I. HALLUCINATORY AND DELUSIONAL SYNDROMES Hallucinosis is a condition characterized by an abundance of hallucinations within one analyzer and not accompanied by clouding of consciousness. The patient is anxious, restless, or, conversely, inhibited. The severity of the condition is reflected in the patient's behavior and attitude towards hallucinations.
Verbal auditory hallucinosis: voices are heard talking to each other, arguing, condemning the patient, agreeing to destroy him. Auditory hallucinosis is defined as clinical picture the same name alcoholic psychosis; the syndrome can be isolated in other intoxication psychoses, in neurosyphilis, in patients with vascular lesions of the brain.
It is observed in psychoses of late age, with organic damage to the central nervous system. Patients with tactile hallucinosis feel insects, worms, microbes crawling on and under the skin, touching the genitals; criticism of the experience is usually absent.
Visual hallucinosis is a common form of hallucinosis in the elderly and people who have suddenly lost their vision; it also occurs with somatogenic, vascular, intoxication and infectious psychoses. With hallucinations of Charles Bonnet BLIND (blind during life or from birth), patients suddenly begin to see on the wall, in the room, bright landscapes, sunlit lawns, flower beds, playing children, or simply abstract, bright “images”.
Usually, with hallucinosis, the patient’s orientation in place, time and self is not disturbed, there is no amnesia of painful experiences, i.e., there are no signs of clouding of consciousness. However, in acute hallucinosis with life-threatening the patient's content sharply increases the level of anxiety, and in these cases consciousness can be affectively narrowed.
Paranoid syndrome is a syndrome of delusion, characterized by delirious interpretation of the facts of the surrounding reality, the presence of a system of evidence used to “justify” errors of judgment. The formation of delusions is facilitated by personality traits, manifested by significant strength and rigidity of affective reactions, and in thinking and actions - thoroughness and a tendency to detail. In terms of content, this is litigious delirium, invention, jealousy, persecution.
Paranoid syndrome may be the initial stage in the development of schizophrenic delusions. At this stage there are still no hallucinations and pseudo-hallucinations, no phenomena of mental automatism. Paranoid syndrome exhausts the psychopathological symptoms of paranoid psychopathy, alcoholic paranoid
Hallucinatory-paranoid syndromes, in which hallucinatory and delusional disorders, organically related, are presented in different proportions. When there is a significant predominance of hallucinations, the syndrome is called hallucinatory; when delusional ideas predominate, it is called paranoid.
Paranoid syndrome also denote the paranoid stage of delusion development. At this stage, the previous system of erroneous conclusions corresponding to paranoid delusions may persist, but signs of its disintegration are revealed: absurdities in behavior and statements, the dependence of delusions on the leading affect and on the content of hallucinations (pseudo-hallucinations), which also appear at the paranoid stage.
Kandinsky-Clerambault mental automatism syndrome is a special case of hallucinatory-paranoid syndrome and includes pseudohallucinations, phenomena of alienation of mental acts - automatisms and delusions of influence. Being in the grip of perceptual disturbances, the patient is confident in their violent origin, in their creation - this is the essence of automatism.
Automatism can be ideational, sensory or motor. The patient believes that they are controlling his thoughts, “making” them parallel, forcing him to mentally utter curses, putting other people’s thoughts into his head, taking them away, reading them. In this case we are talking about ideptor automatism. This type of automatism includes pseudohallucinations.
Sensory automaticity concerns more disorders sensory knowledge and corresponds to the statements of patients about “doneness”: Feelings - “cause” indifference, lethargy, a feeling of anger, anxiety Sensations - “cause” pain in different parts body, sensation of electric current passing, burning, itching. With the development of motor automatism, the patient becomes convinced that he is losing the ability to control his movements and actions: by someone else’s will, a smile appears on his face, his limbs move, complex actions, such as suicidal acts.
There are chronic and acute hallucinatory-paranoid syndromes. Chronic hallucinatory-paranoid syndrome gradually becomes more complex, the initial symptoms acquire new ones, and a full-blown syndrome of mental automatism is formed.
Acute hallucinatory-paranoid syndromes can be reduced under the influence of treatment and can quickly transform into others psychopathological syndromes. The structure of acute hallucinatory-paranoid syndrome contains acute sensory delirium, delusional perception of the environment, confusion or significant intensity of affect;
Acute hallucinatory-paranoid syndrome is often a stage in the development of acute paraphrenia and oneiric state. Hallucinatory-paranoid syndromes can be diagnosed in all known psychoses, except manic-depressive.
II. SYNDROMES OF INTELLECTUAL DISORDERS Intelligence is not a separate, independent mental sphere. It is considered as the ability for mental, cognitive and creative activity, to acquiring knowledge, experience and applying them in practice. With intellectual disabilities, the ability to: analyze material, combine, guess, implement thought processes synthesis, abstraction, create concepts and inferences, draw conclusions. education of skills, acquisition of knowledge, improvement of previous experience and the possibility of its application in activities.
Dementia (dementia) is a persistent, difficult-to-recover loss of intellectual abilities caused by a pathological process, in which there are always signs of a general impoverishment of mental activity. There is a decrease in intelligence from the level acquired by a person during life, its reverse development, impoverishment, accompanied by a weakening of cognitive abilities, impoverishment of feelings and changes in behavior.
With acquired dementia, sometimes memory and attention are primarily impaired, and the ability to judge is often reduced; the core of personality, criticism and behavior remain intact for a long time. This type of dementia is called partial or lacunar (partial, focal dysmnestic). In other cases, dementia is immediately manifested by a decrease in the level of judgment, violations of criticism, behavior, and leveling of the patient’s characterological characteristics. This type of dementia is called complete or total dementia (diffuse, global).
Organic dementia can be lacunar and total. Lacunar dementia is observed in patients with cerebral atherosclerosis, cerebral syphilis (vascular form), Total - with progressive paralysis, senile psychoses, in Pick's and Alzheimer's diseases.
Epileptic (concentric) dementia is characterized by extreme sharpening of characterological features, rigidity, and slowness of the course of all mental processes, slower thinking, its thoroughness, difficulty switching attention, impoverished vocabulary, a tendency to use the same cliched expressions. In character this is manifested by rancor, vindictiveness, petty punctuality, pedantry and, along with this, hypocrisy and explosiveness.
With steady progression pathological process, with increasing rigidity and thoroughness, a person turns out to be less and less capable of diverse social functioning, gets bogged down in trifles, the range of his interests and activities becomes increasingly narrowed (hence the name of dementia - “concentric”).
Schizophrenic dementia characterized by a decrease in energy potential, emotional impoverishment, reaching the level of emotional dullness. An uneven disturbance of intellectual processes is revealed: in the absence of noticeable memory disorders and a sufficient level of formal knowledge, the patient turns out to be completely socially maladapted, helpless in practical matters. There is autism, a violation of the unity of the mental process (signs of mental splitting) in combination with inactivity and unproductivity.
