Perseveration
Doctors call perseveration a behavioral disorder expressed in the repeated repetition of certain actions. Repetition may be caused by the patient's inability to remember current events. He can repeat the same action, believing that he is performing it for the first time. Often the patient repeats actions that were previously associated with his professional activities. Such actions are carried out out of not knowing what to do with oneself.
The most common repetitive actions include:
Repeating the same question over and over again. Only patience can help here. Anticipate common questions if they have been asked more than once before. For example, if the patient constantly asks what time it is, place the clock in a visible place. Of course, this could work if he is still able to use them. Repeating a question may also be due to concern about a particular topic.
Repeating a phrase, movement or action. The main reason here is idleness. Due to lack of work, the patient occupies himself as best he can. Another possible reason is a feeling of discomfort that occurs during overheating, hypothermia, hunger, thirst, anxiety, stress, etc. Try to support your loved one emotionally and relieve tension. If you cannot calm him down, perhaps the reason is the malaise caused by the disease. In this case, you should contact a therapist for examination and testing. Repetitive actions (rearranging objects in the room, rearranging things...) are also usually caused by idleness and boredom.
Constant requests to take me home. When a person “wants to go home,” this is a signal that he is experiencing discomfort. He may be anxious and even scared. Most likely, we are talking about his childhood home, associated with good memories. Convincing the patient that he is at home is usually pointless. It is better to try to calm him down by showing him that he is safe.
Intrusive calls. Some patients constantly call their loved ones, which can cause a lot of trouble, especially when the calls come at night. Of course, the patient does not remember that he called 10 minutes ago, and does not understand that it is night outside. Therefore, there is no point in swearing at this; you can simply turn off your phone at night and use an answering machine or caller ID during the day. If you are tormented by remorse because of an unanswered call, think about the fact that sleepless nights negatively affect your condition, and the quality of patient care depends on you in the future. You need to take care of yourself.
Imaginative illustration in a cute video
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perseveration
Stereotypes should be distinguished from perseverations. Perseverations, according to M. S. Lebedinsky and V. N. Myasishchev (1966), are characterized by the fact that an already completed action, entirely or in some of its elements, penetrates into the subsequent one, aimed at solving a new task, although for its implementation the perseveratory components of the activity , which began as part of the previous task, are alien and unsuitable. With stereotypies, the patient’s activity (mental, speech, motor) loses all meaning and is not at all connected with solving any problem. We cannot grasp the connection between stereotypical phrases in thinking or speech with any previous activity; they are also alien to previous mental tasks.
Stereotypes appear over a long period of time and do not change under the influence of a specially created switch in the mode of activity of the psychiatrist in communication with the patient. Perseverations depend on the degree of difficulty of solving a new problem; they are more easily identified in activities similar to past actions. These signs are not found in stereotypies. Unlike perseverations, the patient does not try to counteract stereotypies.
E. Kraepelin (1918), who saw in stereotypies a tendency to repeat the same ideas for a long time, emphasized that with them, unlike perseverations, the content of these ideas does not depend on the previous ones.
We give an example of stereotypy in the thinking of a patient with schizophrenia.
“I was attacked 8 years ago by foreign intelligence officers, who cut my stomach and sewed radio equipment in my stomach. And wherever I go, I hear voices on the radio in my head from the radio machines that are hardwired in my stomach, I hear how on the radio various feelings are instilled into my soul. The seam after the abdominal incision, when radio equipment was sewn into it, was smoothed out and the radio equipment was felt so much that the seam was no longer visible.” Next, several pages detail the patient’s painful experiences and describe his pseudohallucinatory experiences. The patient very clearly outlines the phenomena of Capgras syndrome observed in him (the same foreign intelligence officers replaced his closest relatives—12 people—in his village with people similar to them). Eight pages later in the same letter, the patient writes: “Foreign intelligence officers cut open my uncle’s stomach and then sewed radio devices into it, and with these radio devices they angered him so much that he hit his wife, and his wife died. The prosecutor did not know that the uncle had radio equipment sewn into his stomach and that they deliberately angered him, and the uncle was tried in the city of Makeyevka. This is what foreign intelligence officers wanted, so that my uncle would be convicted and put in prison.”
Thinking disorders.
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Thinking is the highest form of human mental activity, which includes the active processing of sensory sensations and perceptions, that is, it is an indirect reflection of connections and relationships between objects and phenomena of the objective world. The thinking process is based on operations such as analysis, synthesis, comparison, abstraction, generalization, and classification of features. As a result of these operations, concepts and conclusions are formed.
