RU2497453C1 - Method of psychopathological estimation of psychic state of infants and preschool children - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to field of medicine, in particular to psychiatry and can be applied for psychopathological estimation of psychic state of infants and preschool children. To perform psychopathological estimation of psychic state of infants and preschool children estimation of child's psychic and neurological state is performed. As symptoms of patient's psychic state estimated are state of sphere of cognitive functions: play, thinking, memory, speech; state of sphere of psychic activity: aim-oriented behaviour, volitional desires, motives, workability; state of emotional sphere, sphere of attraction, sensor perception, impairment of perception: acousma, photopsia, hallucinations, self-consciousness and state of sphere of social behaviour: communication disorders, autistic symptom, social skills. As symptoms of patient's neurological state, state of sphere of neurological signs, motor activity and state of initial vegetative tome - vagotonia and sympaticotonia are estimated. Estimation of each symptom is performed in points from 0 to 7. Total value of average point of identified symptoms for each sphere, reflecting severity of patient's psychic and neurological state, is calculated. Average points are summed up for each sphere and severity of state is determined in accordance with determined values, namely if the total sum of average points is from 0 to 9, psychic state is estimated as child's practical health; if value is from 10 to 18 points, presence of boundary psychic disorders is estimated, from 19 to 27 points - as mild severity of psychic disorders, from 28 to 36 - as moderate severity, from 37 to 45 points - as medium, from 46 to 54 - as severe, from 55 to 63 points, psychic state is estimated as extremely severe degree of psychic disorders.EFFECT: method makes it possible to increase accuracy of psychic state of infants and preschool children due to application of differential and diagnostic criteria of symptoms of psychic disorders.4 ex

Description

The invention relates to medicine, in particular to psychiatry, and can be used for qualitative and quantitative psychopathological assessment of the mental state of children of early and preschool age.

A known method for diagnosing a mental state using the PANSS scale (Kay SR, Fiszbein A., Opler LA The Positive and Negative rating Scale (PANSS) for schizophrenia. // Schizophr.Bull. 1987, vol.13, p.261-276), which allows you to quantify the mental state of patients with schizophrenia in 5 leading areas of disorders: negative and positive symptoms, impaired thinking, impulsiveness, aggression and depression, as well as a scale of general psychopathology. The disadvantage of this scale is its limited use in young children or in adult patients with other nosological forms.

There is a method of assessing the mental state of children by taking into account negative and positive symptoms of the patient’s mental state, namely, impaired thinking, impulsivity, aggression and depression: Glossary of childhood mental disorders (Glossary of children's mental disorders: Guidelines / Kovalev V.V., Kozlovskaya G .V. - Approved by the Office for the Introduction of New Medicines and Medical Equipment of the Ministry of Health of the USSR on August 2, 1976 - 100 pp.). However, this method did not find wide application due to the fact that the Glossary did not provide for a quantitative assessment, it could not be used as a formalized scheme of the medical history. In addition, over the past time, new data have been obtained on the forms and dynamics of the course of mental disorders in childhood, which are not taken into account in this method, which directly affects the accuracy of assessing the mental state of children of early and preschool age.

The technical result of the invention is to increase the accuracy of assessing the mental state of children of early and preschool age through the use of a formalized scheme of the medical history, which includes a list of disorders of both mental and neurological symptoms.

The technical result is achieved by the fact that for a psychopathological assessment of the mental state of children of early and preschool age, negative and positive symptoms of the patient’s mental state are recorded, namely, impaired thinking, impulsiveness, aggression and depression, and negative and positive symptoms are evaluated in the process of determining mental and the patient’s neurological condition in nine areas, while the patient’s mental state is assessed as follows:

- reveal the state of the sphere of cognitive functions, namely: the presence of symptoms of unstable attention, attention hypermetamorphosis, pseudo-deafness, the presence of a delayed or perverted or stereotypical game, a slowed or accelerated pace, breaks in thoughts, diverse thinking, its slipping, in the form of flows and automatism, metaphysical intoxication , resonance, reflection, obsessive thoughts, overvalued formations, pathological fantasies, delusional disorders, critical thinking, the presence of decreased memory, or hyper nezia, or its selectivity, or confabilization, pseudo-reminiscence, the presence of an accelerated or slowed-down pace of speech with oligophasia or the variability of its content and the peculiarities of its formation - delayed, intercalated or alalia, as well as the presence of echolalia, mutism, stuttering, schizophasia, persistence, verbigeration or stamps speech;

- identify the state of the sphere of mental activity, namely the presence of symptoms of reduced or increased or paradoxical goal-oriented behavior, increased, reduced, distorted or impulsive volitional desires, impulses, increased, reduced or distorted performance,

- identify the state of the emotional sphere, namely the presence of symptoms of inadequacy, paradoxicality, hypersensitivity and hypersensitivity of emotional resonance, irritable weakness, lability, dysthymia, depression, painful anesthesia, dysphoria, increased hyperthymia, mania, raptus, fears, anxiety disorders, panic reactions, ambivalence, deficiency, apathy, joylessness, daily and seasonal fluctuations of emotions;

- identify the state of the sphere of attraction, namely the presence of symptoms of bulimia, anorexia, peak symptoms, care, vagrancy, arson, coprolalia, autoaggression, suicidal behavior, sexualized behavior, external aggression, attraction to alcohol, drugs, victim behavior, self-incrimination, slander, kleptomania ;

- reveal the state of the sensory sphere, namely the presence of symptoms of delay in the formation of spatial perception, hyperesthesia, hypesthesia, paradoxical sensations, sensopathies, senestopathies;

- identify the state of the perception sphere, namely the presence of symptoms of acoasma, photopsy, auditory and visual illusions, true and pseudo-hallucinations of visual, auditory, olfactory, bodily and visceral, self-awareness disorder - depersonalization, derealization, dysmorphophobia, psychosensory disorders the absence of “I”, the feeling of an outsider, the feeling of “done”, the denial of vitality;

- identify the state of the sphere of social behavior, namely, symptoms of communication disruption: presence of ambitiousness, rejection, negativity, indifference and impulsive behavior, autistic signs - the phenomenon of identity, rituals, protodiac crisis, pseudo-deafness and stereotyping in speech, motor skills, social skills: delayed or distorted - neatness, self-care, eating or social behavior;

and the patient’s neurological condition is assessed by detecting violations in the field of motor skills, namely, the presence of symptoms of hypomimia, paramimia, grimaces, awkward or artsy fine motor skills or major motor skills - dexterity, gait, coordination, the presence of non-localized neurological signs - oculomotor symptoms, “eye care” attacks ”, Myoclonus, diffuse muscle hypotension, muscle dystonia, chore-like symptoms, delayed reduction of labyrinth reflexes, repulsion reflex, flickering right-sided hemisyndrome, as well as the presence of developmental syndromes: delayed or advanced motor skills, hyperdynamic syndrome, lethargy, stupor, tics, stereotype, catatonia, seizures and lack of control of pelvic functions,

- then, violations in the field of vegetatics - the initial vegetative tone, are identified, namely, the presence of vagotonia symptoms according to the erythematous skin color, marbling of its vascular pattern, red dermographism, distal hyperhidrosis, as of thermoregulation - the presence of body temperature less than 36 degrees, warm hands and feet, prolonged subfebrile condition for infections, according to the state of meteosensitivity - increased cold tolerance and reduced heat tolerance, according to the state of the eyes - their reduced gloss, narrowed eye cracks and the pupil cam, pupil play and increased lacrimation, the state of the cardiovascular system - the presence of labile bradycardia, the state of the respiratory system - a slowed breathing rate and the presence of repeated sighs, the state of the digestive system - reduced appetite, increased salivation, the presence of regurgitation and vomiting, spastic constipation , gas formation and increased body weight, according to the state of the urinary system - reduced need for water, the presence of pastiness and rare urination, as the immune systems - the presence of frequent allergic reactions and increased, loose lymph glands, as the sleep-wake system - the presence of a deep sleep and owls rhythm,

as well as the presence of sympathotonia symptoms due to the state of white skin color, vascular pattern, white dermographism, dry skin, and thermoregulation to the presence of a normal body temperature of more than 36.7 degrees, cold hands and feet, more than 38 degrees of temperature in case of infections, as meteosensitivity - reduced cold tolerance, and increased heat tolerance, according to the condition of the eyes - their increased shine, dilated palpebral fissures and pupils, pupil play and reduced lacrimation, as cardiovascular of the distal system - the presence of labile tachycardia, the state of the respiratory system - its increased frequency, the state of the digestive system - increased appetite, decreased salivation, lack of regurgitation and vomiting, the presence of weak peristalsis and atonic constipation and reduced body weight, and the state of the urinary system - increased need in water, lack of pastiness and the presence of frequent urination, as the immune system - the presence of rare allergic reactions and not enlarged lymph glands, according to standing the system of sleep and wakefulness - the presence of superficial sleep and the rhythm of a lark,

