Sperrung

One of the disorders of the dynamics of thinking, a mental delay in the thought process, manifested by the blocking of thoughts that lose their coherence and purposefulness, which interrupts the associative process and is accompanied by a short-term stupor, is called sperrung. It is manifested by a sudden cessation of the train of thought, a stop in thinking, speech and activity. Most specialists attribute to sperrung also a break in thoughts, their sudden loss, instant silence and a transition to another topic, essentially not accompanied by a noticeable stupor, believing that these are different degrees of manifestation of the same condition.

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Epidemiology

Statistics show that most often sperrung accompanies schizophrenia, and its manifestation, therefore, is observed in the age group of 20-28 years among the male population, 26-32 - among the female population.

Causes sperrung

In principle, such a thought block can occur in any person as a result of a strong emotional shock. In this case, there is no pathology of thinking, however, a periodic disorder of the thought process indicates the need for examination by a psychiatrist, since sperrung is most often a symptom of schizophrenia, and can occur in epileptics, autists, and with Gattington's chorea. The causes of periodic occurrence of pathological interruptions of thoughts are related to psychiatric or neurological diseases.

The risk factors for its occurrence are varied. First of all, this is heredity, which plays one of the main roles in the development of such diseases as schizophrenia and epilepsy. Injuries and tumors, intoxications, inflammation of brain structures and degenerative processes of various genesis - any factors that disrupt blood circulation and metabolism can cause biochemical changes in the brain and trigger the pathogenesis of thinking disorders.

Reversible episodes of cessation of thought activity occur under the influence of stress factors in sensitive individuals prone to getting stuck, lacking self-confidence, irritable and experiencing certain difficulties with adaptation in society. Eugen Bleuler wrote that such blocking of thinking, psychomotor retardation, occurs under the influence of affect in all nervous people, especially hysterical individuals are susceptible to it. Sperrung itself is not a pathology. But where the delay in the thought process continues for a long time or occurs very often without apparent reasons, one can suspect the presence of schizophrenia.

Sperrung as a symptom demonstrates the presence of a mismatch in the work of brain systems. A thought activated by unconditional stimuli begins to form, conditioned reflexes and speech analyzers are connected, and at some stage the process is interrupted. The thought disappears, the person falls silent for a certain time. Then the ability to think returns, but the course of the interrupted process is not restored. The person switches to another topic. It is not yet known exactly which neurobiological processes are involved in the formation of this symptom. Epileptics suffering from sperrung have temporal lobes of the brain affected.

Symptoms sperrung

The first signs of the cessation of thought activity are expressed in the fact that a person suddenly falls silent or interrupts some activity, sometimes for a few seconds or minutes, in severe cases - hours, and then cannot return to the previous topic, although the ability to communicate and act returns. Moreover, the person realizes that his thought has disappeared and the course of the thought process has been interrupted. Schizophrenics suffering from this symptom explain this by the fact that someone is stealing their thoughts.

At the moment of disconnection, mental activity is suspended, the individual stops reacting to surrounding events, does not answer questions, freezes for some time, consciousness is not lost. During the mental block, he loses the ability to think associatively, perceive what is happening, speak and act. After the restoration of thinking ability, a person can describe what happened to him - thoughts have disappeared completely, there is emptiness in the head or fragments of thoughts swarm. Emil Kraepelin interpreted sperrung as a short-term episode of catatonic stupor.

Often people who experience short-term interruptions of thought try to hide their peculiarity from their interlocutor. This “trick” is manifested by switching attention to a completely different topic, jumping from one thought to another, and the previous one can end in the middle of a phrase. It is not possible to immediately restore the interrupted thought, but later, sometimes after a couple of days, it is suddenly remembered without any effort. Interruptions (deprivation) of thoughts are much more common than a full-fledged blockage of thinking sperrung. Patients describe subjective sensations as a loss of the current thought, which is accompanied by a feeling of slight confusion. Everything that has already been said and was supposed to be said next falls out of memory. Nevertheless, mild forms of loss of thought may not be noticeable to the interlocutor.

The opposite symptom of a thought disorder is mentism. This is an uncontrolled influx of many unrelated thoughts. They are characterized by a rapid change, in which one thought, interrupted at any point, can be replaced by the next one, which also cannot be thought through to the end. The flow of thoughts can have any content, both joyful and negative, but in any case it is very tiring for the individual, keeps him in tension. A violent flow of thoughts of any content interferes with normal thinking, even a short-term state leads to mental exhaustion of the patient.

Mentism and sperrung are symptoms of thinking disorder characteristic of schizophrenia. Patients are unable to control the flow of images and memories, are unable to manage them, and feel their alienness. They complain that thoughts are put into their heads from outside, transmitted via an implanted transmitter, etc.

Both the influx and the interruption of thoughts are in most cases a painful disorder, depriving a person of the ability to reason sensibly, causing a slowdown in thinking and are very burdensome for the patient.

Complications and consequences

The blockage of thinking sperrung itself is not dangerous. The ability to think, speak and act is usually restored fairly quickly.

However, as a symptom of schizophrenia, it is a serious danger. You should think about visiting a psychiatrist when such conditions arise periodically on their own, and not in stressful conditions, such as during an exam. Long-term suspensions of mental activity are also an alarming sign.

