Hospitalism

Hospitalism as a syndrome of pathology of children's mental and personal development is the result of the separation of the infant from the mother and its early institutionalization ^[3] , mental and physical retardation ^{[3] [4]} , resulting from a lack of communication and education ^[4] . According to R. Spitz , hospitalism in children is mainly due to separation from the mother; it can occur both in various institutions where childcare and upbringing is carried out with the complete or partial absence of the mother, and in family conditions, if the mothers do not love their children or do not give them enough attention ^[1] .

In institutions with a long stay of children (baby house, weekly nursery, hospitals, other medical institutions) the following factors leading to hospitalism are possible: poor psychological climate, lack of human attention to the child, lack of emotional manifestations on the part of the staff. These factors cause the children so-called emotional deficiency, leave them passive, they do not develop the necessary skills, dexterity and mental abilities. With deficiencies in hygienic care and care, not only somatic disorders develop (for example, eating disorders and infections ), but also disorders of the harmonious development of higher nervous activity ^[2] .

Signs of hospitalism: late development of movements, especially walking, a sharp lag in mastering speech, emotional impoverishment, senseless obsessive movements (for example, swaying of the body), low anthropometric indices accompanying this complex of mental deficiencies, rickets ^[4] , reduced level of adaptation to the environment , weakened resistance to infections ^[1] . Hospitalism in infancy is characterized by the following signs: loss of weight, lethargy, apathy , increased drowsiness, muscular hypotonia, avoiding contact with others (lack of visual tracking, “voice” turns, “aggravations” in response to the caress of an adult), weak crying and so on. ^[3]

Hospitalism imposes a negative imprint on all spheres of an emerging personality, inhibits intellectual and emotional development, distorting the self-concept , destroying physical well-being. In extreme forms, it can lead to severe mental disorders (infant marasmus , etc.), chronic infection, and sometimes death ^[3] .

Hospitalism in adults (chronically ill, especially in old age) occurs when staying - again and for long periods - in a hospital environment. Due to these factors, the patient lives into the role of the chronically ill, his stay in the hospital becomes a “lifestyle”. When weaning from life outside the hospital, a person sometimes makes considerable efforts to return to the hospital again ^[2] .

According to some data, after hospitalization in elderly people, memory deteriorates more intensively and thinking is disturbed than before this event ^[5] .

Hospitalism in Psychiatry

In psychiatry, hospitalism is understood as a deterioration of the mental state due to prolonged hospital stay: social disadaptation phenomena, loss of interest in work and labor skills, decrease in synthness , deterioration of contact with others, a tendency to chronic the disease, etc. ^{[6] [1]}

It is known that a long stay of mentally ill in closed inpatient facilities adversely affects the prognosis of the disease. Even clinically satisfactory remission is not always accompanied by the restoration of social and labor adaptation, and the success of this adaptation is the less, the longer the patient is in hospital. A long round-the-clock stay in a psychiatric hospital increases the disability of patients, and the less time a patient is in a closed medical institution, the more opportunities he has to retain social positions ^[7] .

Formed syndrome of hospitalism, researchers consider as one of the variants of a mental defect, the origin of which plays a role in long-term social isolation, excessive dependence on the department staff with the suppression of one’s own activity and long-term use of antipsychotics ^[8] . The apathy inherent in hospitalism, affective flatness , lack of plans and hopes, mannerism and stereotypes were erroneously previously viewed only as a manifestation of chronic schizophrenia ^[9] .

It is noted that the severity of manifestations of hospitalism increases with the increase in the total duration of inpatient treatment: for patients with a relatively short period of hospital stay, not exceeding 5-10 months, only a few symptoms of hospitalism are characteristic; with a duration of hospitalization from 10 to 15 months, manifestations reach the phase of the emerging or phase of the formed syndrome of hospitalism. The syndrome is most pronounced in individuals with long periods (15 months or more) of hospitalization.

In patients with short periods of hospital stay, even with a significant duration of the disease, either individual symptoms of hospitalism or a phase of the emerging syndrome are observed; the phase of the formed syndrome of hospitalism in these patients is not observed ^[8] . The researchers concluded that a long stay in psychiatric wards has a more destructive effect on the personality of patients than the actual mental illness ^{[8] [10] [11]} .

G. Putyatin identifies several clinical variants of the syndrome of hospitalism ^[8] :

1. Syndrome of deprivation desocialization .
2. The syndrome of paternalistic dependence or imposing the role of the patient.
3. The syndrome of pharmacogenic psycho-emotional and social personality regress .
4. Mixed version.

Signs of pharmacogenic personality regression , unlike other components of the syndrome of hospitalism, quickly and with considerable intensity appear already at the first hospitalizations in a psychiatric hospital, while other components of the syndrome are absent or slightly expressed. The main role in the development of pharmacogenic regression is played by the adverse side effects of intensive neuroleptic therapy, affecting the sphere of the personal functioning of patients; the lack of use of psychosocial forms of rehabilitation intervention and the therapeutic resistance of patients, leading to polypragmasy and prescribing high doses of psychotropic drugs, also play a role ^[8] .

The syndrome of pharmacogenic personality regression is characterized by dependence on a long-term, clinically insufficiently differentiated use of psychotropic drugs. Asthenic and apato-abulic symptomatology predominates in the form of lethargy, exhaustion, slowed-down motility with general stiffness, monotonous and rigid affect , lack of initiative, associative stiffness, and dullness of attention. Characterized by inactivity, a negative attitude to the inclusion in the work process and to discharge from the hospital. With the correction of drug therapy and lowering the dose of psychotropic drugs, the depth of deficiency symptoms usually decreases: patients become more alive and mobile, the effects of general stiffness decrease, and interest in the environment and their own fate increases ^[8] .

The initial signs of the syndrome of paternalistic dependence appear at the first hospitalizations in a psychiatric hospital, with a total duration of inpatient treatment of 10-15 months and stabilize at the level of the average severity of violations ^[8] .

The syndrome of paternalistic dependence is not only a reflection of procedural deficiency symptoms, but also a consequence of systematic care and patronage from the medical staff . This syndrome is characterized by moral anhedonia , loss of interest in practical activities, rejection or fear of effort, lack of motor activation, affective indifference (lack of initiative and curiosity, carelessness, monotonous monotony of actions, "ossification" of emotions). Ultimately, this version of hospitalism contributes to the destruction of relations with the outside world, the cessation of social relations, the destruction of interpersonal relations ^[8] .

The syndrome of deprivation desocialization is formed with a significant lag from other variants of hospitalism: its first signs appear after a 5–10-month period of hospitalizations and reach a maximum in patients with the longest hospital stay ^[8] .

The main prerequisite for the formation of the syndrome of deprivation desocialization is the long-term isolation of patients in psychiatric wards and the disabling effect of the hospital environment. This syndrome is characterized by the loss or significant weakening of social, including family and kinship ties, initiatives , and impulses to work. Pathological adaptation to hospital conditions is manifested in the rigidity of the psyche and the extremely simplified life stereotype of patients; characterized by complete inconsistency in the solution of basic household tasks, relationships with others, leveling premorbid personality traits. Helplessness in matters of self-service and behavior in the conditions of community life, passivity and indifference to the environment, and emotional emptiness gradually increase ^[8] .

• Deprivation
• De-institutionalization of psychiatry
• Discrimination against persons with mental disorders
• Neuroleptic extrapyramidal disorders
• Neuroleptic deficiency syndrome
• Neuroleptic depression