Oligophrenia

OLIGOPHRENIA, oligophrenia (from Greek oligos-small and phren-mind), feeble-mindedness, a psychiatric term proposed by Kraepelin to denote a series of cases that differ in pathogenesis but are similar in external manifestations. The main feature of O.--underdevelopment of mental functions due to congenital causes (hereditary predisposition and damage to the embryo or fetus); however, damage to the nervous system in the first months or even years of life results in developmental retardation so similar to congenital forms that such cases are also classified as O. Mental deficiency can be of various degrees-from almost complete absence of mental functions to states close to normal. The most severe degrees of O. are designated as idiocy (see), moderate degrees as imbecillitas (see), and mild degrees as debility (see). To assess the degree of mental retardation, various methods are used (Binet, Rossolimo and others). In addition to intellectual disorders, oligophrenics also show deviations in temperament, which leave a marked imprint on the personality of such patients: since ancient times, eretic (mobile, excited) and torpid (lethargic) forms have been distinguished. The peculiarities of drives and affects are also of no less importance. Very frequent increases in lower-order drives (sexual, food-related) and a tendency for affective outbreaks, in the absence of restraining influences from underdeveloped higher mental functions, lead to improper, often antisocial behavior and can be dangerous to others. In addition to mental functions, other properties of oligophrenics' bodies also usually deviate from normal. These patients typically exhibit motor deficiency with underdevelopment of the finest psychomotor functions. The more severe the O., the more pronounced, as a rule, is the motor deficiency; however, there are exceptions when even severe oligophrenics exhibit sufficient motor dexterity. In addition to general motor deficiency, oligophrenia is also characterized by underdevelopment of certain special motor mechanisms. The most important should be considered speech defects, the development of which is closely related to mental functions. In profound idiots, there is complete absence of speech; generally, oligophrenics usually start talking late and their speech often remains deficient in terms of articulation (not to mention the poverty of vocabulary). Furthermore, oligophrenics are characterized by inexpressive, monotonous facial expression, insufficient manual dexterity, frequent left-handedness, and enuresis. In terms of somatic development, oligophrenics are also usually deficient. Body build is mostly markedly disharmonious with incorrect proportions. Height and weight often do not reach normal levels, sometimes, conversely, excessively exceeding them. Sharp discrepancies in limb length and body size are observed. The general appearance often does not correspond to age; sexual development is frequently delayed and does not reach normal levels, while premature development and maturation occur less frequently. These disproportions are usually associated with dysfunction of the endocrine glands and degeneration. Anomalies of the skull are very common-very small or excessively large size, incorrect shape, asymmetries, underdevelopment or excessive development of facial bones, etc. Frequently encountered are: cleft palate, harelip, unusual hairiness, polydactyly, various deformities of the sexual organs, and deficiency of sensory organs (vision, hearing). All these anomalies of the somatic sphere, as well as neurological symptoms (paralysis, hyperkinesias, seizures), vary depending on the pathogenesis of O. Thus, O. should be considered not only as mental deficiency but also as a manifestation of a general disorder of the development of the entire organism. From the point of view of pathogenesis, O. is heterogeneous. The following forms are distinguished. I. O. due to endogenous brain malformations. These include: 1) Microcephaly, characterized by small skull and brain size (weight-500-700 g), with the brainstem and cerebellum sufficiently developed, but the cerebral hemispheres and especially the frontal lobes are underdeveloped. Body build is markedly disharmonious, mental development in pronounced cases is at the level of idiocy, and patients are usually fidgety, mobile, good-natured, and imitative. 2) Megaloencephaly-large head (without hydrocephalus) with excessive development of brain gray matter and underdevelopment of white matter. Psychologically-profound idiocy. 3) O. associated with partial manifestations of brain underdevelopment (agyria, microgyria-underdevelopment of gyri, absence of the corpus callosum, Marchiafava-Bignami disease with underdevelopment of white matter not covered by myelin, etc.). 4) O. based on malformations due to underdevelopment of the brain's vascular system. II. O. due to exogenous brain injuries. These include: 1) Infectious forms based on diffuse damage to nervous tissue or local meningitis and encephalitis, contracted during the fetal period or early childhood. Persistent consequences of these processes lead to general retardation of brain development (and the entire organism) and local focal phenomena (paralysis, seizures, etc.). 2) O. based on congenital syphilis-a very common form resulting from damage to the embryo or early specific meningoencephalitis. In addition to focal symptoms (and sometimes serological reactions), somatic stigmata of congenital syphilis are observed (saddle nose, Hutchinson's teeth, etc.). 3) Hydrocephalus (hydrocephalus), also a consequence of infections (particularly often syphilis); pathological increase in the amount of cerebrospinal fluid leads to an increase in skull circumference (up to 75 cm or more). The shape of the skull is very characteristic (the root of the nose appears deeply sunken under an excessively protruding forehead). As a result of increased intracranial pressure, there can be: a) focal symptoms-spastic paralysis, epileptiform seizures, sometimes atrophy of the optic nerve and endocrine disorders (obesity) due to pressure on the pituitary gland, b) phenomena of general mental underdevelopment of various degrees (from profound idiocy to states close to normal). Additionally, mental symptoms usually include euphoria, irritability, attention instability, and affective outbreaks. 4) Traumatic O. In the intrauterine period, injuries to the mother's abdomen and unsuccessful attempts at mechanical expulsion of the fetus can cause brain injury (hemorrhage), but this more often occurs during childbirth (especially with the use of forceps). As a result, developmental retardation and sometimes focal symptoms. 