Perseveration refers to psychological, mental and neuropathological phenomena in which there is an obsessive and frequent repetition of actions, words, phrases and emotions. Moreover, repetitions appear both in oral and written form. Repeating the same words or thoughts, a person often does not control himself, conducting a verbal method of communication. Perseveration can also manifest itself in nonverbal communication based on gestures and body movements.

Manifestations

Based on the nature of perseveration, they distinguish the following types its manifestations:

• Perseveration of thinking or intellectual manifestations. It is distinguished by the “settling” in the human creation of certain thoughts or its ideas, manifested in the process of verbal communication. A perseverative phrase can often be used by a person when answering questions to which it has absolutely nothing to do. Also, a person with perseveration can pronounce such phrases out loud to himself. A characteristic manifestation of this type of perseveration is constant attempts to return to the topic of conversation, which has long been stopped talking about or the issue in it has been resolved.
• Motor type of perseveration. Such a manifestation as motor perseveration is directly related to a physical disorder in the premotor nucleus of the brain or subcortical motor layers. This is a type of perseveration that manifests itself in the form of repeating physical actions repeatedly. This can be either a simple movement or a whole complex of different body movements. Moreover, they are always repeated equally and clearly, as if according to a given algorithm.
• Speech perseveration. It is classified as a separate subtype of the motor type perseveration described above. These motor perseverations are characterized by constant repetition of the same words or entire phrases. Repetition can manifest itself in oral and written form. This deviation is associated with lesions of the lower part of the premotor nucleus of the human cortex in the left or right hemisphere. Moreover, if a person is left-handed, then we're talking about about damage to the right hemisphere, and if a right-handed person, then, accordingly, to the left hemisphere of the brain.

Reasons for the manifestation of perseveration

There are neuropathological, psychopathological and psychological reasons for the development of perseveration.

Repetition of the same phrase, caused by the development of perseveration, can occur against the background of neuropathological reasons. These most often include:

• Traumatic brain injuries that damage the lateral region of the orbitofrontal cortex. Or it is due to the physical types of damage to the frontal convexities.
• For aphasia. Perseveration often develops against the background of aphasia. It is a condition characterized pathological abnormalities previously formed human speech. Similar changes occur in the event of physical damage to the centers in the cerebral cortex responsible for speech. They can be caused by trauma, tumors or other types of influences.
• Transferred local pathologies in the frontal lobe of the brain. These may be similar pathologies, as is the case with aphasia.

Psychiatrists, as well as psychologists, call perseveration deviations of a psychological type that occur against the background of dysfunctions occurring in the human body. Perseveration often acts as additional disorder and is an obvious sign of the formation of a complex phobia or other syndrome in a person.

If a person shows signs of developing perseveration, but has not suffered severe forms of stress or traumatic brain injury, this may indicate the development of both psychological and mental forms deviations.

If we talk about the psychopathological and psychological reasons for the development of perseveration, there are several main ones:

• Tendency to increased and obsessive selectivity of interests. Most often this manifests itself in people characterized by autistic disorders.
• The desire to constantly learn and learn, to learn something new. It occurs mainly in gifted people. But the main problem is that that person may become fixated on certain judgments or his activities. The existing line between perseveration and such a concept as perseverance is extremely insignificant and blurred. Therefore, with an excessive desire to develop and improve oneself, serious problems can develop.
• Feeling of lack of attention. Occurs in hyperactive people. The development of perseverative inclinations in them is explained by an attempt to attract increased attention to themselves or their activities.
• Obsession with ideas. Against the background of obsession, a person can constantly repeat the same physical actions caused by obsession, that is, obsession with thoughts. The simplest, but very understandable example of obsession is the desire of a person to constantly keep his hands clean and wash them regularly. The person explains this by saying that he is afraid of getting infected. terrible infections, but such a habit can develop into a pathological obsession, which is called perseveration.

It is important to be able to distinguish when one person simply has strange habits in the form of constant hand washing, or whether it is obsessive-compulsive disorder. It is also not uncommon for repetitions of the same actions or phrases to be caused by a memory disorder, and not by perseveration.

Features of treatment

There is no universally recommended treatment algorithm for perseveration. Therapy is carried out based on the use of a whole range of different approaches. One method should not be used as the only method of treatment. It is necessary to take new methods if the previous ones did not produce results. Roughly speaking, treatment is based on constant trial and error, which ultimately makes it possible to find the optimal method of influencing a person suffering from perseveration.

Methods presented psychological impact can be applied alternately or sequentially:

• Expectation. It is the basis in psychotherapy for people suffering from perseveration. The point is to wait for changes in the nature of the deviations that have arisen against the background of application various methods impact. That is, the waiting strategy is used in conjunction with any other method, which we will discuss below. If no changes occur, switch to other psychological methods of influence, expect results and act according to the circumstances.
• Prevention. It is not uncommon for two types of perseveration (motor and intellectual) to occur together. This makes it possible to prevent such changes in time. The essence of the technique is based on the exclusion of physical manifestations that people most often talk about.
• Redirection. This is a psychological technique based on a sharp change in ongoing actions or current thoughts. That is, when communicating with a patient, you can suddenly change the topic of conversation or move from one physical exercise or movement to another.
• Limitation. The method is aimed at consistently reducing a person’s attachment. This is achieved by limiting repetitive actions. A simple but clear example is to limit the amount of time a person is allowed to sit at a computer.
• Abrupt cessation. This is a method of actively getting rid of perseverative attachment. This method is based on the effect of introducing the patient into a state of shock. This can be achieved through harsh and loud phrases, or by visualizing how harmful they can be. intrusive thoughts or movements, actions of the patient.
• Ignoring. The method involves completely ignoring the manifestations of the disorder in a person. This approach works best if the disorders were caused by attention deficit. If a person does not see the point in what he is doing, since there is no effect, he will soon stop repeating obsessive actions or phrases.
• Understanding. Another relevant strategy with which the psychologist recognizes the patient’s train of thought in case of deviations or in the absence of them. This approach often allows a person to independently understand his thoughts and actions.

Perseveration is a fairly common disorder that can be caused by for various reasons. When perseveration occurs, it is important to choose a competent treatment strategy. Medication is not used in this case.

Motor (motor) perseveration - obsessive reproduction of the same movements or their elements

There are:
- elementary motor perseveration;

Systemic motor perseveration; and also

Motor speech perseveration.

