Mutism is a severe psychomotor pathology in which the sick cannot answer the questions posed and make it clear with signs about their ability to communicate with the individuals around him. Translated from the Latin language Mutism means silent, dumb. In neurology, this pathology is characterized by impaired speech, while in psychiatry this condition is considered within the framework of mental deviations, while the ability to understand speech and have a conversation with a patient is preserved.

Mutism must be distinguished from aphasia, which is also characterized by a loss of ability to speak and it arises due to damage to the brain. If the patient is able to write, but is not able to speak at the same time, then most likely he has mutism, not aphasia. Severe psychomotor state can flow into logoneurosis or logophobia.

What is mutism

This condition is a symptom of psychomotor disorder, which can manifest itself after bruising and concussion, fire, severe mental trauma, death of loved ones, as one of the later expressions of the AIDS-dementia syndrome complex and so on. The described pathology can also develop in neurological diseases, for example, in the paralysis of the vocal cords, bilateral lesions of the cortico-bulbar tracts and severe spasticity.

The following types of mutism are distinguished:

- catatonic, due to unmotivated disorder, not having external causes, opposing the urge to communicate. It is noted in catatonic schizophrenia due to negativism;

- psychogenic mutism (the emergence of this type is possible as an acute reaction to mental trauma, or in certain social situations that cause anxiety or fear);

- hysterical mutism (often caused by a depressed and unconscious desire of a person to draw the attention of the surrounding society to the loss of the ability to speak), observed in conversion (dissociative) disorders and hysterical personality disorder;

- Akinetic mutism or organic occurs in organic brain lesions, for example, in mesencephalic hemangiomas, frontal gunshot wounds, tumors in the region of the third ventricle, and thrombosis of the basilar artery;

- allocate also selective (elective) mutism, when the patient enters into a conversation with a select circle of people in certain situations.

Mutism in children

Elective mutism in children is often noted at the age of 3 years or in elementary school and is manifested only in communication with selected individuals, for example, a child is in contact with all members of the family, except one. This type of pathology in children passes after reaching the age of ten. The described psychomotor state is characterized by a passive protest of the individual. Treatment includes psychotherapeutic sessions of sedation.

Voluntary mutism in children is marked by a lack of initiative and activity, increased sensitivity, stubbornness, infantilism, mood swings, and capriciousness. Such children resist the new load, they are afraid of the new situation, they are afraid of changes in the situation.

An example of mutism in children is the stress experienced during the war years. This pathology occurs due to the inability of the child's personality to establish the desired contact. The psychomotor state in children is accompanied by impressionability, depressive mood, inhibition, timidity. This psychomotor condition refers to the manifestation of neurosis that occurs after mental trauma.

The signs of pathology in children include: anxiety, frequent protest reactions, indecision, disturbed sleep and appetite, fearfulness, lethargy.

Mutism in children is classified according to various criteria. It is divided by the intensity of appearance: short-term (situational), permanent (elective) and total.

By the duration of the flow, transient and continual mutism is distinguished. Specialists in psychiatry refer mutism to an acute psychogenic shock reaction, as well as a sub-shock one.

The provoking factor of this pathology in children is a psychogenic effect that affects the function of speech. There is a big difference between psychogenic mutism in babies and older children. The clinical picture in older children is much more complex and diverse. In girls, the psychomotor state is more common than in boys. It occurs in families where there is a burden of hereditary speech disorders. Patients with psychogenic mutism have delayed speech development, as well as other defects in speech function. Such children grow up in families in the midst of a negative psychological climate. Many of the children have residual cerebral pathology.

Children's neurotic mutism is characterized by:

- impaired speech after a certain period of communication with others, as well as impaired motility, facial expressions, behavior. The child expresses his desires with a gesture and a look;

- the selectivity of the nature of the disease, depending on a particular person or situation;

- a delay in intellectual development and the occurrence of speech defects.

Children with manifestations of signs of psychotic mutism are silent from early childhood, and their behavior is marked by isolation and detachment from the whole surrounding world. The child gives the impression of indifference, but is able to show aggression toward himself or against his mother. The baby may be very worried when referring to him.

One of the reasons for the emergence of elective mutism are socio-cultural factors. When moving to a new country, immigrant children experience great mental stress, they are characterized by anxiety, depression, and hostility towards others.

Mutism Diagnosis

The process of recognition of the disease includes the analysis of complaints and the history of the disease, namely:

- how long ago the patient stopped talking, answering questions, moving;

- what event directly affected the cessation of speech (strong emotional shock, loss of consciousness, traumatic brain injury).

A neurological examination includes an assessment of the presence of speech and reflexes, opening the eyes, an assessment of the respiratory rhythm, measurement of arterial (blood) pressure, as well as a search for other signs of neurological pathology that allow finding the cause of mutism (asymmetry of the face, disturbance of eyeball movements, strabismus).

EEG (electroencephalography). This method evaluates the electrical activity of different parts of the brain.

MRI (magnetic resonance imaging) or CT scan (computed tomography) of the brain: these methods study the structure of the brain in layers and find out the cause of brain function disorders.

If necessary, appoint a consultation with a psychiatrist and a speech therapist.

Mutism treatment

Many effective methods and methods are noted in the treatment of this psychomotor state. The main focus is on such areas: speech therapy, psychiatric, psychological, neurological.

When psychogenic mutism apply massive psychotherapeutic treatment in combination with neuroleptic and tranquilizers.

Features of care for patients suffering from severe psychomotor state lies in the fact that it is necessary to constantly maintain communication, using a letter, facial expressions, gestures. Conversations are shown, in conjunction with the means that stimulate the activity of the nervous system, they are very useful and completely relieve dumbness and deafness.

Treatment of psychomotor pathologies prescribed by a physician includes a method of disinhibition. After injection of 1 ml of a 10% caffeine solution, after 5 minutes, the patient is slowly intravenously injected (1 ml / min) with Amobarbital solution until a state of slight intoxication occurs. Often enough one procedure. The nurse, completing the procedure, during the day should force the patient several times to answer questions and engage in conversation with him.

Effectively used in the treatment of herbs (valerian, motherwort), they help calm the nervous system. Recommended also in the treatment of salts of Bromine, Mebrium, Aminazin, Andoxin, Reserpine.

The neglected condition is treated much longer. If therapy is not started on time, the disease can take on a persistent nature.

The prognosis of mutism depends directly on the underlying disease. A lot depends on the patient's personal qualities, as well as on how long the disease has deformed the character of the patient.