Masi G
Istituto di Neuropsichiatria e Psicopedagogia dell'Età Evolutiva, Università degli Studi di Pisa.
Minerva Psichiatr. 1994 Jun;35(2):81-92.
There is a high incidence of psychiatric disorders in mentally retarded subjects: one third to two thirds of mentally retarded subjects exhibit psychiatric disorders, a proportion which is much higher than that found in subjects with normal intelligence. The issue is to clarify the nature of the relationship between cognitive and psychiatric disorders (generally analyzed in a dichotomous approach). A way to analyze the phenomenon is to consider a psychopathological approach, which can define the underlying mechanisms responsible for this incidence. The aim of this paper is to analyze the explicatory value of deficient cognitive development, as the main factor determining a specific personality organization. Direct and indirect effects of cognitive impairment on the development of personality disorders are described: the first, in terms of how cognitive deficit (i.e. severity, homogeneity in several cognitive domains, pattern of development) disorganizes personality; the second, in terms of impact that cognitive deficit could have on the child's relationship with the external world, especially with the mother. In order to illustrate these viewpoint, the paper discusses the role of cognitive functions in the development of personality. Specifically, the way the normal child processes his perceptual and motor experiences is analyzed, that is pursuit of new causal links in his knowledge seeking activity of mastering the world. The child's primitive relationship with the world is then aimed at learning, exploring and searching for new causal links. In the light of these considerations, what the child with Mental Retardation experiences is discussed. A series of psychopathological mechanisms in Mental Retardation are postulated. The organization of the Mentally Retarded child's internal world is described, as reflected in Rorschach protocols, which outline a chaotic and primitive internal world, but with a specificity of its own. Finally, the paper discusses the hampering effect that cognitive impairment has on the quality of the relationship with the caregiver. This effect can be seen in terms of the child's interactive capacity and, at the same time, in terms of the emotional impact on the caregiver that derives from interacting with a mentally retarded child. From the above considerations a global approach to the psychopathology of cognitive and affective aspects of Mental Retardation seems warranted. Both aspects acquire a specific significance when seen in light of a specific personality organization. Defining the characteristic of this specific organization seems to be the key to a more comprehensive approach to psychiatric disorders of Mental Retardation.
三分之一到三分之二的精神发育迟滞患者存在精神障碍，这一比例远高于智力正常者。问题在于厘清认知障碍与精神障碍之间关系的本质（通常采用二分法进行分析）。分析这一现象的一种方法是考虑精神病理学方法，该方法能够确定导致这种发病率的潜在机制。本文旨在分析认知发育缺陷作为决定特定人格结构的主要因素所具有的解释价值。描述了认知障碍对人格障碍发展的直接和间接影响：前者涉及认知缺陷（即严重程度、多个认知领域的同质性、发育模式）如何扰乱人格；后者涉及认知缺陷可能对儿童与外部世界，尤其是与母亲的关系产生的影响。为了阐明这些观点，本文讨论了认知功能在人格发展中的作用。具体而言，分析了正常儿童处理其感知和运动体验的方式，即在其掌握世界的求知活动中对新因果关系的追求。儿童与世界的原始关系旨在学习、探索并寻找新的因果关系。鉴于这些考量，讨论了精神发育迟滞儿童的经历。假定了精神发育迟滞中的一系列精神病理机制。描述了精神发育迟滞儿童内心世界的结构，这在罗夏墨迹测验记录中有所体现，这些记录勾勒出一个混乱且原始的内心世界，但具有其自身的独特性。最后，本文讨论了认知障碍对与照顾者关系质量的阻碍作用。这种作用可以从儿童的互动能力方面来看，同时也可以从与精神发育迟滞儿童互动对照顾者产生的情感影响方面来看。基于上述考量，似乎有必要对精神发育迟滞的认知和情感方面的精神病理学采取一种整体方法。当从特定的人格结构来看时，这两个方面都具有特定的意义。界定这种特定结构的特征似乎是更全面地处理精神发育迟滞精神障碍的关键。
