Infantile psychosis in children. Infantile disorder (personality infantilism): what is it, how is it manifested and treated

In psychiatry, atypical childhood psychosis refers to a range of psychotic disorders that affect young children. This is characterized by the presence of some manifestations that are typical of early childhood autism. Symptoms include movements that are repeated stereotypically, as well as lesions, echolalia, delayed speech development, and disturbed social relationships. Moreover, such disorders occur in children, regardless of their intellectual level, although more often atypical childhood psychosis occurs in children with mental retardation. If we talk about psychosis in general, then in children they are observed infrequently, and at the same time they are divided into two groups.

These are early childhood psychosis, which occurs in infants and preschoolers, and late childhood psychosis, which occurs in preadolescence and adolescence. Childhood autism, which belongs to the category of early psychoses, is characterized by the fact that the child does not seek to communicate with others, even with the closest parents. Usually such a child goes to the doctor about a serious deviation in speech development. Such a patient is distinguished by isolation, he can be alone for hours, and this does not bother him. All this time, the baby can enthusiastically engage in one toy, not paying attention to others. If someone tries to play with him together, the child does not react to it in any way. At the same time, if you try to interrupt his game, a very bright outburst of anger may follow.

The child falls to the floor, knocks with his feet, and so on. Actions are active, and often entail damage. The baby can follow the movement of his own fingers, or taste things. This indicates a high level of consciousness and the presence of sensitivity to certain stimuli. But there is a reduced response to pain, there is no orienting reaction that occurs to loud sudden sounds, which is a confirmation of a decrease in sensitivity to other stimuli. As a rule, there is a decrease in the mental abilities of the baby. But if speech is developed, then the abilities are quite adequate.

Features of the disease

It often happens that an autistic child has a certain isolated talent, and it is not clear what mechanism in this case implies the presence of atypical childhood psychosis. Observations of psychiatrists show that among the causes of the disease can be called brain damage, constitutional insufficiency, neurophysiological disorders, various autointoxications, chronic and acute infections, unfavorable environmental conditions. If a child has autism, then treatment, of course, is carried out, but it is sometimes ineffective. Tranquilizers are used only if aggressive behavior occurs. Treatment of such children is carried out in a hospital.

In atypical childhood psychosis, there is no clear clinical definition. The pathology itself, characteristic of the disease, occurs from the second year of life to the age of five. The appearance of a younger child in the family can act as a provoking factor, and at the same time the older one experiences panic, expressed very sharply. There is its combination with the regression of the behavior and abilities of the child in the intellectual plane. Speech before the onset of the disease can be fully mastered, but in this situation it loses its communicative function and becomes jargon. Symptoms can reach secondary level autism. At the same time, the condition is quite stable, chronic, similar to early childhood autism.

If we are talking about late childhood psychoses, then in this case the reactions are similar to those that occur in adults. This also causes symptoms. In this case, it is disturbed thinking, delirium, disordered behavior, rejection of existing interpersonal relationships. In this case, the child loses a sense of reality. If we compare with early psychosis, then late psychoses occur in those families that are at risk for. Although experts note that in this case the prognosis is more favorable. When prescribing conventional therapeutic measures, family and individual therapy, reception, and behavior modification are included. In acute periods of the disease, hospitalization is recommended.

When does atypical childhood psychosis appear?

It has now been established that the disease in this form of autism sometimes does not manifest itself for quite a long time, for years. If autism has a mild form, the main symptoms that distinguish atypical childhood psychosis are not detected. Therefore, it is not surprising that a lot of time is required to clarify the diagnosis, and everything happens with a delay. Moreover, patients with this disease have other disorders. However, their development is higher than the level of those patients who suffer from classic autism. At the same time, there are signs that can be called common. First of all, these are violations in the field of social interaction.

Symptoms have varying degrees expressiveness, and has a peculiar character. For example, some children experience complete indifference to interaction with others. Others, as the complete opposite, strive for communication. But at the same time they do not know how to build it correctly. In atypical childhood psychosis, patients often have problems with language acquisition, and sometimes they do not understand others. It is very noticeable that vocabulary the patient is limited, and obviously does not correspond to age. Each word is understood by patients only in its direct meaning.

In everyday life, "children's psychosis" young mothers call children's tantrums and growth crises. FROM medical point vision, everything is much more complicated and more serious: psychoses in children are rare, it is not so easy to make a diagnosis, but at the same time, this disease needs mandatory treatment and observation.
Childhood psychosis is not heart-rending screams and wallowing on the floor, which happen in almost every child. A psychotic disorder has a definite clinical picture, and in order to make a correct diagnosis in childhood, usually need advice from more than one specialist.

One of the main indicators of the clouding of the mind in a person is most often his speech. In psychosis, a person is not able to think coherently, and the flow of his speech clearly demonstrates the confusion, the chaotic nature of the sick consciousness.
Is it possible to diagnose psychogeny for sure in a child under three years old who has not yet attended kindergarten, and who does not know how to speak properly? Often, this is more difficult for a larger number of medical experts. In this case, the child's psychosis can be seen only by his behavior. It will also be difficult to determine when and for what reason the psyche was so seriously affected.
The subject of the doctors' dispute is also the delusions of reason that affect children in pre-adolescence. Medicine has classified childhood and adult psychotic disorders, but most doctors believe that even in pre-adolescence, the psyche can suffer to the point of psychogeny. Clinical picture at the same time, it has different symptoms, separating teenage, with a number of its differences, psychosis from a similar pathology in the early or adult periods of life.
It is important to distinguish pathology from other mental disorders in early age such as neurosis and hysteria. With many similar symptoms, it is psychoses in children that lead to the destruction of adequate consciousness and the loss of a real picture of the world.