- “elementary” motor perseveration, which manifests itself in repeated repetition of individual elements of movement and occurs when the premotor parts of the cerebral cortex and underlying subcortical structures are damaged;

- “systemic” motor perseveration, which manifests itself in repeated repetition of entire movement programs and occurs when the prefrontal parts of the cerebral cortex are damaged;

Motor speech perseveration, which manifests itself in the form of multiple repetitions of the same syllable or word in oral speech and when writing and occurs as one of the manifestations of efferent motor aphasia with damage to the lower parts of the premotor region of the cortex of the left hemisphere (in right-handed people).

Sensory perseveration is an obsessive reproduction of the same sound, tactile or visual images, which occurs when the cortical parts of the analyzing systems are damaged.

28. Forms of apraxia.

Apraxia– this is a violation of voluntary movements and actions with damage to the cerebral cortex, not accompanied by clear elementary movement disorders (paresis, paralysis, impaired tone, etc.).

Luria identified 4 types of apraxia, which depend on the lesion factor:

1. Kinesthetic apraxia. Inferior parietal zone. 1, 2 and partially 40 fields. Predominantly left hemisphere. Afferentation is disrupted. The person does not receive feedback. Praxis of posture suffers (the inability to give parts of the body the desired position). Can't feel the position of fingers, etc. "Shovel hand." All substantive actions are impaired, writing, and cannot grasp a pen correctly. Test: apraxia - posture (we show hand postures, the Patient must repeat). Strengthening your visual control helps. With eyes closed - inaccessible.

2. Kinetic apraxia. Lower parts of the premotor area (lower forehead). Smooth switching from one operation to another is disrupted. Elementary perseverations - having started to move, the Patient gets stuck (repeat of the operation). Violation of writing. They realize their inadequacy. Test: fist – palm – rib; fences

3. Spatial apraxia. Parieto-occipital regions, especially with left lesions. Visual-spatial contacts of movements are disrupted. Difficulty of execution spatial movements: get dressed, cook food, etc. Everyday life is difficult. Head's samples : repeat the movement. Optical-spatial agraphia occurs. Elements of letters. Inability to relate your body to the world around you. Occurs with damage to the parieto-occipital cortex at the border of the 19th and 39th fields, especially with damage to the left hemisphere or bilateral lesions. The junction of the parietal, temporal and occipital lobe often defined as the zone of the statokinesthetic analyzer, since local lesions of this zone cause disturbances spatial relationships when performing complex motor acts.
This form of apraxia is based on a disorder of visual-spatial synthesis, a violation of spatial representations. Thus, visuospatial afferentation of movements is primarily affected in patients. Spatial apraxia can occur against the background of intact visual gnostic functions, but is more often observed against the background of visual optical-spatial agnosia, then a complex picture of apraktoagnosia arises. In all cases, patients experience apraxia of posture and difficulty performing spatially oriented movements. Strengthening visual control of movements does not help them. There is no clear difference when performing movements with open and closed eyes.

This type of disorder also includes constructive apraxia - special and most common forms of praxis impairment, mainly related to the construction of figures from parts and drawing.
Patients find it difficult or unable to depict, according to instructions, to copy directly or from memory simple geometric figures, objects, animal and human figures. The contours of the object are distorted (instead of a circle - an oval), its individual details and elements are not drawn (when drawing a triangle, one corner turns out to be under-drawn). It is especially difficult to copy more complex geometric shapes- a five-pointed star, a rhombus (for example, a star is drawn in the form of two intersecting lines or in the form of a deformed triangle). Particular difficulties arise when copying irregular geometric shapes.

Similar difficulties arise when drawing according to instructions or sketching animal figures and “little men” or human faces. The contours of a person turn out to be distorted, incomplete, with disproportionate elements. Thus, when copying a person’s face, the patient can place one eye in an oval (sometimes in the form of a rectangle) or place one eye above the other, omit some parts of the face in the drawing, the ears are often located inside the oval of the face, etc.

Drawing from memory is most disrupted when the sample presented to the patient is removed or not presented at all, if we are talking about well-known figures. Drawing a three-dimensional, three-dimensional image of an object (cube, pyramid, table, etc.) also causes great difficulty; for example, when drawing a table, the patient places all 4 legs on the same plane.

Difficulties occur not only when drawing, but also when constructing figures from sticks (matches) or cubes according to a given pattern (adding, for example, simple drawings from Kos cubes).
Disorders of constructive praxis appear especially clearly when copying unfamiliar figures that do not have a verbal designation (“non-verbal figures”). This technique is often used to identify hidden disorders of constructive praxis.

A characteristic manifestation of constructive apraxia is also difficulty in choosing a place to draw an object on a sheet of paper - the drawing can be located in the upper right corner of the paper or in the lower left, etc. When copying objects, a “switching on symptom” may be observed when the patient draws or draws very close to the sample or superimposes your drawing on the sample. Often, with right hemisphere damage, the left field of space is ignored in the drawings.

Constructive apraxia, according to the literature, occurs when the parietal lobe (angular gyrus) is damaged in both the left and right hemispheres. More noted frequent occurrence this defect of the HMF and a more severe degree of severity in left-sided lesions in right-handed people.
There are other points of view about the dependence of the severity of defects in design and drawing on the lateralization of lesions. THEM. Tonkonogiy (1973) indicates a greater overall severity of disorders in patients with damage to the right parietal lobe. In these cases, a more detailed type of drawing is noted, the presence of a larger number of elements (“extra lines”), deformation of the spatial relationships of parts with elements of “ignoring” the left part of the structure, etc. Operations of “rotation” of drawings (in relation to the sample) cause particular difficulties. at 90° or 180°.
With damage to the left hemisphere, it was noted that the patients’ drawings are more primitive, poor in details, there is a desire of patients to copy samples rather than drawing according to instructions, difficulties in identifying corners, joints between structural elements. Many elements of this disorder are revealed when analyzing writing (constructing letters and numbers).

Regulatory apraxia. Prefrontal parts of the brain. Speech regulation disorder. Control over movements and actions suffers. The patient cannot cope with motor tasks. arise systemic perseverations(repeating the entire action). Difficulty in mastering the program. Skills are lost. There are patterns and stereotypes that remain. The result does not match the intention. The lesion is localized in the area of ​​the convexital prefrontal cortex anterior to the premotor regions. It occurs against the background of preservation of tone and muscle strength.

