is important to be an example of restrained and constructive behavior for your child. Thirdly, in the development of emotional intelligence, children 3-4 years old are helped by playing with plush toys, when you act out different scenes: for example, a bear cub and a bunny quarreled, the bunny fights, they tell him: “Don’t fight!” The little bear understands everything and forgives the bunny for his reaction, but the little bunny doesn’t fight anymore. It is not necessary to draw instructive conclusions from this: “Here you behave like this.” The child's psyche very easily appropriates schemes that play with them, but this has a cumulative effect. So be patient, have a positive attitude, and your child will definitely learn.

In this article we wrote about what emotional intelligence is and how to develop it in a child.

What is recommended for emotional children?

Try to have some kind of angry pillow at home and tell your child that you can scream at it or hit it when you are angry. You can teach a child in those moments when he is angry to stomp his feet, scream, and moo. Your task is to show your child that it is normal to be angry, cry and protest. But you can’t harm someone. It’s bad when a child is forced to endure, is not allowed to cry and feel his emotions.

How to respond to the whims of an older child caused by jealousy of a younger one?

- Why do you feed him with a spoon, but not me? I want too!

In such a situation, we are not talking about whims.
This is called regression. This is a normal phenomenon when an older child sees that everyone is spinning around the baby and he also wants to be the center of attention. It is much more effective not to explain to the child that he is already big, but, on the contrary, to indulge his desire. Say: “You are my little one, let me spoon feed you.” Feed. Buy a pacifier if the child asks. The child will get tired of it very quickly. We've played and that's enough. Often the conditions for jealousy are created by the parents themselves, canceling the childhood of the older one because the younger one was born. It is important not only to give all children an equal amount of attention, but also to allow the eldest to remain a child.

Early mental illness. Mental retardation

In addition to neurotic disorders, quite serious mental illnesses can also begin in childhood, among which today, perhaps, we can classify two diseases as the most common of all other mental disorders of childhood.

The first disease is called mental retardation

. Unfortunately, it happens quite often. If we are talking about severe forms of mental retardation, then it attracts attention even in the first years of life. If we are talking about its mild or borderline forms, then this only manifests itself when the child goes to school, and from the first days he does not keep up with his peers in mastering the material.

Mental retardation can be different; there are many reasons for its occurrence. Among them are many different kinds of neurological or therapeutic, pediatric diseases that the child suffers from very early infancy. Or which started a little later. These include traumatic brain injuries, and some kind of neuroinfections, perhaps some kind of genetic, hereditary, chromosomal pathology, which leads to underdevelopment of the central nervous system and, accordingly, to mental disorders in the form of mental retardation.

Children with mental retardation are more vulnerable to neurotic symptoms, since in the case of mild mental retardation they understand and realize the fact of their inadequacy and see how they lag behind their peers. And they very often find themselves at the center of so-called bullying. Peers begin to mock them, painfully making fun of their odd behavior.

Childhood psychosis: main etiological factors

Due to their development, childhood psychoses (as, by and large, similar mental disorders in adults) are divided into endogenous and exogenous. The first group includes schizophrenia and autism (diagnosed more often), the second is more extensive and includes organic, somatic, and reactive psychoses. Considering the prevalence and availability of a variety of psychostimulants, specialists are often faced with narcotic psychoses that develop either against the background of an overdose or during severe withdrawal syndrome.

The most common causes of childhood psychoses (regardless of their form) are:

hereditary factors;
birth trauma, intrauterine hypoxia;
malformations of the central nervous system;
complications after meningitis or other neuroinfections;
consequences of head injuries, high, unbreakable temperature;
features of the course of pregnancy, including concomitant diseases in the mother, use of drugs, alcohol, etc. during pregnancy;
taking certain medications;
endocrine pathologies.

Speaking about the etiology of childhood psychoses, one cannot fail to mention the influence of external factors:

family relationships;
severe psychological trauma (divorce of parents, death of someone close);
relocation, change of staff at school;
natural disasters or other disasters that directly or indirectly affect the child.

But psychological factors alone extremely rarely become causes of psychosis in children. They are more likely to provoke various kinds of neuroses, which are more amenable to psychotherapy. But in the presence of concomitant pathologies, stress “triggers” a chain reaction ending in psychosis.