Symptoms of childhood psychosis

Psychosis in children manifests itself in different ways, the symptoms in different forms pathologies are heterogeneous. However, most often a certain set of symptoms is manifested, such as:

1. hallucinations. The child sees objects, beings, events that do not exist in reality. Hears voices, smells, experiences tactile sensations of false origin.
2. Rave. The patient's consciousness is confused, which is clearly manifested in his speech. It has no meaning, no connection, no sequence.
3. Inappropriate behavior, for example, inappropriate fun, uncontrollable pranks. The child suddenly becomes extremely irritable out of the blue, begins to break toys, things, hurts animals.
4. Aggression, anger. When visiting a school or kindergarten, he speaks rudely and evilly with other children, is able to call names or hit, and is often aggressive with adults. On insignificant occasions, he reacts with sharp irritation.
5. Appetite is unstable: from strong greed for food to complete rejection of it.
6. Stupor. He freezes in one position for a long time, the position of his body and facial expressions do not change, his gaze freezes, his face expresses suffering, does not respond to external stimuli.
7. Abrupt change of state. The stupor is suddenly replaced by extreme excitability, high physical activity, combined with an aggressive attitude towards others.
8. Affects. Euphoria, fear, frequent bouts of melancholy, resentment, tears up to hysterical sobs.
9. Sleeps poorly at night, but constantly wants to sleep during the day. Headaches, high fatigue without external causes.
10. A febrile-like condition (combined with symptoms of impaired consciousness). The child has cold skin, severe sweating, dry lips, dilated pupils.

Signs of the destruction of consciousness should immediately cause alarm in parents. A child in the acute stage of the disease cannot attend school or kindergarten, and needs urgent hospitalization.

But is it possible for an ordinary person without medical education distinguish children's games and fantasies from hallucinations and delusions? After all, a little boy, playing, imagines himself a knight saving the princess from an evil dragon. Remember that in the case of psychopathy, a number of symptoms will be noticeable that indicate clouding of the mind. So a mentally ill person will actually see an evil monster and behave accordingly - show strong fear, aggression and other signs of a distorted perception of the world.

In children, the symptoms of psychosis have a number of age-related features. By one year, such a child may have partial or complete absence manifestations of emotions characteristic of infancy. At 2, 4, even at 6 months, the baby does not smile, does not “coo”. Against the background of healthy 8-9 month old babies, the patient is distinguished by the fact that he does not recognize the family, does not show interest in the world around him, he may experience obsessive monotonous movements.

At two years of age, a child with a psychotic disorder will show marked developmental delays. In a 3-year-old baby, an inadequate perception of reality will already be more obvious.

In young children, atypical childhood psychosis is distinguished. In terms of symptoms, it is similar to autism (one of its varieties even has a similar name - “infantile psychosis”). It can occur even in intellectually developed children (although it is more common in mentally retarded children).

The sick person will have poor contact with people, demonstrate a delay in speech development. It may be characterized by obsessive identical movements or uncontrolled repetition of other people's words (echolalia). When attending a kindergarten, such kids do not sharply fit into the general group, as they do not understand others and have difficulty adapting to the slightest changes.

Causes of pathology

To physiological reasons onset of psychotic disorders at an early age include:

1. Thyroid dysfunction.
2. Consequences of hormonal failure, puberty.
3. High fever caused by other diseases.
4. Side effects of chemotherapy, medications.
5. Meningitis.
6. Alcohol taken by a pregnant woman (fetal alcoholism) or while breastfeeding.
7. genetic inheritance.

Teenagers often have mental breakdowns as a result of getting into a stressful situation. Serious trauma for them can be the death of a loved one, conflict situations in the family or with friends, a sharp change in life circumstances.

Psychosis that arose against the background of psychotrauma in a teenager, like similar manifestations of the disease in adults, may not last long and disappears with the elimination of the stress factor.
But it is worth remembering that the tendency to psychotic disorders can be inherited, and then the course of the disease is more severe. Sometimes dysfunction of consciousness reaches disability, remaining all life.

Psychologist talks about how parental behavior can trigger the development of psychosis in a child

Variety of forms of the disease

Depending on many factors, the disease can proceed in different ways:

• quickly and rapidly, with a vivid manifestation of symptoms;
• long, but with sharp periodic bursts;
• quickly, but with unexpressed symptoms;
• the symptomatology develops over a long period, manifests itself dimly, sluggishly.

Depending on the age of patients, early (up to adolescence) and late (in adolescents) forms of pathology.

Psychotic states caused by external temporary factors are usually easier to diagnose and treat. The acute phase passes when the problem-provocateurs stop, although additional time is always required for the full recovery of the exhausted psyche.

In the case of a long stay of a person in a traumatic situation or brain damage caused by biochemical abnormalities (both congenital and provoked by taking medicines, diseases and other factors) an acute psychotic disorder develops into a chronic one. Protracted clouding of the mind is extremely dangerous for little man. From dysfunction brain activity intellectual development suffers, the child cannot adapt in society, communicate with peers, do favorite things.

Drug treatment and corrective psychotherapeutic course in severe forms of mental illness are mandatory. Especially dangerous is acute psychosis, when all the symptoms are very strong and bright, and the growth of pathological processes is rapidly.

Diagnosis of the disease

A detailed diagnosis of mental disorders is best done in a hospital under the constant supervision of doctors. For appointment effective therapy it is necessary to clearly determine the cause of the psychotic reaction.

In the examination, in addition to the psychiatrist, an otolaryngologist, a neuropathologist, a psychologist, a speech therapist must take part. In addition to a general examination of the body, the child also undergoes special testing of mental development (for example, a computer or written test for the level of development of thinking in accordance with the age group, speech coherence, picture tests, etc.).

Therapy and prevention of psychotic disorders at an early age

Small patients are prescribed a course of medications in combination with psychological correction sessions.

The symptoms and treatment prescribed to the child are directly related, since drugs are needed only in cases where the disease has led to biochemical disturbances in the body. "Heavy" forms of psychotropic drugs, such as tranquilizers, are prescribed only in the presence of aggressive conditions.

In cases where the disease is protracted, and not episodic, it is necessary to treat a young patient under the constant supervision of a psychiatrist.

The corrective effect of psychotherapy is especially noticeable when an emotional breakdown occurred as a result of experienced stress. Then, by eliminating the factor that caused the onset of the disease, and working with the internal attitudes and reactions of a small patient, the psychologist helps him cope with stress and develop adequate reactions to negative events in life.
Parents need to help their son or daughter follow the rules of a healthy life.

