It is not easy to give the correct definition of the concept of “mental retardation” (oligophrenia, dementia), but in general, it is an incomplete development of the psyche, accompanied by a manifestation of pronounced intellectual insufficiency, difficulties or asocial development of the personality. It is a complex of pathological conditions congenital or acquired in childhood. A characterized by a diverse course of this disease, it has different degrees of severity. It is not possible to recover from mental failure. The author of the concepts of amentia, dementia and mental retardation is Philippe Pinel. This is a French psychiatrist who lived in the 17th century.
Concept and signs of mental retardation
The symptomatology of mental retardation has a different course depending on the severity and stage of development. In medicine, it is customary to distinguish several degrees of the disease. According to the concept of "mental retardation" and its classification, pathology is divided into three degrees depending on the ability of patients to learn and work:
- Debility is a mild manifestation of the disease. The severity of underdevelopment is the weakest. A suffering disease of this stage is characterized by a lack of ability to form a complex conceptual apparatus and a slowdown in the development of abstract type of thinking. Often the thoughts of such patients are possible only in a simplified form. As a result, the individual does not have the ability to holistic perception of the situation and the inner essence of events.
- A moderate degree of mental retardation corresponds to the concept of "imbecility." Patients lack the ability to form a concept; only the formation of a representation is available to them. The possibility of abstract thinking and generalization is completely absent. However, despite this, imbeciles retain the ability to self-service. It is also possible to teach them to light work, such as cleaning the premises, packing, etc. The vocabulary possessed by such patients is limited. Only elementary speech is available for their perception and understanding. In turn, the speech they possess consists solely of standard phrases, often not including adjectives. Imbeciles have the ability to adapt only in the environment and environment that is familiar and standard for them. They are characterized by such features as sloppiness, primitive interests, suggestibility.
- The most profound and severe of the degrees of mental retardation is considered idiocy. Patients susceptible to the disease of this phase are deprived of cognitive activity, the ability to respond to the environment, including loud sounds and bright light. There is no possibility of acquiring any self-service skills. The predominant part of such patients is characterized by a reduced degree of sensitivity, expression of emotions of only a primitive nature, which most often refers to anger and anger. They are deprived of the ability to rejoice and laugh, as well as cry. Their motor reactions are also primitive, chaotic and inconsistent.
Disclosed the concepts of mental retardation in psychiatry, Philippe Pinel. Further it was supplemented by Soviet scientists.
Causes of Mental Retardation
The study of the concept of causes and forms of mental retardation has been going on for more than 100 years, but often, when considering an individual case, it is impossible to determine specific factors. A wide range of harmful effects can cause mental disorders and mental retardation.
Internal causes
According to the works of F. Pinel (the one who introduced the concept of "mental retardation"), it is customary to attribute to internal reasons:
- Mutational changes in the structure of chromosomes. Changes in the quantification and structure of chromosomes are a common cause of mental retardation. The manifestation of mutations throughout life is a natural and ongoing process. In addition, mutations can be caused by the harmful effects of chemicals (antitumor drugs, etc.) or physical effects (x-rays, electromagnetic radiation). Also, factors such as the presence of a predisposition to impaired control of cell division at the gene level, as well as the age of the parents, can influence the appearance of mutations.
- Adverse, painful heredity. Such reasons include diseases of the endocrine system or defects in metabolic processes. The cause of the child’s mental retardation may be maternal diabetes. When the mother’s blood content of phenylalanine exceeds the norm (phenylketonuria), phenylalanine embryopathy occurs. Complex changes in sperm and egg cells, occurring from the beginning of their maturation to the formation of a zygote, indicate that germination of germ cells has begun. Such phenomena can be triggered by a hormonal disorder, but most often an increase in the length of the period between ovulation and the implementation of fertilization of the egg.
Such changes can also cause the development of mental retardation. The birth rate indicator of children with trisomy 13, 18, 21, increases depending on the age of the parents. In this connection, such a factor as the age of parents can trigger the development of mental retardation. This possibility is due to aging, which sex cells undergo, as well as an increase in the frequency of mutations, which can be caused by a decrease in enzyme activity, impaired resistance of chromosomes to harmful effects, as well as hormonal disruptions.