The concept is a reflection in the human mind of the general patterns and qualities of objects and phenomena. The concept includes knowledge of the real internal essence of a particular phenomenon or object.
Depending on the degree of abstraction and generalization, concepts are specific or abstract in nature. Therefore, concrete-figurative and abstract thinking are distinguished. Visual-figurative, sensory or concrete thinking is associated with verbal images of specific objects that are directly cognizable through the senses. With abstract thinking, we generalize, i.e. we capture the totality of essential features that are characteristic of a given phenomenon, discarding any insignificant, particular features for it. Thus, abstract concepts arise, for example “animals”, “trees”, “underwater world”. They differ from specific concepts, for example, “rhino,” “birch,” “shark.”
An inference arises as a result of comparing several judgments, their comparison and, thus, ends the thinking process as a final conclusion.
The physiological basis of thinking is, as is known, the second signaling system (I.P. Pavlov), which reflects at a higher level not only the past and present, but also the future through the formation of temporary connections - associations. Thinking materializes into speech. That is why, by analyzing a person’s speech production, one can judge the presence or absence of a thinking pathology.
Thinking disorders are divided into pathology of the associative process and pathology of judgment.
Pathology of the associative process
The acceleration of thinking is expressed in the fact that, conditionally, more associations are formed per unit of time than normal, while their quality suffers. Images, ideas, judgments, and conclusions that quickly replace each other are extremely superficial. The abundance and ease of new associations that spontaneously arise from any visual, sound, olfactory and other stimuli are reflected in speech production, which may resemble so-called machine-gun speech. From continuous talking, patients sometimes even lose their voice or it becomes hoarse and whispery.
This type of thinking disorder is characterized by increased distractibility, which prevents the patient from completing any undertaking. There are so many thoughts in my head that they often take on the character of a race of ideas.
At the same time, the thought process and speech production seem to imitate incoherence. However, if this speech is recorded on a tape recorder and played back at a slow pace, then it is possible to determine a certain meaning and purpose in it, which never happens when thinking is incoherent.
Another option for accelerating the pace of thinking is mentalism.
, which is an influx of thoughts that occurs against the will of the patient. A stream of images, ideas, memories falls on the patient at such a rapid pace that he cannot cope with them, is lost from their abundance, and feels helpless. Some researchers consider mentism to be a variant of ideatorial automatism of Kandinsky-Clerambault syndrome in schizophrenia or organic psychoses.
Acceleration of the associative process is a mandatory derivative of manic syndrome of various origins (affective disorders, schizophrenia, drug addiction, etc.).
Slowing down of thinking manifests itself in inhibition and poverty of associations. The slowdown in the associative process is most pronounced in an absolutely “empty head, in which thoughts do not appear at all.” Patients answer questions in monosyllables and after a long pause (the latent period of speech reactions increases compared to the norm by 7-10 times). Such a disorder is usually characteristic of depressive syndrome, but can be observed in apathetic and asthenic states, as well as in mild degrees of confusion.
Complete stopping of the flow of thoughts (sperung - a term from German authors, blocking thoughts
- English speakers) occurs when, against the background of clear consciousness and in the absence of hallucinations, the patient loses the thread of the conversation for some time, while a feeling of emptiness arises in the head, he stops speaking and seems to come to his senses only after a while. This disorder is very characteristic of schizophrenia.
Violent thinking is characterized by the fact that in the patient’s mind, against the will and desire, random, unimportant thoughts or a stream of thoughts arise in the patient’s mind, which he cannot get rid of. In this case , they talk about the “influx of thoughts”
or mentalism.
Pathological thoroughness of thinking is excessive viscosity, stiffness of the associative process, getting stuck on unimportant signs, difficulty switching from one topic to another. The speech of patients is replete with many unnecessary details, since they are not able to distinguish the main from the secondary; every little detail or shade of the problem being discussed seems important to them. In addition, speech often acquires special intonations, words are drawn out, and diminutive suffixes are used.
Pathological thoroughness is especially characteristic of epilepsy (so-called labyrinthine thinking),
however, it is possible with brain injuries, vascular psychoses and other types of mental pathology.
Perseveration of thinking - getting stuck on the same ideas, is expressed in the constant repetition of a word or group of words. Usually this is the correct answer to the first question asked of the patient. To all subsequent questions he gives the same primary answer. So, to the question: “How old are you?”, the patient correctly answers: “65.” And further: “What is your name?” - “65”, “Where do you live” - “65”, etc.
