Stereotypes

Under the term "stereotypy" experts understand a specific psychiatric disorder or symptom, which is characterized by a person's repetition of the same action (motor, speech) without any direction or semantic load. Such a disorder can occur at any age and is characteristic of autism, phobias, anxiety states, emotional arousal, as well as simply for a certain uncomfortable situation for a person. In the latter case, stereotypes become a kind of self-soothing.

The approach for eliminating stereotypy is comprehensive, individualized, and aimed at eliminating the cause of the disorder. [1]

Stereotyping in psychology

Almost every person has "his or her" stereotypical symptoms. Someone constantly rubs his nose, someone taps his fingers, chews his nails, "crunches" his finger bones, constantly scratches the back of his head or twirls a marker in his hands. Thus, stereotypy is not always a pathology, but sometimes just a way to calm oneself down, to adjust oneself to some activity, to attract attention, to distract oneself, etc.

But in psychology and psychopathology, such senseless actions are called autostimulation, or self-stimulation, or stimming. Pathological stimming implies aggravated symptoms, painful repetitions, which become burdensome and unacceptable, create certain difficulties for a person in everyday life, study, communication, professional activity. This is the main difference that allows to distinguish pathology from easy stereotypical behavior of healthy people prone to it.

Epidemiology

Stereotypies are more characteristic of children, with and without various developmental disorders. Most often "secondary" disorders are diagnosed - that is, those that are part of the structure of a particular pathology. Less often there are "primary" stereotypies with a normal level of intellectual emotional and social development.

If we consider the cases of pathologies in which a certain percentage of stereotypic failures occur, the following series can be drawn up:

• in autism - about 98% of patients suffer from stereotypies;
• for congenital blindness, 52-86%;
• for mental retardation, 62-79%;
• for congenital deafness/hearing impairment - 69%.

In children from orphanages, violations were detected in about 65% of cases.

In addition, it is possible to make a list of some genetic syndromes characterized by stereotypy. Thus, this symptom is most often found in patients with Rett syndrome: peculiar "washing" movements of the upper limbs (76%), licking of hands (58%), and poking with fingers (30%) are typical.

In Prader-Willi syndrome, more than 85% of patients tingle themselves.

In Angelman syndrome, 12% of patients move their lips, smack their lips, move their lower jaw, and 10% of patients wave their hands.

In the syndrome of "cat cry" in more than 80% of cases, there is an excessive attachment to some things: patients repeatedly correct elements of clothing, hair, arrange toys and objects in rows in a certain order.

In Smith-Magenis syndrome, licking of objects and body parts is noted in more than 80%, clapping and hand waving in 60%, and self-biting in 80%.

In Lové's oculocerebrorenal syndrome, more than 80% of patients have combined motor stereotypies.

Less frequently (30-50%), such abnormalities are found in individuals suffering from the broken chromosome syndrome.

Causes of the stereotypes

The emergence of stereotypes often reflects a person's need to show or feel himself or herself in the environment. In this way, some goals are achieved, sometimes seemingly unobvious from the outside. In some cases, such goals are simple and indicate vital needs (hunger, thirst), but they often indicate anxiety and insecurity.

Stereotypical symptoms in childhood are in many cases caused by the child's desire to feel "the opposite effect", both from people or objects around him/her, and from himself/herself, his/her body. Verbal stereotypies are often explained by the desire to communicate when it is impossible to do so correctly and fully - for example, with age-related speech problems. Since these attempts at self-expression arise unexpectedly and a bit strangely, people around them are not always accepting of them, are annoyed and even frightened. [2]

Currently, experts point to such possible causes of stereotypical displays:

• excessive flow of stimuli, in response to which a person tries to suppress unnecessary information to avoid psycho-emotional overload;
• a lack of sensory stimulation, causing the patient to seek out additional stimuli and sensations, whether it be the sensation of pain or screaming, etc..;
• the possibility of distraction from other stimuli, including pain (there is information that during stereotypy there is a release of beta-endorphins - neuropeptides with morphine-like effects);
• negative or overly vivid positive emotions;
• situations that require complacency, avoidance of danger.