The defect is based on a violation of voluntary control over the implementation of movement, a violation of speech regulation of motor acts. Manifests itself in the form of violations of the programming of movements, disabling conscious control over their execution, replacement necessary movements motor patterns and stereotypes. Systemic perseverations (according to Luria) are characteristic - perseverations of entire motor programs. The greatest difficulties for such patients are caused by changing programs of movements and actions.
With a gross breakdown of voluntary regulation of movements, patients experience symptoms of echopraxia in the form of imitative repetitions of the experimenter’s movements.

This form apraxia is most pronounced when the left prefrontal region of the brain is damaged.
According to Lipmann, the following types of apraxia are distinguished: a) kinetic apraxia of the limbs; b) ideomotor apraxia; c) ideational apraxia; d) oral apraxia; e) apraxia of the trunk; e) apraxia of dressing.
Writing disorder is identified as a relatively independent form of these disorders.

29. Prefrontal frontal regions and their role in the regulation of activity.

As is known, the frontal lobes of the brain, and in particular their tertiary formations (which include the prefrontal cortex), are the most recently formed department cerebral hemispheres.

The prefrontal regions of the brain - or the frontal granular cortex - are mainly composed of cells in the upper (association) layers of the cortex. They have the richest connections with both the upper parts of the trunk and formations thalamus(see Fig. 35, a), and with all other zones of the cortex (see Fig. 35, b). Thus, the prefrontal cortex is built not only over the secondary sections of the motor area, but actually over all other formations big brain. This ensures a two-way connection of the prefrontal cortex with both the underlying structures of the reticular formation, which modulate the tone of the cortex, and with those formations of the second block of the brain, which ensure the receipt, processing and storage of exteroceptive information, which allows the frontal lobes to regulate general condition cerebral cortex and the course of the main forms of human mental activity.

The prefrontal regions play a decisive role in the formation of intentions, programs, and in the regulation and control of the most complex forms of human behavior. They consist of fine-grained cells with short axons and have powerful bundles of ascending and descending connections with the reticular formation. Therefore, they can perform an associative function, receiving impulses from the first block of the brain and have an intense modulating effect on the formation of the reticular formation, bringing its activating impulses into accordance with the dynamic patterns of behavior that are formed directly in the prefrontal (frontal) cortex. The prefrontal sections are actually built on top of all sections of the cerebral cortex, performing the function of general regulation of behavior.

It should be noted that, entering into work at the very latest stages of development, the prefrontal parts of the cerebral cortex are at the same time the most vulnerable and most susceptible to involution. Their higher (“associative”) layers atrophy especially sharply in such diffuse diseases as Pick’s disease or progressive paralysis.

The fact that the cortex of the frontal region is close in structure to the motor and premotor areas and, according to all data, is included in the system of the central sections of the motor analyzer, suggests its immediate participation in the formation of the analysis and synthesis of those excitations that underlie motor processes.

On the other hand, the frontal lobes of the brain have the closest connections with the reticular formation, receiving constant impulses from it and directing corticofugal discharges to it, which makes them important body regulation active states body. This function frontal lobes brain is especially important because the frontal lobes themselves are closely connected with all other parts of the brain and allow impulses, previously processed with the participation of the most complex cortical apparatus, to be sent to the underlying subcortical formations.

The prefrontal parts of the brain belong to tertiary systems that form late in both phylo- and ontogenesis and reach greatest development in humans (25% of the total area of ​​the cerebral hemispheres). According to A.R. Luria, the frontal cortex is, as it were, built on top of all brain formations, ensuring the regulation of their activity states.

In addition to direct participation in ensuring the operating mode of cortical tone when solving various problems, the prefrontal sections, as clinical and psychological data show, are directly related to the integrative organization of movements and actions throughout their implementation and, above all, at the level of voluntary regulation. What does voluntary regulation of activity imply? Firstly, the formation of intention, in accordance with which the goal of the action is determined and, based on past experience, an image of the final result that corresponds to the goal and satisfies the intention is predicted. Secondly, the means necessary to achieve the result are selected in their sequential connection, i.e. the program. Thirdly, the implementation of the program must be monitored, since the conditions for achieving the result may change and require correction. Finally, it is necessary to compare the achieved result with what was expected to be obtained and, again, make corrections, especially if there is a discrepancy between the forecast and the result. Thus, the arbitrarily planned execution of a task in itself is a complex, multi-link process, during which the correctness of the chosen path to the realization of the original intention is constantly checked and corrected.

One of the features of the “frontal syndrome”, usually associated with dysfunction of the prefrontal regions, complicating both its description and clinical neuropsychological diagnostics, is the variety of options in terms of the severity of the syndrome and its symptoms. A. R. Luria and E. D. Chomskaya (1962) point to large number determinants that determine variants of frontal syndrome. These include the localization of the tumor within the prefrontal regions, the massiveness of the lesion, the addition of cerebral clinical symptoms, the nature of the disease, the age of the patient and his premorbid characteristics. It seems to us that the individual typological characteristics of a person, the level of that psychological structure, which L. S. Vygotsky designated as the “core” of the personality, largely determines the possibilities of compensation or masking of the defect. We are talking about the complexity of activity stereotypes formed during life, the breadth and depth of the “buffer zone” within which the decline occurs. general level regulation of mental activity. It is known that high level established forms of behavior and professional characteristics, even with severe pathology of the prefrontal regions, determine the patient’s ability to perform quite complex types of activities.

Everything that has been said about the variants of the frontal syndrome, about the mystery of the function of the frontal lobes (according to G.L. Teuber) to some extent can serve as an excuse for the lack of clarity with which the syndrome of damage to the prefrontal parts of the brain will be described in this work. Nevertheless, we will make an attempt to systematize the main components of this form of local pathology, based on the ideas of A. R. Luria.

One of the leading features in the structure of frontal syndrome, in our opinion, is the dissociation between the relative preservation of the involuntary level of activity and the deficiency in the voluntary regulation of mental processes. This dissociation can take on an extreme degree of severity when the patient is practically unable to perform even simple tasks that require minimal voluntary activity. The behavior of such patients is subject to stereotypes, cliches and is interpreted as a phenomenon of “responsiveness” or “field behavior”. Such cases have been described

“field behavior”: when leaving the room, instead of opening the door, the patient opens the doors of the closet located at the exit; When following the instructions to light a candle, the patient takes it into his mouth and lights it like a cigarette. A. R. Luria often said that it is better to judge the state of mental processes and the level of achievements during a neuropsychological examination of a patient with frontal syndrome if one examines not this patient, but his neighbor in the ward. In this case, the patient is involuntarily included in the examination and can detect a certain productivity when involuntarily performing a number of tasks.