External causes (exogenous)
You can define the concept of "mental retardation", "oligophrenia" after familiarization with the causes and symptoms of these pathologies. There are many external factors that can affect the ripening of the fetus, causing damage. During the course of the development of the fetus in the womb, its central nervous system has a special sensitivity, in connection with which frequent damage is possible, resulting in mental underdevelopment. In addition, impaired development of the child's psyche can be caused by harmful effects that affect the embryo in utero (in the prenatal period), as well as during childbirth (in the natal period) and in the early stages of the postnatal period.
Prenatal exposure
In the event of mental retardation, a high degree of importance is at what point in the development of the fetus is a lesion, how well its development proceeds, as well as the presence of tissues that have not been damaged, that can compensate for damage, as well as the slowdown in development that was provoked by the infectious agent.
The earlier a harmful effect on the embryo in the first trimester is rendered, the faster the developmental defects, fading of pregnancy or miscarriage will occur. The most common causes of an underdeveloped psyche in the prenatal period are the causes given below.
Fetal hypoxia is strongly associated with a high risk of having a baby with UR in mothers who suffer from the following serious illnesses:
- of cardio-vascular system;
- liver
- thyroid gland;
- kidney
- as well as diabetes.
Such painful conditions can be a provoking factor for the occurrence of prematurity of the baby or manifestations of complications during childbirth.
Rhesus conflict
The reason for the occurrence of mental retardation may be the incompatibility of ABO blood factors or Rh factor incompatibility. Approximately one in eight women does not have an Rh factor in the blood. Accordingly, the child is at risk of suffering from Rh-incompatibility, when such a factor is present in the blood of the child's father. The Rh-positive fetus, which received this factor from the father, produces antibodies in the blood of the pregnant woman, when they enter the bloodstream of the child, the destruction of red blood cells occurs.
Infections
Erythroblastosis, which occurs as a result of this, can lead to impaired development of the central nervous system. This, in turn, can subsequently manifest itself in neurological diseases and mental retardation. Approximately every 170th infant has erythroblastosis.
Many infections have the ability to be transmitted in utero from mother to fetus. But only a small percentage of them leads to the onset of mental retardation. Such infections cause damage to the central nervous system of the embryo in 5% of cases with a severe degree of UO and in only 1% of cases of its mild degree.
Viruses
Among the microorganisms that can cause mental retardation, the most common viruses are protozoa and spirochetes. Viruses become the causative agent of fetal infections in 5% of pregnant women. Once in the mother’s body, the infection may not have external manifestations and signs, but the fetus is damaged anyway, which may be due to a lack of oxygen, malnutrition or insufficient blood-brain barrier. This, in turn, makes the central nervous system of the fetus an environment favorable for the development of microorganisms.
The main mechanism of damage to the fetal nervous system is a lack of oxygen (anoxia), which leads to a halt in cell division, resulting in the appearance of deformities or limited organ growth. Another factor affecting the fetus is the placenta, which provides for it a barrier through which pathogens of many acute infections cannot pass. The effectiveness of such protection has a different degree with various pathogens of the virus.
The causative agents of toxoplasmosis and syphilis are able to penetrate the placental barrier, as well as reach the fetus, getting to it from the amniotic fluid. Syphilis, which has an inborn nature of the disease, also causes the development of fetal infection. A mother infected during pregnancy is capable of transmitting syphilitic spirochetes through the placenta. Spirochete penetrates the fetus only after the 5th month of pregnancy.
To reduce the degree of damage to the fetus allows the use of antibiotics. Maternal antibodies also protect the embryo from developing infections, but this mechanism is not effective in all situations. Having immunity to any disease, a pregnant woman can transmit the causative agent of the infection to the embryo. Listeria bacteria are able to bypass the barrier created by the placenta and cause damage to the fetal nerve tissue, which can lead to meningoencephalitis, accompanied by severe organic lesions of the central nervous system, or to death of the embryo.
