INFANTILITY (infantilismus; lat. infantilis is infantile, children's, from infans nonspeaking) — the clinical syndrome of various genesis which is characterized by an arrest of development of an organism with preservation at the patient of the morphological, physiological and mental features inherent to earlier age.
The term is offered by E. Ch. Lasegue in 1864. Detailed description wedge, pictures I. belongs to Lauren (P. J. Lorain, 1871). Anton (G. Anton, 1908) allocated the general And. (delay of the general development) and partial And. (rather isolated disturbance of somatic sexual or mental development), considered an etiology of a syndrome. Falt (W. Fait and) and Tsondek (N. of Zondek, 1929) was suggested to be excluded from the concept «infantility» of a form of an arrest of development at which lines of certain endocrine diseases, i.e. so-called endocrine forms I are observed. old authors. E.g., thyroid And. (Brisso's disease), developing as a result of the lowered function of a thyroid gland and characterized by a growth inhibition, mental development and the expressed symptoms of a hypothyroidism, is considered by modern writers as symptomatology hypothyroidism (see). Questions of an etiology, clinic and treatment And. M. Ya. Breytman, A. A. Kisel, D. M. Rossiysky, N. A. Shereshevsky, etc.
the Reason developed development And. there can be hron, diseases at children's age (diseases went. - kish. path, liver, pancreas, kidneys, cardiovascular and hemopoietic system, tuberculosis, syphilis, malaria, etc.), diseases and brain injuries (especially birth trauma). And. can be manifestation of functional or organic gipotalamo-pituitary insufficiency (total or partial). Intoxications at parents (alcoholism, drug addiction, etc.) and bad material conditions (a hyponutrient, hypo - and avitaminosis) in the early childhood are of great importance hron. In some cases And. has hereditary character.
So-called late And. (reverse, or regressive old authors), coming in the post-pubertal period, at the age of 20 — 40 years (thyrogenic, sexual, pituitary) can result from tumoral, traumatic, vascular, infectious and toxic defeat of a hypothalamus or a hypophysis, and also the autoagressivny immune process breaking functions of closed glands. At men sexual And. it is possible owing to a dysgenesis of testicles and seed tubules (see. Klaynfeltera syndrome ), cryptorchism (see), as a result of damage or surgery in the field of the tail of an urethra at children. At assessment of genesis late sexual And. it is necessary to exclude genetic pathology.
Irrespective of an etiology patol, the process causing an arrest of development of an organism is always mediated by an arrest of development of c. N page and insufficient functional activity of one or several closed glands with the corresponding disturbances of exchange processes. Always the underdevelopment of bodies of a reproductive system — primary (a dysgenesis of gonads, the Hyper gonadotropic hypogonadism) or secondary takes place (a hypogonadotropic hypogonadism).
Hormonal insufficiency can arise in connection with primary pathology of endocrine organs (a hypophysis, thyroid, gonads), but it is more often it is connected with disturbance of the central (hypothalamic) regulation of endocrine functions, as causes the multiglandular (multiferruterous) nature of a disease. Main symptomatology of the general And. is defined by disturbance of somatotropic and gonadotropic functions of a front share of a hypophysis and hormonal insufficiency, a thicket secondary, gonads, and also an arrest of development of c. N of page, expressed in weakness of active braking, insufficiency of cortical control over activity of the subcrustal centers, dominance of the first alarm system over the second.
The clinical picture
the Clinical picture depends on an etiology, defeat of this or that system, degree of an arrest of development and age, the disease developed in Krom. Current And. (irrespective of genesis) chronic. Influence etiol, factors in the dopubertatny period leads to development of the general And., including sexual and mental I. Odnako sexual or mental And. can be the basic a wedge, manifestation of a syndrome (partial And.).
Based on the correspondence principle of outward, a structure and the sizes of an organism to a certain period of normal development, M. Ya. Breytman (1949) allocates three forms: 1) And. in the narrow sense of the word — preservation of signs of chest age, 2) a puerilism (Latin puer the boy) — preservation of signs of the dopubertatny period, 3) a yuvenilizm (Latin juvenilis youthful) — preservation of signs of youthful age. Some authors allocate an embrionalizm — preservation of germinal signs (at premature children).
the brightest symptom of the general And. the growth inhibition and weight serves at preservation of children's proportions of a body: an appearance and sexual development of the adult the organism does not get. According to D. G. Rokhlin (1931), at And., unlike pituitary dwarfism (see), it is only about the insufficient growth (140 — 149 cm). Fragility of skeleton structure (often bone age lags behind true age), thin not on age gentle skin is characteristic. Typically sharp lag in development of outside and internal generative organs; secondary sexual characteristics, as a rule, are absent, sometimes — are poorly expressed. From internals the greatest hypoplasia is found in cardiovascular system (a narrow aorta, a pendulous heart), is more often lowered by the ABP. The delay of intellectual development is quite often noted.