Risk factors

Stereotypes in most cases are caused by painful processes that lead to improper functioning of brain structures. It is important to note that stereotypical behavior can occur in any person, including absolutely healthy people - it appears in the course of communication, deep thinking actions, when performing complex tasks. However, in patients with autism and some other problems stereotypies are more pronounced.

Such abnormalities may be associated with such pathologies:

• autism; [3]
• cerebral palsy;
• mental retardation;
• central nervous system disorders;
• traumatic brain injuries;
• Tourette's or Rett syndromes;
• Lesch-Nyhan syndrome;
• obsessive-compulsive disorder;
• chorea acanthocytosis;
• minimal brain dysfunction;
• congenital deafness and blindness.

In addition, a number of factors are also known to contribute to stereotyping:

• psychological pressures, stresses;
• brain surgery;
• high sensitivity to unfavorable psychological phenomena;
• Prolonged or systematic unfavorable emotional states.

The possibility of hereditary origin of the problem cannot be excluded. If relatives have such disorders, the chances of the child developing them are increased.

However, it is important to realize that we are not talking about an independent stereotypic pathology, but only about symptoms of some common causative disease or condition. Therefore, it is important to find the initial factor, and direct the treatment towards its elimination. [4]

Pathogenesis

Stereotypies in patients with developmental disorders were described as early as the nineteenth century by Dr. Eduard Seguin, whose work focused on cases of severe mental retardation in children. Regular studies of stereotypic behavior began around the 70s of the twentieth century. Most of the works of that time were built on the type of psychological experiment with further evaluation of patients' behavior in different conditions. At present, research on stereotypy continues mainly in children with autism. At the same time there is an active search for probable pathogenetic schemes, psychophysiological and neurobiological mechanisms of development of such disorders. Stereotypies are studied in patients with different known genetic syndromes, as well as with local brain lesions. Some scientists make attempts to model stereotypic phenomena in animals. However, despite many studies and experiments, the mechanisms of speech stereotypy and stereotypic behavior still remain poorly understood.

To date, the following approaches to the study of this issue have been applied:

• Stereotypy is viewed as an individual behavioral modality that produces an immediate predictable effect and is satisfying to the patient;
• stereotypies are a way of self-regulation of nervous tone - for example, in case of deficiency of external stimulation or in case of its overabundance (in case of overexcitation);
• stereotypes become a specific communicative tool, the only one available to children with reduced cognitive and social development;
• Stereotypies are a natural variant of behavior of young children, but with age they are sometimes aggravated and consolidated;
• Stereotypies reflect an abnormal course of physiologic reactions in the brain, which may be the result of some neurological or biochemical disorders.

Stereotypic disorders are most often represented by rhythmic movements or verbal repetitions made by patients without any obvious direction or purpose. The aimless actions can be so engrossing that the patient forgets even about the natural needs of the body - in particular, about eating. At the same time, this situation is not always pathological: we speak of pathology only when stereotypies disrupt daily life activities, impair adaptation, or lead to episodes of physical self-harm.

Symptoms of the stereotypes

Stereotypies are very diverse in their visual expression. In particular, more than five dozen variations of pathology are distinguished, including:

• stereotypical movements of the neck, limbs, fingers;
• the whole body swaying;
• spontaneous shrieks;
• increased audible deep inhalations and exhalations;
• touching the eyes, ears, mouth, tongue, chin;
• the same manipulations with toys, clothing items, etc;
• nibbling and licking objects, body parts;
• adopting unusual postures, etc.

The forms of the disorder may be typical (seen in many patients) or rare (individualized).