5) Intoxication oligophrenia is possible due to metabolic disorders in pregnant women (e.g., in uremia). This also includes damage to the embryo and fetus due to alcoholism and poisoning with industrial poisons (lead, etc.). III. O. based on endocrine disorders developing in early childhood. These include: 1) Cretinism (see) as a result of hypofunction of the thyroid gland (endemic form in goiter in mountainous areas, sporadic form occurs everywhere and depends on underdevelopment of the gland); characterized by lack of growth, myxedema, trophic disorders, intellectual underdevelopment, and lethargy. 2) Adiposogenital dystrophy (see) in case of pituitary gland damage (enormous development of fat, underdevelopment of the sexual apparatus, and mental deficiency). 3) Mongolism (see). 4) Infantilism associated with hypoplasia of the gonads (and partly the thyroid gland), as well as sometimes internal organs (especially the heart), and characterized by underdeveloped childish mentality and corresponding body proportions. This form should be distinguished from dystrophic infantilism due to exogenous causes (infections, nutritional deficiency, etc.), which does not belong to O. 5) Other forms of endocrine O. (in case of thymus damage and others).- IV. In addition to the listed forms with a definite etiological factor and anatomical substrate, there remains a significant number of cases of underdevelopment with unclear pathogenesis. The most diverse factors, eluding clarification and related to both endogenous and exogenous factors, can cause insufficient mental development in the absence of obvious signs of nervous system damage. These are usually milder degrees of O., associated with subtle changes in nervous tissue, still almost inaccessible to research. The course of O. is essentially stationary (continues throughout life). At the same time, however, age and other biological factors, on the one hand, and the social environment, on the other, have a great influence on the external manifestations of O. Patients with age, although slowly, do develop, acquire certain skills and knowledge, and appropriate education and training play, of course, a huge role in acquiring labor and social skills. Conversely, homelessness, neglect, and alcoholism lead to antisocial deviations. Under unfavorable external conditions, especially due to excessive stress, often associated with awareness of one's own deficiency, reactive mental outbreaks can develop in oligophrenics, which usually end favorably ^ch when external conditions improve.

Pathological anatomy of O. depends on the pathogenesis; endogenous forms are characterized by developmental defects of brain substance, while exogenous forms show remnants of old processes (scars, cortical vacuoles, porencephaly, hydrocephalus, thickening of the membranes, endarteritis, etc.). In many (usually milder) cases of O., however, no significant pathological-anatomical changes are found. - Diagnosis. In differentiating O. from other mental diseases that cause feeblemindedness, one should base this on the fact that O. manifests from early childhood, is usually accompanied by phenomena of general biological inferiority, and does not show progression. In schizophrenia, epilepsy, etc., feeblemindedness develops gradually, does not appear at the beginning of life, and the patient loses previously acquired skills and knowledge, as a result of which degradation of their psyche is observed. It is important to differentiate mild forms of O. from normal with low intelligence. Temporary, minor, and unstable delays in mental (and sometimes somatic) development may be explained not by O., but by other transient factors: 1) later maturation of the individual, not dependent on organic causes, 2) prolonged somatic diseases of an exhausting nature, but without direct brain lesions, 3) physical defects (especially blindness, deaf-mutism, etc.), 4) prolonged stay in an uncultured primitive environment and complete educational neglect in childhood. All these cases differ from O. in that with appropriate educational and cultural influence (or due to improvement in somatic condition), they catch up with their peers. Prevention. The number of oligophrenics in the population is very significant, it is difficult to account for, especially if mild degrees of debility without sharp boundaries into normal are taken into account. According to approximate calculations, the number of pronounced oligophrenics may be about 2 per thousand population. Among the child population, there are more oligophrenics than among adults, due to the short lifespan of these patients. Already from these data, it is clear how great the social significance of O. is. These patients are not only a burden to those around them and society, but they also replenish in large numbers the ranks of antisocial groups (beggars, vagrants, prostitutes, various types of lawbreakers). Offspring of oligophrenics are often also inferior. Since a large part of O. is associated with external factors, and even congenital and therefore endogenous factors for the individual are often exogenous in relation to parents (e.g., syphilis), the prevention of O. is largely covered by the fight against infections, intoxications, syphilis, and measures to protect motherhood and infancy, to improve cultural and living conditions, etc. In relation to the oligophrenics themselves, timely therapeutic-pedagogical measures in appropriate conditions and using methods suitable for their level of development are extremely important. Education in auxiliary schools and workshops allows mild oligophrenics to later lead a working life. Some oligophrenics show ability, even of an increased type, for music (absolute pitch). In general, training in labor is the main measure preventing antisocial deviations. When choosing a profession, one must of course take into account the physical and mental strength of oligophrenics, directing them to simpler and less responsible types of labor. Professional consultations at dispensaries are very useful in this regard, and such persons should be under their supervision. In relation to more severe oligophrenics, the tasks of education come down to teaching the simplest skills, cleanliness, self-care, and, if possible, the simplest labor processes. Deep oligophrenics, due to their helplessness, have to be kept in special institutions. Oligophrenics of any significant degree cannot bear full responsibility for their actions, and in relation to those prone to lawbreaking, special measures to protect society are required. Such patients should be under appropriate supervision, and the more dangerous ones should be kept in colonial-type institutions with a labor regime.