III. AFFECTIVE SYNDROMES Manic syndrome in its classic version includes a triad of psychopathological symptoms: 1) increased mood; 2) acceleration of the flow of ideas; 3) speech motor excitation. These are obligate (basic and constantly present) signs of the syndrome. Increased affect affects all aspects of mental activity, which is manifested by secondary, unstable (optional) signs of manic syndrome.
There is an unusual brightness of perception of the environment, in the memory processes there are phenomena of hypermnesia In thinking - a tendency to overestimate one’s capabilities and one’s own personality, short-term delusional ideas of greatness In emotional reactions - anger In the volitional sphere - increased desires, drives, rapid switching of attention Mimicry, pantomime and all the patient's appearance expresses joy.
Depressive syndrome is manifested by a triad of obligate symptoms: Decreased mood, Slowing down of ideas, Speech retardation. Optional signs of depressive syndrome: In perception - hypoesthesia, illusory, derealization and depersonalization phenomena In the mnestic process - a violation of the sense of familiarity In thinking - overvalued and delusional ideas of hypochondriacal content, self-accusation, self-abasement, self-incrimination In the emotional sphere - reactions of anxiety and fear; motor-volitional disorders include suppression of desires and drives, suicidal tendencies. Sorrowful facial expression and posture, quiet voice.
Anxiety-depressive syndrome (agitated depression syndrome), manic stupor and unproductive mania in their origin are so-called mixed conditions, transitional from depression to mania and vice versa.
The psychopathological triad traditional for classical depression and mania is violated here, effective syndrome loses some of its properties and acquires signs of a polar opposite affective state. Thus, in the syndrome of agitated depression, instead of motor retardation, there is excitement, which is characteristic of a manic state.
Manic stupor syndrome is characterized by motor retardation with elevated mood; Patients with nonproductive mania experience increased mood, motor disinhibition, combined with a slower pace of thinking.
Depressive-paranoid syndrome is classified as atypical for the affective level. A special feature is the intrusion into the affective syndrome corresponding to manic-depressive psychosis, symptoms from other nosological forms of schizophrenia, exogenous and exogenous-organic psychoses.
Paraphrenic delusions of enormity, described by Cotard, can also be attributed to atypical affective states: hypochondriacal experiences, which are based in depression on a feeling of one’s own change, take on a grotesque character with the patient’s confidence in the absence internal organs, with denial of the outside world, life, death, with ideas of doom to eternal torment. Depression with hallucinations, delusions, and confusion is described as fantastic melancholia. Blackout of consciousness at the height of a manic state gives grounds to speak of confused mania.
Asthenodepressive syndrome. Some authors consider this concept of syndrome to be theoretically untenable, believing that we are talking about a combination of two simultaneously existing syndromes - asthenic and depressive. At the same time, attention is drawn to the clinical fact that asthenia and depression are mutually exclusive conditions: the higher the proportion of asthenic disorders, the less the severity of depression; with increasing asthenia, the suicidal risk decreases, motor and ideational retardation disappears.
In the practical work of a doctor, asthenodepressive syndrome is diagnosed as one of the most common within the framework of borderline mental pathology. Manic and depressive syndromes can be a stage in the formation of psychopathological symptoms of any mental illness, but in their most typical manifestations they are presented only in manic-depressive psychosis.
IV. SYNDROMES OF MOTOR AND VOLITIONAL DISORDERS Catatonic syndrome is manifested by catatonic stupor or catatonic agitation. These outwardly different states are actually united in their origin and turn out to be only different phases of the same phenomenon.
In accordance with the research of I.P. Pavlov, the symptoms of catatonia are the result of a painful weakness of nerve cells, for which ordinary stimuli turn out to be super strong. The inhibition that develops in the cerebral cortex is protective and transcendental. If inhibition covers not only the entire cortex, but also the subcortical region, symptoms of catatonic stupor appear. The patient is inhibited, does not care for himself, does not respond to speech addressed to him, does not follow instructions, and mutism is noted.
Some patients lie motionless, turned to the wall, in a uterine position with the chin brought to the chest, with arms bent at the elbows, knees bent and legs pressed to the stomach for days, weeks, months or years.
The uterine position indicates the release of more ancient reactions characteristic of early age period developments that in an adult are inhibited by later, higher-order functional formations. Another very characteristic position is also lying on your back with your head raised above the pillow - a symptom of an air cushion.
Disinhibition of the sucking reflex leads to the appearance of the proboscis symptom; when you touch the lips, they fold into a tube and protrude; In some patients, this position of the lips occurs constantly. The grasping reflex (normally characteristic only of newborns) is also disinhibited: the patient grasps and tenaciously holds everything that accidentally touches his palm.
With incomplete stupor, echosymptoms are sometimes observed: echolalia - repetition of the words of someone around, echopraxia - copying the movements of other people. The basis of echosymptoms is the disinhibition of the imitative reflex, which is characteristic of children and contributes to their mental development. The release of stem postural reflexes is expressed by catalepsy (waxy flexibility): the patient maintains the position given to his body and limbs for a long time.
Phenomena of negativism are observed: the patient either does not fulfill what is required at all (passive negativism), or actively resists, acts opposite to what is required of him (active negativism). In response to a request to show his tongue, the patient compresses his lips tightly, turns away from the hand extended to him for a handshake and removes his hand behind his back; turns away from the plate of food placed in front of him, resists the attempt to feed him, but grabs the plate and attacks the food when trying to remove it from the table. I. P. Pavlov considered this an expression of phase states in the central nervous system and associated negativism with the ultraparadoxical phase
In the paradoxical phase, weaker stimuli can produce a stronger response. Thus, patients do not respond to questions asked in a normal, loud voice, but answer questions asked in a whisper. At night, when the flow of impulses into the central nervous system from the outside it sharply decreases, some stuporous patients disinhibit, begin to move quietly, answer questions, eat, wash; with the onset of morning and an increase in the intensity of irritation, the numbness returns. Patients with stupor may not have other symptoms, but more often there are hallucinations and delusional interpretation of the environment. This becomes clear when the patient disinhibits.
Depending on the nature of the leading symptoms, three types of stupor are distinguished: 1) with phenomena of waxy flexibility, 2) negativistic, 3) with muscle numbness. The listed options are not independent disorders, but represent stages of stuporous syndrome, replacing one another in the specified sequence with the worsening of the patient’s condition.
Catatonic excitation is senseless, undirected, sometimes taking on a motor character. The patient’s movements are monotonous and are essentially subcortical hyperkinesis; aggressiveness, impulsive actions, echopraxia, negativism are possible. Facial expressions often do not match poses; sometimes paramimic expression is observed: the facial expressions of the upper part of the face express joy, the eyes laugh, but the mouth is angry, the teeth are clenched, the lips are tightly compressed and vice versa. Facial asymmetries can be observed. In severe cases, there is no speech, the excitement is mute, or the patient growls, hums, shouts out individual words, syllables, or pronounces vowels.
