What are Motor and Volitional Disorders?
Will is the desire for purposeful activity, which is realized consciously in achieving the goal and unconsciously in instinctive activity. Outwardly volitional activity is expressed in action (movement). There are violations of food (bulimia, anorexia, coprophagy), sexual (decrease, increase, paraphilia), parental, agonistic instincts, as well as migration, hierarchical, comfort, gaming, territorial and research instincts. Movement disorders are manifested in arousal, stupor and motor failure.
Background
Volitional activity and its expression in motor acts are studied by the methods of psychology, physiology and ethology. Will is defined as the desire to achieve the goal by means of its awareness or unconsciously, that is, instinctively. The motives for achieving the goal can be individual, group and social, in this sequence they develop in ontogenesis. Stages of volitional action include: the goal and the desire to achieve it, awareness of the possibilities of achieving it, the emergence of motives that support or reject these opportunities, the struggle of motives, and the choice, the adoption of one of the possibilities as a solution, the implementation of the decision.
Instinct is the biological basis of the will, it consists of the following stages: an impulse that requires satisfaction, a search for the object of satisfaction and the final motor act. Movements that present instinct, as K. Lorenz believed, are formed into complexes of fixed actions that arise in evolution as phylogenetic adaptations intended for the survival of the species. There are sleep, food, sexual, comfortable, hierarchical, agonistic, territorial instincts, as well as parental, support, possession, migration, research and social instincts. Each instinct is associated with a specific neuronal brain network and manifests itself in clear sequences of behavior. Manifestations of human instincts are controlled by culture in the course of historical development and ontogenesis. All human instincts can be traced in phylogenesis. The basic mechanisms of instinct realization are the ways of their direct manifestation in the absence of an obstacle to the realization of behavior; gain when activity increases with increasing obstacles; weakening (“vacuum activity”) under the influence of an obstacle. Other mechanisms are:
- redirection, when an object changes in the system of the same attraction,
- displacement when switching to another attraction occurs,
- ritualization, in which different stages of manifestations of behavior are embellished,
- ambivalence, when the goal is opposed to another goal,
- regression, when ontogenetic early features of the manifestations of behavior appear,
- imitation, in which there is an imitation of the behavior of others or groups. Each individual has all the mechanisms, but with mental pathology there is a fixation on any one mechanism and the plasticity of behavior is lost.
Symptoms of Motor and Volitional Disorders
Holistic changes in volitional activity are manifested in hyperbulia, hypobulae, parabulia and abulia, but individual changes in the spheres of instinct are described depending on the type of instinct.
Hyperbulia refers to the incidence of motivation, which is motivated by increased attraction, which is manifested in the vigorous activity and disinhibition of all drives. This condition is characteristic of mania.
For hypobulia, on the contrary, it is characteristic of a decrease in impulses, desires and drives, and motor activity also decreases. Subjectively, patients note this decrease in activity and lack of interest in all manifestations of life (anhedonia), the internal interpretation of the state corresponds to the loss of energy, therefore this state is called the reduction of the energy potential.
With abulia, all desires and motives are absent, even in order to feed the patient, willful efforts of those around are required. He answers questions briefly and in monosyllables, facial expressions are deprived of vitality. He is usually not interested in anything, he spends all the time in bed. Abulia occurs in schizophrenic defect. This condition is close to a vegetative coma, when the patient, while in bed, performs all physiological functions without control, eats only the food offered by the caretaker and refuses speech activity. Vegetative coma is the final stage of dementia.
Increasing the food instinct – bulimia, accompanied by gluttony, patients eat a lot, but often do not get better. This is characteristic of endocrine pathology and dementias. Reduction of the food instinct – anorexia, is expressed in refusal to eat or in selective monotonous food. For example, a patient can make up her diet only from apples or only from bread. Anorexia is observed in endocrine pathology and dissociative disorders, as well as in depression. In psychopathology, eating inedible also occurs – coprophagy, for example, patients with mental retardation can eat small stones, clay, and drink urine.
Enhancement of sexual instinct is referred to in men as satiriasis, in women as nymphomania. They are characterized by promiscuous, frequent sexual intercourse with an increased risk of the incidence of venereal pathology in these states. It is typical for delusions, episodes of substance use, organic brain damage. Reduction of sexual instinct is referred to as impotence in men and frigidity in women. For more information about these symptoms can be found in the relevant chapters of the textbook, as, indeed, about the distortion of sexual desire – paraphilia. A controversial issue is the assignment of homosexuality to paraphilia. The fact is that the risk of homoerotic development is about 10% in men and women. This fact, as well as the association of homoeroticism with puberty’s normative sexuality, led to the recognition of homosexuality as the norm and its exclusion from ICD 10.
Increasing the research instinct is referred to as neophilia, that is, undifferentiated curiosity, which manifests itself for any reason and under any circumstances and is often inadequate. Patients ask a lot of questions, are interested in everything and constantly want to be aware of all cases. It is characteristic of manias. The opposite condition is neophobia, typical of a schizophrenic defect, schizotypical disorders and schizoid personality disorders. At the same time at the time of the conversation the patient does not look into the eyes of the interlocutor. He turns away and speaks to the side, avoids bodily contact and seeks not to use new things, is suspicious of any news and avoids new routes of movement.
Reduced parental instinct is manifested in the coldness of parents in relation to children, they tend to solve their problems, but do not pay attention to the child. This is typical of schizoid personalities. In another case, the opposite state is noted – parental hyperprotection, which is noticeable in the overcontrol and over-involvement of parents in the fate and life of the child. Hyperprotection can be the result of anxiety personality disorders. Distortion of parental instincts is manifested in the cruelty of parents towards children or the cruelty of children towards their parents. Such disorders are characteristic of disocial personalities.