In addition, stereotypies differ depending on how complex the mental reactions involved are, such as motor coordination, self-correction, separating and comparing objects, and verbal communication. Complex organized reactions include monotonous drawing, repetition of sentences, orderly arrangement of objects, etc. The weak level of reactions includes simple sensorimotor self-stimulations typical of patients with various developmental defects or children with autism. These simple reactions (touching, repeating words) most often disappear with age or become much easier.

First signs

It is noteworthy that the first stereotypic manifestations can occur both in early infancy and adulthood. For example, infants of the first year of life may have monotonous head movements, "self-pumping" in the crib, hand movements. Older children are able to spin or sway for a long time, repeat a word or sound. And only in some cases it really comes to pathological stereotypical manifestations.

Stereotypies in autism (ASD - autism spectrum disorder) are expressed by repetitive interactions with certain parts of objects, even non-functional ones. For example, a child may shift toys, disassemble and reassemble them, take them out of the box and put them back in. Stereotypes in autistic children can take the form of meaningless habits: the desire to walk the same route every day, wear the same sweater, eat the same food, watch the same TV channel, etc. The child may practice these or other repetitions. The practice of certain repetitions allows autistic people to stabilize their psycho-emotional balance, promote self-soothing and normalize their own internal balance.

Stereotypes in children with RAS require careful handling, they should not be eliminated by force, and children should not be forbidden to use them, as this may cause aggravation or exacerbation of the condition, up to destructive actions that are dangerous for the child and for others.

Stereotypies in schizophrenia act as part of psychomotor functions, which are based on increased activity of dopaminergic neurons. Particularly often in patients are noted speech manifestations of the disorder: these are repetitions of individual pronouns, articles, words that lack a cohesive thread of meaning. Phrases seem incoherent, while speech is slow, banal, not conveying any information. In general, schizophrenic speech is usually poorly perceived, it is incomprehensible, ambiguous. In addition to stereotypes, other linguistic disorders are usually present.

Asperger's syndrome and stereotypy are not as pronounced as in autism. However, this syndrome is also characterized by a focus on certain narrow topics. For example, the child favors only one cartoon, not wanting even a little to watch others; plays only one game. Usually over the years, such symptoms become less pronounced, although some difficulties in socialization still remain.

Forms

First of all, such basic types of low-level stereotypes are distinguished:

• Simple stereotypies are the most common and are often observed in children from 6 months to three years of age. These are symptoms such as rocking the whole body, swinging the arms, jumping up and down, and so on. At an older age, such actions as nail biting, tapping, banging their head against surfaces are possible.
• Complex stereotypies are most often manifested by unusual movements of the upper limbs. These may include hand shaking, unusual hand positions, grimacing, spontaneous shrieks: however, limb movements are usually dominant.
• Head movements are rhythmic nodding, rocking, turning to the sides, repeated at a frequency of 1-2 times per second. The movements are sometimes accompanied by eyeball turns or corresponding limb movements.

The pathology includes stereotypies in behavior, which are often and repeated many times, but have no meaning and do not carry any functional load. The main focus of such manifestations is a kind of communication, self-regulation and self-stimulation. The pathology interferes with social communication and can even be harmful to the patient himself.

Motor stereotypies involve meaningless repetition of the same movements, be it jumping up and down, stepping over objects, walking in a circle, bobbing the head, "fluttering" with the hands, etc., as well as repetitive movements of the tongue or lips. Repetitive movements of the tongue or lips, retraction or puffing of the cheeks can also be attributed to this series. Such compulsive and senseless actions are considered a manifestation of obsessive-compulsive disorder.

According to the method of pictograms (a method of psychological research), which consists in the necessity to memorize certain words and word combinations, dynamic stereotypy is manifested by repetitions of drawings. But typical stereotypy is expressed in stereotyped repetition (without full coincidence) of emasculated symbols, smallest details of human figures and images, elements of architecture, animals, etc. The typical stereotypy is expressed in stereotyped repetition (without full coincidence). If partial replacement of images with some "original", non-standard details is noted, the term "atypical stereotypy" is used.