The loss of the function of voluntary control and regulation of activity is especially clearly manifested when following instructions for tasks that require constructing a program of action and monitoring its implementation. In this regard, patients develop a complex of disorders in the motor, intellectual and mnestic spheres.

In frontal syndrome, a special place is occupied by the so-called regulatory apraxia, or apraxia of target action. It can be seen in such experimental tasks as performing conditioned motor reactions. The patient is asked to perform the following motor program: “when I hit the table once, you raise your right hand, when you hit it twice, raise your right hand.” left hand"Repetition of the instruction is accessible to the patient, but its implementation is grossly distorted. Even if the initial execution may be adequate, then when repeating the sequence of stimulus beats (I - II; I - II; I - II), the patient develops a stereotype of hand movements (right - left, right - left, right - left). When changing the sequence of stimuli, the patient continues to carry out the stereotyped sequence he has developed, not paying attention to the change in the stimulus situation. In the most severe cases, the patient may continue to update the existing stereotype of hand movements when the supply of stimuli stops. Following the instruction “squeeze my hand 2 times,” the patient shakes it repeatedly or simply squeezes it once for a long time.

Another variant of a violation of the motor program may be its initial direct subordination to the nature of the presented stimuli (echopraxia). In response to one blow, the patient also performs one tap, and in response to two blows, he knocks twice. In this case, it is possible to change hands, but there is an obvious dependence on the stimulus field, which the patient cannot overcome. Finally (as an option), when repeating instructions at a verbal level, the patient does not carry out the motor program at all.

Similar phenomena can be seen in relation to other motor programs: mirror uncorrected execution of the Head test, echopraxic execution of a conflict conditioned reaction (“I will raise my finger, and you will raise your fist in response”). Replacement of the motor program with echopraxia or a formed stereotype is one of the typical symptoms in the case of pathology of the prefrontal regions. In this case, the actualized stereotype replacing the real program may refer to well-established stereotypes of the patient’s past experience. As an illustration, consider the example above of lighting a candle.

A description of the symptoms characteristic of target action apraxia will be incomplete without touching upon one more feature in the disruption of the execution of motor programs, which, however, has a broader significance in the structure of prefrontal frontal syndrome and can be identified as the second leading symptom. This violation is classified as a violation of the regulatory function of speech. If we turn again to how the patient performs motor programs, we can see that the speech equivalent (instruction) is absorbed and repeated by the patient, but does not become the lever with which control and correction of movements is carried out. The verbal and motor components of activity seem to be torn off and split off from each other. In its crudest forms, this can manifest itself in the replacement of movement by the reproduction of verbal instructions. Thus, a patient who is asked to squeeze the examiner’s hand twice repeats “squeeze twice,” but does not perform the movement. When asked why he does not follow the instructions, the patient says: “squeeze twice, I’ve already done it.” Thus, the verbal task not only does not regulate the motor act itself, but is also not a trigger mechanism that forms the intention to perform the movement.

Both the violation of voluntary regulation of activity and the violation of the regulatory function of speech are in close connection with each other and in connection with another symptom - the inactivity of a patient with a prefrontal lesion.

Inactivity as insufficient intention in organizing behavior in performing movements and actions can be represented by various stages. At the stage of formation of intention, it manifests itself in the fact that the instructions and tasks offered to the patient are not included in the internal plan of his activity, according to which the patient, if included in the activity, replaces the task required by the instructions with a stereotype or echopraxia. If activity is preserved at the first stage (the patient accepts the instructions), inactivity can be seen at the stage of formation of the execution program, when the correctly started activity is ultimately replaced by an already established stereotype. Finally, the patient’s inactivity can be identified at the third stage - comparison of the sample and the obtained result of the activity.

Thus, prefrontal frontal syndrome is characterized by a violation of the voluntary organization of activity. , violation of the regulatory role of speech, inactivity in behavior and when performing neuropsychological research tasks. This complex defect is especially clearly manifested in motor, intellectual, mnestic and speech activities.

The nature of movement disorders has already been discussed. In the intellectual sphere, as a rule, purposeful orientation in the conditions of the task and the program of actions necessary for the implementation of mental operations are disrupted.

A good model of verbal-logical thinking is counting serial operations (subtraction from 100 to 7). Despite the availability of single subtraction operations, under serial counting conditions, task performance is reduced to replacing the program with fragmented actions or stereotypies (100 - 7 = 93, 84,... 83, 73 63, etc.).

A more sensitized test is solving arithmetic problems. If the task consists of one action, its solution does not cause difficulties. However, in relatively more complex tasks, as shown by A. R. Luria and L. S. Tsvetkova (1966), the general orientation in the conditions is also disrupted (this is especially true for the question of the task, which is often replaced by the patient due to the inert inclusion of one of the elements in it conditions), and the course of the decision itself, which does not obey the general plan or program.

In visual-mental activity, the model of which is the analysis of the content of a plot picture, similar difficulties are observed. From the general “field” of the picture, the patient impulsively snatches some detail and subsequently makes an assumption about the content of the picture, without comparing the details with each other and without correcting his assumption in accordance with the content of the picture. Thus, having seen the inscription “Caution” in a picture depicting a skater who has fallen through the ice and a group of people attempting to save him, the patient concludes: “Current high voltage"The process of visual thinking is replaced here by the actualization of a stereotype caused by a fragment of a picture.

The mnestic activity of patients is disrupted primarily at the level of its volition and purposefulness. Thus, writes A.R. Luria, these patients do not have primary memory impairments, but the ability to create strong motives for remembering, maintain active tension and switch from one set of traces to another is extremely difficult. When memorizing 10 words, a patient with frontal syndrome easily reproduces 4-5 elements of the sequence that are accessible to direct memorization upon the first presentation of the series, but upon repeated presentation there is no increase in the productivity of reproduction. The patient inertly reproduces the initially imprinted 4-5 words, the learning curve has a “plateau” character, indicating the inactivity of mnestic activity.

Particularly difficult for patients are mnestic tasks that require sequential memorization and reproduction of two competing groups (words, phrases). Adequate reproduction is replaced by inert repetition of one of the groups of words, or one of 2 phrases.