1. The child needs a measured daily routine, the absence of strong shocks and surprises.
2. It is unacceptable to show rudeness and physical violence to children, and measures of encouragement and punishment should be clear to them.
3. A benevolent and positive atmosphere in the family, love and patience between all its members help the patient return to normal life faster.
4. If the stressful situation was associated with a visit to an educational institution, then it makes sense to change schools or kindergartens.

All this is extremely important for the final and sustainable restoration of the psyche of a small patient.

The question arises, is it possible for children who have suffered a temporary clouding of their mind to hope for a complete cure and a full-fledged adult life? Will they be able to grow into adequate members of society, create their own families, have children? Fortunately, yes. With timely medical care and quality therapy, many cases of early psychogenia are cured completely.

original nootropic drug for children from birth and adults with a unique combination of activating and sedative effects

Effective pharmacotherapy and rehabilitation of patients with autism spectrum disorders

MD N.V. Simashkova
Scientific Center for Mental Health of the Russian Academy of Medical Sciences

Autism Spectrum Disorders (ASD) in childhood are attracting more and more attention from researchers and doctors general practice due to their high prevalence (50-100 per 10,000 children), resistance to pharmacotherapy, insufficient development of habilitation approaches, and disability of patients. Experts agree that therapy should be “multimodal”, doctors, psychologists, social educators, parents and teachers should actively participate in the development of treatment and rehabilitation programs. This contributes to the improvement social adaptation children with autistic disorders.

Analysis of literature data, taking into account the latest reviews on drug therapy showed that, despite some progress in this area, at the present stage, pharmacotherapy has not become a causal (pathogenetic) method of treating ASD. This is due to the fact that medications do not act on the cause of the disorder, they are prescribed for symptomatic therapy. various syndromes and RAS forms. As clinical observations show, none of the methods of treatment is effective for all patients, in addition, each method has its drawbacks. Autism is characterized by a disorder mental development, an autistic form of contact with others, speech and motor disorders, stereotyping of activities and behavior that lead to persistent social maladaptation. That is why autism must be diagnosed as early as possible in order to start habilitation measures in time, not to miss the sensitive periods of a child's development, when autistic symptoms are fixed and progressing. When diagnosing ASD, we relied on the ICD-10, adapted for practice in Russian Federation. ASD can be represented as a continuum of autistic disorders, on one side of which is the evolutionary-constitutional Asperger's syndrome, on the other - atypical childhood psychosis of schizophrenic origin; the central position is occupied by childhood psychosis (Fig. 1).

Rice. one. The autism spectrum disorder continuum

Asperger's Syndrome
Asperger's syndrome (F84.5) occurs in 30-70 children out of 10,000. Evolutionary-constitutional autism usually manifests itself during integration into society (visit kindergarten, schools). Patients have deviations in two-way social communications, non-verbal behavior (gestures, facial expressions, mannerisms, eye contact); patients are not capable of emotional empathy. Severe disturbances in attention and motor skills, lack of effective communication in society make them an object of ridicule, forcing them to change schools even with good intellectual abilities of the child. Patients with Asperger's syndrome have early speech development, a rich vocabulary, the use of unusual speech patterns, peculiar intonations, good logical and abstract thinking, as well as monomanic stereotyped interest in specific areas of knowledge. By the age of 16-17, autism softens, in 60% of cases a diagnosis of schizoid personality disorder (F61.1) can be made, in 40% of patients the condition worsens during developmental crises with the addition of phase-affective, obsessional disorders, often masked by psychopathic manifestations. With timely and effective pharmacotherapy, a favorable outcome of the disease is observed without further deepening of personality disorders.

Kanner syndrome
Clinical manifestations evolutive procedural Kanner syndrome (F84.0) determines asynchronous disintegrative dysontogenesis with incomplete maturation of higher mental functions. Kanner's syndrome manifests itself from birth and is characterized by the presence of the following disorders: this is a lack of social interaction, communication, the presence of stereotypical regressive forms of behavior. Receptive and expressive speech develops with a delay, there is no gesticulation, echolalia, cliched phrases, and egocentric speech are preserved. Patients with Kanner's syndrome are not capable of dialogue, retelling, do not use personal pronouns. The level of intellectual development is reduced in more than 75% of cases (IQ< 70). Крупная моторика, угловатая, с атетозоподобными движениями, ходьбой с опорой на пальцы ног. Отмечаются негативизм, мышечная дистония. Нарушения инстинктивной деятельности проявляются в форме расстройств eating behavior, inversion of the sleep-wake cycle. Severe autism persists throughout life. The absence of pronounced positive symptoms, progression, the tendency to partial compensation of an intellectual defect by the age of 6 serve as the basis for separating Kanner's syndrome into a separate subcategory of classical childhood autism within the framework of "general disorders of mental development". The prevalence of Kanner's syndrome in the population is 2 cases per 10,000 children.

Childhood psychosis
Manifest catatonic seizures occur in the first 3 years of life against the background of dissociated dysontogenesis or normal development. Catatonic disorders occupy a leading place in psychosis, are hyperkinetic in nature. Patients are excited, run in a circle or in a straight line, jump, sway, climb up with the dexterity of a monkey, perform stereotypical movements (athetosis, shaking hands, clapping). Slurred speech, with echolalia, perseverations. The severity of autism on the CARS scale is 37 points (the lower limit of severe autism). The duration of attacks is 2-3 years. The combination of catatonia with autism suspends the physiological development of the child during the attack and contributes to the formation of secondary mental retardation. In remission, patients have hyperdynamic syndrome as a secondary negative disorder at the exit from catatonia. There are affective and psychopathic (aggression, eating disorders, stool retention, urination) disorders, cognitive dysontogenesis with impaired attention, slowness of thought processes, motor clumsiness, with good cognitive activity. With the manifestation of childhood psychosis polymorphic seizures catatonic disorders, along with affective, neurosis-like ones, are noted only in a manifest attack. Autism in remission loses its positive component and decreases to an average of 33 points (mild/moderate according to CARS). The age and development factors (positive trends in ontogenesis), timely habilitation contribute to a favorable outcome in 84% of cases (6% - practical recovery, 50% - high-functioning autism, 28% - regenerative course). This allows us to consider child psychosis as a separate nosological unit "infantile autism" (F84.0), outside the diagnosis of schizophrenia.

