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  • Psychopathy (personality disorders)
  • Types of psychopathy
  • Dynamics and treatment of psychopathy
DYNAMICS Psychopaths

By PB Gannushkina, psychopathy is necessary to study not only static, highlighting the most common options, but also in the dynamics. In this connection it is important to note that a personality disorder not be attributed to disease processes, as they do not have a progressive flow (as opposed to, for example schizophrenia), but the speaker when psychopathies evident. Changes in state (periods of decompensation), which are regarded as phase (seizures) may occur in psychopathic personalities without reasons spontaneously (autochthonous), with a return upon completion to the state prior to the beginning of the attack, or depend on a variety of external influences. For example, the VM Bekhterev (1886) noted decompensation relationship not only with psychogenic effects, but also such things as the menstrual cycle in women, pregnancy, physical illness and even changes in the weather. All these factors play a role of triggering mechanisms, and are not substantially affect the clinical phase and its duration.

Phase can not always be considered as part of a temporary exacerbation of constitutional properties (depressive phase at gipotimikov, manic at gipertimikov). Indeed, experience shows that depressive phase can develop not only cycloids, but also schizoid, hysterical, anxious-hypochondriac astenikov. Considered as PB Gannushkin, the occurrence of more stable phases indicates deeper compared with psychogenic decompensation mental impairment, for their appearance in addition to constitutional predisposition requires "some additions" resembling a progressive manifestation of the respective diseases. For example, if psychopathy schizo-anankastnogo circle [ideoobsessivnaya psychopathy, in SA Sukhanov, (1905), anankastnaya psychopathy, according to K. Schneider (1928)] formed autochthonous obsessive phase with no direct connection with affective disorders.

Pathological reactions (decompensation) are the result of unpleasant life events, stress, prolonged surge unreacted expectations. Given the fact that each type has its own set of individually significant "injuring" events for other types of psychopaths, another mosaic these events but may not be as significant. For example, Psychasthenic hardly experiencing a situation of choice, and asteniki cycloid and tantrums - loneliness, isolation, and explosive gipertimnye - situations that require accuracy, precision, pedantry; paranoid do not tolerate objections sensitive to the non-recognition of their merits. By themselves, the reaction can be directed inward (this leads to internal conflict, neurosis) or outward (aggression, overvalued ideas of persecution, kverulyantstvo).

Etiology and Pathogenesis

Psychopathy has multifactorial etiopathogenesis conditionality. The main role belongs to genetic, constitutional factors. E. Kretschmer, B. Sheldon and then developed the doctrine of the role of the relation between body structure and personality type (cycloid - picnics, schizoid - leptosomy and asteniki).

Importance of genetic factors in personality disorders confirmed by biological research, according to which the concordance in monozygotic twin pairs for personality disorders was significantly higher than in dizygotic (VD Moskalenko, 1988). In favor of the participation of the genetic processes in the formation of personality disorders study results show foster children. According Shulzinger F. (1972), a survey of foster children sociopathic showed that similar personality disorder in the biological parents to 5 times more often than in receiving.

Great importance in the genesis of psychopathy, as suggested more PB Gannushkin are also structurally unstable exogenous organic brain damage in utero, perinatal and early postnatal development. Such injuries may be associated with different brain diseases, infections, injuries, intoxication. Recently, the importance of the concept of personality disorders in the attached catecholamine neuromediation defects at the synapse and its structural elements (BM Kogan, 1995; TB Dmitrieva, 1997), although the exact mechanisms of their development so far not been fully established.

Differential diagnosis of psychopathy is needed with psychopathic maloprogredientnoy schizophrenia. Thus, the main criterion is the lack of demarcation of progression, as well as the absence of major symptoms of schizophrenia (see Chap. 18 "Schizophrenia"), and the preservation of the general picture of the person with psychopathy. Paranoid state within the dynamics of psychopathy differ from delusional schizophrenia entirely concrete constructions, their constant communication with real events, the lack of generalization and systematization. Schizoid personality disorder in schizophrenia is characterized by contrast beginning in childhood formation of anomalous character without abrupt shifts, she lifelong retains its identity, and its "owners" are finding a niche in the social environment, and show no signs of the devastation of the person with reduced energy potential that characteristic of schizophrenia.

Decompensation psychopathy or in cases of pathological personality development positive symptoms represent only the addition of affective disorders (mostly depressive) and reinforcing basic psychopathic stigmas (schizoid, asthenia, hysterical reactions, etc.), which, after authorization phase and attenuation of symptoms development (neurotic symptoms) are reduced and disappear, so that the person is returned to its original state.

Organic pathology is excluded after a thorough paraclinical studies (EEG, KT, neurological examination, exclusion of signs of increased intracranial pressure, changes in the fundus, etc.).

TREATMENT

Psychopathy therapy performed during periods of decompensation, the dynamics of psychopathy and is performed using psychotropic drugs.

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