The emotional-volitional sphere is unstable. Medical educational literature. Mental development in asynchronies with predominance

Emotions - this is one of the most important mechanisms mental activity, producing a sensually colored subjective summary assessment of incoming signals, the well-being of a person’s internal state and the current external situation.

A general favorable assessment of the current situation and existing prospects is expressed in positive emotions - joy, pleasure, tranquility, love, comfort. The general perception of the situation as unfavorable or dangerous is manifested by negative emotions - sadness, melancholy, fear, anxiety, hatred, anger, discomfort. Thus, the quantitative characteristics of emotions should be carried out not along one, but along two axes: strong - weak, positive - negative. For example, the term “depression” refers to strong negative emotions, while the term “apathy” indicates weakness or complete absence of emotions (indifference). In some cases, a person does not have sufficient information to evaluate a particular stimulus - this can cause vague emotions of surprise and bewilderment. Healthy people rarely experience conflicting feelings: love and hatred at the same time.

Emotion (feeling) is an internally subjective experience that is inaccessible to direct observation. The doctor judges the emotional state of a person by affect (in the broad sense of this term), i.e. by external expression of emotions: facial expressions, gestures, intonation, vegetative reactions. In this sense, the terms “affective” and “emotional” are used interchangeably in psychiatry. Often one has to deal with a discrepancy between the content of the patient’s speech and the facial expression and tone of the statement. Facial expressions and intonation in this case make it possible to assess the true attitude to what was said. Statements by patients about love for relatives, desire to get a job, combined with monotony of speech, lack of proper affect, indicate the unfoundedness of the statements, the predominance of indifference and laziness.

Emotions are characterized by some dynamic features. Prolonged emotional states correspond to the term “ mood", which in a healthy person is quite flexible and depends on a combination of many circumstances - external (success or failure, the presence of an insurmountable obstacle or expectation of a result) and internal (physical ill health, natural seasonal fluctuations in activity). A change in the situation in a favorable direction should lead to an improvement in mood. At the same time, it is characterized by a certain inertia, so joyful news against the background of sorrowful experiences cannot evoke an immediate response from us. Along with stable emotional states, there are also short-term violent emotional reactions - a state of affect (in the narrow sense of the word).

There are several main functions of emotions. The first of them, signal, allows you to quickly assess the situation - before a detailed logical analysis is carried out. Such an assessment, based on a general impression, is not completely perfect, but it allows you to avoid wasting unnecessary time on the logical analysis of unimportant stimuli. Emotions generally signal to us about the presence of some kind of need: we learn about the desire to eat by feeling hungry; about the thirst for entertainment - through a feeling of boredom. The second important function of emotions is communicative. Emotionality helps us communicate and act together. The collective activity of people involves emotions such as sympathy, empathy (mutual understanding), and mistrust. Violation of the emotional sphere in mental illness naturally entails a violation of contacts with others, isolation, and misunderstanding. Finally, one of the most important functions of emotions is shaping behavior person. It is emotions that make it possible to assess the significance of a particular human need and serve as an impetus for its implementation. Thus, the feeling of hunger prompts us to look for food, suffocation - to open the window, shame - to hide from spectators, fear Ha- flee. It is important to consider that emotion does not always accurately reflect the true state of internal homeostasis and the characteristics of the external situation. Therefore, a person, experiencing hunger, can eat more than the body needs; experiencing fear, he avoids a situation that is not actually dangerous. On the other hand, a feeling of pleasure and satisfaction (euphoria) artificially induced with the help of drugs deprives a person of the need to act despite a significant violation of his homeostasis. Loss of the ability to experience emotions during mental illness naturally leads to inaction. Such a person does not read books or watch TV because he does not feel bored, and does not take care of his clothes and body cleanliness because he does not feel shame.

Based on their influence on behavior, emotions are divided into: sthenic(inducing action, activating, exciting) and asthenic(depriving activity and strength, paralyzing the will). The same psychotraumatic situation can cause excitement, flight, frenzy or, conversely, numbness (“my legs gave way from fear”) in different people. So, emotions provide the necessary impetus for taking action. Direct conscious planning of behavior and the implementation of behavioral acts is performed by the will.

Will is the main regulatory mechanism of behavior, allowing one to consciously plan activities, overcome obstacles, and satisfy needs (drives) in a form that promotes greater adaptation.

Attraction is a state of specific human need, a need for certain conditions of existence, dependence on their presence. We call conscious attractions desires. It is almost impossible to list all possible types of needs: each person’s set of needs is unique and subjective, but several of the most important needs for most people should be indicated. These are physiological needs for food, safety (instinct of self-preservation), sexual desire. In addition, a person, as a social being, often needs communication (affiliative need), and also strives to take care of loved ones (parental instinct).

A person always simultaneously has several competing needs that are relevant to him. The choice of the most important of them on the basis of an emotional assessment is carried out by the will. Thus, it allows you to realize or suppress existing drives, focusing on the individual scale of values - hierarchy of motives. Suppressing a need does not mean reducing its relevance. The inability to fulfill a need that is urgent for a person causes an emotionally unpleasant feeling - frustration. Trying to avoid it, a person is forced either to satisfy his need later, when conditions change to more favorable ones (as, for example, a patient with alcoholism does when he receives a long-awaited salary), or to attempt to change his attitude towards the need, i.e. apply psychological defense mechanisms(see section 1.1.4).

Weakness of will as a personality trait or as a manifestation of mental illness, on the one hand, does not allow a person to systematically satisfy his needs, and on the other hand, leads to the immediate implementation of any desire that arises in a form that is contrary to the norms of society and causes maladjustment.

Although in most cases it is impossible to associate mental functions with any specific neural structure, it should be mentioned that experiments indicate the presence of certain centers of pleasure (a number of areas of the limbic system and the septal region) and avoidance in the brain. In addition, it has been noted that damage to the frontal cortex and pathways leading to the frontal lobes (for example, during lobotomy surgery) often leads to loss of emotions, indifference and passivity. In recent years, the problem of functional asymmetry of the brain has been discussed. It is assumed that the emotional assessment of the situation mainly occurs in the non-dominant (right) hemisphere, the activation of which is associated with states of melancholy and depression, while when the dominant (left) hemisphere is activated, an increase in mood is more often observed.

8.1. Symptoms of Emotional Disorders

Emotional disorders are an excessive expression of a person’s natural emotions (hyperthymia, hypothymia, dysphoria, etc.) or a violation of their dynamics (lability or rigidity). We should talk about the pathology of the emotional sphere when emotional manifestations deform the patient’s behavior as a whole and cause serious maladjustment.

Hypotymia - persistent painful depression of mood. The concept of hypothymia corresponds to sadness, melancholy, and depression. Unlike the natural feeling of sadness caused by an unfavorable situation, hypothymia in mental illness is surprisingly persistent. Regardless of the immediate situation, patients are extremely pessimistic about their current condition and existing prospects. It is important to note that this is not only a strong feeling of sadness, but also an inability to experience joy. Therefore, a person in such a state cannot be cheered up by either a witty anecdote or good news. Depending on the severity of the disease, hypothymia can take the form of mild sadness, pessimism to a deep physical (vital) feeling, experienced as “mental pain,” “tightness in the chest,” “stone on the heart.” This feeling is called vital (pre-cardiac) melancholy, it is accompanied by a feeling of catastrophe, hopelessness, collapse.

Hypotymia as a manifestation of strong emotions is classified as a productive psychopathological disorder. This symptom is not specific and can be observed during an exacerbation of any mental illness; it is often found in severe somatic pathology (for example, with malignant tumors), and is also included in the structure of obsessive-phobic, hypochondriacal and dysmorphomanic syndromes. However, first of all, this symptom is associated with the concept depressive syndrome for which hypothymia is the main syndrome-forming disorder.

Hyperthymia - persistent painful increase in mood. This term is associated with bright positive emotions - joy, fun, delight. Unlike situationally determined joy, hyperthymia is characterized by persistence. Over the course of weeks and months, patients constantly maintain amazing optimism and a feeling of happiness. They are full of energy, show initiative and interest in everything. Neither sad news nor obstacles to the implementation of plans disturb their general joyful mood. Hyperthymia is a characteristic manifestation manic syndrome. The most acute psychoses are expressed by especially strong exalted feelings, reaching the degree ecstasy. This condition may indicate the formation of oneiric stupefaction (see section 10.2.3).

A special variant of hyperthymia is the condition euphoria, which should be considered not so much as an expression of joy and happiness, but as a complacent and carefree affect. Patients do not show initiative, are inactive, and are prone to empty talk. Euphoria can be a sign of a wide variety of exogenous and somatogenic brain lesions (intoxication, hypoxia, brain tumors and extensive disintegrating extracerebral neoplasms, severe damage to hepatic and renal function, myocardial infarction, etc.) and can be accompanied by delusional ideas of grandeur (with paraphrenic syndrome, in patients with progressive paralysis).

The term Moria denote foolish, careless babbling, laughter, and unproductive agitation in deeply mentally retarded patients.