Speech stereotypies are represented by non-directed repetitions of separate sounds, words, sentences. Sometimes such manifestations should be distinguished from echolalia - repetitions of what has just been heard. For example, if the patient is asked a question, he will answer it with the same question or part of it.

Ideatoric stereotypies are such manifestations that relate to the thinking sphere. Otherwise, the pathology can be called "thinking stereotypy"

Stereotypes in children

In early childhood, stereotypies can manifest themselves as twitching of limbs, rocking in bed, sucking fingers. With age, such actions lose their isolation and are integrated into the whole directed behavior of the baby, sometimes reaching a pronounced intensity. Specialists explain this phenomenon by the weakness of inhibition and control processes, which are carried out by the higher parts of the frontal cortex: these brain areas are more vulnerable to any negative factors.

Children with stereotypies without disorders of mental and emotional-social development have anatomically revealed disproportionate reductions in the relative volume of white matter in the frontal lobes compared to peers who do not suffer from stereotypic deviations. In addition, the appearance of such disorders was noted as a result of acquired pathology of frontoparietal and frontal temporal zones of the cerebral cortex.

Motor stereotypies are most often found in children with autistic disorders, in some genetic pathologies, and less often in mental retardation. There is also a small category of patients with a separate psychiatric diagnosis of "stereotypic motor disorder" associated with a limited disorder of speech or motor development.

Stereotypy in infants may result from excitation of the subcortical nuclei of the brain. Preterm infants have been shown to be at increased risk of developing autism with stereotypy as a result of frequent perinatal hemorrhages in the ventricular and subcortical areas. Similar symptoms are found in children with hemorrhages in the thalamus and lenticular nucleus.

Head movements are described in infants with a variety of brain developmental defects, including hydrocephalus, brain stem or cerebellar malformations. In a rare neurological pathology - puppet head shaking - a disorder of liquor dynamics is detected: with fluid accumulation, the third ventricle rhythmically contracts, excites extrapyramidal motor directions at the level of subcortical structures.

Complications and consequences

Stereotypies are behavioral traits that can manifest themselves to varying degrees and in various combinations. These disorders can lead to difficulties in areas such as:

• Difficulties in building relationships with others. Patients with stereotypical behavior often find it difficult to form emotional attachments to people around them. Such problems arise in early childhood: the baby shows indifference when hugged, or even aggressively opposes it. Over the years, such difficulties smooth out somewhat, but difficulties in communication often remain.
• Language communication disorders. Stereotypical people may have difficulty processing information related to word meanings as they age. In children, language development may be delayed.
• Difficulty perceiving and responding to sensitive stimuli. Patients may react suddenly and unexpectedly to any stimuli - visual, auditory, gustatory, light, etc. This can lead to a burst of febrile activity, and to a passive state, to loss of response to traumatic injuries and pain. This can lead to a burst of febrile activity and passive state, loss of reaction to traumatic injuries and painful moments.
• Difficulties in adapting to changes in daily life routines. It is difficult for patients to switch to even small changes and rearrangements, which further creates more pronounced difficulties in education and professional activities.

Diagnostics of the stereotypes

All diagnostic methods used can be categorized into the following:

• observation, conversation (information gathering);
• Examination, evaluation of visual, auditory, sensory perception, testing of reflexes;
• certain instrumental diagnostic techniques;
• conducting experimental tests, games, filling out questionnaires;
• Collecting information on the status and function of the brain and cardiovascular system.

Instrumental diagnostics can be represented by these types of studies:

• electroencephalography - determination of bioelectric brain activity, functional state of the brain;
• rheoencephalography (rheography) - assessment of the state of the cerebral vascular network, diagnosis of cerebral circulation disorders;
• echoencephalography - measurements of intracranial pressure, detection of tumor processes;
• magnetic resonance imaging - a non-neurogenologic study of internal organs and structures of the body;
• A CT scan is a layer-by-layer scan of brain structures;
• cardiointervalography, or variation pulsometry - assessment of the state of the autonomic nervous system.