Some patients exhibit an uncontrollable desire to speak. At the same time, the speech is pretentious, stilted, speech stereotypies, perseveration, echolalia, fragmentation, verbigeration are noted - meaningless stringing of one word onto another. Transitions from catatonic excitation to a stuporous state or from stupor to a state of excitation are possible.
Catatonia is divided into lucid and oneiric. Lucid catatonia occurs without clouding of consciousness and is expressed by stupor with negativism or numbness or impulsive excitement. Oneiric catatonia includes oneiric stupor, catatonic agitation with confusion, or stupor with waxy flexibility. Catatonic syndrome is more often diagnosed with schizophrenia, sometimes with epilepsy or exogenous-organic psychoses.
Hebephrenic syndrome is close to catatonic both in origin and in manifestations. Characterized by excitement with mannerisms, pretentiousness of movements and speech, foolishness. Fun, antics and jokes do not infect others. Patients tease, grimace, lisp, distort words and phrases, tumble, dance.
As part of sluggish schizophrenia, adolescents are sometimes diagnosed with heboidism - an incompletely developed hebephrenic state, manifested by a touch of foolishness, swagger in behavior, impaired drives and antisocial tendencies.
V. NEUROTIC SYNDROMES This pathology is distinguished by the partiality of mental disorders, a critical attitude towards them, the presence of consciousness of the disease, an adequate assessment of the environment and abundant somatovegetative symptoms accompanying the weakness of mental functions. Characterized by the absence gross violations knowledge of the environment. In the structure of neurotic syndromes there are no disorders of objective consciousness, delusional ideas, hallucinations, dementia, manic state, stupor, or agitation.
With true neurotic disorders, the personality remains intact. Moreover, the effect of external harmfulness is mediated by the patient’s personality, its reactions, which characterize the personality itself, its social essence. All of the above features make it possible to qualify this type of disorder as borderline mental pathology, a pathology located on the border between normality and pathology, between somatic and mental illnesses.
Neurasthenic (asthenic) syndrome is characterized by irritable weakness. Due to acquired or congenital deficiency internal inhibition, excitement is not limited by anything, which is manifested by irritability, impatience, increased exhaustion of attention, sleep disturbances (superficial sleep, with frequent awakenings).
There are hyper- and hyposthenic variants of asthenia. With hypersthenic asthenia, the preservation of the excitatory process and the weakness of the inhibitory process leads to the advancement of a tendency to explosive, explosive reactions. With hyposthenic asthenia, there are all signs of weakness not only of the inhibitory, but also of the excitatory process: extreme fatigue with mental and physical activity, low performance and productivity, memory impairment.
Obsessive-phobic syndrome manifests itself as psychopathological products in the form of various obsessions and phobias. During this period, anxiety, suspiciousness, and indecision intensify, and signs of asthenia are revealed.
Hypochondriacal syndrome in its content can be: 1) asthenic, 2) depressive, 3) phobic, 4) senestopathic, 5) delusional.
In neurotic conditions we are talking about simple, non-delusional hypochondria, expressed by exaggerated attention to one’s health and doubts about its well-being. Patients are fixated on unpleasant sensations in their body, the source of which can be the neurotic state itself and the somatovegetative changes caused by it, depression with its sympathicotonia and other reasons. Patients often seek help from various specialists and are examined extensively. Favorable research results calm patients for a while, and then anxiety increases again, thoughts about a possible serious illness return. The occurrence of hypochondriacal symptoms may be associated with iatrogenicity.
Hysterical syndrome is a combination of symptoms of any disease, if in origin these symptoms are a consequence of increased suggestibility and self-hypnosis, as well as personality traits such as egocentrism, demonstrativeness, mental immaturity, increased imagination and emotional lability. The condition is characteristic of hysterical neurosis, hysterical personality development, hysterical psychopathy.
Psychopathic syndrome. This is a persistent syndrome of socially maladaptive disharmony in the emotional and volitional spheres of the patient, which is an expression of character pathology. Disorders do not concern the cognitive process. Psychopathic syndrome is formed in certain conditions of the social environment on the basis of congenital (psychopathy) and acquired (post-processual state) changes in the highest nervous activity. Pathology is considered borderline in psychiatry.
Variants of the psychopathic syndrome correspond to clinical forms of psychopathy and are manifested by excitable traits or reactions of increased inhibition. The first case is characterized by emotional incontinence, anger, conflict, impatience, quarrelsomeness, volitional instability, tendency to abuse alcohol and use drugs.
A feature of the other option is weakness, exhaustion of personality reactions, insufficient activity, low self-esteem, and a tendency to doubt.
All the many syndromes in psychopathology increasingly do not occur independently. In most cases, syndromes are combined into complex, difficult-to-diagnose complexes. When caring for “complex” patients, every doctor must take into account that a somatic illness can often be a manifestation of one or another psychopathological syndrome
Syndrome is a typical set of pathogenetically related symptoms.
Syndromes, depending on predominant defeat of one or another sphere of mental activity, are divided into neurosis-like syndromes, syndromes of upset consciousness, delusional syndromes, syndromes of affective and motor-volitional disorders, etc.
*WITH. amentive - (“incoherent” clouding of consciousness) syndrome of stupefaction, characterized by deep disorientation, incoherent thinking, affect of bewilderment, motor stereotypies (like yactation) and subsequent complete amnesia.
*WITH. amnestic (Korsakov's syndrome) is a disorder manifested by a variety of mnestic disorders (fixation, retrograde and anterograde amnesia, confabulation) against a background of euphoria.
*WITH. asthenic– neurotic syndrome, manifested by increased mental and physical exhaustion, various viscero-vegetative disorders and sleep disorders.
*WITH. hallucinosis– a pathological condition, the clinical picture of which is practically completely exhausted by the presence true hallucinations.
-acute hallucinosis- a type of hallucinosis, characterized by an affect of confusion, anxiety, with sensually vivid hallucinatory experiences and motor agitation.
- chronic hallucinosis– a type of hallucinosis, characterized by monotony of affect and monotony of hallucinations.
*WITH. hallucinatory-paranoid- a disorder characterized by the predominance of pseudohallucinations against the background of delusional ideas (persecution, influence) and other mental automatisms.
*WITH. Ganzer– a variant of psychogenic twilight darkness consciousness, characterized by the phenomena of “mimic responses” and “mimic actions”.
*WITH. hebephrenic- characterized by mannered and foolish forms of behavior, motiveless actions and unproductive euphoria (O.V. Kerbikov’s triad).
*WITH. delirious- (“hallucinatory” stupefaction) is a form of stupefaction characterized by disorders of allopsychic orientation and an abundance of fragmentary true hallucinations (illusions).
