Attention deficit hyperactivity disorder

Attention and hyperactivity in the structure of affective disorders

Manic-depressive psychosis is virtually non-existent at an early age, with its typical phases beginning to manifest only by ages 12–14. At the same time, in adolescents the disease often runs a continuous course, meaning affective phases constantly succeed one another without lucid intervals.

It is precisely during the hypomanic phase that those around may notice symptoms outwardly resembling hyperactivity. The child becomes unexpectedly active, disobedient, and talkative. Marked restlessness and reduced attention are observed. The patient loses the ability to adequately assess their own strength and commensurate planned actions with real capabilities.

At the same time, the depressive phase looks different. Adolescents rarely complain of classic sadness. The condition is masked by somatovegetative disorders (constipation, sleep and appetite disturbances), persistent lethargy, moodiness, tearfulness, and refusal to communicate with peers. Unpleasant bodily sensations and feelings of worthlessness appear.

Childhood fears and pathological habitual actions

Many motor disorders in children are initially regarded as pathological habitual actions (nail biting, thumb sucking, body rocking). They bear an external resemblance to tics and in most cases disappear without a trace after puberty. An exception is trichotillomania (compulsive hair pulling), which is characterized by high persistence.

Childhood fears differ from adult phobias by their stereotypy and simplicity. Children are afraid of the dark, animals, loneliness, or fairy-tale characters.

Differential diagnosis of fears:

• Favorable prognosis: if the basis is an anxious-suspicious character. Later this may transform into panic attacks or obsessive-compulsive neurosis.
• Epilepsy equivalent: if fears manifest as recurring nightmares that cause the child to wake up.
• Suspicion of schizophrenia: if fears acquire a complex, far-fetched, fantastic character and are accompanied by hallucinatory experiences.

Adolescent behavioral syndromes

During puberty, antisocial acts may come to the fore, forming the so-called hebephrenic syndrome (delinquent behavior). The pathogenesis is associated with a decrease in moral control, loss of the understanding of good and evil, and disinhibition of sexual drive. Adolescents demonstrate extreme egocentrism, hostility toward loved ones, and a tendency toward vagrancy, theft, and the use of available psychoactive substances and alcohol. The etiology of such conditions may lie either in banal pedagogical neglect or acceleration, or in a progressive endogenous process (schizophrenia). Nevertheless, as they grow older, the symptoms often soften.

Another characteristic syndrome is dysmorphophobia (dysmorphomania). This is a morbid conviction in the presence of a physical defect. Patients persistently refuse to be photographed, resort to strange diets, and demand plastic surgery.

Two forms are distinguished:

1. Non-delusional: the patient retains a share of insight and maintains contact with the doctor. The prognosis is usually favorable.
2. Delusional: absolute conviction in the defect, distrust of others. Any attempts at reassurance are perceived as humiliating pity. It is often accompanied by olfactory hallucinations and is a sign of schizophrenia. Requires strict control due to the high risk of suicide or exhaustion (anorexia).

Features of schizophrenia and neuroses in children

Childhood schizophrenia is characterized by a predominance of behavioral and motor disorders (hebephrenic and catatonia symptoms), whereas adult-typical pseudohallucinations and delusions of control are extremely rare. A polarity of manifestations is noted: from complete passivity to drive disinhibition. A specific sign is mental retardation, outwardly resembling oligophrenia (a special form — pfropf-schizophrenia). One-third of such patients were mistakenly diagnosed with "neurosis" in childhood.

As for true neuroses, in young children they rarely have a defined picture. More often these are short-term reactions to fright or prohibitions, the risk of which increases with organic brain damage. The clinical picture is dominated by motor and somatovegetative disorders, such as tics, enuresis, and stuttering, rather than classic adult forms (hysteria or neurasthenia).

Class and exam questions

What else to study on this topic

• Clinical picture of hebephrenic syndrome
• Differential diagnosis of pathological fantasy
• Symptoms of neuroses in children with organic brain damage
• Evolution of childhood fears into adulthood

Other topics of the section "Chapter 27. Features of mental disorders in childhood and adolescence"

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