Express symptoms according to their severity in points from 0 to 7, while 0 is the absence of a symptom and never has been; 1 - almost healthy; currently not at all sick, the symptom was short-lived in the past; 2 - borderline mental disorder, dubious pathology - a symptom rarely manifests itself 1-2 times a year, passes by itself; 3 - easily ill, a symptom occurs 1-2 times a month; no treatment required; 4 - moderately sick - a symptom occurs in a situation of stress, not more often 1-2 times a week, does not determine the patient’s behavior, the condition can be overcome by psychotherapeutic methods; 5 - moderate severity - the symptom is constantly observed, the behavior can be ordered, it is difficult to maintain self-control; effective treatment with small doses of sedatives; 6 - seriously ill - a symptom is observed constantly, interferes with normal communication with others; continuous treatment is necessary; 7 - extremely seriously ill - the disorder completely determines the condition of the patient who is not capable of controlling his behavior, emotions; socially maladaptive, disabled, calculate the total value of the average score, the identified symptoms for each area, reflecting the severity of the mental and neurological condition of the patient, then summarize the average scores in nine areas and determine the severity of the condition in accordance with the established values, namely, with a total value of average scores from 0 to 9 evaluate the mental state as the child’s practical health; when assessing from 10 to 18 points, they are assessed as the presence of borderline mental disorders, from 19 to 27 points as the mild severity of mental disorders, from 28 to 36 as moderate, from 37 to 45 points as moderate, from 46 to 54 as severe , from 55 to 63 points evaluate the mental state as an extremely severe degree of mental disorders.

The method is as follows.

The inventive "Protocol of clinical observation", hereinafter "Protocol", is a set of registration tables for formalized qualitative and quantitative assessment of the mental status of the child. The whole scale is divided into spheres of mental activity, formed in the form of tables. The protocol indicates the physical condition of the child, which is examined upon receipt of the child. They determine weight, height, body temperature, blood pressure, conduct a general analysis of blood, urine, a biochemical blood test, and an electrocardiogram. Then, the child is examined all aspects of the mental and neurological state in nine areas: cognitive functions, mental activity, emotions, drives, sensory, impaired perception, social behavior, as well as neurological signs, motility and autonomics. In this case, the study of all symptoms in nine areas is carried out according to generally accepted methods described in special publications: “Guide to Psychiatry. In 2 volumes. Edited by A.S. Tiganova and others, M .: Medicine, 1999, S. 17-407 "; "Handbook of psychology and psychiatry of childhood and adolescence. Edited by S.Yu. Tsirkina, St. Petersburg, Publ. "Peter", 1999, S.151-627 "; “Vegetative disorders. Under. ed. A.M. Wayne, M .: Medicine, 1998, S.7-98 "; "Badalyan L.O. and other Guidelines on neurology of early childhood, Kiev: Health, 1980, S. 5-108. ". First of all, a study of cognitive impairment is carried out, revealing attention disorders, various disorders of thinking, games, memory and speech development disorders. Namely, the presence of symptoms of unstable attention, hypermetamorphosis of attention, pseudo-deafness, the presence of a delayed or perverted or stereotypical game, a slowed or accelerated pace of thinking, breaks in thoughts, diverse thinking, its slippage, influxes and automatisms, metaphysical intoxication, resonance, reflection, obsessive, are determined supervalued formations, pathological fantasizing, delusional disorders, a decrease in the criticality of thinking, the presence of a decrease in memory, or hypermnesia, or its selective spine, or confabulation, pseudo-reminiscence, the presence of an accelerated or slowed-down pace of speech with oligophasia or the eloquence of its content and the features of its formation - delayed, intercalated or alalia, as well as the presence of echolalia, mutism, stuttering, schizophasia, persistence, verbigeration or stamped speech. Assess the severity of violations of the identified symptoms in scores from 0 to 7, as indicated in table 1.

Table 1 EVALUATION OF THE SEVERITY OF MANIFESTATION OF SYMPTOMS 0 - no symptom, never had it 1 - almost healthy; currently not at all sick, the symptom was briefly in the past 2 - borderline mental disorder, doubtful pathology, the symptom may rarely be 1-2 times a year, passes by itself 3 - easily ill, a symptom occurs 1-2 times a month; no treatment required 4 - moderately sick - a symptom rarely occurs in a situation of stress, not more often 1-2 times a week, does not determine the patient’s behavior, the condition can be overcome by psychotherapeutic methods 5 - moderate severity - the symptom is constantly observed, the behavior can be ordered, it is difficult to maintain self-control; effective treatment with small doses of sedatives 6 - seriously ill - a symptom is observed constantly, interferes with normal communication with others; need constant treatment 7 - extremely seriously ill - the disorder completely determines the condition of the patient who is not capable of controlling his behavior, emotions; socially maladaptive, disabled

The scale for assessing the severity of disorders allows us to trace and quantify not only the pronounced mental disorder, but also the intermediate state of risk with the presence of individual symptoms that do not yet fit into the classical picture of the developed syndrome. The absence of the disorder is indicated in points by the number 0, the absence of the symptom in the past, by the number 1, dubious pathology by the number 2. The borderline severity level, when at the same time the patient may have short-term manifestations of the symptom, is rated as 3. The next level is 4 - corresponds to a situation where there is a systematic appearance of a separate disorder, that is, every time a child gets into an unusual situation, accompanied by excitement, experiencing stress, causes the patient to appear with sponding symptoms. Levels from 4 to 7 characterize the increase in the intensity of painful manifestations over time, during which they are observed, as well as the severity of decompensation.

The presence of detected deviations is noted in the corresponding line of the Protocol by a score in accordance with the table for assessing the severity of the condition.

Then, an assessment of the severity of the state of the sphere of cognitive functions is revealed by calculating the average score by CGI (sum of the scores set in accordance with the table for assessing the severity of the condition of the identified symptom, and the resulting amount is divided by the number of identified symptoms in this area).

After that, the child is determined by a disorder of mental activity. That is, the presence of symptoms of reduced or increased or paradoxical goal-oriented behavior, increased, reduced, distorted or impulsive volitional desires, promptings, increased, reduced or distorted performance. These symptoms are determined using the tests described in the manuals mentioned above. Assess the severity of violations identified during the study of symptoms in scores from 0 to 7, according to table 1 and the severity of the state of the sphere of mental activity, calculating the average score for CGI, as described above.

After that, the severity of the symptoms of the sphere of emotions is assessed, namely, the presence of symptoms of inadequacy, paradoxicality, hypersensitivity and hypersensitivity of emotional resonance, irritable weakness, lability, dysthymia, depression, painful anesthesia, dysphoria, increased hyperthymia, mania, raptus, fears, anxiety disorders , panic reactions, ambivalence, deficiency, apathy, joylessness, daily and seasonal fluctuations of emotions. The severity of the disorders identified during the examination of the symptoms is evaluated in scores from 0 to 7 according to Table 1, and then the severity of the state of the emotional sphere, calculating the average score by CGI.

Further, the scope of drives is assessed by the severity of symptoms, namely, the presence of symptoms of bulimia, anorexia, peak symptoms, withdrawal, vagrancy, arson, coprolalia, auto-aggression, suicidal behavior, sexualized behavior, external aggression, attraction to alcohol, drugs, victimization, self-incrimination , slander, kleptomania. The severity of the disorders identified during the examination of the symptoms is assessed in points from 0 to 7 according to Table 1 and the severity of the state of the attraction sphere, calculating the average score by CGI.

Then, the sensory sphere is evaluated according to the severity of the symptoms, namely, the presence of a delay in the formation of spatial perception, hyperesthesia, hypesthesia, paradoxical sensations, sensopathies, and senestopathies is revealed. The severity of the disorders identified during the examination of the symptoms is assessed in points from 0 to 7 according to Table 1 and the severity of the sensory sphere, calculating the average score by CGI.

After that, the state of the sphere of perception is assessed by the severity of symptoms, revealing the presence of acoasms, photopsies, auditory and visual illusions, true and pseudo-hallucinations of visual, auditory, olfactory, bodily and visceral, self-consciousness disorders - depersonalization, derealization, dysmorphophobia, psycho-sensory disorder ”Or the absence of“ I ”, the presence of a feeling of an outsider, a sense of“ done ”, a denial of vitality. The severity of the disorders identified during the examination of the symptoms is evaluated in scores from 0 to 7 according to table 1 and the severity of the state of the perception sphere, calculating the average score by CGI.