*WITH. depressive– a variant of the affective syndrome, characterized by decreased mood, motor retardation and slower thinking (“depressive” triad).
*WITH. hypochondriacal – a disorder characterized by the patient's unreasonable concern about his or her health.
*WITH. hysterical– neurotic syndrome, characterized by the presence of conversion and (or) dissociative disorders against the background specific features personality.
*WITH. Capgras- a disorder characterized by impaired recognition and identification of people.
*WITH. catatonic- a disorder characterized by a combination of severe motor disorders(in the form of hypo-, hyper-, parakinesia) with a variety of psychopathological manifestations.
*-lucid catatonia– catatonic syndrome without oneiric stupefaction.
*-oneiric catatonia– catatonic syndrome combined with oneiric stupefaction.
*S. Kotara- paraphrenic hypochondriacal delirium.
*WITH. frontal- a disorder characterized by a predominance affective disorders against the background of intellectual-mnestic decline, spontaneity or disinhibition.
*WITH. manic- an affective syndrome characterized by high mood, motor disinhibition and acceleration of thinking (“manic triad”).
*WITH. obsessive – a neurotic syndrome manifested by a variety of obsessions (often in combination with rituals) against the background of psychasthenic personality characteristics.
*WITH. oneiric (“dreamlike” stupefaction) - a form of clouding of consciousness, characterized by auto- and allopsychic disorientation, an influx of pseudo-hallucinations of fantastic content.
*WITH. paranoid– a disorder characterized by the predominance of primary delusions of persecution and (or) influence against the background of pseudohallucinations of fantastic content.
*WITH. paranoid – a disorder, the clinical picture of which is almost completely exhausted by primary (interpretive) delusion.
-spicy option - a type of paranoid syndrome in which delusions arise as an “insight” and are formed against the background of pronounced affective tension (anxiety).
- chronic variant – a type of paranoid syndrome, with progressive development of delirium.
*WITH. paraphrenic- a disorder manifested by absurd delusions (persecution, influence, grandeur), various phenomena of mental automatism, fantastic confabulations and euphoria.
*WITH. mental automatism (Kandinsky-Clerambault) – a disorder characterized by a variety of mental automatisms in combination with delusional ideas (persecution, influence) and pseudohallucinations.
*WITH. psychoorganic – a disorder characterized by severe intellectual decline, incontinence of affect and mnestic disturbances (“Walter-Bühel triad”).
- apathetic option - a type of syndrome with a predominance of the phenomena of aspontaneity, narrowing of the range of interests, and indifference.
-asthenic variant- a type of syndrome with a predominance of mental and physical exhaustion.
- local (diffuse) option- varieties of the syndrome, differing in the severity of the disorders and the degree of preservation of the “core of personality.”
- acute (chronic) variant– varieties of the syndrome, differing in the severity of development and duration of the course.
- euphoric version - a type of syndrome with a predominance of the phenomena of complacency, disinhibition of drives and sharp decline critics.
- explosive option – a type of syndrome with a predominance of psychopathic-like disorders (extreme irritability, brutality).
*WITH. twilight (“concentric”) clouding of consciousness – a form of clouding of consciousness, characterized by paroxysmal occurrence, automaticity of actions, deep disorientation and complete subsequent amnesia.
*WITH. puerilism– a type of psychogenic (hysterical) twilight stupefaction with “childish” behavior, speech, and facial expressions.
*WITH. epileptiform - paroxysmal (convulsive and non-convulsive) disorders that develop with exogenous or endogenous organic damage to the brain.
Literature:
- Balabanova L.M. Forensic psychopathology (issues of determining the norm and deviations), - D.: Stalker, 1998. – p. 74 -108.
- Vygotsky L.S. Dynamics and structure of a teenager’s personality. Pedology of a teenager. M., L.; 1931.
- Kaplan G., Sadok B. “Clinical psychiatry” - translation from English, M. Geotar Medicine, 1999. P. 223-231, 269-288.
- Lee S.P. “Forensic Psychiatry” UMK, Minsk, MIU Publishing House, 2006. P. 17-25.
- Lichko A.E. Features of self-destructive behavior with various types of accentuations in adolescents. Self-destructive behavior in adolescents. – L., 1991.
- Lichko A.E. Adolescent psychiatry. M., 1985., pp. 20-32
- Misyuk M.N. “Physiology of behavior”, UMC, publishing house MIU, 2008, p. 179, 197, 209, 232, 244.
- Morozov G.V. "Forensic Psychiatry". "Legal Literature", Moscow, 1978, p. 143-150.
- Polivanova K.N. Psychological analysis of crises of age-related development. // Questions of psychology, 1994 No. 1, pp. 61-69.
- Psychology individual differences. Texts edited by Yu.B. Gippenreiter, V.Ya. Romanova. M.: Moscow State University Publishing House, 1982. pp. 262-269.
- Remschmidt H. Adolescence and youth: Problems of personality formation. M., 1994. P.150-158.
- Usova E.B. Psychology of social deviations (deviations). Mn., 2005. P.4-10.
- Shapovalenko I.V. Age-related psychology. M., 2005. P.242-261.
- Elkonin D.B. Selected psychological works. M., 1989. P.277, 72-75.
Psychopathology- a branch of psychology that studies the causes of mental disorders and anomalies, carries out their diagnosis, psychotherapy and psychocorrection.
The main stages of the development of psychopathology.
First stage. Psychopathology arose as a result of the study of individual diseases and the generalization of the data from this study. It originated at the end of the 18th century in the doctrine of mental illness of the Italian psychiatrist Chiaruggi. For the first time, a definition of dementia was given, the division of hallucinations and, the doctrine of. Founder general teaching the outstanding psychiatrist Griesinger spoke about mental illness.
Second phase in the development of general psychopathology is associated with the activities of the English psychiatrist Model, who applied Darwin’s evolutionary method to the study of mental illness. An important point of his research was the assertion that the clinical picture of psychosis depends not only on the characteristics of external harms, but that external harms cause psychosis through the internal conditions of brain activity.
Third stage the development of general psychopathology is associated with activity - experimentally proved the reflex nature of mental activity, showed that mental activity arises as a result of the relationship of a person, an individual, with the outside world. In the 19th century German psychiatrist Emingauz was the first to express the idea that general psychopathology is a general doctrine of mental illness and is part general pathology person. Further development The general doctrine of psychosis is associated with Meinert, Wernicke, and also Jackson. They begin to understand mental activity differently: as a result of intracerebral relationships. The second half and end of the 19th century is characterized by a decrease in the general theoretical level in the consideration of mental illness; on the other hand, the end of the 19th century is characterized by the fact that enormous work was done by psychiatrists in all countries. TO end of the 19th century centuries include classical research in the field of pseudohallucinations and phenomena and the study of memory. At the beginning of the 20th century, in the development of general psychopathology there was a shift towards psychology, and psychopathologists ceased to be interested in brain research.