Dysphoria are called sudden attacks of anger, malice, irritation, dissatisfaction with others and with oneself. In this state, patients are capable of cruel, aggressive actions, cynical insults, crude sarcasm and bullying. The paroxysmal course of this disorder indicates the epileptiform nature of the symptoms. In epilepsy, dysphoria is observed either as an independent type of seizures, or is part of the structure of the aura and twilight stupefaction. Dysphoria is one of the manifestations of psychoorganic syndrome (see section 13.3.2). Dysphoric episodes are also often observed in explosive (excitable) psychopathy and in patients with alcoholism and drug addiction during the period of abstinence.

Anxiety - the most important human emotion, closely related to the need for security, expressed by a feeling of an impending uncertain threat, internal excitement. Anxiety is a sthenic emotion: accompanied by tossing, restlessness, restlessness, and muscle tension. As an important signal of trouble, it can arise in the initial period of any mental illness. In obsessive-compulsive neurosis and psychasthenia, anxiety is one of the main manifestations of the disease. IN last years As an independent disorder, panic attacks that occur suddenly (often against the background of a traumatic situation) are distinguished, manifested by acute attacks of anxiety. A powerful, unfounded feeling of anxiety is one of the early symptoms of incipient acute delusional psychosis.

In acute delusional psychoses (syndrome of acute sensory delirium), anxiety is extremely expressed and often reaches the degree confusion, in which it is combined with uncertainty, misunderstanding of the situation, and impaired perception of the surrounding world (derealization and depersonalization). Patients are looking for support and explanations, their gaze expresses surprise ( affect of bewilderment). Like the state of ecstasy, such a disorder indicates the formation of oneiroid.

Ambivalence - simultaneous coexistence of 2 mutually exclusive emotions (love and hatred, affection and disgust). In mental illness, ambivalence causes significant suffering to patients, disorganizes their behavior, and leads to contradictory, inconsistent actions ( ambition). Swiss psychiatrist E. Bleuler (1857-1939) considered ambivalence as one of the most typical manifestations of schizophrenia. Currently, most psychiatrists consider this condition to be a nonspecific symptom, observed, in addition to schizophrenia, in schizoid psychopathy and (in a less pronounced form) in healthy people prone to introspection (reflection).

Apathy - absence or sharp decrease in the expression of emotions, indifference, indifference. Patients lose interest in loved ones and friends, are indifferent to events in the world, and are indifferent to their health and appearance. The patients' speech becomes boring and monotonous, they do not show any interest in the conversation, their facial expressions are monotonous. The words of others do not cause them any offense, embarrassment, or surprise. They may claim that they feel love for their parents, but when meeting with loved ones they remain indifferent, do not ask questions and silently eat the food brought to them. The unemotionality of patients is especially pronounced in a situation that requires an emotional choice (“What food do you like best?”, “Who do you love more: dad or mom?”). Lack of feelings prevents them from expressing any preference.

Apathy refers to negative (deficit) symptoms. It often serves as a manifestation of final states in schizophrenia. It should be taken into account that apathy in patients with schizophrenia is constantly increasing, going through a number of stages that differ in the degree of severity of the emotional defect: smoothness (leveling) of emotional reactions, emotional coldness, emotional dullness. Another reason for apathy is defeat frontal lobes brain (trauma, tumors, partial atrophy).

A symptom should be distinguished from apathy painful mental insensibility (anaesthesiapsychicadolorosa, mournful insensibility). The main manifestation of this symptom is not considered to be the absence of emotions as such, but a painful feeling of one’s own immersion in selfish experiences, the consciousness of the inability to think about anyone else, often combined with delusions of self-blame. The phenomenon of hypoesthesia often occurs (see section 4.1). Patients complain that they have become “like a piece of wood”, that they “don’t have a heart, but an empty tin can”; They lament that they do not feel worried about their young children and are not interested in their successes at school. The vivid emotion of suffering indicates the severity of the condition, the reversible productive nature of the disorders. Anaesthesiapsychicadolorosa is a typical manifestation of the depressive syndrome.

Symptoms of disturbances in the dynamics of emotions include emotional lability and emotional rigidity.

Emotional lability - this is extreme mobility, instability, ease of emergence and change of emotions. Patients easily move from tears to laughter, from fussiness to carefree relaxation. Emotional lability is one of the important characteristics of patients with hysterical neurosis and hysterical psychopathy. A similar condition can also be observed in syndromes of stupefaction (delirium, oneiroid).

One of the options for emotional lability is weakness (emotional weakness). This symptom is characterized not only by rapid changes in mood, but also by the inability to control external manifestations of emotions. This leads to the fact that every (even insignificant) event is experienced vividly, often causing tears that arise not only from sad experiences, but also express tenderness and delight. Weakness is a typical manifestation of vascular diseases of the brain (cerebral atherosclerosis), but can also occur as a personal trait (sensitivity, vulnerability).

Patient 69 years old, with diabetes mellitus and severe memory disorders, he vividly experiences his helplessness: “Oh, doctor, I was a teacher. The students listened to me with their mouths open. And now kneading kneading. Whatever my daughter says, I don’t remember anything, I have to write everything down. My legs can’t walk at all, I can barely crawl around the apartment...” The patient says all this while constantly wiping her eyes. When the doctor asks who else lives in the apartment with her, he answers: “Oh, our house is full of people! It's a pity my dead husband didn't live long enough. My son-in-law is hard-working and caring. The granddaughter is smart: she dances, and draws, and speaks English... And her grandson will go to college next year - his school is so special!” The patient pronounces the last phrases with a triumphant face, but the tears continue to flow, and she constantly wipes them with her hand.

Emotional rigidity - stiffness, stuckness of emotions, tendency to experience feelings for a long time (especially emotionally unpleasant ones). Expressions of emotional rigidity are vindictiveness, stubbornness, and perseverance. In speech, emotional rigidity is manifested by thoroughness (viscosity). The patient cannot move on to discussing another topic until he fully speaks out about the issue that interests him. Emotional rigidity is a manifestation of general torpidity mental processes observed in epilepsy. There are also psychopathic characters with a tendency to get stuck (paranoid, epileptoid).

8.2. Symptoms of disorders of will and desires

Disorders of will and drives manifest themselves in clinical practice behavioral disorders. It is necessary to take into account that the statements of patients do not always accurately reflect the nature of existing disorders, since patients often hide their pathological desires and are ashamed to admit to others, for example, their laziness. Therefore, the conclusion about the presence of violations of the will and drives should be made not on the basis of declared intentions, but based on an analysis of the actions performed. Thus, a patient’s statement about his desire to get a job looks unfounded if he has not worked for several years and has not attempted to find a job. A patient’s statement that he likes to read should not be taken as adequate if he read the last book several years ago.

Quantitative changes and distortions of drives are distinguished.

Hyperbulia - a general increase in will and drives, affecting all the basic drives of a person. An increase in appetite leads to the fact that patients, while in the department, immediately eat the food brought to them and sometimes cannot resist taking food from someone else’s nightstand. Hypersexuality is manifested by increased attention to the opposite sex, courtship, and immodest compliments. Patients try to attract attention with bright cosmetics, flashy clothes, stand for a long time in front of the Mirror, tidying up their hair, and can engage in numerous casual sexual relationships. There is a pronounced desire to communicate: every conversation of others becomes interesting for patients, they try to join in the conversations of strangers. Such people strive to provide patronage to any person, give away their things and money, make expensive gifts, get involved in a fight, wanting to protect the weak (in their opinion). It is important to take into account that the simultaneous increase in drives and will, as a rule, does not allow patients to commit obviously dangerous and grossly illegal actions, sexual violence. Although such people usually do not pose a danger, they can disturb others with their intrusiveness, fussiness, behave carelessly, and misuse property. Hyperbulia is a characteristic manifestation manic syndrome.

Tipobulia - general decrease in will and drives. It should be borne in mind that in patients with hypobulia, all basic drives are suppressed, including physiological ones. There is a decrease in appetite. The doctor can convince the patient of the need to eat, but he takes food reluctantly and in small quantities. A decrease in sexual desire is manifested not only by a drop in interest in the opposite sex, but also by a lack of attention to one’s own appearance. Patients do not feel the need to communicate, are burdened by the presence of strangers and the need to maintain a conversation, and ask to be left alone. Patients are immersed in a world of their own suffering and cannot take care of loved ones (the behavior of a mother with postpartum depression, who is unable to bring herself to care for her newborn, is especially surprising). Suppression of the instinct of self-preservation is expressed in suicidal attempts. Characteristic is a feeling of shame for one’s inaction and helplessness. Hypobulia is a manifestation depressive syndrome. Suppression of impulses in depression is a temporary, transient disorder. Relieving an attack of depression leads to renewed interest in life and activity.