atypical autism
The ICD-10 identifies several types of atypical autism (F84.1). If the disease begins to develop after the age of 3 years, then the clinical picture of atypical childhood psychosis (ADP) does not differ from childhood psychosis. Manifest regressive-catatonic seizures occur against the background of autistic dysontogenesis in the 2-3rd year of life. They begin with a deepening of autistic detachment with a rapid regression of speech, gaming skills, neatness, eating disorders (eating inedible). Catatonic disorders, mainly in the form of motor stereotypes, occur after negative symptoms, against the background of asthenia. In the hands, movements of the ancient archaic level are noted: washing, folding, rubbing type, beating on the chin, flapping the arms like wings. The duration of attacks in atypical childhood psychosis is 4.5-5 years. Regression, catatonia, severe autism contribute to the formation of an irreversible oligophrenic defect already in the period of a manifest attack. Remissions in atypical childhood psychosis are short-term, of low quality, with the preservation of catatonic stereotypes. Autism as a primary negative symptom of deficiency is observed in patients with ADP throughout the course of the disease in a severe form (mean 46 points according to CARS). The outcome of the disease is unfavorable. All patients are unteachable, in 1/3 of cases they are placed in boarding schools of the social security system. Negative dynamics in the course of the disease with an increase in cognitive deficit allows us to consider atypical childhood psychosis in the framework of childhood schizophrenia (F20.8). Atypical psychoses within the identified genetic syndromes in mental retardation(UMO) (F84.11, F70) have a phenotypically universal clinical picture in regressive catatonic seizures. They are traced in isolated genetic chromosomal syndromes (Martin-Bell, Down, Williams, Angelman, Sotos, etc.) of metabolic origin (phenylketonuria, tuberous sclerosis, etc.), where autism is comorbid with UMO. They are also united by the increase in asthenia from the “regression” stage. They differ in a set of motor stereotypes: subcortical catatonic type - in patients with atypical psychosis in Down syndrome, archaic catatonic stem type - in patients with Rett and Martin-Bell syndromes.

Rett syndrome
Rett syndrome (F84.2) is a verified degenerative monogenic disease caused by a mutation in the MeCP2 regulator gene, which is located on the long arm of the X chromosome (Xq28) and is responsible for 60-90% of cases of the disease. The prevalence of Rett syndrome is 1 in 15,000 children aged 6 to 17 years. The classic Rett syndrome manifests at 1-2 years of age with a peak at 16-18 months and goes through a number of stages in its development:

Death occurs 12-25 years after the onset of the disease.

Treatment and rehabilitation of patients with ASD
In connection with the improvement of psychiatric care, the expansion of the range of indications for the appointment of psychotropic drugs, the emergence of new dosage forms, features of drug pathomorphosis, the influence of the age factor on the results of therapy, the issues of pharmacotherapy and rehabilitation of ASD are of particular relevance. Habilitation efforts are aimed at stopping the positive symptoms of the disease, reducing cognitive impairment, mitigating the severity of autism, social interaction, stimulating the development of functional systems, and creating prerequisites for learning opportunities. In each case, before prescribing drug therapy, a detailed diagnosis and a thorough analysis of the relationship between the desired effect and undesirable effects are required. side effects. The choice of the drug is carried out taking into account the characteristics of the psychopathological structure of the disorder, the presence or absence of concomitant mental, neurological and somatic disorders. Difficulties in the psychopharmacotherapy of ASD are primarily due to the fact that new generation drugs (atypical antipsychotics, antidepressants) are not recommended for use in childhood for one reason or another (lack of drug testing, evidence-based efficacy, etc.). That is why the arsenal of drugs for the treatment of ASD is limited. When choosing a drug, one should be guided by the list of registered drugs approved for use in children and the recommendations of manufacturing companies in accordance with the laws of the Russian Federation (Tables 1, 2, 3). If there are pronounced fluctuations in affect (affective disorders) in the clinical picture, normothymic agents should be prescribed, which also have an antipsychotic effect (Table 4). Sodium valproate is also used to stop motor and behavioral stereotypes. Nootropics and substances with nootropic effects are widely used for all types of ASD (Table 5).

Table 1.

The most commonly used antipsychotics in patients with ASD

Table 2.

Most commonly used antidepressants in patients with ASD

Table 3

The most commonly used tranquilizers, hypnotics in patients with ASD

Table 4

Most commonly used anticonvulsants in patients with ASD

Table 5

Most commonly used nootropics in patients with ASD

Pharmacotherapy of patients with Asperger's syndrome
In the treatment of Asperger's syndrome, preference is given to course treatment with nootropics (Phenibut, Pantogam 250-500 mg / day); neuropeptides and their analogues (Cerebrolysin - 1.0 No. 10, Cortexin - 5-10 mg 2.0 No. 10, Cerebramin - 10 mg / day for 1 month, Semax 0.1% - 1 drop in the nose for 1 month), as well as cerebrovascular means (Cavinton, Stugeron). In SA with phasic affective disorders masked by psychopathic, obsessive-compulsive symptoms, antidepressants are administered: Anafranil (25-50 mg/day), Zoloft (25-50 mg/day), Fevarin (25-50 mg/day); normotimics, anticonvulsants - Finlepsin, Tegretol (200-600 mg / day); sodium valproate (Depakine, Konvuleks up to 300 mg / day).

Pharmacotherapy of patients with Kanner's syndrome
In patients with Kanner's syndrome, complex treatment. Antipsychotics aimed at the development of cognitive functions (Triftazin - 5-10 mg / day, Etaperazin - 4-8 mg / day, Azaleptin - 6.2525 mg / day) are combined with the course use of nootropics (Fenibut, Pantogam) - 250-500 mg /day; neuropeptides and their analogues (Cerebrolysin, Cortexin, Cerebramin, Semax 0.1%); multicomponent medicines(Instenon - 0.5-1 tab/day for 1 month, Actovegin - 1 tab/day for 1 month); cerebrovascular drugs (Cavinton, Cinnarizine, Stugeron); amino acids (Glycine 300 mg/day, Biotredin 100 mg/day); to stimulate the main analyzer systems, the glutamatergic drug akatinol-memantine is used - 1.25-2.5 mg / day.