And finally, they assess the severity of the symptoms of the sphere of social behavior, revealing a violation of communication: the presence of ambitiousness, rejection, negativity, indifference and impulsive behavior, autistic signs - the phenomenon of identity, rituals, protodiac crisis, pseudo-deafness and stereotyping in speech and motor skills, delayed or distorted social skills: neatness, self-care, eating or social behavior. Assess the severity of violations of the symptoms identified during the examination of the child, scores from 0 to 7 according to table 1 and the severity of the state of the sphere of social behavior, calculating the average score by CGI.

Then, the child is examined on all sides of the neurological condition. Violations are identified in the areas of “neurological signs”, motor skills, initial vegetative tone: vagotonia and sympathotonia. The neurological condition is evaluated according to traditional directions, which takes into account violations in the field of motor skills, in particular, identifies the presence of symptoms of hypomimia, paramimia, grimaces, awkward or artsy fine motor skills, or major motor skills - dexterity, gait, coordination, the presence of non-localized neurological signs, namely , oculomotor symptoms - attacks of “eye care”, myoclonus, diffuse muscle hypotension, muscle dystonia, chore-like symptoms, delayed reduction of labyrinth reflexes, the presence of reflexes X-ray repulsion, flickering right-sided hemisyndrome, as well as syndromes of disorders in the development of motility - hyperdynamic syndrome, lethargy, stupor, tics, stereotypy, catatonia, seizures and lack of control of pelvic functions. The severity of the disorders identified during the examination of the symptoms is assessed in points from 0 to 7 in Table 1 and the severity of the state of the motor sphere, calculating the average score by CGI.

Further, violations in the field of vegetatics - the initial vegetative tone, are revealed, namely, revealing the severity of the condition of vagotonia symptoms by the state of the skin - its erythematous color, marbling of the vascular pattern, red dermographism, distal hyperhidrosis, by the state of thermoregulation - the presence of an ordinary body temperature of less than 36 degrees, warm brushes and feet, prolonged subfebrile condition for infections, according to the state of meteosensitivity - increased cold tolerance, and reduced heat tolerance, according to eye conditions - their reduced gloss, narrowed palpebral fissures and pupils, pupil play and increased lacrimation, the state of the cardiovascular system - the presence of labile bradycardia, the state of the respiratory system - its slowed breathing rate and the presence of sighs, the state of the digestive system - reduced appetite, increased salivation, the presence of regurgitation and vomiting, spastic constipation, gas formation and increased body weight, according to the state of the urinary system - reduced need for water, the presence of pastiness and rare urination, according to Stoyanov of the immune system - the presence of frequent allergic reactions and increased, loose lymph glands, as sleep-wake system to the presence of a deep sleep and owls rhythm. Then, the severity of the symptoms of sympathotonia is also assessed, revealing the state of the skin - its white color, the severity of the vascular pattern, white dermographism, dry skin, and thermoregulation - the presence of an ordinary body temperature of more than 36.7 degrees, cold hands and feet, more than 38 degrees of temperature in case of infections, due to meteosensitivity - reduced cold tolerance, and increased heat tolerance, according to the state of the eyes - their increased shine, dilated palpebral fissures and pupils, pupil play and reduced lacrimation , by the state of the cardiovascular system, by the presence of labile tachycardia, by the state of the respiratory system, by its increased frequency, by the state of the digestive system, by increased appetite, decreased salivation, the absence of regurgitation and vomiting, the presence of weak peristalsis and atonic constipation and reduced body weight, as urinary system - an increased need for water, lack of pastiness and the presence of frequent urination, as the immune system - the presence of rare allergic reactions and not increased lymph glands, as the sleep-wake system - the presence of surface-sleep rhythm and the lark. Assess the severity of disorders identified during the examination of the symptoms of vagotonia and sympathotonia, in scores from 0 to 7 according to table 1 and the severity of the state of the vegetative sphere, calculating the average score by CGI.

Three types of autonomic responses are known: eutonia, sympathotonia, vagotonia. Eitonia means a balanced vegetative response, and corresponds to the level of practical health. In those cases when multidirectional responses are recorded between different life systems, one judges the presence of "amphotonia", in which there are regulatory shifts in both branches of the autonomic nervous system (ANS). Detected changes in autonomic responses indicate dysfunction and impaired maturation of the ANS, or secondary vegetative pathology in the framework of various diseases. With a balanced manifestation of vegetative signs, the state is assessed as eutonia.

The condition of the child is assessed in all 9 areas of the disorder. Summarize the average scores in 9 areas and make a conclusion about the mental state of the child’s health. In this case, the total value of the average scores from 0 to 9, the mental state is evaluated as the practical health of the child; with a sum of points from 10 to 18 - assessed as the presence of borderline mental disorders, from 19 to 27 points - as a mild severity of mental disorders, from 28 to 36 - as moderate, from 37 to 45 points - as average, from 46 to 54 - as severe, from 55 to 63 points assess the mental state as an extremely severe degree of mental disorders.

For each area, an average violation score is set, which is calculated as the arithmetic average of the sum of all the symptom ratings set. If the result is not an integer, then the digital value is rounded to the integer in accordance with the existing mathematical rules (if the number is equal to or less than 0.5, then the number is rounded to an integer smaller number, if the value is above 0.5, then rounding goes to the next , integer). By calculating the arithmetic average of the sum of all the estimates in a particular area, they judge the violation of this particular area. At the end of the Protocol, scores for all 9 mental areas are summarized. According to this final assessment, the state of mental health of the child as a whole is judged.

Examples of the method.

Example 1. Dmitry V. is 14 years old. There is a diagnosis of childhood autism. Proband from 5 pregnancies, 3 urgent births. Birth weight 3320, length 54 cm. Motor development was slightly ahead: holding his head from 2 weeks, turning from 4 months, sitting from 7, got up, went to 9 months. Pre-speech development is timely, by 10 months there was active babble, syllables. Neatness skills formed by the end of 1 year.

Specific developmental features in the form of individual symptoms were noted from an early age in the form of hyperesthesia (intolerance to touch), identity syndrome. At 10 months, the condition gradually changed. Attention has become unstable. Attacks of “withdrawal into oneself” appeared without loss of consciousness. Impulsivity, pseudo-deafness with normal hearing were noted. At times, excitement attacks with field behavior arose, in the form of outlined episodes during the day. By the year the condition worsened. Often he was excited, or immersed in his own experiences, made stereotypical movements in the form of pulling out the threads from the tissues. I did not immediately respond to calls, after 4-6 calls.

By the year he stopped pronouncing syllables, then completely lost his speech. Phrase speech did not appear until 5 years old. The game was stereotyped for a long time. From 3 years old he played wheels, rolled on the floor, tried to roll other toys as well. In behavior, excessive accuracy paid attention, could not stand the slightest dirt on his hands.

At 3.5 years old, he was first hospitalized in the hospital № 6. He received treatment with sonapax, cerebrolysin. During his stay in the hospital he began to hide his hands behind his back, did not take anything with his hands. For a long time and after discharge, if I wanted to ask my mother for something, I pushed her with my shoulder and explained her with gestures. In the future, the condition remained severe until 5 years, against which seasonal exacerbations were noted. The behavior was determined by manifestations of protodiac crisis, symptoms of identity, autism.

In connection with dyspeptic phenomena that occur when taking milk food, at 4.5 years old he was examined at the Pediatrics Research Institute: intolerance to gluten and casein was revealed. Began to receive a special diet, goat milk. From this time on, the somatic state improved, and later the mental state began to improve. With 5.5 years of age, speech appeared in a short phrase. At the age of 6, he began to smile at relatives, give a hand, and make elementary contact. To clarify the diagnosis and the selection of therapy was sent for consultation at the NCHP RAMS.

An assessment of the condition of the child according to the claimed method, and the data were recorded in the Protocol.