At abulia Usually there is no suppression of physiological drives; the disorder is limited to a sharp decrease in will. The laziness and lack of initiative of people with abulia are combined with a normal need for food and a clear sexual desire, which are satisfied in the simplest, not always socially acceptable, ways. Thus, a patient who is hungry, instead of going to the store and buying the food he needs, asks his neighbors to feed him. The patient satisfies her sexual desire with continuous masturbation or makes absurd demands on her mother and sister. In patients suffering from abulia, higher social needs disappear, they do not need communication or entertainment, they can spend all their days inactive, and are not interested in events in the family and in the world. In the department, they do not communicate with their ward neighbors for months, do not know their names, the names of doctors and nurses.

Abulia is a persistent negative disorder, together with apathy it forms a single apathetic-abulic syndrome, characteristic of final states in schizophrenia. With progressive diseases, doctors can observe an increase in the phenomena of abulia - from mild laziness, lack of initiative, inability to overcome obstacles to gross passivity.

A 31-year-old patient, a turner by profession, after suffering an attack of schizophrenia, left work in the workshop because he considered it too difficult for himself. He asked to be hired as a photographer for the city newspaper, since he had done a lot of photography before. One day, on behalf of the editors, I had to write a report about the work of collective farmers. I arrived in the village in city shoes and, in order not to get my shoes dirty, did not approach the tractors in the field, but only took a few pictures from the car. He was fired from the editorial office for laziness and lack of initiative. I didn’t apply for another job. At home he refused to do any household chores. I stopped caring for the aquarium that I had built with my own hands before I got sick. All day long I lay in bed dressed and dreamed of moving to America, where everything was easy and accessible. He did not object when his relatives turned to psychiatrists with a request to register him as disabled.

Many symptoms described perversions of drives (parabulia). Manifestations of mental disorders may include perversion of appetite, sexual desire, desire for antisocial behavior (theft, alcoholism, vagrancy), and self-harm. Table 8.1 shows the main terms denoting impulse disorders according to ICD-10.

Parabulia is not considered as an independent disease, but is only a symptom. The reasons arose

Table 8.1. Clinical variants of impulse disorders

Code according to ICD-10	Name of disorder	Nature of manifestation
	Pathological
	passion for gambling
	games
	Pyromania	The desire to commit arson
	Kleptomania	Pathological theft
	Trichotillomania	The urge to snatch at myself

	Pica (pica)	The desire to eat inedible things
	» in children	(as a variety, coprofa-
		Gia- eating excrement)
	Dipsomania	Craving for alcohol
	Dromomania	The desire to wander
	Homicidomania	A senseless desire to
		commit murder
	Suicidemania	Suicidal impulse
	Oniomania	The urge to shop (often
		unnecessary)
	Anorexia nervosa	The desire to limit oneself
		food, lose weight
	Bulimia	Binges of overeating
	Transsexualism	The desire to change gender
	Transvestism	The desire to wear clothes
		opposite sex
	Paraphilias,	Sexual predilection disorders
	including:	respects
	fetishism	Getting sexual pleasure
		joy from contemplating before
		intimate wardrobe items
	exhibitionism	Passion for nudity
	voyeurism	Passion for peeping
		married
	pedophilia	Attraction to minors
		in adults
	sadomasochism	Achieving sexual pleasure
		creation by causing
		pain or mental distress
	homosexuality	Attraction to one's own person

Note. Terms for which a code is not provided are not included in ICD-10.

Pathological drives include gross intellectual impairments (mental retardation, total dementia), various forms of schizophrenia (both in the initial period and at the final stage with so-called schizophrenic dementia), as well as psychopathy (persistent personality disharmony). In addition, desire disorders are a manifestation of metabolic disorders (for example, eating inedible things during anemia or pregnancy), as well as endocrine diseases (increased appetite in diabetes, hyperactivity in hyperthyroidism, abulia in hypothyroidism, sexual behavior disorders due to an imbalance of sex hormones).

Each of the pathological drives can be expressed to varying degrees. There are 3 clinical variants of pathological drives - obsessive and compulsive drives, as well as impulsive actions.

Obsessive (obsessive) attraction involves the emergence of desires that the patient can control in accordance with the situation. Attractions that clearly diverge from the requirements of ethics, morality and legality are in this case never implemented and are suppressed as unacceptable. However, refusal to satisfy the drive gives rise to strong feelings in the patient; against your will, thoughts about an unfulfilled need are constantly stored in your head. If it is not clearly antisocial in nature, the patient carries it out as soon as possible. Thus, a person with an obsessive fear of contamination will restrain the urge to wash his hands for a short time, but will definitely wash them thoroughly when no one is looking at him, because all the time he endures, he constantly thinks painfully about his need. Obsessive drives are included in the structure of obsessive-phobic syndrome. In addition, they are a manifestation of mental dependence on psychotropic drugs (alcohol, tobacco, hashish, etc.).

Compulsive drive - a more powerful feeling, since its strength is comparable to such vital needs as hunger, thirst, and the instinct of self-preservation. Patients are aware of the perverted nature of the desire, try to restrain themselves, but when the need is unsatisfied, an unbearable feeling of physical discomfort arises. The pathological need occupies such a dominant position that a person quickly stops the internal struggle and satisfies his desire, even if this is associated with gross antisocial actions and the possibility of subsequent punishment. Compulsive drives can be a cause of repeated violence and serial killings. A striking example of a compulsive desire is the desire for a drug during withdrawal syndrome in those suffering from alcoholism and drug addiction (physical dependence syndrome). Compulsive drives are also a manifestation of psychopathy.

Impulsive actions are committed by a person immediately, as soon as a painful attraction arises, without a previous struggle of motives and without a decision-making stage. Patients can think about their actions only after they have been committed. At the moment of action, an affectively narrowed consciousness is often observed, which can be judged by subsequent partial amnesia. Among impulsive actions, absurd ones, devoid of any meaning, predominate. Often patients subsequently cannot explain the purpose of what they did. Impulsive actions are a frequent manifestation of epileptiform paroxysms. Patients with catatonic syndrome are also prone to commit impulsive actions.

Actions caused by pathology in other areas of the psyche should be distinguished from impulse disorders. Thus, refusal to eat can be caused not only by a decrease in appetite, but also by the presence of delusions of poisoning, imperative hallucinations that prohibit the patient from eating, as well as a severe motor disorder - catatonic stupor (see section 9.1). Actions that lead patients to their own death do not always express a desire to commit suicide, but are also caused by imperative hallucinations or clouding of consciousness (for example, a patient in a state of delirium, fleeing from imaginary pursuers, jumps out of a window, believing that it is a door).

8.3. Syndromes of emotional-volitional disorders

The most striking manifestations of the disorder affective sphere appear depressed and manic syndromes(Table 8.2).

8.3.1. Depressive syndrome

Clinical picture of a typical depressive syndrome usually described as a triad of symptoms: decreased mood (hypotymia), slowed thinking (associative inhibition) and motor retardation. It should, however, be taken into account that a decrease in mood is the main syndrome-forming symptom of depression. Hypotymia can be expressed in complaints of melancholy, depression, and sadness. Unlike the natural reaction of sadness in response to a sad event, melancholy in depression is deprived of connection with the environment; patients do not react either to the good news or to new blows of fate. Depending on the severity of the depressive state, hypothymia can manifest itself as feelings of varying intensity - from mild pessimism and sadness to a severe, almost physical feeling of “a stone on the heart” ( vital melancholy).

Manic syndrome

Table 8.2. Symptoms of manic and depressive syndromes

Depressive syndrome

Depressive triad: decreased mood, ideational retardation, motor retardation

Low self-esteem

pessimism

Delusions of self-blame, self-abasement, hypochondriacal delusions

Suppression of desires: decreased appetite, decreased libido, avoidance of contacts, isolation, devaluation of life, suicidal tendencies

Sleep disorders: decreased duration, early awakening, lack of sense of sleep

Somatic disorders: dry skin, decreased skin tone, brittle hair and nails, lack of tears, constipation

tachycardia and increased blood pressure, pupil dilation (mydriasis), weight loss

Manic triad: increased mood, accelerated thinking, psychomotor agitation

High self-esteem, optimism

Delusions of grandeur

Disinhibition of drives: increased appetite, hypersexuality, desire for communication, need to help others, altruism

Sleep disorder: reduced sleep duration without causing tiredness

Somatic disorders are not typical. Patients have no complaints, look young; increased blood pressure corresponds to high activity of patients; body weight decreases with pronounced psychomotor agitation

Slowing down of thinking in mild cases is expressed by slow monosyllabic speech, long thinking about the answer. In more severe cases patients have difficulty comprehending the question asked and are unable to cope with solving the simplest logical tasks. They are silent, there is no spontaneous speech, but complete mutism (silence) usually does not occur. Motor retardation is manifested in stiffness, slowness, clumsiness, and in severe depression it can reach the level of stupor (depressive stupor). The posture of stuporous patients is quite natural: lying on their backs with their arms and legs outstretched, or sitting with their heads bowed and their elbows resting on their knees.

