Causes of organic personality changes
Persistent changes in character and behavior may develop against the background of various organic lesions of the central nervous system. The main causes include:
- Infectious diseases: prion diseases (e.g., Creutzfeldt-Jakob disease), acute brain infections (encephalitis, rabies), and general infections complicated by CNS involvement.
- Intracranial tumors: mental disorders often become the first symptom when neoplasms are localized in "silent" areas (frontal lobes, corpus callosum, deep temporal lobe regions).
- Traumatic brain injuries (TBI): specific personality changes form in the remote period following head injury.
Clinical manifestations in various lesions
Symptoms depend on the nature and localization of the pathological process.
Intracranial tumors
The clinical picture consists of general cerebral symptoms (increased intracranial pressure, headache, vomiting, impaired consciousness) and focal symptoms. Of particular importance is involvement of the frontal lobes, which manifests either as increasing adynamia and passivity or, conversely, as disinhibition of drives and a sharp decrease in insight. In elderly patients, the clinical presentation is often modified due to concomitant atherosclerosis and atrophic processes.
CNS infections
Severe or protracted infections can lead to the development of psycho-organic syndrome (Korsakoff's syndrome or dementia). Depression often develops during the resolution phase of acute symptoms.
Head injuries
In the remote period of TBI, personality changes such as egocentrism, mental torpor, and persistent asthenia are observed. In severe cases, the development of dementia is possible, accompanied by euphoria or apathy and abulia.
Features of affective psychopathies
Persistent personality disorders may manifest as mood disturbances (cyclothymic spectrum).
- Hyperthymic personalities: distinguished by high activity, optimism, and agile thinking. They overestimate their capabilities, tend to dominate, and frequently conflict with others due to high self-esteem. Neuroses do not develop in them, but in situations restricting initiative, decompensation in the form of depression is possible.
- Hypothymic (dysthymic) personalities: characterized by pessimism, slowness, and lowered self-esteem. They experience failures with difficulty, are passive, and use the defense mechanism of devaluation.
When various psychopathic traits mix, a mosaic psychopathy is formed, leading to marked disharmony and extremely poor adaptation.
Dynamics of psychopathies
Psychopathy is considered a relatively stable state and does not have a classic course (there is no onset, progression, and outcome). However, dynamics are possible under the influence of psychological trauma, new experience, or internal cycles. P.B. Gannushkin identified the following variants of dynamics:
- Evolutionary changes: development of pathological traits as a person matures.
- Pathological reactions (decompensations): adaptation failure in stressful situations.
- Phases: fluctuations in state.
Briefly: answers to topical questions
What is included in the classic Walther-Büel triad in psycho-organic syndrome?
The classic Walther-Büel triad in psycho-organic syndrome includes memory impairments, intellectual decline, and affective disorders.
- Memory impairment — may manifest as memory decline, various types of amnesia, paramnesias.
- Intellectual impairment — decrease in the level of judgment and reasoning; later-acquired skills are affected first.
- Affective disorders — instability of affective reactions, rapid shift of affect.
How does Korsakoff's amnestic syndrome differ from dementia?
Korsakoff's amnestic syndrome is characterized by the relative preservation of intellect and past experience, as well as incomplete insight into the disease. Gross intellectual and memory disorders are described in sources for dementia; impaired insight is noted in certain types of dementia.
What mental disorders develop in the acute period of CNS infections?
Acute psychoses develop in the acute period of CNS infections, manifesting as exclusion or clouding of consciousness, primarily delirium and amentia. They occur predominantly in the evening against the background of pronounced fever and inflammatory changes in the blood and CSF. Depression develops more frequently during the resolution phase of acute symptoms, while manic and catatonia-like disorders are rare complications of infections.
Class and exam questions
How does traumatic brain injury affect personality in the long-term period?
In the remote period of traumatic brain injury, persistent asthenia, egocentrism, and torpidity (sluggishness) of mental processes develop. In severe injuries, dementia or Korsakoff's amnestic syndrome may develop.
Can psychopathy "progress"?
No, psychopathy is not a process and does not have a progressive course. Its changes (dynamics) are related to age stages (evolutionary changes) or decompensations under the influence of stress.
What else to study on this topic
- Clinical picture of prion diseases
- Acute psychoses in infectious diseases
- Symptoms of irritation and deficit in temporal and occipital lobe tumors
- Epileptic syndromes in brain tumors
- Differential diagnosis of mosaic psychopathy and schizophrenia
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