EXCITEMENT PSYCHOMOTOR — morbid condition, at Krom is observed strengthening and acceleration of rate of manifestations of the different parties of mental activity — the speech, thinking, emotions, movements happening at the same time, separately or to dominance any one of them. Accusative — the frequent form of a mental disorder which is followed by a behavior disorder. Features of Accusative quite often allow to judge the nosological nature of a disease. Allocate speech, motive and affective excitement. Motive and speech excitement can not be followed by affective excitement. Affective excitement is accompanied, as a rule, by speech motor excitement. V.P.'s intensity fluctuates in very wide limits.
A clinical picture
At easy or moderate degree of Accusative the speech, actions, acts, behavior in general keep signs of relative focus, motivation, sequence and co-ordination. With strengthening of Accusative of the movement accelerate, become more various, gusty, there are incomplete actions, there are a fussiness, random motions. The speech is accelerated, turns into shout, words and phrases because of haste are sometimes said not completely, connectivity of the speech is lost, also its grammatical system can be broken. The speech can be continuous (monologue) or sketchy to incoherence.
The contents of the speech reflect initiation of cogitative activity. It is shown in acceleration of a current of thoughts and representations, in emergence of unexpected associations, in rhyming or in persistent repetition of the same words and phrases. Affective excitement is expressed by anger, ecstasy, gaiety, fear, malignancy, melancholy, alarm. According to the dominating affect speak about excitement with irascibility, cheerful or sad excitement.
At sharp degree of Accusative of action gain inexpedient, senseless character, approach impulsive. The movements become in-coordinate, accept as if convulsive character, remind hyperkinesias. The speech becomes badly articulated, incoherent and, at last, turns into muffled mutter. At bigger strengthening of excitement the speech can stop absolutely, and excitement becomes «mute».
Features of manifestation of Accusative can be caused by age of patients. At children's and senile age are more inherent to excitement monotony of speech and motive acts. At children monotonous crying or laughter and shouts, stereotypic repetition of the same questions, rocking, run around, scattering of objects, grimacing are observed. At senile age excitement has the nature of fussiness with expression of efficient concern and with complacent garrulity or with peevishness, irritability, alarm more often.
Accusative can be the leading symptom at maniacal, catatonic, hebephrenic syndromes, delirious and amental stupefaction, at nek-ry types of epileptic twilight conditions of consciousness, at an acute delirium (delirium acutum) and states, close to them. At nek-ry organic lesions of c. and. the page, at crazy and hallucinatory syndromes of Accusative is noted along with other symptoms.
An example of initiation of all processes of mental activity is maniacal excitement (see. Maniacal syndromes ), alarming excitement with verbigerations (see. Depressive syndromes ), nek-ry cases of excitement at katatono-oneiric states. The last is characterized by expressiveness of poses, movements and a mimicry, changeable manifestations of affect, the pathetic recitation, rhyming, divagation, unexpected figurativeness, irreality of associations, confusion.
At catatonic syndrome (see) prevails chaotic motive, to a lesser extent speech excitement with stereotypies, a cut during the strengthening turns into «mute» motive excitement.
At hallucinations of Accusative is expressed less, is characterized by intense concentration with a changeable mimicry, the gusty movements, incoherent phrases (answers to «voices»), defensive or aggressive gestures and intonations. It is difficult to draw attention of patients, but the mimicry often reflects contents heard or seen.
At crazy syndromes (see. Nonsense ) excitement happens incidental and is connected with a sharpening of the crazy ideas of prosecution, poisoning, influence and quite often selectively directed against the persons suspected of hostile actions. Patients are strained, spitefully cry out threats, turn away from the interlocutor, can strike, spit in a face. Unlike patients with hallucinatory excitement, they quickly react to change of a situation, on a form of the treatment of them and are easily induced by excitement of surrounding patients.
Excitement at epileptic dysphorias (see) often is followed by a condition of the changed consciousness and quite often constitutes danger to people around.
Excitement at many organic and toxic lesions of a brain, at an idiocy, in prekomatozny and post-comas has preferential motive character. The movements are uniform, stereotypic, approach hyperkinesias. The movements of rotation, rocking, a pochesyvaniye, marking time, «obiraniye» are often observed. An example of extremely heavy organic excitement is excitement at the galloping general paralysis and at an acute delirium (see Delirium acutum). Excitement accrues quickly, patients continuously change situation in a bed, spin, flounder, bang legs, clap, grimace, inflate cheeks, thrust hands into a mouth, tear and throw off clothes, senselessly strike around themselves, make inarticulate sounds or repeat rhythmic the same syllables, do not sleep, do not eat and catastrophically grow thin.
At hysterical states (see. Hysteria ) Accusative is followed by the exaggerated expressiveness and often reaches pathetic theatricality. Patients very clearly express despair, powerlessness, timidity, hopelessness or, on the contrary, enthusiasm. They loudly sob, the plastic movements break hands, tear on themselves clothes, lament, fall by a floor, sometimes represent the whole scenes connected with the injuring situation. Accusative seldom happens in these cases long and intensive and usually amplifies when pay attention to patients.
Excitement at psychopathies (see. Psychopathies ) and psychopatholike frustration it is connected most often at patients with the real conflicts, antipathies, whims, harassments, the requirement to itself of special attention. Shouts, abuse, threats, aggression are directed to persons, with to-rymi there was a conflict. Patients in such state can be dangerous to people around.
Accusative can arise at mentally healthy people at so-called extreme situations.
Treatment needs to be carried out to the shortest possible time. The best stopping effect has intramuscular administration of drugs of a fenotiazin and phenyl propyl ketones. For patients it is necessary to create a quiet situation since under the adverse, irritating conditions, at improper handling with sick Accusative amplifies and, on the contrary, in some cases weakens even without special treatment in the conditions of rest. Patients with Accusative need leaving and constant observation.
the Forecast depends on a current of a basic disease. At long affective and affective and crazy attacks of schizophrenia, at involutional melancholy, at depressions and manias of organic genesis a sign of an adverse course of psychosis is stereotypification of motive excitement, easing and monotony of affective excitement (hardening of affect), emergence of speech stereotypies. At alcoholic deliriums emergence of movements, to-rye lose signs of difficult acts and are expressed in senseless shuffle by fingers, friction by the head about a pillow, catching for surrounding objects, always speak about the heaviest course of psychosis and threat for life of the patient.
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V. N. Favorina.