Fourth stage in the development of general psychopathology is associated with teaching. In his research, he shows that the basis of mental activity is reflex activity, which is at the same time physiological and at the same time mental.
Differences between psychopathology and other disciplines.
If private psychiatry studies individual diseases, then general psychopathology studies general patterns mental disorder. Psychopathological typical conditions may occur when various diseases, therefore, they have a common meaning. General psychiatry is based on the generalization of all those changes that occur during individual mental illnesses.
Department of Psychiatry and NarcologyNorthwestern Medical
University named after I.I. Mechnikov
Professor, Doctor of Medical Sciences Pashkovsky V.E.
Symptom (K. Jaspers)
Symptoms are things thatrecognized with each repetition
as identical.
In the course of historical development
psychopathology behind every symptom
the status of nosological was recognized
units (hallucinations, delusions, types
behavior: pyromania, kleptomania and
etc.).
What is a syndrome?
Sustainableset of series
symptoms with a single
pathogenesis.
The syndrome may
make a picture
the whole disease or
parts of it, being at
this manifestation
pathology of one
system or organ
What is a syndrome?
The syndrome is notequivalent
diseases like
nosological
unit, because he can
be associated with many
diseases
What is a syndrome?
Sometimes the termsyndrome
used as
synonym for disease
when etiology and
pathogenesis is not clear.
What is a syndrome?
The term "syndrome" is notcorresponds to the term
symptom complex,
which
characterizes
symptomatology
diseases in a compressed
form.
The concept of syndromes according to A.V. Snezhnevsky
Syndrome (“running together” symptoms) - a setsymptoms that have a common development mechanism. Himself
itself a symptom outside the syndrome is devoid of clinical
sense.
Selected disorders mental functions
found in most healthy individuals.
Pathological phenomena are systemic in nature and
expressed in the form of syndromes.
From syndromes and their natural sequence
shifts - pathokinesis - clinical is developing
picture of the disease in its statics and dynamics
(Snezhnevsky, 1960; Davydovsky, 1962).
Syndrome parameters
SyndromeStructure
Syndrome
Level (positive-negative)
Syndrome
Dynamics (syndromokinesis,
syndromotaxis)
Syndrome
Relationships with others
syndromes (simple and complex)
Syndrome
Etiopathogenesis
Syndrome
Brain localization
Syndrome
Personality
Syndrome
Heaviness
Syndrome
Disease
Structure of the syndrome
Symptomsobligatory
additional
optional
Obligatory symptoms
SyndromeObligatory sign
Asthenic
Fatigue
Affective
Decrease and increase in mood
Depersonalization
Alienation of somatic and
mental functions
Kandinsky-Clerambault syndrome
The feeling of being done
external influences
Catatonic
Disorganization of behavior,
abnormal movement disorders:
from motor excitement to
stupor.
Syndromes of confusion
Detachment from the real world
disorientation, loss of coherence
experiences, memory impairment.
Types of relationships: syndrome-symptom
Types of relationships: syndromesymptomThe peculiarity of the relationship between symptom and syndrome is due to
instability of the syndrome.
Further study of the structure of syndromes led to the identification
obligatory, additional and optional symptoms (G. Stertz,
1928, Yu.M. Saarma, L.S. Mehilane, 1980, A.O. Bukhanovsky, 1998).
The former are a mandatory component of it. They define
mental content of the syndrome from the beginning of its occurrence to
termination.
The latter characterize the signs that naturally occur within its framework,
but mighty and absent
Still others depend on pathoplastic factors that modify it
structure.
Positive and negative syndromes
Productive psychopathological syndromesare an indicator of depth and generalization
mental activity, reflecting that
side of pathogenesis, which indicates
existence, and often about the quality of protective
body strength.
Negative syndromes reflect the other side
pathogenesis of mental illness, which
testifies to the existence and quality
broken defense mechanisms body
Positive syndromes
NeuroticAffective
Depersonalization-derealization
Confusion
Hallucinatory-delusional
Movement disorders
Blackouts
Epileptiform
Psychoorganic
Negative syndromes
Reactive labilityAsthenic personality shift
Stenic personality shift
Psychopathic-like personality shift
Decrease in energy potential
Decline and personality regression
Amnestic disorders
Dementia
Marasmus
The concept of psychosis.
A fundamental, radical distortion of the picture of the real world in the mindpatient. This is due deep depression, delirium,
hallucinations and other profound mental disorders
activities
Severe behavioral disturbances associated with the patient's inability
take into account the demands of reality and healthy tendencies
own personality.
The patient's lack of understanding of his own mental disorder
or, in other words, a lack of critical attitude towards
disease - anosognosia.
Non-psychotic disorders.
Preservation of the patient's ability to display realisticallyreality. Distortions of the general picture of the world and individual aspects
lives are possible here too, but they are accessible to a certain extent
corrections by past and present experience;
Generally adequate social behavior based on accounting
real relationships and the dominance of non-painful tendencies
personality.
Full or at least clear understanding by the patient of the fact
available to him mental disorders, conscious desire for
their overcoming and compensation.
Psychotic and non-psychotic syndromes
Non-psychoticPsychotic
Asthenic
Obsessive-phobic
Hypochondriacal
Hypochondriacal
Hysterical
Hysterical
Depersonalization-derealization
Affective
Affective
Hallucinatory-delusional
Catatonic, hebephrenic
Syndromes of confusion
Dementia
apathetic.
amnestic, psychoorganic,
apathetic.
Syndromokinesis
Syndromokinesis - process, occurrencedevelopment, existence, relationship and
disappearance structural elements syndrome.
Syndromes, with the maximum possible number
elements are designated as expanded, with
in a limited number - as abortifacients.
Syndromokinesis (A.A. Portnov)
Transitory syndromes - with themthere is no syndrokinesis, they have nothing
precedes, does not replace it
other syndrome (example: lightning flashes, seizures)
Stage syndromes - when they are observed
development of one clinical phenomenon into
another.
End-to-end (axial) – Syndromes observed in
course of the entire illness
Relationships between axial and stage syndromes in alcoholism
Withdrawal symptomsEncephalope
tic
Delirious
Syndrome
dependencies
Dismnesty
chesical
Soporous
Comatose
Syndromotaxis - the order of alternation, combination and disintegration of symptom complexes and syndromes
Syntropy is the relationship between syndromes in the formmutual kinship
an example of syntropy is the relationship
amnestic syndrome with
dementia and amentia
Dystropia - relationships between syndromes
form of antagonism
an example of dystropia is
antagonism between amentive and
hebephrenic syndrome.
Complex syndrome
When variouspsychopathological conditions between
they may be interconnected,
leading to the formation new system
– a complex syndrome, which is the first time
drew the attention of I.G. Orshansky (1910).
