Psychology and Psychiatry

Organic personality disorder

Organic personality disorder - this is a permanent disruption of the brain caused by a disease or injury that causes a significant change in the patient's behavior. This condition is marked by mental exhaustion and decreased mental functions. Disorders are found in childhood and can remind of themselves throughout life. The course of the disease depends on age and critical periods are considered dangerous: pubertal and menopausal. Under favorable conditions, persistent compensation of the individual with disability can occur, and if negative effects occur (organic disturbances, infectious diseases, emotional stress), the likelihood of decompensation with pronounced psychopathic manifestations is high.

In general, the disease has a chronic course, and in some cases it progresses and leads to social disadaptation. Providing appropriate treatment, it is possible to improve the condition of the patient. Often, patients avoid treatment, not recognizing the fact of the disease.

Causes of Organic Personality Disorder

Organic disorders due to a huge number of traumatic factors are very common. The main causes of the disorders include:

- injuries (craniocerebral and damage to the frontal or temporal lobe of the head;

- brain diseases (tumor, multiple sclerosis);

- infectious brain damage;

- vascular diseases;

- encephalitis in combination with somatic disorders (parkinsonism);

- children's cerebral paralysis;

- chronic manganese poisoning;

- temporal epilepsy;

- The use of psychoactive substances (stimulants, alcohol, hallucinogens, steroids).

In patients suffering from epilepsy for more than ten years, an organic personality disorder is formed. It is hypothesized that there is a relationship between the extent of the disorder and the frequency of seizures. Despite the fact that organic disorders have been studied since the end of the nineteenth century, the features of the development and formation of symptoms of the disease have not been fully identified. There is no reliable information about the influence of social and biological factors on this process. The basis of the pathogenetic link is brain damage of exogenous origin, which leads to impaired inhibition and the correct ratio of excitation processes in the brain. Currently, the most correct approach is considered to be an integrative approach in the detection of the pathogenesis of mental disorders.

The integrative approach assumes the influence of the following factors: socio-psychological, genetic, organic.

Symptoms of Organic Personality Disorder

Symptoms are characterized by characterological changes, manifested in the appearance of viscosity, bradifrenia, torpidity, sharpening premorbid traits. The emotional state is marked either by dysphoria or unproductive euphoria, apathy and emotional lability are characteristic of the later stages. The threshold of affect in such patients is low, and an insignificant stimulus is capable of provoking an outbreak of aggressiveness. In general, the patient loses control over impulses and impulses. A person is not able to predict his own behavior regarding others, he is characterized by paranoia and suspicion. All his statements are stereotypical and are marked by characteristic flat as well as monotonous jokes.

At later stages, organic personality disorder is characterized by dysmnesia, which is able to progress and transform into dementia.

Organic personality and behavior disorders

All organic behavioral disorders occur after a head injury, infections (encephalitis) or as a result of a brain disease (multiple sclerosis). In human behavior, there are significant changes. The emotional sphere is often affected, as well as in humans, the ability to control impulsive behavior decreases. The attention of forensic psychiatrists to the organic disorder of a person in behavior is caused by the absence of control mechanisms, increased egocentricity, as well as the loss of social normal sensitivity.

Unexpectedly for everyone, previously benevolent individuals begin to commit crimes that do not fit into their character. Over time, these people develop an organic cerebral condition. Often this picture is observed in patients with anterior lobe injury.

Organic personality disorder is taken into account by the court as a mental illness. This disease is accepted as a mitigating circumstance and is the basis for referral to treatment. Often problems arise in antisocial individuals with brain injuries that exacerbate their behavior. Such a patient, due to the antisocial and stable attitude towards situations and people, indifference to consequences and heightened impulsivity can appear very difficult for psychiatric hospitals. The case can also be complicated by depression, anger of the subject, which is associated with the fact of the disease.