MENTAL CONDITION I. COGNITIVE FUNCTIONS 2006 2009 2011 Attention Disorders Unstable 5 four four Hypermetamorphosis of attention Pseudo deafness 5 four four A game

Detained 5 four four Perverted 5 four four Stereotype 5 four four Thinking Pace Slow motion 5 four four Accelerated Clippings of thoughts 5 four four Versatility 5 four four Slips 5 four four Bursts, automatisms Metaphysical intoxication Resonance Reflection Obsessive thoughts Supervalued education Pathological fantasies 5 four four Delusional Disorders Criticality 5 four four Memory Decline Hypermnesia 5 four four Selectivity 5 four four Confabulations, pseudo-reminiscences Speech Pace Accelerated Slow motion 5 four four Content Oligophasia 5 four four Circumlocution Formation Features Detained 5 four four Retransmission Alalia Echolalia Mutism Stuttering 5 four four

Schizophasia Stamped 5 four four Perseveration Verbigeration CGI severity score (GPA) 5 four four II. MENTAL ACTIVITY 2006 2009 2011 Targeted Behavior Reduced Increased Paradoxical 5 four 3 Volitional desire, motivation Elevated Reduced 5 four four Distorted 5 four 3 Impulsiveness 5 3 2 Operability Increased reduced (fatigue) distorted (paradoxical) 5 four four CGI severity score (GPA) 5 four 3 III. EMOTIONS 2006 2009 2011 Emotional resonance ( inadequacy , paradox, hypersensitivity , hypersensitivity) (underline as necessary) four four four Annoying weakness four one one Lability Dysthymia Depression (longing) Painful anesthesia Dysphoria Elevated (hyperthymia, mania) Mania

Raptus Fears Anxiety Disorders four four four Panic reactions Ambivalence four one one Scarcity four four four Apathy Dullness (anhedonia) four four four Daily fluctuations four four four Seasonal fluctuations CGI severity score (GPA) four 3 3 IV. ATTRACTIONS 2006 2009 2011 Anorexia Bulimia Peak symptom Cares Vagrancy Arson Coprolalia Autoaggression Suicidal behavior Sexualized behavior 5 3 3 External aggression Attraction to alcohol, drugs Victim behavior Self-incrimination, reservations Kleptomania CGI severity score (GPA) 5 3 3 V. SENSORICA 2006 2009 2011 Delayed formation (spatial perception) four 3 3 Hyperesthesia Hypesthesia

Paradoxical sensations Sensopathies (Algias) Senestopathy CGI severity score (GPA) four 3 3 VI. PERFORMANCE VIOLATIONS 2006 2009 2011 1. Acoasma, photopsia 2. Illusions (auditory, visual) 3. Hallucinations (true, pseudo) Visual Auditory Olfactory Bodily Visceral 4. Identity Depersonalization 3 2 2 Derealization Dysmorphophobia Psychosensory disorders Fission of "I" The lack of "I" The feeling of an outsider The feeling of "done" Denial of vitality CGI severity score (GPA) 3 2 2 VII. SOCIAL BEHAVIOR 2006 2009 2011 A. Disruption of communication (with mother, children, adults ) (underline as appropriate) Ambition Rejection Negativism 5 5 four Indifference 5 5 four Impulsive behavior 5 5 four

B. Autistic symptoms ( emotional, playful, bodily, visual , total) (underline as necessary) Identity phenomenon 5 5 four Rituals Protodiac crisis 5 3 2 Pseudo deafness 5 5 four Stereotypies (speech, motor skills) B. Social skills (neatness, self-care, nutritional, social behavior ) (type of skill to emphasize) Detainees 5 5 four Distorted 5 5 four CGI severity score (GPA) 5 5 four NEUROLOGICAL CONDITION Viii. NEUROLOGICAL SIGNS AND MOTORICITY 2006 2009 2011 Facial expressions (hypomimia, paramimia, grimaces ) (underline as necessary) four four 3 Fine motor skills (awkward, artsy) four four 3 Large motor skills ( agility, gait , coordination) (underline as necessary) four four 3 Pathological pyramidal reflexes Non-localized neurological signs Oculomotor symptoms: (nystagmus, saccadic eye movements , stopping gaze, weak innervation 4, 6 pairs) four four 3 Attacks of "eye care" Myoclonus Diffuse muscle hypotension Muscular dystonia four four 3 Choreal symptoms Labyrinth reflex reduction delay Repulsion reflex Flickering Right Hemisyndrome Syndromes of Disorders Motility development (delayed, leading)

Hyperdynamic syndrome Inhibition, stupor four four 3 Tiki four four 3 Stereotypies four one one Catatonia four four 3 Cramps Pelvic function control (enuresis, encopresis) four four 3 CGI severity score (GPA) four four 3 IX. VEGETATICS (Original vegetative tone) 2006 2009 2011 Leather Color Vagotonia - erythematous Sympathy - White four four four Vascular pattern Vagotonia - marbling Sympathy - not expressed four four four Dermographism Vagotonia - red Sympathy - White four four four Sweating Vagotonia - distal hyperhidrosis Sympathotonia - dry skin Thermoregulation Body temperature Vagotonia - <36.0 Sympathy -> 36.7 four four 3 Brush temperature, feet Vagotonia - warm four four four Sympathy - Cold Temperature for infections Vagotonia - protracted subfebrile condition Sympathy -> 38.0 Weather sensitivity Cold tolerance Vagotonia - increased Sympathy - reduced Heat tolerance Vagotonia - lowered Sympathy - increased Eyes Eye shine Vagotonia - reduced, dull four four 3 Sympathy - enhanced

Eye slits Vagotonia - narrowed Sympathy - extended Pupils Vagotonia - narrowed Sympathy - extended Pupil game Vagotonia - is Sympathy - is Lacrimation Vagotonia - enhanced Sympathotonia - reduced The cardiovascular system Heart rate Vagotonia - labile bradycardia four four one Sympathotonia - labile tachycardia Respiratory system Breathing rate Vagotonia - slow, sighs Sympathy - rapid Digestive system Appetite Vagotonia - reduced four four 3 Sympathy - increased Salivation Vagotonia - enhanced Sympathy - Reduced Spitting up, vomiting Vagotonia - characteristic Sympathy - not characteristic Intestinal motility Vagotonia - spastic constipation, gas formation Sympathotonia - weak, atonic constipation four four 3 Body mass Vagotonia - increased 5 5 four Sympathy - reduced urinary system Water requirement Vagotonia - reduced Sympathy - increased Pastosity Vagotonia is characteristic Sympathy - no Urination -
niya Vagotonia - rare Sympathy - frequent The immune system

Allergic reactions Vagotonia - frequent Sympathy - rare one 3 one Lymph glands Vagotonia - enlarged, loose Sympathy - not increased Sleep-wake system Sleep Vagotonia - deep four 3 2 Sympathy - superficial Rhythm Vagotonia - owls four 3 3 Sympathy - Lark CGI severity rating four four 3 Total points in all areas 39 32 28

Diagnosis. Autism due to other causes (ICD 10). Syndromes - autistic, emotional-volitional disorders, psychopathic, fragmentary catatonic disorders. The total score for basic mental functions during the first examination (2006) was 39 points, which corresponds to the moderate severity of the disease. As follows from the results of the examination of the patient, the largest violations were found in the field of cognitive functions, mental activity, attraction and social behavior. The boy’s mental illness is accompanied by autonomic disorders. In general, the boy has an amphotonic type of regulation: sympathetic to the skin, vagotonic for the eyes, cardiovascular, immune and sleep-wake systems, mixed (amphotonic) for thermoregulation of the digestive systems; the severity of autonomic abnormalities decreases against the background of ongoing therapy. In accordance with the revealed violations and the severity of the patient's condition, the treatment was specified. Gradually, the condition improved in all areas. In dynamics, there is a tendency to improve the condition, the sum of points for the main mental functions in 2009 amounted to 32 points, and by 2011 - 28 points (moderate severity of the condition).

Example 2. Patient Vyacheslav S. 13 years. Observed by a neuropsychiatrist from an early age. Early development of the schizoid type. Speech, motility within age. In the same period, transient neurological disorders were observed in the form of regressive symptoms in motor activity (walking on tiptoe, etc.), symptoms of identity, affective lability.

From 3 years of age, behavior sharply worsened, became almost uncontrollable, for a minor reason increased irritability was noted. Increased mental rigidity, ritual behavior. At the age of 4.5 years, a psychotic state of affective-catatonic structure developed. The most difficult period was observed at the age of 5.5 years. Hospitalization is offered in DPB No. 6. The mother refused the proposed hospitalization. Examined at the Department of Early Childhood NCHPZ RAMS. A psychological study revealed emotional-motivational disorders of the endogenous type. The condition of the child was qualified as schizophrenia of a child type (F.20.8.003). A survey of the child according to the claimed method, and the data are recorded in the Protocol.