Sexual infantility at women
Sexual infantility at women is expressed in an underdevelopment of preferential reproductive system (partial). The basic the wedge, a syndrome at the same time is a hypogenitalism (see. Hypogonadism ): an arrest of development of outside and internal generative organs, mammary glands and other secondary sexual characteristics are not developed or poorly developed, it is broken menstrual cycle (see) on type oligo-, opsomenorrheas, dysfunctional are possible uterine bleedings (see), amenorrhea (see), infertility (see) or misbirth (see).
At ginekol, a research find underdevelopment of a clitoris, big and small vulvar lips, a narrow, short vagina, insufficient depth the vulval arches, a thin mucous membrane of a vagina with poorly expressed skladchatost. The neck of uterus is extended, conic. The body of the womb is reduced in sizes, highly located in a small basin, often rejected aside. Sometimes the underdevelopment only of a uterus is found at good development of external genitals and quite female general constitution. Sexual And. it can be combined with the general obesity or with exhaustion. At sexual And. constant pains in the field of a sacrum, pressure sense in the depth of a basin, morbidity are noted at the sexual intercourses, sexual desire is lowered.
Features of a constitution depend on genesis I. Tak, growth can be low at an agenesia of gonads as Shereshevsky's syndrome — Turner (see. Turner syndrome ), normal or high at other syndromes. At an inborn form of a hypogonadism the Crocq's disease, sometimes bed wetting and lack of sense of smell are often noted.
Sexual infantility at men.
The delay only of sexual development at men is observed less than at women; at men more often it is combined with the general And. With a low growth almost total absence of secondary bases of sex and an underdevelopment of generative organs is noted. Patients look much younger, have a brittle constitution, the high pitched voice remains; pilosis on a face, a pubis and in axillary hollows is expressed poorly or is absent completely. A penis of conical shape with tranzitorny phymosis (see). The scrotum is underdeveloped, depigmented. Testicles are small, a jellylike consistence. The prostate is so small that at a palpatorny research, as a rule, is not found. Sexual desire, spontaneous and adequate erections (see) and emissions (see) are absent. Sometimes erections arise, but at the small size of a penis sexual intercourse is complicated.
Partial And.— the preferential underdevelopment of generative organs — can be observed at clearly the expressed forms of primary and secondary hypogonadism. Wedge, picture partial And. is defined by a form of the hypogonadism which is its cornerstone.
Laseg wrote that the persons suffering mental And., remain «children for the rest of life»; Lauren noted that the frustration making mental And., treat more all constitution, than separate systems of an organism.
Little signs mental And. can meet also at normal physical. development. In patol, cases of feature mental And. are caused by a variety etiol, and pathogenetic factors, conditions under which it is shown.
Various classifications of forms of mental I. Razlichayut endogenous and exogenous are offered And.; inborn and acquired And., «pure» constitutional And., connected with nek-ry types of a psychopathy; And., observed at endocrine diseases; And. at organic lesions of a brain; And., connected with somatic diseases or defeats of separate bodies (a liver, kidneys, cardiovascular system); And., connected with mental diseases (schizophrenia, epilepsy, etc.), and also the infantilization psikhogenno caused under the influence of the wrong, coddling education.
G.E. Sukhareva marks out harmonious, disgarmonichesky and organic infantility. V. V. Kovalyov distinguishes idle time, or uncomplicated, and complicated mental And.; complicated And. includes tserebrastenichesky, neuropathic, disproportional (a combination mental And. with partial physical. acceleration), and also mental And. in combination with the expressed underdevelopment of the emotsionalnovolevy sphere. Suggest to distinguish also partial and total mental And.; And. as immaturity, existing throughout all life, And. as manifestation of the late maturing, a cut is overcome with age.
