Debility – mild mental retardation, low level of intelligence (IQ 50-70). The main signs of moronity are the underdevelopment of abstract thinking, the inability to fully distract and generalize objects and phenomena of reality, the lack of critical abilities, the predominance of concrete thinking. Patients are unable to understand complicated relationships; their prospective assessment of what is happening and the possible consequences of their actions is inferior. Phrasal speech is developed, but the vocabulary is poor, speech is tongue-tied, often in the form of speech stamps.
The emotional and volitional sphere is characterized by underdevelopment of higher emotions, low differentiation and insufficient correction of affective reactions, obstinacy, increased suggestibility, lack of independence and initiative, lack of fine motor skills and coordination. Morons can have a good mechanical memory, master professions that do not require creativity, successfully work according to the pattern and adapt to life. They are also characterized by defects in physical development and physique, small deformities: irregular shape of the auricles, epicanthus, coloboma, hypertelorism, hypoplasia of the upper and lower jaw, syn- and polydactyly, congenital heart defects and other internal organs.
Diagnosis of debility in children under 3 years of age is difficult, since in healthy children during this period there is no abstract thinking. The lack of curiosity, interest in fairy tales, an understanding of the situation conveyed in fairy tales, and the ambiguous nature of games make one assume mental retardation. At preschool age, children do not learn spatial and temporal relationships, do not ask questions “why?” And “how?”, Cannot compose a story from a picture. Children of primary school age find it difficult to comprehend a simple plot picture or story, especially with a hidden meaning, cannot break away from a specific situation, try to apply old ways to solve new problems. Such children do not have the concept of number; they cannot use a hint. Children older children and adults do not understand the metaphorical meaning of proverbs and metaphors that do not emit the main, can not classify objects by leading features, draw conclusions, do not understand irony, without a sense of humor. The weakness of associative processes is compensated to some extent by mechanical memorization. Abstract concepts are external in nature, have no content, are used as stamps without understanding their meaning.
Depending on the nature of affective-volitional disorders, hyperdynamic (eretic, excitable) and adynamic (torpid, inhibitory) forms of oligophrenia are distinguished (O.E. Freyer, 1964, etc.). With hyperdynamic forms, an explosive-dysthymic or morio-like syndrome is observed, with adynamic forms, an apathetic-abulic or adynamic syndrome with periodic affective discharges. The hyperdynamic form of oligophrenia is characterized by disinhibition and violation of volitional regulation. With explosive-dysthymic syndrome, impulsivity, frequent mood swings, slight excitability, disinhibition of drives, a tendency to violent affective discharges with a narrowing of consciousness, fuzzy perception and partial amnesia, as well as excitement states inadequate to the external cause, are noted . Patients are not so much angry and dreary as irritably picky, tearful, demanding, aggressive. In the case of a morio-like syndrome, an increased mood background with foolishness and disinhibition predominates. Patients are mobile, annoying, cheeky, silly, gluttonous, erotic, stupid.
With the adynamic form of oligophrenia, there is a general inhibition of mental processes and akinesia; with apathetic-abulic syndrome – lethargy, slowness, apathy, poverty facial expressions. Changing the situation causes fear and confusion in patients. If you need to quickly complete the task, they are lost, cease to understand something. Some patients are calmly indifferent, happy with everything, others are tearful, hypochondriacal, inactive, they always have a low mood. Due to the lethargy and scarcity of affects, in some cases there is a need to differentiate oligophrenia and a simple form of schizophrenia. So, with schizophrenia, a history of dynamics is noted, dullness and perversity of affective reactions prevail. Apathetic-abulic dementia in organic cerebral lesions is characterized by the absence of such a uniform defect in intellectual activity.
In patients with adynamic syndrome and periodic affective discharges against the background of general adynamia, torpidity, poverty and unmodulated emotions, unmotivated excitement states often occur, which proceed as violent affective discharges, with a tendency to unmotivated aggressive-destructive actions without affective orientation and remorse ( psychopathy). Disinhibition of drives, grudge, hostility, a tendency to generalization of affect, and special intolerance to alcohol are noted (intoxication is accompanied by a sharp arousal with aggressive destructive tendencies, incorrigible sexual arousal, realized in dangerous and perverted forms).
Differentiated forms of hereditary oligophrenia – clinically defined diseases and syndromes with an established type of inheritance – make up about 50% of all genetically determined cases of general mental underdevelopment. The occurrence of these forms is due to anomalies in the set of chromosomes, as well as mutations in genes that function during the period of intrauterine development.
Allocate a rather large group of oligophrenia of preiatric origin, in which mental underdevelopment is combined with malformations of the skull and limbs. With primary (hereditary) microcephaly, the hemispheres of the large brain are underdeveloped, especially the frontal sections. Patients have an elongated head shape, a low and sloping forehead, the lower jaw is enlarged, long limbs with normal growth. Emotional reactions are primitive, patients are mobile, fussy, prone to imitation.