Autism Spectrum Disorders

The second most common mental disorder in childhood is autism spectrum disorder. Abbreviated as RAS. The structure of these disorders includes many different types of clinical units. One of the most striking and classic manifestations of autism spectrum disorder was described at one time by the domestic psychiatrist Grunya Efimovna Sukhareva and her foreign colleague Hans Asperger.

This form is now called Asperger's syndrome.

, that is, early childhood autism syndrome, in which a rather pronounced asynchrony of the child’s mental development occurs. In his development, we see a significant acceleration in relation to peers of intellectual, cognitive functions, and to a significant extent a lag in relation to emotional and volitional functions.

The personality of such a child is formed in a deformed way; he ultimately finds himself deprived of the mental capabilities for communication with peers. He has no choice but to withdraw into his own inner world, which is called the “autistic world.” Autistic world

- this is the world of his fantasies, attitudes, known very often only to him. Help for such a child can only be provided by a specialist who has managed to at least somehow look into this world, not to mention getting into this world and understanding its laws.

Atypical childhood autism

In addition to Asperger's syndrome, autism spectrum disorders also include other variants: Kanner's syndrome, Geller's syndrome - this is the so-called atypical childhood autism. We begin to talk about atypical childhood autism when, against the background of autistic manifestations, some psychopathological phenomena begin to appear in a child, indicating to us the onset of some kind of mental illness. For example, he begins to have some hallucinations, or he becomes so detached from what is happening that he generally stops reacting to what is happening around him and “freezes” - this is the so-called catatonia syndrome. However, a complete picture of mental illness does not emerge. And these symptoms are ultimately reversible.

We must remember that early childhood autism and all autism spectrum disorders are a very ambiguous group in prognostic terms. In particular, there are options that have a fairly favorable prognosis; literally, all manifestations of autism completely disappear with age and appropriate treatment. At the other pole are those forms of childhood autism that, with age, unfortunately transform into current mental illnesses, more typical of adolescence or adulthood.

Symptoms depending on the form of failure

Different symptoms of mental illness are justified by different forms of the disease. Common symptoms of the disease are:

hallucinations - the baby sees, hears, feels something that is not really there;
delusion – a person sees the existing situation in his own incorrect interpretation;
decreased clarity of consciousness, difficulty in orientation in space;
passivity, lack of initiative;
aggressiveness, irritability, rudeness;
obsession syndrome.
deviations associated with thinking.

Psychogenic shock often occurs in children and adolescents. Reactive psychosis occurs as a result of psychological trauma.

This form of psychosis has signs and symptoms that distinguish it from other mental spectrum disorders in children:

its reason is deep emotional shock;
reversibility - symptoms weaken over time;
symptoms depend on the nature of the injury.

Early age

At an early age, mental health problems manifest themselves in autistic behavior in the child. The baby does not smile or in any way show joy on his face. Up to a year, the disorder is detected in the absence of humming, babbling, and clapping. The baby does not react to objects, people, or parents.

Age crises, during which children are most susceptible to mental disorders from 3 to 4 years, from 5 to 7, from 12 to 18 years.

Early mental disorders manifest themselves in:

frustration;
capriciousness, disobedience;
increased fatigue;
irritability;
lack of communication;
lack of emotional contact.

Later ages up to adolescence

Mental problems in a 5-year-old child should worry parents if the child loses already acquired skills, communicates little, does not want to play role-playing games, and does not take care of his appearance.

At the age of 7, the child becomes mentally unstable, he has an appetite disorder, unnecessary fears appear, his performance decreases, and rapid fatigue appears.

At the age of 12-18, parents need to pay attention to their teenager if he or she develops:

sudden mood swings;
melancholy, anxiety;
aggressiveness, conflict;
negativism, inconsistency;
a combination of the incompatible: irritability with acute shyness, sensitivity with callousness, the desire for complete independence with the desire to always be close to mom;
schizoid;
refusal of accepted rules;
penchant for philosophy and extreme positions;
intolerance of guardianship.

More painful signs of psychosis in older children include:

suicide attempts or self-harm;
causeless fear, which is accompanied by palpitations and rapid breathing;
desire to harm someone, cruelty towards others;
refusal to eat, taking laxative pills, strong desire to lose weight;
increased feeling of anxiety that interferes with life;
inability to persevere;
taking drugs or alcohol;
constant mood swings;
bad behavior.

