PsyGuide: Attention Deficit. # 0001/1001

    *** The emotional nighttime tale of Scheherazade, the eldest daughter of the vizier, who caught manic psychosis, accompanied by a feeling of her own chosenness, irresistibility and intellectual superiority over the world pushing her, risking her head, to go to the crazy king Shahriyar to make the unjust world fair and stop the meaningless daily executions of young beautiful Persian maidens.

    The expression “attention deficit” in psychiatric practice is usually considered in terms of the symptoms of ADHD (attention deficit hyperactivity disorder, F90 ICD-10). It is believed that the instability of attention of such patients is a pathology that requires correction. The rest, complaining of poor concentration, are just idlers. And there are some psychiatric reasons for this position. Although the question remains open where to take lazy people and slovens who do not want to be lazy people and slobs, experiencing obvious suffering, but who do not succeed in the endless struggle for “better self”. However, I have an answer to this question.

    The diagnosis of ADHD, especially in adults, still raises widespread debate in psychiatric circles. But I’m not a psychiatrist, but a psycho, so in this series of articles I’m trying to put all the dots on the “i” and eliminate all the stumbling blocks. But please treat the material critically. Resonance, quick conclusions and the Dunning-Krueger effect are regular satellites of ADHD.

    One of the main problems with the diagnosis of ADHD is that its symptoms are extremely diverse and vary greatly. At one end of its spectrum, the symptoms of ADHD creep into a schizoid personality disorder of asthenic type and, passing through the “golden classics of ADHD”, at the other end of the spectrum it goes over to specific forms of BAR-2.

    Resonators tend to write treatises. Including ADHDs, but, unlike schizoid hypersthenics and schizophrenics, ADHDs do not add them. So I myself have no illusions about the 1001 articles in this series. But the topic of the principles of our mental apparatus and the functional features of the brain associated with attention mechanisms is really extensive.

    In general, ADHD patients see the root of all their problems only in the unstable focus of attention and low ability to concentrate, but, in truth, this is not entirely true. ADHD accompanies a whole bunch of specific cognitive biases, high expectations, reassessment of one’s abilities and inappropriate behavioral outcomes.

    Part of these problems is explained by schizophrenic patterns of thinking, part - by the features of the functioning of the limbic system, part - by the calibration of the reward system, and, finally, impulsivity.

    ADHD is not primarily about focus. This is about schizophrenia and thunder lightning, streaming megavolt discharges through a low-current logic system from the prefrontal cortex to the reticular formation, breaking through all its fuses and interlock relays.

    We are obliged to schizophrenia for all the achievements of our civilization, the most terrible pages of our history and comments revealing a lunar conspiracy in LJ. Schizophrenia inspires, gives phenomena a special meaning and drives us to the great construction of the kingdom of heaven on earth. Schizophrenia is beautiful and consistent, as long as the observer does not look at her. With her, I would like to start.

    Since severe forms of schizophrenia are not the subject of this series of articles, let's talk about schizophrenia “light”.


    - What a strange question. What can make me pray? Many things. A huge number of things can make me pray.
    - Well, for example?
    “The baseball bat is in your hands.” Steel reinforcement. Brass knuckles. Pistol. AK-47. Garden knife ...
    - No, I mean, personal evidence of healing, or how people could not get pregnant for years ...
    - And as soon as they ordered a zirconia bracelet charged in the Church of the Holy Sepulcher, they flew right away.
    “In short, only the resurrection from the dead before your eyes ?!”
    - Even if the heavens open before my eyes, and the Lord God himself comes down to me, surrounded by archangels, I will go without a fuss, but immediately go to the doctor for antipsychotics.

    Schizoid is a fashionable term in popular articles about psychology. Basically, the authors describe schizoids as dreamy, self-contained individuals with hobbies strange from the point of view of a normal person. Intuitively sort of like typical geeks as they are.

    And this intuitive understanding of the phenomenon, oddly enough, is generally true. With the only clarification that, of course, every real geek is a schizoid, but not every schizoid is a geek.

    In studying the phenomenon, psychologists and psychiatrists tried to identify the main factors by which a person could be classified as a schizoid. The main points were fixation on their own ideas and emotional isolation from the external environment. But any further refinement led to an infinite growth of subtypes, which significantly differed in emotional structure and behavior. In one heap here were hypersensitive asthenics and cold hypersthenics.

    To give examples of such typing is a waste of time.

    Clarification:The term “stenichnost” (from the Greek. Sthenos - force) as applied to mental mechanisms should be understood as willpower, purposefulness, the ability to withstand difficulties and adverse circumstances on the way to the goal. “Asthenia” is weakness and the exact opposite of stenicity.