Laboratory tests consist of determining blood composition, assessing immune status. The tests help to identify the presence of heavy metal derivatives, find out the causes of dysbacteriosis (there is a theory that autism originates from intestinal damage). In addition, diagnostic measures involve a neurologist, neuropathologist, psychiatrist, endocrinologist, other specialists.

Differential diagnosis

Diagnostics in infancy and early childhood should help to exclude disorders that prevent adequate speech development and the formation of correct social skills in the child. Thus, stereotypy should be differentiated with such pathological conditions:

• hearing loss (sensorineural hearing loss, perceptual disorders of the auditory analyzer in children with autism);
• Psychosocial deprivation with pseudoautistic symptomatology;
• intellectual underdevelopment, cognitive deficits, congenital brain malformations;
• Rett syndrome (hereditary neuropsychiatric disorder, cerebroatrophic hyperammonemia);
• receptive-expressive speech disorder;
• Landau-Kleffner syndrome, or acquired aphasia with epilepsy.

At school age, it often becomes difficult to diagnose the cause of stereotypic disorders, especially in the absence of delayed speech and cognitive development. At this age, it is important to consider the possibility of a diagnosis of schizophrenia (specific symptoms include hallucinations and delusions).

Another mental disorder that requires a distinctive diagnosis is attention deficit hyperactivity disorder. In some cases, obsessive-compulsive disorder has to be considered. Difficulties may arise in distinguishing between stereotypies and motor obsessions, repetitive behaviors and protective rituals.

Perseverations and stereotypies should be distinguished by such features:

Perseverations are repetitions of thoughts, words, actions that have been expressed (done) before.

Stereotypes are spontaneous meaningless repetitions of words, thoughts, expressions, actions.

Stereotypy, echolalia, echopraxia, and verbigemia can all coexist with each other. For example, such a combination is particularly characteristic of patients with schizophrenia, Pick's disease.

Echolalia - automatic repetition of words voiced by people around you.

Echopraxia - involuntary imitative repetition of actions, movements after surrounding people.

Verbigeration is the stereotyped rhythmic repetition of certain sounds or words.

Dementia, echolalia, abulia, schizophasia, stereotypy and mutism refer to psychopathologies, manifestations of some disorder of mental activity:

Dementia is an independent pathology, during which there is a violation of thinking ability: memory deteriorates, mental functions weaken, loss of orientation in time and space.

Abulia is a painful lack of will: the patient loses the ability to perform any action, to make a necessary decision (even elementary).

Schizophasia is speech disconnectedness, with proper construction of phrases but without any meaning, indicating the presence of disconnected thinking (a kind of "speech delirium").

Mutism is a condition in which a person who understands and is able to talk does not engage with others, either verbally or even signally.

Parakinesias, mannerisms, motor and speech stereotypies are often combined in catatonic patients:

Parakinesias - strangeness, unnaturalness of movements, flamboyance with deliberately mannered facial expressions and pantomimics.

Mannerism is a specific behavior characterized by exaggeration of speech, body position, movements, and facial expressions.

Treatment of the stereotypes

According to medical guidelines, the treatment of stereotypy is based on the following principles:

• There is no therapy that is equally effective for all patients with stereotypy. Some patients may have an autistic spectrum of symptoms, others may have impaired formation of individual skills, and others may be affected by environmental influences and lack of family support. That is why individual therapeutic tactics and rehabilitation program should be followed.
• It is important to ensure regular follow-up of the patient with further evaluation of the dynamics of the treatment process.
• The prescribed therapeutic measures should not be episodic and short-term, but systematic, regular, involving both medical specialists and close people (family, friends) of the patient.

Both in children and adults, the patient's family members should act as key figures in the implementation of treatment measures. It is important to provide relatives with appropriate methodological materials, trainings and consultations.