Onset of adult mental illness. Childhood form of schizophrenia

In addition, in childhood we can, unfortunately, observe the onset of adult mental illness. It is rare, however, that childhood forms of schizophrenia

. Its course is usually very difficult, unfavorable and malignant. In these cases, the child finds himself at the mercy of very severe painful symptoms when he hears voices or sees some visual images that cause him certain fears. When he, being in this psychotic state, hides from these ghosts, which seem very dangerous to him and are present somewhere nearby.

It is practically impossible to establish any contact with this child on a verbal level. The only way to help is to hospitalize him in a children's psychiatric hospital. Such hospitals exist; they specialize specifically in childhood mental illnesses, when specialists in this case have experience working specifically with children.

Analyzing the literature data on the current state of the problem, one can note the contradictory ideas about the clinical picture of schizophrenia in children and adolescents with this range of disorders, the incompleteness of information about the age-related evolution of delirium in the range of different forms of the disease and the insufficient clarity of the prognosis of these schizophrenias (1-18).

In this report we will talk about a variant of acute childhood and adolescent schizophrenia with affective-delusional and hallucinatory-delusional attacks.

12 children and 25 adolescents with schizophrenia and affective-delusional attacks were examined. The disease manifested itself at the age of 5-15 years. 95 attacks were studied, of which 39 were primary and 56 repeated. The duration of clinical follow-up was from 3 to 8 years.

In 18 patients, a few months before the manifestation of the process, moodiness, affective lability, as well as erased unipolar and bipolar mood disorders were detected. In two thirds of the observations there was depression with anxious fears and obsessions. In adolescents, depression occurred with loss of interest in the environment, life, and senesto-hypochondriacal manifestations. In the remaining third of observations, hypomania occurred, veiled by motor disinhibition, activity, talkativeness, and psychopathic manifestations in behavior. Hypomania was mild and, as a rule, short.

In these patients and the remaining 14, the latter - after episodes of obsessions, against the background of erased neuropathic manifestations, less often - of relative health, states of anxious mood developed with fear, sleep disorders, and frightening dreams. Adolescents also developed a feeling of impending disaster, a threat to existence, a fear of going crazy, and the presence of strangers. The surroundings began to be perceived as delusional, acquired an ominous, gloomy, unfamiliar appearance, fraught with a threat (“The gas water pump is evil”..., “The door with a chain is a policeman who could strike”...).

At the same time, a number of patients developed acoasmas, calls, auditory deceptions, photopsia (“The mouse squeaks”..., “The elephant stomps”..., “Sparkles in the corner”...). In adolescents, these were already distinct true verbal and olfactory hallucinations.

In 4 children and 3 adolescents, the condition was exhausted by the listed disorders and could be defined as anxious with delusional mood.

In 5 other children, further worsening of the disease led to confusion and fluctuating disturbances in orientation in the environment. At times the children did not recognize their relatives, hid from their mother and immediately called out to her and looked for her. They suddenly perceived their surroundings as illusory. At the same time, erased manifestations of delusional derealization and depersonalization were discovered. The children were frightened of their hands, noses, other parts of the body, clothes, and looked at them in bewilderment. Among the staff and patients they saw “scarecrows”, “Baba Yaga”, “hands”, “human heads”, various, often predatory, animals: “Here is a deer, a tiger ran”..., “There is a kitten on the wall”... There is a clear verbal qualification of these phenomena they didn’t have any problems. The presence of false recognitions and other perception disorders was usually established indirectly, by actions, behavior, children’s failure to recognize their relatives, confusion in a familiar situation, or based only on individual, fragmentary statements. In addition, children often stopped trusting their parents and staff, believed that they could harm them, thought that their mother was not their own, refused to eat gifts brought by their relatives, scattered them, trampled them, and could immediately greedily pounce on hospital food. In patients in this group, the condition no longer became more complicated, but a gradual recovery from psychosis was observed.