MENTAL CONDITION I. COGNITIVE FUNCTIONS 2001 2009 1. Attention Disorders Unstable Hypermetamorphosis of attention 6 one Pseudo deafness 6 one 2. The game Detained Perverted Stereotype 5 one 3. Thinking Pace Slow motion Accelerated 6 one

Clippings of thoughts Versatility 6 one Slips 6 one Bursts, automatisms Metaphysical intoxication Resonance Reflection Obsessive thoughts Supervalued education 5 one Pathological fantasies Delusional Disorders 6 one Criticality 6 one 4. Memory Decline Hypermnesia 5 one Selectivity Confabulations, pseudo-reminiscences 5. Speech Pace Accelerated 6 one Slow motion Content Oligophasia Circumlocution Formation Features Detained Retransmission Alalia Echolalia Mutism Stuttering 5 one Schizophasia Stamped Perseveration Verbigeration CGI severity score (GPA) 6 one

II. MENTAL ACTIVITY 2001 2009 1. Targeted behavior Reduced Increased 2 Paradoxical 6 2 2. Volitional desire, motivation Elevated 3 Reduced Distorted 5 2 Impulsiveness 5 one 3. Performance Increased reduced (fatigue) 7 one distorted (paradoxical) CGI severity score (GPA) 6 2 III EMOTIONS 2001 2009 Emotional resonance ( inadequacy, paradox , hypersensitivity, hypersensitivity) (underline as necessary) 6 3 Annoying weakness Lability 6 3 Dysthymia 6 3 Depression (longing) Painful anesthesia Dysphoria 6 2 Elevated (hyperthymia, mania) Mania Raptus Fears Anxiety Disorders Panic reactions Ambivalence 6 3 Scarcity 6 3

Apathy Dullness (anhedonia) 6 2 Daily fluctuations 6 3 Seasonal fluctuations 6 3 CGI severity score (GPA) 6 3 IV. ATTRACTIONS 2001 2009 Anorexia Bulimia Peak symptom Cares Vagrancy Arson Coprolalia 5 one Autoaggression Suicidal behavior Sexualized behavior External aggression 5 one Attraction to alcohol, drugs Victim behavior Self-incrimination, reservations Kleptomania CGI severity score (GPA) 5 one V. SENSORICA 2001 2009 Formation Delay 3 one Hyperesthesia Hypesthesia Paradoxical sensations Sensopathies (Algias) Senestopathy CGI severity score (GPA) 3 one VI. PERFORMANCE VIOLATIONS 2001 2009

1. Acoasma, photopsia 2. Illusions (auditory, visual) 3. Hallucinations (true, pseudo) (underline as necessary) Visual Auditory Olfactory Bodily Visceral 4. Identity Depersonalization four one Derealization Dysmorphophobia Psychosensory disorders Fission of "I" The lack of "I" The feeling of an outsider The feeling of "done" Denial of vitality CGI severity score (GPA) four one VII. SOCIAL BEHAVIOR 2001 2009 A. Disruption of communication ( with mother , children, adults) (underline as appropriate) Ambition Rejection 6 2 Negativism 6 2 Indifference Impulsive behavior 6 2 B. Autistic signs (emotional, playful, bodily, visual, total) (underline as necessary) Identity phenomenon 6 2

Rituals 6 2 Protodiac crisis Pseudo deafness and others. 6 2 Stereotypies (speech, motor skills) 6 one B. Social skills (neatness, self-care, nutritional, social behavior ) (type of skill to emphasize) Detainees Distorted 6 2 CGI severity score (GPA) 6 2 NEUROLOGICAL CONDITION Viii. NEUROLOGICAL SIGNS MOTORICA 2001 2009 Facial expressions (hypomimia, paramimia, grimaces ) (underline as necessary) four one Fine motor skills (awkward, artsy) Large motor skills (agility, gait , coordination) (underline as necessary) four one Pathological pyramidal reflexes Non-localized neurological signs Oculomotor symptoms: (nystagmus, saccadic eye movements , stopping gaze, weak innervation 4, 6 pairs ) four one Attacks of "eye care" Myoclonus Diffuse muscle hypotension Muscular dystonia four one Choreal symptoms four one Labyrinth reflex reduction delay Repulsion reflex Flickering Right Hemisyndrome Syndromes of Disorders

Motility development (delayed, leading) Hyperdynamic syndrome 5 one Inhibition, stupor Tiki Stereotypies Catatonia four one Cramps Pelvic function control (enuresis, encopresis) four one CGI severity score (GPA) four one IX. VEGETATICS (Original vegetative tone) 2001 2009 Leather Color Vagotonia - erythematous Sympathy - White four four Vascular pattern Vagotonia - marbling Sympathy - not expressed four four Dermographism Vagotonia - red four 3 Sympathy - White Sweating Vagotonia - distal hyperhidrosis Sympathotonia - dry skin Thermoregulation Body temperature Vagotonia - <36.0 Sympathy -> 36.7 3 3 Brush temperature, feet Vagotonia - warm 3 3 Sympathy - Cold Temperature for infections Vagotonia - protracted subfebrile condition four one Sympathy -> 38.0 Weather sensitivity Cold tolerance Vagotonia - increased Sympathy - reduced Heat tolerance Vagotonia - lowered Sympathy - increased Eyes Eye shine Vagotonia - reduced, dull 3 one

Sympathy - enhanced Eye slits Vagotonia - narrowed 3 2 Sympathy - extended Pupils Vagotonia - narrowed 3 3 Sympathy - extended Pupil game Vagotonia - is Sympathy - is Lacrimation Vagotonia - enhanced Sympathotonia - reduced The cardiovascular system Heart rate Vagotonia - labile bradycardia four four Sympathotonia - labile tachycardia Respiratory system Breathing rate Vagotonia - slow, sighs Sympathy - rapid Digestive system Appetite Vagotonia - reduced four four Sympathy - increased Salivation Vagotonia - enhanced Sympathy - Reduced Spitting up, vomiting Vagotonia - characteristic Sympathy - not characteristic 3 2 Intestinal motility Vagotonia - spastic constipation, gas formation Sympathotonia - weak, atonic constipation Body mass Vagotonia - increased Sympathy - reduced 5 5 urinary system Water requirement Vagotonia - reduced Sympathy - increased 5 3 Pastosity Vagotonia is characteristic Sympathy - no four four

Urination Vagotonia - rare Sympathy - frequent The immune system Allergic reactions Vagotonia - frequent Sympathy - rare 3 3 Lymph glands Vagotonia - enlarged, loose Sympathy - not increased 3 3 Sleep-wake system Sleep Vagotonia - deep four 3 Sympathy - superficial Rhythm Vagotonia - owls Sympathy - Lark four 3 CGI severity score (GPA) four 3 Total points in all areas 44 fifteen

Diagnosis: Schizophrenia of childhood type, phase-affective paroxysmal course, type B remission. Was examined according to the protocol. On global grounds, at the age of 5.5 years, he scored 44 points, which corresponds to the moderate severity of the disease. As follows from the results of the examination of the patient, the greatest violation was found in the field of cognitive functions, mental activity, emotions and social behavior. In accordance with the revealed violations and the severity of the patient's condition, the treatment was specified. In the field of vegetation, the detection of multidirectional symptoms was noted in the skin system, thermoregulation, digestive system, sleep-wake system, vagotonic orientation in the regulation of the cardiovascular system, sympathetic - in the regulation of the urinary and immune systems, the severity of which decreases from moderate to mild during therapy. Gradually, the condition improved in all areas. At the age of 7, he was able to go to school and stay in the team. By age 13, the patient's condition was qualified as a mild severity of mental disorder. Could do without treatment. Established contacts with peers. Attentive to the mother. Found a common language with his stepfather. Good student. Making plans for the future. In a state of remission, the total score in all areas reaches 15 points (i.e., the level of practical health).

Example 3. Vladislav M. From the anamnesis it is known that at a young age was observed by a neurologist about perinatal encephalopathy, muscular dystonia, and increased neuro-reflex excitability. He received treatment with nootropics.

At the age of 3 years, parents turned to a psychiatrist due to restlessness, motor disinhibition. In the psychomotor development did not lag behind. At age 7, he entered high school with individual instruction. He showed abilities, was considered one of the best students. At the same time, relations with children were quite formal, they did not become attached to anyone, they clashed. I got along badly in the team. Necessarily in the selection of therapy, turned to the department of early age NCPP RAMS. Inspected according to the Protocol by the claimed method.

MENTAL CONDITION I. COGNITIVE FUNCTIONS 2006 2011 1. Attention Disorders Unstable four four Hypermetamorphosis of attention Pseudo deafness Other 2. The game Detained four one Perverted Stereotype another four one 3. Thinking Pace Slow motion Accelerated Clippings of thoughts Versatility four 3 Slips 5 four Bursts, automatisms Metaphysical intoxication Resonance Reflection four four Obsessive thoughts Supervalued education 5 3 Pathological fantasies Delusional Disorders

Criticality four 3 4. Memory Decline Hypermnesia Selectivity Confabulations, pseudo-reminiscences 5. Speech Pace Accelerated four four Slow motion Content Oligophasia Circumlocution 5 3 Formation Features Detained Retransmission Alalia Echolalia Mutism Stuttering 3 3 Schizophasia Stamped Perseveration Verbigeration CGI severity score (GPA) four 3 II. MENTAL ACTIVITY 2006 2011 1. Targeted behavior Reduced four 3 Increased Paradoxical four 3 2. Volitional desire, motivation Elevated Reduced four 2 Distorted four 3 Impulsiveness 3 3 3. Performance

