Imbecility is a lack of mental development that has developed in utero or in the first years of life. Denotes oligophrenia of moderate severity. Along with external signs of underdevelopment of intelligence, primitive speech, underdeveloped learning abilities (IQ — 25-50), memory problems, increased unconscious instincts (sexual promiscuity, tendency to overeating) are observed. Thinking is consistent, but rather primitive. Small horizons, suggestibility and the desire to imitate can be manifested by antisocial behavior, especially in an unfamiliar environment. Training in self-service elements is possible, while imbeciles cannot live independently. The diagnosis is established on the basis of the clinical picture, assessment of intellectual and psychomotor development. Treatment includes symptomatic therapy (nootropics, neuroleptics, sedatives, etc.). Medical supervision and constant care in combination with adequate upbringing are required.
ICD 10
F71 F72
General information
Imbecility is dementia (oligophrenia) of moderate severity. Outwardly noticeable deviation in mental development is caused by pathological processes in the intrauterine or postnatal period of the child’s development. Mental changes in imbecility are more pronounced, and learning ability is less pronounced than in imbecility. The emotional background is more diverse than with idiocy. Imbecility is quite rare. The proportion of such patients among patients with underdeveloped mentality is about 20%. Pathology affects 4 people out of 10,000. High suggestibility and the desire to imitate bad examples causes the need for constant supervision. Once in unfavorable conditions, patients get lost and can behave asocially.
Causes
Often the disease is formed in the prenatal period. This is facilitated by hereditary predisposition, genetic and chromosomal abnormalities (Down syndrome, Angelman syndrome, etc.). Imbecility can develop after an infectious disease suffered by the expectant mother (syphilis, rubella, cytomegalovirus, toxoplasmosis, etc.) or with Rh-conflict between mother and child (immunological incompatibility of blood).
Chemicals (primarily narcotic drugs and alcohol), as well as increased doses of various kinds of radiation (frequent X-ray examinations of a pregnant woman) act as a damaging factor leading to the development of a pathological process. The imbecility of the baby may be a consequence of a lack of iodine in the pregnant woman’s body. It is this trace element that plays an important role in the formation of the fetal nervous system. Insufficient nutrition, poor in vitamins, macro- and microelements, also increases the risk of developing the disease.
At an early age, imbecility can provoke severe childbirth with asphyxia and injury to the fetus, traumatic brain injuries, childhood infections. Imbecility also develops with a lack of communication with adults. Usually this factor in combination with insufficient nutrition (lack of the same iodine) is observed in dysfunctional families. In the development of imbecility, not only physical abnormalities in the nervous system play a role, but also the lack of intellectual development after birth (a social factor).
Symptoms
Depending on the severity of mental underdevelopment (the degree of decrease in the IQ), moderate imbecility is distinguished (the severity of symptoms is minimal, IQ is 35-50), pronounced (IQ is 25-34) and deep (learning ability is almost impossible, IQ is 20-25).
Depending on the main character traits, patients can be good-natured, shy, aggressive and spiteful. The behavioral response in imbecility is also twofold. Some patients are apathetic and indifferent. Others, on the contrary, are highly mobile. The facial expression is not burdened by a mimic reaction (frozen or “doll” face). A reduced blinking of the eyes is characteristic. Most patients have a rather rough structure of the skull, often combined with malformations (defective bite, hydro- or microcephalic skull, pronounced separation of the ears from the skull).
Imbecility is accompanied by impaired coordination and undeveloped motor skills. The movements of such patients are angular and stiff, and the gait is clumsy, often stooping. Small hand actions that require precision are impossible. Patients focus mainly on their own needs, often showing gluttony and sexual promiscuity. The appearance is sloppy.
Thinking is quite primitive, generalization is not available. However, such patients think consistently. Imbecility is characterized by an extremely narrow outlook, lack of attention and will, underdevelopment of memory. There is no independent thinking, patients think in patterns learned from the outside. They perceive speech well, but their own abilities are limited to simple sentences. The vocabulary is sparse: only 200-300 words. At the same time, patients may make inaccuracies in the description of something. Although learning is difficult, in a calm familiar environment, such patients can be taught elementary counting, reading by syllables.
According to the principle of repetition, imbeciles are trained in elementary self-service rules and simple labor actions (winding threads, washing dishes, cleaning the room, etc.), but they do not show their own initiative, they are easily suggestible.
Imbecility is limited to satisfying one’s own needs (sleep, nutrition, etc.). Many patients show good hearing. In an unfamiliar environment, they are confused, often the behavior becomes antisocial. The emotional background is more developed than with idiocy. Imbeciles are strongly attached to people who take care of them and treat them well. Patients react especially warmly to praise, censure causes them a negative reaction. They feel a strong attachment (love) to their parents, call them by their first names, but often do not recognize and frighten people they know.
Imbecility causes problems with adaptation in society. Some patients feel oppressed by their inferiority compared to other people. Involvement in labor is also problematic, imbeciles work only according to learned patterns, the change of which causes them confusion. Active patients with an aggressive nature often commit acts that are dangerous for themselves and society. There is a tendency to escape.
Diagnostics
Imbecility can be determined based on IQ level. A detailed anamnesis helps to confirm the diagnosis (the course of pregnancy, past illnesses, living conditions, specified dates of the first manifestations of pathology). With the help of tests and special scales (the Wexler scale is less than 55 points), the neuropsychiatrist evaluates the level of mental abilities. During the conversation, the person’s attachments, academic performance at school, the level of speech and social adaptation are clarified.
The genetic imbecility of the fetus is determined by screening examination. To identify the cause of the disease, instrumental research methods can be used: CT of the brain and MRI of the brain. Tomographic examination allows you to obtain a layered image of the brain (with CT, thinner layers) and determine the nature of its damage. Vascular pathology is determined using brain angiography and rheoencephalography (a safe method for studying the electrical resistance of tissues). EEG (electroencephalogram), along with the methods described above, makes it possible to identify functional disorders in brain activity, as well as to monitor them dynamically.
Imbecility should be differentiated from early schizophrenia, some forms of congenital epilepsy and acquired dementia, also accompanied by a decrease in intelligence. To do this, the attending neurologist can prescribe consultations of an epileptologist, a neurosurgeon, a psychiatrist.
Treatment
Treatment of imbecility is purely symptomatic. Neuroleptics, psychostimulants and tranquilizers are prescribed exclusively under the supervision of the attending physician. To improve blood circulation and brain nutrition, nootropic drugs (piracetam, hydralizate from the brain of pigs, etc.), vitamin therapy are used. According to the indications, dehydration is carried out (magnesium sulfate, furosemide, etc.) and anticonvulsants are prescribed.
A systematic visit to a neuropsychiatrist is mandatory. The doctor will give recommendations on the patient’s upbringing and assess the dynamics of the disease. If there are problems with the spine or the presence of speech defects, a consultation of narrow specialists (a vertebrologist, a psychiatrist, a speech pathologist, a speech therapist) is appointed.
Prevention and prognosis
The prognosis of imbecility is directly related to the degree of dementia and the timeliness of treatment. The mild stage of pathology detected in the early stages allows to minimize mental retardation, and proper training and adequate care will increase the patient’s adaptive abilities in society. Since such patients are incapable of independent living, they require regular medical monitoring and constant care. Children with imbecility should be taught at home according to a special program or in special schools.
Primary prevention of the disease consists in the protection of the fetus and the pregnant woman, the management of pregnancy with early genetic (screening) research. Secondary prevention includes early detection of pathology for timely correction of mental development and organization of adaptation and rehabilitation measures.