Of the remaining ones, in 3 children aged 8-10 years and 22 adolescents aged 11-15 years, the condition continued to change, sensory delirium with a changeable plot expanded, ideas of relationship, damage, “other people's parents”, influence, “harmful food” were discovered. Occasional perception disorders were represented by verbal hallucinations in the form of voices of unclear content, “conversation”, as well as visual hallucinations, often of a scene-like nature: “They are talking in the basement”..., “A rooster is climbing into the window”... Adolescents and 2 children formed ideas about the opposite acting forces - positive and negative, some defended the interests of the patient, others acted against. Some of the children's statements indicated the presence of delusions of meaning and staging. Thus, open doors and windows meant the possibility of “bad events.” “Old women and wolves walked through the department”..., “The doctor became either a devil or a doctor..., then she tried to help, then she harmed the patient..., she plotted intrigues against her.” In adolescents, these manifestations were more clearly expressed: “Everything changed, moved, girls moved from bed to bed”...

The anxiety state with delusional derealization was unstable and flickering. Periodically, orientation in the surroundings was restored for a short period of time.

With further aggravation of the condition (in isolated cases), erased catatonic disorders appeared, agitation with absurd impulsive actions, and lethargy were observed. At the same time, somato-vegetative disorders, rises in blood pressure, cyanosis of the extremities, hyperemia or paleness of the skin, weight loss, rise in temperature, dry or greasy skin, hair, pronounced under-eyes, cracked lips, dryness, coated tongue, smell of mouth, loss of appetite and other phenomena. Female teenagers often stopped menstruating.

The recovery from affective-delusional states was critical in 75% of observations, and lytic in the remaining 25%. During the period of recovery from the affective-delusional attack of the disease, affective disorders became apparent, in most cases occurring with a clear continuity. Depression with adynamia, inactivity, lethargy, detachment from others, lack of interest in games, dolls, activities, peers, and relatives predominated. Hypomania occurred with behavioral disturbances, foolishness, tactless actions, sometimes impulsivity, aproductivity, and disinhibition of drives. The children became gluttonous, took food from the plates with their hands, ate gifts brought with greed, did not take care of their clothes, were rude and cruel to their relatives, peers, and staff.

Criticism of the transferred state developed gradually and only in children older than 8-10 years. In children aged 5-7 years, the attitude towards the experience remained autistic in nature, without a sense of awareness of the disease. When asked about the painful condition, fear appeared in the younger children. They became wary, fearfully looked around them, peered at something in front of them, at the doctor, and then suddenly became brutal, as if remembering something, they could attack the doctor, staff, children, hit, push them. For some, a motor storm set in: children rushed about, hit themselves and those around them, screamed, threw things around, and pronounced vegetative reactions appeared. Brief reports about the experience were fragmentary, incomplete, and frightening in content.

Affective disorders in the post-attack state were detected for 6-20 months. Gradually they were reduced, from bipolar they turned into monopolar, more and more erased, they began to have a seasonal character, and later they arose only in connection with provocations and, finally, disappeared completely. Then there were negative personality disorders, autism, emotional withering, sharpening of premorbid character traits (inertness in habits and actions while maintaining the sthenic radical in the majority of patients, sthenic-asthenic in the minority, traits of psychaesthetic proportion in feelings). Affective disorders during the period of recovery from an attack and the establishment of remission for a long time and sharply complicated the adaptation of sick children and adolescents. As a result, there was a need to prescribe lithium, small doses of antidepressants, tranquilizers in combination with small doses of antipsychotics (neuleptil, sonapax, chlorprothixene) for a long time, until the condition stabilized.

Let's move on to characterize the variant of acute childhood and adolescent schizophrenia with hallucinatory-delusional disorders in attacks.

23 children and 17 adolescents were examined. The disease manifested itself at the age of 3-15 years. A total of 52 attacks were studied, of which 42 were primary and 10 were repeated. The duration of clinical follow-up is from 3 to 15 years.

6–42 months before the manifestation of psychosis, children experienced episodes of moodiness, crying, obsessive fears, and night terrors. Adolescents experienced atypical unipolar, with a predominance of depressive, and bipolar affective disorders, psychotic episodes, followed by an exacerbation of schizoid character traits.

In children, the disease manifested itself acutely with anxiety, sleep disorders, and hypnagogic illusory deceptions. The latter in children aged 3-5 years occurred in a drowsy state. Then behavior became disrupted and communication with family became disrupted. The children became fearful, their play disappeared, their appetite decreased, hyperesthesia and hyperacusis appeared, and agitated anxiety with tossing, restlessness, and dissatisfaction occurred several times during the day. When put to bed, the children became especially anxious, became protestful, refused to sleep in their usual place, shook off something from themselves, bedding, and could say: “There are mosquitoes there...”, “Bedbugs,” “Turtle,” etc. Questioning , persuasion increased fear.