Valence of syndromes I - depressive, II - hypochondriacal, hysterical, manic, III - anxious, IV - CC, paranoid, amentive, demen
Valence of syndromesI - depressive, II - hypochondriacal, hysterical, manic, III - anxious, IV - CC,
paranoid, amentive, dementia, V- paraphrenic, VI- asthenic, DDS, hallucinosis VII- OPD,
stuporous, oneiric VIII - paranoid, delirium, IX - catatonic, X - apathetic,
16
14
12
10
8
6
4
2
0
I
II
III
IV
V
VI
VII
VIII
IX
X
Ability to be combined with other syndromes
Valence of syndromes2
5
6
27
12
24
24
N
A
G-B
WITH
D
P
Ng
N - neurotic, A - affective, G-B - hallucinatory-delusional, C -
impaired consciousness, D- motor, P- psychoorganic, Ng negative
The relationship of syndromes according to O.V. Kerbikov
The largest number of positivecorrelations are found among neurotic
(neurasthenic, hypochondriacal, obsessive)
states, the least - twilight, catatonic,
dementia. So, we can assume that
valence reflects the degree of hardness
pathophysiological structures behind each
syndrome and is determined not so much by it
belonging to a certain circle
(neurotic, affective), how many properties
this syndrome to include in its structure or
prevent the onset of symptoms related to
various registers.
Syndrome-etiopathogenesis model of “reaction form” A. Hoche (1912)
“Etiological moments - internal and externalrepresent only the shocks from which they come to
action preformed mechanisms embedded in
degenerative, and, perhaps, in every normal
psyche.
These symptom complexes represent a variety of
options that appear depending on the internal and
external moments. But there's no way
establish here various subspecies and varieties;
Vague boundaries between syndromes will no longer become
distinct if you move them from one category to
another; it's the same as "counting on enlightenment
cloudy liquid, continuously pouring it from one
vessel into another"
Concept by K. Bonhoeffer (1911, 1912).
Completely differentetiological reasons
cause the same in
its main features
symptom complexes,
that appear or
don't appear in
depending on
available or not
relevant
exogenous, sometimes
complex
pathogenetic
factors.
STUN
DELIRIUM
AMENCIA
TWILIGHT BLACKNESS
CONSCIOUSNESS
ACUTE HALLUCINOSIS
H.H. concept Wieck (1956)
These syndromesmay arise
before development
acute
psychotic
states with
darkness
consciousness or
change them, but yourself
are characterized
lack of
disorders
consciousness and
reversibility.
TRANSITIONAL SYNDROMES
CHANGING INCIDENTS
DEPRESSIVE
SCHIZOFORMIC
AMNESTIC
DEPRESSION
ORGANICDEPRESSION
Etiopathogenetic
Classification
depression by
P. Kielholz
SYMPTOMATIC
SCHIZOPHRENIC
CYCLIC
PERIODIC
LATE (INVOLUTIONAL MELANCHOLIA)
CONSTITUTIONAL
NEUROTIC
DEPRESSION EXHAUSTION
REACTIVE
Syndrome-etiopathogenesis Conclusion
Thus, from a systemic point of viewapproach syndrome is a response, (sign)
hidden from direct internal observation
pathological processes.
According to K. Conrad (1967), every
psychotic symptom (syndrome)
determined on the one hand
biochemical “starting position”, with
the other side of its determinant is always
is a pathogenic cause, even where
it is not literally "external"
sense.
Syndrome-morphological localization
Anatomical and physiological direction in psychiatry XIXV. most clearly manifested in the works of Th.Meynert (1890) and
C. Wernike (1894).
Open C. Wernike aphasic symptom complex
predetermined all further construction of it
research.
Considering the anatomical basis of mental processes
associative fibers, he came to the conclusion that
a combination of symptoms (syndrome) or the entire clinical
the picture depends on what anatomical and physiological
the system has undergone certain changes.
Therefore, in his opinion, the classification should be based on
be based on anatomical changes, not
clinical options.
Requests for neuropsychopharmacology (van Praag HM. Nosologomania: a disorder of psychiatry.//World J Biol Psychiatry. 2000 Jul;1(3):151-8.
Dichotomy “nosology - form of reaction”Individual pictures of diseases
represent endless, complex networks
individual configurations - not the same as
plants that can be classified into
herbariums.
Psychopathological conditions that are included in
their composition is comparable to clouds: you can
describe the shape of the cloud, but every moment of it
the shape changes.
Anxious-aggressive depression
Anxious-aggressive depression isstress-induced depression
cortisol-induced and associated
with serotonin (SeTA – depression)
Concept of SeTA depression
Biochemical factorOppression
5gt 1A
receptor
psychopathology
Anxiety,
aggressiveness,
depressed
mood
Decline
tolerance to
psychotraumatic
events
Peculiarities
personalities
Conclusion
In the latest ICD classification -10 syndromes withindicating the localization are considered in the cluster
organic disorders « F07.2 Post-motional
syndrome" and "F07.8 Other organic disorders:
(right hemisphere organic affective
disorders)".
Progress in this direction is hampered by a “huge gap
between what we know about clinical forms And
manifestations of mental illness and incomplete,
one can say with rudimentary knowledge of their pathophysiology
and etiopathogenesis" (J.A. Costa e Silva, 1998).
Syndrome-personality
“The characteristics of each individual case arewrote V. Magnan (1995), - are determined
religious and other beliefs
the patient, his education, social
environment and daily activities.
In constructing delirium, the patient draws from all these
sources and places them each time on a single
common outline for all cases
a unique personal imprint.”
schizothymic
schizoid
schizophrenic
cyclothymic
cycloid
cyclophrenic
Syndrome-personality. Concept by E. Kretschmer (1930).
epileptoticepileptoid
epileptic
hysteriothymic
hysterical
hysterical
Personal reaction to illness
In many cases, the size of the personalreactions exceed the size of the pathology,
which are represented by others
components of the syndrome.
This happens with some psychopathic
syndromes, when the severity
personal reaction to the disease is not
corresponds to the degree of damage
brain substrate (A.A. Portnov, 1971).
Syndrome-disease
The syndrome correlates withdisease as a small system with
big, i.e. obeys her
patterns.
Asthenic neurotic, neurosis-like
Depressive, manic
Paranoid, paranoid, paraphrenic
Confusion of consciousness, gross organic phenomena.
Relationships between syndrome and disease
The originality of the nosological unitdetermined by coexistence and
mutual influence of negative and
positive, end-to-end and stage-by-stage signs
diseases.
Relationships between syndrome and disease (continued)
The severity of the disease process is determinedpolymorphism of the stage syndrome.
Kaleidoscopic variability
symptoms, rapid changes in conditions,
alternation of syndromes and the wedging of one into
others talk about clinical instability
paintings.