Pharmacotherapy of patients with psychotic forms of autism
Patients with psychotic forms of autism (children's psychosis, atypical childhood psychosis, atypical psychosis in ULV) are also prescribed complex treatment with the basic use of antipsychotics. When excited, typical antipsychotics with a sedative effect are prescribed: Aminazine (25-75 mg / day), Tizercin (6.25-25 mg / day), Teraligen (5-25 mg / day), Sonapax (20-40 mg / day) ; Chlorprothixene (15-45 mg/day); Haloperidol (0.5-3 mg/day), etc. To overcome cognitive deficits, typical neuroleptics are used (Triftazin 5-10 mg/day, Etaperazin 4-8 mg/day), atypical neuroleptics (Azaleptin 6.25-25 mg/day , Rispolept 0.5-1 mg/day). To overcome developmental delay in an attack, and especially in remission, nootropics, neuropeptides, amino acids, drugs of other drugs are administered. pharmacological groups with elements of nootropic activity (Elkar). Among the drugs of the nootropic series, one can single out Pantogam with a wide range of clinical applications, which, in combination with Elcar, is used to treat attention deficit hyperactivity disorder (ADHD) at the exit from catatonic seizures in remission. The use of Pantogam contributes to the relief of asthenia, improvement of cognitive functions (cognitive activity, attention, memory), increases the rate of mental processes; mitigation of the manifestations of neurolepsy, which is especially important in childhood. Elkar as a means for correcting metabolic processes is used to treat eating disorders (one of the forms of psychopathic-like disorders in ASD). For the treatment of psychotic forms of ASD, normotimics, anticonvulsants - Carbomazepine, Finlepsin, Tegretol (200-600 mg / day) are used; sodium valproate (150-300 mg/day); tranquilizers are used - Seduxen, Relanium, Sibazon (2.5-5 mg / day), Clonazepam (0.5-1 mg / day); antidepressants - Amitriptyline (6.25-25 mg / day), Anafranil (25-50 mg / day); Ludiomil (10-30 mg/day); Zoloft (25-50 mg / day); Fevarin (25-50 mg/day). new stage in pathogenetic treatment DP and ADP of schizophrenic origin, both in Russia and abroad, is the combined use of neuroleptics with immunotropic agents, which allows you to overcome therapeutic resistance and promotes the development of higher mental functions.

Treatment of Rett syndrome and atypical autism in ULV
Therapy for Rett syndrome and atypical autism in UMO includes the use of neuropeptides and their analogues (Cerebrolysin, Cortexin, Cerebramin, Semax); amino acids (Glycine, Biotredin), cerebrovascular agents (Cavinton, Cinnarizine, Stugeron), anticonvulsants - carbomazepine (Finlepsin, Tegretol); sodium valproate (Depakine, Konvuleks). An indispensable tool for the correction of metabolic processes, especially those disturbed in the late stages of the course of Rett's syndrome, is Elkar (a drug related to B vitamins).

Non-drug correction
The complex use of drug and non-drug methods of treatment in combination with neuropsychological and psychological-pedagogical correction, social work with the patient and his family is one of the fundamental principles of curation of autistic disorders in children. Corrective work should begin at an early stage of the formation of autistic disorders, at physiologically favorable terms for the development of the child (from 2 to 7 years - the period of active ontogenesis), continue in subsequent years (8-18 years) and be carried out by a team of specialists (child psychiatrists, exercise therapy doctors , psychologists, speech therapists, defectologists, music workers, etc.).

Specialized care for children with autism
Stationary care is carried out in the departments of child psychiatry, where beds are open for the joint stay of the mother and child, and day semi-hospital. The main principle of treatment is a biosocial integrated approach, including medical, psychotherapeutic, defectological assistance under the programs of the National Center for Health Care of the Russian Academy of Medical Sciences of rehabilitation education - TEACCH; behavioral therapy - ABA, etc. The outpatient stage of care follows the inpatient or is independent and includes, along with drug therapy, a more extended pedagogical correction in centers for psychological, medical and social support, speech therapy, audiology, correctional kindergartens, schools, PND. have a positive effect on communication skills child with autism music lessons. By communicating with animals (horses, dogs, dolphins), children with ASD learn to build relationships with people. Getting an adequate education is one of the main and indispensable conditions for the successful socialization of children with ASD. Currently in Russia in the existing structure school education patients with ASD can be trained in special (correctional) educational institutions: for children with severe speech disorders (type V), for children with mental retardation (type VII), for mentally retarded children (type VIII), schools individual training at home for disabled children. In addition, the process of integrating children with ASD in educational institutions is developing in Russia. general type(correctional classes at educational institutions of a general type and teaching children with ASD in the same class as children without developmental disorders). It is possible to train patients with ASD according to an individual curriculum or according to an individual correctional training program.

Working with the family and environment of the child
Parents of patients with ASD also need help: psychotherapeutic support, learning how to get out of a crisis situation, ways of constructive interaction of all family members. Psychoeducational training for parents, focused on the needs of a particular child with autism, is one of the components of a multimodal family assistance program. Without specialized habilitation, most autistic children (75-90%) become severely disabled, while with timely and adequate correction, up to 92% get the opportunity to study according to the school curriculum, almost everyone can adapt to family conditions. The results of clinical follow-up (more than 20 years) of a cohort of 1400 patients aged 3 to 7 years with autistic disorders who received assistance in a semi-hospital for patients with autism at the Mental Health Research Center of the Russian Academy of Medical Sciences (1984-2010, show that 40% of patients were able to study under the program of mass and correctional schools for children with severe speech disorders (type V), 30% - in schools for children with mental retardation (type VII), 22% - in correctional schools for mentally retarded children (type VIII). Only 8% of sick children with malignant forms of autistic disorders are placed in boarding schools of the regional department of social protection.

conclusions
Autism in childhood remains an urgent problem in psychiatry today. Autistic disorders in children due to dissociation in the development of higher mental functions with asynchrony and the influence of positive tendencies of ontogenesis without exacerbations of the disease can be corrected with effective pharmacotherapy and rehabilitation. Much attention in the treatment of ASD is paid to nootropic drugs, means of correcting metabolic processes, among which Pantogam, Elcar are widely used in combination with antipsychotics and drugs of other pharmacological groups. More economical outpatient forms of care based on a multimodal approach occupy a leading place in the habilitation of patients.