In older children, aged 6-10 years, the manifest condition at the initial stage developed in almost the same

sequences, with acute or subacute anxiety at night and in the evening with hypnagogic illusory and hallucinatory deceptions. Children anxiously, crying, screaming looked at the stains on the wall, patterns of wallpaper, carpet, others threw off their laundry, shook something off, complained that someone was “biting” them, assured that there was a thread in their “finger”..., “there is hair in the mouth..., paper”..., “there is a cobweb on the curtain, there is a spider”..., “fear in the fan”, etc. The anxiety state was not relieved by persuasion, the children did not succumb to dissuading for a long time. During the daytime, the affect remained anxious, unstable, and at times anxious and angry. Phenomena of hyperesthesia were noted; confusion and false recognitions occurred at times. Children refused to communicate with their relatives, began to avoid and fear individual family members, did not always accept food from them, often rejected the toys they offered with protest and dissatisfaction. Sometimes they unexpectedly viciously attacked their relatives, with shouting and bitterness they committed aggressive acts. Based on some fragmentary statements, one could assume a distrustful attitude towards relatives and others, a fear that they would cause them harm, offense, or harm their health. Spontaneous activity was limited. The children were mostly inactive, walked around the room, not stopping their attention on anything, or, having climbed into secluded corners, could remain alone for a long time, listen to something, cover their eyes and ears with their hands, and mutter something inarticulate. This state was again unexpectedly interrupted by anxiety with aggression and destructive tendencies.

After 3-4 weeks, the anxiety began to subside and then, by questioning the patients, it was possible to confirm or identify for the first time the presence of illusory deceptions, true visual, tactile, olfactory hallucinations: “A voice in the head says something incomprehensible”..., “There is a conversation in the ears”..., “Cartoons before their eyes”... The children had an autistic attitude towards their experiences and answered questions with tension. In a number of patients at this stage, it was possible to identify the presence of monotonous dreams, repeating from night to night.

In some observations, delirium of metamorphosis was noted, at the height of which children perceived themselves in accordance with the plot of delirium (“Hands and hooves”..., “Nose and snout”, so they rolled around in the mud, “like a pig”...).

Of the 17 adolescents, 6, 11 -15 years old, the disease developed acutely, over several hours - days, starting with an anxious state with a delirious mood, a premonition of impending trouble, "misfortune", "madness", "threat" from others, feelings changes in one's own "I". Teenagers became suspicious, assumed “betrayal” of friends and relatives, “bad influence”, “bad attitude towards them”, “taking away their power”. The state of anxiety deepened, and a sensual delirium of relationship and influence was formed, often combined with stage-like ideas. Somato-vegetative disorders were detected. The fleeting everyday delirium of meaning and staging quickly took on the character of the fantastic and was accompanied by ideas about how it was done: “Evil forces stage a comedy for them”..., “give them visions”..., “sensations..., dreams.” Delusional derealization, depersonalization, and false recognitions were detected. At the same time, verbal and tactile, less often visual, hallucinations and ideas about the existence of antagonistic forces arose.

The acute period lasted 3-7 days, followed by a complication of the hallucinatory-delusional syndrome, which will be described below.

Of the 17, in 11 adolescents, 13–17 years old, the disease developed subacutely. Initially, over the course of 3-14 days, behavior became psychopathic, irritability and protest increased, interest in learning disappeared, elements of philosophical intoxication were noted, affective instability increased, and in some cases, with a tendency toward phasic behavior, anxiety. Then sleep was disturbed and frightening dreams appeared. In the drowsy state, hypnagogic and hypnopompic hallucinations occurred. Later, true verbal hallucinations were added, already in the form of a monologue or dialogue. Dreams acquired the character of caused, made, hallucinations - imperative, and later commentary. At the same time, visual hallucinations were also detected in patients - first true, and then pseudohallucinations. The latter in a number of patients were of a scene-like nature. In rare cases, there were tactile - “there are a crowd of cockroaches on the skin”..., olfactory - “smells like frogs” - and gustatory - “bitter water” - hallucinations.