This condition (the so-called standing symptoms) is very characteristic of atrophic processes of the brain (Pick's disease, Alzheimer's disease), but can be observed in traumatic and vascular psychoses.
Verbigeration is the spontaneous and stereotypical repetition of some words, sounds or simple sentences. It occurs involuntarily and is more often observed in schizophrenia.
Partialization of thinking is characteristic only of schizophrenia. It is expressed in the fact that, according to patients, absolutely all parts of the body can think.
Reasoning is a tendency to empty, fruitless reasoning with a lack of specific ideas. The patient puts the extreme emptiness and poverty of judgments into a grammatically correct, but lengthy, sometimes florid verbal form using pompous expressions and an abundance of scientific and philosophical terms.
As an example, here is a statement from patient S, a mathematician by training, who was undergoing treatment for an attack of schizophrenia:
Normally, something formally resembling reasoning is called demagoguery. The presence of reasoning in thinking usually indicates a stale schizophrenic process.
Symbolic thinking is inherent in all people - both healthy and sick. There are symbols that are understandable, if not to everyone, then to most. For example, a white coat is a symbol of a doctor, black clothes are a symbol of mourning. In case of pathology of the associative process in the form of symbolic thinking, symbols are always purely individual and understandable only to the patient himself.
No two patients have the same symbolism. The source of symbolic thinking can be any object, a neutral phrase said by someone, any color of clothing, a natural phenomenon. For example, patient 3. regarded the rain as the tears of the Universe over her ruined life, and the red color of the tie as a hint that she would soon burn in “fiery Gehenna.” Symbolic thinking also indicates a stale schizophrenic process.
Paralogical thinking develops according to the laws of crooked logic and is understandable only to the patient himself. There is no logical connection in thinking, the conclusions to which the patient comes are absurd and inadequate. Most often observed in schizophrenia.
For example, a patient states: “I can’t see well, because it’s deep autumn outside.” He further explains: “Autumn is the forerunner of winter, withering and death of the plant world. My vision has decreased, this is a sign of old age. This means that I will soon die along with all the plants in the country.” Another patient stated that he was short because his growth was hampered by the war in Indonesia.
Discontinuity of thinking is the loss of a logical connection between ideas, concepts and ideas, although the thought sometimes takes on the correct grammatical form. For example: “The bohemianism of cosmic phantasmagoria prevents the slowdown of Michurin’s teaching.” Or: “The dream was formed from the residual products of irrigation fields with tomorrow's distribution of extreme clouds over all of Spain.” An extreme variant of discontinuity is schizophasia or “verbal hash,” when speech production is expressed in unrelated individual words or simple sentences with an abundance of neologisms (new words made up of a prefix of one and a root, suffix or ending of another word).
Disruptive thinking is typical of schizophrenia.
Incoherent thinking is characterized by complete chaos and meaninglessness of the associative process; speech consists of separate, unrelated words. Somewhat reminiscent of schizophasia, incoherence differs from it in that it always occurs against the background of impaired consciousness, in particular with amentia of any origin.
Pathology of judgment
The pathology of judgment includes obsessive states, overvalued, delusional and delusional ideas.
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Date added: 2016-06-22; views: 2982; ORDER A WORK WRITING
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Reasons for the manifestation of perseveration
There are neuropathological, psychopathological and psychological reasons for the development of perseveration.
Repetition of the same phrase, caused by the development of perseveration, can occur against the background of neuropathological reasons. These most often include:
- Traumatic brain injuries that damage the lateral region of the orbitofrontal cortex. Or it is due to the physical types of damage to the frontal convexities.
- For aphasia. Perseveration often develops against the background of aphasia. It is a condition characterized by pathological deviations of previously formed human speech. Similar changes occur in the event of physical damage to the centers in the cerebral cortex responsible for speech. They can be caused by trauma, tumors or other types of influences.
- Transferred local pathologies in the frontal lobe of the brain. These may be similar pathologies, as is the case with aphasia.
Psychiatrists, as well as psychologists, call perseveration deviations of a psychological type that occur against the background of dysfunctions occurring in the human body. Often, perseveration acts as an additional disorder and is an obvious sign of the formation of a complex phobia or other syndrome in a person.
If a person shows signs of developing perseveration, but has not suffered severe forms of stress or traumatic brain injury, this may indicate the development of both psychological and mental forms of deviation.