    The term "schizoid" is introduced in psychiatry to refer to individuals by nature close to schizophrenics. Most hypotheses of the pathogenesis of schizophrenia only recently revolved around dopamine, which, apparently, was an oversimplification. Dopamine is not the only player here, although the main one. It affects the limbic system, and, therefore, our emotions. Emotions affect our thinking, and this is undeniable. Also, the direct effect of dopamine on thought processes is carried out along the mesocortical path leading to the area of ​​the prefrontal cortex, which is responsible for planning and general management of mental activity. But the whole picture as a whole was difficult to explain only with dopamine. Because the violent nature of dopamine, which cannot be confused with anything, clinical psychiatry learned very well by the sixties on the example of amphetamine psychoses, who were treated at that time - from a runny nose to depression. Paradoxical as it may seem, amphetamine helped worse than depression. Otolaryngologists were pleased. Psychiatrists do not.

    Recent neurobiological studies in mice suggest that endogenous cannabinoids, in particular anandamide, are involved in the pathophysiology of schizophrenia. Anandamide is a inhibitory neurotransmitter. But in some cases, it activates the main inhibitory mechanism of the brain through activation of CB1 receptors in GABAergic neurons. A brake pick that slows down another brake pick ... It turns me on.

    Also, deviations in the work of GABA receptors are associated with some aspects of attention deficit disorder. Gamma-aminobutyric acid (GABA) is the main inhibitory mediator of the brain. The predominance of excitation processes over inhibition processes can have a very different effect. With a large bias in the local area of ​​the brain, an epileptic focus may occur. Moreover, the focus that does not affect the motor areas of the brain may not lead to convulsive activity, but may manifest itself in the form of psychosis, hallucinations, fear, aggression or delirium, depending on what functions are performed by the part of the brain in which it is located. A more moderate bias can cause an overly dreamy, suspicious, hyperactive, anxious ... an enthusiastic type of psyche. However, the role of GABA in the central nervous system, on the one hand, is too global, on the other, it is only one of the most important mediators of the central nervous system. But about others, and especially about dopamine, we'll talk another time. For now, we simply turn our attention to the anandamide regulation of the GABAergic system.

    Once I mentioned endogenous cannabinoids in the paragraph above, the article will probably be incomplete without a short account of exogenous cannabinoids.

    The brain is partly a machine of interpretations. Probably, it is precisely the suppression of the inhibitory mechanisms of individual parts of the brain that gives rise to the breadth of interpretation characteristic of schizoids.

    And THC, the main cannabinoid found in cannabis, which is a direct agonist of CB receptors, induces a broad interpretation similar to schizoid thinking. It is only necessary to understand that the nature of thinking is only one of many components. Another of many is previous experience and learned models. Therefore, a technologist, his natural breadth of interpretation can lead to the thought of making a programmable moonshine with Arduino control and experience the excitement of it. And for an ordinary person who smoked weed, a temporarily widened range of interpretations would rather lead to the thought: “And let's smoke a cat!” and also experience the characteristic delight of this mind-blowing idea.

    But the main thing is that when ingested exogenous cannabinoids act on the brain not selectively. And the characteristic excitement with the full breadth of interpretations can be obtained through an alarming channel. Then the whole creative search will be aimed at interpreting threats with their intense and intense experience. In addition, cannabis contains more than 80 cannabinoids. And the main after THC is CBD. Unlike the first, the second is an indirect antagonist of CB receptors. That is, THC and CBD act opposite each other! This, by the way, explains the nature of cannabis intoxication - primary arousal, enthusiasm and a flurry of ideas and associations in the first phase and sedation, relaxation and drowsiness after 30-60 minutes. Although talking about some kind of cannabis intoxication is only conditional, because unlike many other psychoactive substances, the effect of cannabis is very individual on each individual person due to the multicomponent and complex effects. The effect can be expressed in the fact that a telecast about Ukraine suddenly became incredibly interesting. In addition, all studies clearly indicate that cannabis use impairs short-term memory and attention. Controversial for creativity, especially requiring detailed study.

    In addition to the breadth of interpretations for schizoid thinking, as a rule, the presence of overvalued ideas is characteristic. However, overvalued ideas are already the work of dopamine. Without dopamine (with moderate dopamine activity), the nature of thinking is somewhat different. I call it an “overvalued idea for an hour.” That is, the emotions associated with a particular thought are very intense, the thought is perceived as archival, but the process is unstable.

