Perseveration is a persistent compulsive repetition of a mental, emotional or motor act. Perseverative thinking is characterized by constantly pondering one idea without developing it. Emotional perseverations are realized by “getting stuck” on the experience of a certain emotion. Perseverative motor skills - repetitive reproduction of one movement, a motor complex. With speech perseverations, involuntary repetition of a word or phrase is observed. Clinical methods, neuropsychological tests are used for diagnosis. Symptomatic care includes psychocorrection, psychotherapy, medication.
Perseverative phenomena were first described by the ancient Greek scientist Aristotle, although the term "perseveration" was introduced only in 1894 by the German physician A. Neisser. Currently, there are several types of perseverations: intellectual, sensory, emotional, motor. Intellectual ones are manifested by the repetition of stereotypical mental operations that do not lead to the goal, do not solve the task. For example, in a conversation, a person returns again and again to a question that has already been answered.
Sensory perseverations are multiple repetitions of visual, auditory and tactile images after the direct stimulus has ceased to affect the analyzer. A common option is the sound "in the head" of a recently listened melody. Perseverative emotions are characteristic of impressionable people who experience resentment, fear or joy for a long time, while the situation that provoked them has already ended, has lost its relevance.
Motor perseverations are implemented by repeated repetition of individual movements or entire motor programs. Example: inability to write the letter "b" due to obsession with drawing an oval, inability to move to the image of the upper element of the letter. A special type of motor disorder is speech perseveration. Its sign is the repetition of a syllable, word or part of a phrase in the process of oral utterance or writing.
Perseveration is based on the inability to switch from one action or process to another, more relevant one. The disorder may be due to functional changes in brain activity associated with overwork, stress, the stage of development of nervous activity, and neurotic disorder. More persistent and severe perseverative disorders are observed with organic brain damage, in particular, with local damage to the prefrontal and premotor cortex, subcortical structures, and tertiary cortical zones. The causes of perseverations are divided into physiological, psychopathological and neurological.
Most people at some point in their lives become prone to perseveration. The most common causes are a decrease in the function of activity control, the lack of a clear program of action due to fatigue, emotional exhaustion, and prolonged stress. Physiologically conditioned perseverations are unstable, manifest in a mild degree, more often associated with thought processes, emotions, less often with the motor sphere. Possible causes of development:
The most common cause of perseveration is gross organic pathology of the brain. Disorders of the motor type are determined by the defeat of the anterior parts of the cerebral hemispheres. The development of the pathological process in the premotor zones and underlying subcortical structures provokes elementary motor perseveration; if the prefrontal zones are damaged, systemic motor perseveration is formed, which is manifested by repeated repetition of the action program. Damage to the lower parts of the premotor cortex of the left hemisphere leads to speech perseverative disorders.
Perseverative thinking develops in the pathology of the frontal lobes of the cerebral cortex, reflecting a decrease in control over intellectual functions, programming activities. Sensory perseverative changes are based on organic damage to the cortical sections of the analyzers - the areas of processing information coming from the senses. The occurrence of perseverations is most likely in the following diseases:
In psychiatry and psychology, perseverations are considered in the context of pathopsychological syndromes. Often they are a sign of insufficient flexibility of mental processes or emotional-volitional functions, inertia of personal qualities, for example, against the background of perfectionism. Psychopathological causes of the development of perseverative symptoms are:
In everyday situations, perseverations are manifested by the repetition of the same phrase, despite the change in the topic of the conversation or question, the cyclic reproduction of any actions (for example, turning over the book without trying to read), repeated voicing of a request that does not make sense or has already been completed. Children have monotony, a narrow focus of games and hobbies, interest in learning new things is weak, unstable.
Medical diagnostics is carried out by a psychiatrist and a neuropsychologist. The primary collection of information is carried out by the method of conversation and observation. With pronounced perseverations, repetitions of phrases, words, syllables, movements and actions are detected already at the first medical consultation. To objectively determine perseverations, a number of neuropsychological tests are performed:
The main treatment for perseverative deviations is aimed at eliminating the cause - a mental or neurological disease. Medical and psychological assistance is provided comprehensively, including medication support, psychotherapy, psychocorrection. The key objectives of these areas are to reduce the tension caused by perseverative symptoms, improve the skill of controlling actions, and master the ways of arbitrary switching of attention.
Psychotherapeutic sessions are focused on reducing anxiety, emotional stress, as well as replacing perseverative processes with adequate behavior and thinking. The ability to relax, manage your emotional state is achieved with the help of auto-training, neuromuscular relaxation techniques. To eliminate perseverations, behavioral psychotherapy is used: the technique of redirecting thoughts by a sharp change in the topic of conversation, the method of limiting, which allows reducing perseverative manifestations by limiting the volume of repetitive actions.
Psychocorrective work is aimed at increasing mental performance, developing self-regulation skills through improving cognitive processes, especially attention and thinking. To successfully overcome perseverations, the ability to purposefully switch attention is necessary. Training of this function is carried out during special exercises (for example, finding numbers in red-black tables), group psychotechnical games. Another line of work is to increase the flexibility of thinking. The main method of developing this quality is solving creative problems.
According to individual indications, a psychiatrist or neurologist selects drugs. In order to reduce emotional tension, anxiety, anxiety, sedatives, drugs with a slight anxiolytic effect are used. Additionally, nootropics can be recommended - neurometabolic stimulants that improve the nutrition of nerve tissues, increasing their resistance to stress and hypoxia. Their reception activates cognitive functions, improves memory, increases the ability to learn.