Techniques used to correct stereotypic seizures include:

• The substitution technique involves replacing some actions with other, less dangerous ones;
• The switch technique provides an opportunity for the patient to switch to another activity, which minimizes the need for stereotyped behavior;
• The intermittent method consists of abruptly prohibiting the patient from performing certain actions.

Conservative drug therapy is used as an adjunct to treatment by a psychotherapist or psychiatrist. Medication is necessary if the child suffers from hyperactivity, insomnia, or hysteria.

Medications

In some cases, there is a need to prescribe medication. In particular, antidepressants, sedatives, tranquilizers are used.

Clomipramine	Dosage is selected individually, taking into account the patient's condition. Treatment tactics is to achieve optimal efficacy with the lowest dosage of the drug. Exceeding the recommended doses may cause prolongation of the QT interval.
Glycesed	Children over 3 years of age and adults are prescribed 1 tablet 2-3 times a day sublingually. The drug is usually well tolerated, side effects are rare.
Fluoxetine	It is taken orally regardless of food intake, according to an individualized regimen (on average - 20 mg per day). Possible side effects: weakness, chills, hemorrhages, hypersensitivity reactions, decreased appetite.
Sertraline	It is administered once a day in the morning or in the evening, regardless of food intake. The average dosage is 50 mg per day. Treatment may be accompanied by nausea, unstable stools, dry mouth.
Fluvoxamine	The daily dose of the drug is 100-200 mg, with possible increase up to 300 mg. Possible side effects: dyspepsia, drowsiness, headache, asthenia.
Tenoten	Take orally 1 tablet twice a day, between meals: the tablet should be held in the mouth until completely dissolved. Side effects in the form of allergies are rare.

Physiotherapy treatment

Physiotherapy is considered a necessary component of rehabilitation treatment for many neurological pathologies, including those accompanied by stereotypies. The rehabilitation complex includes various procedures:

• Drug electrophoresis is a common method that uses a wide range of drugs. Nicotinic acid, cavinton, magnesium, etc., as well as lidase, sulfur, zinc, copper preparations are often used for stereotypy.
• Magnetotherapy involves exposure of the body to a magnetic field. It is believed that natural magnetic fields affect the higher centers of humoral and nervous regulation, brain and cardiac biocurrents, the degree of permeability of biomembranes, the properties of water and colloidal medium in the body. After the procedures there is a decrease in vascular tone, improvement of cerebral blood circulation, stimulation of metabolic processes, increase of brain resistance to oxygen deficiency.
• Photochromotherapy consists of light exposure to one of the colors of the spectrum. Irradiation can be exposed to both specific areas and individual bioactive points. The procedure helps to balance the processes of excitation and inhibition of the central nervous system, stabilize vascular tone and muscle function, improve the emotional background, activate metabolism, optimize sleep and concentration, relieve pain and stop the development of inflammation.
• Laser therapy has antispasmodic, vasodilating effect, improves local blood circulation.

Contraindications to physical therapy for stereotypy may include:

• benign and malignant tumors;
• open tuberculosis;
• certain mental disorders;
• fever;
• pregnancy;
• clotting disorders;
• Children under 2 years of age.

In addition to physiotherapy, it is possible to prescribe diet therapy, physical therapy, sessions of neuropsychological correction, massage procedures.

Herbal treatment

In stereotypy, the use of herbal preparations with sedative, stress-protective, vegetostabilizing effects is indicated. However, herbal treatment should be started only with the permission of the attending physician.

Folk remedies usually include infusions and decoctions of medicinal plants. Patients with stereotypy can use such recipes:

• Take 15 g of dried melissa, brewed 0.5 liters of hot water. Withstand the infusion for two hours (can be in a thermos). Take the remedy 150 ml three times a day, between meals. The minimum duration of treatment - three weeks.
• Brew 30 g thyme in 300 ml of hot water, kept under a lid for 2-3 hours. Take 100 ml of the infusion three times a day, half an hour after meals.
• Brew crushed valerian root (1/2 teaspoon) in 0.5 liters of boiling water, kept in a thermos for an hour. Take 100 ml of the infusion three times a day, after meals.
• Prepare an equal mixture of rosehip berries and red mountain ash, St. John's wort and ergot herb, medicinal turfgrass, marshmallow, melissa, merbennik, peony roots, schlemint and licorice, flax seeds. Brew 20 g of the mixture in 500 ml of boiling water, insist in a thermos for 40 minutes. Take 50-100 ml three times a day.