Literature
N.V. SIMASHKOV. Effective pharmacotherapy and rehabilitation of patients with autism spectrum disorders

1. Bashina V.M., Kozlova I.A., Yastrebov B.C., Simashkova N.V. and others. Organization of specialized care for early childhood autism: guidelines. USSR Ministry of Health. M., 1989. 26 p.
2. Bashina V.M., Simashkova N.V. Autism in childhood // V.M. Bashin. Treatment and rehabilitation. M.: Medicine, 1999. S. 171-206.
3. ICD-10. International classification diseases (10th revision). Classification of mental and behavioral disorders. Clinical descriptions and instructions for diagnosis / ed. Yu.L. Nuller and S.Yu. Tsirkin. St. Petersburg: Overlaid, 1994. 303 p.
4. Childhood autism: reader / comp. L.M. Shipitsyn. St. Petersburg: Didaktika Plus, 2001, pp. 336-353.
5. Simashkova N.V. Atypical autism in childhood: diss. doc. honey. Sciences. M., 2006. 218 p.
6. Simashkova N.V. Modern approaches to the problem of autistic disorders in childhood (clinical, correctional and preventive aspects // Modern technologies health care in the protection of neuropsychic health of children: mater. scientific and practical. conf. Tula, 2009, pp. 77-78.
7. Simashkova N.V., Yakupova L.P., Klyushnik T.P. Interdisciplinary approaches to the problem of childhood and atypical endogenous autism // Proceedings of the III Congress of Psychiatrists and Narcologists of the Republic of Belarus "Psychiatry and Modern Society". 2009. S. 291-293.
8. Tiganov A.S., Bashina V.M. Modern approaches to understanding autism in childhood // Zhurn. nevrol. i psikhiat., 2005. T. 105. No. 8. S. 4-13.
9. Campbell M., Schopler E., Cueva J ., Hallin A. Treatment of autistic disorders // Journal of the American academy of Child and Adolescent Psychiatry. 1996 Vol. 35. P. 134-143.
10. Howlin P. Prognosis in autism: Do specialist treatments affect long-term outcome? // European Child and Adolescent Psychiatry. 1997 Vol. 6. P. 55-72.
11. Gillberg C. Autism spectrum disorders // 16th World Congress of International Association for child and Adolescent Psychiatry and Allied Professions. Berlin. 2004. P. 3.
12. Psychiatry of childhood and adolescence / ed. K. Gillberg and L. Hellgren, rus. ed. under total ed. acad. RAMS P.I. Sidorov. M.: GEOTAR-MED, 2004. 544 p.
13. Lovaas O.I. Bihavioral treatment and normal educational and intellectual fanctioning in young autistic children // Journal of Consulting and Clinical Psychology, 1987. Vol. 55. P. 3-9.
14. Child and adolescent psychiatry / per. with him. T.N. Dmitrieva. M.: EKSMO-Press, 2001. 624 p.
15. Rutter M. Genetic studies of autism: from the 1970s into the millennium // Journal of Abnormal Child Psychology, 2000. Vol. 28. P. 3-14.
16. Schopler E., Reichler R.J., DeVellis R.F., Daly K. Toward objective classification of childhood autism: Chilhood Autism Rating Scale (CARS) // Journal of Autism and Developmental Disorders, 1980. Vol. 10. P. 91-103.
17. Schopler, E., Reichler, R. J., Lansing, M. Strategien der Entwicklungs-forderung fur Eitern, Padagogen und Therapeuten. Verlag Modernes Lernen, Dortmund, 1983.
18. Schopler, E., Mesibov, G. B., Hearsey, K. Structured teaching in the TEACCH system // Learning and cognition in autism Current issues in autism. Plenum Press / E.Schopler, G.B. Mesibov, eds. New York, 1995. P. 243-268.

Psychosis in children atypical Various psychotic disorders in young children, characterized by some of the manifestations characteristic of early childhood autism. Symptoms may include stereotypically repetitive movements, hyperkinesis, self-injury, speech delay, echolalia, and impaired social relationships. Such disorders can occur in children with any level of intelligence, but are especially common in mentally retarded children.

Brief explanatory psychological and psychiatric dictionary. Ed. igisheva. 2008 .

See what "Psychosis in children atypical" is in other dictionaries:

"F84.1" Atypical autism- Type of general disorder development that differs from childhood autism (F84.0x) either in age of onset or in the absence of at least one of the three diagnostic criteria. So, one or another sign of abnormal and / or disturbed development for the first time ... ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic instructions. Research Diagnostic Criteria

List of ICD-9 codes- This article should be wikified. Please, format it according to the rules for formatting articles. Transition table: from ICD 9 (Chapter V, Mental disorders) to ICD 10 (Section V, Mental disorders) (adapted Russian version) ... ... Wikipedia

Delirium- (lat. delirium - madness, insanity). Syndrome of stupefaction, characterized by pronounced visual true hallucinations, illusions and pareidolia, accompanied by figurative delirium and psychomotor agitation, disorders ... ... Explanatory Dictionary of Psychiatric Terms

A pervasive developmental disorder defined by the presence of abnormal and/or impaired development presenting before the age of 3 years and abnormal functioning in all three areas of social interaction, communication, and restricted, repetitive behaviour. In boys, the disorder develops 3-4 times more often than in girls.