During this period of the illness, sensory delirium was discovered, which acquired an increasingly polythematic character as it developed (relationships, influence, damage, damage, dysmorphophobia, special origin, influence). The plot of delusions often turned out to be associated with the content of verbal, visual, and tactile hallucinations. Subsequently, delirium remained unsystematized and it was precisely in patients of this age group that it was combined with ideas of being made (their actions are “directed by someone”..., they are “made sick”) and ideas of the influence of the patients themselves on others (they themselves can “mentally influence their enemies” "..., "hypnotize others"...).

The phenomena of mental automatism occupied a large place in the structure of the attack of the disease. At first, there were influxes of figurative ideas, a feeling of openness (“The patient’s thoughts are known to a certain person”...), with the appearance of which, which is especially typical for adolescents, arose the opposite feeling of confidence in the magical ability to “mentally communicate with others”, “read the thoughts of other people” . Subsequently, ideational ones arose - in the form of inspired thoughts, ideas (“The narcologist inspired thoughts”..., “evoked images of a demon, the devil”...), senestopathic (“Everything... causes a feeling of weakness in the body”...), speech motor (“My tongue responded in addition to will..."), motor automatisms ("The policeman makes movements for her..."), which complemented the formation of Kandinsky-Clerambault syndrome.

Some teenagers experienced a violation of physical self-awareness and alienation of their movements. Thus, one patient felt her heart was “dismembered”, another felt that her insides were “plastic, iron teeth”, the third perceived her movements as “slow, strange, similar to the movements of other people”...

At the exit from an attack of illness, mentism and sperrungs became obvious (“Thoughts in the head go in a continuous stream”..., “There are gaps, cliffs in my thoughts”...).

Affective disorders also occupied a prominent place in the clinical picture of the attack.

The way out of the attack is lytic. The duration of hallucinatory-delusional attacks is from 2 to 4.5-6 months.

In remissions, children showed labile affect or states of adynamic depression, residual fears, apprehensions, and movement disorders in the form of unnecessary movements, motor obsessions, and hyperkinesis. Adolescents in remissions retained residual delusions, hallucinations, and erased phenomena of mental automatism against the background of adynamic depression and unproductive hypomania with disinhibition of drives. Criticism of the psychotic state suffered was incomplete. The personality of the patients revealed emotional dullness, a cold attitude towards relatives, and a tendency toward hypochondriacal fears. Due to these manifestations, patients required continued treatment with antipsychotics (leponex, haloperidol, stelazine, etc.) and tranquilizers.

Concluding this message, it should be noted that the features of affective-delusional attacks in the range of acute childhood and adolescent schizophrenia include, first of all, their heterogeneous, reduced nature with the possibility of developing attacks of a full-blown type in older children and adolescents, approaching the clinical picture of those in adult patients.

In children under 5-8 years of age, the main clinical picture of attacks is an anxious mood with delusional mood. Sensual delirium in these states, as a rule, is completely absent, or, in extremely rare cases, is short-lived and rudimentary. Delirium is difficult to identify due to insufficient awareness of it and unclear verbalization. At the same time, in the state there is bewilderment, an illusory perception of the environment, often with the expectation of something incomprehensible and terrible. Anxiety in children, unlike adolescents, is much more labile. Their anxiety is masked by tearfulness, capriciousness incomprehensible to others, hysterical behavior with rude demands, aggression and malice. These conditions easily turn into difficult-to-control agitation with severe autonomic disorders.

In older children - at the age of 8-9 years - with good intellectual development, anxious-delusional states with elementary sensory delusions are formed. Its content is changeable and does not go beyond the limits of children's everyday ideas. Despite this, the range of delusional ideas is close to the ideas of relationships, stepparents, ideas of unhealthy food, and hypochondriacal ones. These ideas are not interpreted in any way; verbal reporting of them remains difficult.

In adolescents with an undeveloped picture of psychosis, rudimentary anxiety states with delusional mood and sensory delirium are also possible. However, in them these attacks of the disease occur more severely. alienation, distrust, isolation, significantly less lability of affect. In general, these states are more stable in adolescents, and upon recovery from them, an almost complete verbal interpretation of the experience is possible.