Defects in voluntary regulation of activity in combination with inactivity also appear in the speech activity of patients. Their spontaneous speech is impoverished, they lose speech initiative, echolalia predominates in the dialogue, speech production is replete with stereotypes and cliches, meaningless statements. Just as in other types of activity, patients cannot construct a program for an independent story on a given topic, and when reproducing a story proposed for memorization, they slip into side associations of a stereotypical situational plan. Such speech disorders are classified as speech spontaneity, speech adynamia or dynamic aphasia. The question of the nature of this speech defect has not been fully resolved: whether it is actually speech or occurs in a syndrome of general inactivity and aspontaneity. It is obvious, however, that the general radicals that form the syndrome of impaired goal setting, programming and control with damage to the prefrontal parts of the brain find their clear expression in speech activity.

In the characteristics of prefrontal syndrome, its lateral features remained unconsidered. Despite the fact that all the described symptoms are most clearly manifested with bilateral damage to the anterior parts of the frontal lobes of the brain, the unilateral location of the lesion introduces its own characteristics. With damage to the left frontal lobe, a violation of the regulatory role of speech, impoverishment of speech production, and a decrease in speech initiative are especially clear. In the case of right hemisphere lesions, there is disinhibition of speech, an abundance of speech production, and the patient’s willingness to explain his mistakes quasi-logically. However, regardless of the side of the lesion, the patient’s speech loses its meaningful characteristics and includes cliches and stereotypes, which in the case of right-hemisphere lesions gives it a “reasoning” coloring. More roughly, when the left frontal lobe is damaged, inactivity appears; decrease in intellectual and mnestic functions. At the same time, localization of the lesion in the right frontal lobe leads to more pronounced defects in the area of ​​visual, nonverbal thinking. Violation of the integrity of the assessment of the situation, narrowing of the volume, fragmentation - characteristic of right hemisphere dysfunctions of the previously described brain zones are fully manifested in the frontal localization of the pathological process.

30.Mediobasal sections of the cortex and their functional significance.

Note. The following levels of deep brain structures are distinguished: brain stem (medulla oblongata, pons, midbrain), interstitial brain - the upper floor of the brain stem (hypothalamus and thalamus), mediobasal cortex of the frontal and temporal lobes (hippocampus, amygdala, limbic structures, basal nuclei of the old cortex, etc.). The deep structures also include the median commissure of the brain - corpus callosum. The topical diagnosis of damage to deep brain structures is based mainly on the totality of clinical and paraclinical data. The results of a neuropsychological study - in contrast to damage to cortical structures - are of an auxiliary, phenomenological nature.

All these facts are associated with profound changes physiological mechanisms regulating the normal behavior of the animal, undoubtedly indicate that mediobasal sections of the neocortex, together with the entire complex of phylogenetically ancient cortical, subcortical and stem formations of the brain associated with them, are closely related to the regulation of the internal states of the body, perceiving the signals of these states and their changes and accordingly “tuning” and “rebuilding” each time active work animal, directed outward. The close connections between these formations and especially between the limbic region and the basal frontal cortex justify the general conclusion that in the frontal region there is a comparison and functional unification of two most important types of feedback signaling. We mean here, on the one hand, signaling coming from motor activity of the body, aimed at the outside world and formed under the influence of information about events occurring in the environment, and on the other hand, signaling coming from the internal sphere of the body. Thus, a comprehensive account is provided of everything that happens outside the body and inside it as a result of its own activities. In view of this, it can be assumed that the frontal cortex, in which the most complex syntheses of external and internal information take place and their transformation into final motor acts, from which integral behavior is formed, is of very significant importance in humans as the morphophysiological basis of the most complex types of mental activity.

The first - energy - block includes non-specific structures different levels: reticular formation brain stem, nonspecific structures of the midbrain, diencephalic regions, limbic system, mediobasal cortex of the frontal and temporal lobes brain This brain block regulates activation processes: general generalized changes in activation, which are the basis of various functional states, and local selective activation changes required for HMF to occur. The functional significance of the first block in ensuring mental functions consists, first of all, in the regulation of activation processes, in providing a general activation background on which all mental functions are carried out, in maintaining the general tone of the central nervous system necessary for any mental activity. This aspect of the work of the first block is directly related to the processes of attention - general, indiscriminate and selective, as well as in consciousness as a whole. The first block of the brain is directly associated with memory processes, with the imprinting, storage and processing of multimodal information.

The first block of the brain is the direct brain substrate of various motivational and emotional processes and states. The first block of the brain perceives and processes various interoceptive information about states internal environment body and regulates these states with the help of neurohumoral, biochemical mechanisms. Thus, the first block of the brain is involved in the implementation of any mental activity and especially in the processes of attention, memory, regulation emotional states and consciousness in general.

Syndromes of damage to the mediobasal cortex of the temporal region of the brain. Because the mediobasal sections of the cortex are an integral part of the first (energy) block. Damage to this zone of the cortex leads to disruption of modally nonspecific factors, manifested in disorders of various mental functions.

The three groups of symptoms included in these syndromes have been most studied.

The first group is modality-nonspecific memory impairment (auditory-speech and other types). As A. R. Luria noted, defects in “general memory” manifest themselves in these patients in difficulties in directly retaining traces, that is, in primary impairments of short-term memory.

The second group of symptoms is associated with disorders in emotional sphere. Damage to the temporal regions of the brain leads to distinct emotional disorders, which are qualified in the psychiatric literature as affective paroxysms. They manifest themselves in the form of attacks of fear, melancholy, horror and are accompanied by violent vegetative reactions.

The third group of symptoms consists of symptoms of impaired consciousness. In severe cases, these are drowsy states of consciousness, confusion, and sometimes hallucinations; in milder cases, difficulties in orientation in place, time, confibulation. These symptoms have not yet become the object of special neuropsychological study.

31 Neuropsychological analysis of memory disorders.

Memory is one of the mental functions and types of mental activity designed to preserve, accumulate and reproduce information.

Perseveration refers to psychological, mental and neuropathological phenomena in which there is an obsessive and frequent repetition of actions, words, phrases and emotions. Moreover, repetitions appear both in oral and written form. Repeating the same words or thoughts, a person often does not control himself, conducting a verbal method of communication. Perseveration can also manifest itself in nonverbal communication based on gestures and body movements.