Increased reduced (fatigue) four 3 distorted (paradoxical) four four CGI severity score (GPA) four 3 III. EMOTIONS 2006 2011 Emotional resonance (inadequacy, paradox, hypersensitivity, hypersensitivity) (underline as necessary) 5 3 Annoying weakness Lability 5 3 Dysthymia Depression (longing) Painful anesthesia Dysphoria Elevated (hyperthymia, mania) Mania Raptus Fears 5 3 Anxiety Disorders 6 3 Panic reactions Ambivalence four 3 Scarcity 5 3 Apathy 5 2 Dullness (anhedonia) Daily fluctuations 5 3 Seasonal fluctuations 5 3 CGI severity score (GPA) 5 3 IV. ATTRACTIONS 2006 2011 Anorexia Bulimia Peak symptom Cares

Vagrancy Arson Coprolalia Auto-aggression (provokes peers to a fight and is beaten) 5 3 Suicidal behavior Sexualized behavior External aggression Attraction to alcohol, drugs Victim behavior Self-incrimination, reservations Kleptomania CGI severity score (GPA) 5 3 V SENSORIC 2006 2011 Formation Delay 3 2 Hyperesthesia Hypesthesia Paradoxical sensations Sensopathies (Algias) 3 2 Senestopathy CGI severity score (GPA) 3 2 VI. PERFORMANCE VIOLATIONS 2006 2011 1. Acoasma, photopsia 2. Illusions (auditory, visual) 3 one 3. Hallucinations (true, pseudo) (underline as necessary) Visual Auditory Olfactory Bodily Visceral 4. Identity Depersonalization

Derealization Dysmorphophobia Psychosensory disorders Fission of "I" The lack of "I" The feeling of an outsider The feeling of "done" Denial of vitality CGI severity score (GPA) 3 one VII SOCIAL BEHAVIOR 2006 2011 A. Disruption of communication (with mother, children, adults) (underline as appropriate) Ambition 5 3 Rejection Negativism four 2 Indifference Impulsive behavior four 2 B. Autistic signs (emotional, playful, bodily, visual, total) (underline as necessary) Identity phenomenon Rituals Protodiac crisis Pseudo deafness and others. Stereotypies (speech, motor skills) stamps four 3 B. Social skills (neatness, self-care, nutritional, social behavior) (emphasis on type of skill) Detainees 6 four Distorted 7 four CGI severity score (GPA) 5 3 NEUROLOGICAL CONDITION Viii. NEUROLOGICAL SIGNS, MOTORIC 2006 2011

Facial expressions (hypomimia, paramimia, grimaces ) (underline as necessary) four 3 Fine motor skills ( awkward , artsy) four 3 Large motor skills ( agility , gait, coordination) (underline as necessary) four 3 Pathological pyramidal reflexes Non-localized neurological signs Oculomotor symptoms: (nystagmus, saccadic eye movements, stopping gaze, weak innervation 4, 6 pairs ) four 2 Attacks of "eye care" Myoclonus Diffuse muscle hypotension Muscular dystonia Choreal symptoms Labyrinth reflex reduction delay Repulsion reflex Flickering Right Hemisyndrome Syndromes of Disorders Motility development (delayed, leading) Hyperdynamic syndrome four one Inhibition, stupor Tiki four one Stereotypies Catatonia four 2 Cramps Pelvic function control (enuresis, encopresis) CGI severity score (GPA) four 2 IX. VEGETATICS (Original vegetative tone) 2006 2011 Leather Color Vagotonia - erythematous Sympathy - White Vascular pattern Vagotonia - marbling Sympathy - not expressed four four Dermographism Vagotonia - red

Sympathy - White four four Sweating Vagotonia - distal hyperhidrosis Sympathotonia - dry skin Thermoregulation Body temperature Vagotonia - <36.0 Sympathy -> 36.7 Brush temperature, feet Vagotonia - warm four four Sympathy - Cold Temperature for infections Vagotonia - protracted subfebrile condition Sympathy -> 38.0 5 3 Weather sensitivity Cold tolerance Vagotonia - increased Sympathy - reduced 3 3 Heat tolerance Vagotonia - lowered 5 four Sympathy - increased Eyes Eye shine Vagotonia - reduced, dull Sympathy - enhanced four 3 Eye slits Vagotonia - narrowed four 3 Sympathy - extended Pupils Vagotonia - narrowed Sympathy - extended Pupil game Vagotonia - is Sympathy - is Lacrimation Vagotonia - enhanced Sympathotonia - reduced The cardiovascular system Heart rate Vagotonia - labile bradycardia four four Sympathotonia - labile tachycardia Respiratory system Breathing rate Vagotonia - slow, sighs Sympathy - rapid Digestive system Appetite Vagotonia - reduced

Sympathy - increased Salivation Vagotonia - enhanced four 3 Sympathy - Reduced Spitting up, vomiting Vagotonia - characteristic Sympathy - not characteristic Intestinal motility Vagotonia - spastic constipation, gas formation four four Sympathotonia - weak, atonic constipation Body mass Vagotonia - increased Sympathy - reduced urinary system Water requirement Vagotonia - reduced four 3 Sympathy - increased Pastosity Vagotonia is characteristic Sympathy - no Urination Vagotonia - rare Sympathy - frequent The immune system Allergic reactions Vagotonia - frequent Sympathy - rare Lymph glands Vagotonia - enlarged, loose Sympathy - not increased Sleep-wake system Sleep Vagotonia - deep Sympathy - superficial 5 four Rhythm Vagotonia - owls 5 3 Sympathy - Lark CGI severity score (GPA) four 3 Total points in all areas 37 23

Diagnosis. The condition determines schizotypal personality disorder (according to ICD 10). Syndromes - microcatatonic disorders, emotional deficiency. By the total score of all areas during the first examination, which is 37 points, the state of a teenager is assessed as a moderate severity of mental disorder. The most pronounced violations are noted in the sphere of emotions, attraction and communication - social behavior. According to the type of vegetative regulation, the child has amphotonia according to skin systems (skin color, dermographism), thermoregulation, meteosensitivity, eyes, sleep-wakefulness system, and only certain symptoms revealed in the cardiovascular, digestive and urinary systems show violations of the type of vagotonia.

According to the follow-up, during the observation received treatment: small doses of antipsychotics metabolic therapy. Over the years, there has been an improvement in the mental state. According to the severity of autonomic disorders, the state has changed from moderate to mild. Tension, conflict, decreased, tends to communicate with peers, timely teenage interests, friends appeared. He graduated from secondary school, then music school. In 2010, he worked as an external student, preparing to enter a music school. Currently studying at the school. Ippolitov-Ivanov in the class of music history. After 5 years of observation and treatment, the condition is estimated at 23 points, which on the rating scale refers to mild disorders.

Example 4. Mikhail K. The family has been monitored since the birth of the child. Proband from 3 pregnancies, proceeding with mild early toxicosis, anemia in the second half of pregnancy. Mother suffered from varicose veins of the hepatolienal circle. Delivery at 38 weeks Caesarean section due to increasing circulatory failure, weak fetal movement. Birth weight 2700, length 43 cm. Diagnosis at birth: intrauterine hypoxia of the fetus of 1 degree. The adaptation period proceeded satisfactorily. Applied to the chest on day 5 in connection with the serious condition of the mother. Discharged from the maternity hospital on day 11.

It was observed by a neurologist according to the standards for 1 year. Up to 3 months was observed mild hypertonicity of flexors of the hands. After 3 months, muscle tone became physiological.

He grew up an active, lively, emotionally balanced child. He ate well, and was breast-fed for the first months. From 6 months on mixed. Easily absorbed new types of food, complementary foods. He slept well at night, without awakening for 6-7 hours. Woke up in the morning easily, without tears. During the day he was rarely capricious.

Motor developed with a slight lead. He kept his head from 2 months, turned on his stomach from 3 months, back - from 5, sat on his own at 6 months, walked with support from 9 months, on his own from 10 months.

Agucanie, early walk began at 2-3 months, song walk at 5, the first words (5-6) were made up to a year, phrasal speech from 1 year 9 months. Mother began to allocate at 3 months, strangers - at 6-7. The first smile - at the end of 1 month, laughter - from 3 months. After the death of his mother, when the boy was 7 months old, he was brought up by his grandmother and father. He began to reach for toys from 3 months, at 4 - he held them well in his hand. He played with toys by age, from six months he began to prefer subject ones, in the form of fluffy toys.