Untreated schizophrenia has a progressive course. Patients lose the ability to adequately assess and react to current events, their behavioral control and self-organization of activities at home and at work are impaired. They become dependent on outside care, which provokes a depressive mood, contributes to the formation of antisocial behavior, and increases the likelihood of suicide.

Diagnostics sperrung

In the presence of a symptom such as sperrung, a comprehensive examination of the patient is necessary, including a detailed interview with a psychiatrist, testing, and a consultation with a neurologist.

Laboratory tests are prescribed to assess the general state of health and instrumental diagnostics that provide an idea of the functioning of the brain: electroencephalography, echoencephalography, magnetic resonance imaging.

Differential diagnostics, first of all, should confirm or exclude the presence of schizophrenia in the patient. This disease is characterized by a wide range of symptoms and sperrung as a violation of the coherence of thinking is considered one of the main ones.

Affective disorders are distinguished from mental illnesses by the absence of personality changes in the patient.

Differential diagnosis

Mental pathologies are also differentiated. In epileptics, sperrung may develop before seizures, and autism is also differentiated. Autists usually do not notice social signals from other people, they have reduced motivation for social interaction, while schizophrenics know how to communicate, notice everything, but interpret everything incorrectly, creating an incorrect picture of the world in accordance with their painful perception.

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Treatment sperrung

The appointment of therapeutic measures is determined by the nature of the underlying disease. In schizophrenia and epilepsy, the main treatment is pharmacotherapy. Such patients generally take medications throughout their lives, which allows them to maintain their quality of life at a practically normal level.

The main drugs for the treatment of schizophrenia are neuroleptics. The antipsychotic effect of this group of drugs is realized by blocking the central dopaminergic and α-adrenoreceptors. Drugs of this group have the ability to influence the frequency and intensity of the generation of nerve impulses in different parts of the central nervous system and their transmission to the periphery. They are able to influence metabolic processes in the cerebral cortex, improve cognitive functions and activate thinking.

Depending on the observed symptoms, drugs of different generations are used (Aminazin, Clozapine, Olanzapine, Risperidone, Sertindole, Aripiprazole), all of them have a wide range of side effects. Their direct action is associated with the main neuroplegic side effects they cause - muscle numbness, constant muscle spasms, tremors in the limbs and other extrapyramidal reactions. Typical antipsychotics are especially famous for such effects, newer drugs (atypical) cause drug-induced parkinsonism less often and are more suitable for long-term (constant) use. They are better tolerated and provide a low frequency of side effects (extrapyramidal, hyperprolactinemia, weight gain, cardiovascular dysfunctions and others).

Neuroleptics enhance the effect of other sedatives, inhibit various reflex activities that ensure the physiological processes of homeostatic regulation of the functions of internal organs.

Absolute contraindications to the use of antipsychotics are severe systemic pathologies of the brain and spinal cord, inflammatory and degenerative diseases of the liver and kidneys, decompensated heart disease, hematopoiesis disorders, myxedema, and vascular thrombosis.

The dosage of the drugs is individual, it is not recommended to deviate from the treatment regimen proposed by the doctor. If the course is interrupted, a withdrawal syndrome occurs, so the drug should be discontinued gradually and under the supervision of a doctor. You cannot change the dosage on your own.

If the patient has symptoms of depression, antidepressants are added to the treatment regimen. In the presence of concomitant diseases, appropriate therapy is prescribed based on known drug interactions.

Epileptics are prescribed anticonvulsants - Lamotrigine, Finlepsin, valporates.

Lamotrigine usually has a rapid anticonvulsant effect, and this drug does not have such a negative effect on the ability to remember information, concentration and thinking abilities as other anticonvulsants. It interrupts the transmission of nerve impulses that ensure the release of the aliphatic amino acid - glutamate, the excess of which provokes the occurrence of seizures. By stopping epileptic seizures, the drug also relieves the patient of symptoms characteristic of the prodromal phase, including sperrung.

Another anticonvulsant, Finlepsin, has a more pronounced anticonvulsant effect, and also stops hyperkinesis (which includes mentism). In addition to anticonvulsant activity, the drug enhances the effects of antidepressants and increases the activity of neurotransmitters responsible for stabilizing emotions, liberation, and productive brain activity.

In cases of cerebral circulation disorders, hypoxia, consequences of intoxication and trauma, drugs with nootropic activity are used.

Psychocorrection is also used - training courses with a psychologist are conducted in the form of group sessions or according to an individual program. They are aimed at restoring impaired thinking functions.

Prevention

It is possible to prevent the occurrence of sperrung in healthy people by increasing their stress resistance, positivity and trying to avoid psychotraumatic situations.

In sick people, with the help of timely diagnosis and treatment of the underlying disease, and compliance with all medical recommendations.

Optimizing work and rest schedules, proper nutrition and giving up bad habits are relevant for all categories of the population.

Forecast

Neurotic disorders and stress reactions are more favorable in terms of prognosis. In the presence of mental illnesses, drug-compensated states of long-term remission occur in the overwhelming majority of cases.