Manifestations

Based on the nature of perseveration, the following types of its manifestation are distinguished:

• Perseveration of thinking or intellectual manifestations. It is distinguished by the “settling” in the human creation of certain thoughts or its ideas, manifested in the process of verbal communication. A perseverative phrase can often be used by a person when answering questions to which it has absolutely nothing to do. Also, a person with perseveration can pronounce such phrases out loud to himself. A characteristic manifestation of this type of perseveration is constant attempts to return to the topic of conversation, which has long been stopped talking about or the issue in it has been resolved.
• Motor type of perseveration. Such a manifestation as motor perseveration is directly related to a physical disorder in the premotor nucleus of the brain or subcortical motor layers. This is a type of perseveration that manifests itself in the form of repeating physical actions repeatedly. This can be either a simple movement or a whole complex of different body movements. Moreover, they are always repeated equally and clearly, as if according to a given algorithm.
• Speech perseveration. It is classified as a separate subtype of the motor type perseveration described above. These motor perseverations are characterized by constant repetition of the same words or entire phrases. Repetition can manifest itself in oral and written form. This deviation is associated with lesions of the lower part of the premotor nucleus of the human cortex in the left or right hemisphere. Moreover, if a person is left-handed, then we are talking about damage to the right hemisphere, and if a person is right-handed, then, accordingly, to the left hemisphere of the brain.

Reasons for the manifestation of perseveration

There are neuropathological, psychopathological and psychological reasons for the development of perseveration.

Repetition of the same phrase, caused by the development of perseveration, can occur against the background of neuropathological reasons. These most often include:

• Traumatic brain injuries that damage the lateral region of the orbitofrontal cortex. Or it is due to the physical types of damage to the frontal convexities.
• For aphasia. Perseveration often develops against the background of aphasia. It is a condition characterized by pathological deviations of previously formed human speech. Similar changes occur in the event of physical damage to the centers in the cerebral cortex responsible for speech. They can be caused by trauma, tumors or other types of influences.
• Transferred local pathologies in the frontal lobe of the brain. These may be similar pathologies, as is the case with aphasia.

Psychiatrists, as well as psychologists, call perseveration deviations of a psychological type that occur against the background of dysfunctions occurring in the human body. Often, perseveration acts as an additional disorder and is an obvious sign of the formation of a complex phobia or other syndrome in a person.

If a person shows signs of developing perseveration, but has not suffered severe forms of stress or traumatic brain injury, this may indicate the development of both psychological and mental forms of deviation.

If we talk about the psychopathological and psychological reasons for the development of perseveration, there are several main ones:

• Tendency to increased and obsessive selectivity of interests. Most often this manifests itself in people characterized by autistic disorders.
• The desire to constantly learn and learn, to learn something new. It occurs mainly in gifted people. But the main problem is that that person may become fixated on certain judgments or his activities. The existing line between perseveration and such a concept as perseverance is extremely insignificant and blurred. Therefore, with an excessive desire to develop and improve oneself, serious problems can develop.
• Feeling of lack of attention. Occurs in hyperactive people. The development of perseverative inclinations in them is explained by an attempt to attract increased attention to themselves or their activities.
• Obsession with ideas. Against the background of obsession, a person can constantly repeat the same physical actions caused by obsession, that is, obsession with thoughts. The simplest, but very understandable example of obsession is the desire of a person to constantly keep his hands clean and wash them regularly. A person explains this by saying that he is afraid of contracting terrible infections, but such a habit can develop into a pathological obsession, which is called perseveration.

It is important to be able to distinguish when one person simply has strange habits in the form of constant hand washing, or whether it is obsessive-compulsive disorder. It is also not uncommon for repetitions of the same actions or phrases to be caused by a memory disorder, and not by perseveration.

Features of treatment

There is no universally recommended treatment algorithm for perseveration. Therapy is carried out based on the use of a whole range of different approaches. One method should not be used as the only method of treatment. It is necessary to take new methods if the previous ones did not produce results. Roughly speaking, treatment is based on constant trial and error, which ultimately makes it possible to find the optimal method of influencing a person suffering from perseveration.

The presented methods of psychological influence can be applied alternately or sequentially:

• Expectation. It is the basis in psychotherapy for people suffering from perseveration. The point is to wait for changes in the nature of the deviations that have arisen against the background of the use of various methods of influence. That is, the waiting strategy is used in conjunction with any other method, which we will discuss below. If no changes occur, switch to other psychological methods of influence, expect results and act according to the circumstances.
• Prevention. It is not uncommon for two types of perseveration (motor and intellectual) to occur together. This makes it possible to prevent such changes in time. The essence of the technique is based on the exclusion of physical manifestations that people most often talk about.
• Redirection. This is a psychological technique based on a sharp change in ongoing actions or current thoughts. That is, when communicating with a patient, you can suddenly change the topic of conversation or move from one physical exercise or movement to another.
• Limitation. The method is aimed at consistently reducing a person’s attachment. This is achieved by limiting repetitive actions. A simple but clear example is to limit the amount of time a person is allowed to sit at a computer.
• Abrupt cessation. This is a method of actively getting rid of perseverative attachment. This method is based on the effect of introducing the patient into a state of shock. This can be achieved through harsh and loud phrases, or by visualizing how harmful the patient’s obsessive thoughts or movements or actions can be.
• Ignoring. The method involves completely ignoring the manifestations of the disorder in a person. This approach works best if the disorders were caused by attention deficit. If a person does not see the point in what he is doing, since there is no effect, he will soon stop repeating obsessive actions or phrases.
• Understanding. Another relevant strategy with which the psychologist recognizes the patient’s train of thought in case of deviations or in the absence of them. This approach often allows a person to independently understand his thoughts and actions.

Perseveration is a fairly common disorder that can be caused by various reasons. When perseveration occurs, it is important to choose a competent treatment strategy. Medication is not used in this case.

Emotions, sensations (depending on this, perseverations of thinking, motor, emotional, sensory perseverations are distinguished). For example, persistent repetition of a word in oral or written speech.

Perseveration of speech is the “getting stuck” in a person’s mind of one thought or one simple idea and their repeated and monotonous repetition in response, for example, to questions that have absolutely nothing to do with the original ones.

