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CLINICAL PICTURE

The clinical picture of mental disorders does not depend on the nosological form of cancer, but is associated with a whole complex of endogenous, psychogenic and somatogenic factors, the specific gravity of which is different in these processes.

The clinical picture of mental disorders in children suffering from cancer is quite diverse both in the manifestation of the leading syndrome and in severity. The degree of severity in psychiatry primarily refers to the level of non-psychotic and psychotic disorders *.

Nonpsychotic syndromes include the most common astenigo syndrome. This syndrome refers to one of the least specific forms of neuropsychic response to the most diverse, including somatogenic, harmfulnesses. Almost every somatic disease is accompanied, debuted or ends with a symptom complex of irritable weakness, sleep disturbance and autonomic disorders [Bamdas B. S, 1967]. In children suffering from cancer, as a rule, during the manifestation of the disease manifestations of physical asthenia are pronounced: even after minor exertion, they feel pronounced fatigue, which persists for a long time. In more favorable periods of the disease, manifestations of mental asthenia come to the fore: quick fatigue occurs after a short reading, games, communication with others. Against the background of mental and physical asthenia, marked disturbances in concentration of attention, memory, tearfulness and irritable weakness are noted. Sleep disorders in the structure of the syndrome are expressed as

* Psychosis is a pronounced form of mental disorders in which the patient’s mental activity is characterized by a sharp discrepancy between the surrounding reality, the reflection of the real world is grossly distorted.

difficulty falling asleep in the evening. Vegetative disorders are more often manifested in persistent general or distal hyperhidrosis. Headache complaints are less common. Of the behavioral characteristics of patients with asthenic syndrome, slowness is noteworthy. Most children are actively involved in the treatment, endure all procedures.

Under the dysthymic syndrome is understood the oppressed mood with no obvious reasons with the predominance of negative emotions and a decrease in drives [Moskalenko V. D., 1985]. In children with dysthymia, there is a shallow decrease in mood, combined with irritability, grumpiness and a touch of dissatisfaction with others. Some children resist examinations and medical procedures, at the same time being interested in the course of treatment, sometimes expressing concerns about their health. Patients have a difficult relationship with their parents. At the clinic, they look forward to the arrival of their parents, but constantly express their dissatisfaction with them for being late or for not fulfilling minor requests. Without any explanation, in an ultimatum form they require parents to fulfill all their desires or simply scold them.

Anxiety syndrome. Anxiety is defined as a negative emotion directed to the future and causing a feeling of an indefinite threat [Nuller Yu. L., Mikhalenko NN, 1988]. Anxiety in patients is manifested by internal stress and alertness directed outward. It should be noted that when exposed to negative or positive external factors, anxiety intensifies or decreases, but never disappears at all. Anxiety syndrome can occur in two ways:

1. Anxiety is combined with slowness (lethargy). The facial expressions of patients are lively, but always bear a hint of alertness. They cautiously meet strangers, especially adults, carefully come into contact. Game activity is age-appropriate, but they often play mechanically, without being carried away.

2. Anxiety is combined with anxiety (agitation). These children are distinguished by lively rich facial expressions, they are willing to make contact, in their speech often ingratiating intonations. Patients listen to the conversations of adults, worry at any change in the situation. They cannot stay in one place for a long time, do the same thing. Patients hardly fall asleep, their superficial sleep in the first half of the night, often awaken from nightmare dreams.

Depressive syndrome is characterized by low mood, inhibition of intellectual and motor activity, a decrease in vital motives, pessimistic assessments of oneself and one's position of the surrounding reality, somatoneurological

disorders [Bleicher V. M., Kruk I. V., 1996]. Given the clinical picture and severity, non-psychotic, including neurotic, and psychotic depression are distinguished. This division is sometimes conditional, especially in childhood. In children with cancer, most often two types of nonpsychotic depression can be distinguished: depressive-dysthymic and anxiety-depressive.

Depressive-dysthymic syndrome is characterized primarily by the presence of a decreased mood, combined with irritability, and sometimes even viciousness. Sad facial expression in patients is periodically replaced by discontent and suspicion. Patients come into contact selectively. Interests are often limited by the disease, displacing the usual game activity. Severe motor and mental inhibition is not observed. The future seems uncertain and bleak, there is a lack of desire to communicate with peers. With loved ones, these children behave despotic, require increased attention from them.

With anxiety-depressive syndrome, a decreased mood is combined with anxious timidity, a wary expectation. A sad facial expression comes to life when exposed to pleasant events. Communicative function is not seriously impaired. Children play and do normal activities without much interest. Along with anxiety and depression, these patients have fears for their health, parents, and school performance. They often blame themselves for the occurrence of the disease, being sure that they are sick from "long walks", "neglect of physical education and sports", etc. In situations related to illness and treatment, anxiety and anxiety intensifies, and depressive affect deepens. Most have sleep disturbances in the form of early awakening and unpleasant dreams.