The statements of depressed patients reveal sharply low self-esteem: they describe themselves as insignificant, worthless people, devoid of talents. Surprised that the doctor

devotes his time to such an insignificant person. Not only their present state, but also their past and future are assessed pessimistically. They declare that they could not do anything in this life, that they brought a lot of trouble to their family, and were not a joy for their parents. They make the saddest forecasts; as a rule, they do not believe in the possibility of recovery. In severe depression, delusional ideas of self-blame and self-deprecation are not uncommon. Patients consider themselves deeply sinful before God, guilty of the death of their elderly parents and the cataclysms occurring in the country. They often blame themselves for losing the ability to empathize with others (anaesthesiapsychicadolorosa). The appearance of hypochondriacal delusions is also possible. Patients believe they are hopelessly ill, perhaps a shameful disease; They are afraid of infecting their loved ones.

Suppression of desires, as a rule, is expressed by isolation, decreased appetite (less often, attacks of bulimia). Lack of interest in the opposite sex is accompanied by distinct changes in physiological functions. Men often experience impotence and blame themselves for it. In women, frigidity is often accompanied by menstrual irregularities and even prolonged amenorrhea. Patients avoid any communication, feel awkward and out of place among people, and the laughter of others only emphasizes their suffering. Patients are so immersed in their own experiences that they are unable to care for anyone else. Women stop doing housework, cannot care for young children, and do not pay any attention to their appearance. Men cannot cope with the work they love, are unable to get out of bed in the morning, get ready and go to work, and lie awake all day long. Patients have no access to entertainment; they do not read or watch TV.

The greatest danger with depression is a predisposition to suicide. Among mental disorders, depression is the most common cause of suicide. Although thoughts of death are common to almost all people suffering from depression, the real danger arises when severe depression is combined with sufficient activity of patients. With pronounced stupor, the implementation of such intentions is difficult. Cases of extended suicide have been described, when a person kills his children in order to “save them from future torment.”

One of the most difficult experiences of depression is persistent insomnia. Patients sleep poorly at night and cannot rest during the day. Waking up in the early morning hours (sometimes at 3 or 4 o'clock) is especially typical, after which patients no longer fall asleep. Sometimes patients insist that they did not sleep a minute at night and never slept a wink, although relatives and medical staff saw them sleeping ( lack of feeling of sleep).

Depression is usually accompanied by a variety of somatovegetative symptoms. As a reflection of the severity of the condition, peripheral sympathicotonia is more often observed. A characteristic triad of symptoms is described: tachycardia, dilated pupils and constipation ( Protopopov's triad). The appearance of the patients is noteworthy. Skin dry, pale, flaky. A decrease in the secretory function of the glands is expressed in the absence of tears (“I cried all my eyes out”). Hair loss and brittle nails are often noted. A decrease in skin turgor manifests itself in the fact that wrinkles deepen and patients look older than their age. An atypical eyebrow fracture may be observed. Fluctuations in blood pressure with a tendency to increase are recorded. Gastrointestinal disorders are manifested not only by constipation, but also by deterioration of digestion. As a rule, body weight decreases noticeably. Various pains are frequent (headaches, heartaches, stomach pains, joint pains).

A 36-year-old patient was transferred to a psychiatric hospital from the therapeutic department, where he was examined for 2 weeks due to constant pain in the right hypochondrium. The examination did not reveal any pathology, but the man insisted that he had cancer and admitted to the doctor his intention to commit suicide. Didn't object to transfer to mental asylum. Upon admission he is depressed and answers questions in monosyllables; declares that he “doesn’t care anymore!” Doesn't communicate with anyone in the department most lies in bed for a long time, eats almost nothing, constantly complains of lack of sleep, although the staff reports that the patient sleeps every night, according to at least until 5 o'clock in the morning. One day, during a morning examination, a strangulation groove was discovered on the patient’s neck. Upon persistent questioning, he admitted that in the morning, when the staff fell asleep, he tried, while lying in bed, to strangle himself with a noose tied from 2 handkerchiefs. After treatment with antidepressants, painful thoughts and all unpleasant sensations in the right hypochondrium disappeared.

Somatic symptoms of depression in some patients (especially during the first attack of the disease) may act as the main complaint. This is the reason why they contact a therapist and undergo long-term, unsuccessful treatment for “ischemic heart diseases», « hypertension"", "biliary dyskinesia", "vegetative-vascular dystonia", etc. In this case they talk about masked (larved) depression, described in more detail in Chapter 12.

The intensity of emotional experiences, the presence of delusional ideas, and signs of hyperactivity of the autonomic systems allow us to consider depression as a syndrome of productive disorders (see Table 3.1). This is confirmed by the characteristic dynamics of depressive states. In most cases, depression lasts several months. However, it is always reversible. Before the introduction of antidepressants and electroconvulsive therapy into medical practice, doctors often observed spontaneous recovery from this state.

The most typical symptoms of depression have been described above. In each individual case, their set may vary significantly, but a depressed, melancholy mood always prevails. Full-blown depressive syndrome is considered a psychotic level disorder. The severity of the condition is evidenced by the presence of delusional ideas, lack of criticism, active suicidal behavior, pronounced stupor, suppression of all basic drives. The mild, non-psychotic version of depression is referred to as subdepression. When conducting scientific research To measure the severity of depression, special standardized scales (Hamilton, Tsung, etc.) are used.

Depressive syndrome is not specific and can be a manifestation of a variety of mental illness: manic-depressive psychosis, schizophrenia, organic brain damage and psychogenic disorders. For depression caused by an endogenous disease (MDP and schizophrenia), pronounced somatovegetative disorders are more typical; an important sign of endogenous depression is the special daily dynamics of the state with increased melancholy in the morning and some weakening of feelings in the evening. It is the morning hours that are considered to be the period associated with the greatest risk of suicide. Another marker of endogenous depression is a positive dexamethasone test (see section 1.1.2).

In addition to the typical depressive syndrome, a number of atypical variants of depression are described.

Anxious (agitated) depression characterized by the absence of pronounced stiffness and passivity. The sthenic affect of anxiety makes patients fuss, constantly turn to others with a request for help or with a demand to stop their torment, to help them die. The premonition of an imminent catastrophe does not allow patients to sleep; they may attempt to commit suicide in front of others. At times, the patients' excitement reaches the level of frenzy (melancholic raptus, raptus melancholicus), when they tear their clothes, make terrible screams, and bang their heads against the wall. Anxious depression is more often observed at involutionary age.

Depressive-delusional syndrome, in addition to the melancholy mood, it is manifested by such plots of delirium as delusions of persecution, staging, and influence. Patients are confident of severe punishment for their crimes; “notice” constant observation of themselves. They fear that their guilt will lead to oppression, punishment or even the murder of their relatives. Patients are restless, constantly asking about the fate of their relatives, trying to make excuses, swearing that they will never make a mistake in the future. Such atypical delusional symptoms are more characteristic not of MDP, but of an acute attack of schizophrenia (schizoaffective psychosis in terms of ICD-10).

Apathetic depression combines the affects of melancholy and apathy. Patients are not interested in their future, they are inactive, and do not express any complaints. Their only desire is to be left alone. This condition differs from apathetic-abulic syndrome in its instability and reversibility. Most often, apathetic depression is observed in people suffering from schizophrenia.

8.3.2. Manic syndrome

It manifests itself primarily as an increase in mood, acceleration of thinking and psychomotor agitation. Hyperthymia in this condition is expressed by constant optimism and disdain for difficulties. Denies the presence of any problems. Patients constantly smile, do not make any complaints, and do not consider themselves sick. The acceleration of thinking is noticeable in fast, jumping speech, increased distractibility, and superficiality of associations. With severe mania, speech is so disorganized that it resembles “verbal hash.” The pressure of speech is so great that patients lose their voice, and saliva, whipped into foam, accumulates in the corners of the mouth. Due to severe distractibility, their activities become chaotic and unproductive. They cannot sit still, they want to leave home, they ask to be released from the hospital.

There is an overestimation of one's own abilities. Patients consider themselves surprisingly charming and attractive, constantly boasting about their supposed talents. They try to write poetry, demonstrate their vocal abilities to others. A sign of extremely pronounced mania is delusions of grandeur.

An increase in all basic drives is characteristic. Appetite increases sharply, and sometimes there is a tendency to alcoholism. Patients cannot be alone and are constantly looking for communication. When talking with doctors, they do not always maintain the necessary distance, calling simply “brother!” Patients pay a lot of attention to their appearance, try to decorate themselves with badges and medals, women use excessively bright cosmetics, and try to emphasize their sexuality with clothes. Increased interest in the opposite sex is expressed in compliments, immodest proposals, and declarations of love. Patients are ready to help and patronize everyone around them. At the same time, it often turns out that there is simply not enough time for one’s own family. They waste money and make unnecessary purchases. At excessive activity It is not possible to complete any of the tasks, because new ideas arise every time. Attempts to prevent the realization of their drives cause a reaction of irritation and indignation ( angry mania).