Polymorphic syndromes – manifestations of acute
development of psychosis, prognostic
favorable.
Monomorphy indicates flow transition
diseases in subacute and chronic. SYNDROME-SEVERITY OF DISORDER
Syndromes such as delirium,
oneiroid, amentive, twilight
the state certainly reflects
stage of destabilization, have
tendency to be combined with syndromes
stupor - somnolence, stupor,
precoma and coma are
critical conditions.
Syndromes corresponding to the chronic stage of the disease
Other syndromes, for example, the samepsychoorganic correspond
chronic stage and point to
disability, as in
given period of time and in the long term
perspective
Syndromes corresponding to both acute and chronic stages of the disease
Still others, for example, affective, are observedas in the stage of destabilization (schizoaffective
attack), and in chronic (recurrent
depressive disorder).
It should also be noted that each syndrome
itself has varying degrees of severity -
light, moderate and heavy.
For example, considered mildly asthenic
syndrome in some cases according to degree
impairments may
approach the heaviest ones.
Classification of syndromes
I AsthenicII Affective
III Neurotic and neurosis-like
IV Psychopathic-like syndromes
V Depersonalization-derealization
VI Hallucinatory-delusional syndromes
VII Catatonic-hebephrenic syndromes
VIII Syndromes of impaired consciousness
IX Paramnestic
X Convulsive
XI Psychoorganic
XII Negative
XIII Dependency syndromes
Conclusion
Psychopathological syndromes, clinicallyexpressing various types of mental disorders,
being an intermediate link between
symptoms (signs) and nosological
units (diseases), are the most important
link in establishing psychiatric
diagnosis.
They are closely related to the general concept of diagnosis
and its various components – clinical and
etiopathogenetic, anamnesis, status,
course, severity of the condition, prognosis and
outcome.
What are the syndromes?
If the presence of maladjustment is obvious, then the following sequence is assumed when establishing a diagnosis:
2. identification of their typical combinations (syndromes),
3. determining the diagnosis, taking into account the specificity of the identified symptoms and syndromes
A range of possible etiological and pathogenetic factors, analysis of anamnestic information to determine the dynamics of the disease and, finally, the formulation of a nosological diagnosis. This sequence may be significantly shorter if symptoms characteristic of only one or a few diseases are detected. Therefore, of greatest interest to the diagnostician are high C y ph ical symptoms and syndromes .
There are several common features that determine the specificity of symptoms and syndromes,
1. severity of the disorder,
2. its reversibility,
3. degree of damage to basic mental functions.
Psychopathological symptoms
A SYMPTOM of a mental disorder is a phenomenon that is repeated in different patients, indicating pathology, a painful deviation from the natural course of mental processes, leading to maladjustment.
symptoms are the basis of diagnosis, but their diagnostic value can vary greatly. In psychiatry, there are practically no pathognomonic symptoms - only some of the painful phenomena can be considered quite specific. Thus, the feeling of reading thoughts, transmitting them at a distance, the feeling of forcibly inserting and taking them away are quite characteristic of paranoid schizophrenia. Most signs in psychiatry are non-specific. For example, sleep disorders, decreased mood, anxiety, restlessness, and increased fatigue occur in almost any mental illness; delusions and hallucinations occur only in severe illnesses; however, they are not specific enough, since they can occur in many psychoses.
Thus, the main diagnostic value of symptoms is realized through the syndromes formed from them. Moreover, the symptoms vary depending on their position in the structure of the syndrome.
In this case, the symptom may appear as obli ugly, syndrome-forming sign . Thus, decreased mood is an obligate sign of depression, fixation amnesia is central disorder with Korsakov's syndrome. on the other hand, it is necessary to take into account optional symptoms , indicating the characteristics of the course of the disease in a given patient. Thus, the appearance of anxiety and psychomotor agitation as part of the depressive syndrome is not typical, but it must be taken into account during diagnosis, since this may indicate a high probability of suicide.
Sometimes a symptom directly indicates to the doctor the need for special measures: for example, psychomotor agitation usually indicates a high severity of the condition and serves as an indication for hospitalization, regardless of the intended nosological diagnosis. Refusal to eat, an active desire for suicide require active actions doctor before making a final diagnosis.
The concepts of neurotic and psychotic level are not associated with any specific disease. Moreover, with the same disease, the person’s condition is different periods sometimes described as neurotic or psychotic. It should be noted that in some diseases, throughout the patient’s life, the symptoms do not go beyond the neurotic level (the group of neuroses proper, clothymia, low-progressive forms of schizophrenia, psychopathy)
The division of disorders into productive and negative is of utmost importance for diagnosis and prognosis.
Productive symptoms (positive symptoms, PLUS symptom) are a new painful phenomenon, a certain new feature, which appears as a result of the disease and is absent in healthy people. Examples of productive disorders are delusions and hallucinations, epileptiform paroxysms, psychomotor agitation, obsessions, a strong feeling of melancholy in depression, and inadequate joy in mania.
Negative symptoms (defect, minus symptom), on the contrary, are the damage that the disease causes to the natural healthy functions of the body, the disappearance of any ability. Examples of negative symptoms are loss of memory (amnesia), intelligence (dementia), and the ability to experience vivid emotional feelings (apathy).
The identification of these concepts belongs to the English neuropathologist J.H. Jackson (l835# 1911), who believed that negative symptoms are caused by the destruction or temporary inactivity of brain cells, and productive ones are a manifestation of pathological activity
living cells and tissues surrounding the painful focus and therefore working in an unnatural, disordered mode. In this sense, negative symptoms seem to indicate which brain structures are destroyed. It is closely related to the etiology of the disease and is more significant for nosological diagnosis than productive. Productive disorders, in turn, are a nonspecific reaction of healthy tissues to irritant effect focus and therefore can be common for various diseases.
Psychiatrists use the concept of negative and productive symptoms in relation not only to focal lesions. Productive symptoms are very dynamic.
For doctors, the concept of persistence and irreversibility of negative symptoms is important, but in clinical practice There are rare cases of reverse development of some negative symptoms. Such dynamics are very typical for memory disorders in acutely emerging Korsakoff psychosis. Cases of reverse development of negative symptoms of schizophrenia have been repeatedly discussed in the literature. Apparently, it should be assumed that loss of function does not necessarily mean the death of the brain structures that perform this role; in some cases, the defect is due only to their temporary inactivity. Thus, in acute psychoses, excitement and confusion prevent patients from concentrating; they cannot count correctly or solve logical problems. However, after gaining calm and relief from productive symptoms, it becomes obvious that these abilities have not been lost forever. Therefore, the depth and severity of negative SYMPTOMS should be assessed only after the acute onset of the disease.
So, the main properties of productive and negative disorders can be presented as follows:
Productive disorders
1. . manifest themselves as new functions that did not exist before the disease;
2. . nonspecific, since they are a product of living functioning brain cells;
3. . reversible, well controlled medicines, may resolve without treatment;
4. . indicate the severity of the process.
