EXCLUSIVE STATES

From Big Medical Encyclopedia

EXCLUSIVE STATES — group of temporary disorders of mental activity which combine such general signs as the sudden beginning, a state dulled from knowledge during short time (minutes — hours), disappearing critically with full or partial amnesia of the events which were taking place during this period.

K I. pages belong only cases of quickly taking place disorders of mental activity at the persons who are not finding before signs of a mental disease or at people at whom the inborn or acquired deviations in the mental sphere do not reach degree of a mental disease.

And. page — a rare form of a mental disorder.

And. pages have great practical value in judicial psychiatry. Allocation And. the page in separate group is reasonable from the practical point of view: they are combined similarity by a wedge, manifestations and feature of a current, unity of diagnostic and forensic-psychiatric criteria. During the studying of this group of frustration the most important and their essential feature — disorder of mental activity in the form of psychosis comes to light. Treat them: 1) patol, intoxication (see. Alcoholic psychoses ); 2) patol, affect (see. Affect pathological ); 3) twilight stupefactions ( see), not being a symptom any hron, diseases; 4) patol, prosonochny states; 5) reaction of «short circuit».

Clinical picture

And. the page represents special group of psychotic episodes. In one cases defining And. pages symptoms are poor, hardly give in to identification and a differentiation, in others — there are clear and difficult psikhopatol, states. The basic defining everything And. the page frustration is a condition of stupefaction, as a rule, in the form of twilight this or that structure, coming to an end with a dream or conditions of sharp mental and physical exhaustion up to prostration and various degrees of amnesia of a psychotic episode.

Twilight stupefaction is heterogeneous on the manifestations. Often it reminds similar states at epilepsy. Against the background of a full disorientation in the place, time and surrounding there are affective frustration in the form of melancholy, fear, rage, frenzied rage, frightening visual hallucinations, crazy statements about prosecution, motive frustration with the nature of attack or flight with desperate self-defense. In some cases twilight stupefaction is shown only by motive excitement. The described forms differ from hysterical twilight stupefaction.

At hysterical twilight stupefaction a disorientation usually incomplete, and in statements hopes, desires, fears, likes and dislikes of this person, and also the maintenance of the situation injuring it constantly are reflected. In motive frustration the exaggerated expressiveness and theatricality; in disorders of affect — its variability often with existence of ecstatic or children's foolish fig.

Patol. prosonochny states arise at the slowed-down awakening after a deep sleep. Awakening happens at the same time unevenly, extending in the beginning only to simpler functions of the movement while consciousness remains in a condition of sleepy braking of various depth. This prolonged transition from a dream to wakefulness can be followed by residual dreams, disorders of orientation and perception surrounding, the illusions, hallucinations and the crazy ideas which are combined with wrong, in some cases dangerous to people around and themselves behavior.

Reaction of «short circuit» results is long and silently the transferable expressed affective tension in the form of gloomy melancholy, rage, hatred badgered by despair of expectation with concentration on these experiences for an appreciable length of time of the majority of representations. Content of dangerous action, a cut till any moment it was also not supposed to carry out, is defined by instantly ripened, often accidental situation. Such situation gives as if the last impetus to the category of gradually collecting steady stress. According to E. Krechmer, in these cases the impulse to action thanks to the excessive force of «stagnant» affect is carried out refleksoobrazno. Wedge, picture of reaction of «short circuit» decides, in addition to the expressed affective frustration, by motive excitement on the aggressive actions directed against persons, objects (murder, arsons) or themselves (suicide) and also a condition of the changed consciousness of various depth.

Etiology and pathogeny

And. pages can develop at healthy people, but most often they arise at persons with mental anomalies. The last are shown by a psychopathic warehouse of character (see. Psychopathies ), neurotic frustration (see. Neurosises ), the residual phenomena after organic diseases of c. N of page, in particular after a craniocereberal injury, alcoholism also create this or that degree of mental instability. Its combination to various external vrednost causes emergence And. page. Value patol, background undoubtedly significantly. Tells existence of the known correlations between a form of mental anomaly and a form I about it. page. So, the twilight stupefactions coming to those which meet at epilepsy and patol intoxication arise at persons with residual organic diseases of c more often. N of page, at influence of such accessory external factors, as acute infectious or somatopathies, alcoholic intoxication, forced sleeplessness.

Hysterical twilight stupefactions and reaction of «short circuit» arise at psychopathic persons, first of all under the influence of psychogenias (see. Reactive psychoses ), while factors of the exhausting character have smaller value here.

Rarity And. pages, as a rule, allow to assume single character at the same person (an exception conditions of twilight stupefaction represent) that their emergence requires not a simple combination of the internal and external reasons, and their special quantitative and qualitative ratios. Such ratios can arise only at very large number of variations from which is implemented in And. page only one.

The diagnosis

First of all ascertaining of the main a wedge, signs is necessary And. page. Diagnosis And. page it is often difficult because these states, being tranzitorny, almost never happen a subject of direct medical observation. As a rule, the wedge, a picture of estimated disease state should be recovered retrospectively, later various, in some cases considerable, time terms, on the basis of the data of lawsuit often very poor in the necessary facts. In these cases the data reported by witnesses of the former mental disorder which the psychiatrist expert can receive during the conducting judicial examination in court session or at a stage of preliminary investigation are important. In the act court. - medical examinations shall be given accurate proofs of existence of the dulled consciousness.

Differential diagnosis it is carried out first of all with various on structure (crazy, hallucinatory, proceeding with stupefaction etc.) tranzitorny frustration at schizophrenia (see), epilepsies (see), alcoholism (see. Alcoholic psychoses ), vascular diseases of c. N of page, reactive psychoses.

Treatment

Treatment in the conditions of out-patient clinic or a hospital is carried out when after disappearance of symptoms of psychosis the sharpening of mental anomalies or when in time comes to light And. the page was committed the crime which caused development of a reactive state.

Forecast favorable, repeated cases of emergence And. the page, except for twilight stupefactions, usually does not meet.

Forensic-psychiatric assessment

In cases of diagnosing And. pages examinees admit deranged.



Bibliography: Vvedensky I. N. A problem of exclusive states in forensic-psychiatric clinic, in book: Probl, court. psikhiat., under the editorship of Ts. M. Feynberg, century 6, page 331, M., 1947; Korsakov S. S. Course of psychiatry, t. 2, M., 1901; L at N of c of D. R. Forensic-psychiatric examination of exclusive states, in book: Vopr. court. - psikhiat, examinations, under the editorship of A. N. Buneev, etc., page 94, M., 1955; M about r about z about in G. V., To and h and e in A. K. and Lukacher G. Ya. Differential diagnosis of simple and pathological intoxication, M., 1973, bibliogr.; The guide to judicial psychiatry, under the editorship of G. V. Morozov, page 348, M., 1977, bibliogr.

See also bibliogr, to St. Alcoholic psychoses , Affect pathological .

A. K. Kachayev.

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