Katalepsiya – the ideomotorny phenomenon which is characterized by impossibility independently to move at high flexibility and ability it is long to keep a pose, without making efforts. Develops at a narcolepsy, hysteria, a catatonic form of schizophrenia, it is recreated in the period of a hypnotic dream. It is shown by tension, hardening of muscles, almost total loss of sensitivity to heat and pain. Diagnostics includes data collection of the anamnesis, survey of the neurologist, a conversation with the psychiatrist. For elimination of attacks of a katalepsiya treatment of the main disease is carried out, the technicians of psychotherapy increasing ability randomly to operate a body are applied.
The term "katalepsiya" of the Greek origin, literally means "skhvatyvaniye", "keeping". Other widespread name of a syndrome – wax flexibility. Epidemiological indicators are low, make 0,018-0,02% in population with approximately equal ratio of men and women. The cataleptic state is observed not only at people, but also at all vertebrata therefore can be considered as biologically expedient reaction. At animals it arises in situations of vital threat, represents a common form of passive and defensive behavior – dying down, oppression of vegetative functions is imitation of death that reduces probability of attack of the enemy, and also prepares an organism for possible real death.
Provocative factor of wax flexibility long experience of a stress, intensive emotions – nervousness, fear, anger, rage is considered. Katalepsiya develops against the background of neurologic and mental diseases, artificially is called in a condition of hypnosis at certain psychological lines. Can be the reasons of an attack:
- Catatonic schizophrenia. Typical symptoms of this form of a disease are the alternating excitement and a stupor. At a catatonic stupor the katalepsiya can be observed.
- Cerebellum diseases. Neurologic pathologies at which communications between frontal departments of bark and a cerebellum are blocked become the reason of a syndrome. Such violations are defined at tumors, after injuries.
- Hysterical neurosis. Katalepsiya arises at a hysterical stupor. It is found in women more often.
- Reception of medicines. The medicinal katalepsiya develops as a result of application of high doses of the medicines blocking and reducing activity of dopamine. For example, pathological flexibility is observed after introduction of a haloperidol, a triftazin.
- Suggestibility. People with the weakened will, dependent, susceptible are more subject to hypnosis and effects formed in it. Signs of a katalepsiya extend to all body or separate parts.
- Narcolepsy of 1 type. At this option of a gipersomniya (sleep disorders) the katalepsiya is considered as a specific symptom. It is formed a year later after the beginning of a disease.
Cataleptic states are various by origin, the emotional state, functional and structural changes of TsNS, the hypnotist's signals can act as the trigger. "The general final way" of development of a syndrome are the activated subcrustal systems of modulation of a muscular tone at relative deactivation of bark, a retikulyarny formation, basal kernels. Balance of a body remains, but randomness of movements is lost. According to the last researches, damages of kaudalny department of a hypothalamus and a tegmentum to the top departments of a midbrain cause the syndrome similar to a katalepsiya.
The tone of muscles is supported, the difficult innervation of motive acts is broken. It is shown by drowsiness, motive block, hardening in the given poses. The attack develops not in one stage, pathological changes gradually extend in the top cervical department, hands, then move to a lower body. The return order is less often observed. An exit can occur in the direction opposite to the beginning of an attack. At most of patients duration makes of 1 minute till several o'clock, but cases when the katalepsiya remained several weeks are known.
At a cataleptic attack muscular tension increases, sensitivity to pain and temperature changes decreases, an opportunity to move extremities, to move is lost. The patient sees, hears, understands, but cannot react to the events around. Pulse, heartbeat and other vegetative reactions are strongly slowed down that causes the assumption of death in people around. Muscles become firm to the touch, but catalepsy is absent. Position of extremities, trunks easily changes by external efforts. The pose remains throughout all attack.
In some cases at the patient affective, crazy frustration and hallucinations can be also noted. Often the katalepsiya is followed by an ekhopraksiya (involuntary repetition of gestures), negativism (resistance to requests and violent change of a pose), an ekhofaziya (repetition of words, phrases), a verbigeration (an incessant pronunciation of the same words, offers), a stereotypy (steady repetition of aimless movements). After an exit from an attack the patient experiences emotional excitement – cries, shouts.
Hard cases of a katalepsiya are complicated by crazy and hallucinatory frustration. During an attack at patients consciousness obscuring, as a rule – with flow of crazy fantastic images and representations is observed. Hallucinations develop in a certain sequence, creating the complete, finished according to contents picture. After a sharp state amnesia on really taking place events is usually noted, but patients describe own state rather precisely. Complications of long cataleptic attacks result from vegetative frustration. Headaches, dizzinesses, a sleep disorder and digestion develop.
Diagnostics of a katalepsiya is carried out by the psychiatrist and the neurologist. Attacks of wax flexibility can be shown at the established main diagnosis or be the cause of primary address to the expert. Depending on this factor the volume of diagnostic procedures is defined. Comprehensive examination includes:
- Poll. The discussion is led with the patient, relatives. The doctor collects anamnestichesky data, finds out symptoms. At communication with the patient the expert defines ability to productive contact, safety of critical abilities, intellectual functions.
- Observation. Assessment of behavioural and emotional deviations is made in the course of consultation of the patient and his stay in a hospital. Quite often the doctor manages to be present at development of an attack directly.
- Neurologic survey. At primary diagnostics of test allow to reveal neurologic pathology as the possible reason of a katalepsiya. Inspection of the patient during an attack confirms decrease in painful and temperature sensitivity, block of reflex answers, a muscular hyper tone with plasticity preservation.
At statement of the main diagnosis the psychodiagnostics, tool researches TsNS, laboratory blood tests and urine can be in addition appointed. Data of objective methods give the chance to establish the disease which served as the katalepsiya reason and to differentiate pathology with other syndromes of motive functions.
Treatment of a katalepsiya
Elimination of a katalepsiya is a part of therapy of the leading disease – catatonic schizophrenia, hysterical neurosis, a narcolepsy, tumors and consequences of injuries of brain. At adequately picked up methods the frequency and duration of attacks are reduced. Carry to specific treatment of a syndrome:
- Interactive imagogika. The psychotherapeutic technique based on work with imagination. The patient studies ability to better feel a condition of muscles, to realize management process of them. Then the positive image through which control over the movements and actions, the katalepsiya attack allowing to warn develops is created.
- Medicamentous correction. Medicines are selected the doctor individually taking into account the existing emotional and behavioural deviations. For knocking over of attacks psychostimulators, antidepressants, neuroleptics are used.
- Family consultation. A task of family members – to ensure emotional comfort and physical safety of the patient. On consultations relatives are told about features of a course of a disease, an operations procedure at a katalepsiya. It is impossible to sneer, humiliate the patient, to leave unguarded when performing potentially dangerous actions (cooking, crossing of the street). When hardening in an unnatural pose, it is necessary to give to a body a comfortable position, to stay nearby before the termination of an attack.
Forecast and prevention
The forecast of a katalepsiya favorable at successful treatment of the main pathology, safety of cognitive functions, ability to critical thinking. Under such circumstances effective is a method of an interactive imagogika developing skill of any prevention of attacks. Specific measures of prevention do not exist, it is possible to reduce probability of a katalepsiya by means of timely diagnosis and treatment of mental and neurologic diseases on the basis of which it arises.