Deviations that negatively affect children's adaptability to their environment are now commonly called personality disorders. Such mental disorders in children are detected quite rarely, since throughout the entire period of growing up the psyche constantly undergoes changes. Sometimes children develop conditions that have characteristics of a personality disorder.
Once a child reaches adolescence, we can talk about the end of personality formation. If signs of a personality disorder persist during this period, then we can already talk about a condition that needs correction.
Medical and social examination
Hello, tell me what to do. The child has been disabled since childhood (birth injury - brain hypoxia), she is now 19 years old, deprived of legal capacity by a court decision, in 2014 she was given the 2nd group of disability. In 2020, they gave me the 3rd group, they said he could work and gave me a referral to the labor exchange, the diagnosis was Moderate mental retardation with behavioral disorders. To appeal this decision, where should I go?
In 2012, for the last time (4 times in total), she was in a psychiatric clinic; according to the Epicrisis, the doctor wrote that she was socially dangerous. According to all the documents with which we went to the commission, the child is not legally competent, is not responsible for his actions, is aggressive and needs care. The girl studied at a correctional school in the SSD class at home. He won’t get on the bus on his own, is afraid of people, starts screaming and hitting everything nearby. He won’t wash himself or change his clothes unless his mother tells him to. He can go to the nearest store with a maximum of 50 rubles; he does not accept money above this amount. Mom calls there (the store) in advance and warns what to give. We live in the village, a 5-minute walk to the store.
According to the current legislation, to appeal a decision
from the primary ITU bureau to the higher ITU Main Bureau
of your region
is given a period of 1 month.
If you have doubts about the correctness of the decision made by the primary ITU bureau, you have the right to appeal
it to the higher ITU Main Bureau
of your region
(no later than 1 month).
If the above period of 1 month has already expired, then only 2 options remain: 1. Appeal the decision on the disability group in court. 2. Fill out a new referral for medical examination using form 088/u-06 - preferably after fresh inpatient treatment in a specialized (psychiatric) department - to clarify and document the severity of mental disorders.
It is difficult for me to answer this question, due to the fact that psychiatry is still a fairly specialized area of medical knowledge, and I personally am not a psychiatrist. Patients with mental illnesses will be examined by specialized ITU bureaus for patients with psychoneurological diseases (in common parlance - “ITU mental bureaus”). I work in a general medical examination bureau and we do not examine mentally ill people.
Generally speaking, attending psychiatrists usually have sufficient experience in registering patients for MSA, so if they consider it necessary to refer you to MSA, then this circumstance itself indicates a fairly high chance of establishing disability.
Disability is established at a percentage of 40% and above (with the simultaneous presence of disability in the established categories). The specific disability group depends on the amount of interest in the appendix to Order 1024n.
10-30% - disability is not established. 40-60% correspond to the 3rd disability group. 70-80% correspond to the 2nd disability group. 90-100% correspond to the 1st disability group.
Your case corresponds to one of the subparagraphs of paragraph 7.3.5 of the appendix to Order N 1024n
:
7.3.5 Schizotypal disorder 7.3.5.1
Slowly progressive course with productive psychopathological symptoms of the borderline register, which does not have a significant impact on social adaptation and preserved criticism - 10-30%
7.3.5.2
Slowly progressive course with persistent moderate productive psychopathological symptoms of the borderline register, complicating social adaptation - 40-60%
7.3.5.3
Slowly progressive course with persistent, pronounced productive psychopathological symptoms of the borderline register, endogenous personality changes, decreased criticism, social maladaptation - 70-80%
7.3.5.4
Slowly progressive course with significantly pronounced hysteroconversion symptoms (hysterical amaurosis, hysterical pseudoparalysis of the lower extremities, etc.), the need for constant care and supervision - 90-100%
Answer the questions asked and tell the truth - everything is as it really is. You should not exaggerate your complaints and you should not minimize them.
Most likely, you should be assigned at least group 3 disability if your treating psychiatrists refer you to MSA (I can’t say more precisely, since I’m not a psychiatrist).
www.invalidnost.com
Before applying for disability for schizophrenia, you must make sure that it is impossible to restore the lost quality of life. In most cases, when using new methods of treatment and rehabilitation of schizophrenia, used in the Preobrazhenie clinic, the quality of life can be restored or significantly improved.