Diagnostic instructions:

There is usually no preceding period of undoubtedly normal development, but if there is, then anomalies are detected before the age of 3 years. Qualitative violations of social interaction are always noted. They act in the form of an inadequate assessment of socio-emotional signals, which is noticeable by the absence of reactions to the emotions of other people and / or the absence of modulation of behavior in accordance with the social situation; poor use of social cues and little integration of social, emotional, and communicative behaviour; the absence of socio-emotional reciprocity is especially characteristic. Qualitative disturbances in communication are equally obligatory. They act in the form of a lack of social use of existing speech skills; violations in role-playing and social simulation games; low synchronicity and lack of reciprocity in communication; insufficient flexibility of speech expression and the relative lack of creativity and fantasy in thinking; lack of emotional response to verbal and non-verbal attempts by other people to enter into a conversation; impaired use of tonalities and expressiveness of the voice to modulate communication; the same absence of accompanying gestures, which have an amplifying or auxiliary value in conversational communication. This condition is also characterized by limited, repetitive and stereotyped behavior, interests and activities. This is manifested by a tendency to establish a rigid and once and for all routine in many aspects of daily life, usually this applies to new activities, as well as old habits and play activities. There may be a special attachment to unusual, often hard objects, which is most characteristic of early childhood. Children may insist on a special order for non-functional rituals; there may be a stereotypical preoccupation with dates, routes, or schedules; motor stereotypes are frequent; characterized by a special interest in the non-functional elements of objects (such as smell or tactile surface qualities); the child may resist changes to routines or details of his environment (such as decorations or home furnishings).

In addition to these specific diagnostic signs Children with autism often present with a number of other non-specific problems, such as fears (phobias), sleep and eating disorders, temper tantrums, and aggressiveness. Self-injury (for example, as a result of biting the wrists) is quite common, especially with concomitant severe mental retardation. Most children with autism lack spontaneity, initiative, and creativity in leisure activities, and they find it difficult to use general concepts when making decisions (even when the tasks are well suited to their abilities). The specific manifestations of the defect characteristic of autism change as the child grows, but throughout adulthood this defect persists, manifesting itself in many respects by a similar type of problems of socialization, communication and interests. To make a diagnosis, developmental anomalies must be noted in the first 3 years of life, but the syndrome itself can be diagnosed in all age groups.

In autism, there can be any level of mental development, but in about three-quarters of cases there is a distinct mental retardation.

Differential Diagnosis:

In addition to other variants of general developmental disorder, it is important to consider: specific developmental disorder of receptive language (F80.2) with secondary socio-emotional problems; reactive attachment disorder in childhood (F94.1) or childhood attachment disorder of the disinhibited type (F94.2); mental retardation (F70 - F79) with some associated emotional or behavioral disorders; schizophrenia (F20.-) with unusually early onset; Rett syndrome (F84.2).

Included:

autistic disorder;

Infantile autism;

Infantile psychosis;

Kanner syndrome.

Excluded:

Autistic psychopathy (F84.5)

F84.01 Childhood autism due to organic brain disease

Included:

Autistic disorder caused by an organic brain disease.

F84.02 Childhood autism due to other causes

AUTISM CHILDREN

a property of a child or adolescent whose development is characterized by a sharp decrease in contacts with others, poorly developed speech and a peculiar reaction to changes in the environment.

F84.0 Childhood autism

A. Abnormal or impaired development manifests before the age of 3 years in at least one of the following areas:

1) receptive or expressive speech used in social communication;

2) development of selective social attachments or reciprocal social interaction;

3) functional or symbolic game.

B. A total of at least 6 symptoms from 1), 2) and 3) must be present, with at least two from list 1) and at least one from lists 2) and 3):

1) Qualitative violations of reciprocal social interaction are manifested in at least one of the following areas:

a) inability to adequately use eye contact, facial expressions, gestures and body postures to regulate social interaction;

b) inability to establish (in accordance with mental age and contrary to what is possible) relationships with peers, which would include common interests, activities and emotions;

c) the absence of socio-emotional reciprocity, which is manifested by a disturbed or deviant reaction to the emotions of other people and (or) the absence of modulation of behavior in accordance with the social situation, as well as (or) the weakness of the integration of social, emotional and communicative behavior.

d) the absence of a spurious search for shared joy, common interests or achievements with other people (for example, the child does not show other people the objects of interest to him and does not draw their attention to them).

2) Qualitative anomalies in communication appear in at least one of the following areas:

a) delay or complete absence of colloquial speech, which is not accompanied by an attempt to compensate for this lack of gestures and facial expressions (often preceded by the absence of communicative cooing);

b) relative inability to start or maintain a conversation (at any level of speech development) that requires communicative reciprocity with another person;

c) repetitive and stereotyped speech and/or idiosyncratic use of words and expressions;

d) the absence of spontaneous diverse spontaneous role-playing games or (at an earlier age) imitative games.

3) Restricted, repetitive, and stereotyped behaviors, interests, and activities that manifest themselves in at least one of the following areas:

a) preoccupation with stereotypical and limited interests that are anomalous in content or direction; or interests that are anomalous in their intensity and limited nature, though not in content or direction;

b) externally obsessive attachment to specific, non-functional acts or rituals;

c) stereotyped and repetitive motor mannerisms that include clapping or twisting fingers or hands, or more complex whole body movements;

G) increased attention to parts of objects or non-functional elements of toys (to their smell, touch of the surface, noise or vibration emitted by them).

B. The clinical picture cannot be explained by other types of general developmental disorder: specific developmental disorder of receptive speech (F80.2) with secondary socio-emotional problems; reactive attachment disorder of childhood (F94.1) or disinhibited attachment disorder in childhood (F94.2), mental retardation (F70-F72) associated with certain emotional and behavioral disorders, schizophrenia (F20) with unusually early onset and Rett syndrome (F84.2)

Childhood autism

see also Autism) - early childhood autism (English infantile autism), first identified as a separate clinical syndrome L. Kanner (1943). Currently, it is considered as a pervasive (general, multilateral) disorder, a distortion of mental development, due to the biological deficiency of the central nervous system. child; revealed its polyetiology, polynosology. R.d.a is noted in 4-6 cases per 10 thousand children; more common in boys (4-5 times more common than in girls.). The main features of R.d.a. are the child's congenital inability to establish affective contact, stereotyped behavior, unusual reactions to sensory stimuli, impaired speech development, early onset (before the 30th month of life).