The reduction of agonistic, that is, conflict-related instincts is manifested in auto-aggression – suicide. Although the overwhelming number of suicides are made by mentally healthy people during the loss of the object of love, friendship, financial collapse, depression and substance use, especially alcohol, are the main place among the pathological states that predispose to suicide. Increased agonity leads to hicide, that is, murder. Among the killers, the percentage of perpetrators of this crime on pathological, in particular, delusional motives is quite high.
Distortion of agonality leads to a pathological passion for theft (kleptomania) and arson (pyromania).
A person’s sense of dominance and rank can be enhanced, this is typical of mania. The patient is convinced that he belongs to a much higher place than he occupies. On the contrary, in depressions he considers himself to be worthless and unnecessary and as a result inadequately lowers his rank, losing social contacts. Persons with anomalies of personality and delusions may distort their place in society as “special” or “messianic”.
Increased migratory instinct leads to vagabondazh and dromomania. In the case of a vagabondage, a permanent change of residence is often due to the flight from the pursuers or the pursuit of a person, for example for erotic reasons. In dromomania, movements are not motivated, since they occur against the background of an altered state of consciousness. The patient in this case cannot say why he moved and how he found himself in this place. Reducing the need for migration leads to the fact that a person does not leave his home because of the fear of visiting open and crowded places (agoraphobia) or delusional fear.
Increasing the comfort instinct is characteristic of misophobia — the fear of pollution, in which the patient spends many hours doing the stereotypical washing of his body or hands. This is typical of obsessive compulsive disorder. But with abulia and dementia, any interest in the purity of one’s body is lost, and negligence and negligence become stable.
The instinctive attitude to one’s own territory also changes under certain psychopathological conditions. For example, in case of fear, a lot of locks appear on the doors, and lattices on the windows; in case of alcoholism and drug addiction, the habit of closing the door is completely lost and the apartment becomes like a cave or a hole.
Many researchers point to the instinctive nature of play behavior. Indeed, in mania, play behavior may acquire the character of obsession and dependence on the game (lyumanii), stereotypical games are observed during oligophrenia, and in autism children prefer non-game objects such as radio components or coils to beautiful and interesting toys.
Movement disorders are represented by the following groups:
- psychomotor agitation varies depending on its causes on psychogenic, epileptic, paranoid and catatonic, as well as delirious, hebephrenic and manic arousal.
Psychogenic arousal occurs immediately after trauma, is accompanied by the displacement of individual trauma events, other events are clearly heard in the patient’s speech, anxiety is expressed, palpitation (trembling) is possible. Excitement usually goes away after the disappearance of the mental trauma.
Epileptic excitement is accompanied by constriction of consciousness, twilight disorders of consciousness and dysphoria.
Paranoid arousal is focused and associated with objects included in the nonsense; proper clinic delirium sounds in the structure of excitement.
Catatonic excitement is unfocused and impulsive, accompanied by mutism or torn speech.
Delirious arousal is accompanied by an influx of frightening visual images, disorientation in time and place.
Hebephraous arousal proceeds with foolishness, clowning and mimicry, grimaces, fanciful movements.
Manic arousal is characterized by an increase in the rate of speech, an increase in mood, and high speech pressure;
- stupor (freezing) and lethargy. Allocate psychogenic, catatonic, hallucinatory, depressive, oneiric.
Psychogenic stupor occurs after a loss, a catastrophe; patients answer the questions in monosyllabic, noticeable mimicry of sadness and confusion, the stupor disappears after the loss of severity of injury.
Catatonic stupor is characterized by solidification, silence (mutism), negativism, which is expressed in motor opposition to movements, for example, the intention to raise the arm, a symptom of an airbag (the head remains in the same position after the pillow has been removed), a toothed gear symptom arm), catalepsy (raised limb stiffens), Pavlov’s symptom (the patient responds to the whisper speech, but does not respond to the usual).
For hallucinatory stupor indirect signs of hallucination (see the relevant chapter) with external catatonic motility are characteristic.
A depressive stupor may also be accompanied by mutism and negativism, however, on the face there is mimicry of sadness, and there are anamnestic data on the development in the initial period of depression;
- imitative violations are expressed in echolalia (repetition of the words of the interlocutor) and ecopraxia (repetition of movements). These symptoms are noted in catatonia and frontal atrophy (Pick’s disease);
- motor impairment, or motor infantilism, are marked with endocrine pathology, as a result of deprivation, for example, after a long prison term, with frontal and extrapyramidal insufficiency. It is expressed in embarrassment, unnecessary uncoordinated movements, inability to perform certain actions, for example, to run, jump, swim or write smoothly.
Diagnosis of Motor and Volitional Disorders
The main methods of the study of movements (nonverbal behavior) and volitional activity are the methods of ethology and reflexology. The method of ethology consists in recording the ethogram via communication channels, which include the visual, olfactory, auditory, tactile, social channels. The visual channel is objectified by recording the dynamics of facial expressions, posture, gesture, manipulation; auditory – audiographically and sonographically; social channel – communication systems between members of a group and society, for example, donations, exchanges, manifestations of aggressiveness, dominance; olfactory – the study of pheromones; tactile – frequency, zone of contact with others and to yourself. Channels can be recorded in parallel as a score, but they can also be recorded separately.