    Anandamide suppression of the GABAergic system of the higher parts of the brain gives rise to a jump and “curliness” of thoughts, which, with insufficient dopamine activity along the mesocortical pathway, results in acute attention deficit, uncontrollable reverie, planning problems, and general lack of thinking. The focus of attention in this case is extremely unstable, since the mechanisms of active suppression of competing processes can not cope, which translates into an asthenic type of schizoid disorder. It is difficult for such people to realize themselves in life. Their psyche is very vulnerable to environmental influences and easily falls into social maladaptation. An example would be hikikomori. But this is if such a schizoid has parents who are ready to support him. Otherwise, without corrective trainings, his life will be difficult and sad. Besides the lack of thinking, low willingness to violence (both physical and psychological), inability to stand up for themselves and resist aggression most often lead to chronic depression and an oppressed state of mind. Welcome to the Planet of the Apes.

    At the other extreme, we will see a very different picture. With dopamine hyperstimulation along the mesocortical path, we will see a ram-stiff, concentrated schizoid encompassed by supervaluable ideas. The whole life of such an individual will be subordinated to his main interest, or rather the main dominant. At this pole of the schizoid spectrum, you can often meet a successful fanatic, ready for hard work for a hundred or more hours a week in the name of an idea. But, despite the general stenichnost, this type of psyche is also vulnerable, and with an unfavorable external environment has a tendency to develop protective reactions, resulting in social maladaptation.

    In general, it is impossible to reduce all the features of the thinking of a schizoid (in fact, not only a schizoid, but also anyone else) only to the activity of GABA and dopamine.

    Firstly, to avoid confusion, it should be said that dopamine is not a rival to GABA on the tennis court. GABA rival is glutamate, which is the main excitatory neurotransmitter of the nervous system. Dopamine is more likely a judge sitting on a tower and giving orders to tennis players, which particular sector of the stands are now to be thrown with balls, and which to suppress with rackets on the head. Dopamine is not only arousal, but also an active suppression (inhibition).

    Secondly, you need to be aware that even a single neuron is affected by dozens of factors that counteract, correct, transform, or reinforce each other, on which it depends whether the action potential arises or not. I will not continue that these neurons in the amount of more than 80 billion pieces, differing in specialization, form thousands of subsystems, combined into a bizarre single structure of our brain. We will talk a little about some of these factors when it comes to such an important characteristic of the psyche as impulsivity.

    Remember! Any complex multifactorial phenomenon has a simple incorrect explanation.

    And even the most primitive brain process cannot be reduced to one or two factors, not to mention a process such as thinking.

    I seem to have just discredited all of the above, or did it seem to me?

    In addition to thinking, schizoids are characterized by their isolation from society. It seems to be. But this statement is also a problem. With a careful study of the phenomenon, psychologists have found many examples of quite socialized and even hypersocial schizoids. And they gave birth to the concept of "secret schizoid." Well ok, let it be secret. Whatever psychologists entertained ... just to not measure the skull.

    The fact is that the main driver for establishing strong social ties are emotions experienced jointly. There is nothing surprising in the fact that people who have gone through joint hostilities keep companionship much longer than office colleagues. And this, by the way, is why team building with field trips to paintball shoot-outs or climbing walls as a whole really works. Joint feasts, games, hiking ... All those collective actions that are accompanied by intense emotions. One of the main mechanisms of empathy is the general interest in something: whether it is a drinking party, a series or a certain direction of pop music ...

    If all the interests of the individual are focused around one or several topics, and at the same time are so intense that they develop into an unhealthy passion, then this leads to disruption of social contact with other members of the society who do not share this interest. Moreover, the emergence of such a dominant, as a rule, leads to the weakening or complete loss of all other interests.

    At the same time, within a subculture, such people are quite capable of establishing sufficiently strong social ties. Although, in any case, when a person has something to do alone with himself, the need for external interaction is greatly reduced. Especially when his egocentrism scratches the clouds.

    There is no doubt that the emotional apparatus of schizoids is somewhat different. But the picture of detachment and isolation that psychiatric guides draw is probably not only or not so much a natural property of schizoids, but rather it is a defensive reaction.

    To all of the above, I’ll add that I’m very skeptical about typing “Schizoid - Paranoid - Hysteroid ..." Obviously, although with a superficial look at the phenomenon (very superficial), the concept seems working, in practice, schizoids can be paranoid and hysterical ... That is demonstrate mixed type.

    In the next article, we will continue to analyze in more detail the characteristics of thinking and behavioral outcomes that such brain chemistry has. For now, remember that schizoid asthenic type disorder contains a pronounced component of attention deficit associated with a weak mechanism for suppressing competing processes in the brain.

    The manic verbal diarrhea of ​​Shaherizada continued until dawn. And now her life depended entirely on whether the almighty king wants to hear the continuation of this story or orders to execute ...

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