If we talk about the psychopathological and psychological reasons for the development of perseveration, there are several main ones:
- Tendency to increased and obsessive selectivity of interests. Most often this manifests itself in people characterized by autistic disorders.
- The desire to constantly learn and learn, to learn something new. It occurs mainly in gifted people. But the main problem is that that person may become fixated on certain judgments or his activities. The existing line between perseveration and such a concept as perseverance is extremely insignificant and blurred. Therefore, with an excessive desire to develop and improve oneself, serious problems can develop.
- Feeling of lack of attention. Occurs in hyperactive people. The development of perseverative inclinations in them is explained by an attempt to attract increased attention to themselves or their activities.
- Obsession with ideas. Against the background of obsession, a person can constantly repeat the same physical actions caused by obsession, that is, obsession with thoughts. The simplest, but very understandable example of obsession is the desire of a person to constantly keep his hands clean and wash them regularly. A person explains this by saying that he is afraid of contracting terrible infections, but such a habit can develop into a pathological obsession, which is called perseveration.
It is important to be able to distinguish when one person simply has strange habits in the form of constant hand washing, or whether it is obsessive-compulsive disorder. It is also not uncommon for repetitions of the same actions or phrases to be caused by a memory disorder, and not by perseveration.
Speech stereotypies and psychoneurological diseases
The causes of speech stereotypies often lie in the development of neurological and psychological diseases.
Causes of perseverations
Experts believe that the cause of perseveration is damage to the lower parts of the premotor nuclei of the cortex of the left hemisphere in right-handers, and the right hemisphere in left-handers.
The most common cause of perseveration is considered to be neurological diseases resulting from physical damage to the brain. In this case, it becomes impossible to switch between different activities, changing the train of thought and the order of actions when performing various tasks.
With the neurological nature of the disease, the causes of perseveration are:
- Traumatic brain injuries , in which the lateral orbitofrontal areas of the cortex and its prefrontal convexities are affected.
- Aphasia is the appearance of disturbances in speech formed at a previous stage of life. These disorders arise due to physical damage to the speech centers, as a result of traumatic brain injury, encephalitis, and brain tumors.
- Pathologies related to the area of the frontal lobes of the cerebral cortex.
Psychiatry and psychology classify perseveration as a symptom of various phobias and anxiety syndromes. The course of this speech stereotypy in the psychological and psychiatric direction can be caused by:
- obsessiveness and selectivity of individual interests, which is most often found in people with autistic disorders;
- lack of attention with hyperactivity, while stereotypy arises as a defense mechanism to attract attention to oneself;
- a steady desire to learn and experience new things can lead to fixation on one conclusion or activity;
- Perseveration is often a symptom of obsessive-compulsive disorder.
Perseveration should not be confused with obsessive-compulsive disorder, human habits, and sclerotic changes in memory.
Perseverations are more often observed in patients with dementia (dementia), which is caused by vascular damage to the brain, as well as with age-related atrophic processes in the brain. The patient’s intellect is impaired, and he cannot understand the question being asked and, instead of a logical answer, repeats previously used phrases.
What provokes the development of verbigeration?
With verbigeration there is no connection with certain neuropsychic conditions. One of the features of verbigeration is that the patient pronounces words without showing emotion. As a rule, verbal repetitions are accompanied by active facial expressions and motor disturbances.
Article on the topic: What are the main causes of hoarse and hoarse voices in children and adults?
Most often, these verbal iterations occur in patients with dementia and catatonic schizophrenia.
Causes of standing revolutions, palilalia and echolalia
The appearance of standing phrases in speech signals a decrease in intelligence and empty thinking. They often appear with a disease such as epileptic dementia. Also, one of the diseases characterized by standing movements is Pick's disease, as well as other atrophic diseases of the brain.
Palilalia is a typical manifestation of Pick's disease. It is also often accompanied by diseases such as striatal pathology, striopallidal pathology (atrophic, inflammatory, vascular), postencephalic parkinsonism, pseudobulbar syndrome, catatonia, Tourette's syndrome, schizophrenia.
The occurrence of echolalia is often associated with damage to the frontal lobes of the brain. If the patient has symptoms such as hallucinations, lack of coordination, and forgetfulness, it is necessary to seek advice from a specialist. If brain damage is not diagnosed, then the causes of echolalia may be imbecility, schizophrenia, autism, Asperger's syndrome, Tourette's syndrome.