Our patients return to the normal rhythm of life, get a good job, continue their studies at universities, start families and often have healthy children.
Registration of disability for schizophrenia should be used as the last method to arrange the patient’s life.
You need to understand that the mere presence of a mental illness is not a guarantee of receiving a disability group.
Disability in schizophrenia, as a chronic endogenous disorder, is associated with a lack of criticism of the ongoing changes in the psyche, a decrease in the ability to learn and perform productive activities, and a loss of control over one’s behavior and self-care skills.
If the patient is able to perform simple work, has not lost the ability to care for himself, exacerbations of the disease and hospitalization in a psychiatric hospital are rare, and during periods of remission asthenic and depressive symptoms are mild, then the condition can be assessed as able to work.
The prognosis in terms of disability depends on both the type of schizophrenia and the course of the disease. The earlier the disease develops, the faster a personality defect will form - gross mental disorders of the patient.
With the paranoid type of schizophrenia and schizoaffective disorder, a person usually remains safe for a long time. This allows him to lead a normal life, continue to work and have a family, losing his ability to work only at the time of psychosis. Schizotypal disorder (sluggish schizophrenia) does not lead to personality regression, and therefore loss of performance and self-care skills.
The continuous progradient course of schizophrenia leads to a more rapid personality defect than in the recurrent type, when after an exacerbation there begins a period of long-term stable condition without clinical manifestations.
Disability in schizophrenia
Disability is irreversible or persistent pathological changes in the body or psyche of the patient, reducing his socialization, ability to work, movement and ability to self-care.
Disability for schizophrenia is issued in the following cases:
- the course of the disease is more than 3 years;
- frequent and prolonged psychoses with hospitalization;
- pronounced negative symptoms: decreased energy potential, lack of commitment to work, social isolation;
- reduction of criticism during remission;
- persistent asthenic and affective disorders outside of psychosis;
- pronounced personality defect: lethargy, unemotionality, loss of initiative, coldness, irritability;
- change in behavior in the form of mannerism, whimsicality, foolishness, aggression and self-aggression, lack of harmony with people;
- prolonged catatonia or psychomotor agitation;
- loss of previous abilities and skills for self-care.
40% of patients with schizophrenia have a mental disability. Usually a 2nd non-working group is assigned. In milder cases of persistent changes in the patient’s psyche, disability group 3 is assigned.
Disability group 1 can also be assigned. When the disease proceeds with virtually no visible remissions, apatoabulic syndrome is expressed, when the patient practically does not leave the house and cannot provide himself with food, basic hygiene and the preservation of his health, or, due to continuous hallucinatory-delusional and catatonic states, the connection with the objective is completely lost the world and your personality.
preobrazhenie.ru
Features of schizotypal personality disorder
Schizotypal disorder is a chronic, slowly developing disease of the schizophrenia spectrum, the main manifestations of which are neurotic, hypochondriacal, psychopathic, affective and unexpressed paranoid symptoms.
Synonyms for schizotypal disorder are sluggish schizophrenia, latent schizophrenia, low-progressive schizophrenia. This is what this disease was previously called.
Most often, the disease develops before the age of 20, but even at a later age the first signs of mental illness may appear.
This pathology is slightly more common among men than among women.
Causes
The causes of schizotypal disorder literally lie in the genes. The disease, like schizophrenia, is an endogenous pathology that is inherited.
Very often it is possible to establish that one of the blood relatives of such a patient suffered from schizophrenia, affective disorders, or was distinguished by eccentricities and oddities.
When a patient comes to the attention of psychiatrists and close relatives begin to visit him, often one of them is distinguished by inappropriate, conspicuous behavior.