Neatness skills were formed by age, there was a distinct reaction to wet diapers, I independently controlled using the pot by the age of 1.5 years. By the age of 2.5, he independently ate with a spoon solid and liquid food, drank from a cup. He paid attention if he got dirty, spilled something on himself. Wet, soiled clothes he pulled off himself. After 2 years, he liked to help his grandmother in the kitchen, tried to wash the dishes himself, to collect plates. He was very attached to loved ones. Grandmother loved more, grandfather was a little afraid. He also loved his father, whom he saw only at the weekend, and was glad of his arrival. He was affectionate in relation to loved ones. Even if he was offended, he was angry with his grandmother, but he could only wave, but not hit. At home he loved to play in the presence of loved ones, he opened the doors to keep his grandmother in sight, although he did not show obvious fear. A lot of time he could engage in designers, board games, he could organize the game himself. After 2.5 years, a story game appeared. For example, cars loaded with cotton. Grandmother offered to “carry bread”, played hide and seek, and also involved grandmother in outdoor games. I began to watch children's programs: "Good night, kids," cartoons. I liked to listen to music on the radio, sing along. From 10 months he began to reach for peers, and closer to the year he himself asked that he be taken to play with children. From 3 years old, he tried to interact in the game, he could take the toy he liked from the child, but he himself could easily give it away. In communication was patient, balanced. It was quite easy to communicate with older children.

By nature, from an early age he was stubborn, persistent, likes to bring his plan to the end.

At the age of 2 years, a period was observed when darkness was breaking. Before entering a dark room, he lit a light. Passing through the apartment, in the dark, everywhere he lit a light. After 3-4 months, this fear has passed. At the age of about 3 years old, trying to get his way, he could get upset, fall to the floor, kick. However, this behavior stopped when my grandmother, on the advice of a doctor, stopped paying attention to “tantrums,” and after a while, when the boy stopped crying, he went up to his grandson and began to negotiate with him. Realizing that with tears he could not force adults to fulfill his requirements, the boy began to meet the adults.

From infancy, dynamically examined according to the protocol.

MENTAL CONDITION I. COGNITIVE FUNCTIONS 1999 2001 2010 Attention Disorders Unstable four 3 one Hypermetamorphosis of attention Pseudo deafness A game Detained Perverted Stereotype Thinking Pace Slow motion Accelerated Clippings of thoughts Versatility Slips Bursts, automatisms

Metaphysical intoxication Resonance Reflection Obsessive thoughts Supervalued education Pathological fantasies Delusional Disorders Criticality Memory Decline Hypermnesia Selectivity Confabulations, pseudo-reminiscences Speech Pace Accelerated four 3 one Slow motion Content Oligophasia Circumlocution Formation Features Detained Retransmission Alalia Echolalia Mutism Stuttering Schizophasia Stamped Perseveration Verbigeration CGI severity score (GPA) four 3 one II. MENTAL ACTIVITY 1999 2001 2010 1. Targeted behavior Reduced Increased

Paradoxical 2. Volitional desire, motivation Elevated Reduced Distorted four one Impulsiveness 3 one one 3. Performance Increased reduced (fatigue) distorted (paradoxical) CGI severity score (GPA) 3 2 one III. EMOTIONS 1999 2001 2010 Emotional resonance (inadequacy, paradox, hypersensitivity, hypersensitivity) (underline as necessary) Annoying weakness four one Lability four one Dysthymia Depression (longing) Painful anesthesia Dysphoria Elevated (hyperthymia, mania) Mania Raptus Fears four one Anxiety Disorders four one Panic reactions Ambivalence Scarcity Apathy Dullness (anhedonia) Daily fluctuations Seasonal fluctuations

CGI severity score (GPA) 0 four one IV. ATTRACTIONS 1999 2001 2010 Anorexia Bulimia Peak symptom Cares Vagrancy Arson Coprolalia Autoaggression Suicidal behavior Sexualized behavior External aggression 3 one Attraction to alcohol, drugs Victim behavior Self-incrimination, reservations Kleptomania CGI severity score (GPA) 0 3 one V. SENSORICA 1999 2001 2010 Formation Delay Hyperesthesia Hypesthesia Paradoxical sensations Sensopathies (Algias) Senestopathy CGI severity score (GPA) 0 0 0 VI. PERFORMANCE VIOLATIONS 1999 2001 2010 1.Acoasma, photopsia 2. Illusions (auditory, visual) 3. Hallucinations (true, pseudo) (underline as necessary)

Visual Auditory Olfactory Bodily Visceral 4. Identity Depersonalization Derealization Dysmorphophobia Psychosensory disorders Fission of "I" The lack of "I" The feeling of an outsider The feeling of "done" Denial of vitality CGI severity score (GPA) 0 0 0 VII. SOCIAL BEHAVIOR 1999 2001 2010 A. Disruption of communication (with mother, children, adults) (underline as appropriate) Ambition Rejection four one Negativism Indifference Impulsive behavior 3 four one B. Autistic signs (emotional, playful, bodily, visual, total) (underline as necessary) Identity phenomenon Rituals four one Protodiac crisis Pseudo deafness Stereotypies (speech, motor skills)

B. Social skills (neatness, self-care, nutritional, social behavior) (emphasis on type of skill) Detainees Distorted CGI severity score (GPA) 3 four one NEUROLOGICAL CONDITION Viii. NEUROLOGICAL SIGNS MOTORICA 1999 2001 2010 Facial expressions (hypomimia, paramimia, grimaces) (underline as necessary) Fine motor skills (awkward, artsy) Large motor skills (agility, gait, coordination) (underline as necessary) four 3 one Pathological pyramidal reflexes four one one Non-localized neurological signs Oculomotor symptoms: (nystagmus, saccadic eye movements, stopping gaze, weak innervation 4, 6 pairs) Attacks of "eye care" Myoclonus Diffuse muscle hypotension Muscular dystonia Choreal symptoms Labyrinth reflex reduction delay Repulsion reflex Flickering Right Hemisyndrome Syndromes of Disorders Motility development (delayed, leading) Hyperdynamic syndrome four 3 one Inhibition, stupor Tiki Stereotypies Catatonia

Cramps Pelvic function control (enuresis, encopresis) CGI severity score (GPA) four 2 one IX - VEGETATICS (Original vegetative tone) 1999 2001 2010 Leather Color Vagotonia - erythematous Sympathy - White Vascular pattern Vagotonia - marbling one one one Sympathy - not expressed Dermographism Vagotonia - red Sympathy - White 2 2 2 Sweating Vagotonia - distal hyperhidrosis Sympathotonia - dry skin Thermoregulation Body temperature Vagotonia - <36.0 Sympathy -> 36.7 2 2 2 Brush temperature, feet Vagotonia - warm 2 2 one Sympathy - Cold Temperature for infections Vagotonia - protracted subfebrile condition Sympathy -> 38.0 four 2 2 Weather sensitivity Cold tolerance Vagotonia - increased 2 2 2 Sympathy - reduced Heat tolerance Vagotonia - lowered 2 2 2 Sympathy - increased Eyes Eye shine Vagotonia - reduced, dull Sympathy - enhanced 2 2 one Eye slits Vagotonia - narrowed Sympathy - extended 3 3 one Pupils Vagotonia - narrowed Sympathy - extended 2 3 one Pupil game Vagotonia - is

Sympathy - is Lacrimation Vagotonia - enhanced Sympathotonia - reduced The cardiovascular system Heart rate Vagotonia - labile bradycardia Sympathotonia - labile tachycardia 2 3 one Respiratory system Breathing rate Vagotonia - slow, sighs one one one Sympathy - rapid Digestive system Appetite Vagotonia - reduced Sympathy - increased 3 3 one Salivation Vagotonia - enhanced Sympathy - Reduced Spitting up, vomiting Vagotonia - characteristic Sympathy - not characteristic 2 2 one Intestinal motility Vagotonia - spastic constipation, gas formation Sympathotonia - weak, atonic constipation Body mass Vagotonia - increased 3 four 2 Sympathy - reduced urinary system Water requirement Vagotonia - reduced 2 2 one Sympathy - increased Pastosity Vagotonia is characteristic 2 2 2 Sympathy - no Urination Vagotonia - rare 2 2 one Sympathy - frequent The immune system Allergic reactions Vagotonia - frequent Sympathy - rare Lymph glands Vagotonia - enlarged, loose 2 2 2 Sympathy - not increased Sleep-wake system

Sleep Vagotonia - deep 3 3 2 Sympathy - superficial Rhythm Vagotonia - owls Sympathy - Lark 3 3 3 CGI severity rating 2 2 one Total points in all areas 16 twenty 7

Diagnosis: at 1 year hypoxic-ischemic damage to the central nervous system, mild cerebral dysfunction. By the sum of the points of all areas in the first year of life of 16 points, the state of the child is assessed as the presence of borderline mental disorders. The most pronounced violations are noted in the field of cognitive functions, the sphere of emotions and in the field of neurological signs and motor skills.