In addition to medicinal plants, experts recommend to introduce into the diet of the patient as much as possible products with a high content of magnesium, chromium, zinc, vitamins C, E, B group.

Surgical treatment

Surgery is not the main treatment for patients with stereotypy. Surgical assistance may be required, for example, in cases of brain tumors:

• with increasing intracranial hypertension;
• in ocular stasis, progressive optic nerve atrophy;
• when there is a high likelihood of impairment of important brain functions.

Examples of such transactions include:

• liquor shunt interventions to normalize intracranial pressure;
• insertion of devices to remove cystic contents;
• decompressive cranial trepanation.

The need for surgery is determined on an individual basis by a medical consilium.

Prevention

There are no specific recommendations for the prevention of stereotypy. However, doctors advise to minimize risk factors as much as possible by following these rules:

• to maintain a full and varied nutrition for all family members, to ensure that the necessary amount of vitamins and microelements is supplied to the body;
• lead a healthy and active lifestyle;
• avoid strict diets, starvation, monotonous diet, especially in childhood;
• avoid unjustified intake of medicines, biologically active supplements;
• pay attention to any pathological manifestations and visit doctors in a timely manner;
• maintain normal family relationships and positive atmosphere, avoid scandals, stress, too bright psycho-emotional moments;
• provide normal solar insolation, do not allow the development of vitamin D deficiency;
• women - to plan pregnancy in advance, to take a responsible approach to the processes of conception and carrying a child.

Forecast

Stereotypies are more likely to begin in early childhood and can significantly affect developmental and maturational processes. Children with such traits need to be monitored for individual adaptation over a long period of time. Specialists point out the instability of short-term results of behavioral correction of preschoolers, which depends on the individual characteristics of the child and the therapeutic and adaptive techniques used.

The lower the level of cognitive function, the worse the index of adaptive behavior and, accordingly, the prognosis of pathology. Earlier speech and adequate intellectual development are associated with a more positive prognosis.

In general, the further course and outcome of stereotypy depend on the severity of the primary pathology, personal characteristics, and the environment. All this in combination allows to achieve the maximum possible degree of adaptive behavior, minimize clinical symptomatology.

Behavioral and adaptive skills in patients most often improve with age. However, not only physicians, but also family and loved ones should be involved in eradicating stereotypes: it is important to focus all efforts to achieve the most optimal neuropsychiatric stability.

Books on Stereotypes

1. "A concise guide to psychiatry" (Shorter, E., & Healy, D.) - 2018.
2. "Psychiatry: Psychotherapy and psychopharmacotherapy" (Sadock, B. J., Sadock, V. A., & Ruiz, P.) - 2020.
3. "Psychiatry: Foundations of psychopathology and clinical practice" (Gelder, M., Andreasen, N., & Lopez-Ibor, J. J.) - 2021.
4. "Psychiatry: A national handbook" (Levenson, J. L.) - 2020.
5. "Fundamentals of clinical psychiatry" (Hosseini, S. H.) - 2020.
6. "Psychiatry and psychotherapy" (Beck, A. T., & Alford, B. A.) - 2018.
7. "Psychiatry for general practitioners" (Maudsley, H.) - 2021.

Literature used

• Psychiatry. N. M. Zharikov, Yuri Tulpin. 2000
• Psychiatry. National Manual. Authors: Yury Anatolievich Alexandrovsky, Nikolay Grigorievich Neznanov, Evgeny Yuryevich Abritalin. 2022