Manic syndrome is characterized by a sharp decrease in the duration of night sleep. Patients refuse to go to bed on time, continuing to fuss at night. In the morning they wake up very early and immediately get involved in vigorous activity, but they never complain of fatigue and claim that they sleep quite enough. Such patients usually cause a lot of inconvenience to others, harm their financial and social situation, but, as a rule, they do not pose an immediate threat to the life and health of other people. Mild subpsychotic mood elevation ( hypomania) in contrast to severe mania, it may be accompanied by awareness of the unnaturalness of the state; no delirium is observed. Patients can make a favorable impression with their ingenuity and wit.

Physically, those suffering from mania look completely healthy, somewhat rejuvenated. With pronounced psychomotor agitation, they lose weight, despite their voracious appetite. With hypomania, significant weight gain may occur.

The patient, 42 years old, has been suffering from attacks of inappropriately elevated mood since the age of 25, the first of which occurred during her postgraduate studies at the Department of Political Economy. By that time, the woman was already married and had a 5-year-old son. In a state of psychosis, she felt very feminine and accused her husband of not being affectionate enough towards her. She slept no more than 4 hours a day, passionately engaged in scientific work, and paid little attention to her son and household chores. I felt a passionate attraction to my supervisor. I sent him bouquets of flowers in secret. I attended all his lectures for students. One day, in the presence of all the department staff, on her knees she asked him to take her as his wife. She was hospitalized. After the attack ended, she was unable to finish her dissertation. During the next attack, I fell in love with a young actor. She went to all his performances, gave flowers, and secretly invited him to her dacha, secretly from her husband. She bought a lot of wine to get her lover drunk and thereby overcome his resistance, and she drank a lot and often. In response to her husband’s perplexed questions, she ardently confessed everything. After hospitalization and treatment, she married her lover and went to work for him in the theater. During the interictal period she is calm and rarely drinks alcohol. She speaks warmly about her former husband and regrets the divorce a little.

Manic syndrome is most often a manifestation of MDP and schizophrenia. Occasionally, manic states caused by organic brain damage or intoxication (phenamine, cocaine, cimetidine, corticosteroids, cyclosporine, teturam, hallucinogens, etc.) occur. Mania is a sign of acute psychosis. The presence of bright productive symptoms allows us to count on a complete reduction of painful disorders. Although individual attacks can be quite long (up to several months), they are still often shorter than attacks of depression.

Along with typical mania, atypical syndromes of complex structure are often encountered. Manic-delusional syndrome, in addition to the affect of happiness, it is accompanied by unsystematized delusional ideas of persecution, staging, and megalomaniacal delusions of grandeur ( acute paraphrenia). Patients declare that they are called upon to “save the whole world,” that they are endowed with incredible abilities, for example, they are “the main weapon against the mafia,” and criminals are trying to destroy them for this. A similar disorder does not occur in MDP and most often indicates an acute attack of schizophrenia. At the height of a manic-delusional attack, oneiric stupefaction can be observed.

8.3.3. Apathetic-abulic syndrome

It manifests itself as a pronounced emotional-volitional impoverishment. Indifference and indifference make patients quite calm. They are hardly noticeable in the department, spend a lot of time in bed or sitting alone, and can also spend hours watching TV. It turns out that they did not remember a single program they watched. Laziness is evident in their entire behavior: they don’t wash their face, don’t brush their teeth, refuse to take a shower or cut their hair. They go to bed dressed, because they are too lazy to take off and put on clothes. It is impossible to attract them to activities by calling them to responsibility and a sense of duty, because they do not feel shame. The conversation does not arouse interest among patients. They speak monotonously and often refuse to talk, declaring that they are tired. If the doctor manages to insist on the need for dialogue, it often turns out that the patient can talk for a long time without showing signs of fatigue. During the conversation, it turns out that the patients do not experience any suffering, do not feel sick, and do not make any complaints.

The described symptoms are often combined with disinhibition of the simplest drives (gluttony, hypersexuality, etc.). At the same time, the lack of modesty leads them to try to realize their needs in the simplest, not always socially acceptable form: for example, they can urinate and defecate right in bed, because they are too lazy to go to the toilet.

Apathetic-abulic syndrome is a manifestation of negative (deficient) symptoms and has no tendency to develop reversely. Most often, the cause of apathy and abulia are the final states of schizophrenia, in which the emotional-volitional defect increases gradually - from mild indifference and passivity to states of emotional dullness. Another reason for the occurrence of apathetic-abulic syndrome is organic damage to the frontal lobes of the brain (trauma, tumor, atrophy, etc.).

8.4. Physiological and pathological affect

The reaction to a traumatic event can proceed very differently depending on the individual significance of the stressful event and the characteristics of the person’s emotional response. In some cases, the form of manifestation of affect can be surprisingly violent and even dangerous for others. There are well-known cases of murder of a spouse due to jealousy, violent fights between football fans, heated disputes between political leaders. A grossly antisocial manifestation of affect can be facilitated by a psychopathic personality type (excitable psychopathy - see section 22.2.4). Still, we have to admit that in most cases such aggressive actions are committed consciously: participants can talk about their feelings at the moment of committing the act, repent of their incontinence, and try to smooth out a bad impression by appealing to the severity of the insult inflicted on them. No matter how serious the crime committed, in such cases it is considered as physiological affect and entails legal liability.

Pathological affect is called short-term psychosis, which occurs suddenly after the action of psychological trauma and is accompanied by clouding of consciousness with subsequent amnesia for the entire period of psychosis. The paroxysmal nature of the onset of pathological affect indicates that a psychotraumatic event becomes a trigger for the implementation of existing epileptiform activity. Patients often have a history of severe injuries head or signs of organic dysfunction since childhood. The confusion of consciousness at the moment of psychosis is manifested by fury, the amazing cruelty of the violence committed (dozens of severe wounds, numerous blows, each of which can be fatal). Those around him are unable to correct the patient’s actions because he does not hear them. Psychosis lasts several minutes and ends with severe exhaustion: patients suddenly collapse without strength, sometimes falling into deep sleep. Upon recovery from psychosis, they cannot remember anything that happened, they are extremely surprised when they hear about what they have done, and cannot believe those around them. It should be recognized that disorders of pathological affect can only conditionally be classified as emotional disorders, since the most important expression of this psychosis is twilight stupefaction(see section 10.2.4). Pathological affect serves as the basis for declaring the patient insane and releasing him from responsibility for the crime committed.

BIBLIOGRAPHY

Izard K. Human emotions. - M.: Moscow State University Publishing House, 1980.

Numer Yu.L., Mikhalenko I.N. Affective psychoses. - L.: Medicine, 1988. - 264 p.

Psychiatric diagnosis / Zavilyansky I.Ya., Bleikher V.M., Kruk I.V., Zavilyanskaya L.I. - Kyiv: Vyshcha School, 1989.

Psychology emotions. Texts / Ed. V.K.Vilyunas, Yu.B.Gippen-reuter. - M.: MSU, 1984. - 288 p.

Psychosomatic disorders in cyclothymic and cyclothymic-like conditions. - Proceedings of MIP., T.87. - Answer. ed. S.F. Semenov. - M.: 1979. - 148 p.

Reikovsky Ya. Experimental psychology of emotions. - M.: Progress, 1979.

Sinitsky V.N. Depressive states (pathophysiological characteristics, clinical picture, treatment, prevention). - Kyiv: Naukova Dumka, 1986.

Often, parents' concern is mainly concentrated in the area of children's physical health, when sufficient attention is not paid to the emotional state of the child, and some early alarming symptoms of disturbances in the emotional-volitional sphere are perceived as temporary, characteristic of age, and therefore not dangerous.

Emotions play significant role from the very beginning of a baby’s life, and serve as an indicator of his attitude towards his parents and what surrounds him. Currently, along with common problems health in children, experts note with concern the increase in emotional and volitional disorders, which result in more serious problems in the form of low social adaptation, tendency to antisocial behavior, learning difficulties.

External manifestations of disorders of the emotional-volitional sphere in childhood

Despite the fact that you should not independently make not only medical diagnoses, but also diagnoses in the field of psychological health, and it is better to entrust this to professionals, there are a number of signs of disturbances in the emotional-volitional sphere, the presence of which should be the reason for contacting specialists.

Violations in the emotional-volitional sphere of a child’s personality have characteristics age-related manifestations. So, for example, if adults systematically note in their child at an early age such behavioral characteristics as excessive aggressiveness or passivity, tearfulness, “getting stuck” on a certain emotion, then it is possible that this early manifestation emotional disorders.

In to school age In addition to the above symptoms, inability to follow norms and rules of behavior and insufficient development of independence may be added. At school age, these deviations, along with those listed, can be combined with self-doubt, impaired social interaction, decreased sense of purpose, and inadequate self-esteem.

It is important to understand that the existence of disorders should be judged not by the presence of a single symptom, which may be the child’s reaction to a specific situation, but by the combination of several characteristic symptoms.

The main external manifestations are as follows:

Emotional tension. With increased emotional tension, in addition to well-known manifestations, difficulties in organizing mental activity and a decrease in play activity characteristic of a particular age can also be clearly expressed.