Motor perseverations are obsessive reproduction of the same movements or their elements (writing letters or drawing). There is a distinction between “elementary” motor perseveration, which manifests itself in repeated repetition of individual elements of movement and occurs when the premotor parts of the cerebral cortex and underlying subcortical structures are damaged; and “systemic” motor perseveration, which manifests itself in repeated repetition of entire movement programs and occurs when the prefrontal parts of the cerebral cortex are damaged. There is also motor speech perseveration, which manifests itself in the form of multiple repetitions of the same syllable or word in oral speech and writing and occurs as one of the manifestations of efferent motor aphasia - with damage to the lower parts of the premotor region of the cortex of the left hemisphere (in right-handed people).

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Synonyms:

See what “Perseveration” is in other dictionaries:

perseveration- (from Latin perseveratio persistence) cyclical repetition or persistent reproduction, often contrary to conscious intention, of any action, thought or experience. P. is distinguished in motor, emotional, sensory-perceptual (see ... Great psychological encyclopedia

Persistence, repetition Dictionary of Russian synonyms. perseveration noun, number of synonyms: 2 repetition (73) ... Dictionary of synonyms

- (from Latin perseveratio perseverance) stereotypical repetition in a person of any mental image, action, statement or state. It is observed, for example, with severe fatigue; may be a manifestation of a disease of the central nervous system... Big Encyclopedic Dictionary

- (from Latin regseveratio persistence) obsessive reproduction of the same movements, thoughts, ideas. There are motor, sensory and intellectual perseverations... Psychological Dictionary

- (from Latin perseverantia - persistence) persistence, especially the persistent return of an idea in consciousness, for example. constant recall of the melody. Philosophical encyclopedic dictionary. 2010… Philosophical Encyclopedia

- [German] Perseveration Dictionary of foreign words of the Russian language

- (from Latin persevera tio perseverance, perseverance) English. perseveration; German Perseveration. Cyclic repetition or persistent repetition, often contrary to conscious intention, k.l. actions, thoughts or experiences. Antinazi. Encyclopedia... ... Encyclopedia of Sociology

PERSEVERATION- PERSEVERATION, inclination of certain ideas, movements, actions, etc. to return to consciousness again. Each idea that has entered consciousness tends to reappear in consciousness (associations) and the more intensely, the smaller... ... Great Medical Encyclopedia

- (from Latin perseveratio perseverance), stereotypical repetition in a person of any mental image, action, statement or state. It is observed, for example, with severe fatigue; may be a manifestation of a central nervous disease... Encyclopedic Dictionary

Perseveration- a thinking disorder in which the formation of new associations is significantly (maximum) difficult due to the long-term dominance of one thought or idea. * * * (Latin persevero – hold on stubbornly, continue) 1. term C Neisser... ... Encyclopedic Dictionary of Psychology and Pedagogy

Perseveration is a stable reproduction of any statement, activity, emotional reaction, sensation. Hence, motor, sensory, intellectual and emotional perseverations are distinguished. The concept of perseveration, in other words, is a “stuck” in the human consciousness of a certain thought, a simple idea, or their repeated and monotonous reproduction as an answer to the previous last interrogative statement (intellectual perseveration). There are spontaneous and repeated repetitions of what has already been said or accomplished, often referred to as iterations, and reproductions of experiences, referred to as echonesia.

What is perseveration

Perseveration is considered a very unpleasant manifestation of obsessive behavior. Characteristic feature is the reproduction of a certain physical action, phoneme, representation, phrase.

A typical example is a song that gets stuck in your head for a long time. Many subjects noticed that they wanted to repeat certain word forms or melody out loud for a certain period. Such a phenomenon, naturally, is a weak analogy of the deviation in question, but this is precisely the meaning of perseverative manifestations.

Individuals suffering from this disorder have absolutely no control over their own person at such moments. Intrusive repetition appears absolutely spontaneously and also suddenly stops.

The deviation in question is found in the persistent reproduction of an idea, manipulation, experience, phrase or concept. Such repetition often develops into an obsessive, uncontrollable form; the individual himself may not even detect what is happening to him. Thus, the concept of perseveration is a phenomenon caused by a psychological disorder, mental disorder or a neuropathological disorder of the individual's behavior and speech.

Similar behavior is also possible when severe fatigue or distraction not only due to mental illness or neurological disorders. It is believed that the basis of perseveration is the processes of repeated excitation neural elements, due to the delay of the signal about the end of the action.

The violation in question is often mistaken for stereotypy, however, despite the general desire for obsessive repetition, perseveration is distinguished in that it is the result of associative activity and structural component. Subjects suffering from perseveration undergo therapy with doctors who first help identify the root cause, after which they carry out a set of measures aimed at eliminating the reproducible thought, phrase, or repeated action from everyday life of this subject.

In order to prevent the formation of the described syndrome in adults, parents should carefully monitor the baby’s behavioral response for signs of perseveration. We can distinguish the following “attributes” of the violation in question: regular repetition of one tiny phrase that does not correspond to the topic of the conversation, characteristic actions (a baby, for example, can constantly touch a certain area on the body in the absence of physiological prerequisites), constant drawing of identical objects.

In childhood, there are specific manifestations of perseveration due to the peculiarities of the psychology of children, their physiology, and the active change in life guidelines and values ​​of the little ones. different stages growing up. This gives rise to certain difficulties in differentiating the symptoms of perseveration from the conscious actions of the baby. In addition, manifestations of perseveration can camouflage more serious mental disorders.

For the sake of more early detection possible disorders mental state of a child, you should carefully monitor the manifestations of perseverative symptoms, namely:

– systematic reproduction of one statement regardless of circumstances and the question asked;

– the presence of certain operations that are repeated invariably: touching a certain area of ​​the body, scratching, narrowly focused activity;

– repeated drawing of one object, writing a word;

– invariably repeated requests, the need for fulfillment of which is highly doubtful within the boundaries of specific situational conditions.

Causes of perseveration

This disorder is often caused by exposure to physical nature on the brain. In addition, the individual has difficulty switching attention.

The main reasons for the neurological nature of the described syndrome are:

– suffered localized brain lesions, reminiscent of aphasia (an illness in which the individual cannot pronounce verbal structures correctly);

– obsessive reproduction of actions and phrases appears as a result of already existing aphasia;

– traumatic brain injury with lesions of the lateral segments of the cortex or the anterior zone, where the prefrontal convexity is located.

In addition to neurological causes associated with brain damage, there are psychological factors, contributing to the development of perseveration.