At 2 years of age, the child’s mental health status is estimated at 20 points, which reaches a mild severity of mental disorders. This condition manifests itself due to the appearance of neurosis-like disorders (by subscales of mental activity, emotions, drives, impaired social skills). Vegetative regulation does not significantly deviate from eutonia. In the system of regulation of the eyes, the cardiovascular system, the sympathetic prevails, in the urinary, meteorological, respiratory systems - the vagotonic orientation. The condition of the skin, thermoregulation, digestive and sleep-wakefulness systems have multidirectional manifestations (amphotonia), which even in the first years of life remain at the level of lungs and doubtful deviations. Only at 1 year of life is hyperthermia observed in diseases (4 points). Subsequently, autonomic regulation corresponded to eutonia (healthy).

After the examination, the corresponding psychotherapeutic work was carried out, medications were made, which made it possible to improve the condition of the boy. Follow-up examination showed that by 7 years of life the child's condition is stable. The boy was taken at the initiative of his father in a new family. He learned new rules for communicating with family. Willingly went to school, began to study well. In the classroom I made friends. According to the characteristics of the class teacher, a successful student, friendly, obedient, adequately responds to comments, a good friend. Currently moved to grade 5 (12 years). In somatic status, neurological abnormalities there. When examined at 11 years of age, the protocol scores a total of 7 points, which fits into the framework of practical health.

According to the claimed method, the developed form of the Protocol examined 235 patients. The results of the application of the method confirmed the achievement of the purpose of the invention is to increase the accuracy of assessing the mental state of children of early and preschool age.

New in this psychodiagnostic system is the use of a full range of mental disorders in accordance with the authors' own research.

In addition, the scale is compact; the use of the quantitative assessment method allows you to quickly and clearly assess the severity and structure of mental disorder, to notice the dynamics in the state of the child, not only to the attending physician, but also to doctors of other institutions and specialties.

This method of assessment can be used by psychiatrists, specialists in childhood and early childhood. It is useful for monitoring the mental state in the process of drug therapy, for screening the mental state during medical examinations or scientific research in the field of psychiatry.

Claims (1)

A method of psychopathological assessment of the mental state of children of early and preschool age, including taking into account the negative and positive symptoms of the patient’s mental state, namely impaired thinking, impulsiveness, aggression and depression, characterized in that the assessment of negative and positive symptoms is carried out in the process of determining the patient’s mental and neurological state in nine areas, while the patient’s mental state is evaluated as follows: reveal the state of the sphere of cognitive functions, namely: the presence of symptoms of unstable attention, attention hypermetamorphosis, pseudo-deafness, the presence of a delayed, or perverted, or stereotypical game, slow or accelerated pace, breaks in thoughts, diverse thinking, slipping, in the form of flows and automatism, metaphysical intoxication, resonance, reflection, obsessive thoughts formations, pathological fantasizing, delusional disorders, critical thinking, the presence of decreased memory, or hypermnesia, or its selectivity, or confabulation, pseudoremini censorship, the presence of an accelerated or slowed-down pace of speech with oligophasia or the linguistic nature of its content and the features of its formation - delayed, intercalated or alalia, as well as the presence of echolalia, mutism, stuttering, schizophasia, persistence, verbigration or stamped speech, reveal the state of the sphere of mental activity, and it is the presence of symptoms of reduced, or increased, or paradoxical goal-oriented behavior, increased, reduced, distorted or impulsive volitional desires, urges, increased, reduced failure or distorted performance, they reveal the state of the emotional sphere, namely the presence of symptoms of inadequacy, paradoxicality, hypersensitivity and hypersensitivity of emotional resonance, irritable weakness, lability, dysthymia, depression, painful anesthesia, dysphoria, increased hyperthymia, mania, raptus, fears, anxiety disorders , panic reactions, ambivalence, deficiency, apathy, joylessness, daily and seasonal fluctuations of emotions, reveal the state of the sphere of attraction, namely the presence of symptoms of bu limy, anorexia, peak symptoms, withdrawal, vagrancy, arson, coprolalia, autoaggression, suicidal behavior, sexualized behavior, external aggression, craving for alcohol, drugs, victim behavior, self-incrimination, slander, kleptomania, reveal the state of the sensory sphere, namely the presence of symptoms delays in the formation of spatial perception, hyperesthesia, hypesthesia, paradoxical sensations, sensopathies, senestopathies, reveal the state of the sphere of perception, namely the presence of symptoms of acoasma, photopsy, illusion of auditory and visual, true and pseudo-hallucinations of visual, auditory, olfactory, bodily and visceral, self-consciousness - depersonalization, derealization, dysmorphophobia, psychosensory disorders, a split “I” or lack of “I”, a sense of extraneous, a sense of “doneness”, a denial of vitality reveal the state of the sphere of social behavior, namely, symptoms of communication disruption: the presence of ambitiousness, rejection, negativity, indifference and impulsive behavior, autistic symptoms - the identity society, rituals, protodiac crisis, pseudo-deafness and stereotypes of speech and motor skills, social skills: delayed or distorted neatness, self-care, eating or social behavior, and the patient’s neurological condition is assessed by identifying violations in the field of “neurological signs”, motor skills, namely the presence of symptoms of hypomimia , paramimia, grimaces, awkward or artsy fine motor skills or large motor skills - dexterity, gait, coordination, the presence of non-localized neurological signs, namely oculomotor symptoms, рист eye gaze ’, myoclonus, diffuse muscle hypotension, muscle dystonia, chore-like symptoms, delayed reduction of labyrinth reflexes, repulsion reflex, flickering right-sided hemisyndrome, as well as disorders syndromes in the development of motility, hyperdynamic syndrome, stagnation, stuporia, tic, , seizures and lack of control of the pelvic functions, then reveal violations in the field of vegetation - the initial vegetative tone, namely the presence of vagotonia symptoms according to the skin condition - its erythema to color, marbling of vascular pattern, red dermographism, distal hyperhidrosis, thermoregulation - body temperature less than 36 degrees, warm hands and feet, prolonged subfebrile condition for infections, meteosensitivity - increased cold tolerance and reduced heat tolerance, eye condition - their decreased gloss, narrowed palpebral fissures and pupils, pupil play and increased lacrimation, the state of the cardiovascular system - the presence of labile bradycardia, as a respirator system - its slowed breathing rate and the presence of sighs, the digestive system - reduced appetite, increased salivation, the presence of regurgitation and vomiting, spastic constipation, gas formation and increased body weight, the state of the urinary system - reduced need for water, the presence of pastes and rare urination, by the state of the immune system - the presence of frequent allergic reactions and enlarged, loose lymph glands, by the state of the sleep and wake system - the presence of deep sleep and rhythm and owls, and the presence of symptoms of sympathotonia by the state of the skin - its white color, the severity of the vascular pattern, white dermographism, dry skin, by the state of thermoregulation - the presence of a body temperature of more than 36.7 degrees, cold hands and feet, more than 38 degrees of temperature during infections , according to the state of meteosensitivity - reduced cold tolerance and increased heat tolerance, as of the eyes - their increased shine, dilated palpebral fissures and pupils, pupil play and reduced tearing, as cardiovascular of the system - the presence of labile tachycardia, the state of the respiratory system - its increased respiration rate, the state of the digestive system - increased appetite, decreased salivation, lack of regurgitation and vomiting, the presence of weak peristalsis and atonic constipation and reduced body weight, and the state of the urinary system - increased the need for water, the absence of pastiness and the presence of frequent urination, as the immune system - the presence of rare allergic reactions and not enlarged lymph glands, a system of sleep and wakefulness - the presence of surface-sleep rhythm and a lark, express symptoms by their severity on a scale from 0 to 7, with 0 - no symptoms and never was; 1 - almost healthy; currently not at all sick, the symptom was short-lived in the past; 2 - borderline mental disorder, dubious pathology, a symptom can rarely be 1-2 times a year, passes by itself; 3 - easily ill, a symptom occurs 1-2 times a month; no treatment required; 4 - moderately sick - a symptom rarely occurs in a situation of stress, not more often 1-2 times a week, does not determine the patient’s behavior, the condition can be overcome by psychotherapeutic methods; 5 - moderate severity - the symptom is constantly observed, the behavior can be ordered, it is difficult to maintain self-control; effective treatment with small doses of sedatives; 6 - seriously ill - a symptom is observed constantly, interferes with normal communication with others; continuous treatment is necessary; 7 - extremely seriously ill - the disorder completely determines the condition of the patient who is not capable of controlling his behavior, emotions; socially maladaptive, disabled, calculate the total value of the average score of the identified symptoms in each area, reflecting the severity of the mental and neurological condition of the patient, then summarize the average scores of all nine areas and determine the severity of the condition in accordance with the established values, namely, with a total value of average points from 0 up to 9 assess the mental state as the practical health of the child; when assessed from 10 to 18 points - assessed as the presence of borderline mental disorders, from 19 to 27 points - as a mild severity of mental disorders, from 28 to 36 - as moderate, from 37 to 45 points - as average, from 46 to 54 - as severe, from 55 to 63 points assess the mental state as an extremely severe degree of mental disorders.