Primary craniosteiosis is a premature healed suture of the skull, leading to its deformation, intracranial hypertension. Aper syndrome (acrocephalosyndactyly) is inherited in an autosomal dominant manner, characterized by craniofacial dysostosis (tower skull, hypertelorism, exophthalmos, thickened nose, short nose, high palate, micrognathia, cleft palate, true symmetrical syndromy, often) . Cruson’s disease has a phenotypic similarity with Aper syndrome, but with it there are no malformations of the limbs. The main sign of acrodysostosis is peripheral dysostosis (in patients with small hands with short thick fingers, the back surface of the hands and fingers is covered with many folds and swelling). Pituitary dwarfism and cerebral gigantism also belong to dysostosis forms of oligophrenia.
Chromosomal forms of oligophrenia in 60% of cases are associated with autosomal abnormalities, in 40% of sex chromosomes.
The phenotype of autosomal abnormalities is characterized by many dysmorphies. Anomalies in the structure of the face are especially often observed: a peculiar section of the eyes, hypertelorism, epicanthus, micrognathia; an almost constant sign is deformation, violation of the size or location of the auricles, small size of the skull and its deformation (brachycephaly, dolichocephaly, plagiocephaly, acrocephaly). Dysraphic symptoms are often noted: non-infection of the palate, colobomas of the iris. The physique is dysplastic, there is syndactyly, hypoplasia of the phalanges, a change in dermatoglyphics, malformations of internal organs, and defects in the development of the genitourinary system are often found. Mental development is abnormal from birth, and its evolutionary dynamics is extremely slow. Autosomal syndromes: trisomy 13 – Patau syndrome, trisomy 18 – Edwards syndrome, trisomy 21 – Down disease.
The development of Shereshevsky-Turner syndrome (monosomy X or trisomy and more X chromosomes in the karyotype of women) and Klinefelter syndrome (extra X or Y chromosome in the karyotype of men) is associated with abnormalities in the sex chromosome system. Shereshevsky-Turner syndrome is characterized by mental retardation, absence or hypoplasia of the ovaries, short stature, pterygoid folds on the neck, poor hair growth on the back of the head, smoothed neck, underdevelopment of secondary sexual characteristics, Klinefelter syndrome manifests itself as an intellectual defect in the degree of debility, high growth, suggestiveness eunuchoid, gynecomastia.
Oligophrenia due to hereditary metabolic disorders includes phenylpyruvic oligophrenia, the most common amino acid enzyme. This form of oligophrenia is due to a deficiency of phenylalanine hydroxylase; characterized by severe hyperphenylalaninemia with the release of phenylketones in the urine. It is transmitted by a recessive type, manifested by depigmentation of the skin and hair (thin, white skin, blond hair and eyes). Patients have hyperkinesis, “fluttering” movements, and a profound morbidity. Early diagnosis is based on the positive results of the Felling test: green staining of the urine with the addition of a few drops of 10% iron chloride at the 2nd month of a child’s life or the establishment of an increased content of phenylalanine in the blood (12-60 mg% from the 10th day of life instead of 1 -2 mg% normal). For the early detection and treatment of patients with phenylketonuria, urine is examined in all children at the 2nd and 3rd month of life for the presence of phenylpyruvic acid.
Congenital disorders of carbohydrate metabolism are the basis of galactosemia and fructosuria: hypoglycemic syndrome, acidosis, hypokalemia.
Hereditary pathology of mucopolysaccharide metabolism leads to disruption of endochondral and periosteal ossification, proliferation of blood vessels and cartilage. Diseases are characterized by a combined lesion of the apparatus of movement and support, internal organs, eyes, and nervous system. The ugly appearance of patients served as the basis for the designation of this pathology by the term “gargoyleism.” The facial features of the patients are coarse, grotesque (overhanging forehead, hypertelorism, sunken nose, improper tooth growth), small growth, shortened limbs, kyphosis, stiffness in the joints, hearing loss, optic atrophy are observed. Methods for express diagnostics of increased excretion of mucopolysaccharides with urine were developed: precipitate formation with the addition of acetyltrimethylammonium bromide to the patient’s urine.
Marfan’s syndrome is inherited in an autosomal dominant manner, patients develop pathology of the skeleton, eyes, cardiovascular system (skeleton elongated, arachnodactyly, high palate, keeled chest, cataract, lens dislocation, congenital heart disease). Dementia occurs in 20-30% of patients.
Ichthyosis, Rada syndrome (non-neural form) are characterized by a combination of mental retardation with malformations of the skin (its scaly, birthmarks, hemangiomas).