Fast mental fatigue of a child in comparison with peers or with earlier behavior is expressed in the fact that the child has difficulty concentrating, he may demonstrate a clear negative attitude towards situations where the manifestation of thinking and intellectual qualities is necessary.
Increased anxiety. Increased anxiety, in addition to the known signs, can be expressed in avoidance of social contacts and a decrease in the desire to communicate.
Aggressiveness. Manifestations can be in the form of demonstrative disobedience to adults, physical aggression and verbal aggression. Also, his aggression can be directed at himself, he can hurt himself. The child becomes disobedient and with great difficulty succumbs to the educational influences of adults.
Lack of empathy. Empathy is the ability to feel and understand the emotions of another person, to empathize. In case of disturbances in the emotional-volitional sphere, this symptom is usually accompanied by increased anxiety. An inability to empathize may also be a warning sign of a mental disorder or intellectual disability.
Unpreparedness and unwillingness to overcome difficulties. The child is lethargic and does not enjoy contact with adults. Extreme manifestations of behavior may look like complete ignorance of parents or other adults - in certain situations, a child may pretend that he does not hear an adult.
Low motivation to succeed. A characteristic sign of low motivation for success is the desire to avoid hypothetical failures, so the child takes on new tasks with displeasure and tries to avoid situations where there is even the slightest doubt about the result. It is very difficult to persuade him to try to do anything. A common answer in this situation is: “it won’t work,” “I don’t know how.” Parents may mistakenly interpret this as a manifestation of laziness.
Expressed distrust of others. It can manifest itself as hostility, often accompanied by tearfulness; school-age children can manifest it as excessive criticism of the statements and actions of both peers and surrounding adults.
Excessive impulsiveness of a child, as a rule, is expressed in poor self-control and insufficient awareness of his actions.
Avoiding close contacts with other people. A child may repel others with remarks expressing contempt or impatience, insolence, etc.

Formation of the emotional-volitional sphere of the child

Parents observe the manifestation of emotions from the very beginning of the child’s life; with their help, communication with parents occurs, so the baby shows that he feels good, or he experiences unpleasant sensations.

Later, in the process of growing up, the child faces problems that he has to solve with to varying degrees independence. Attitude to a problem or situation causes a certain emotional response, and attempts to influence the problem cause additional emotions. In other words, if a child has to show arbitrariness in carrying out any actions, where the fundamental motive is not “I want”, but “I need”, that is, volitional effort will be required to solve the problem, in fact this will mean the implementation of a volitional act.

As we grow older, emotions also undergo certain changes and develop. Children at this age learn to feel and are able to demonstrate more complex manifestations of emotions. The main feature of the correct emotional-volitional development of a child is the increasing ability to control the manifestation of emotions.

The main causes of violations of the emotional-volitional sphere of the child

Child psychologists place special emphasis on the statement that the development of a child’s personality can occur harmoniously only with sufficient trusting communication with close adults.

The main causes of violations are:

suffered stress;
retardation in intellectual development;
lack of emotional contacts with close adults;
social and everyday reasons;
movies and computer games, not intended for his age;
a number of other reasons that cause internal discomfort and feelings of inferiority in the child.

Violations of the children's emotional sphere manifest themselves much more often and more clearly during periods of so-called age-related crises. Vivid examples Such points of maturation may be the “I myself” crisis at the age of three and the “Adolescence crisis” in adolescence.

Diagnosis of disorders

To correct disorders, timely and correct diagnosis is important, taking into account the causes of the development of deviations. Psychologists have a range of special techniques and tests to assess the development and psychological state of a child, taking into account his age characteristics.

For preschoolers, projective diagnostic methods are usually used:

drawing test;
Luscher color test;
Beck Anxiety Scale;
questionnaire “Well-being, activity, mood” (SAM);
Phillips School Anxiety Test and many others.

Correction of disorders of the emotional-volitional sphere in childhood

What to do if the baby’s behavior suggests the presence of such a disorder? First of all, it is important to understand that these violations can and should be corrected. You should not rely only on specialists; the role of parents in correcting the behavioral characteristics of the child’s character is very important.

An important point in laying the foundation for a successful resolution of this problem is the establishment of contact and trust between parents and the child. In communication, you should avoid critical assessments, show a friendly attitude, remain calm, praise adequate manifestations of feelings more, you should be sincerely interested in his feelings and empathize.

Contact a psychologist

To eliminate disturbances in the emotional sphere, you should contact a child psychologist, who, with the help of special classes, will help you learn how to react correctly when stressful situations arise and control your feelings. Another important point is the work of the psychologist with the parents themselves.

Psychology currently describes many methods for correcting childhood disorders in the form of play therapy. As you know, the best learning occurs with the involvement of positive emotions. Teaching correct behavior is no exception.

The value of a number of methods lies in the fact that they can be successfully used not only by specialists themselves, but also by parents interested in the organic development of their baby.

Practical correction methods

These are, in particular, the methods of fairy tale therapy and puppet therapy. Their main principle is the child’s identification with a fairy tale character or his favorite toy during the game. The child projects his problem onto the main character, the toy and, during the game, resolves them according to the plot.

Of course, all these methods imply the obligatory direct involvement of adults in the game process itself.

If parents in the process of upbringing pay sufficient and due attention to such aspects of the development of the child’s personality as emotional volitional sphere, then in the future this will make it much easier to survive the period of teenage personality formation, which, as many know, can introduce a number of serious deviations in the child’s behavior.

The work experience accumulated by psychologists shows that not only taking into account the characteristics age development, thorough selection diagnostic techniques and psychological correction techniques, allows specialists to successfully solve problems of violation of the harmonious development of a child’s personality; the decisive factor in this area will always be parental attention, patience, care and love.

Psychologist, psychotherapist, personal well-being specialist

Svetlana Buk

Clinical picture of emotional-volitional disorders

The main external manifestations of a violation of the emotional-volitional sphere include:

Emotional stress. With increased emotional tension, disorganization of mental activity and decreased activity occur.
Rapid mental fatigue (in a child). It is expressed by the fact that the child is unable to concentrate, and is also characterized by a sharp negative reaction to certain situations where a demonstration of his mental qualities is necessary.
A state of anxiety, which is expressed by the fact that a person avoids in every possible way any contact with other people and does not strive to communicate with them.
Increased aggressiveness. Most often occurs in childhood when a child defiantly disobeys adults and experiences constant physical and verbal aggression. Such aggression can be expressed not only towards others, but also towards oneself, thereby causing harm to one’s own health.
Lack of ability to feel and comprehend the emotions of other people, to empathize. This symptom is usually accompanied by increased anxiety and is the cause of mental disorder and mental retardation.
Lack of desire to overcome life difficulties. In this case, the child is in a constantly lethargic state, he has no desire to communicate with adults. Extreme manifestations of this disorder are expressed in complete ignorance of parents and other adults.
Lack of motivation to succeed. The main factor of low motivation is the desire to avoid possible failures, as a result of which a person refuses to take on new tasks and tries to avoid situations where even the slightest doubt arises about final success.
Expressed distrust of other people. Often accompanied by such symptoms as hostility towards others.
Increased impulsivity in childhood. It is expressed by such signs as a lack of self-control and awareness of one’s actions.

Classification of disorders in the emotional-volitional sphere

Disorders of the emotional sphere in adult patients are distinguished by such features as:

Hypobulia or decreased willpower. Patients with this disorder lack any need to communicate with other people, experience irritability in the presence of strangers, and lack the ability or desire to carry on a conversation.
Hyperbulia. It is characterized by increased desire in all areas of life, often expressed in increased appetite and the need for constant communication and attention.
Abulia. It is distinguished by the fact that a person’s volitional drives sharply decrease.
Compulsive attraction is an irresistible need for something or someone. This disorder is often compared to animal instinct, when a person’s ability to be aware of their actions is significantly suppressed.
Obsessive desire is a manifestation of obsessive desires that the patient is not able to independently control. Failure to satisfy such desires leads to depression and deep suffering for the patient, and his thoughts are filled with the idea of their realization.

Syndromes of emotional-volitional disorders

The most common forms of emotional disorders are depressive and manic syndromes.

Depressive syndrome

The clinical picture of depressive syndrome is described by its 3 main signs, such as:

Hypotomia, characterized by decreased mood;
Associative inhibition (mental inhibition);
Motor retardation.

It is worth noting that the first point listed above is a key sign of a depressive state. Hypotomia can be expressed in the fact that a person is constantly sad, feels depressed and sad. Unlike the established reaction, when sadness arises as a result of experiencing a sad event, with depression a person loses connection with the environment. That is, in this case the patient does not show a reaction to joyful and other events.

Depending on the severity of the condition, hypotomy can occur with varying intensity.

Mental retardation in its mild manifestations is expressed in the form of slowing down monosyllabic speech and taking a long time to think about the answer. A severe course is characterized by the inability to comprehend the questions asked and solve a number of simple logical problems.