Mother's disease
Thus, a disease such as listeriosis is another reason for the development of severe mental retardation. Not frequent cases of the occurrence of MA in congenital disease of the fetus with tuberculosis are noted. The causative agent of mental retardation may also be the influenza virus in case of intrauterine infection.
Rubella in the first trimester of pregnancy leads to a risk of mental retardation in a born child with a probability of up to 20%. Infection of the salivary gland, getting to the fetus from a pregnant woman, contributes to inflammation of the membranes of the brain and cytomegaly, the consequences of which are serious diseases of the embryo and even its death. Other infections can also cause mental retardation. So, with toxoplasmosis, a person is infected with a unicellular microorganism (toxoplasma) by eating infected animal meat. The disease has a low prevalence as a congenital pathology in newborns. Infection is possible both after birth and before birth. Up to 10% of children exposed to the disease die after 2 months. A significant proportion of the babies who survived are confronted with multiple malformations and mental retardation.
In addition to viral and infectious diseases affecting the fetus, various chemical substances that have a harmful effect on the embryo and contribute to the formation of an intellectual defect in the child can serve as the causes of MA. Any of the harmful factors, for example, medicines, lead, alcohol, can lead to fetal malformations and death.
Poison
Perhaps the detrimental effect of poisons on the central nervous system, which do not affect organs that have already developed normally. Drugs that have a teratogenic effect (disrupting the development of the embryo and leading to various congenital malformations) include drugs aimed at suppressing metabolism, destroying cancer cells, etc. At the same time, some contraceptives, LSD and smoking abuse.
Also, the lack of vitamins A, B, pantothenic and folic acids and nutrients required for a pregnant woman’s body can jeopardize the development of the intellectual abilities of a born child. The harmful effect that various substances have is also different:
- Blood clotting drugs can cause brain hemorrhage and damage.
- Antimicrobials (sulfonamides) lead to brain damage due to the development of jaundice in a child.
Damage to the fetus by teratogenic drugs also depends on the time and method of exposure to a certain substance. Due to the genetic identity of each fetus, one agent is able to cause reactions that are different in effect.
In addition to chemical factors, factors of physical origin can also have a harmful effect on the embryo with the subsequent occurrence of mental retardation. So, the cause may be the effect of radiation on a woman during pregnancy with any therapeutic, diagnostic, or other x-ray irradiation.
The provision of a teratogenic effect with the subsequent development of MA has a dependence on the ongoing stage of development of the embryo, as well as on the power and dose of the resulting radiation and its type. Also the role is played by the individual characteristics of the sensitivity of the fetus. The occurrence of defects caused by irradiation is caused by metabolic processes and the degree of permeability of the cell membranes of the pregnant woman, as well as the presence of direct damage to the embryo.
Mental malformations can be caused by mechanical influences, which include:
- Excessive uterine pressure on the fetus (with large fibroids and oligohydramnios).
- Amniotic fusion.
Also, the occurrence of malformations and mental retardation is likely in case of emotional stress during pregnancy, having an acute or chronic nature.
Exposure to the natal period
Oxygen starvation (hypoxia) of the fetus often becomes the cause of mental retardation of the child. If the birth process is accompanied by oxygen deficiency, which can be caused by severe illnesses of the mother, fetal asphyxiation occurs. Often, she is accompanied by birth injuries as a result of the gluteal or facial presentation of the fetus, portability or prematurity, prolonged or too fast birth.
Postnatal Impact
The most common causes of mental retardation in the early years of life are in the following conditions of the body:
- Severe intoxication;
- Clinical death;
- Traumatic brain injuries;
- Encephalitis
- Severe depletion of the body.
Socio-cultural factors, in particular the family, have a serious impact on the development of the child’s personality and intelligence. Creating a favorable atmosphere in the family is a prerequisite and extremely important condition for the necessary development of cognitive functions. The occurrence of mental retardation is possible in the absence of the proper manifestation of social and psychological factors. Particularly affected by partial deprivation are children who have had multiple infectious diseases and have congenital diseases at an early age. Children who have suffered brain injuries are characterized by increased fatigue during mental exertion.
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