Embryo and fetopathy due to infectious diseases. Oligophrenia with congenital syphilis (mental retardation) is detected early. When making a diagnosis, somatic signs are taken into account: parenchymal keratitis, deafness, which developed as a result of syphilitic labyrinthitis and degeneration of the vestibulo-cochlear nerve; damage to the upper central incisors – barrel-shaped teeth with a lunate notch, skull deformity, saddle nose, enlarged liver and spleen.
Toxoplasmic oligophrenia is the most severe form of the disease that developed as a result of infection of the fetus with toxoplasmosis in the first 3 months of intrauterine development, accompanied by impaired development of the organ of vision (microphthalmia, cataract, chorioretinitis, iridocyclitis), hydrocephalus and microcephaly, convulsive seizures. In the brains of patients, calcifications are found scattered in the parietal, occipital lobes, in the base nuclei.
Intrauterine listeriosis manifests itself in the form of generalized granulomatosis with damage to the skin, pharynx, tonsils, meninges, brain, and liver. Detect specific rashes, which are nodules containing infectious agents. Listeriosis meningitis and encephalitis are acute and often fatal.
Viral oligophrenia. The rubeolar form is caused by the rubella virus, its feature is a combination of dementia with malformations of the eyes, heart, hearing aid, hyperkinesis, muscle hypertension, impaired swallowing, symptoms of sluggish meningoencephalitis, micro and hydrocephalus.
Congenital cytomegaly. The main symptoms are hepatosplenrmegaly, jaundice, thrombocytopenia, interstitial pneumonia, eye malformations, cerebellar aplasia or hypoplasia. Manifestations of congenital cytomegalovirus infection during the neonatal and early childhood period may be insignificant, however in the future often children with this pathology do poorly in school, they reveal symptoms of minimal brain dysfunction (L.O. Badalyan et al., 1980).
Oligophrenia in hemolytic disease of the newborn, resulting from the incompatibility of the antigenic properties of the blood of the mother and the fetus, is due to bilirubin encephalopathy. The most severe lesions are found in the subcortical ganglia. Extrapyramidal motor disorders, athetoses, paralysis, deafness appear in the clinical picture. The degree of intellectual defect is different. Often there is disinhibition, increased excitability, timidity, impaired attention.
Oligophrenia due to maternal endocrine diseases. In pregnant women with diabetes, the fetus has hyperplasia of the pancreas, hyperglycemia. Children are born large, often in asphyxia, lagging behind in development.
Oligophrenia of alcohol-embryopathic genesis in children is a complex of psychopathological symptoms, neurological and somatic dysembryogenetic stigma. The structure of alcoholic embryopathy includes a lag in mental development (debility), a violation of behaviors with disinhibition, aggressiveness, often cruelty, sometimes euphoria, and a silly mood background. Observed hydrocephalic configuration of the head, lack of fine motor skills, strabismus, nystagmus, muscle hypotension, asymmetric, narrow and short palpebral fissures, single or bilateral ptosis, physique dysplasticity, growth deficiency, asymmetry and dysplasia of the auricles, hypoplasia of the upper or lower jaw, hypertelia congenital heart defects, joint abnormalities, chest deformity, syndactyly. The number and severity of these symptoms depend on the severity of the mother’s alcoholic illness.
Oligophrenia due to asphyxia and birth injury. The clinical picture of the disease consists of the symptoms of underdevelopment and residual effects of organic brain damage. Typical are sensory disorders, hypersensitivity to irritants, especially auditory ones, headache, disturbance of autonomic-vascular regulation, asthenic symptom complex.
Oligophrenia due to early postnatal infections and injuries. The severity of dementia and neurological symptoms depend on the location, severity of the lesion, the onset of the disease. The most characteristic are cerebrosthenic, diencephalic and hypertensive symptoms: headache, fatigue, decreased mechanical memory, obesity, genital hypoplasia, hydrocephalus. Dysplasticity of the physique and deformations of the skull structure, characteristic of congenital forms, are absent.
Hypothyroid oligophrenia occurs on the basis of epidemic or sporadic, cretinism, congenital myxedema and is characterized by a general slowdown in mental processes, growth, and sexual development.
Oligophrenia resulting from hydrocephalus is manifested by varying degrees of severity of dementia, paroxysmal headache, hypertensive crises, unmotivated bouts of fear or mood swings. In most cases, patients are euphoric, talkative, complacent. Spherical enlargement of the skull, expansion of the subcutaneous venous network of the head, violation of statics and coordination, paresis, paralysis, convulsive seizures are typical.