Motor retardation manifests itself in the form of stiffness and slowness of movements. In severe cases of depression, there is a risk of depressive stupor (a state of complete depression).

Manic syndrome

Often, manic syndrome manifests itself within the framework of affective bipolar disorder. In this case, the course of this syndrome is characterized by paroxysmal episodes, in the form of individual episodes with certain stages of development. Symptomatic picture, which stands out in the structure of a manic episode, is characterized by variability within one patient depending on the stage of development of the pathology.

Such a pathological condition as manic syndrome, as well as depressive syndrome, is distinguished by 3 main features:

Elevated mood due to hyperthymia;
Mental excitability in the form of accelerated thought processes and speech (tachypsia);
Motor excitement;

An abnormal increase in mood is characterized by the fact that the patient does not feel such manifestations as melancholy, anxiety and a number of other signs characteristic of depressive syndrome.

Mental excitability with accelerated process thinking arises up to the jump of ideas, that is, in this case, the patient’s speech becomes incoherent due to excessive distractibility, although the patient himself is aware of the logic of his words. It also stands out because the patient has ideas of his own greatness and denial of the guilt and responsibility of other people.

Increased physical activity in this syndrome, it is characterized by disinhibition of this activity in order to obtain pleasure. Consequently, with manic syndrome, patients tend to consume large amounts of alcohol and drugs.

Manic syndrome is also characterized by such emotional disturbances as:

Strengthening instincts (increased appetite, sexuality);
Increased distractibility;
Reassessment of personal qualities.

Methods for correcting emotional disorders

Features of the correction of emotional disorders in children and adults are based on the use of a number of effective techniques that can almost completely normalize their emotional state. Usually, emotional correction for children is the use of play therapy.

Often in childhood, emotional disorders are caused by a lack of gameplay, which significantly inhibits mental and mental development.

The systematic motor and speech factor of the game allows you to reveal the child’s capabilities and feel positive emotions from the game process. Working through various real-life situations in play therapy allows the child to adapt to real life conditions much faster.

There is another therapeutic approach, namely psychodynamic, which is based on the method of psychoanalysis aimed at resolving the patient’s internal conflict, awareness of his needs and life experiences.

The psychodynamic method also includes:

Art therapy;
Indirect play therapy;
Fairytale therapy.

These specific effects have proven themselves not only for children, but also for adults. They allow patients to relax, show creative imagination and present emotional disorders as a certain image. The psychodynamic approach is also distinguished by its ease and ease of implementation.

Also common methods include ethnofunctional psychotherapy, which allows you to artificially create a duality of the subject, in order to understand your personal and emotional problems, as if focusing your view from the outside. In this case, the help of a psychotherapist allows patients to transfer their emotional problems to an ethnic projection, work through them, realize them and let them pass through themselves in order to finally get rid of them.

Prevention of emotional disorders

The main goal of preventing disorders of the emotional-volitional sphere is the formation of dynamic balance and a certain margin of safety of the central nervous system. This state is determined by the absence of internal conflicts and a stable optimistic attitude.

Sustained optimistic motivation makes it possible to move towards the intended goal, overcoming various difficulties. As a result, a person learns to make informed decisions based on a large amount of information, which reduces the likelihood of error. That is, the key to an emotionally stable nervous system is a person’s movement along the path of development.

The most striking manifestations of affective disorders are depressive and manic syndromes (Table 8.2).

Depressive syndrome

Clinical picture of a typical depressive syndrome usually described as a triad of symptoms: decreased mood (hypotymia), slowed thinking (associative inhibition) and motor retardation. It should, however, be taken into account that a decrease in mood is the main syndrome-forming symptom of depression. Hypotymia can be expressed in complaints of melancholy, depression, and sadness. Unlike the natural reaction of sadness in response to a sad event, melancholy in depression is deprived of connection with the environment; patients do not react either to the good news or to new blows of fate. Depending on the severity of the depressive state, hypothymia can manifest itself as feelings of varying intensity - from mild pessimism and sadness to a heavy, almost physical feeling of a “stone on the heart” (vital melancholy).

Slowing down of thinking in mild cases is expressed by slow monosyllabic speech, long thinking about the answer. In more severe cases, patients have difficulty comprehending asked question, are unable to cope with solving the simplest logical tasks. They are silent, there is no spontaneous speech, but complete mutism (silence) usually does not occur. Motor retardation is manifested in stiffness, slowness, clumsiness, and in severe depression it can reach the level of stupor (depressive stupor). The posture of stuporous patients is quite natural: lying on their backs with their arms and legs outstretched, or sitting with their heads bowed and their elbows resting on their knees.

The statements of depressed patients reveal sharply low self-esteem: they describe themselves as insignificant, worthless people, devoid of talents.

Table 8.2. Symptoms of manic and depressive syndromes

We are surprised that the doctor devotes his time to such an insignificant person. Not only their present state, but also their past and future are assessed pessimistically. They declare that they could not do anything in this life, that they brought a lot of trouble to their family, and were not a joy for their parents. They make the saddest forecasts; as a rule, they do not believe in the possibility of recovery. In severe depression, delusional ideas of self-blame and self-deprecation are not uncommon. Patients consider themselves deeply sinful before God, guilty of the death of their elderly parents and the cataclysms occurring in the country. They often blame themselves for losing the ability to empathize with others (anaesthesia psychica dolorosa). The appearance of hypochondriacal delusions is also possible. Patients believe they are hopelessly ill, perhaps a shameful disease; They are afraid of infecting their loved ones.

Depression is usually accompanied by a variety of somatovegetative symptoms. As a reflection of the severity of the condition, peripheral sympathicotonia is more often observed. A characteristic triad of symptoms is described: tachycardia, dilated pupils and constipation (Protopopov triad) . The appearance of the patients is noteworthy. The skin is dry, pale, flaky. A decrease in the secretory function of the glands is expressed in the absence of tears (“I cried all my eyes out”). Hair loss and brittle nails are often noted. A decrease in skin turgor manifests itself in the fact that wrinkles deepen and patients look older than their age. An atypical eyebrow fracture may be observed. Fluctuations in blood pressure with a tendency to increase are recorded. Gastrointestinal disorders are manifested not only by constipation, but also by deterioration of digestion. As a rule, body weight decreases noticeably. Various pains are frequent (headaches, heartaches, stomach pains, joint pains).

A 36-year-old patient was transferred to a psychiatric hospital from the therapeutic department, where he was examined for 2 weeks due to constant pain in the right hypochondrium. The examination did not reveal any pathology, but the man insisted that he had cancer and admitted to the doctor his intention to commit suicide. He did not object to being transferred to a psychiatric hospital. Upon admission he is depressed and answers questions in monosyllables; declares that he “doesn’t care anymore!” He does not communicate with anyone in the department, lies in bed most of the time, eats almost nothing, constantly complains of lack of sleep, although the staff reports that the patient sleeps every night, at least until 5 a.m. One day, during a morning examination, a strangulation groove was discovered on the patient’s neck. Upon persistent questioning, he admitted that in the morning, when the staff fell asleep, he tried, while lying in bed, to strangle himself with a noose tied from two handkerchiefs. After treatment with antidepressants, painful thoughts and all unpleasant sensations in the right hypochondrium disappeared.

Somatic symptoms of depression in some patients (especially during the first attack of the disease) may act as the main complaint. This is the reason why they turn to a therapist and undergo long-term, unsuccessful treatment for “coronary heart disease,” “hypertension,” “biliary dyskinesia,” “vegetative-vascular dystonia,” etc. In this case, they speak of masked (larved) depression, described in more detail in Chapter 12.

The intensity of emotional experiences, the presence of delusional ideas, and signs of hyperactivity of the autonomic systems allow us to consider depression as a syndrome of productive disorders (see Table 3.1). This is confirmed by the characteristic dynamics depressive states. In most cases, depression lasts several months. However, it is always reversible. Before the introduction of antidepressants and electroconvulsive therapy into medical practice, doctors often observed spontaneous recovery from this state.

The most typical symptoms of depression have been described above. In each individual case, their set may vary significantly, but a depressed, melancholy mood always prevails. Full-blown depressive syndrome is considered a psychotic level disorder. The severity of the condition is evidenced by the presence of delusional ideas, lack of criticism, active suicidal behavior, pronounced stupor, suppression of all basic drives. The mild, non-psychotic version of depression is referred to as subdepression. When conducting scientific research, special standardized scales (Hamilton, Tsung, etc.) are used to measure the severity of depression.

Depressive syndrome is not specific and can be a manifestation of a variety of mental illnesses: manic-depressive psychosis, schizophrenia, organic lesions brain and psychogeny. For depression caused by an endogenous disease (MDP and schizophrenia), pronounced somatovegetative disorders are more typical; an important sign of endogenous depression is the special daily dynamics of the state with increased melancholy in the morning and some weakening of feelings in the evening. It is the morning hours that are considered to be the period associated with the greatest risk of suicide. Another marker of endogenous depression is a positive dexamethasone test (see section 1.1.2).