Wedge, picture mental And. it can be conditionally divided into symptoms the most general and into the signs connected with features nozol, accessories. In a picture of the general And. lines of childishness are equally shown as in physical., and mental warehouse of the patient (psychophysical And.), at the same time both signs of immaturity are harmoniously combined. At infantile children not only lag in growth and weight is noted, but proportions of a body, feature of a mimicry, gesticulation and the psychomotor systems inherent to earlier age remain. In a mental warehouse into the forefront immaturity of the emotsionalnovolevy sphere acts; at relative safety of intellectual development the thinking differs in concreteness, immaturity of judgments, dominance of superficial associations and weakness of abstract thinking. Ability to intellectual tension and concentration of attention is poorly expressed, there is a bystry fatigue from the activity demanding strong-willed effort at indefatigability in games. Instability of interests, constant aspiration to changes, special aspiration to new feelings and impressions («touch thirst») is observed. The spontaneity and inconsistency in statements and acts, insufficient independence, the increased suggestibility is characteristic. In mood instability, easily there are affective flashes which also quickly take place.
Disgarmonichesky I. can be designated as psychopathic And., because manifestations And. integrally enter into structure of the psychopathic personality, a thicket hysterical and unstable. Lines of children's mentality in these cases are especially pointed, the disgarmonichnost of mental properties, irritability and disbalance, inability to manage the behavior clearly acts, a cut submits a prelude of all to desires of the present moment. In addition to immaturity of thinking, dominance of imagination over logic is noted; lines of immaturity of mentality are combined with normal or even advancing physical. development and the accelerated puberty.
At integrally caused And. mental immaturity acts against the background of the organic insufficiency caused by encephalopathy or hron, organic process. In these cases mental And. it is shown along with signs of an organic psychosyndrome. Clearly irritable weakness, the raised exhaustion, easing of memory and attention acts.
Features mental And. at endocrine pathology are defined first of all by symptomatology of a basic disease; mental disturbances in these cases are various. At an inborn hypogenitalism inability of children to steady strong-willed stress, tendency to argue instead of working, emotional lability at the general complacent background of mood is most characteristic. Levity and the raised self-assessment, boasting are combined with feeling of inferiority. Extreme dependence and suggestibility, absent-mindedness, sluggishness and awkwardness of movements is noted. The combination of a children's appearance to inappropriate is characteristic of a pituitary subnanism I will increase solidity («little old men»); change of depressive and euphoric states, reserve and distrustfulness is observed. Along with it it is shown inherent And. the increased suggestibility, insufficient independence, instability of behavior.
At the schizophrenia which developed at early age signs of the general are combined And. and schizophrenia. In other cases of schizophrenia of manifestation And. act along with symptoms of defect as expression of regress of the personality. Wedge, originality And. at the same time it is shown in special pretentiousness and airs and graces, oddity of appearance and behavior (the exaggerated disgarmonichnost up to grotesqueness).
And., noted in certain cases epilepsies at children, it is found along with symptoms of change of the personality and the weak-mindedness inherent to epilepsy.
Mental And. at hron, somatic diseases it is shown in the form of tserebrastenichesky, disproportional options and in combination with the expressed underdevelopment of the emotional and strong-willed sphere.
The infantile behavior caused by the wrong, coddling education is characterized by an egocentrism, a capriciousness. The constant aspiration to recognition and sympathy follows from self-admiration; unjustified claims are combined with helplessness and sometimes with vulnerability, i.e. the general insolvency, despite full-fledged intelligence is available.
Clinically diagnosis And. put on the basis of lack of secondary sexual characteristics at that age when they shall develop with a normal growth of an organism. Radiological it is possible to establish lag of bone age. Sexual And. is established on signs of an underdevelopment of generative organs. At bikontrastny ginekografiya (see) at women find the reduction of a cavity of the uterus, lengthening of the cervical channel, long, narrow, gyrose uterine tubes reduced in sizes ovaries.
For diagnosis of the reasons And. at men carry out definition of a morphotype, a biopsy of testicles, etc. At expressed sexual And. in blood and urine reduction of maintenance of sex hormones is found. Definition is of great importance sex chromatin (see); its absence speaks about men's genetic type.
Laboratory researches often find anemia and a lymphocytosis. For differential diagnosis of primary and secondary hypogonadism define the maintenance of gonadotrophins in blood serum for development of tactics of treatment.
Treatment shall be directed to the basic disease which caused an arrest of development. Holding medical and recreational actions is necessary (improvement of living conditions, good nutrition with increase in amount of animal protein and vitamins, to lay down. gymnastics, sanatorium therapy, restriction of an intellectual overstrain). Delicate correction of hormonal disturbances and disturbance of processes of protein metabolism is necessary (appoint Somatotropinum, insulin, anabolic steroids, vitamins of group B, an aloe, hemotransfusion, etc.). In parallel carry out treatment sexual And. with the purpose to cause maturing of generative organs, formation of secondary sexual characteristics and to normalize functions of gonads.