The dynamics of oligophrenia depends on its clinical form, the severity of the underdevelopment, the time of the start of therapeutic and correctional work; environmental conditions, temperament, somatic state, mental trauma of the child. Oligophrenia, like psychopathy, has its own statics and dynamics. Although its constant and indispensable feature is the underdevelopment of intellectual functions, a well-thought-out system of education, training and social and rehabilitation measures contributes to a certain compensation of the defect and the acquisition of some domestic and labor skills. Negative dynamics is also observed in the form of a worsening of intellectual deficiency (for example, due to additional exogenous brain lesions), situational, psychogenic and somatogenic reactions and conditions. Spontaneous, autochthonous decompensation is also possible, especially during periods of age-related crises, manifested by excitement with increased sexuality and aggressiveness.
The negative dynamics observed in oligophrenia and psychopathy have much in common, especially since an intellectual defect is always accompanied by a characterological insufficiency of an excitable or inhibitory type, which is especially noticeable in secondary, organic oligophrenia. Often identify the so-called psychopathic oligophrenia and psychopathy with mental underdevelopment. The degree and form of oligophrenia decompensation undoubtedly depends on the severity of intellectual deficiency: the greater it is, the more elementary the psychopathological symptoms. With mild and moderate debility, quite often there are quite complex and long-term observed psychotic conditions.
Patients with oligophrenia in the order of spontaneous, somatogenic or environmental decompensation quite often, especially with its excitable form, have dysphoric conditions. In addition to psychomotor agitation, anger and fear, distorted perception and a delusional interpretation of the situation, partial amnesia of actions are observed.
Very relevant situational (stressful and adaptive) reactions in oligophrenics arising in conflict and unusual circumstances. With deep moronity and imbecility, they are manifested by confusion, anxiety, fear, affective disinhibition, often with aggressiveness, and with morbidity of mild to moderate degree – reactions of panic, explosions of despair with crying, reactions of protest, escape, etc.
Non-psychotic psychogenic pathological conditions in oligophrenics include neurotic reactions and psychopathic conditions (A.N. Buneev, 1950; N.I. Felinskaya, 1950; O.E. Freyer, 1964). They include mainly asthenic, hysterical, obsessive-phobic, anxiety-depressive, hypochondriacal and other symptoms. They are distinguished by the primitiveness of the patient’s experiences, the absurdity, concreteness, straightforwardness of the connection with the content of mental trauma and the search for help in fulfilling the desired, increased suggestibility or low-grade negativity. Patients’ actions are difficult to predict; extended aggressiveness, including towards casual individuals, and suicidal attempts are possible.
Almost specific for moronity are nostalgia reactions, manifested by homesickness, attraction, ending in an escape or a suicidal act, as it sometimes happens when getting into another environment. An examination reveals that at a certain moment the criticism is completely suppressed by the affect of longing and there are no fears of further adverse consequences of his act. Nostalgia occupies an intermediate position between nonpsychotic (neurotic) and psychotic disorders in oligophrenics, but we believe that it is more correct to attribute it to the first group, since true psychotic symptoms are still not observed.
Oligophrenic psychoses can be acute short-term and, less often, touched. They usually arise by the mechanism of psychotic decompensation of an oligophrenic defect by psycho-, exo- and somatogenic factors, often their combination. The spontaneous development of psychosis is hardly possible, although some authors observed it during the period of puberty crisis. The complexity of the clinical picture is associated with the severity of intellectual deficiency: the smaller it is, the more complex the psychotic states and vice versa.
Most often, oligophrenics develop reactive psychoses. Twilight states of a hysterical type with absurd, artsy behavior of patients, psychogenic stupor and fugiform reactions with subsequent amnesia are observed. When bringing patients to criminal responsibility, they reveal pseudo-dementia (patients do not understand where they are, look around, goggle, give ridiculous answers to questions). Sometimes pseudo-dementia is accompanied by puerility.
The types of psychosis of the psychogenic and exogenous-somatogenic types that are affected include the depressive-paranoid, hallucinatory-paranoid, including senestopathic-hypochondriacal, and catatonic syndromes. In patients with a depressive-paranoid state, an oppressed mood with the affect of longing, anxiety or fear, delusions of attitude, persecution, interpretation or hypochondriacal nature with a specific content is found. In some cases, unmotivated anxiety (anxiety-depressive syndrome) comes to the fore.
Hallucinatory-paranoid states are characterized by visual, auditory hallucinations and senestopathies, as well as ideas of attitude, persecution, influence, bewitching, obsession, robbery and hypochondriacal ideas. Delusional statements are primitive, they relate to specific individuals and circumstances. Hypochondriacal ideas range from overvalued to delusional, have, like ideas of a different content, a secondary character, stem from unpleasant somatic sensations or bodily hallucinations, are concrete and naive, without a tendency to generalization. Patients are intrusive in seeking help.