In addition to the typical depressive syndrome, a number of atypical variants of depression are described.

Anxious (agitated) depression characterized by the absence of pronounced stiffness and passivity. The sthenic affect of anxiety causes patients to fuss, constantly turning to others asking for help or demanding an end to their torment, to help them die. The premonition of an imminent catastrophe does not allow patients to sleep; they may attempt to commit suicide in front of others. At times, the patients' excitement reaches the level of frenzy (melancholic raptus, raptus melancholicus), when they tear their clothes, make terrible screams, and bang their heads against the wall. Anxious depression is more often observed at involutionary age.

Depressive-delusional syndrome , in addition to a melancholy mood, is manifested by such plots of delirium as delusions of persecution, staging, and influence. Patients are confident of severe punishment for their crimes; “notice” constant observation of themselves. They fear that their guilt will lead to oppression, punishment or even the murder of their relatives. Patients are restless, constantly asking about the fate of their relatives, trying to make excuses, swearing that they will never make a mistake in the future. Such atypical delusional symptoms are more typical not for MDP, but for acute attack schizophrenia (schizoaffective psychosis in terms of ICD-10).

Apathetic depression combines the affects of melancholy and apathy. Patients are not interested in their future, they are inactive, and do not express any complaints. Their only desire is to be left alone. This condition differs from apathetic-abulic syndrome in its instability and reversibility. Most often, apathetic depression is observed in people suffering from schizophrenia.

Quite often, parental care is mainly focused on physical health your child, while the emotional component remains virtually unattended. This is due to the fact that most parents consider early symptoms of emotional disorders to be temporary and therefore harmless.

The place of emotional disturbances in the mental development of a child seems to be one of the key aspects of his life, due to the fact that these disturbances affect his attitude towards his parents and the environment in general. Today, there is a tendency towards an increase in emotional disorders in children, in the form of reduced social adaptation and a tendency to aggressive behavior.

There are many reasons for the occurrence of emotional disorders in a child, so parents should be especially careful when various pathological signs appear. As a rule, specialists make a final diagnosis when registering 3 signs of emotional instability.

The most common causes of emotional disturbances are:

Physical characteristics, taking into account diseases suffered in infancy;
Inhibition of mental and mental development;
Improper upbringing of a child in the preschool period;
Poor nutrition, namely insufficient intake necessary substances, which significantly affects the development of the baby;

Also, these above reasons are divided into two large groups:

Biological.

This causal group includes characteristic type nervous system. For example, if attention deficit disorder is present, the child may subsequently experience pathological process in the brain, formed as a result severe course pregnancy and childbirth of his mother.

Social

This group determines the process of interaction of the child with other people and the environment. For example, if a child already has experience communicating with age group people, his peers and the primary group for him - his family, then in some cases such socialization can also harm him.

If a child is constantly subjected to denial by adults, then he unconsciously begins to repress the received information that comes from the environment.

The emergence of new experiences that do not coincide with his conceptual structure begins to be perceived negatively by him, which ultimately creates a certain stress for him.

In the absence of understanding from peers, the child develops emotional experiences (rage, resentment, disappointment), which are characterized by severity and duration. Also, constant conflicts in the family, demands on the child, lack of understanding of his interests, also cause emotional disturbances in the mental development of the child.

Classifications of emotional disorders and their symptoms

The difficulty in identifying emotional-volitional disorders has resulted in the fact that a number of psychologists have formed different views on these types of disorders. For example, the scientist-psychologist G. Sukhareva noted that emotional disturbances at primary school age are often observed in children suffering from neurasthenia, which was characterized by excessive excitability.

Psychologist J. Milanich had a different idea about these disorders. He found that emotional-volitional disorders include 3 groups of emotional disorders;

Acute emotional reactions, which are characterized by the coloring of certain conflict situations, which manifested themselves in aggression, hysteria, reactions of fear or resentment;
A state of increased tension – anxiety, fearfulness, decreased mood.
Dysfunction of the emotional state, which manifested itself in a sharp transition from positive emotional phenomena to negative ones and also in the reverse order.

However, the most detailed clinical picture emotional disorders were N.I. Kosterina. She divides emotional disorders into 2 large groups, which are characterized by an increase in the level of emotionality and, accordingly, a decrease in it.

The first group includes such conditions as:

Euphoria, which is characterized by an inadequate increase in mood. child in this state, as a rule, has increased impulsiveness, impatience and a desire for dominance.
Dysphoria is the opposite form of euphoria, characterized by the manifestation of such emotions as anger, irritability, aggressiveness. It is a type of depressive syndrome.
Depression is a pathological condition characterized by the manifestation of negative emotions and behavioral passivity. A child in this state feels depressed and sad.
Anxiety syndrome is a condition in which a child feels unreasonably worried and expressed nervous tension. Expressed in constant mood swings, tearfulness, lack of appetite, hypersensitivity. Often this syndrome develops into a phobia.
Apathy – serious condition, in which the child feels indifferent to everything that happens around him, and is also characterized by a sharp decrease in initiative functions. Most psychologists argue that the loss of emotional reactions is combined with a decrease or complete loss of volitional impulses.
Paratamia – characteristic disorder emotional background, in which the experience of one specific emotion is accompanied by external manifestations of completely opposite emotions. Often observed in children suffering from schizophrenia.

The second group includes:

Attention deficit hyperactivity disorder is characterized by symptoms such as motor disorientation and impulsivity. It follows that the key signs of this syndrome are distractibility and excessive motor activity.
Aggression. This emotional manifestation is formed as part of a character trait or as a reaction to environmental influences. In any case, the above violations need correction. However, before correcting pathological manifestations, the main causes of the disease are first identified.

Diagnosis of disorders

For subsequent therapy of disorders and its effectiveness, timely diagnosis is very important emotional development child and his disorders. There are many special methods and tests that assess the development and psychological state of a child, taking into account his age characteristics.

Diagnosis of preschool children includes:

Diagnosis of anxiety level and its assessment;
Study of psycho-emotional state;
Luscher color test;
Studying the child’s self-esteem and personality traits;
Study of the development of volitional qualities.

Seeking psychological help is necessary if a child experiences certain difficulties in learning, communicating with peers, behavior, or has certain phobias.

Parents should also pay attention if the child experiences any emotional experiences, feelings, and also if his condition is characterized as depressed.

Methods for correcting emotional disorders

A number of domestic and foreign scientists in the field of psychology identify a number of techniques that make it possible to correct emotional-volitional disorders in children. These methods are usually divided into 2 main groups: individual and group, but such a division does not reflect the main goal of correcting mental disorders.

Mental correction of affective disorders in children is an organized system of psychological influences. This correction is mainly aimed at:

Alleviating emotional discomfort
Increased activity and independence
Suppression of secondary personal reactions (aggression, excessive excitability, anxiety, etc.).
Correction of self-esteem;
Formation of emotional stability.

World psychology includes 2 main approaches to the psychological correction of a child, namely:

Psychodynamic approach. Advocates for the creation of conditions that make it possible to suppress external social barriers, using methods such as psychoanalysis, play therapy and art therapy.
Behavioral approach. This approach allows you to stimulate the child to assimilate new reactions aimed at the formation of adaptive behavioral forms and, conversely, suppresses non-adaptive forms of behavior, if any. Includes such methods of influence as behavioral and psychoregulatory training, which allow the child to consolidate learned reactions.

When choosing a method of psychological correction of emotional disorders, one should proceed from the specifics of the disorder, which determines the deterioration of the emotional state. If a child has intrapersonal disorders, then an excellent way would be to use play therapy (not computer therapy), and the method of family psychocorrection has also proven itself well.

If there is a predominance of interpersonal conflicts, group psychocorrection is used, which allows optimizing interpersonal relationships. When choosing any method, the severity of the child’s emotional instability must be taken into account.

Methods of psychological correction such as game therapy, fairytale therapy, etc. work effectively if they correspond to the mental characteristics of the child and the therapist.

The age of a child up to 6 years (preschool period) is the most important period of his development, since it is during this period that the child’s personal foundations, volitional qualities are formed, and the emotional sphere also rapidly develops.

Volitional qualities develop mainly due to conscious control over behavior, while maintaining certain behavioral rules in memory.

The development of these qualities is characterized as the general development of personality, that is, mainly by shaping the will, emotions and feelings.

Consequently, for the successful emotional-volitional upbringing of a child, parents and teachers need to especially pay attention to creating a positive atmosphere of mutual understanding. Therefore, many experts recommend that parents formulate the following criteria for their child:

When communicating with a child, you must maintain absolute calm and show your goodwill in every possible way;
You should try to communicate with your child more often, ask him about anything, empathize, and be interested in his hobbies;
Joint physical labor, games, drawing, etc. will have a positive effect on the child’s condition, so try to pay him as much attention as possible.
It is necessary to ensure that the child does not watch films or play games with elements of violence, as this will only aggravate his emotional state;
Support your child in every possible way and help him build confidence in himself and his abilities.