According to ICD-10, diagnosis is carried out on the basis of the characteristic signs of schizotypal disorder, which I will give you:
- various oddities and peculiarities are observed in a person’s behavior and appearance, egocentrism is possible;
- excessive suspicion is characteristic, paranoid ideas can be traced;
- the person looks aloof, he is emotionally cold, and his reactions are often inadequate;
- one can note the impoverishment of contacts, a tendency towards social withdrawal;
- there are strange views and beliefs that are not consistent with generally accepted norms, thinking can acquire a magical character, that is, a person begins to associate many absolutely natural things with the influence of some magical forces, which is incomprehensible to others;
- the thinking of such people can acquire an overly detailed, amorphous, detailed character;
- There may be perceptual anomalies such as body illusions, derealization, or depersonalization;
- various obsessions are noted, the distinctive feature of which is the absence of internal resistance;
- without external provocation, rare episodes of hallucinations (most often auditory), illusions, and delusional ideas may be observed.
It is not necessary for a person to have all of these symptoms of schizotypal disorder, it is enough that 4 or more of the signs I listed above have been observed for at least 2 years.
To make a diagnosis of schizotypal disorder, it is first necessary to rule out schizophrenia.
In the current International Classification of Diseases, 10th revision (ICD-10), schizotypal disorder is coded as F21.
Causes of organic personality disorder
The causes of organic personality disorders are extremely varied. Among the main ones:
- traumatic brain injuries of any location,
- tumors and cysts,
- epilepsy,
- degenerative brain diseases (multiple sclerosis, Alzheimer's disease, etc.),
- infectious diseases of the brain,
- encephalitis,
- cerebral palsy,
- poisoning with neurotoxic substances, in particular manganese,
- pathology of cerebral vessels,
- Substance abuse.
Long-term epilepsy (more than ten years) with frequent seizures leads to the appearance of an organic personality disorder. There are a number of studies proving the connection between the frequency of attacks and the severity of mental pathology.
Organic personality disorders have been known and studied for more than a century. However, there is still no accurate information about their pathogenesis and development. The impact of social factors and characteristics of the premorbid state on the course of this class of disorders has not been fully studied. The main mechanism for the development of the disease is considered to be a violation of the normal ratio and mechanics of the processes of excitation and inhibition in the brain due to its damage.
Recently, an integrative approach to the pathogenesis of this class of diseases has been gaining popularity, which, in addition to organic factors, takes into account the genetic characteristics of the patient and his social environment.
Differential diagnosis
Differential diagnosis of schizotypal disorder is most often carried out with schizophrenia, obsessive-compulsive disorder, and schizoid psychopathy.
Differences from schizophrenia
Why was the disease, previously called sluggish schizophrenia, given the name schizotypal disorder and separated into a separate category? Everything is very simple. The fact is that with schizotypal disorder, although personality changes develop, they never reach the same depth and severity as in schizophrenia, and deep emotional devastation never occurs. That is why these 2 pathologies were differentiated.
Schizotypal personality disorder is considered as a slow and relatively favorably developing psychosis of the endogenous circle. That is, a person with this diagnosis can lead an almost normal life, maintain social adaptation, work, and will not become deeply disabled, in need of outside help and supervision, as happens with schizophrenia.
With schizotypal disorder there will never be persistent delusions or prolonged vivid hallucinations. Although thinking disorders may occur, in general thinking will be preserved.
OCD and schizotypal disorder
Obsessive-compulsive disorder (OCD) is similar to schizotypal disorder in that both pathologies are characterized by the occurrence of various compulsions.
In the early stages of schizotypal disorder, the symptoms of the disease are nonspecific, and obsessions (thoughts, ideas, actions) may be almost the only symptom. However, as the disease develops in schizotypal disorder, internal resistance to these obsessions will be lost, they will no longer be so painful for the person. Over time, other symptoms that are more characteristic of the schizophrenia spectrum will begin to appear - emotional coldness, thinking disorders, psychopathic-like symptoms, etc.
With obsessive-compulsive disorder, criticism of one’s condition and existing obsessions will persist constantly, the person will understand all the “abnormality” of his condition.
Schizoid and schizotypal disorders
Schizoid personality disorder (psychopathy) has some similarities with schizotypal disorder. People suffering from both pathologies are distinguished by eccentricity, self-centeredness, emotional coldness, and are incomprehensible to others. There may be autism, paradoxical emotions and behavior, one-sided interests, and difficulties in contacting people.