Negative disorders (defect)
1. . are expressed in the loss of healthy functions and abilities;
2. . quite specific, indicating a specific affected locus;
3. . usually irreversible (except for disorders in the acute period of the disease);
4. . indicate the outcome of the disease.
**********************
1.2 Main psychopathological syndromes
Syndrome - a complex of symptoms.
Psychopathological syndrome - a complex is a more or less typical set of internally (pathogenetically) interconnected psychopathological symptoms, in the particular clinical manifestations of which the volume and depth of damage to mental functions, the severity and massiveness of the effect of pathogenic harmfulness on the brain are expressed.
Psychopathological syndromes - this is the clinical expression of various types of mental pathology, which include mental illnesses of psychotic (psychosis) and non-psychotic (neuroses, borderline) types, short-term reactions and persistent psychopathological conditions.
1.2.1 Positive psychopathological syndromes
There is currently practically no single view on the concept of positive, and therefore negative, syndromes.
Positive consider syndromes that are qualitatively new, absent normally, symptom complexes (they are also called pathological positive, “plus” - disorders, phenomena of “irritation”), indicating progression mental illness that qualitatively changes the patient’s mental activity and behavior.
1.2.1.1 Asthenic syndromes.
Asthenic syndrome - a state of neuropsychic weakness - the most common in psychiatry, neurology and general medicine and at the same time a simple syndrome of predominantly quantitative mental disorders.
The leading manifestation is mental asthenia itself.
There are two main variants of asthenic syndrome - emotional-hyperesthetic weakness
1. hypersthenic and
2. hyposthenic.
At emotional-hyperesthetic weakness short-term emotional reactions of dissatisfaction, irritability, anger for minor reasons (the “match” symptom), emotional lability, weakness arise easily and quickly; patients are capricious, gloomy, dissatisfied. Drives are also labile: appetite, thirst, food cravings, decreased libido and potency. Characterized by hyperesthesia loud sound, bright light, touch, smells, etc., intolerance and poor tolerance expectations. Replaced by exhaustion of voluntary attention and its concentration, distractibility and absent-mindedness increase, concentration becomes difficult, a decrease in the volume of memorization and active recollection appears, which is combined with difficulties in comprehension, speed and originality in solving logical and professional problems. All this complicates neuropsychic performance, fatigue, lethargy, passivity, and a desire for rest appear.
Typically an abundance of somato-vegetative disorders: headaches, hyperhidrosis, acrocyanosis, activity lability of cardio-vascular system, sleep disturbances, predominantly superficial sleep with an abundance of everyday dreams, frequent awakenings up to persistent insomnia. There is often a dependence of somato-vegetative manifestations on meteorological factors and fatigue.
With hyposthenic variant primarily physical asthenia, lethargy, fatigue, weakness, fast fatiguability, pessimistic mood with decreased performance, increased sleepiness with lack of satisfaction from sleep and a feeling of weakness, heaviness in the head in the morning.
Asthenic syndrome occurs when
1. somatic (infectious and non-infectious) diseases,
2. intoxications,
3. organic and endogenous mental illnesses,
4. neuroses.
It amounts to essence of neurasthenia ( asthenic neurosis) , going through three steps:
▪ hypersthenic,
▪ irritable weakness,
▪ hyposthenic.
1.2.1.2 Affective syndromes.
The syndromes of affective disorders are very diverse. At the core modern classification affective syndromes are based on three parameters:
1. the actual affective pole (depressive, manic, mixed),
2. structure of the syndrome (harmonious - disharmonious; typical - atypical) and
3. degree of severity of the syndrome (non-psychotic, psychotic).
Typical (harmonious) syndromes include a uniformly depressive or manic triad of obligatory symptoms:
1. pathology of emotions (depression, mania),
2. change in the course of the associative process (slowdown, acceleration) and
3. motor-volitional disorders /inhibition (substupor) - disinhibition (excitement), hypobulia-hyperbulia/.
The main (core) among them are emotional.
Additional symptoms speakers:
1. decreased or increased self-esteem,
2. violations of self-awareness,
3. obsessive, overvalued or delusional ideas,
4. suppression or strengthening of drives,
5. suicidal thoughts and actions in depression.
In the most classic look Endogenous affective psychoses occur and, as a sign of endogeneity, include somato-vegetative symptom complex V. P. Protopopov (
· arterial hypertension,
· tachycardia,
· constipation,
· hyperglycemia,
· menstrual irregularities,
· change body weight),
daily fluctuations in affect (improvement of well-being in the second half of the day), seasonality, periodicity and autochthony.
For atypical affective syndromes characterized by a predominance of optional symptoms (.
1. anxiety,
3. senestopathies,
5. obsessions,
6. derealization,
7. depersonalization,
8. delusions of a non-holothymic nature,
9. hallucinations,
10. catatonic symptoms)
over the main affective syndromes.
TO mixed affective syndromes include such disorders that seem to be introduced from the opposite triad (for example, motor agitation during the affect of melancholy - depressive agitation).
There are also
1. sub-affective.(
◦ subdepression,
◦ hypomania; they are non-psychotic)
2. classic affective and
3. complex affective disorders (affective-delusional:
a) depressive-paranoid,
b) depressed-hallucinatory-paranoid,
c) depressive-paraphrenic or manic-paranoid.
d) manic-hallucinatory-paranoid,
e) manic-paraphrenic).
1.2.1.2.1 Depressive syndromes.
Classic depressive syndrome includes the depressive triad:
1. pronounced melancholy,
2. depressed gloomy mood with a touch of vitality;
3. intellectual or motor retardation.
Hopeless melancholy is often experienced as mental pain, accompanied by painful feelings of emptiness, heaviness in the heart, mediastinum or epigastric region. Additional symptoms - a pessimistic assessment of the present, past and future, reaching the level of holothym overvalued or delusional ideas of guilt, self-humiliation, self-blame, sinfulness, low self-esteem, disturbances in self-awareness of activity, vitality, simplicity, identity, suicidal thoughts and actions, sleep disorders in the form of insomnia, sleep agnosia, shallow sleep with frequent awakenings.
Subdepressive (non-psychotic) syndrome is not presented as a pronounced melancholy with a tinge of sadness, boredom, depression, pessimism. Other main components include hypobulia in the form of lethargy, fatigue, tiredness and decreased productivity and slowing of the associative process in the form of difficulty finding words, decreased mental activity, and memory impairment. From additional symptoms- obsessive doubts, low self-esteem, disturbances in self-awareness and activity.
Classic depressive syndrome is characteristic of endogenous depressions (manic-depressive psychosis, schizophrenia); subdepression in reactive psychoses, neuroses.
TO atypical depressive syndromes include subdepressive. relatively simple and complex depression.
The most common subdepressive syndromes are:
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