APATHETIC SYNDROME (Greek apatheia insensibility, indifference) — a mental disorder at which there is full sincere exinanition, a mental and physical adynamia, extraordinary poverty of the affective sphere up to its total block («paralysis of emotions»).
States close to Ampere-second., were described in literature as «the acute cured dementia» [Bayarzhe, Krafft-Ebing (J. G. F. Baillarger, R. Krafft-Ebing)], etc., «a struporous amentia» [Meynert (T. N. by Meynert)], «struporous diznoya» (S. S · Korsakov), «stupidnost» [Tsiyen, Ball, Shyule (G. T. Ziehen, V. of Ball, H. Schüle)], M. 3. Kaplinsky described these states as «an apathetic stupor» and «an asthenic stupor».
A clinical picture
Patients are indifferent both to own personality, and to the surrounding phenomena of life. There are no desires, inclinations and aspirations. With the most expressed depth of defeat of emotional reactions, weakening of all mental manifestations the condition of an apathetic stupor develops. At the same time there is no attempt to mobilization of attention, to the slightest intellectual tension. The patient not movably lies on spin, full muscular relaxation is observed, eyes are constantly open, the look is sent to space, without being fixed on anything. Night wakefulness — «the awake coma» or «death with open eyes» is characteristic [Jaspers (To. Jaspers)]. At smaller expressiveness of Ampere-second. patients are sluggish, give terse answers. Short-term emotional proper responses are possible. Due to the phenomena of an aprozeksiya (disturbance of attention) the condition of an apathetic disorientation against the background of not changed consciousness is observed.
Ampere-second. it is quite often combined with deep strong-willed frustration in the form of weakness of motives (abulia, an aspontannost). This state is defined as an apatiko-abulichesky stupor [A.S. Shmaryan, Gauptmann, Feykhtvanger (A. Hauptmann, E. Feuchtwanger)].
Etiology and pathogeny
Ampere-second. it is most characteristic of long symptomatic somatopsychoses at tuberculosis, malaria, typhus, avitaminosis, a traumatosepsis, some endocrine frustration, cachexias of various origin, at damages of a brain of the organic nature (an injury, a tumor, a general paralysis, epidemic encephalitis, atrophic process), meets as well at schizophrenia.
Ampere-second. most often develops as a result of heavy exhaustion of reactive forces of an organism with development of a cachexia (A. V. Snezhnevsky, P.E. Snesarev) and involvement in process of an interstitial brain with disturbance of carrying out impulses between bark and a subcortex at organic diseases of a brain [Reykhardt, Kleyst (M. of Reihardt, To. Kleist), etc.]. In a pathoanatomical picture dominance of toksiko-degenerative processes in mesenchymal elements of a brain (P.E. Snesarev) is noted.
the Diagnosis is made on the basis of a clinical picture. In rare instances of Ampere-second. defines all clinic of psychosis, appears in certain stages of development of a disease and it is combined with other displays of a disease in which nosological framework it develops.
The differential diagnosis
Unlike devocalization, Ampere-second. it is characterized by firmness, lack of fluctuations is able. Are not inherent to it as to devocalization, drowsiness, aspiration to mobilization of intellectual tension, perseveration. Looking alike is shown by devocalization only in devastation of consciousness. From oneiric disorder of consciousness of Ampere-second. differs in poverty of psychopathological frustration; from a catatonic stupor — lack of muscular tension, the phenomena of wax flexibility, active and passive negativism, a mutism; at a catatonic stupor of the patient lies in the bent situation («an embryonal pose»), at Ampere-second. the pose of the patient weakened on spin. From apathetic weak-mindedness at schizophrenia of Ampere-second. differs in lack of negative symptoms of a disease; from the melancholic stupor characterized by a saturation of depressive frustration — poverty of affect, spiritual life; from an aspontannost of organic genesis — firmness with almost total block of intelligence whereas at an aspontannost fluctuation of affect, irregularity of disorders of intellectual functions (A.S. Shmaryan) is possible.
the Forecast is various depending on a current of a basic disease. At symptomatic somatopsychoses of Ampere-second. — the phenomenon is passing, at improvement of a somatic state it disappears. At a heavy current of a basic disease of Ampere-second. can pass into a coma; the lethal outcome is possible. At organic diseases of Ampere-second. more resistant; at schizophrenia — can be one of types of a final irreversible state.
Treatment it is directed to a disease, within to-rogo the Ampere-second develops.
See also - Struporous states .
Bibliography: Kaplinsky M. 3. About one peculiar group of endotoxic psychoses. Works nauch. - issled. in-that psychiatry of Gannushkin, century 5, page 276, M., 1940; Snezhnevsky A. V. About late symptomatic psychoses, in the same place, page 156, bibliogr.; With N e about are e in P. B. Late changes of a brain at a hydrocyanism and its salts, the Neuropath, and psikhiat., t, 8, No. 9-10, page 3, 1939; Hess W. R. Psychologie in biologischer Sicht, Stuttgart, 1968; Jaspers K. Allgemeine Psychopathologie, B ·» 1948.
Century of M. Shamanina.