In adolescence, adolescence, and even in youth, significant difficulties may arise in the differential diagnosis of these two mental pathologies, but over the years, the differential diagnosis will become easier, because with schizotypal disorder, specific symptoms appear over time.
Goals of psychotherapeutic treatment:
- increasing the patient’s subjective psychological comfort,
- improving quality of life,
- fight against depression,
- elimination of sexual disorders,
- treatment of obsessive-compulsive conditions,
- teaching the patient socially acceptable behavior patterns.
Psychotherapy is carried out in the form of a series of personal conversations with a psychiatrist, followed by exercises aimed at learning new behavior patterns. Family, group and individual psychotherapy is used. Working with the patient’s family is especially effective, as a result of which it is possible to improve relationships with relatives and ensure their support for the patient.
Hospitalization of a patient in a specialized institution is carried out when there is a threat of suicide or the patient is highly aggressive and poses a danger to others.
There is no complete prevention of organic personality disorders. It is important to pay great attention to the prevention of injuries during childbirth, industrial and domestic injuries, medical examination of the population in order to timely detect pathology for early treatment. After identifying the disease, it is necessary to create conditions for stabilizing the condition and work with the patient’s environment.
Features of mental illness
During the course of schizotypal personality disorder, 3 main periods are conventionally distinguished:
Latent period
In the initial stages of the disease, most patients do not show signs of social or intellectual decline; moreover, there may even be a tendency towards professional growth.
The main manifestations of schizotypal disorder that occur during the latent period:
Affective manifestations
Affective disorders may be observed - neurotic or somatized depression, which is regarded as a reaction to overwork, and hypomanic states.
Symptoms of depression are depression, tearfulness, self-doubt, irritability, and a tendency to introspection. The presence of depression, excessive self-doubt, and pessimistic thoughts can lead to the development of suicidal behavior.
Hypomanic states are characterized by productive, but one-sided “tireless activity”, increased activity, and excessive optimism. At the same time, obsessions, rituals, and phobias may appear, accompanied by insomnia, increased excitability, and transient somatized symptoms (vegetative crises, dysfunction of internal organs, pain syndrome).
Active period of the disease
The disease can occur either continuously or in the form of attacks (exacerbations).
Attacks of schizotypal disorder in adolescence and young adulthood are characterized by signs of hypochondria, reluctance to do anything, and disturbances in thinking. Senestopathies (various unusual causeless sensations in the body) may be observed - burning, crawling, transfusion, crunching, etc.
Attacks that occur in adulthood are more often accompanied by affective and paranoid disorders (delusions of jealousy, litigiousness).
Common symptoms of exacerbation:
Features of schizotypal disorder:
- the disease has a long latent period, activation of the process occurs, as a rule, only at distant stages of the disease;
- the development of signs of schizotypal disorder occurs from less specific to more specific; at the onset of the disease, the symptoms are more similar to neurotic disorders, which is why difficulties arise in making the correct diagnosis;
- the disease has a wave-like development;
- Throughout the course of the disease, a number of symptoms called axial symptoms will be observed, which represent the basis of the personality defect.
The core symptoms of schizotypal disorder are disorders of self-awareness, obsessions, and somatized mental disorders.
Diagnosis of organic personality disorder
To establish a diagnosis of “organic personality disorder,” it is necessary to identify a combination of emotional, cognitive and characterological changes with organic brain damage.
Diagnostics is carried out using the following methods:
- neurological examination,
- psychological research (testing and conversation with a psychologist),
- functional study of the brain (electroencephalography),
- visualization of brain structures (CT and MRI).
During the examination, a search is made for brain damage and dysfunction, changes in behavior and drives, speech disorders, memory integrity and level of consciousness are checked.
For final confirmation of the diagnosis, a long-term observation of the patient by a specialist - a neurologist or psychiatrist - is necessary for at least six months. During this period, the presence of three or more diagnostic signs of organic personality disorder is confirmed according to the ICD-10 criteria described above.