Finally, only in adolescents and in rare, isolated observations in children 9-10 years old, it is possible to detect affective-delusional disorders in attacks with almost the full range of figurative delusions, namely relationships, influences, meanings, staging, the action of two opposing forces and phasing their formation. It should be emphasized that the nature of the plot of delirium remains simple and ordinary, fantastic delirium is found mainly in boys, and in girls - erotic or fairy-tale content. Characteristic of attacks of this type is the presence in them, and then in isolated cases, of only symptoms of openness without other manifestations of Kandinsky-Clerambault syndrome. The latter, apparently, is explained primarily by the structural features of the affective-delusional state itself in acute attacks of recurrent schizophrenia. The rudimentary nature of the affective-delusional state, and most of all sensory delirium, can be linked to the mental immaturity of sick children. This assumption was confirmed by the results of follow-up observation of the group of patients under consideration. It turned out that in some patients the clinical picture in repeated attacks of the disease became more complicated mainly due to the expansion of the plot of sensory delusions, the appearance of distinct delusional depersonalization and derealization, the emergence of both ordinary and fantastic delusions of meaning, staging, ideas of the action of antagonistic forces and the staged development of the listed disorders . In repeated attacks of the disease, Kandinsky-Clerambault syndrome did not develop. In other patients, in the presence of signs of pronounced infantilism in the personality structure, regression of the delusional register was observed in subsequent attacks of schizophrenia, despite the fact that the disease as a whole did not acquire a regressive course.

Analysis of the clinical features of acute attacks of schizophrenia with a predominance of hallucinatory-delusional disorders allows us to come to the following conclusions.

In children aged 3-5 years, the main place in acute attacks of the disease is occupied by fear, anxiety, hypnagogic illusory and hallucinatory disorders. Visual and tactile deceptions predominate. Against this background, in isolated observations there may be a non-verbalizable feeling of hostility towards relatives that cannot be corrected.

In children aged 6-8 years, in clinically similar acute attacks of schizophrenia, also occurring with anxiety, fear, hypnagogic hallucinatory deceptions, first of all, the circle of hallucinations expands, acoasms, elementary calls appear, then verbal hallucinations, and finally, in children 9-10 years - pseudohallucinations, no longer associated with drowsy states. Visual and tactile deceptions often become the basis for the formation of delusions and ideas of metamorphosis; false recognitions, double negative and positive orientation - ideas of the double, antagonistic forces.

The hostile feeling towards relatives in these patients is verbally qualified and verbalized. These are not actually ideas of relationship, but ideas of the presence of something bad, evil in the people around them, and, as a rule, its carriers include the people closest to the sick child. In these ideas, it is often difficult to distinguish between the plot of relationship and influence from the hypochondriacal one. Delirium still occupies a small proportion in the structure of an attack of the disease; it is distinguished by its primitiveness, routine content, sensual nature and lack of system in it.

In children from the age of 8-10 years, it becomes possible for ideas of meaning to appear when they attach significance to ordinary events, facts, and objects.

In acute attacks in adolescents aged 11-15 years, a subsequent complication of the hallucinatory-delusional state and the formation of all its equivalents were observed. It is interesting that in a number of sick adolescents the initial stage of a hallucinatory-delusional attack is not noticeably different from that in young children already discussed above. As the disease deepens, first of all, the complication of hallucinatory disorders is observed, and finally, the formation of different types of pseudohallucinations becomes possible. Delusional disorders come first in the attacks of all these patients; the formulation and verbal qualification of the ideas of relationship, influence, influence become exhaustive. Despite the fleeting nature of ideas of meaning and staging in attacks of this type, they quickly take on a fantastic character. The plot of delusions of influence is also expanding, which is reflected in the ideas of witchcraft, hypnotic influence, and influence by various technical means. The patients' feelings, mood, dreams - everything flows with the character of a done thing. Delirium becomes figurative, sensual, and begins to be combined with phenomena of mental automatism, a feeling of mastery, influence, and openness.

It is in adolescents aged 15-17 years during these attacks of the disease that the formation of all types of mental automatism becomes possible: ideational, sensory, motor, mentism, openness of thoughts, their sound, the phenomenon of “unwinding of memories” become clear, the formation of Kandinsky-Clerambault syndrome becomes possible .

Thus, the study of two groups of paroxysmal schizophrenia in children and adolescents with an affective-delusional and hallucinatory-delusional structure of attacks in the age aspect reveals different pathokinesis of these conditions, depending both on the age maturity of the patient and on the form of the disease process. The dynamic study of the psychopathological structure of affective-delusional attacks in the age aspect is of interest, making it possible to trace the formation of all forms of sensory delirium. A similar study of the structure of hallucinatory-delusional states in the age aspect reveals to us the main trends in the development of hallucinatory disorders, figurative delusions and the formation of Kandinsky-Clerambault syndrome.