In the 70s of the 20th century, researchers proposed the term "episodic loss of control syndrome". It was suggested that individuals exist who are not suffering from brain damage, epilepsy, psychosis, but who are aggressive due to a deep organic personality disorder. At the same time, aggressiveness is the only symptom of this disorder. Most of the individuals endowed with this diagnosis are men. They have long-lasting aggressive manifestations that go back to childhood, with an unfavorable family background. The only evidence in favor of such a syndrome is EEG abnormalities, especially in the area of ​​the temples.

It is also suggested that there is an abnormality of the functional nervous system, leading to increased aggressiveness. Doctors have suggested that the severe forms of this condition are due to brain damage, and they can remain in adulthood, as well as show themselves in disorders associated with irritability, impulsiveness, lability, violence and explosiveness. According to statistics, the third part of this category in childhood was observed antisocial disorder, and in adulthood, most of them became criminals.

The diagnosis of organic personality disorder

Diagnosis of the disease is based on identifying characterological, emotional, typical, and cognitive personality changes.

The following methods are used to diagnose organic personality disorder: MRI, EEG, psychological methods (Rorschach test, MMPI, thematic apperceptive test).

Organic disorders of brain structures (trauma, illness or dysfunction of the brain), lack of memory and consciousness disorders, manifestations of typical changes in the character of behavior and speech are determined.

However, for the accuracy of diagnosis, it is important long-term, at least six months, monitoring the patient. During this period, the patient should show at least two signs in an organic personality disorder.

The diagnosis of organic personality disorder is established in accordance with the requirements of ICD-10 in the presence of two of the following criteria:

- a significant reduction in the ability to carry out targeted activities that require a long time and not so quickly lead to success;

- altered emotional behavior, which is characterized by emotional lability, unjustified fun (euphoria, passing easily into dysphoria with short-term attacks of aggression and anger, in some cases, the manifestation of apathy);

- cravings and needs that arise without taking into account social conventions and consequences (antisocial orientation - theft, intimate claims, voracity, not observing the rules of personal hygiene);

- paranoid ideas, as well as suspicion, excessive concern with an abstract topic, often a religion;

- change of pace in speech, hypergraph, super-inclusion (inclusion of side associations);

- Changes in sexual behavior, including a decrease in sexual activity.

Organic personality disorder must be differentiated from dementia, in which personality disorders are often combined with memory disorders, with the exception of dementia in Pick's disease. More precisely, the disease is diagnosed on the basis of neurological data, neuropsychological research, CT and EEG.

Treatment for Organic Personality Disorder

The effectiveness of the treatment of organic personality disorder depends on an integrated approach. It is important in the treatment of a combination of drug and psychotherapeutic effects, which, if properly used, reinforce each other's effects.

Drug therapy is based on the use of several types of drugs:

- anti-anxiety drugs (Diazepam, Phenazepam, Elenium, Oxazepam);

- antidepressants (Clomipramine, Amitriptyline) are used in the development of a depressive state, as well as exacerbation of obsessive-compulsive disorder;

- neuroleptics (Triftazin, Levomepromazin, Haloperidol, Eglonil) are used for aggressive behavior, as well as during the period of exacerbation of paranoid disorder and psychomotor agitation;

- Nootropics (Phenibut, Nootropil, Aminalon);

- Lithium, hormones, anticonvulsants.

Often medications affect only the symptoms of the disease and after the drug is discontinued, the disease progresses again.

The main goal in the application of psychotherapeutic methods is to ease the psychological state of the patient, help in overcoming intimate problems, depression, obsessive states and fears, learning new behaviors.

Assistance is provided in the presence of both physical and mental problems in the form of a series of exercises or conversations. Psychotherapeutic effects with the use of individual, group, family therapy will allow the patient to build a competent relationship with family members, which will provide him with emotional support from relatives. Placement of the patient in a psychiatric hospital is not always necessary, but only in cases where he represents a danger to himself or to others.

Prevention of organic disorders includes adequate obstetric care and postnatal rehabilitation. Of great importance is the proper upbringing in the family and at school.