The patho-characterological formation of personality is called the psychogenic pathological formation associated with a chronic psycho-traumatic situation in the microenvironment, improper upbringing.
In oncological diseases, the most common pathological formation of the deficit type [Kovalev V.V., 1995]. Among the general clinical features of children with a deficient type of pathological personality formation, one or another degree of consciousness of their inferiority should be mentioned, which becomes distinct from 10-11 years old, the prevalence of lowered mood, a tendency to self-restriction of social contacts with the departure of internal experiences into the world. The most common is the braking option. He is characterized by fencing off from peers, a pronounced desire to limit contact with them in connection with a fear of drawing attention to his illness, increased vulnerability, resentment, and a tendency to fantasize. In fantasies

children present themselves as strong, healthy, see themselves as warriors, astronauts, etc. P. In some cases, a disproportionate variant is encountered, which is characterized by a peculiar combination of high intellectual development and personal immaturity. The main role in the origin of this option belongs to the improper upbringing of a sick child with premature promotion of intellectual interests and activities, but with limited physical activity and isolation from peers. In children with cancer, hysteroid and hypochondriacal variants of deficient pathological personality formation are quite common. With the hysterical option, demonstrativeness, a desire to attract attention, selfish attitudes, inability and unwillingness to reckon with the interests and needs of others are formed. The hypochondriac variant is characterized by fixation on one’s disease. Usual childhood interests are supplanted by thoughts and conversations about one’s illness, fears about one’s health, the desire for examination and communication with medical workers, even during favorable periods of the illness or upon completion of it.

Psychoorganic syndrome. This syndrome is based on disorders of the intellectual-mnestic sphere: memory loss, impaired concentration of attention, difficulty in intellectual processing of information, low level of task performance, as well as emotional disturbances in the form of a decrease in the differentiation (coarsening) of emotions or their lability. In cancer patients, apathetic and euphoric forms of this syndrome are observed.

With an apathetic form, lethargy, lack of initiative, monotony of the emotional background are noted. Game activity is poor, inexpressive, is stereotyped. Patients slowly, without interest perform tasks, constantly requiring stimulation. Children passively submit to treatment, in everyday matters they show complete helplessness.

In children with a seyphoric form, intellectual-mnestic disturbances are combined with foolishness, euphoria, which is sometimes replaced by irritability and aggression. In communication, increased self-esteem and an inadequately optimistic assessment of the situation associated with the disease are noted.

Psychotigical states in oncological diseases in children should be regarded as exogenous (symptomatic, exogenous-organic) psychoses. Exogenous psychoses are caused by exposure to various harmful factors external to the brain or the body as a whole. The term "symptomatic psychosis" is expediently used to refer to transient psychotic disorders that occur without a distinct organic damage to the brain. In cases of psychotic disorders arising from a direct effect on the brain (consequences

radiation and chemotherapy, intoxication, metastasis), they should be regarded as exogenous-organic psychoses. The division into symptomatic and exogenous-organic psychoses is rather arbitrary [Kovalev V.V., 1995].

Syndrome of psychotic anxiety. This syndrome is based on intense anxiety with the expectation of a serious threat from others. As a result of intense anxiety, there is a pronounced disorder of concentration of attention, a constant feeling of confusion, which, with an increase in anxiety, turns into a difficulty in understanding what is happening. Contacts at these children are not stable, superficial, game activity is not productive.

In the case of an anxiously agitated variant, anxiety is combined with severe motor anxiety (patients move erratically and sometimes rush about in bed or in the ward), communicate only with their mother, constantly tend to hold her hands, cling to her (as a rule, these are children 2–5 years old ) The faces of these patients are constantly reflected fear, and sometimes horror. The general pattern of behavior is panicky.

Anxiety-asthenic variant is combined with constant irritability, tearfulness, emotional lability. On the faces of these children are reflected, replacing each other, fear, alertness, grimace of crying or discontent. They constantly ask or ask something, annoyed at an insignificant occasion or without it at all.

Psychotigical depression. This syndrome is characterized by persistent depressive mood that does not change under the influence of external factors. This psychotic state disrupts adaptation, leads to a significant disintegration of all mental activity. In cancer patients, more often, two variants of psychotic depression are observed: melancholy depression and anergic depression.

Sad depression is characterized by a pronounced decrease in mood with a touch of melancholy. The whole appearance of the patients bears the imprint of oppression, a suffering expression on the face, speech is quiet. Patients do not first come into contact, do not look in the face of the interlocutor. Mental retardation is noted, patients are not interested in anything, mostly spend time in bed. They are characterized by guilty feelings and low self-esteem.

The basis of energy depression is a depressive state, characterized by a monotonous affect. Facial expressions are poor, not expressive. They come into contact formally, they speak in a low voice. Such patients are characterized by lethargy, a lack of vivacity and curiosity inherent in children, and a lack of interest in games and activities. Without asthenia, patients often complain of memory, inability to concentrate. They are characterized by passive humility before the current situation in life.
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