The persistence of reproducing phrases and manipulations arises as a result of stressors that affect subjects for a long time. This phenomenon is often accompanied by phobias when it turns on defense mechanism through the reproduction of operations of the same type, which give the individual a feeling of non-danger and calm.

If the presence is suspected, excessively scrupulous selectivity in committing certain actions or interests is also noted.

The described phenomenon is often detected with hyperactivity, if the child believes that he is not receiving enough attention, in his opinion. In this case, perseveration also acts as a component of defense, which in children compensates for the lack of external attention. With such behavior, the baby seeks to attract attention to his own actions or attention.

The phenomenon in question often appears among scientists. constantly studying something new, striving to learn something important, which is why he gets fixated on a certain little thing, statement or action. Often the behavior described characterizes such an individual as a stubborn and persistent person, but sometimes such actions are interpreted as a deviation.

Intrusive repetition can often be a symptom, expressed in following a certain idea, which forces the individual to constantly perform specific actions (), or in the persistence of some thought (). Such persistent repetition can be seen when the subject washes his hands, often unnecessarily.

Perseveration must be distinguished from other illnesses or stereotypes. Phrases or actions of a repetitive nature are often a manifestation of an established habit, sclerosis, subjective annoying phenomena in which patients understand the strangeness, absurdity and meaninglessness of their own behavioral patterns. In turn, with perseveration, individuals do not realize the abnormality of their own actions.

If an individual develops signs of perseveration, but there is no history of stress or trauma to the skull, this often indicates the occurrence of both psychological and mental variations of the disorder.

Types of perseveration

Based on the nature of the disorder under consideration, the following variations are distinguished, as already listed above: perseveration of thinking, perseveration of speech and motor perseveration.

The first type of deviation described is characterized by the individual’s “fixation” on a certain thought or idea that arises during communicative verbal interaction. A perseverative phrase can often be used by an individual to answer the above questions, without having anything to do with the meaning of the interrogative statement. Jamming on one representation is expressed in stable reproduction of a certain word or phrase. More often this is the correct response to the first interrogative sentence. The patient gives a primary answer to further questions. Characteristic manifestations perseveration of thinking is considered a sustained effort to return to the subject of conversation, which has not been discussed for a long time.

This condition is inherent atrophic processes, occurring in the brain (or). It can also be detected in traumatic and vascular disorders.

Motor perseveration is manifested by repeated repetition of physical operations, both simple manipulations and a whole set of various body movements. At the same time, perseverative movements are always reproduced clearly and equally, as if according to an established algorithm. There are elementary, systemic and speech motor perseverations.

The elementary type of the described deviation is expressed in repeated reproduction of individual details of movement and arises as a result of damage to the cerebral cortex and underlying subcortical elements.

The systemic type of perseveration is found in the repeated reproduction of entire complexes of movements. It occurs due to damage to the prefrontal segments of the cerebral cortex.

The speech type of the pathology in question is manifested by repeated reproduction of a word, phoneme or phrase (in writing or in oral conversation). Occurs in aphasia due to damage to the lower segments of the premotor zone. Moreover, in left-handed people this deviation occurs if the right side, and in right-handed individuals – when the left segment of the brain is damaged, respectively. In other words, the type of perseveration under consideration arises as a result of damage to the dominant hemisphere.

Even in the presence of partial aphasic deviations, patients also do not notice differences in the reproduction, writing or reading of syllables or words that are similar in pronunciation (for example, “ba-pa”, “sa-za”, “cathedral-fence”), they confuse letters that sound similar .

Speech perseveration is characterized by persistent repetition of words, statements, phrases in writing or oral.

In the mind of a subject suffering from speech perseveration, it is as if a thought or word is “stuck”, which he repeats repeatedly and monotonously during communicative interaction with interlocutors. In this case, the reproduced phrase or word has no relation to the subject of the conversation. The patient's speech is characterized by monotony.

Treatment of perseveration

The basis of the therapeutic strategy in the correction of perseverative anomalies is always a systematic psychological approach based on alternating stages. It is not recommended to use one technique as the only method of corrective action. It is necessary to use new strategies if the previous ones did not bring results.

More often, the treatment course is based on trial and error rather than a standardized therapy algorithm. If neurological brain pathologies are detected, therapy is combined with appropriate medication. Of the pharmacopoeial drugs, weak ones are used sedatives central action. Nootropics must be prescribed along with multivitaminization. Speech perseveration also requires speech therapy.

Corrective action begins with testing, based on the results of which an examination is prescribed, if necessary. Testing consists of a list of elementary questions and solving certain problems, which often contain some kind of catch.

Below are the main stages of the psychological assistance strategy, which can be applied sequentially or alternately.

The waiting strategy consists of waiting for changes in the course of perseverative deviations due to the appointment of certain therapeutic measures. This strategy is explained by its resistance to the disappearance of perseveration symptoms.

A preventive strategy involves preventing the occurrence motor perseveration against the background of the intellectual. Since perseverative thinking often awakens the motor type of the deviation in question, as a result of which these two variations of the disorder coexist in the aggregate. This strategy allows you to prevent such transformation in a timely manner. The essence of the technique is to protect the individual from those physical operations that he often talks about.

The redirection strategy consists of an emotional attempt or physical effort by a specialist to distract the sick subject from annoying thoughts or manipulations, through a sharp change in the subject of the conversation at the time of the current perseverative manifestation or nature of actions.

The limiting strategy implies a consistent reduction in perseverative attachment by limiting the individual in performing actions. Limitation allows for intrusive activity, but in a clearly defined quantity. For example, access to computer entertainment for the permitted time.

The abrupt termination strategy is based on the active removal of perseverative attachments by shocking the patient. An example here is the sudden, loud phrases “This is not there!” All!" or visualizing the damage caused by intrusive manipulations or thoughts.

The strategy of ignoring is an attempt to completely ignore the manifestations of perseveration. The technique is very effective if the etiological factor of the deviation in question is attention deficit. An individual, not receiving the expected result, simply does not see the point in further reproducing actions.

The strategy of understanding is an attempt to understand the true flow of the patient’s thoughts during the course of perseverative manifestations, as well as in their absence. Often this behavior helps the subject to put his own actions and thoughts in order.

The information provided in this article is for informational purposes only and is not intended to substitute for professional advice and qualified advice. medical care. At the slightest suspicion of the presence of this disease Be sure to consult your doctor!