The data obtained in the study are of great scientific interest, revealing the age-related pathokinesis of delusions and hallucinatory disorders, and also have practical significance, since they can be used for the differential diagnosis of different forms of childhood and especially adolescent schizophrenia with affective-delusional and hallucinatory-delusional types seizures.

LITERATURE

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SUMMARY

The work is devoted to the clinical features of delusional attacks (in the age aspect) in the recurrent and fur-like course of schizophrenia in children and adolescents.

We studied 95 affective-delusional attacks in 12 children and 25 adolescents and 52 hallucinatory-delusional attacks that manifested at the age of 3-17 years. Clinical-dynamic and clinical-follow-up observation varied from 3 to 15 years.

A clinical description of anxiety states, anxiety states with delusional mood and rudimentary sensory delusions, affective-delusional states in the circle of recurrent schizophrenia and anxiety states with hallucinations, hallucinatory-delusional states in the circle of fur-like schizophrenia in the age aspect is given.

The dynamic study of the psychopathological structure of affective-delusional attacks in the age aspect made it possible to trace the formation of all forms of sensory delirium. A similar study of the structure of hallucinatory-delusional states is the main trends in the development of hallucinatory disorders, figurative delusions and the formation of Kandinsky-Clerambault syndrome.

Favorable treatment prognosis

There are also many other mental illnesses, it is almost impossible to cover everything. The only thing that needs to be said is that children with certain mental disorders, as a rule, are treated quite well, that is, it is sometimes possible to achieve much greater results with them than with adults. But only under one condition: if their relatives, especially parents, who are extremely concerned about the health of their child, agree with psychiatrists that their beloved child needs the help of a child psychiatrist.

Child psychiatry, as a rule, uses not only medical, that is, purely psychiatric technologies, with medications or some other methods of treatment. Psychologists are mostly involved in child psychiatry. Family psychologists conducting group psychotherapy, teachers, various kinds of educators, defectologists, speech therapists, and pediatricians participate in the provision of assistance. As a rule, this is a whole multi-professional team that takes on the child’s health and which jointly solves various aspects of his problem.

Seeking medical help in such a situation will greatly facilitate the task of diagnosis, since in child psychiatry there are many methods, including very accurate, almost 100% methods for diagnosing certain mental illnesses.

For example, genotyping is very widely used, when we can with a high degree of probability diagnose a particular disease associated with a mutation or genetics. The main thing is that the child is in the field of view of specialized specialists. The main thing is that he receives the medical care he needs on time in order for his future life to be healthy.

Providing professional assistance

Short-term attacks of psychosis in a child disappear immediately after their cause disappears. More severe diseases require long-term therapy, often in an inpatient hospital setting. Specialists use the same drugs to treat childhood psychosis as for adults, only in appropriate doses.

Treatment of psychoses and psychotic spectrum disorders in children involves:

prescription of antipsychotics, antidepressants, stimulants, etc.;
consultations with relevant specialists;
family therapy;
group and individual psychotherapy;
attention and love of parents.

If parents were able to identify a mental disorder in their child in time, then several consultations with a psychiatrist or psychologist are usually sufficient to improve the condition. But there are cases that require long-term treatment and being under the supervision of doctors.

Psychological failure in a child, which is associated with his physical condition, is cured immediately after the disappearance of the underlying disease. If the illness was provoked by a stressful situation experienced, then even after the condition improves, the baby requires special treatment and consultations with a psychotherapist.

In extreme cases, when severe aggression occurs, the child may be prescribed tranquilizers. But for the treatment of children, the use of heavy psychotropic drugs is used only in extreme cases.

In most cases, psychoses experienced in childhood do not return in adulthood in the absence of provoking situations. Parents of recovering children must fully adhere to the daily routine, do not forget about daily walks, a balanced diet and, if necessary, take care of taking medications in a timely manner.

The baby cannot be left unattended. If there is the slightest disturbance in his mental state, it is necessary to seek help from a specialist who will help him cope with the problem that has arisen.

To treat and avoid consequences for the child’s psyche in the future, it is necessary to follow all recommendations of specialists.