Disability
It is necessary to understand that disability for schizotypal personality disorder is not given to everyone and not always.
It all depends on the course of the disease (paroxysmal or continuous), on what symptoms will be leading in the clinical picture of the disease, how socially adapted the person is, how often he needs hospital treatment.
Each person is individual, and each person’s disease develops according to its own pattern. Therefore, one patient can adapt well, find an interesting job and not need financial support from the state; the other will be deprived of all this, moreover, his disease will develop more actively, and naturally, disability will be shown to the second, and not to the first.
Schizotypal disorder is a chronic disease from which it is not yet possible to completely recover. It is necessary to understand that the disease, although slowly, will progress, but over time the process will stabilize.
Compared to schizophrenia, the prognosis for schizotypal personality disorder is much more favorable: such a pronounced and irreversible personality defect does not form as in schizophrenia.
Many people diagnosed with schizotypal personality disorder receive higher education, a profession, work, including in their specialty, have families, children, and are generally socially adapted.
Of course, it is much better to be physically and mentally healthy, but if symptoms of this disease have already appeared, then in no case should you give up, give up a full life and wait for a medical commission to confirm the presence of disability. You need to work on yourself, take active (during exacerbations) and supportive treatment, try to lead a normal lifestyle.
Symptoms of organic personality disorder
According to ICD-10, the following symptoms are identified with organic personality disorder.
First of all, it is necessary to have general criteria for a psychiatric illness due to brain damage:
- confirmed data on the presence of a disease or brain injury,
- preserved consciousness and memory,
- absence of other mental disorders.
Next, the criteria for organic personality disorder are clarified. Its symptoms require the presence of three or more of the following for at least six months:
- Emotional disorders, which can manifest as euphoria, irritability, anger, apathy, the appearance of flat or inappropriate witticisms in speech, attacks of aggression, frequent fluctuations in emotions, their instability and changeability.
- Cognitive disorders. More than others, organic personality disorder is characterized by the presence of paranoid ideas or excessive suspicion, a tendency to categorize people as “good” and “bad,” and pathological preoccupation with one activity.
- Changes in speech, in particular viscosity, slowness, excessive detail, a tendency to use colorful adjectives.
- Decreased ability for long-term purposeful activities, including professional ones. This is especially noticeable in relation to activities that require a lot of time, the results of which do not appear immediately.
- Sexual dysfunction - changes in preferences or increased libido.
- Disinhibition of drives, including those of an antisocial nature - the patient may develop hypersexuality, aversion to personal hygiene, a tendency to gluttony, and may participate in illegal acts.
Depending on the prevailing combination of symptoms, the following types of organic personality disorder are distinguished:
- aggressive,
- labile,
- paranoid,
- disinhibited,
- apathetic,
- mixed.
Prevention
Given the endogenous nature of the disease, it is almost impossible to prevent the occurrence of mental disorders.
Attacks of the disease can be provoked from the outside. Severe stress, somatic illness, pregnancy and childbirth, or excessive physical activity can trigger another round of exacerbation. This must be understood and, if possible, avoid exposure to such factors in order to avoid exacerbations of the disease.
Treatment of schizotypal disorder should be carried out under the strict supervision of a psychiatrist.
Some people believe that schizotypal disorder can be left untreated because it does not develop as quickly as schizophrenia. And here lies the biggest mistake, because the disease causes enormous discomfort both to the person himself and to his loved ones.
Various obsessions, illusions, hallucinations, depressive experiences, psychopathic behavior, outbursts of aggression and many other symptoms are successfully corrected under the influence of modern drugs.
Can schizotypal disorder be cured? Unfortunately, this disease is chronic, and it has not yet been possible to develop drugs that could completely stop its development. But to significantly reduce the number and severity of exacerbations, slow down the progression, and reduce emotional and behavioral disorders is a feasible task.
Which drugs are most effective?
Neuroleptics come first. These drugs eliminate productive symptoms - hallucinations and delusions.
In the presence of depressive symptoms and various obsessions, the use of antidepressants is indicated.
The choice of drug, dose and frequency of administration should be made individually by a psychiatrist. There can be no talk of any self-medication.