Therapy sexual And. at women is defined by degree and the nature of dysfunction of ovaries. At unsharply expressed phenomena And. and cyclic hormonal therapy is shown to a hypo-ovaria with existence of an ovulation; therapy by synthetic progestins was widely adopted; appoint it is combined drugs of type of Infecundinum or Bisecurinum (from the 5th day from the beginning of periods within 21 days, in a row two-three courses, then at an interval of 2 — 3 months).
At sharply expressed And. and Haller (J. Haller, 1971) recommends to a hypoplasia of a uterus treatment by high doses synthetic stay it is new during 4 — 6 weeks. Such treatment is directed to braking of function gipotalamo - pituitary and ovarian system during reception of hormones and counted on the subsequent activation of function of this system as «a phenomenon of cancellation». However at sharply expressed oppression of function of ovaries more often appoint the drugs which are directly stimulating function of gonads.
In 1961 Mr. Grinblatt (R. Century of Greenblatt) suggested to apply Clamidum to stimulation of function of ovaries (the synonym klostilbegit — see. Clomifencitratum ); during treatment for the patient careful observation is necessary (survey and a palpation of a stomach, ginekol, a research for specification of the sizes of ovaries, inspection according to tests of functional diagnosis). With effect appoint repeated courses of treatment with increase in a dose of drug; in total carry out no more than 3 — 6 courses of treatment. In the absence of effect of treatment by Clomifencitratum at patients with sharply expressed phenomena And. and the amenorrhea showed treatment by gonadotrophins. Most of clinical physicians recommends to apply this treatment under control of concentration of estrogen in blood or in urine.
Apply to stimulation of sexual development of men horiogonin courses 15 — 20 injections. For the purpose of strengthening of growth use of anabolic steroids or small doses of androgens is recommended.
At mental disturbances appoint also neuroleptics, antidepressants, tranquilizers, and also according to indications both dehydrational and other symptomatic therapy. Medical and pedagogical actions, especially are of great importance for children and teenagers.
the Forecast depends on character and a possibility of elimination of the reason and degree of manifestation And. Recovery of normal development under the influence of treatment is usually observed at And., accompanying the endocrine diseases which are well giving in to hormonal therapy (a hypothyroidism, a diabetes mellitus), and unsharply expressed And., caused by defective food in a growth period. Normalization of development of an organism is doubtful at the chronic or sharply progressing diseases which are quite often badly giving in to treatment. Predictively it is especially adverse And., connected with disturbance of pre-natal fetation or a birth trauma.
Prevention assumes the prevention hron, infections, creation correct a gigabyte. and dietary conditions during development of the child, an exception hron, intoxications at parents; the correct education prevents emergence psikhogenno caused mental And.
Bibliography: Breytman M. Ya. Clinical semiotics and differential diagnosis of endocrine diseases, page 164, L., 1949; B at x m and N And. II. Radiodiagnosis in endocrinology, M., 1974, bibliogr.; In B. A artapet. Primary (testicular) hypogonadism, Kharkiv, 1973, bibliogr.; Bugs-with of a k*a y M. A. Children's endocrinology, M., 1971; Clinical psychiatry, under the editorship of G. Grule, etc., the lane with it., page 706, M., 1967; D. D Falcons. Endocrine diseases at children and teenagers, M., 1957, bibliogr.; Starkova H. T. Fundamentals of clinical andrology, M., 1973; Sukhareva G. E. Clinical lectures on psychiatry of children's age, t. 2, page 208, 328, M., 1959; T e of t of e r E. Hormonal disturbances at men and women, the lane with polsk., Warsaw, 1968; Wu Yi of l to and N with L. Diagnosis and treatment of endocrine disturbances at children's and youthful age, the lane with English, M., 1963; In 1 e u 1 e of M. of Endokrinologische Psychiatrie, in book: Psychiatrie der Gegen-wart, hrsg. v. H. W. Gruhle u. a., Bd 1/1 B, S. 161, B. u. a., 1964.
H. A. Zarubina; B. A. Vartapetov, And. H. Demchenko (yp.), M. I. Vrono (psikhiat.), T. Ya. Pshenktaikova (gin.).