Autism in children (infantile)

a relatively rare disorder, the signs of which are already detected in infancy, but usually established in children in the first 2 to 3 years of life. Childhood autism was first described by L. Kanner in 1943 in a work under a poor translation of its title “Autistic Disorders of Affective Communication”. L. Kanner himself observed 11 children with this disorder. He insisted that it had nothing to do with schizophrenia and was an independent form. mental disorder. This opinion is shared at the present time, although it is not argued in any way. Meanwhile, some patients have affective disorders mood, some symptoms of the disorder are actually identical to the manifestations of catatonia and parathymia, which may indicate an attack of schizophrenia suffered in infancy (E. Bleiler, as you know, believed that 1% of all cases of onset of schizophrenia belong to the first year of life after birth). The prevalence of childhood autism, according to various sources, ranges from 4-5 to 13.6-20 cases per 10,000 children under the age of 12, there is a tendency to increase. The causes of childhood autism have not been established. It is reported that it is more common in mothers who have had measles rubella during pregnancy. Indicate that in 80-90% of cases, the disorder is caused by genetic factors, in particular, the fragility of the X chromosome (see Fragile X Syndrome). There is also evidence that children with autism in early childhood anomalies of the cerebellum are detected or occur. In boys, the disorder occurs 3-5 times more often than in girls. In most cases, the signs of the disorder are detected at the age of children under 36 months, its most striking manifestations are between the ages of 2 and 5 years. By the age of 6-7 years, some manifestations of the disorder are smoothed out, but its main symptoms persist in the future. The symptom complex of the disorder is represented by the following main features:

1. the infant’s lack of a readiness posture when picking him up, as well as the absence of a revival complex when the mother’s face appears in his field of vision;

2. sleep disorders, digestion, thermoregulation and other, usually numerous somatic dysfunctions, difficulties in the formation of neatness skills, in other words, severe neuropathic manifestations that are observed already in the first year of life;

3. ignoring the child of external stimuli, if they do not hurt him;

4. lack of need for contacts, attachment, isolation from what is happening with an extremely selective perception of reality, detachment from others, lack of desire for peers;

5. lack of a social smile, that is, an expression of joy when the face of the mother or another close person appears in the field of view;

6. long-term lack of ability in a number of patients to distinguish between living and inanimate objects (up to 4-5 years). For example, a 5-year-old girl is talking to a working vacuum cleaner or refrigerator;

7. egocentric speech (echolalia, monologue, phonographisms), incorrect use of personal pronouns. Some patients show mutism for a long time, so that parents consider them to be suffering from muteness. Half of the children have significant speech development disorders, especially those related to the communicative aspects of speech. So, children cannot learn such social speech skills as the ability to ask questions, formulate requests, express their needs, etc. Up to 60-70% of patients are unable to master satisfactory speech. Some of the patients do not speak at all and do not respond to the speech of others until the age of 6-7 years;

8. neophobia, or more precisely, the phenomenon of identity (the term of L. Kanner), that is, fear of the new or irritation, dissatisfaction with changes in the external environment, the appearance of new clothes or unfamiliar food, as well as the perception of loud or, conversely, quiet sounds, moving objects. For example, a child prefers the same, almost utterly worn out clothes or eats only two types of food, protesting when parents offer him something new. Such children do not like new words and phrases either; they should be addressed only with those to which they are accustomed. Cases of a pronounced reaction of children's indignation even to omissions or substitutions of words in the lullabies of their parents are described;

9. monotonous behavior with a tendency to self-stimulation in the form of stereotypical actions (multiple repetition of meaningless sounds, movements, actions). For example, a patient runs up dozens of times from the first to the second floor of his house and just as rapidly descends, without pursuing any goal that is understandable to others. The monotony of behavior will most likely continue, and in the future, the life of such patients will be built according to some rigid algorithm, from which they prefer not to make any exceptions that cause them anxiety;

10. strange and monotonous games, devoid of social content, most often with non-game items. Most often, patients prefer to play alone and whenever someone interferes with their game or is even present, they are indignant. If they use toys at the same time, then the games are somewhat abstract from social reality. For example, a boy, playing with cars, lines them up in a row, along one line, makes squares, triangles out of them;

11. sometimes excellent mechanical memory and the state of associative thinking, unique counting abilities with delayed development of the social aspects of thinking and memory;

12. refusal of patients from sparing conditions during illness or the search for pathological forms of comfort during malaise, fatigue, suffering. For example, a child with high temperature it is impossible to put him to bed, he finds for himself the place where he sees the most;

13. underdevelopment of expressive skills ( masked face, expressing nothing, etc.), incapable of non-verbal communication, lack of understanding of the meaning of acts of expression of others;

14. affective blockade (in this case, we mean the poverty of emotional manifestations), underdevelopment of empathy, compassion, sympathy, that is, the disorder mainly concerns prosocial emotional manifestations, especially positive social emotions. Most often, patients are fearful, aggressive, sometimes show sadistic tendencies, especially in relation to the closest people and / or prone to self-harm;

15. the presence of significant, clinically significant motor restlessness in many patients, including various hyperkinesis, epileptic seizures are observed in a third of patients, serious signs of organic pathology of the brain are revealed;

16. lack of eye contact, patients do not look into the eyes of the person who comes into contact with them, but, as it were, somewhere in the distance, bypassing him.

There is no specific treatment for the disorder; they are mainly used special methods training, education. It is difficult to judge the results of work with patients, but there are very few publications reporting significant successes, if any. Some of the children subsequently fall ill with schizophrenia, in other, the most frequent cases, the diagnosis is limited to ascertaining mental retardation or autistic personality disorder. There are known cases of a combination of early autism with Lennox-Gastaut syndrome (Boyer, Deschartrette, 1980). See Lennox-Gastaut syndrome. See: Children's autistic pichopathy.