From Big Medical Encyclopedia

AGGRAVATION (Latin aggravatio — burdening) — exaggeration by the patient of separate symptoms of really available disease.

The clinical physician of any specialty needs to mean a possibility of Aggravation. The last can be subconscious, in a varying degree inherent in general to the sick person, intentional (conscious) or pathological (at mentally sick).

Subconscious aggravation is explained by extramental desire of the patient to summon sympathy of people around, to attract attention the doctor. Such patients complain all of the painful feelings, vastly and importunately tell about them, exaggerating the valid diseases of a symptom. Such And. especially often arises at easily, the inspired people and it can be called by careless notes or actions of the doctor, i.e. to have iatrogenic character (see. Iatrogenic diseases ). And. it can be also caused by acquaintance with the issued certificates of a disease or with special medical literature.

Intentional aggravation (conscious) aims at extraction of benefit and concerns symptoms of various somatopathies or effects of damages. Intentional And. happens passive and active. Passive And. it is shown by exaggeration of separate symptoms, e.g. lamenesses, head a hearing impairment, complaints to lack of improvements, to the continuing painful frustration, to the impossibility or restriction of movements and other phenomena which are not corresponding to the nature of a disease and not confirmed by objective data. At active And. the patient takes measures to tightening of a disease or an aggravation of symptoms of the health, e.g. does not make active movements of a brush at its fire damage, than tries to obtain a resistant contracture, etc. Active And. can turn into mutilation, e.g. a rastravlivaniye of ulcers, wounds, hems.

Most often Aggravation is observed at chronic diseases and after damages (wounds, bruises) of bodies of the movement (top and bottom extremities), arthritises and arthroses, contractures, cicatricial changes, etc. Morbidity at the movement is exaggerated, limitation of certain movements up to a full immovability. At a disease of sense bodys decrease in visual acuity, loss of sight on one or both eyes is exaggerated; decrease in auditory acuity of a pas one or both ears; diseases of a throat are exaggerated by the shepotny speech and aphonia (see). At diseases and after damages central and peripheral nervous systems the exaggerated complaints of a pas of pain, disorder of consciousness, attacks, morbidity at the movements are observed; at diseases of cardiovascular system — the strengthened complaints to pains in heart, heartbeat, an asthma; at diseases of a respiratory organs — the strengthened cough in the presence of medical staff, neighbors in chamber, strangers. At diseases of the digestive system pains in a stomach, functional dispeptic frustration are exaggerated (nausea, vomiting, heartburn, disturbances of appetite). At diseases of urinogenital system patients exaggerate frustration of a mocheotdeleniye. Meet and other types

of A. Umyshlennuyu A. should be meant at examination of temporary disability, in insurance practice when resort to it for the purpose of release from work due to illness, obtaining the permit in sanatorium, rest house, an insurance premium etc.

In military medical practice Aggravation can be observed at the persons who are trying to obtain constant or temporary release from military service.

It is possible to prove Aggravation careful clinical inspection of the suspect in And. person.

Modern methods of clinical inspection of the patient and diagnosis of diseases sharply limit opportunities And. and deceptions of the doctor and other medical staff. The prejudiced approach of the doctor to the patients showing the complaints seeming to the doctor exaggerated is inadmissible. Such patients need to be inspected at the neuropathologist p the psychiatrist. Intentional And., if it is directed to the conflict with the law and proved, can be penal (see. Simulation ).

It is necessary to understand exaggeration of symptomatology of somatopathies at mentally sick people (psychopaths, hysterics etc.) as pathological aggravation.

Aggravation of mental disorders — rather widespread phenomenon in forensic-psychiatric practice.

A main objective of aggravation of mental disorders is the aspiration to achieve the desirable decision of commission of experts. Therefore And. is considered in this case as simulation of mental disorders. K A. mental disorders the state when intentionally complain of many or separate symptoms which defined a disease earlier to a certain extent belongs, but now passed — so-called metasimulation of Poro.

In many cases And. there are in the same form repeatedly in everyone the injuring situation new psikhogenno, especially if first attempts And. were crowned with success. A certain dependence between a form A is noted. mental disorders and the existing painful frustration (A. A. Govseev). So, patients with an oligophrenia aim to show big intellectual insufficiency, than they have it. It considerably complicates an opportunity to establish the valid degree of an intellectual underdevelopment. At patients with cerebral atherosclerosis it is more often observed And. dysmnesias (a remembering and reproduction), active attention and the account, and also the aphotic phenomena which long ago passed.

In cases And. at persons with effects of an injury of a brain the exaggerated tics, stutter, decrease in hearing, psychosensorial disorders, diverse manifestations of emotional instability are usually noted.

In a chronic stage of encephalitis (preferential epidemic) it is noted And. psychomotor frustration — violent movements, muscle tension, a tremor, oculogyric spasms. At psychopathies, hysteria of a form A. are diverse and expressive, are shown in bright emotional reactions, various somatic and neurologic symptoms.

The choice of the aggravated symptoms p a form A. reflect character and depth of the available changes of mentality. Than extent of the available changes is deeper, especially it is naive, ridiculous and naked on the target tendency And.; it can become a usual form of behavior of the changed personality in any difficult or dangerous situation. A form and nature of manifestations And. sometimes promote assessment of weight of the available mental disturbances. Govseev noted that the below in the spiritual relation there is a subject, the more elementary, the more rough it pretense so this simplicity testifies to its valid limitation.

S. S. Korsakov emphasized that «sometimes the utrirovka is display of a disease, a part depending on a form of a disease (e.g., at hysteria), a part from identity of the patient». Therefore at And. assessment of a condition of patients is defined by features of really available painful frustration and the course of a disease, data of comprehensive inspection, and also objective anamnestic data in comparison to character and a form A.

Bibliography: Avdeev M. I. A grant on forensic medical examination, M., 1943; it. Forensic medical examination of living persons, page 177, M., 1968; Tikhonov V. M. Aggravation and simulation at diseases of bodies of the movement, Kazakhsk. medical zhurn., No. 3-4, page 437, 1935; Shamburov D. A. Recognition of simulation and aggravation of lumbar and sciatic pains. Works Hovrinsk. Region wedge,-tsy, page 84, Khovrino, 1948. And. mental disorders — Buneev A. N. Simulation of mental disorders, in book: Sudebn. psikhiat., under the editorship of A. I. Buneev, page 336, M., 1954; Vvedensky I. N. Simulation, in book: Sudebn. psikhiat., under the editorship of A. N. Buneev and Ts. M. Feytsberg, page 326, M., 1938; Krasnushkin E. K. Chosen works, page 73, M., 1960; Serbian Century. Judicial psychopathology, century 2, M., 1900; Felyanskaya N. I. Simulation of mental disorders, in book: Sudebn. psikhiat., under the editorship of G. V. Morozov, page 397, M., 1965; Porot A. ctBardcnat Ch. Psy-chiatrie mldico-llgale, P., 1959; Uszkiewiczowa L. Zaburzenia reaktywne i symulacja w praktyce sqdowo-psychia-trycznej, Warszawa, 1966.

M. I. Avdeev (court.), G.V. Morozov (psikhiat.).